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AAO > External1,2,8 > Flashcards

External1,2,8 Flashcards

1
Q

در موارد recurrent corneal erosion درمان با naclرا تا چه مدت باید ادامه داد؟

A

6_12 months

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2
Q

خصوصیات BCLمورد استفاده در recurrent corneal erosion؟

A

high DK

flat BC

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3
Q

Megalocornea

A

nonprogressive
13 mm or greater
usually bilateral, congenital usually X linked
90%male

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4
Q

Association with X linked megalocornea

A

Iris transilluminationm

Deep AC

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5
Q

Late changes seen in X linked megalocornea

A

corneal mosaic degeneration (shagreen), arcus juvenilis, presenile cataracts, and
glaucoma. Treatment includes lubrication if patients have exposure keratopathy

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6
Q

Cilia are replaced every 3–5 months; they usually regrow in 2 weeks when cut and within 2 months if pulled out

A

Holocrine sebaceous glands and eccrine sweat glands are present in the eyelid skin.
Near the eyelid margin are the apocrine sweat glands (the glands of Moll) and numerous sebaceous glands (the glands of Zeis)

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7
Q

Smooth-muscle fibers from the levator muscle maintain the superior fornix, and fibrous slips extend from the horizontal rectus tendons into the temporal conjunctiva and plica to form cul-de-sacs during horizontal gaze

A

The cell morphology of the conjunctival epithelium
varies from stratified cuboidal over the tarsus to
columnar in the fornices to squamous on the globe

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8
Q

چند درصد سلولهای بازال اپیتلیوم کونژ را سلولهای گابلت تشکیل می دهند؟

A

۱۰ درصد

most numerous in the tarsal conjunctiva and the inferonasal bulbar conjunctiva

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9
Q

Conjunctiva-associated lymphoid tissue (CALT)?

A

consists of lymphocytes and other leukocytes, is present, especially in the fornices

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10
Q

Blood supply of the conj?

A

The palpebral conjunctiva shares its blood supply
with the eyelids. The bulbar conjunctiva is supplied by
the anterior ciliary arteries branching off the ophthalmic
artery. These capillaries are fenestrated and leak
fluorescein just as the choriocapillaris does.

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11
Q

Lacrimal Functional Unit components?

LFU

A

Lacrimal glands
ocular surface (cornea, conjunctiva, and meibomian glands)
eyelids
sensory and motor nerves

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12
Q

نقش LFU؟

A

regulation, production, and health of the precorneal tear film.

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13
Q

How LFU works?

A

The afferent component of the LFU is mediated through nociceptors found in the cornea and ocular surface and passing through the trigeminal nerve (cranial nerve V). These nociceptors synapse in the brainstem with autonomic and motor (efferent) nerves. The autonomic
nerve fibers innervate the meibomian glands, conjunctival goblet cells, and lacrimal glands. The
motor nerve fibers innervate the orbicularis muscle to initiate blinking, with the blink rate in adults
being about 15 times per minute. During blinking, the meibomian glands express lipid, and the tears
are replenished from the inferior tear meniscus and spread across the cornea while excess tears are
directed into the lacrimal puncta.

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14
Q

What is the most important refractive interface of the eye and is primarily responsible for maintaining a smooth optical surface between blinks?

A

The tear film

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15
Q

RI of the cornea?

A

1.376

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16
Q

Diameter of the cornea?

A

11–12 mm horizontally and 10–11 mm vertically

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17
Q

What is the corneal cap?

A

The cornea is aspheric, although its radius of curvature is often recorded as a spherocylindrical convex mirror
representing the central anterior corneal surface, also
called the corneal cap

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18
Q

What is The average radius of curvature of the central cornea?

A

7.8 mm

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19
Q

What is the dioptric power of a normal human eye?

A

The cornea contributes 74%, or 43.25
diopters (D), of the total 58.60 dioptric power of a
normal human eye

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20
Q

What is the major source of astigmatism in the optical system?cornea or lens?

A

The cornea

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21
Q

nutrition of the cornea?

A

glucose diffusing from the aqueous humor and oxygen diffusing through the tear film. In addition, the peripheral cornea is supplied with oxygen from the limbal circulation.

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22
Q

حساسیت قرنیه چند برابر کونژ است؟

A

the sensitivity of the cornea is 100 times that of the conjunctiva.

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23
Q

What is the sensory nerve of the cornea?

A

Sensory nerve fibers extend from the long ciliary nerves and form a subepithelial plexus

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24
Q

What is the Neurotransmitters in the cornea?

A

acetylcholine, catecholamines, substance P, calcitonin
gene–related peptide, neuropeptide Y, intestinal peptide,
galanin, and methionine-enkephalin.

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25
Q

corneal epithelium

A

stratified squamous epithelial cells and makes up
approximately 5%–10% of the total corneal thickness Tight junctions between superficial
epithelial cells prevent penetration of tear fluid into the stroma.

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26
Q

Continuous proliferation of perilimbal basal epithelial cells gives rise to the other layers that subsequently differentiate into superficial cells
With maturation, these cells become coated with microvilli and then desquamate into the tears.
این پروسه چقدر طول می کشد؟

A

۷ تا ۱۴ روز

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27
Q

Basal epithelial cells secrete a continuous, 50-nm-thick

basement membrane, composed of?

A

type IV collagen, laminin, and other proteins.

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28
Q

The clarity of the cornea depends on?

A

the tight packing of epithelial cells to produce a layer with a nearly uniform refractive index and minimal light scattering.

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29
Q

The density of keratocytes declines with age

but to a lesser degree than does that of endothelial cells.

A

The density of keratocytes also declines with corneal surgery and msy not recover completely

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30
Q

Collagen of the corneal stroma?

A

156

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31
Q

proteoglycans of the cornea?

A

decorin (associated with dermatan sulfate)

lumican (associated with keratan sulfate)

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32
Q

خلف قرنیه خیسه

A

the posterior stroma is“wetter” than the anterior (3.85 mg H2O/mg dry weight vs 3.04).

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33
Q

water-soluble proteins, analogous to lens
crystallins, may be secreted by keratocytes or contained
in the epithelial cells to control the optical properties of
the cornea

A

جالبه ها….یعنی یه پروتئین شبیه کریستالین در قرنیه هم هست که مسئول خصوصیات اپتیکی قرنیه است😎

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34
Q

The lamellae of the anterior stroma are short,
narrow sheets with extensive interweaving between
layers

A

the posterior stroma has long, wide, thick lamellae extending from limbus to limbus with minimal interlamellar connections

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35
Q

How much is the elasticity of the cornea?

A

The human cornea has little elasticity and stretches only 0.25% at normal intraocular pressure (IOP).

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36
Q

The lattice arrangement of collagen fibrils embedded in the extracellular matrix is partly
responsible for corneal transparency.

A

This pattern acts as a diffraction grating to reduce light
scattering by means of destructive interference. Scattering is greater anteriorly, resulting in a higher
refractive index that decreases from 1.401 at the epithelium to 1.380 in the stroma and 1.373
posteriorly.

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37
Q

The cornea is transparent because ?

A

the size of the lattice elements is smaller than the
wavelength of visible light.
Transparency also depends on keeping the water content of the corneal stroma at 78%.

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38
Q

Corneal hydration is largely controlled by ?

A

intact epithelial and endothelial barriers and the functioning of the endothelial pump, which is linked to an ion-transport system controlled by temperature-depend
enzymes such as Na+,K+ -ATPase. In addition, negatively charged stromal glycosaminoglycans tend to
repel each other, producing a swelling pressure (SP). Because the IOP tends to compress the cornea,
the overall imbibition pressure of the corneal stroma is given as IOP – SP. The total transendothelial
osmotic force is calculated by adding the imbibition pressure and the various electrolyte gradients
produced by the endothelial transport channels.

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39
Q

Human endothelial cells do not proliferate in vivo, but they can divide in cell culture

A

Correct

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40
Q

تعداد سلولهای اندوتلیال در پریفر قرنیه بیشتر است

A

ص

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41
Q

The corneal endothelium maintains corneal clarity

through 2 functions:

A

by acting as a barrier to the aqueous humor and by providing a metabolic pump.

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42
Q

Endothelial alterations can be reversible (eg, pseudoguttata)

A

It can be permanent (eg, cornea guttata).

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43
Q

The Descemet membrane

A

It increases in thickness from 3 μm at birth to 10–12 μm in adults, as the endothelium gradually lays down a
posterior amorphous nonbanded zone.

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44
Q

cornea’s biomechanical properties?

A

The Bowman layer and the corneal
stroma are key factors contributing to the cornea’s biomechanical properties. The Bowman layer, a
woven, matlike layer composed of randomly dispersed type I collagen fibrils, is stiffer and stronger
than the underlying stroma proper, while the highly woven anterior stroma proper is stiffer and
stronger than the nonwoven posterior stroma proper. This difference is evident clinically, as blunt
dissection of a plane through the anterior stroma is much more difficult to achieve than that through
the posterior stroma.

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45
Q

Biomechanical failure?

A

corneal ectasia, or keratectasia. In
keratectasia, the shape of the cornea is distorted, causing irregular astigmatism and vision loss.
Keratectasia can occur as a result of tissue fatigue, which is caused by chronic low-grade stress and
leads to biomechanical failure. Potential sources of corneal stress include chronic eye rubbing,
refractive surgery, elevated IOP, and possibly external nocturnal pressure on the eye.

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46
Q

What is The sclera composed of?

ABCDEF😁

A 
type I collagen 
proteoglycans (decorin, biglycan, and aggrecan)
elastin 
glycoproteins such as fibronectin
Fibroblasts
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47
Q

Nerve of anterior sclera?

A

The long posterior ciliary nerves

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48
Q

sclera becomes more translucent when?

A

1)thinning occurs
2)water content changes, falling below 40% or rising above 80%.
For example, senile scleral plaques
are areas of calcium phosphate deposits just anterior to the insertions of the medial and lateral rectus
muscles that become dehydrated and reveal the blue color of the underlying uvea.

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49
Q

patient with an abnormal cornea and reduced vision. How can we determine whether the loss of vision is from irregular astigmatism or stromal scarring?

A

RGP
neutralize irregularity caused by an abnormal ocular
surface or corneal curvature.
The average keratometry reading is used in selection of the base curve of the lens; the refractive power of the lens is based on the spherical equivalent. After placing the lens, the examiner can perform an overrefraction or use a pinhole occluder to measure the best visual
acuity. If the vision does not improve, then corneal scarring may be the cause of the decreased vision

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50
Q

The biomicroscope is a binocular Galilean telescope with multiple magnifications

A

The illumination and microscope arms are

parfocal, arranged so that both focus on the same spot, with the slit beam centered in the field of view.

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51
Q

Direct Illumination Methods?

A

Diffuse
Focal
Specular reflection

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52
Q

Diffuse illumination

A

the light beam is broadened
reduced in intensity
directed at the eye from an oblique angle.
Swinging the illuminator arm to produce highlights and shadows can enhance the visibility of raised lesions of the ocular surface and iris.

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53
Q

Focal illumination

A

the light and the microscope are focused on the same spot, and the slit aperture is adjusted from wide to narrow.
1)Broad-beam illumination, using a slit width of around 3
mm, is optimal to visualize eyelid lesions as well as the corneal opacities seen in dystrophies or scarring.
2)Slit-beam illumination, using a beam width of about 1 mm or less, gives an optical section of the cornea that is essential for evaluation of corneal thinning, edema, stromal infiltrates and endothelial abnormalities.
3)a very narrow slit beam to help identify
refractive index differences in transparent structures as light rays pass through the cornea, anterior
chamber, and lens.
4)The examiner can also reduce the height of a narrow beam to determine the presence and amount of cell and flare in the anterior chamber.

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54
Q

Specular reflection

A

Specular reflections are normal light reflexes bouncing
off a surface. An example is the bright round or oval spot seen reflected from the ocular surface in a typical flash
photograph of an eye. These mirror images of the light
source can be annoying, and it is tempting to ignore them during slit-lamp examination. However, the clarity and sharpness of these reflections from the tear film give clues to the condition of the underlying tissue.
A faint reflection also comes from the posterior
corneal surface. The examiner can enhance this specular reflection by using a light beam at an appropriate angle,
revealing the corneal endothelium

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55
Q

the steps for examining the corneal endothelium

A
  1. Begin by setting the slit-beam arm at an angle of
    60° from the viewing arm and using a short slit or
    0.2-mm spot.
  2. Identify the very bright mirror image of the
    lightbulb’s filament and the paired epithelial and
    endothelial Purkinje light reflexes.
  3. Superimpose the corneal endothelial light reflex
    onto the filament’s mirror image, giving a bright
    glare.
  4. Use the joystick to move the biomicroscope
    slightly forward in order to focus the endothelial
    reflex.
    بصورت مونواکولار انجام می شود و از ×۲۵/ eyepiece ×۴۰ استفاده می شود
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56
Q

در اسپکولار میکروسکوپی گوتاتا به چه صورت دیده می شود؟kp چطور؟

A

هر دو بصورت مناطق تیره non reflective

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57
Q

انواع indirect illumination?

A

Proximal illumination
Sclerotic scatter
Retroillumination

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58
Q

Proximal illumination

A

decenters the light beam from its isocentric position, causing the light beam and the microscope to be focused at different but adjacent spots.
highlights an existing opacity against
deeper tissue layers and allows the examiner to see
small irregularities that have a refractive index similar
to that of their surroundings. Moving the light beam back
and forth in small oscillations can help the examiner
detect small 3-dimensional lesions such as a corneal
foreign body.

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59
Q

کدامیک از تکنیکهایSLE از TIR استفاده می کند؟

A

Sclerotic scatter

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60
Q

Sclerotic scatter

A

Total internal reflection in the cornea makes possible another form of indirect illumination
Decentering the isocentric light beam so that an intense beam shines on the limbus and scatters off the sclera causes a very faint glow of the cornea. Reflective opacities stand out against the dark field, whereas areas of
reduced light transmission in the cornea are seen as shades of gray. This technique is effective in
demonstrating:
1)epithelial edema
2)mild stromal infiltration
3)nebulae
4)cornea verticillata

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61
Q

با کدام تکنیک می توان reflective opacities را در زمینه ی تاریک مشاهده کرد؟

A

Sclerotic scatter

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62
Q

Retroillumination

A

can be used to examine more than one
area of the eye.
Retroillumination from the iris is
performed by displacing the beam tangentially while
examining the cornea. Through observing the zone
between the light and dark backgrounds, the examiner
can detect subtle corneal abnormalities.
Retroillumination from the fundus is performed by
aligning the light beam nearly parallel with the
examiner’s visual axis and rotating the light so it shines
through the edge of the pupil. Opacities in the cornea or
lens (such as corneal dystrophies) are highlighted against the red reflex, and iris defects are transilluminated

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63
Q

کدام تکنیک SLE برای معاینه ی بیش از یک منطقه در چشم به کار می رود؟

A

Retroillumination

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64
Q

کدام تکنیک SLE اپاسیته های قرنیه را در زمینه یRR مشخص می کند؟

A

رتروایلومیناسیون از فوندوس

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65
Q

عصب قرنیه از long ciliary

A

خونرسانی قرنیه از anterior ciliary

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66
Q

orderly fashion of slit-lamp examination?

A

1)direct illumination of the eyelids
(margin, meibomian glands, and eyelashes), conjunctiva,
and sclera
2)A broad beam illuminates the cornea and
overlying tear film in the optical section.
3)Details are examined with a narrow beam.
4)The examiner estimates the height of the tear meniscus and looks for mucin cells and other debris in the tear film. Discrete lesions are
measured with a slit-beam micrometer or an eyepiece
reticule.
5)Retroillumination and indirect illumination
accentuate fine changes.
6) specular reflection to inspect the endothelium and has the patientshift gaze in different directions so that each corneal quadrant can be surveyed.
7)A slit beam is used to estimate the thickness of the cornea and the depth of the anterior chamber.
8)A short beam or spot will show flare
or cells in the aqueous humor.

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67
Q

Which techniques are used to identify abnormalities of the iris and lensm?

A

Direct, slit, and retroillumination

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68
Q

Except for the …….., deeper and peripheral intraocular structures require special lenses.

A

anterior vitreous

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69
Q

تکنیک broad beam یک optical section از tear film تهیه می کند

A

تکنیک slit beam یک optical section از قرنیه تهیه می کند

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70
Q

ضایعات خوش خیم کونژ شایعتر اند یا ضایعات بدخیم؟منشا؟

A

خوش خیم ۳ برابر

اغلب از پوست پلک منشا می گیرند

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71
Q

What is the clinical characteristics of the conj neoplastic lesion?

A 
Single or multifocal?
pigmented or amelanotic?
Where is it located?
Does the lesion extend onto the cornea?
solid or cystic?
flat or elevated?
fixed to the underlying tissues or mobile?
Feeder vessels?
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72
Q

در بررسی ضایعه نئوپلاستیک کونژ موارد زیر یادت نره…

A

لمس LN های پری اوریکولار و گردن

معاینه فورنیکس فوقانی با برگرداندن پلک

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73
Q

در ضایعه کونژ چه چیزهایی را دیدید به بدخیمی شک می کنید؟

A

برجسته
شدیدا پیگمانته حتی اگر flat است
به بافت های زیرین fixed باشد
وجود feeder vessel

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74
Q

Management of Patients With suspicious conj lesion?

A

برداشتن کامل با ۴ mm مارژین
avoid touching the tumor during removal (a “no touch” technique) in order to prevent inadvertent seeding of the remaining conjunctiva with tumor cells.
Incisional biopsies should be avoided for the same reason, especially in pigmented lesions

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75
Q

Management of Patients With suspicious conj lesion with corneal epithelium involvement?

A

alcohol-assisted epithelial curettage with a surgical blade
care taken to avoid violation of the Bowman membrane, which is a natural barrier to tumor extension
into the corneal stroma.
Some lesions may require lamellar sclerectomy for complete removal.
Cryotherapy at the time of ocular surface surgery has been shown to improve the prognosis,
especially in conjunctival melanoma

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76
Q

نحوه ی بستن دیفکت کونژ بعد از برداشتن ضایعه نئوپلاستیک؟

A

۱)دیفکت کوچک⬅️گرافت /primary closure

۲)دیفکت بزرگ⬅️AMT

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77
Q

انجام کرایوتراپی در زمان جراحی کدامیک از بدخیمی های کونژ توصیه می شود؟

A

ملانوم

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78
Q

What is the advantage of ocular surface reconstruction with AMT after conj tumor removal?

A

1) wider tumor margins
2) less risk of postoperative scarring
3) facilitates reepithelialization
4) reduces postoperative inflammation

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79
Q

نکات لازم در مواردی که برای بازسازی کونژ بعد از برداشتن تومور از گرافت استفاده می شود؟

A

The graft should be cut slightly larger than the defect and may be attached with fibrin-based tissue adhesive. If tissue adhesive is not available, either absorbable (9-0 or 10-0 polyglactin) or nonabsorbable (10-0
nylon) suture may also be used to fixate the graft.

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80
Q

چنانچه در بدخیمی کونژ و قرنیه بیش از ۲/۳لیمبوس برداشته شود چه پیامدی خواهد داشت؟

A

chronic epitheliopathy

Stem cell transplantation using tissue harvested from the fellow eye of the patient may eventually be required.

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81
Q

نحوه ی ارسال نمونه ی کونژ به پاتولوژی؟

A

placed on filter paper and the edges
labeled to facilitate histopathologic diagnosis.
The clinical history is relevant to the pathologist’s interpretation of the lesion; thus, the label should include the following information: the age and ethnicity of the patient, the duration of the lesion, and whether the lesion has changed clinically.

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82
Q

Topical chemotherapy can be used in the management of ocular surface tumors as primary treatment
before or instead of surgical tumor removal or, more commonly, as an adjunctive therapy after tumor
excision

A

An advantage of topical chemotherapy is that it treats the entire ocular surface.

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83
Q

For squamous lesions, topical interferon-α2b

is first-line therapy

A

For atypical melanocytic lesions, MMC is the most commonly used agent
M=M

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84
Q

Recent reports have suggested the use of topical

interferon-α2b as primary therapy for tumors in the squamous cell family

A

1)one potential disadvantage of this course of treatment is the lack of histopathologic diagnosis.
2)the effectiveness of topical interferon-α2b
in the treatment of melanotic tumors has not been proven. Since there is some overlap in the appearance of various tumors (eg, amelanotic conjunctival melanoma
may resemble squamous cell carcinoma), there is concern that if chemotherapy is elected and the
tumor does not respond, valuable time in the management of a potentially deadly lesion may have
been lost.
3)Another disadvantage of topical interferon-α2b
is that it is expensive and may take several
months to work.
بعضی درمان با آن را جهت کوچک کردن ضایعه ی بزرگ قبل از جراحی پیشنهاد می کنند

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85
Q

مایتومایسین هم در ملانوم هم در اسکواموس ها موثره
Topical MMC, because of its potential toxicity, is typically administered for short periods (1 to 2 weeks), with a drug holiday of 2 to 4 weeks between treatments.

A 
اینترفرون در اسکواموس ها اثر دارد ولی در ملانوتیک معلوم نیست
 topical interferon-α2b
4 times daily
until clinical response occurs
usually within 2 to 4 months.
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86
Q

تومورهای خوش خیم کونژ با منشا اپیتلیوم؟

A

پاپیلوم
هایپرپلازی pseudoepitheliomatous
دیس کراتوز intraepithelial ارثی خوش خیم

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87
Q

تومورهای preinvasive اپیتلیالی؟

A

Conj and corneal intraepithelial neoplasia

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88
Q

تومورهای بدخیم اپیتلیالی کونژ؟

A

SCC

mucoepidermoid carcinoma

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89
Q

شایع ترین نئوپلاسم سطح چشم؟

A

پاپیلوم

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90
Q

پاپیلوم پدانکوله کونژ معمولا در بچه ها
HPV 6 in children
HPV16 in adults
👯‍♂️👯‍♀️

A

پاپیلوم sessile کونژ خوش خیم

اگر توسط HPV16,18 ایجاد شود ممکنه تظاهرات دیس پلاستیک یا کارسینوماتوز پیدا کند(بیشتر در بالغین)

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91
Q

محل های شایع پاپیلوم پدانکوله کونژ؟
معمولا فورنیکس تحتانی
کونژ تارسال،بولبار،semilunar fold

A

محل شایع پاپیلوم sessile کونژ؟
لیمبوس
ممکنه روی قرنیه گسترش یابد

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92
Q

اگر در بیماری پاپیلوم بسیار بزرگ پدانکوله کونژ دیدی به …… شک کن

A

نقص ایمنی

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93
Q

Management of conj papilloma?

A

1)Many conjunctival papillomas regress
spontaneously. A pedunculated papilloma that is small,
cosmetically acceptable, and nonirritating may be
observed. Spontaneous resolution may take months to
years. An incomplete excision, however, can stimulate
growth and lead to a worse cosmetic outcome.
Cryotherapy alone, excision with cryotherapy to the
base, or excision with adjunctive application of
interferon-α2b is sometimes curative, but recurrences are frequent. Surgical manipulation should be minimized to reduce the risk of virus dissemination to uninvolved
healthy conjunctiva. Oral cimetidine may be a systemic
adjunct acting as an immunomodulator.
2)A sessile limbal papilloma must be observed closely
or excised. If the lesion enlarges or shows clinical
features suggesting dysplastic or carcinomatous growth, then excisional biopsy with adjunctive cryotherapy is
indicated.

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94
Q

اقدامات جانبی در مواردی که برای تومورهای کونژ از کموتراپی تاپیکال استفاده می کنیم؟

A

Application of topical corticosteroids may help with the surface toxicity.
Placement of punctal plugs reduces the
chance of systemic absorption and helps prevent punctal stenosis

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95
Q

Conj CIN?

A

معادل اکتینیک کراتوز در پوست پلک

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96
Q

Conjunctival intraepithelial neoplasia (CIN), or dysplasia

A

dysplastic process does not invade the underlying BM and is referred to as mild (CIN I), moderate (CIN II), or severe (CIN III), depending on the extent of
involvement of the epithelium with atypical cells.
squamous dysplasia=if atypical cells involve only part of the epithelium
carcinoma in situ= if cellular atypia involves the entire thickness of the epithelial layer

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97
Q

عوامل موثر در پاتوژنز CIN?

A

HPV infection
sunlight exposure
host factors

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98
Q

اگر CIN در یک فرد جوان دیده شود اقدام بعدی؟

A

سرولوژی ایدز

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99
Q

رشد سریع CIN در بیماران ایدزی نشان می دهد که؟

A

سرکوب سیستم ایمنی پتانسیل ایجاد نئوپلازی اسکواموس دارد

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100
Q

3 principal clinical variants of CIN

A
  1. papilliform, in which a sessile papilloma harbors dysplastic cells
  2. gelatinous, as a result of acanthosis and dysplasia
  3. leukoplakic, caused by hyperkeratosis, parakeratosis, and dyskeratosis
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101
Q

large feeder blood vessels in CIN indicate?

A

a higher probability of invasion beneath the epithelial BM

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102
Q

Corneal intraepithelial neoplasia?

A

A granular, translucent, gray epithelial sheet broadly based at the limbus extends onto
the cornea. Occasionally, free islands of punctate granular epithelium are present on the cornea. The
edges of corneal lesions have characteristic fimbriated margins and pseudopodia-like extensions
Rose bengal and lissamine green staining help define the edges of the lesion.
Corneal neovascularization does not typically occur, which helps differentiate CIN lesions from limbal stem
cell failure

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103
Q

How can we differentiate CIN lesions from limbal stem

cell failure?

A

Corneal neovascularization

در CIN رخ نمی دهد

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104
Q

Squamous cell carcinoma

A

a plaquelike, gelatinous, or papilliform growth, occurs in limbal and bulbar conjunctiva in the interpalpebral fissure zone of older individuals.

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105
Q

پاتوژنز SCC؟

A

UV radiation
viral
genetic factors

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106
Q

تظاهرات SCC کونژ؟

A

A broad base along the limbus
tends to grow outward with sharp borders
may appear leukoplakic
Although histologic invasion beneath the epithelial BM is present, growth usually remains superficial, infrequently penetrating the sclera or Bowman layer. Pigmentation can occur in dark-skinned patients. Engorged conjunctival vessels suggest malignancy.

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107
Q

CIN and invasive squamous cell carcinoma may have similar clinical appearances

A

علی رغم آنکه SCCبه زیر لایه ی بومن تهاجم پیدا کرده ولی رشد آن اغلب سطحی است

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108
Q

Management of Atypical Epithelial Tumors

Conj CIN,Corneal CIN,SCC

A

1) surgical excision

2) topical chemotherapy

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109
Q

Recurrence rate of Conj CIN,Corneal CIN,SCC?

A

varies from 33% to 50%, in eyes with negative surgical margins and those with positive surgical margins, respectively.

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110
Q

چنانچه SCCکونژ neglect شود پیامدها؟

A

تهاجم به ساختارهای داخل چشم که در آن صورت رشد بسیار سریع خواهد داشت
Invasion of the iris or TM provides the tumor with access to the systemic circulation and may be the route by which metastases occur.
Orbital invasion may require orbital exenteration

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111
Q

Surgical excision of Conj CIN,Corneal CIN,SCC?

A

۱) چنانچه component قرنیه ای داشته باشد ابتدا با رزبنگال حاشیه ی ضایعه کاملا مشخص می شود سپس با blade اقدام به scraping می شود که می توان قبل از آن از epithelialectomy با الکل استفاده کرد
۲)در صورت وجود component کونژ یا لیمبال باید ضایعه را با حاشیه ی۳ تا۴ mm برداشت تا free margin شود،در حاشیه های excision و در لیمبوس می توان از کرایوتراپی استفاده کرد
۳)چنانچه ضایعه باعث درگیری stromal bed شده باشد می توان از lamellar sclerectomy یا کرایوتراپی استفاده کرد

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112
Q

topical chemotherapy of Conj CIN,Corneal CIN,SCC?

A

1)MMC 0.02/0.04% QID
با سه رژیم می توان تجویز کرد۱)روزانه تا زمانی که پاسخ کلینیکی دیده شود که عموما بیش از ۱۴ روز طول نمی کشد۲)سیکل های ۱۴ روزه با ۲تا۴ هفته offدارویی تا زمانی که پاسخ کلینیکی دیده شود۳)سیکل های ۱ هفته ای با ۱ هفته offتا زمانی که پاسخ کلینیکی دیده شود
جهت کاهش عوارض از punctal occlusion و استروئید همزمان نیز استفاده می شود
2)5FU1%QID
با دو رژیم می توان تجویز کرد۱)روزانه تا ۱ ماه۲)۲تا۴ روز با offدارویی۱ تا ۱/۵ ماه تا زمانی که پاسخ کلینیکی دیده
3)IFN-α2b
با دو رژیم می توان تجویز کرد۱)تزریق ساب کونژ یا داخل ضایعه همراه با فرم تاپیکال به شکل QID داده شود۲) فرم تاپیکال به تنهایی به شکل QID داده شود

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113
Q

تمایل کدام یک برای تهاجم به اربیت و گلوب بیشتر است؟

Conj SCC or mucoepidermoid carcinoma

A

mucoepidermoid carcinoma

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114
Q

mucoepidermoid carcinoma of the conj?

A

کونژ لیمبال
فورنیکس
کارونکل

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115
Q

mucoepidermoid carcinoma of conj

سلولهای اپیتلیال بدخیم+گابلت سل بدخیم که با mucin stain نشان داده می شود

A

SCC of conj

فقط سلولهای اپیتلیال بدخیم

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116
Q

در کدام کارسینوم کونژ سلولهای آناپلاستیک به شکل spindle و مشابه فیبروبلاست می باشند؟

A

Spindle cell carcinoma

یک تومور highly malignant در کونژ بولبار یا لیمبال

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117
Q

تومورهای glandular کونژ؟

A

انکوسیتوم(آدنوم)

کارسینوم غدد سباسه

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118
Q

ندول قرمز قهوه ای روی سطح کارونکل در فرد مسن؟

A

Oncocytoma

=slow-growing cystadenoma,from ductal and acinar cells of main and accessory lacrimal glands

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119
Q

منشا آدنوکارسینوم غدد سباسه؟
زن بالای ۵۰ سال
جوان بعد از رادیوتراپی

A 
غدد میبومین
غدد زایس کنار مژه ها
غدد سباسه کارونکل
غدد سباسه ابرو
غدد سباسه پوست صورت
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120
Q

بیمار با بلفاروکنژنکتیویت مزمن یک طرفه؟

A

به فکر کارسینوم غدد سباسه باشید

اقدام؟ بیوپسی تمام ضخامت پلک یا پانچ بیوپسی تمام ضخامت تارس

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121
Q

بیمار با شالازیون عود کننده،اقدام؟

A

به فکر کارسینوم غدد سباسه باشید
اقدام؟
۱) بیوپسی تمام ضخامت پلک یا پانچ بیوپسی تمام ضخامت تارس
۲)مواد خارج شده از شالازیون عود کننده برای پاتولوژی فرستاده شود و شک تشخیصی حتما ذکر شود تا رنگ آمیزی های خاص لیپید درخواست شود

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122
Q

تشخیص افتراقی های کارسینوم غدد سباسه؟

A 
شالازیون
بلفاریت مزمن
BCC
SCC
MMP
SLK😲
پانوس همراه با conjunctivitis انکلوزیونی بالغین
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123
Q

نمای شبیه شالازیون همراه با از دست رفتن مژه ها و تخریب غدد میبومین تشخیص؟

A

کارسینوم غدد سباسه

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124
Q

کارسینوم غدد سباسه چند درصد تومورهای پلک و چند درصد بدخیمی های پلک را تشکیل می دهد؟

A

۱ درصد

۵درصد

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125
Q

آیا کارسینوم غدد سباسه باعث درگیری کونژ می شود؟

A

بله
۱)این تومور تمایل به رشد اینترااپیدرمال دارد و به کونژ پالپبرال و بولبار گسترش می یابد،رشد اینترا اپیدرمال ممکن است اپیتلیوم قرنیه را نیز درگیر کند
برجستگی های ظریف پاپیلری در کونژ تارسال ممکن است نشانه ی گسترش پاژتوئید سلولهای تومورال باشد
۲)ترشحات سباسئوس از کانسر اینترااپیتلیال می تواند باعث قرمزی و التهاب کونژ شود

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126
Q

ندول سفید رنگ نزدیک لیمبوس؟

A

به فکر کارسینوم غدد سباسه هم باشید😲😲😲

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127
Q

Palpebral conj thickening and papillary fronding in……

A

کارسینوم غدد سباسه

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128
Q

آیا رادیوتراپی در درمان کارسینوم غدد سباسه کاربرد دارد؟

A

خیر

زیرا این تومور مقاوم به اشعه است

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129
Q

آیا در تمام موارد کارسینوم غدد سباسه انجام sentinel LN Bx لازم است؟

A

خیر اگر ۱)ضایعه recurrent باشد یا ۲) درگیری گسترده پلک و اربیت وجود داشته باشد باید SLNBxانجام شود

130
Q

چنانچه کارسینوم غدد سباسه به سپتوم تهاجم کند،درمان؟

A

اگزانتراسیون

131
Q

کارسینوم غدد سباسه اغلب به LN های رژیونال متستاز میدهند

A

ولی در تمام موارد نیاز به SLNBx نمیباشد بلکه تنها در ضایعات recurrent و درگیری گسترده پلک یا اربیت توصیه می شود

132
Q

به جز BCCکانسر های کونژ و پلک به طور تیپیک به LN های رژیونال متاستاز می دهند

A

ص

133
Q

تومورهای خوش خیم پیگمانته کونژ با منشا نورواکتودرم؟

A

1) Congenital epithelial melanosis=فرکل=ephelis
2) BAM
3) ocular melanocytosis
4) nevus

134
Q

تومور Preinvasive پیگمانته کونژ با منشا نورواکتودرم؟

A

PAM

135
Q

تومور بدخیم پیگمانته کونژ با منشا نورواکتودرم؟

A

ملانوم

136
Q

Neurogenic and Smooth-Muscle Tumors of conj

منشا نورواکتودرمال

A

1)Subconjunctival peripheral nerve sheath tumors such as neurofibromas, schwannomas, and neuromas
(especially in MEN. A neurofibroma of the
conjunctiva or eyelid is almost always a manifestation of neurofibromatosis

137
Q

Topical fluorescein is a nontoxic, water-soluble hydroxyxanthene dye that is available in several
forms

A

1) 0.25% solution with an anesthetic (benoxinate or proparacaine), an antiseptic (povidone iodine), and a preservative
2) 2% nonpreserved unit-dose eyedrop
3) impregnated paper strips.

138
Q

Fluorexon ?

A

macromolecular compound available as a 0.35% nonpreserved solution that will not stain most contact lenses

139
Q

Usage of Fluorescein?

A

1)applanation tonometry
2)evaluation of the tear film, including filaments and TBUT
3)Fluorescein detects disruption of intercellular junctions and will stain punctate and macroulcerative epithelial defects (positive staining) such as herpetic dendritic lesions or dysplastic epithelium.
4)It can also highlight nonstaining lesions that project through the tear film(negative staining), such as BM dystrophy or Thygeson superficial punctate keratitis.
5)DDT: the tear meniscus is observed for the
disappearance of fluorescein. Prolonged presence of the dye suggests a blockage of the drainage
system.
6)The Seidel test is used to detect seepage of aqueous
humor through a corneal perforation

140
Q

TBUT

A

instilling fluorescein, asking the patient to hold the eyelids open after 1 or 2 blinks, and counting the seconds until a dry spot appears.
The appearance of dry spots in less than 10 seconds is considered abnormal

141
Q

Fluorescein that collects in an epithelial defect will diffuse into the corneal stroma and cause a green flare in the AC

A

Pooling of the dye due to an indentation or thinning of the cornea must be distinguished from actual staining

142
Q

Rose Bengal and Lissamine Green

A

both available as a 1% solution or in impregnated strips
They stain the epithelial cells of the cornea
and conjunctiva whe n a disruption occurs in the
protective mucin coating. These dyes are routinely used
for evaluating tear-deficiency states and for detecting
and assessing various epithelial lesions, such as the
extent of corneal intraepithelial neoplasia.

143
Q

Rose bengal is toxic to the epithelium

A

Lissamine green is better tolerated and has fewer toxic effects on cultured human corneal epithelial cells

144
Q

basic secretion test

A

1)topical anesthetic
2)a thin filter paper strip (5 mm wide, 30 mm long) is placed at the junction of the middle and lateral thirds of lower lid
(test can be performed with the patient’s eyes open or closed although some recommend the eyes be closed) 3)repeated measurements of less than 3 mm
of wetting after 5 minutes, with anesthetic, are highly
suggestive of aqueous tear deficiency (ATD), whereas
3–10 mm is equivocal

145
Q

The Schirmer I test

A

without topical anesthetic
measures basic and reflex tearing combined
Less than 5.5 mm of wetting after 5 minutes is diagnostic of ATD.

146
Q

Schirmer 1 is relatively specific but level of

sensitivity is poor

A

Using lower cutoff measurements

increases the specificity of these tests but decreases their sensitivity.

147
Q

The Schirmer II test

A

measures reflex secretion
with topical anesthetic
Wetting of less than 15 mm after 2 minutes is consistent with a defect in reflex secretion.

148
Q

An alternative to classic Schirmer strips is the phenol red–impregnated cotton thread test

A

allows for quicker assessment

of tear secretion but has not been fully validated

149
Q

highly suggestive of dry eye?

A

1) Tear-film hyperosmolarity (measured by TearLab Osmolarity System)
2) reduced level of tear lysozyme or lactoferrin (measured by The Touch Tear Lactoferrin MicroAssay) 3)InflammaDry Detector performs a microfiltration immunoassay for MMP-9, a product of the inflammatory cycle produced by distressed epithelial cells.

150
Q

بهترین متد تشخیص dry eye؟

A

tear osmolarity testing

151
Q

Imaging Technologies of tear film?

A

1)TBUT ➡️ made by using optical (eg, videokeratoscopic) imaging devices that can detect a break in the tear film.
2)Wavefront ➡️ a useful objective method for evaluating sequential changes in visual performance related to tear-film dynamics.
3)Anterior segment OCT ➡️measure the inferior tear
meniscus and the tear film and its components.

152
Q

کدامیک از روش های imaging اشک قادر است محتویات اشک را نشان دهد؟

A

Anterior segment OCT

153
Q

Impression Cytology

A

assessment of the ocular surface epithelium.
Sheets of epithelial conjunctival or, in rare instances, corneal cells are harvested using a piece of filter paper. They can then be examined directly in morphological and histologic studies, or they may be processed as free cells for flow cytometry. The latter technique allows
quantification of the expression of specific proteins (eg, cytokines, receptors) by the epithelial cells.

154
Q

Conjunctival impression cytology کاربرد

A 
monitor the progression of ocular surface changes
ترتیب تغییرات:
1)decreased goblet cell density
2)squamous metaplasia 
3)keratinization
155
Q

Corneal Pachymetry?

A

Ultrasonic pachymetry:

based on the speed of sound in the normal cornea (1640 m/sec)

156
Q

Instruments for corneal pachymetry?

A 
Corneal pachymeter
Scanning slit technology
Scheimpflug 
OCT
high-resolution ultrasonography
157
Q

The thinnest zone of the cornea is usually about 1.5
mm temporal to the geographic center, and the cornea
becomes thicker in the paracentral zone and peripheral
zone.

A

The average central thickness of the normal human
cornea is 540 μm. In the Ocular Hypertension Treatment
Study, the average central corneal thickness was higher,
at 573 ± 39 μm, but it was acknowledged that these
numbers were probably higher than those of the general
population.

158
Q

Which one has a greater impact on IOP measurement errors?
A)biomechanical properties
B)corneal thickness
C)corneal curvature

A

A

biomechanical properties of the cornea, particularly stiffness, may have a greater impact on IOP measurement errors

159
Q

Pachymetry

A

1) sensitive indicator of endothelial physiology

2) assess corneal hydration

160
Q

پاکی متری چگونه می تواند بیانگر عملکرد اندوتلیوم قرنیه باشد

A

function of the corneal endothelium:
1)barrier to aqueous
2)metabolic pump
When functioning normally, the endothelial pump balances the leak rate to maintain the corneal stromal water content at 78% and the central corneal thickness at about 540 μm

161
Q

Acute corneal edema is often the result of an altered barrier effect of the endothelium or epithelium.

A

Chronic corneal edema is usually caused by an inadequate endothelial pump.

162
Q

Folds in the Descemet membrane

are first seen when corneal thickness increases by 10% or more

A

epithelial edema occurs when

corneal thickness exceeds 700 μm.

163
Q

Early signs of corneal edema evident on slit-lamp examination

A

patchy or diffuse haze of the epithelium
mild stromal thickening
faint but deep stromal wrinkles (Waite-Beetham lines) Descemet membrane folds
patchy or diffuse posterior collagenous layer

164
Q

Stromal edema alters corneal transparency, but vision loss is most severe when epithelial microcysts or bullae occur.

A

A central corneal thickness greater than 640 μm may indicate a higher risk for symptomatic corneal edema after intraocular surgery

165
Q

Measurement of Corneal Biomechanics

A

The Ocular Response Analyzer (ORA):

in vivo clinical testing of a cornea’s direct biomechanical properties

166
Q

How ORA works?

What is CH?

A

a jet pulse of air ➡️ flatten the cornea
2 measurements1)the increase in air pressure required for indention of the cornea 2)the falling air pressure as the cornea returns to its original shape. Corneal hysteresis (CH) is the difference between these pressures.
یک فشار هوا به قرنیه میتابد و قرنیه را هل می دهد.در طی تو رفتن و بیرون آمدن قرنیه ۲ بار plano می شود.یک سیستم نوری هم به قرنیه می تابد که بازتاب نور قرنیه را ثبت می کند.در حالت plano بیشترین بارتاب نور را داریم بنابراین فشاری که قرنیه در آن plano شده ۲ بار اندازه گیری می شود و اختلاف این دو تا CH نام دارد

167
Q

What is CRF?

A

The corneal resistance factor (CRF) is derived from CH using a mathematical calculation to correlate with
corneal thickness. These values have a normal distribution within the general population but are
decreased in:
1)patients who have undergone LASIK or PRK
2)in those who have corneal edema secondary to Fuchs dystrophy

168
Q

ORA measures the viscous properties of the cornea and not the elastic properties,so it is not a particularly effective device for?

A

1) screening refractive surgery patients for the risk of keratectasia
2) documenting the increased stiffness associated with CXL, aging, and DM

169
Q

تکنولوژی های جدیدتر بررسی بیومکانیک قرنیه؟

A

instruments using Placido disk–based technology
the Scheimpflug camera system
OCT
collimated air puffs(more accurate measurement of the corneal deformation)
این تکنولوژی ها قابلیت افتراق بین خصوصیات بیومکانیک الاستیک قرنیه نرمال از قرنیه اکتاتیک و نیز قابلیت افتراق قرنیه CXL شده از قرنیه قبل درمان را دارند
این قابلیت ها با استفاده از متغیرهای زیر مقدور است:
1)quantitative amplitude of inward deformation (greater in softer, ectatic corneas)
2)area of corneal tissue experiencing inward deformation (less area in softer, ectatic corneas).
این تکنولوژی ها نشان داده اند که پاسخ deformation قرنیه بستگی دارد به:
IOP
corneal thickness
innate elastic biomechanical properties of the cornea

170
Q

the central cornea is about 3 D steeper than the periphery, a positive shape factor(=prolate=negative Q value)

A

Zones of the Cornea
1)central zone ➡️ 1–2 mm ,fits a spherical surface
2)paracentral zone➡️3–4-mm doughnut with an outer diameter of 7–8 mm, which is an area of
progressive flattening from the center.
🎈Together, the paracentral and central zones constitute the apical zone, which is used in contact lens fitting. The central and paracentral zones are primarily responsible for the refractive power of the cornea.
3)peripheral zone or transitional zone, with an outer diameter of approximately 11 mm. This is the area
of greatest flattening and asphericity in the normal cornea.
4)limbus, where the cornea steepens prior to joining the sclera at the limbal sulcus, with an outer diameter that averages 12 mm.

171
Q

What is the optical zone of the cornea?

A

the portion of the cornea that overlies the entrance pupil of the iris

172
Q

What is the corneal apex?

A

the point of maximum curvature, typically temporal to the center of the pupil

173
Q

What is the corneal vertex?

A

the point located at the intersection of the patient’s line of fixation and the corneal surface. It is represented by the corneal light reflex when the cornea is illuminated coaxially with fixation. The corneal vertex is the center of the keratoscopic image and does not necessarily correspond to the point of maximum curvature at the corneal apex

174
Q

Three topographic properties of the cornea

A

1)shape
2)curvature
3)refractive power
Shape and curvature are geometric properties of the
cornea, whereas power is a functional property.

175
Q

The refractive power of the cornea is determined by
Snell’s law
n2_n1/r

A

The anterior corneal power using air and corneal stromal refractive indices is higher than clinically useful because it does not take into account the negative contribution of the posterior cornea.
Thus, for most clinical purposes, a derived corneal refractive index of 1.3375 is used in calculating central corneal power. This value was chosen to allow 45 D to equate to a 7.5mm radius of curvature

176
Q

ophthalmometer (keratometer)

A

estimates, but does not directly measure, the central

corneal power

177
Q

۲ عدد برای RI استروما آورده شده؟
۱/۳۸۰
۱/۳۷۶

A

به طور کلی RI قرنیه؟
۱/۳۳۷۵
for most clinical purposes, a derived corneal refractive index of 1.3375 is used in calculating central corneal power. This value was chosen to allow 45 D to equate to a 7.5mm radius of curvature

178
Q

Average refractive power of the central cornea is about +43 D

A

which is the sum of the refractive power at the air stroma interface of +49 D minus the endothelium aqueous power of 6 D

179
Q

RI of corneal stroma?cornea?aqueous and tears?

A
  1. 376
  2. 3375
  3. 336
180
Q

Although the air–tear interface of the cornea is responsible for most of the eye’s refraction, the
difference between total corneal power based on stroma alone and with tears is only –0.06 D

A

😲😲😲😲correct

181
Q

RI ?

A
  1. 336 aqueous and tears
  2. 401 ant cornea
  3. 376 or 1.380 stroma
  4. 373 post cornea
  5. 4 center of the lens
  6. 36 periphery of the lens
182
Q

DDx for pigmented spot in the sclera?

A

collection of melanocytes associated with an intrascleral nerve loop or perforating anterior ciliary vessel.

183
Q

Melanosis?

A

excessive pigmentation without an

elevated mass that may be congenital (whether epithelial or subepithelial) or acquired (whether primary or secondary)

184
Q

Nl pigmented lesions of the globe?

A

1)scleral pigmented spot(collection
of melanocytes associated with an intrascleral nerve
loop or perforating anterior ciliary vessel)
2)melanosis
3)conj pigmentation(chronic exposure to epinephrine, silver, or mascara)

185
Q

سلولهای منشا ملانوم؟

A

ملانوسیت های اپیتلیال
ملانوسیت های ساب اپیتلیال
سلولهای نووس

186
Q

تومورهای نورواکتودرمال سطح چشم ممکن است ۴ منشا داشته باشند؟

A

۱)ملانوسیت های اپیتلیال(ضایعات خوش خیم ناشی از آنها فرکل و BAMاست و ضایعات بدخیم ناشی از آنها PAM و ملانوم میباشد)
۲)ملانوسیتهای ساب اپیتلیال(ضایعات خوش خیم ناشی از آنها اکولار ملانوسیتوز،ملانوسیتوم و Blue nevus بوده ضایعات بدخیم ناشی از آنها ملانوم است)
۳)سلولهای نووس(باعث ضایعات خوش خیم شامل خال اینترااپیتلیال یا جانکشنال،compound و ساب اپیتلیال و ضایعه ی بدخیم ملانوم می شود)
۴)سلولهای نورال(ضایعه خوش خیم ناشی از آن نوروفیبروم و ضایعه بدخیم ناشی از آن لیومیوسارکوم است)

187
Q

Freckle
Congenital epithelial melanosis
CEM
ephelis

A 
منشا از ملانوسیت های اپیتلیال
مسطح
روی کونژ بولبار و نزدیک لیمبوس
در افراد تیره پوست شایع تر
تظاهر در سنین ابتدای زندگی
188
Q

Benign acquired melanosis

BAM

A

Bilateral
منشا از ملانوسیت های اپیتلیال(عامل محرک هایپرپلازی؟احتمالا نور خورشید)
در افراد تیره پوست
میانسال
مسطح
در لیمبوس واضح تر است و به سمت فورنیکس نامشخص تر می شود

189
Q

What is striate melanokeratosis?

A

خطوط و حلقه هایی(streaks and whorls)که در BAM دیده می شود و گاها تا اپیتلیوم پریفر قرنیه کشیده می شوند

190
Q

اکولار ملانوسیتوز

A

congenital
ملانوزیس اپی اسکلرا(در زیر کونژ نرمال خاکستری به نظر می رسد)
پردلیفراسیون ملانوسیتهای ساب اپیتلیال(خال آبی)
یک طرفه
غیرمتحرک

191
Q

همراهی های اکولار ملانوسیتوز؟

A 
Iris and choroid pigmentation(diffuse uveal nevus)
Dermal melanocytosis(nevus of ota)
2nd glaucoma (10%)
192
Q

اکولودرمال ملانوسیتوز؟

A

اکولار ملانوسیتوز(پرولیفراسیون ملانوسیت های ساب اپیدرمال کونژ)+درمال ملانوسیتوز(پرولیفراسیون ملانوسیت های درم در مسیر درماتوم های V1وV2)

193
Q

چند درصد بیماران اکولار ملانوسیتوز دچار گلوکوم ثانویه می شوند؟

A

۱۰درصد

194
Q

آیا اکولار ملانوسیتوز ریسک بدخیمی دارد؟

A

بله ولی خیلی نادر است و فقط در بیماران سفید پوست دیده می شود

ملانوم (پوست،کونژ،یووه،اربیت)

195
Q

ریسک ایجاد ملانوم یووه در افراد عادی ۶در میلیون است

A

ریسک ایجاد ملانوم یووه در افراد با اکولار ملانوسیتوز ۱/۴۰۰ است که از افراد عادی خیلی بالاتر است

196
Q

چند درصد بیماران اکولار ملانوسیتوز در همان طرف درمال ملانوسیتوز هم دارند؟

A

۵۰ درصد

197
Q

در چند درصد موارد اکولار ملانوسیتوز دو طرفه است؟

A

۵ درصد

198
Q

فرکل و BAM؟
متحرک
مسطح
کونژ

A

اکولار ملانوسیتوز؟
ثابت
اپی اسکلرا

199
Q

Papillary conjunctivitis?

A 
باکتری
آلرژی
Floppy eyelid syndrome
VKC
Blepharitis(MGD,SA,seborrheic)
SLK
Thimerosal
تیروزینمی
200
Q

Follicular conjunctivitis

A

کلامیدیا
HSV
داروهای آنتی گلوکوم
EKC

201
Q

تشخیص افتراقی های filamentary keratopathy؟

A

Severe ATD

SLK

202
Q

Corneal Topography

A

based on keratoscopy, in which reflected images of multiple concentric circles can be digitally captured and the analysis performed by computer software. Placido disk–based topographers are the most commonly available type.

203
Q

In corneal topography?

A

on steeper parts of the cornea, the reflected mires appear closer together and thinner, and the axis of the central mire is shorter . Conversely, along the flat axis, the mires are farther apart and thicker, and the central mire is longer.

204
Q

In axial topo the assumption that the visual axis is coincident to the corneal apex may lead to some misinterpretations, such as the overdiagnosis of keratoconus

A

The tangential map typically shows better sensitivity to
peripheral changes with less “smoothing” of the
curvature than the axial maps
(In these maps, diopters are relative units of curvature and not the equivalent of diopters of corneal power.)

205
Q

What can affect the accuracy of corneal topography?

A 
misalignment
stability (test-to-test variation)
sensitivity to focus errors
tear-film effects
distortions
area of coverage (central and limbal)
nonstandardized data maps
colors that may be absolute or varied (normalized)
206
Q

Placido disk–based topography describes only the
surface corneal curvature (power), whereas corneal
tomography provides details such as the anterior and
posterior corneal curvature, corneal thickness, and
anterior chamber depth, as well as information on the
iris and lens.

A

Orbscan IIz combines an advanced Placido disk
system with slit-scanning technology and derives its
posterior elevation map mathematically. This map may
overestimate the posterior corneal curvature, however,
especially in patients who have undergone LASIK
procedures.

207
Q

The Scheimpflug system creates an optical

section of the cornea and lens

A

1) Pentacam uses a rotating Scheimpflug camera

2) Galilei combines a dual Scheimpflug camera system with Placido disk technology.

208
Q

Scheimpflug camera–based systems present

considerable information, including?

A

1)anterior curvature
2)corneal thickness
3)AC depth
4)anterior and posterior elevation
5)pupil indices
6)provide keratoconus detection and classification
7)densitometry function that measures the amount of corneal or lens opacification, information
that is useful in observing patients with Fuchs corneal
dystrophy or those who have undergone endothelial
keratoplasty
8)measurement of the true corneal power for use in IOL power calculation

209
Q

کاربرد سیستم densitometry function در Scheimpflug ؟

A

observing patients with Fuchs corneal dystrophy or those who have undergone endothelial
keratoplasty

210
Q

UBM

A

depth of tissue penetration is approximately 5 mm

the resolution is 35 to 70 μm

211
Q

how can we visualize of the iris and lens in the patient with an “eight-ball” hyphema?

A

UBM

212
Q

how can we visualize of the iris and lens in the patient with an “eight-ball” hyphema?

A

UBM

213
Q

What is the resolution of AS OCT?

A

5 to 10 μm

214
Q

The corneal pachymetry feature of AS OCT is useful in?

A

1)preop evaluation of patients with Fuchs corneal
dystrophy
2)postoperative follow-up of endothelial keratoplasty cases in which the shape and thickness of the donor lenticule can be quantified.
3)In LASIK patients, this function can be used to measure the thickness of the corneal flap and the residual stromal bed to determine the safety of an enhancement (re-treatment).

215
Q

Confocal Microscopy

A

study cell layers of the cornea, even in patients with edema and scarring.

216
Q

Which one has more spatial resolution?

A

Compared with ultrasonography or OCT,
confocal microscopy provides greater spatial resolution
and higher magnification, particularly in the z-axis. This
allows for in vivo optical sections of the cornea with a
resolution at cellular and subcellular levels.

217
Q

کاربرد confocal؟

A

1)infectious crystalline keratopathy
2)fungal keratitis
3)amebic keratitis
4)follow-up of RS patients to analyze haze formation and the complications of LASIK flaps, such as epithelial
ingrowth

218
Q

Four types of confocal microscopes

A

(1) the tandem-scanning(TSCM)
(2) the scanning-slit (SSCM)
(3) the laser scanning (LSCM)
(4) a single-sided disk design that is not commercially available. The first 3 are approved by FDA

219
Q

Advantages of 3 commertial available types of confocal?

A

🎈TSCM provides a shallower depth of field and better anterior-posterior localization and reconstruction.
🎈The SSCM is more user friendly and, as a result, is the most commonly used technique.
🎈The LSCM provides the highest resolution, to approximately 1–2 μm

220
Q

فوتوگرافی اسلیت لامپ؟

A

بزرگنمایی تا۱:۱

توسط لنزهای bellows، extension ring،close focusing

221
Q

دانسیته سلولهای اندوتلیال؟

A

۳۵۰۰ در بچه ها
میانگین بالغین ۲۴۰۰(۱۵۰۰-۳۵۰۰)
۲۰۰۰ در مسن
اگر کمتر از ۱۰۰۰ باشد بعد از جراحی ریسک corneal decompressionوجود دارد

222
Q

Coefficient of variation?

CV

A

SD/M
Nl<0.3
پلی مگاتیسم=افزایش تنوع در سطح سلولها⬅️علت:CL
اگر پلی مگاتیسم بالای 0.4 باشد نمی تواند جراحی را تحمل کند

223
Q

پلی مگاتیسم=افزایش تنوع در سطح سلولها

با CV نشان داده می شود

A

پلی مورفیسم=افزایش تنوع در شکل سلولها

با درصد سلولهای هگزاگونال مشخص می شود

224
Q

درصد سلولهای هگزاگونال قرنیه ۱۰۰ درصد است

A

اگر بیش از ۵۰ درصد سلولها غیر هگزاگونال باشند قرنیه نمی تواند جراحی را تحمل کند

225
Q

کاربرد anterior segment FA؟

A

study the circulatory dynamics of normal and pathologic bulbar conjunctival, episcleral, scleral, and iris blood vessels.

1) anterior segment ischemia
2) focal areas of vascular nonperfusion, as in necrotizing scleritis and corneal neovascularization

226
Q

Esthesiometry?

A

۱)روش کیفی:پنبه

۲)روش کمی: تماسی(cochet bonnet) غیرتماسی(هوا یا مخلوط هوا و co2)

227
Q

cochet bonnet esthesiometry

A

فیلامان نایلون نازک
Flexible
قابل retract شدن
حداکثر طول ۶ cm

228
Q

روش کار cochet bonnet esthesiometry

A

تماس فیلامان با قرنیه برقرار می شود و هر بار ۰/۵ cm از طول آن کم می شود تا به اندازه ی کافی rigid شود و بیمار آن را حس کند
عدد کمتر=فیلامان کوتاهتر=حس قرنیه کاهش یافته تر

229
Q

رتینوسکوپی در قرنیه مولتی فوکال

A 
رفلکس های منظم متعدد
که در جهات مختلف حرکت می کنند
1)KCN
2)post RS
این موارد نشان میدهد که چرا بیماری با قرنیه شفاف خوب نمیبیند
230
Q

رتینوسکوپی در قرنیه مولتی فوکال

A 
رفلکس های منظم متعدد
که در جهات مختلف حرکت می کنند
1)KCN
2)post RS
این موارد نشان میدهد که چرا بیماری با قرنیه شفاف خوب نمیبیند
231
Q

Irregular astigmatism and multifocal

cornea can occur in?

A

keratoconus, with corneal degenerations, or after keratorefractive surgery.

232
Q

retinoscopy can disclose disrupted light reflexes caused by disturbances of the corneal surface.

A

In cases where retinoscopic findings exceed the corresponding slit-lamp findings, retinoscopy can help gauge the relative effect of corneal surface changes on vision

233
Q

Conj nevus

A

1)junctional
2)compound
3)subepithelial➡️ cobblestoneظاهر
شکل اینترااپیتلیال خالص نادر است و فقط در بچه ها دیده می شود که افتراق آن از PAM در هیستوپاتولوژی مشکل است

234
Q

PAM
یک طرفه
پوست روشن

A

BAM
دوطرفه
پوست تیره

235
Q

خال نردیک لیمبوس معمولا flat است

A

ولی در کونژ بولبار،چین سمی لونار،کارونکل و مارژین پلک بیشتر برجسته است

236
Q

نووس کونژ در چند درصد موارد آملانوتیک است؟

A

۱/۳ موارد

237
Q

اگر یک conj nevus ظاهر سنگفرشی داشته باشد محل آن کجاست؟

A

ساب اپیتلیال

238
Q

در کدام نوع از خالهای کونژ کیست های انکلوزیونی کوچک دیده می شود؟

A

در ۱/۲ موارد در انواع ساب اپیتلیال یا مرکب

ترشح موسین توسط گابلت سلهای این کیست ها باعث بزرگ شدن خال و اشتباه شدن آن با بدخیمی می شود

239
Q

بزرگ شدن خال کونژ؟

A

۱)در خالهایی که کیست های انکلوزیونی کوچک دارن ترشح موسین می تواند باعث بزرگ شدن خال شود
۲)بزرگ شدن خال در زمان بلوغ ممکنه رخ دهد
در هر دو مورد ممکنه با ملانوم اشتباه شود

240
Q

ملانوم کونژ پروگنوز بهتری نسبت به ملانوم پوستی دارد

A

ولی باز هم mortality ملانوم کونژ ۲۵ درصد است

241
Q

مورتالیتی ملانوم کونژ چقدر است؟

A

۲۵ درصد

242
Q

احتمال بدخیمی در conj nevus چقدر است؟

A

کمتر از ۱ درصد
F/U Q6_12 m➡️slit photo or drawing
چنانچه ضایعه دچار تغییر شود باید excisional biopsy کرد

243
Q

احتمال ملانوم یووه در بیماران اکولار(اکولودرمال)ملانوسیتوزیس چقدر است؟

A

کمتر از ۱ درصد(۱/۴۰۰)⬅️در تمام زندگی

ریسک ملانوم یووه در افراد عادی ۶ در میلیون است

244
Q

محل ضایعه پیگمانته کونژ؟

A

اپی تلیوم کونژ: خال،اکولار ملانوزیس،PAM
استرومای کونژ: خال،ملانوم
اپی اسکلرا: اکولار(اکولودرمال)ملانوسیتوزیس

245
Q

ضایعات پیگمانته Flat کونژ؟

A

خال نزدیک لیمبوس
اکولار ملانوزیس
اکولار(اکولودرمال)ملانوسیتوزیس

246
Q

خال بیشتر در کونژ بولبار و لیمبوس است

A 
بنابراین تمام ضایعات پیگمانته زیر باید بیوپسی شوند
tarsal conj
fornix
Plica semilunaris
Caruncle
247
Q

معادل اکتینیک کراتوز پوست پلک CIN کونژ

A

معادل Lentigo maligna در پوست،PAMاست

Primary acquired melanosis

248
Q

What is hutchinson freckles?

A

= lentigo maligna

249
Q

علل ملانوزیس اکتسابی کونژ(DDxهای PAM)

A

آدیسون
رادیاسیون
حاملگی

250
Q

PAM

A

یک طرفه
Flat
اغلب خوش خیم
افراد با پوست روشن

251
Q

وجود کیست در ضایعه پیگمانته کونژ به نفع خال است

A

در PAM پیگمانتاسیون غیر کیستیک در کونژ سطحی دیده می شود

252
Q

علل تغییر اندازه ی PAM؟

A

التهاب
تغییرات هورمونی
بدخیمی

253
Q

در PAM چه مواردی باعث شک به بدخیمی می شود؟

A

ندولاریته
بزرگ شدن ضایعه
افزایش وسکولاریته

254
Q

پاتوفیزیولوژی PAM

A

تکثیر ملانوسیت های غیرطبیعی در اپیتلیوم بازال کونژ

255
Q

چند درصد از موارد PAM با آتیپی به سمت ملانوم پیشرفت می کند؟

A

۳۶ تا ۷۵ درصد

256
Q

در هر بیمار با پیگمنتاسیون کونژ……… لازم است

A

upper lid double eversion

257
Q

Mgx for PAM without atypia?

A

F/U Q 6-12m

258
Q

Mgx of PAM with atypia?

A

Focal➡️total excision

Diffuse or multifocal➡️topical chemo

259
Q

بیمار با ocular surface neoplasia کاندید جراحی داخل چشمی است

A

باید دقت کرد زیرا صدمه به بومن منجر به seeding تومور می شود

260
Q

ملانوم کونژ⬅️انتشار لنفاتیک⬅️متاستاز

ملانوم CB⬅️(ندرتا) اسکلرا⬅️شبیه ملانوم کونژ به نظر میرسد

A

Conj SCC➡️TM,iris➡️systemic➡️متاستاز

261
Q

چند درصد ملانوم های کونژ آملانوتیک هستند؟

۲۵%

A

مورتالیته ملانوم کونژ چقدر است؟

۲۵%

262
Q

ملانوم عود کننده کونژ آملانوتیک است حتی اگر ملانوم اوله پیگمانته بوده

A

ملانوم به علت واسکولاریزاسیون شدید اغلب خونریزی می کند

263
Q

منشا ملانوم کونز

A

۷۰ %از PAM
۲۰%از Nevus
۱۰%بصورت de novo
بیشتر از کونژ بولبار یا لیمبوس منشا می گیرند

264
Q

کدام پروگنوز بهتر دارد؟ ملانوم کونژ یا ملانوم پوست؟

A

ملانوم کونژ

265
Q

چند درصد بدخیمی های کونژ را ملانوم کونژ تشکیل میدهد؟

A

کمتر از ۱ درصد

266
Q

الگوی رشد ملانوم؟

A

ندولار

لذا می تواند به اربیت یا گلوب تهاجم کند

267
Q

نشانه های پروگنوز بد ملانوم کونژ؟

A

۱)عدم درگیری لیمبوس(قرار گرفتن در کونژ پالپبرال،کارونکل،فورنیکس)
۲)تهاجم به بافت های عمقی تر یا تهاجم لنفاتیک
۳)ضخامت بالای ۱/۸ mm
۴)درگیری مارژین پلک
۵)باقی ماندن تومور در مارژین جراحی
۶)گسترش پاژتوئید یا تمام ضخامت اینترااپیتلیال
۷)تیپ mixed cell

268
Q

در ملانوم پلک ضخامت بالای ۴ mm پروگنوز بد دارد

A

در ملانوم کونژ ضخامت بالای ۱/۸ mm پروگنوز بد دارد

269
Q

ملانوم ندولار ۱۰ % ملانوم های پوستی را تشکیل میدهد ولی در پلک بسیار نادره

A

ملانوم کونژ کمتر از ۱ درصد بدخیمی های چشم را شامل می شود و رشد ندولار دارد

270
Q

ملانوم ندولار ۱۰ % ملانوم های پوستی را تشکیل میدهد ولی در پلک بسیار نادره

A

ملانوم کونژ کمتر از ۱ درصد بدخیمی های چشم را شامل می شود و رشد ندولار دارد

271
Q

ملانوم کونژ به کجاها متاستاز میدهد؟

A 
غدد لنفاوی رژیونال
مغز
ریه
کبد
استخوان
272
Q

SLN Bx in melanoma?

A

در ملانوم پلک در صورتی که ضخامت بالای ۱ mm باشد

در ملانوم کونژ پیشنهاد شده ولی به طور گسترده هنوز مقبول نیست

273
Q

اندیکاسیون های اگزنتراسیون در ملانوم کونژ؟

A

۱)بیماری پیشرفته به شرطی که متاستاز رد شده باشد و با enucleation نتوان کل ضایعه را برداشت
۲)درمان palliative تومورهای پیشرفته و تهاجمی که بصورت لوکال کنترل نمی شوند

274
Q

آیا رادیوتراپی در درمان ملانوم کونژ موثر است؟

A

مشخص نیست

275
Q

میزان عود ملانوم کونژ؟

A

بالای ۵۰ درصد

276
Q

میزان متاستاز در ملانوم کونژ؟

۲۶ درصد

A

میزان مرگ در ملانوم کونژ؟

۱۳ درصد طی ۱۰ سال از excision

277
Q

ملانوم کونژ بیشتر شبیه ملانوم پوستی است یا ملانوم یووه؟

A

ملانوم پوست

278
Q

Cancer stem cells may play a role in the high recurrence rate of conjunctival melanoma, which may recur despite appearing to be “cured” both clinically and histologically

A

In the future, gene expression profiling may be

helpful in determining the response of conjunctival melanoma to targeted chemotherapies

279
Q

Subconjunctival peripheral nerve sheath tumors such as neurofibromas, schwannomas, and neuromas
have been reported, especially in multiple endocrine neoplasia (MEN).

A

A neurofibroma of the conjunctiva or eyelid is almost always a manifestation of neurofibromatosis

280
Q

neurilemoma

A

rare tumor of the conjunctiva that originates from Schwann cells of a peripheral nerve sheath

281
Q

leiomyosarcoma

A

very rare limbal lesion with the potential for orbital invasion

282
Q

تومورهای نوروژنیک و عضلات صاف کونژ؟

A 
نوروفیبروما
شوانوما
نوروما
Neurilemoma
لیومیوسارکوم
283
Q

اگر همانژیوم کونژ دیدی بگرد دنبال همانژیوم اربیت یا پلک

A

همانژیوم کاپیلری و کاورنو بصورت ایزوله در کونژ بولبار نادر است و اغلب نشانه گسترش از ساختمان های مجاور است

284
Q

اگر همانژیوماتوز منتشر کونژ پالپبرال یا فورنیکس دیدی؟

A

یعنی همانژیوم کاپیلری اربیت وجود دارد

285
Q

ضایعات عروقی مارژین پلک و کونژ؟

A

۱)هامارتوم خوش خیم: همانژیوم کاپیلری و کاورنو،نووس فلاموس
۲)راکتیو:گرانولوم پیوژنیک،تومور گلوموس،هایپرپلازی اندوتلیال پاپیلری اینتراوسکولار
۳)بدخیم:سارکوم کاپوزی،آنژیوسارکوم

286
Q

همانژیوم کاورنوی اربیت ممکن است ابتدا زیر کونژ ظاهر شود

A

ص

287
Q

Nevus flammus

Port wine stain

A

1) isolated

2) SWS➡️گلوکوم ثانویه ،هامارتوم عروقی، آنژیوماتوز لپتومننژ

288
Q

genetic mutation for SWS

A

coding for the vascular endothelial protein receptor for angiopoietin 1, which controls the assembly of perivascular smooth muscle

289
Q

Ataxia-telangiectasia

A

epibulbar telangiectasis
cerebellar abnormalities
immune alterations

290
Q

تومورهای مزانشیمال غیر عروقی کونژ

A 
خوش خیم:
Subconjunctival granulomas 
Sarcoid nodules 
Juvenile xanthogranuloma 
fibrous histiocytoma
Nodular fasciitis 
Necrobiotic xanthogranuloma 
بدخیم:
لیپوسارکوم
لیومیوسارکوم
رابدومیوسارکوم
فیبروز هیستیوسیتوم بدخیم
291
Q

Pyogenic granuloma

misnamed because it is not suppurative and does not contain giant cells

A

reactive hemangioma
may occur:1) over a chalazion 2)when minor trauma or surgery stimulates exuberant healing tissue with fibroblasts (granulation tissue) and proliferating capillaries that grow in a radiating pattern. This rapidly growing lesion is red, pedunculated, and smooth. it bleeds easily and stains with fluorescein dye.

292
Q

Subconjunctival granulomas

A

1) around parasitic and mycotic infectious foci

2) occurred with connective tissue diseases such as RA

293
Q

Sarcoid nodules

A

tan-yellow elevations

resemble follicles

294
Q

Juvenile xanthogranuloma

A

histiocytic disorder

conjunctival mass

295
Q

fibrous histiocytoma

A

composed of fibroblasts and histiocytes with lipid vacuoles

arises on rare occasions from the conjunctiva or limbus

296
Q

Nodular fasciitis

A

a very rare benign tumor of fibrovascular tissue in the eyelid or under the conjunctiva
it may originate at the insertion site of a rectus muscle

297
Q

Necrobiotic xanthogranuloma

A

a very rare tumor
may affect the anterior orbit and eyelids
can present as subconjunctival or subdermal nodular fibrovascular tissue
Biopsy is essential to establish the diagnosis because this tumor is often associated with paraproteinemias, multiple myeloma, or lymphoma.

298
Q

درمان گرانولوم پیوژنیک

A

1)Topical or intralesional corticosteroids may be curative.
2)Excision with cauterization to the base, primary closure of the wound, and generous postoperative
topical corticosteroids may minimize recurrences.

299
Q

Association with Necrobiotic xanthogranuloma

A

paraproteinemias
multiple myeloma
lymphoma

300
Q

عامل سارکوم کاپوزی؟

نئوپلاسم بدخیم اندوتلیوم عروق

A

Kaposi sarcoma herpes virus 8

301
Q

سارکوم کاپوزی در چشم

A

ندول بنفش پلک⬅️=درگیری پلک
ادم کونژ و پلک⬅️=درگیری اربیت
نمای شبیه خونریزی ساب کونژ⬅️=درگیری کونژ⬅️اغلب در فورنیکس تحتانی⬅️۱)ندولار ۲)دیفیوز

302
Q

کدامیک از انواع سارکوم کاپوزی کمتر به درمان پاسخ می دهد؟

A

ندولار

303
Q

تزریق اینترفرون آلفا ۲aدر چه مواردی کاربرد دارد؟

aaaaaaaaaaa

A

سارکوم کاپوزی

مورن

304
Q

راههای کنترل سمپتوم ها در سارکوم کاپوزی؟

A

Debulking
Cryo
Radio
Chema(local c IFNa2a or systemic)

305
Q

چند درصد بیماران با لنفوم کونژ دچار لنفوم اکسترااکولار نیز می باشند؟

A

۲۰ درصد

306
Q

لنفانژکتازی

A

irregularly dilated lymphatic channels in the bulbar
conjunctivaIt
1)developmental anomaly
2)follow trauma or inflammation.
🎈Anomalous communication with a venule can lead to spontaneous filling of the lymphatic vessels with blood.

307
Q

Lymphangiectasia must be distinguished from ataxia-telangiectasia (Louis-Bar syndrome)

A

AT:
1)epibulbar and interpalpebral telangiectasia of the arteries lacks an associated lymphatic
component.
2)The epibulbar vascular lesions of Louis-Bar syndrome can grow with the patient and the
eyeball
3)episodes of hemorrhage or swelling do not occur

308
Q

لنفانژیوم کونژ

A

proliferations of lymphatic channel elements.

🎈Like a capillary hemangioma, a lymphangioma is usually present at birth and may enlarge slowly.

The lesion appears as a patch of vesicles with edema.

🎈Intralesional hemorrhage, producing a “chocolate cyst,” makes differentiation from a hemangioma difficult.

309
Q

Lymphoid Hyperplasia

A

benign-appearing accumulation of lymphocytes and other leukocytes may represent a low-grade B-cell lymphoma

310
Q

تظاهرات هایپرپلازی لنفوئید کونظ

A

1)minimally elevated
2)salmon-colored
3)subepithelial
4)pebbly appearance corresponding to follicle formation
🎈 it is clinically indistinguishable from conjunctival lymphoma.
5)It is often moderately or highly vascularized.
🎈Primary localized amyloidosis can have a similar appearance.

311
Q

درمان و Mgx هایپرپلازی لنفوئید کونژ؟

A

1) resolve spontaneously
2) local excision
3) topical corticosteroids
4) radiation

🎈Biopsy specimens ➡️ special handling to complete
many of the histochemical and immunologic studies.
Fresh tissue is required for IHC, flow
cytometry, and gene rearrangement studies.

🎈Because a patient with an apparently benign polyclonal lymphoid lesion has the potential to develop a systemic lymphoma, general medical consultation is advisable.

312
Q

شایع ترین لنفوم کونژ؟

A

monoclonal proliferation of B lymphocytes

313
Q

تظاهرات لنفوم B نان هوچکین

A

شبیه هایپرپلازی لنفوئید
توده salmon pink متحرک در کونژ
معمولا یک طرفه /۲۰ درصد دو طرفه
اغلب بالای ۵۰ سال یا IS اند

314
Q

چند درصد از بیماران با لنفوم کونژ لنفوم سیستمیک دارند

A

۳۱ درصد

315
Q

درمان لنفوم کونژ

A

محدود به کونژ⬅️local EBRT
لنفوم سیستمیک⬅️کموتراپی
Cryotherapy and intralesional chemotherapy with
interferon-α2b have also been described

316
Q

کانسرهایی که می توانند به کونژ متاستاز دهند؟

A 
پستان
ریه
کلیه
ملانوم پوست
ضایعات متاستاتیک یووه،اربیت و سینوس های پارانازال
متاستاز لوکمیک در لیمبوس و قرنیه
317
Q

ژن دیس اتونومی فامیلیال روی کدام کروموزوم واقع شده؟

A

9

318
Q

افزایش سن چه اثری روی شعاع انحنای قرنیه دارد؟

A

افزایش میابد

=با افزایش سن قرنیه در مریدین ورتیکال flat می شود

319
Q

۲ پروتئین دخیل در اپتیک قرنیه را نام ببرید که نصف proهای محلول استروما را تشکیل می دهند؟

A

آلدئید دهیدروژناز

ترانس کتولاز

320
Q

چند درصد از بیماران اکولار ملانوسیتوز دچار گلوکوم ثانویه می شوند؟

A

10%

321
Q

کلاژن اصلی قرنیه تیپ ۱ است

A

۷۰ درصد وزن خشک استروما را تشکیل می دهد

AAO (45 decks)

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