EYE- Mehrohoff- benign/malignant neoplasms

Question 1

eyelids are lined by loosely attached skin on the external surface and by the _ on the internal surface

Answer 1

conjunctive

Question 2

swelling og the eyelids can be be the m ost prominent sign of _

Answer 2

allergy

Question 3

kidney diseases have _ eyelid swelling

Answer 3

morning

Question 4

hypothyroidism gives you a _ face

Answer 4

puffy

Question 5

increase in orbital contents displaces the eye

Answer 5

proptosis

Question 6

inferior and medial proptosis (positional displacement) involves the _ _

Answer 6

lacrimal gland

Question 7

axial proptosis (straight foward placement) inolves the _ _

Answer 7

optic nerve

Question 8

what is idiopathic orbital inflammation

Answer 8

aka obrital pseudotumor where there is infiltration of lymphocytes and plasma cells and there is relacement of tendons and fat with firbrosis

Question 9

orbital cellulitis

Answer 9

spread of a sinus infection to the orbits and there are painful eyemovements and proptosis which distinguishes it from pre-septal cellulitis

Question 10

complication of proptosis

Answer 10

the eyelid cannot cover the eye and therefore the tears evaporate

this causes an ulcer to form on the cornea or an infection from the air to get into the eye

Question 11

_ is an important clinical manifestation of graves disease

Answer 11

proptosis

Question 12

in graves disease there is autoimmune inflammation of orbital tissues by stimulaiton of orbital _

Answer 12

fibroblasts

Question 13

the orbital fibroblasts in graves disease express _ receptors and the T cells will interact with their _ producing proinflammatory cytokines and hydrophilic _.

this ^^ increases _ muscle and adipose swelling leading to _

Answer 13

CD40

CD40R

GAGs (hyaluron)

osmotic

exopthalmos

Question 14

thyroid ophthalmopathy in graves disease is usually bilateral but often _

Answer 14

asymmetric

Question 15

what are the thyroid opthalmopathy symptoms in graves

Answer 15

orbital/periorbital edema, eyelid retraction, eyelid downgaze, restrictive strabismus, optic neuropathy, expsoure keratopathy, dry eyes

Question 16

what is the difference between idiopathic orbital inflammation and thyroid opthalmopathy

Answer 16

idiopathoc orbital inflammation is tyically unilateral and involves the tendons

thyroid optho- spares the tendons and is bilateral and assymetric

Question 17

what is a xanthelasma

Answer 17

a tumor of FOAM cell macrophages the eat cholesteral; they are multiple soft yellowish plaques

Question 18

xanthelasmas are found near the _ _ there is no pain and slow growth

Answer 18

medial canthus

Question 19

what are meibomian glands

Answer 19

glands along the edge of the eyelid where the eyelashes are found- transparent fluid above the glands

Question 20

what is a hordeolum

Answer 20

a stye; it is an acute and purulent soft mass

main cause is staphylococcus aureus

Question 21

what are the two types of hordeolums and what glands do they involve

Answer 21

external: apocrine glands of Moll of. glands of Zeis

internal: meibomian gland at the palpebral conjunctive

Question 22

histology of hordeolum

Answer 22

neutrophils - do not really need to know for test

Question 23

if a hordeolum doesnt heal properly it can become a _

Answer 23

chalazion

Question 24

what is a chalazion

Answer 24

this is a chronic lipogranuloma due to leakage of sebum from an obstructed meibomian gland

Question 25

characteristics of a meibmian cyst

Answer 25

round-firm lesion within the tarsal plate

painless

rarely last longer than a few weeks*

Question 26

a chalazion results fom a blocked _ gland whereas a stye (hordeolum) indicated an _ oil/hair follicle

Answer 26

oil

infected

Question 27

recurrance of a chalazion (doe not go away after a few weeks) warrants a biopsy and histologic study to rule out ?

Answer 27

sebaceous gland carcinoma

mistaken for chalazion

Question 28

a sebacceous adenocarcinoma of the eyelid is uncommon, slow growing but tend to metastasize first to the _ and then to the _ nodes.

it has predilection for _ patients

it arises from the _ glands

if it presentas as a small, rubbery/firm nodule on the upper eyelid it mimics a _

if it presentas as diffuse tarsal thickening it mimics _ _

watch for eyelid _ and _

Answer 28

parotid then to submandiular nodes

female

meibomian glands

chalazion

ulcerative blepharitis

• watch for eyelid malposition and madarosis (loss of eyelashes)

Question 29

in a sebacceous adenocarcinoma of the eyelid the _ apperance due to sebum is a suspicous sign

Answer 29

yellowish

Question 30

sebaccous adenocarcinoma of the eyelid has _ epithelial cells and is poorly differentiated it has _ cytomplasm or vesicular nucleus due to the presence of _. the Cells spread via _ spread.

Answer 30

atypical

foamy

lipid

pagetoid spread

Question 31

what is Muir torre syndrome

Answer 31

an autosomal dominant cutaneous cancer that is a subset of lynch disease it has multiple skin colored to yellow papules

• retinoids to treat
• • survillance for other visceral malignancies

mismatch repair disdorder- mutation in MSH

Question 32

basal cell carcinoma of the eye is the most common malignancy of the eye

it affects people around the age of _ (light skinned)

risk factors are ?

characterisics: flesh colored to _ raised nodule with _ edges. It rarely metastasizes and displays _ (which makes it a self limiting process)

Answer 32

70

UV light, age, chronic inflammation, immunosuppresion, aresenic/coal derivatives

pearly, rolled edges

palisading

Question 33

what is palisading

Answer 33

a single layer of long cells that are perpendicular to the surface and parallell one another

Question 34

Sqaumous cell carcinoma is hte most common skin cancer in _ skin people

it may spread _ to invade the orbit or sinuses

there is a low risk of metastasis but the risk will increase if the SCC is present on the _, _ or eyelids

pathogenesis: starts off as a _ patch and slowly transforms into a _ and then it will form an _. Most are erythematous/pink nodules with an overlying _

in contrast to BCC they are eosionphilic and form whols known as _ _

Answer 34

dark skin

perineurally

lips, ears, or eyelid

keratin patch, nodule, ulceration

crust/scale

horn pearls ( sqaumous cells)

Question 35

melanoma of the eyelids

Answer 35

rare on the eyelids and has a high mortality rate

Question 36

_ remains a hallmark of melonoma of the eyelids byt half og the eyelind melanomas are _ _ and may lead to a misdiagnosis

the ABCDEs of melanoma of the eyelid ?

do they metastazise?

histology-

Answer 36

pigmentation

non pigmented

asymmetry, border irregularity, color heterogeneity, diameter greater than 6, evolution over time

yes- rapidly

highly pleomorphic with mitotic figures

Question 37

benign pigmented lesions of the eye

Answer 37

Lentigo
nevus
Amelanotic Nevus
Seborrheic keratosis

since they are bening there is not distortion of the eyelid

Question 38

A lentigo of the eyelid is a _ demarcated macule that arises due to _ proliferation in the basal layer of the epidermis. They do not _ when exposed to sunight.

Answer 38

well

melanocyte

darken

Question 39

seborrheic keratosis is proliferation of the _ keratinocytes. There are no melanocytes but they transfer _ to the keratinocytes. It is a well demarcated plaque/papilla with _ demarcated borders

Answer 39

basaloid

melanin

sharp

(moth eaten apperance)