Red Eye and Adnexal Oncology

Question 1

if there is non/ mild pain with pericorneal redness, minimal discharge and blurred vision what is the most likely diagnosis?

Answer 1

uveitis

Question 2

describe symptoms and signs in bacterial conjunctivitis

Answer 2

> no pain/itch
peripheral/diffuse redness
yellow discharge
normal vision

Question 3

what type of conjunctivitis would cause watery discharge?

Answer 3

viral conjunctivitis

Question 4

describe what sort of discharge you would expect allergic conjunctivitis to produce

Answer 4

mucousy

Question 5

what would the most likely diagnosis me for:
> severe/boring pain
> sectoral/diffuse redness
> no discharge 
> normal vision

Answer 5

scleritis

Question 6

what would the most likely diagnosis be for:
> severe pain/headache
> pericorneal redness
> can be discharge
> loss of vision

Answer 6

acute glaucoma

Question 7

describe symptoms that would be seen in keratitis/corneal ulcer

Answer 7

> severe pain/eye closing (?)
pericorneal redness
can be discharge
loss of vision

Question 8

describe symptoms that would be seen in orbital cellulitis

Answer 8

> severe/periocular pain
no redness
can be discharge
normal vision

Question 9

what does anterior uveitis affect?

Answer 9

the iris

Question 10

what does intermediate uveitis affect?

Answer 10

the ciliary body and vitreous

Question 11

what does posterior uveitis affect?

Answer 11

> retina
choroid
blood vessels

Question 12

name the different types of uveitis

Answer 12

> anterior
intermediate
posterior
panuveitis

Question 13

what systemic diseases in uveitis associated with?

Answer 13

> ankylosing spondylitis
> behcets disease
> sarcoidosis
> wegners
> systemic lupus erythematosis

Question 14

what infections are associated with uveitis?

Answer 14

> TB
> syphilis
> toxoplasma
> herpes simplex
> lymes disease
> CMV

Question 15

what are the treatment options for uveitis?

Answer 15

> topical anti-inflammatories
systemic steroids
systemic immunosuppressant’s in steroids not an option

Question 16

what are the symptoms seen in acute angle glaucoma?

Answer 16

> severe pain
vomiting
fixed dilated pupil

Question 17

what are the features of preseptal cellulitis?

Answer 17

> pain
redness
lid swelling
systemically unwell

Question 18

what are some common causes for preseptal cellulitis?

Answer 18

> lid cyst

> insect bite

Question 19

what are some of the features of orbital cellulitis?

Answer 19

> pain
> redness
> lid swelling
> systemically unwell
> double vision
> conjunctivitis
> exophthalmos
> blurred vision

Question 20

what are some common causes for orbital cellulitis?

Answer 20

> sinusitis
dental infections
haematological spread

Question 21

name some inherited conditions that can have ophthalmic presentations

Answer 21

> albinism
> ehlers-danlos
> marfans
> myotonic dystrophy
> neurofibromatosis

Question 22

what ratio of orbital tumours are benign?

Answer 22

2/3

Question 23

what cells are carcinomas derived from?

Answer 23

epithelial cells

Question 24

what cell type are sarcomas derived from?

Answer 24

connective tissue

Question 25

what cell type are lymphomas derived from?

Answer 25

haemopoietic cells maturing in the lymphatic tissue

Question 26

what cell type do leukaemias develop from?

Answer 26

haemopoietic cells maturing in the blood

Question 27

what are blastomas derived from?

Answer 27

cancers derived from immature precursor cells or embryonic cells

Question 28

name some common benign eyelid tumours

Answer 28

> squamous cell papilloma > basal cell papilloma > melanocytic naevus

Question 29

name some rarer eyelid tumours

Answer 29

``` > actinic keratosis > pyogenic granuloma > keratoacanthoma > capillary haemangioma > cavernous haemangioma ```

Question 30

what is the most common malignant eyelid tumour type?

Answer 30

basal cell carcinoma

Question 31

describe a squamous cell papilloma

Answer 31

> benign eyelid tumour > pedunculated or sessile > raspberry texture > usually viral

Question 32

what is the management for a squamous cell papilloma?

Answer 32

excision or laser ablation

Question 33

describe basal cell papilloma

Answer 33

> benign eyelid tumour > greasy, brown, flat and oval > unrelated to sun exposure

Question 34

what is the treatment for basal cell papilloma (seborrheic keratosis)?

Answer 34

excision

Question 35

what is melanocytic naevus composed of?

Answer 35

atypical melanocytes

Question 36

what colour and what level would a junctional melanocytic naevus be?

Answer 36

black and epidermis level

Question 37

what does the location of the melanocytes in melanocytic naevus influence?

Answer 37

clinical appearance and potential for malignant transformation

Question 38

what type of melanocytic naevus is brown and in the deep epidermis?

Answer 38

compound melanocytic naevus

Question 39

what type of melanocytic naevus is grey and in the papillary dermis?

Answer 39

intradermal

Question 40

what are some of the early signs of malignant transformation in melanocytic naevus?

Answer 40

``` > asymmetry > irregular border > variegated colour > diameter > 6mm > growth ```

Question 41

what are some concerning features of melanocytic naevus suggesting nodular malignancy?

Answer 41

> elevated > firm to touch > growing

Question 42

describe a pyogenic granuloma

Answer 42

``` > benign eyelid tumour > fast growing > highly vascularised granuloma > may follow surgery, infection, trauma > erythematous pedunculated mass ```

Question 43

what is the management for pyogenic granuloma?

Answer 43

excision

Question 44

describe actinic keratosis

Answer 44

``` > common premalignant condition > rare in eyelids > flat > scaly > hyperkeratotic skin > can form cutaneous horn > related to sun exposure ```

Question 45

what is the treatment from actinic keratosis?

Answer 45

> excision | > medical treatment

Question 46

describe keratoacanthoma

Answer 46

> rare squamous cell carcinoma is situ > rapidly growing in other wise healthy skin > pink papule, hyperkeratonic crater

Question 47

what can cause keratoacanthoma?

Answer 47

> sun exposure | > immunosuppression

Question 48

what is the treatment for keratoacanthoma?

Answer 48

excision

Question 49

describe capillary haemangioma

Answer 49

> commonest tumour in infancy > predilection upper lip (with/without orbital extension) > astigmatism

Question 50

what is the management for capillary haemoangioma?

Answer 50

> beta blockers > intralesion steroid > surgery

Question 51

describe a cavernous haeangioma

Answer 51

> rare > congenital > well demarcated pink patch > darkens with age-does not involute

Question 52

what is the treatment for cavernous haemangioma?

Answer 52

laser

Question 53

what is the most commonest cancer world wide?

Answer 53

basal cell carcinoma

Question 54

what are basal cell carcinomas associated with?

Answer 54

pale skin and sun exposure

Question 55

what features are suggestive of a basal cell carcinoma?

Answer 55

``` > slow growth over months > non-pigmented, elevated, ulcerated > pearly, rolled, irregular border > telangiectasia > lack of tenderness ```

Question 56

name the clinical subtypes of basal cells carcinomas

Answer 56

> nodular > ulcerative > morpheaform/infiltrative

Question 57

describe ulcerative basal cell carcinoma

Answer 57

> common > can progress from nodular > cycles of crusting and bleeding

Question 58

what is the management for basal cell carcinoma?

Answer 58

> standard excision > mohs surgery > non-surgical treatment

Question 59

describe the non-surgical treatment for basal cell carcinoma

Answer 59

``` > topical > chemotherapy > cryotherapy > radiotherapy > photodynamic therapy ```

Question 60

describe squamous cell carcinoma

Answer 60

> malignant eye tumour > sun damaged skin > scaly surface over thick plaque > growth over weeks

Question 61

what is the management for squamous cell carcinoma?

Answer 61

excision

Question 62

describe sebaceous gland carcinoma

Answer 62

``` > malignant eyelid carcinoma > recurrent chalazion > nodular indurated lid margin > yellowish discolouration > pagetoid spread along conjunctiva ```

Question 63

what is the management form sebaceous gland carcinoma?

Answer 63

excision

Question 64

what are the three types of cutaneous malignant melanoma?

Answer 64

> lentigo maliga > superficial spreading > nodular

Question 65

describe lentigo maligna CMM

Answer 65

> flat | > variably pigmented

Question 66

describe superficial spreading CMM

Answer 66

slightly raised pigmented plaque

Question 67

describe nodular CMM

Answer 67

vertically invasive

Question 68

name some benign orbital tumours

Answer 68

> capillary haemangioma > cavernous haemangioma > pleomorphic adenoma > optic nerve glioma

Question 69

name some malignant orbital tumours

Answer 69

``` > lymphoma > rhabdomyosarcoma > lacrimal gland carcinoma > osteocarcinoma > liposarcoma > primary melanoma ```