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Systems: Neurology AB > The Red Eye and Adnexal Oncology > Flashcards

The Red Eye and Adnexal Oncology Flashcards

1
Q

Uveitis pain

A

None>mild

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2
Q

Uveitis redness

A

Pericorneal/none

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3
Q

Uveitis discharge

A

Minimal/none

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4
Q

Uveitis vision

A

Blurred

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5
Q

Bacterial conjunctivitis pain

A

None> FB sensation/itch

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6
Q

Bacterial conjunctivitis Redness

A

Peripheral/diffuse

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7
Q

Bacterial conjunctivitis discharge

A

Yes/yellow

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8
Q

Bacterial conjunctivitis vision

A

Normal

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9
Q

Viral conjunctivitis pain

A

None> Fb sensation/itch

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10
Q

Viral conjunctivitis redness

A

Peripheral/diffuse

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11
Q

Viral conjunctivitis discharge

A

Yes/watery

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12
Q

Viral conjunctivitis vision

A

Normal

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13
Q

Allergic conjunctivitis pain

A

None> FB sensation/itch

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14
Q

Allergic conjunctivitis redness

A

Peripheral/diffuse

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15
Q

Allergic conjunctivitis discharge

A

Yes/mucous

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16
Q

Allergic conjunctivitis vision

A

Normal

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17
Q

Scleritis pain

A

Severe/boring

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18
Q

Scleritis redness

A

Sectoral/diffuse

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19
Q

Scleritis discharge

A

No

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20
Q

Scleritis vision

A

Normal

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21
Q

Acute glaucoma pain

A

Severe/headache

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22
Q

Acute glaucoma redness

A

Pericorneal

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23
Q

Acute glaucoma discharge

A

Yes/no

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24
Q

Acute glaucoma vision

A

Lost

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25
Q

Keratitis/corneal ulcer pain

A

Severe/eye closing

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26
Q

Keratitis/corneal ulcer redness

A

Pericorneal

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27
Q

Keratitis/corneal ulcer discharge

A

Yes/no

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28
Q

Keratitis/corneal ulcer vision

A

Lost

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29
Q

Orbital cellulitis pain

A

Severe/periocular

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30
Q

Orbital cellulitis redness

A

None

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31
Q

Orbital cellulitis discharge

A

No/yes

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32
Q

Orbital cellulitis vision

A

Normal

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33
Q

Conjunctivitis

A

Inflammation of the conjunctiva

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34
Q

Uveitis

A

Inflammation in the eye

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35
Q

What are the 4 types of uveitis?

A
  • Anterior
  • Intermediate
  • Posterior
  • Panuveitis
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36
Q

What does anterior uveitis affect?

A

Iris

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37
Q

What does intermediate uveitis affect?

A

Ciliary body and vitreous

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38
Q

What does posterior uveitis affect?

A
  • Retina
  • Choroid
  • Blood vessels
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39
Q

What are the classification of causes of uveitis?

A
  • Idiopathic
  • Associated with systemic disease
  • Infection
  • Masquarade
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40
Q

What causes associated with systemic disease of uveitis are there?

A
  • Ankylosing spondylitis
  • Behcet’s disease
  • Sarcoidosis
  • Wegner’s
  • Systemic lupus erythematosus
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41
Q

What infectious causes of uveitis are there?

A
  • TB
  • Syphilis
  • Toxoplasmosis
  • Herpes simplex
  • Lyme’s disease
  • CMV
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42
Q

What masquerade causes of uveitis are there?

A
  • Intraocular lymphoma

- Leukaemia

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43
Q

What treatments are available for uveitis?

A
  • Treat individual infection
  • Topical anti-inflammatories
  • Systemic steroid
  • Systemic immunosuppressant’s
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44
Q

What are the symptoms of acute angle closure glaucoma?

A
  • Severe pain
  • Vomiting
  • Fixed, dilated pupil
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45
Q

Features of preseptal cellulitis

A
  • Pain, redness, lid swelling

- Systemically well

46
Q

What are the common causes of preseptal cellulitis?

A
  • Lid cyst

- Insect bite

47
Q

Features of orbital cellulitis

A
  • Pain, redness, lid swelling
  • Systemically unwell
  • Double vision/limitation in EOEM
  • Conjuntivitis/chemosis
  • Exophthalmos
  • Blurred vision
48
Q

What are common causes of orbital cellulitis?

A
  • Sinusitis/dental infections

- Haematological spread

49
Q

What classification of conditions can there be ophthalmic presentations of systemic disease?

A
  • Diabetes
  • Hypertension
  • Autoimmune
  • Inflammatory
  • Infection
  • Haematological
  • Inherited/genetic
50
Q

What autoimmune conditions can have an ophthalmic presentation?

A
  • Rheumatoid arthritis
  • Crcatricial pemphigoid
  • Myaesthenia gravis
  • Sjogren’s syndrome
  • Systemic lupus erythematosus
  • Grave’s disease
51
Q

What inflammatory conditions can have an ophthalmic presentation?

A
  • Ankylosing spondylitis
  • Crohn’s disease
  • Juvenile idiopathic arthritis
  • Sarcoidosis
52
Q

What inherited/genetic conditions can have an ophthalmic presentation?

A
  • Albinism
  • Ehlers-Danlos
  • Marfan’s
  • Myotonic dystrophy
  • Neurofibromatosis
53
Q

What is the characteristic appearance of thyroid eye disease?

A

Eyes appear to protrude

54
Q

What are the components of the adnexal?

A
  • Orbit
  • Eyelids
  • Lacrimal drainage system
55
Q

What is included in adnexal oncology?

A
  • Eyelid tumours
  • Lacrimal drainage tumours
  • Orbital tumours
56
Q

How common are eyelid tumours?

A
  • Very common

- Up to 20% of Caucasians in their lifetime

57
Q

How common are lacrimal drainage tumours?

A
  • Vanishingly rare

- Less than 1 per 1,000,000 per year

58
Q

How common are orbital tumours?

A
  • Very rare

- Approx 1 per 100,000

59
Q

What is more common, benign or malignant orbital tumours?

A
  • 2/3 benign

- 1/3 malignant

60
Q

Tumour

A

Abnormal proliferation of tissue

61
Q

Describe benign tumours.

A
  • Normal cells in abnormal numbers and/or location
  • Cells lack the ability to invade local tissue or to metastasise
  • Typically slow growing, mass effect
62
Q

Describe malignant tumours.

A
  • Anaplastic cells (loss of form or function)
  • Often rapidly growing, capable of invading surrounding tissue and spreading to distant locations
  • Colloquially known as cancer
63
Q

Give examples of malignant tumours.

A
  • Carcinoma
  • Sarcoma
  • Lymphoma
  • Leukaemia
  • Blastoma
64
Q

What are carcinomas derived from?

A

Epithelial cells (e.g skin, respiratory tract, GIT)

65
Q

What are sarcomas derived from?

A

Connective tissue (Bone, cartilage, fat, nerve)

66
Q

What are lymphomas?

A

Haemopoietic cells maturing in lymphatic tissue

67
Q

What are leukaemia’s?

A

Haemopoietic cells maturing in the blood

68
Q

What are blastomas derived from?

A

Immature precursor cells or embryonic cells

69
Q

Give examples of benign eyelid tumours from common to rare.

A
  • Squamous cell papilloma
  • Basal cell papilloma
  • Melanocytic naevus
  • Actinic keratosis
  • Pyogenic granuloma
  • Keratoacanthoma
  • Capillary haemangioma
  • Cavernous haemangioma
70
Q

Give examples of malignant eyelid tumours from common to rare

A
  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Sebaceaous gland carcinoma
  • Melanoma
  • Kaposi sarcoma
  • Merkel cell carcinoma
71
Q

What are the characteristics of squamous cell papilloma?

A
  • Pedunculated or sessile (broad based)
  • Characteristic ‘raspberry’ texture
  • Usually viral
72
Q

How are squamous cell papillomas treated?

A

Excision or laser ablasion

73
Q

What is another name for basal cell papilloma?

A

Seborrhoeic keratosis

74
Q

What are the characteristics of basal cell papillomas?

A
  • Greasy, brown, flat, round/oval
  • Similar texture to squamous cell papilloma
  • Stuck on appearance
  • Unrelated to sun exposure
75
Q

What is the treatment for basal cell papilloma?

76
Q

What is melanocytic naevus composed of?

A

Atypical melanocytes

77
Q

What does the location of atypical melanocytes n melanocytic naevus influence?

A

Clinical appearance and potential for malignant transformation

78
Q

Describe junctional melanocytic naevus.

A
  • Black
  • Epidermis
  • Very rare to become malignant
79
Q

Describe compound melanocytic naevus.

A
  • Brown
  • Deep epidermis
  • Risk of malignancy transformation between rare and very rare
80
Q

Describe intradermal melanocytic naevus

A
  • Grey in papillary dermis
  • Blue in dermis
  • Rare chance of malignant transformation
81
Q

What are the early signs of malignant transformation of melanocytic naevus?

A
  • Asymmetry
  • Border (irregular)
  • Colour (variegated)
  • Diameter (>6mm)
  • Evolving (growing)
82
Q

What concerning signs of melanocytic naevus would suggest nodular malignant melanoma?

A
  • Elevated
  • Firm to touch
  • Growing
83
Q

What are the characteristics of pyogenic granulomas?

A
  • Fast growing, highly vascularised granuloma
  • May follow surgery, infection, trauma
  • Erythematous pedunculated mass
84
Q

What is the treatment for pyogenic granuloma?

85
Q

What are the characteristics of actinic keratosis?

A
  • Common pre-malignant condition, though relatively rare on eyelids
  • Flat, scaly, hyperkeratotic skin, occasionally forms cutaneous horn
  • Related to sun exposure
86
Q

What is the treatment for actinic keratosis?

A

Excision of medical treatment

87
Q

What are the characteristics of keratoacanthomas?

A
  • Rare, squamous cell carcinoma in situ
  • Rapidly growing in otherwise healthy skin
  • Pink papule, hyperkeratotic crater
  • Sun exposure, immunosuppression
  • Often spontaneous involution after 2-3 months
88
Q

What is the treatment for keratoacanthomas?

89
Q

What are the characteristics of capillary haemangiomas?

A
  • Although rare, one of the commonest tumours of infancy
  • Predilection upper lid with or without orbital extension
  • Can cause amblyopia and astigmatism
  • Involution from age 2, 40% by 4, 70% by 7
90
Q

What is the treatment for capillary haemangioma?

A
  • B blockers
  • Intralesion steroids
  • Surgery
91
Q

What are the characteristics of cavernous haemangiomas?

A
  • Rae, congenital
  • Well demarcated pink patch
  • Darkens with age, does not involute
  • Sturge-weber
92
Q

What is the treatment for cavernous haemangiomas?

93
Q

What are the characteristics of basal cell carcinoma?

A
  • Commonest cancer worldwide
  • Pale skin and sun exposure
  • 70% occur on the face
  • > 100,000 per year in the UK
  • Will affect up to 20% of Caucasians in their lifetime
  • Locally invasive, risk of metastasis ~1:1000
94
Q

Features suggestive of basal cell carcinoma.

A
  • Slow, inexorable growth over months
  • Usually non-pigmented, elevated, ulcerated
  • Pearly, rolled, irregular border
  • Telangiectasia
  • Lack of tenderness
95
Q

What are the clinical subtypes of basal cell carcinoma?

A
  • Nodular: common, classic firm pearly nodule
  • Ulcerative: common, may progress from nodular, cycles of crusting and bleeding
  • Morpheaform/infiltrative: less common, indurated plaques
96
Q

What are the treatment options for basal cell carcinomas?

A
  • Standard excision
  • Mohs surgery
  • Topical
  • Chemotherapy
  • Cryotherapy
  • Radiotherapy
  • Photodynamic therapy
97
Q

What are the characteristics od squamous cell carcinoma?

A
  • Sun damaged skin and pre-existing AK
  • Scaly surface over thick plaque
  • Growth over weeks rather than months
  • Metastatic risk of 3-10%
98
Q

What is the treatment for squamous cell carcinoma?

99
Q

What are the characteristics of sebaceous gland carcinoma?

A
  • Nodular, indurated lid margin
  • Yellowish discoloration (lipid content)
  • Pagetoid spread along conjunctiva, map Bx
  • Tell histologist… staining
100
Q

What is the treatment for sebaceous gland carcinoma?

101
Q

What are the 3 types of malignant melanomas?

A
  • Lentigo maligna: flat variably pigmented macule
  • Superficial spreading: slightly raised pigmented plaque
  • Nodular: vertically invasive (may be amelanotic)
102
Q

Tips for taking biopsies of eyelid tumours.

A
  • Adequate size
  • Try to include area of normal tissue
  • Try not to crush or use excess cautery
  • Give histologist as much information as possible
103
Q

How should biopsy be carried out for suspect malignant melanoma?

A
  • Excision biopsy with small margin

- Gob back to extend margin according to Clark level or Breslow correlation if confrmed

104
Q

Excision margin fro basal cell carcinoma.

A
  • 3mm

- 2mm if small and tissue preservation important

105
Q

Excision margin for squamous cell carcinoma

A
  • 4 mm margin

- Discuss with MDT, consider MRI/abdominal US

106
Q

Excision margin for sebaceous gland carcinoma

A
  • 5-10mm

- Consider sentinel node biopsy

107
Q

Excision margin fro malignant melanoma

A
  • 10-30mm

- Consider sentinel node biopsy

108
Q

What can orbital tumours affect?

A
  • Lacrimal gland
  • Extrinsic eye muscles
  • Nerves
  • Blood vessels
109
Q

Give examples of benign orbital tumours from common to rare

A
  • Capillary haemangioma
  • Cavernous haemangioma
  • Pleomorphic adenoma
  • Optic nerve glioma
110
Q

Give examples of malignant orbital tumours from common to rare.

A
  • Lymphoma
  • Metastatic regional spread
  • Rhabdomyosarcoma
  • Lacrimal gland carcinoma
  • Osteosarcoma
  • Liposarcoma
  • Primary melanoma

Systems: Neurology AB (51 decks)

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