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MBChB - Y2 - Systems - Nervous System > The Red Eye & Adnexal Oncology > Flashcards

The Red Eye & Adnexal Oncology Flashcards

1
Q

What is the acute red eye condition?

A

Uveitis

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2
Q

What is the acute red eye condition?

A

Conjunctivitis:

Bacterial

Viral

Allergic

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3
Q

What is the acute red eye condition?

A

Scleritis

Acute glaucoma

Keratitis / corneal ulcer

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4
Q

What are the different types of uveitis?

A

Anterior

Intermediate

Posterior

Panuveitis

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5
Q

Where does anterior uveitis occur?

A

Iris

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6
Q

Where does intermediate uveitis occur?

A

Ciliary body and vitreous

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7
Q

Where does posterior uveitis occur?

A

Retina

Choroid

Blood vessels

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8
Q

What are the causes of uveitis?

A

Idiopathic

Assocaited with systemic disease

Infection

Masquarade (intraocular lymphoma, leukaemia)

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9
Q

What systemic diseases is uveitis associated with?

A

Ankylosing spondylitis

Behcet’s disease

Sarcoidosis

Systemic lupus erythematosis

Wegner’s

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10
Q

What infections are associated with uveitis?

A

TB

Syphilis

Toxoplasma

Herpes

Lymes

CMV

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11
Q

What is treatment for uveitis?

A

Treat Infection

Topical anti-inflammatories

Systemic steroid

Systemic immunosuppressants

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12
Q

What are signs and symptoms of acute angle-closure glaucoma?

A

Severe pain

Vomiting

Fixed, dilated pupil

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13
Q

What are features of preseptal cellulitis?

A

Pain, redness, lid swelling

Systemically well

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14
Q

What are the common causes of preseptal cellulitis?

A

Lid cyst or insect bite

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15
Q

What are the features of orbital cellulitis?

A

Ø Pain, redness, lid swelling

Ø Systemically unwell

Ø Double vision/limitation in EOEM

Ø Conjunctivitis/chemosis

Ø Exophthalmos (abnormal protrusion of the eyeball or eyeballs.)

Ø Blurred vision

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16
Q

What are the common causes of orbital cellulitis?

A

Sinusitis

Dental infections

Haematological spread

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17
Q

What systemic diseases can cause issues with the eye?

A

Ø Diabetes

Ø Hypertension

Ø Autoimmune

Ø Rheumatoid arthritis

Ø Myaesthenia gravis

Ø Systemic lupus erythematosus

Ø Inflammatory:

Ø Ankylosing spondylitis

Ø Crohn’s disease

Ø Sarcoidosis

Infection

Haematological

Inherited / genetic:

Albinism

Marfans

Thyroid eye disease

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18
Q

What are the three types of adnexal oncology?

A

Eyelid tumours

Lacrimal drainage tumours

Orbital tumours

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19
Q

What are the common types of adnexal oncology pathology?

A

Eyelid tumours: very common (20% of caucasions in their lifetime)

Lacrimal drainage tumours: vanishingly rare - less than 1,000,000 per year - considered to be orbital

Orbital tumours: very rare (2/3 benign, 1/3 malignant), approximately 1 per 100,000 per year

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20
Q

What are the features of 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
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21
Q

What are the features of malignant cells?

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’
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22
Q

What is a carcinoma?

A

•Derived from epithelial cells (i.e. skin, respiratory tract, GI tract)

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23
Q

What is a sarcoma?

A

•Derived from connective tissue (i.e. bone, cartilage, fat, nerve)

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24
Q

What is a lymphoma?

A

Haemopoietic cells maturing in lymphatic tissue

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25
Q

What is a leukaemia?

A

•Haemopoietic cells maturing in the blood

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26
Q

What is a blastoma?

A

•Cancers derived from immature ‘precursor’ cells or embryonic cells

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27
Q

Give examples of benign eyelid tumours

A

Squamous cell papilloma

Basal cell papilloma

Melanocytic naevus

Actinitic keratosis

28
Q

What are the malignant eyelid tumours

A

Basal cell carcinoma (very common - 90-95%)

Squamous cell carcinoma (2-5%)

Sebaceous cell carcinoma (1-2%)

29
Q

What are the features of squamous cell papilloma?

A

Pedunculated or sessile (broad-based)

Characteristic ‘raspberry’ texture

Usually viral

30
Q

What is the treatment for benign eyelid tumours?

A

Excision or laser ablation

31
Q

What are the features of basal cell papilloma?

A

ØGreasy, brown, flat, round/oval

Ø Similar texture to squamous cell papilloma

Ø ‘Stuck on’ appearance

Ø Unrelated to sun exposure

32
Q

What is the treatment for basal cell papilloma?

A

Excision

33
Q

What is melanocytic naevus composed of?

A

Atypical melanocytes

34
Q

What does the appearance of melanocytic naevus depend on?

A

location

35
Q

What are the three types of melanocytic naevus and where are they found?

A
36
Q

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

Forms malignant melanoma

A

ABCDE

A Asymmetry

B Border (irregular)

C Colour (variegated)

D Diameter (>6mm)

E Evolving (growing)

Concerning (suggesting nodular MM)

E Elevated

F Firm to touch

G Growing

37
Q

What type of benign eyelid tumour has an erythematous pedunculated mass?

A

Pyogenic granuloma

May follow surgery, infection or trauma

38
Q

Which benign eyelid tumour is a common pre-malignant condition and is related to sun exposure?

A

Actinitic keratosis

39
Q

What is the appearance of actinitic keratosis?

A

Flat, scaly, hyperkeratotic skin, occasional, forms cutaneous horn

40
Q

What is the treatment for actinitic keratosis?

A

Excision or medical treatment

41
Q

What is the most common cancer worldwide?

A

Basal cell carcioma

42
Q

What causes basal cell carcinoma?

A

Pale skin and sun exposure

43
Q

What is the risk of metastasis of a basal cell carcinoma?

A

1:1000

44
Q

What percentage of basal cell carcinoma occurs on the face?

A

70%

45
Q

What are the features of basal cell carcinoma?

A

Slow, inexorable growth over months

Usually non-pigmented, elevated, ulcerated

Pearly, rolled, irregular border

Telangiectasia

Lack of tenderness

46
Q

What are the clinical subtypes of basal cell carcinoma?

A

Nodular - classic firm pearly nodule

Ulcerative - common, may progress from nodular

Morpheaform / infiltrative - less common, indurated plaques

47
Q

Where is the most common place for a basal cell carcinoma?

A

Lower eyelid

48
Q

What is the management of basal cell carcinoma?

A

Excision

Mohs surgery

Non-Surgical:

Topical (imiquimod, efudex)

Chemotherapy (vismodegib) - Gorlin, Muir-Torre

Cryotherapy

Radiotherapy

Photodynamic therapy

49
Q

What is the cause of squamous cell carcinoma?

A

Sun damaged skin and pre-existing actinitic keratosis

50
Q

What are the features of squamous cell carcinoma?

A

Scaly surface over a thick plaque

Growth over weeks rather than months

51
Q

What is the metastatic risk of a squamous cell carcinoma?

A

3-10%

52
Q

What is the therapy for squamous cell carcinoma?

A

Excision

53
Q

Describe the features of sebaceous gland carcinoma

A

Nodular indurated lid margin

Yellowish discolouration (lipid content)

Pagetoid spread along conjunctivae (invades upper epidermis from below)

54
Q

What are the three types of malignant melanoma?

A
55
Q

Tips for taking adequate biopsies

A

Ø Adequate size

Ø Try to include area of normal tissue

Ø Try not to crush or use excess cautery

Ø Give histologist as much info. as possible

56
Q

What are the common benign orbital tumours?

A

Cappillary haemangioma

Cavernous haemangioma

57
Q

What are the common malignant cancers of the orbit?

A

Lymphoma

Metastatic spread

Rhabdomyosarcoma

58
Q

What is one of the commonest tumours of infacy?

A

Capillary haemangioma

59
Q

What eyelid is often affected by a capillary haemangioma?

A

Upper

60
Q

What are the issues a capillary haemangioma can cause with the eye?

A

Amblyopia

Astigmatism

61
Q

What is the rate of involution of a capillary haemangioma?

A

Involution from age 2, 40% by 4, 70% by 7

62
Q

What is the therapy for capillary haemangioma?

A

Beta blockers

Intralesion steroid

Surgery

63
Q

What are the featuers of a cavernous haemangioma?

A

Rare

Congenital

Well demarcated pink patch

Darkens with age, does not involute

64
Q

What is treatment for cavernous haemangioma?

A

Laser

65
Q
A

MBChB - Y2 - Systems - Nervous System (48 decks)

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