2156 Eye & Skin

Question 1

Lantanoprost ADRs (4)

Answer 1

1. Conjunctival hyperaemia (redness of eyes)
2. brown discoloration of iris
3. lower eyelid pigmentation
4. lengthening of eyelashes

Question 2

Timolol eyedrop CI (1)

Answer 2

asthma

Question 3

Red flag to refer for eye conditions (6)

Answer 3

1. Pain or intense inflammation
2. reduced visual acuity / blurred
3. Photophobia
4. N/V or halo around light (acute angle glaucoma)
5. Unilateral (infection)
6. contact lens use

Question 4

DED differential question (1)

Answer 4

Dry mouth or enlarged glands? (Sjogren syndrome)

Question 5

Infectious conjunctivitis differential question (4)

Answer 5

1. Red eye with pus and sticky discharge? (bacterial)
2. Swollen lymph node? (chlamydial)
3. Unilateral?
4. Contact lens?

Question 6

AMD differential question (1)

Answer 6

Sudden dark spot in your central vision? (wet AMD –> refer)

Question 7

TOP corticosteroids use ADR (3)

Answer 7

1. Withdrawal Sx (erythema, burning, pruritus, stinging)
2. telangiectasias (“spider veins”)
3. Skin thinning, red stretch marks

Question 8

TOP corticosteroids use to avoid (2)

Answer 8

1. Avoid using long term < 2–4 weeks
2. Avoid applying high intensity TCS on the face

Question 9

Steroid strength order

Answer 9

hydrocortisone < Desonide < betamethasone Valerate / Mometasone Furoate

Question 10

TOP Tacrolimus CI (2)

Answer 10

Long term use a/w (black box)
1. Lymphoma
2. Skin cancer

Question 11

PO Steroids use ADR (6)

Answer 11

1. osteoperosis
2. Glaucoma
3. Hyperglycemia
4. Tachyphylaxis
5. adrenal suppression
6. eczema flares on discontinuation

Question 12

TOP Benzoyl Peroxide ADR (2) + administration (1)

Answer 12

1. dryness & peeling
2. Erythema & burning
   Admin: put with sunsreen

Question 13

TOP Adapalene ADR (3)

Answer 13

1. Dryness, erythema, irritation
2. Photosensitivity –> use sunscreen
3. worsen initially –> 6-8 weeks for improvement

Question 14

TOP Tretinoin DDI (1) & CI (1)

Answer 14

DDI: benzoyl peroxide use OM, tretinoin use ON
CI: pregnancy

Question 15

TOP Clindamycin use (2)

Answer 15

1. Best in combi with benzoyl peroxide
2. Only use in pregnancy when necessary

Question 16

PO Abx choice for acne (2) + duration

Answer 16

1. Doxycycline 50mg BD / 100 mg OD
2. Macrolides
   Shortest duration (< 12 months)

Question 17

PO Isotretinoin CI (4)

Answer 17

1. Hepatic / renal insufficiency
2. Lipid level very high
3. Pregnancy / breastfeeding (negative pregnancy test mandated)
4. Tetracycline

Question 18

TOP Imidazoles for fungal infection use (2)

Answer 18

1. continue 1-2 weeks after symptoms resolution
2. takes 4-6 weeks to heal

Question 19

TOP Amorolfine (nail lacquer) administration (2)

Answer 19

1. apply 1-2x a week
2. takes 6 months for fingernail, 9-12 months for toenails

Question 20

TOP Acyclovir administration (3)

Answer 20

1. Apply thin later 5x/day for 5-10d
2. do not cover cold sore with bandage / dressing
3. dab instead of rub to minimise blister spreading

Question 21

TOP Vitamin D analogs (calcipotriol / calcitriol) use (2)

Answer 21

1. Combine with TCS as maintenance
2. avoid use with salicylic acid

Question 22

SC IL-23 Inhibitors (Guselkumab) ADR (2)

Answer 22

1. increased risk of infection (URTI)
2. Hypersensitivity (injection site)

Question 23

SC IL-17 inhibitors (Ixekizumab) ADR (2)

Answer 23

1. Increased risk of infection (candidal infection)
2. Increased risk of IBD exacerbation

Question 24

Systemic therapies for psoriasis (6)

Answer 24

1. IL-23 inhibitors (Guselkumab)
2. IL-17 inhibitors (Ixekizumab)
3. IL-12/23 inhibitors (Ustekinumab)
4. TNF-a inhibitors (infliximab)
5. PDE4 inhibitor (Apremilast)
6. TKI2 inhibitors (Deucravacitinib)

Question 25

Skin red flags questions (6)

Answer 25

1. involvement of unusual areas (face, genitalia, scalp, eyebrows, eyelashes) 2. Extensive area, seriously inflamed, excess exudate 3. DM / immunocompromised 4. Recurrent / no improvement / worsening condition 5. young children < 2 yo 6. secondary infection (bacterial / viral)