5/12/21 Flashcards

Question

Management of Subungal Haematoma

Answer 1

Trephination → only perform in \<48hours after 48hours - most haematomas have clotted and trephination is typically not effective

Answer 2

Larger size than most moles: \> 6 mm and often 1–2 centimetres in diameter at diagnosis Irregular shape Variable pigmentation: colours may include light brown, dark brown, black, blue, grey, pink and red There may be skip areas, which are skin coloured, or white scars due to regression Smooth surface at first, later becoming thicker with an irregular surface that may be dry or warty.

Answer 3

Elevated Firm Growing for NODULAR MELANOMA

Answer 4

Can appear suddenly, grow rapidly OR grow slowly over weeks to months tender and painful on sun exposed sites raised scaly lump common in those who are immunosuppressed

Answer 5

Need biopsy to establish diagnosis - margin 3-5mm ## Footnote review every 6 months for skin check for at least 2 years after excision

Answer 6

Pain Large Size Induration at the Base Anatomic Site → Nose, Ears, Backs of Hands, Scalp, Forearms, Face and Penis Wide base or low height to base ratio Redness at the base of the horn base Lack of terrace formation - rapid unorganised growth

Answer 7

Biopsy - but can use topical therapy or photodynamic therapy in regions where the skin heals poorly. Cannot use topical therapies if the disease has extended into the hair follicles Imiquimod 5% topically, at night 5 times weekly for up to 6 weeks. Fluorouracil 5% cream topically, once daily for 3-4 weeks Photodynamic Therapy

Answer 8

Driving History → accidents and pattern of driving How often pt gets lost Diabetes Recent Hypoglycaemic Episodes Compliance with Medications Hypoglycaemic Aareness History of Syncopal Episodes Signs of CVA Sleep Disorders Insight into dementia if present

Answer 9

Visual Examination - visual acuity, visual fields Co-ordination, Balance, Mobility Peripheral Neuropathy Hearing Assessment of Impairment

Answer 10

Collateral History regarding driving history Geriatric Assessment for Capacity Occupational Therapist for Driving Assessment Anonymous enquiry from Driving Licensing Authority about the requirements

Answer 11

advice patient that he is not able to drive advise him to inform the drivers license authority notify the NOK that pt is not fit to drive Offer assistance and support to look for alternate transport options document the discussions in detail in medical records

Answer 12

Associated with Multiple Sclerosis Monoocular, visual loss + Eye pain can be with central scotoma commonly also can have photpsias → flickering or falshes of light sudden - hours to days - peaking within 1-2 weeks Fundoscopy - 2/3 is normal. inflammation has retrobulbar neuritis

Answer 13

Ankylosing Spondylitis Inflammatory Bowel Disease (IBD) Behcet Syndrome

Answer 14

NonPharm - do not rub eyes, no contact lenses, cool compresses, Management → anti-histamine + mast-cell stabiliser Azelastine Eye Drops or Ketotifen or Olopatadine - Patanol 2nd line -\>. Antihistamine only or Mast-Cell only

Answer 15

NO BLOOD OUTSIDE THE VESSEL Localised area of congestion minimal discomfort, minimal pain, nil impact on vision, unilateral Associated with autoimmunse RA - Rheumatoid Arthritis (RA) IBD SLE Management self-resolving can trial topical NSAIDS

Answer 16

severe pain differentiates between episcleritis and scleritis also presents with photophobia, deep-red or purplish scleral hue

Answer 17

Immediate referral to ophthalmology\*\*\* Topical Antiviral Therapy → aciclovir 3% eye ointment 5 times daily for 10-14 days or at least 3 days after healing whichever is shorter Oral antiviral therapy → valaciclovir 500mg po BD for 7-10 days

Answer 18

Pain Relief Topical ABx NO need for topical anaesthetic NO need for eye patching

Answer 19

Eye Patch Bed Rest with 30 degree head elevation Dilate pupil for examination and pain Relief Control Nausea and Vomiting Topical Pain Relief Referral to Ophthalmologist

Answer 20

Artery - Cherry Red Spot + Pale Retina Vein - Sunset Storm

Answer 21

Non-Proliferative -\> microaneurysms, cotton wool spots, tortuous vessels, exudates Proliferative -\> neovascularisation around the optic disc or retina

Answer 22

Pain Loss of Vision Recent history of flashes and floaters presence of dark shadow or curtain moving over the visual field

Answer 23

Sudden fading central vision Distortion of Vision Straight lines may seem wavy and objects distorted - Amsler Chart Central Vision eventually completely lost Peripheral Fields normal

Answer 24

Older Age Smoking Alcohol Consumption Sunlight Exposure Lower Educational Status Occur prematurely in people with diabetes Systemic Corticosteroids

Answer 25

95% of contact lens infections Red Eye Reduced visual acuity Pain Eyelid Swelling Photophobia Corneal Epithlial Defect