All revision Flashcards
Presentation of flashes/floaters and spider webs.
Visual changes in left eye
Darkening of peripheral vision
No pain nor trauma
Retinal detachment
Risk factors for primary open-angle glaucoma?
Family history Afro-carribbean ethnicity Myopia HyperT Diabetes mellitus
Lisch nodules are an eye characteristic of which inherited condition?
Neurofibromatosis
Mechanism of action of dorzolamide?
Carbonic anhydrase inhibitor
New-onset inability to see near objects
Red patches on fundoscopy
PMH = life-long smoker and hyperT
Wet ARMD
Management = anti-VEGF
Description of an ointment
Semi-solid grease (oil) with a high lipid content and no preservatives
Description of a gel
Semi-solid thickened aqueous solutions
What are Blaschko’s lines?
Lines that the embryological development of skin follow.
Where are melanocytes derived from?
the neural crest
Function of keratinocytes
Produce keratin
Synthesis of vit D
Immune function
What is Breslow thickness?
the depth from the granular layer of the epidermis to the deepest melanoma cell
Atopic triad
Name them now.
Asthma
Eczema
Hayfever
Which types of HPV is found in warts and verrucas
1-4
what do appocrine glands do?
scent glands
what do eccrine glands do?
provide moisture to palms and soles fro grip
which enzyme is deficient in erythropoietic protoporphria?
Ferrochelatane
which enzyme is deficient in acute intermittent poryphoria?
PBG deaminase
How long does it take for cells to migrate from the basal to keratin layer of the epidermis?
28 days
What mediates type ii and type iii hypersensitivity reactions?
IgM and IgG
what mediates type iv hypersensitivity reactions?
TH1 cells
are topical steroids lypophillic?
yes
what is the role of sebaceous glands?
maintain skin barrier
name the contents of the dermis
collagen elastin ground substance fibroblasts lymphocytes macrophages Langerhans cells mast cells
management ladder for psoriasis?
emollients vit d analogues (calcitrol) Dithranol coal tar steroids (mild) salicylate photodynamic therapy immunotherapy
What is bullous pemphigoid?
Autoimmune condition
Antibodies produced against hemi-desmosomes that are involved in the DEJ.
Formation of sub-epidermal blisters.
What is pemphigus vulgaris?
Autoimmune condition
Autoantibodies produced against desmoglein 3.
Loss of adhesion and splitting within the epidermis and loss of desmosomes.
Intra-epidermal blisters and acantholysis.
Antibody involved in dermatitis herpetiformis?
Anti-TTG
Name 2 prandial insulin analogues.
Novorapid
Humalog
Peak at 60-90 mins and last 4-5 hrs
Name 2 soluble prandial insulins.
Humulin S
Actarapid
Peak at 2-4 hours and last 5-8 hrs
Name 2 analogue basal insulins
Lantus
Levemir
Which pro-inflammatory mediator stimulates acute inflammation?
TNF alpha
What is C3b?
An opsonin
Which type of immunological cell is involved in acute inflammation?
Neutrophils
How long after primary contact with an antigen are specific antibodies readily detectable in serum?
5-7 days
Which type of cell secrete antibodies?
Plasma cells
What is the basic antibody unit composed of?
2 identical heavy chains
2 identical light chains
Which cell expresses CD8+?
Cytotoxic T cells
Kill virally infected body cells
What do B cells express before switching class?
IgM and IgD
What is an opsonin?
Extracellular protein that binds to cells and induce phagocytes to phagocytose the cells with the opsonins bound.
What do helper T cells produce?
CD4+
Where do leukocytes develop?
Primary lymphoid tissue
Red bone marrow and thymus
What is the most abundant immunoglobulin?
IgG
Which immunoglobulin is found in breast milk, saliva and mucosal secretions?
IgA
What are the two ways in which B cells can differentiate?
Become plasma cells which produce antibodies
Become memory B cells - immunological memory
What condition is characterised by 47 XXY?
Klinefelter syndrome
What is the chromosomal make-up of Turner syndrome?
45X
Signs and symptoms of Klinefelter’s syndrome.
Infertility Small, firm testes Frontal baldness absent Fewer chest hairs Female pubic hair pattern Long arms + legs Poor beard growth Anxiety + depression
How is Klinefelter’s syndrome diagnosed?
Karyotyping
Symptoms and signs of Kallmann’s syndrome
Small male sexual organs Decreased body hair High pitched voice Low libido Gynaecomastia Tall, slim, long arms + legs
Diagnosis of Kallmann’s syndrome?
MRI of pituitary
Which type of thyroid cancer produces calcitonin?
Medullary
cancer of C cells
Which medication should be used in Grave’s disease to help control symptoms while awaiting endocrinologist appt.?
Propranolol
Which diabetic medication is contraindicated in heart failure?
Pioglitazone
causes fluid retention
Management of thyrotoxicosis and a tender goitre?
Naproxen
What is the appropriate insulin fluid regime for a patient presenting with diabetic ketoacidosis?
IV insulin 0.1 unit/kg/hr
Low dexamethasone test does not suppress cortisol levels but a high dexamethasone test does.
Where in the body is the problem?
Pituitary
Cushing’s disease
Both a low and high dexamethasone test do not suppress cortisol levels.
What are the potential causes?
Ectopic ACTH production from a tumour (e.g. lung)
Adrenal adenoma
Corticosteroid therapy
What is first line management for a prolactinoma?
Cabergoline
Causes of tinnitus
Hearing loss
Noise damage
Ageing
Medication use
Which type of epithelium is found in a cholesteatoma?
Keratinising squamous epithelium
Symptoms of cholesteatoma
Foul smelling discharge White mass behind intact tympanic membrane Hearing loss Resistance to antibiotics Attic crust in retraction pocket
Which diseases can put you at risk of developing a cholesteatoma?
Down’s syndrome
Turner syndrome
Definitive treatment of cholesteatoma
Surgery (mastoidectomy)
Which type of hearing loss does a vestibular neuroma result in?
Unilateral Sensorineural hearing loss
Symptoms of vestibular Schwannoma/acoustic neuroma
Asymmetrical hearing loss Facial numbness Progressive episodes of dizziness Tinnitus Difficulty localising sounds
Which nerve is affected in vestibular schwannoma
Vestibulocochlear nerve
Which disease increases risk of vestibular Schwannoma?
Neurofibromatosis type 2
Autosomal dom
Diagnosis of vestibular Schwannoma
Audiogram - sensorineural hearing loss
Gadolinium enhanced MRI scan of head
CT head
What is the pathophysiology behind BPPV?
Otolith material floating into the vestibular canals and stimulating hair follicles during certain movements.
Duration = 30 secs to 1 min
How is BPPV diagnosed?
Dix-Hallpike manouvre
How is BPPV managed?
Epsley Manouvre
What does an audiogram in BPPV show?
NORMAL
Which test is positive in Ménière’s disease?
Romberg’s test
What is the treatment for Ménière’s disease?
Low salt diet
Diuretics
Anti-emetics
What is the difference between viral and bacterial labyrinthitis?
Viral (serous) = inflammation of the labyrinth only and usually presents with less severe hearing loss and vertigo
Bacterial (suppurative) = direct microbial invasion of the inner ear and usually presents with severe to profound hearing loss and vertigo.
Which bacteria most commonly cause acute otitis media?
Strep. Pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Strep. Pyrogens
Treatment for acute otitis media?
Watch and wait for 4 days
Amoxicillin
Erythromycin
How is glue ear diagnosed?
Otoscopy - shows TM retraction, middle ear fluid bubbles
Tuning fork tests - conductive hearing loss
Audiometry - conductive hearing loss
Tympanometry - type B
Which bacterias cause otitis externa?
Staph. Aureus
Proteus spp.
Pseudomonas aeruginosa
Management of otitis externa
Aural toilet and debridement
Topical antimicrobial drops (Ciprofloxacin) if bacterial
Acitic acid/clottimazole if fungal
Diagnosis for nasal trauma
Review in ENT clinic after 5-7 days post-injury
Exam immediately or after 5-7 days to avoid swelling
Which artery is most likely to cause epistaxis?
Anterior Ethmoidal artery
Name some causes of nasal polyps
Churgg strauss syndrome
Non-allergic asthma
Treatment for nasal polyps
MILD
Intranasal corticosteroid with leukotrine receptor antagonist
Surgical polypectomy
SEVERE
Short course oral corticosteroid with leukotrine receptor antagonist
Surgical polypectomy
Name the two non-allergic rhinitis’s
Vasomotor rhinitis
Non-allergic rhinitis with eosinophilia syndrome