Derm/ENT/Eyes

Question 1

How can you differentiate between labyrinthitis and vestibular neuronitis?

Answer 1

VN DOES NOT have tinnitus or deafness.
Vertigo, N&V, tinnitus, deafness and nystagmus secondary to viral or bacterial infection

Question 2

Treatment for labyrinthitis

Answer 2

Anti-emetics- prochlorperazine, promethazine, cyclizine
Vestibular sedative- calcium channel and histamine antagonist- cinnarizine
Histamine analgoue- betahistine

Question 3

What is Meniere’s Disease?

Answer 3

Endolymphatic hydrops, presents with vertigo, N&V, tinnitus, sensorineural hearing loss and nystagmus away from the affected ear.
MRI and bloods for Ix.
Same treatment as labyrinthitis

Question 4

What is Acute Otitis Media and how do you treat it?

Answer 4

AOM is infection of the middle ear, usually presents with otalgia, decreased hearing, irritability, fever, vomiting and loss of appetite.
Most common bacteria- H. Influenzae and S. pneumoniae

Question 5

Most common cause of erysipelas?

Answer 5

S. pyogenes

Question 6

Features of Age related macular degeneration

Answer 6

Commonest cause of impaired vision in UK
Choroidal neovascularisation (Wet AMD)
Blurring of vision
Scotoma- black patch in central vision
Metamorphosia- straight lines appear curved

Question 7

What is SCC and its most affected demographic

Answer 7

Malignant tumour of the epidermal keratocytes and mainly affects sun-exposed skin of middle-aged and elderly individuals
Rapidly expanding painless, ulcerated lesions
Can arise from precancerous lesions known as actinic keratoses

Question 8

What is acoustic neuroma?

Answer 8

Acoustic neuroma is Schwann cell sheath tumour of the vestibulocochlear nerve.
Usually presents as unilateral sensorineural hearing loss which CAN FLUCTUATE.
Headaches, N&V, tinnitus, vertigo and facial numbness and weakness.

Question 9

Which is the common dermatophyte in onychomycosis and what is the treatment?

Answer 9

Tricophyton rubrum
General lifestyle advice such as good hygiene
Topical nail lacquer
Oral terbinafine and/or itraconazole

Question 10

What is the triad of Osler-Weber-Rendu syndrome?

Answer 10

Telangiectasia
Recurrent epistaxis
Positive family history

Question 11

Common sites of scabies and treatment

Answer 11

Greyish-white linear burrows seen on finger webs, fingers, elbows and wrists.
Permethrin cream is first line treatment

Question 12

What is the difference between pinna cellulitis and pinna perichondritis and what are the causative organisms for each?

Answer 12

PC involves ear lobe redness whereas PP spares the earlobes and only infects the cartilaginous pinna.
PC- S. aureus
PP- P.aeruginosa

Question 13

Hallmark symptom of cholesteotoma?

Answer 13

Painless and frequent recurrence of otorrhoea.
Conductive hearing loss
Dizziness

Question 14

Triad of optic neuritis

Answer 14

Pain on eye movement, impaired colour vision (especially red) and subacute unilateral visual loss.
Most commonly associated with MS
Uhthoff’s and Pulfrich’s phenomenon may be present

Question 15

What is BPPV and what are the two eponymous tests involved?

Answer 15

Benign paroxysmal positional vertigo is due to the displacement of otoliths from maculae into semicircular canals
Dix-Hallpike is the diagnostic test and Epley manoeuvre is the corrective manoeuvre along with self guided positioning and guidance.

Question 16

What is seborrhoeic dermatitis?

Answer 16

Seborrhoeic dermatitis is a scaly rash usually affecting areas rich in sebaceous glands, such as. the nasolabial folds and hair follicles.

Question 17

What is acne rosacea?

Answer 17

Common rash affecting the face and is commonly associated with flushing.
Central facial erythema +/- papules and pustules
Avoid aggravating factors and topical agents such as metronidazole gel.

Question 18

What is vitreous haemorrhage?

Answer 18

Vitreous haemorrhage is extravasated blood in the vitreous as a result of trauma, aneurysms, retinal tear/detachment.
VERY COMMON IN DIABETICS

Question 19

What are the F’s of retinal detachment?

Answer 19

Floaters
Flashes
Fall in acuity
Field loss

Question 20

Describe the lesions in Molluscum contagiosum

Answer 20

Clusters of small shiny papules with an umbilicated centre caused by the Poxvirus.
Treatment-
Advise and reassurance
Potassium hydroxide
Cryotherapy
Curettage

Question 21

Explain acute angle closure glaucoma and its treatment

Answer 21

Increased intra-ocular pressure due to impaired aqueous secretion
IV acetazolamide
Topical pilocarpine
Surgical iridectomy once acute episode managed

Question 22

Common presentation of acute angle closure glaucoma

Answer 22

Periorbital pain, N&V and visual deficits with blurry vision and halos

Question 23

Common presentation of nasal polyps

Answer 23

Headaches, nasal congestion, hyposmia to anosmia, changes in sense of taste and persistent postnasal drip

Question 24

How to investigate and treat for nasal polyps?

Answer 24

Coronal Sinus CT
Medical- topical or systemic steroids
Surigcal- polypectomy or ethmoidectomy

Question 25

What is Bell’s Palsy?

Answer 25

Lower motor neurone facial nerve palsy usually from latent herpes zoster virus.
Facial distortion, loss of taste, hyperacusis and watery eye- usually unilateral
Now recommended to treat with oral pred.

Question 26

What is Ramsay Hunt syndrome?

Answer 26

Varicella zoster virus is reactivated in the geniculate ganglion of the 12th nerve.
Sensorineural deafness, vertigo and facial paralysis.
Treated with acyclovir or steroids.

Question 27

What is guttate psoriasis?

Answer 27

Usually preceded by strep infection.

Tear drop lesions on trunk and limbs.

Most cases resolve spontaneously, topical treatments as per psoriasis and UVB phototherapy

Question 28

What is pityriasis rosea?

Answer 28

Herald patch followed 1-2 weeks later by multiple erythematous slightly raised oval lesions. Fir tree appearance.

Potentially caused by HHV-7

Self limiting in 6 weeks.

Question 29

Common causes of hirsutism

Answer 29

PCOS
Cushings syndrome
Congenital adrenal hyperplasia
Androgen therapy
Obesity