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Rhi’s MSRA > Derm/ENT/Opthal > Flashcards

Derm/ENT/Opthal Flashcards

1
Q

Side effect of chloramphenicol?

A

Common: eye stinging, skin reactions.
Rarely: BONE MARROW SUPPRESSION, fever, paraesthesia

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2
Q

The name for blood fluid level in eye after trauma? Management?

A

Hyphaema (urgent referral to ophthalmology)

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3
Q

Lesion in the temporal lobe (lateral pathway on diagram) will cause what visual field defect?

A

Superior quadranopia on CONTRALATERAL side ‘PIE IN THE SKY!’

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4
Q

Lesion in the parietal pathway (interior on diagram)- what visual field defect?

A

Inferior quadrantanopia

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5
Q

Winter month, pt with widespread coin-shaped lesions, begin as itchy patches of vesicles and papules, then ooze serum and crust over. Mainly on extensor surfaces of extremities and buttocks. Dx?

A

Discoid eczema

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6
Q

Winter month, pt with widespread coin-shaped lesions, begin as itchy patches of vesicles and papules, then ooze serum and crust over. Mainly on extensor surfaces of extremities and buttocks. Dx?

A

Discoid eczema

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7
Q

Winter month, pt with widespread coin-shaped lesions, begin as itchy patches of vesicles and papules, then ooze serum and crust over. Mainly on extensor surfaces of extremities and buttocks. Dx?

A

Discoid eczema

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8
Q

Score for melanoma? What it contains?

A

Glasgow score
-3 major criteria - change in size/shape/colour
4 minor criteria - diameter over 7mm, inflammation, ooze, itch/odd sensation

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9
Q

Advice for shingles patient who asks about contact with other people?

A

Fine as long as lesions well covered. Exception being immunocompromised patients

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10
Q

As per guidelines, when to admit children with a temperature?

A

< 3 months with temp >/= 38
Consider admitting 3-6 month children with temp >/= 39

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11
Q

How does otitis media with effusion (glue ear) usually present?
Management?

A

Conductive hearing loss.
Generally resolves spontaneously. May require grommets.

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12
Q

How does acute otitis media (AOM) present?

A

Otalgia, irritability, decreased hearing, loss of appetite, vomiting, or fever - usually with other symptoms of viral infection

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13
Q

Acne rosacea treatment?

A

-Lifestyle changes - avoid triggers ie alcohol, stress, spicy food, sunlight (wear SPF)
-FLUSHING: B-blockers ie Propanolol
-PAPULES/PUSTULES/NODULES: topical ivermectin, azealic acid or metronidazole. If severe, tetracycline
-PERSISTENT ERYTHEMA -topical Brimonidine

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14
Q

Treatment for folliculitis barbae?

A

Topical or oral anti-staphylococcal abx (as caused by staphylococcus aureus)

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15
Q

Two major types of HSV and which areas they are associated with?

A

HSV-1: orofacial infections
HSV-2: genital infections
(Also there is some overlap)

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16
Q

1st line treatment for non-bullous impetigo?

A

Hydrogen peroxide 1% cream

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17
Q

Rash typical of Systemtic Lupus Erythematosus (SLE)?

A

Malar (butterfly) rash on cheeks - worse with sunlight, spares nasolabial folds

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18
Q

Pt with sudden vision loss, to examine: pale retina, cherry red spot . Dx?

A

Central retinal artery occlusion

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19
Q

Pityriasis Rosacea presentation?

A

Single erythematous herald patch (usually 2-5cm in diameter, bright red with fine scale, sharply demarcated), followed by collection of smaller patches.
Lesions run along parallel to ribs - giving CHRISTMAS TREE appearance (Cheeks ROSY for Christmas, Hark the HERALD!)

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20
Q

Treatment for pityriasis rosacea?

A

Normally not needed. Can use topical steroids or emollient if itchy.

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21
Q

BCC treatment?

A

-Superficial: Imiquomod, 5-flurouracil, curettage/cautery
-Deeper/more extensive: surgery
-Recurrent or cosmetically sensitive area: Moh’s micrographic surgery
-elderly who can’t tolerate surgery:radiotherapy

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22
Q

Pyogenic granuloma - what is it, and how does it present?

A

-Chronic inflammatory lesion of the dermal layer of the skin, occurs due to minor penetrating FBs ie thorns/splinters
-normally hands/feet/gums, reddish blue, solitary, fleshy nodules, bleed easily

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23
Q

Treatment of pyogenic granuloma?

A

Excision. Base of lesions curetted. Should be sent for histology to confirm diagnosis

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24
Q

What is a cholesteatoma?

A

Expanding keratinising squamous epithelium in the middle ear/mastoid process

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25
Q

Appearance of cholesteatoma on otoscopy?

A

Deep retraction pocket in TM, TM usually burst, yellow/brown crust-like lesion, often with surrounding pus

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26
Q

Treatment of cholesteatoma?

A

SURGICAL REMOVAL

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27
Q

Young child, with rubbery lump in aspect of lateral eyebrow. Dx?

A

Dermoid cyst

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28
Q

Sebhorrheic keratoses.
-What are they?
-where do they appear and what age?
-Appearance?
-Treatment?

A

-localised proliferation of epidermis
-Trunk, over 40s
-can be flat or raised, brown/yellow
-Normally don’t need Tx, cryotherapy

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29
Q

Difference between Chalazion and stye?

A

A chalazion - a less painful chronic infection on the inside edge of the eyelid (conjunctival side) often larger and further from eye.
Styes, (hordeola) are painful infected lesions on the edge of the eyelid (eyelash follicles) that come on quickly and eventually break open and drain, often smaller and closer to eye

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30
Q

Keratoconus
-what is it?
-who does it usually affect?
-treatment?

A

-Dome shaped cornea, causes blurred vision
-young people, mostly non-Caucasians
-Contact lenses, unless severe - surgery
-Can also slow progression with corneal cross-linking (CXL) to stiffen the cornea

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31
Q

What does visual acuity 6/12 mean

A

The person can read at 6 metres what a person with normal vision can read at 12 metres

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32
Q

Term for male pattern baldness?
How does it present?

A

Androgenic alopecia
BL temporal loss, (characteristic ‘M’ shape), that progresses to crown area

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33
Q

What is alopecia areata?
What does it look like?
Treatment?

A

-Non-scarring, auto-immune, inflammatory hair loss.
-Well-circumscribed, asymmetric, totally bald smooth patches, usually on scalp. Exclamation mark! Hairs seen around the margins (short broken hairs)
-topical/intralesional corticosteroids

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34
Q

What is tenogen effluviem?
How does it present?
Simple bedside test to check?

A

Increased shedding of normal hairs.
-diffuse alopecia. Normally a history of stress ie pregnancy, surgery, high fever, rapid weight loss etc, or offending medication ie COCP, anti thyroid meds THREE-FIVE months prior to onset
-hair-pull test usually positive (gently pull around 50 hairs, if 5 or more come out, positive)

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35
Q

Treatment for fungal nail infections?

A

-Can just advice simple measures ie hygiene, short nails, avoid damp conditions etc.
-if mild/superficial: topical amorolfine 5% nail lacquer
-Oral terbinafine (confirm diagnosis with culture firsth) 6wks-3m for finger nails, 3-6m for toenails

36
Q

Typical person to present with BCC?Appearance of BCC?

A

Older, sun exposure
Shiny, pearly nodule with central ulceration (rolled edges), overlying telangiectasia

37
Q

Samter’s triad - made up of what 3 things?

A

Asthma, nasal polyps, aspirin sensitivity

38
Q

First presentation of nasal polyp - what to do?

A

REFER TO ENT

39
Q

Symptom of orbital blowout fracture?

A

Varies, can be relatively asymptomatic.
Diplopia
Enopthalmus (posterior displacement of globe)
Hypoglobus (eye looks sunken as globe is lower)
Hypoaesthesia (numbness) of cheek/upper gum on affected side

40
Q

2 most common organisms for cellulitis?

A

Staph aureus, staph pyogenes

41
Q

Typical patient who gets dermatitis herpetiformis?
Treatment?

A

Women 3-4th decade
Strongly associated with coeliac disease
-Dapsone, and sometimes gluten-free diet

42
Q

How and where does lichen PLANUS usually present?

A

Planus Ps: Pruritic, Purpuric, Purple, Polygonal. White lacy white lines
-flexor surfaces of upper extremities, genitalia and mucous membranes

43
Q

Treatment for lichen PLANUS?

A

Systemic antihistamines (as immunologically mediated process)
-coal tar
-menthol
-topical steroids

44
Q

What is lichen simplex chronicus and what is it caused by?

A

THICKENING of skin with variable scaling - arises secondary to repetitive scratching/rubbing.
-most common cause is ECZEMA

45
Q

How does lichen sclerosis present and how is it treated?

A

-VERY ITCHY localised demarcated THICKENED plaque, with SCALING, EXCORIATION and LICHENIFICATION (increased skin markings)
-Topical steroids, tar, antihistamines, occlusive dressings (to stop itching)

46
Q

Most common causative organism of peritonsillar abscess?

A

Strep pyogenes

47
Q

What is the characteristic symptom of tobacco-alcohol ambylopia?
How can it be treated

A

-Central loss of colour vision
-Adequate nutrition - thiamine, folic acid, vitamin B12 etc

48
Q

Triad of symptoms of Ménière’s disease?

A

Vertigo, tinnitus, (sensorineral) hearing loss

(Often accompanied by nausea/vomiting)

49
Q

Eye examination of Ménière’s disease shows what?

A

Nystagmus away from affected ear (if only one ear affected)

50
Q

Management of Ménière’s disease?

A

-Prochlorperazine/cinnarazine for acute attack
-Betahistine for prophylaxis
-surgery for cases resistant to medical treatment

51
Q

Young pt, with midline neck lump, moved upwards when protrudes tongue. Swelling is fluctuating, non-tender and mobile. Dx?

A

Thyroglossal cyst

52
Q

What is chronic suppurative otitis media?
How does it present?
What to do as GP?

A

Chronic inflammation of the middle ear/mastoid cavity
-Recurrent ottorhoea through TM perforation
-Admit anyone with signs of infection beyond ear ie mastoiditis, otherwise refer to ENT and advise no swimming

53
Q

Female with facial flushing, papules on cheeks, nose, but sparing nasolabial folds. Dx?

A

ROSACEA

54
Q

How does amaurosis fugax present?
-cause?

A

Acute temporary (seconds-minutes) unilateral vision loss - like ‘curtain drawn up/down over the eye’!
-transient retinal ischaemia

55
Q

Young patient with sore throat, fever, lymphadenopathy, myalgia, soft splenomegaly, headache, night sweats - Dx?
-Causative virus?

A

-Infectious mononucleosis (glandular fever)
-Ebstein-Barr virus (EBV)

56
Q

Drug choice for tonsillitis? Why?

A

Pen V. Amoxicillin causes rash if symptoms due to infectious mononucleosis!

57
Q

Triad for optic neuritis?
Most important investigation?

A
  1. Painful sub-acute vision loss
  2. eye pain worse with movement
  3. loss of colour vision (especially red!)
    -MRI!!
58
Q

Most common cause of optic neuritis?

A

Multiple sclerosis

59
Q

Other signs/symptoms of optic neuritis? And 2 ‘phenomena’

A

-Relative Afferent Pupillary Defect (Marcus Gunn pupil - dilates instead of constricts when light switches to affected pupil)
-Visual field defect - typically central scotoma
-light flashes
-UHTOFF’s phenomenon- worsening symptoms with increased temperature
-PULFRICH’s phenomenon- objects moving straight appear to have curved trajectory

60
Q

How does an oculomotor (third) cranial nerve palsy present

A

‘Down and out’ of affected eye
Pupil mydriasis, upper lid ptosis, diplopia

61
Q

How does the Holmes-Adie pupil present?

A

Parasympathetic denervation of affected pupil - appears abnormally dilated at rest, and is sluggish to light

62
Q

Horner’s syndrome symptoms?

A

Miosis, ptosis, anhidrosis, enopthalmus (sunken eye)

63
Q

Horner’s syndrome symptoms?

A

Miosis, ptosis, anhidrosis, enopthalmus (sunken eye)

64
Q

Name of condition when unable to properly close eyelid after blepharoplasty?

A

Lagophthalmus

65
Q

How does a Pinguecula present? Risk factor?

A

Yellow/white deposit on conjunctiva, more commonly on nasal side.
-Associated with UV exposure

66
Q

What is Hordeolum externum?

A

Purulent infection of one of the sebaceous glands of Zeis along the eyelid margin. Associated with staph aureus.

67
Q

-Presentation of CMV retinitis?
-Associated disease?
-Opthalmoscopy shows what?

A

-Decreased visual acuity, floaters, loss of visual fields on one side
-HIV
-‘Pizza’ fundus- with RETINAL SPOTS & FLAME HAEMORRHAGES

68
Q

Symptoms of keratoconjunctivitis sicca?
Disease associated with?

A

Reduced tear formation = gritty feeling in eyes.
Sicca = Sjögren’s syndrome!

69
Q

Pt with preceding viral illness, with vertigo lasting days, no hearing loss/tinnitus. Likely Dx?

A

Vestibular neuritis

70
Q

Acute urticaria (hives) main Mx? (If no angioedema)

A

Oral antihistamines

71
Q

First line Tx for nasal polyps?

A

Intranasal corticosteroid spray ie fluticasone, for 3 months

72
Q

Indications for tonsillectomy?

A

-cancer/suspected cancer
-spontaneous tonsillar haemorrhage
-Quinsy
-immunocompromise/other RF medical conditions putting them at risk of severe complications
-over 7 episodes tonsillitis in 1 year, or over 5 episodes per year over 2 years, or over 3 episodes/year over 3 years AND episodes prevent normal functioning

73
Q

Presentation of SCCs?
Typical patients to get SCC?

A

-Rapidly expanding, painless, ulcerated nodules. Sometimes have ‘cauliflower-like appearance with areas of bleeding, ulceration or serous exudation
-Skin-exposed skin of Middle Aged and elderly people (rare in <60s unless immunocompromised!)

74
Q

Which retinal change is characteristic for age-related macular degeneration?

A

Choroidal neovascularisation

75
Q

Which retinal change is characteristic for age-related macular degeneration?

A

Choroidal neovascularisation

76
Q

Retinal changes characteristics of diabetic retinopathy? (3)

A

-microaneurysms
-dot and blot haemorrhages
-flame haemorrhages

77
Q

If visual distortment, or rapid-onset visual loss, which type of AMD is more likely?

A

WET AMD
‘Wet = Worse!’

78
Q

which type of AMD is more common?

A

DRY AMD (90%!)

79
Q

Which virus is most commonly related to nasopharyngeal carcinoma?

A

EBV

80
Q

Safest option for flare of acne vulgaris in pregnancy?

A

Topical benzoyl peroxide
(Isotretinoin is teratogenic, and tetracycline stains teeth of foetus!)

81
Q

Older patient, watching TV in evening, sudden painful vision loss with headache/nausea/vomiting. Likely Dx?

A

Acute angle closure glaucoma (usually happens when pupil is in mid-dilation ie watching tv in dim conditions!)

82
Q

Symptoms of retinal detachment?

A

Four Fs!
-floaters
-flashes
-field loss
-fall in acuity (painless, like curtain over vision)

83
Q

1st line and 2nd line for atopic eczema? (Broad, not specific medications)

A
  1. Topical emollient
  2. Topical corticosteroids
84
Q

Most likely cause for bloody nasal discharge in children!

A

Foreign bodies!!

85
Q

1st and 2nd line for mouth ulcers (apthous ulcers)

A
  1. General advice ie avoid triggers. & Topical therapy ie topical anaesthetics (ie lidnocaine) or topical anti-inflammatories like benzydamine
  2. 2nd line: Topical CORTICOSTEROIDS
86
Q

A 19-year-old woman presented with a gradual development of bilateral hearing loss which was accompanied by nausea and ringing in the ears but denied otalgia or otorrhoea. She reported a family history of hearing problems but was unsure what the exact condition was.

Otoscopic examination demonstrated a reddish blush visible on the cochlear promontory beyond an intact tympanic membrane.
Do?

A

Otosclerosis

Rhi’s MSRA (12 decks)

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