Derm/ENT/Opthal Flashcards
Side effect of chloramphenicol?
Common: eye stinging, skin reactions.
Rarely: BONE MARROW SUPPRESSION, fever, paraesthesia
The name for blood fluid level in eye after trauma? Management?
Hyphaema (urgent referral to ophthalmology)
Lesion in the temporal lobe (lateral pathway on diagram) will cause what visual field defect?
Superior quadranopia on CONTRALATERAL side ‘PIE IN THE SKY!’
Lesion in the parietal pathway (interior on diagram)- what visual field defect?
Inferior quadrantanopia
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?
Discoid eczema
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?
Discoid eczema
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?
Discoid eczema
Score for melanoma? What it contains?
Glasgow score
-3 major criteria - change in size/shape/colour
4 minor criteria - diameter over 7mm, inflammation, ooze, itch/odd sensation
Advice for shingles patient who asks about contact with other people?
Fine as long as lesions well covered. Exception being immunocompromised patients
As per guidelines, when to admit children with a temperature?
< 3 months with temp >/= 38
Consider admitting 3-6 month children with temp >/= 39
How does otitis media with effusion (glue ear) usually present?
Management?
Conductive hearing loss.
Generally resolves spontaneously. May require grommets.
How does acute otitis media (AOM) present?
Otalgia, irritability, decreased hearing, loss of appetite, vomiting, or fever - usually with other symptoms of viral infection
Acne rosacea treatment?
-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
Treatment for folliculitis barbae?
Topical or oral anti-staphylococcal abx (as caused by staphylococcus aureus)
Two major types of HSV and which areas they are associated with?
HSV-1: orofacial infections
HSV-2: genital infections
(Also there is some overlap)
1st line treatment for non-bullous impetigo?
Hydrogen peroxide 1% cream
Rash typical of Systemtic Lupus Erythematosus (SLE)?
Malar (butterfly) rash on cheeks - worse with sunlight, spares nasolabial folds
Pt with sudden vision loss, to examine: pale retina, cherry red spot . Dx?
Central retinal artery occlusion
Pityriasis Rosacea presentation?
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!)
Treatment for pityriasis rosacea?
Normally not needed. Can use topical steroids or emollient if itchy.
BCC treatment?
-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
Pyogenic granuloma - what is it, and how does it present?
-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
Treatment of pyogenic granuloma?
Excision. Base of lesions curetted. Should be sent for histology to confirm diagnosis
What is a cholesteatoma?
Expanding keratinising squamous epithelium in the middle ear/mastoid process
Appearance of cholesteatoma on otoscopy?
Deep retraction pocket in TM, TM usually burst, yellow/brown crust-like lesion, often with surrounding pus
Treatment of cholesteatoma?
SURGICAL REMOVAL
Young child, with rubbery lump in aspect of lateral eyebrow. Dx?
Dermoid cyst
Sebhorrheic keratoses.
-What are they?
-where do they appear and what age?
-Appearance?
-Treatment?
-localised proliferation of epidermis
-Trunk, over 40s
-can be flat or raised, brown/yellow
-Normally don’t need Tx, cryotherapy
Difference between Chalazion and stye?
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
Keratoconus
-what is it?
-who does it usually affect?
-treatment?
-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
What does visual acuity 6/12 mean
The person can read at 6 metres what a person with normal vision can read at 12 metres
Term for male pattern baldness?
How does it present?
Androgenic alopecia
BL temporal loss, (characteristic ‘M’ shape), that progresses to crown area
What is alopecia areata?
What does it look like?
Treatment?
-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
What is tenogen effluviem?
How does it present?
Simple bedside test to check?
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)
Treatment for fungal nail infections?
-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
Typical person to present with BCC?Appearance of BCC?
Older, sun exposure
Shiny, pearly nodule with central ulceration (rolled edges), overlying telangiectasia
Samter’s triad - made up of what 3 things?
Asthma, nasal polyps, aspirin sensitivity
First presentation of nasal polyp - what to do?
REFER TO ENT
Symptom of orbital blowout fracture?
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
2 most common organisms for cellulitis?
Staph aureus, staph pyogenes
Typical patient who gets dermatitis herpetiformis?
Treatment?
Women 3-4th decade
Strongly associated with coeliac disease
-Dapsone, and sometimes gluten-free diet
How and where does lichen PLANUS usually present?
Planus Ps: Pruritic, Purpuric, Purple, Polygonal. White lacy white lines
-flexor surfaces of upper extremities, genitalia and mucous membranes
Treatment for lichen PLANUS?
Systemic antihistamines (as immunologically mediated process)
-coal tar
-menthol
-topical steroids
What is lichen simplex chronicus and what is it caused by?
THICKENING of skin with variable scaling - arises secondary to repetitive scratching/rubbing.
-most common cause is ECZEMA
How does lichen sclerosis present and how is it treated?
-VERY ITCHY localised demarcated THICKENED plaque, with SCALING, EXCORIATION and LICHENIFICATION (increased skin markings)
-Topical steroids, tar, antihistamines, occlusive dressings (to stop itching)
Most common causative organism of peritonsillar abscess?
Strep pyogenes
What is the characteristic symptom of tobacco-alcohol ambylopia?
How can it be treated
-Central loss of colour vision
-Adequate nutrition - thiamine, folic acid, vitamin B12 etc
Triad of symptoms of Ménière’s disease?
Vertigo, tinnitus, (sensorineral) hearing loss
(Often accompanied by nausea/vomiting)
Eye examination of Ménière’s disease shows what in terms of direction of nystagmus (away or towards affected ear?)
Nystagmus away from affected ear (if only one ear affected)
Management of Ménière’s disease?
-Prochlorperazine/cinnarazine for acute attack
-Betahistine for prophylaxis
-surgery for cases resistant to medical treatment
Young pt, with midline neck lump, moved upwards when protrudes tongue. Swelling is fluctuating, non-tender and mobile. Dx?
Thyroglossal cyst
What is chronic suppurative otitis media?
How does it present?
What to do as GP?
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
Female with facial flushing, papules on cheeks, nose, but sparing nasolabial folds. Dx?
ROSACEA
How does amaurosis fugax present?
-cause?
Acute temporary (seconds-minutes) unilateral vision loss - like ‘curtain drawn up/down over the eye’!
-transient retinal ischaemia
Young patient with sore throat, fever, lymphadenopathy, myalgia, soft splenomegaly, headache, night sweats - Dx?
-Causative virus?
-Infectious mononucleosis (glandular fever)
-Ebstein-Barr virus (EBV)
Drug choice for tonsillitis? Why?
Pen V. Amoxicillin causes rash if symptoms due to infectious mononucleosis!
Triad for optic neuritis?
Most important investigation?
- Painful sub-acute vision loss
- eye pain worse with movement
- loss of colour vision (especially red!)
-MRI!!
Most common cause of optic neuritis?
Multiple sclerosis
Other signs/symptoms of optic neuritis? And 2 ‘phenomena’
-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
How does an oculomotor (third) cranial nerve palsy present
‘Down and out’ of affected eye
Pupil mydriasis, upper lid ptosis, diplopia
How does the Holmes-Adie pupil present?
Parasympathetic denervation of affected pupil - appears abnormally dilated at rest, and is sluggish to light
(‘Hurry, Holmes! Because slow’)
Horner’s syndrome symptoms?
Miosis, ptosis, anhidrosis, enopthalmus (sunken eye)
Horner’s syndrome symptoms?
Miosis, ptosis, anhidrosis, enopthalmus (sunken eye)
Name of condition when unable to properly close eyelid after blepharoplasty?
Lagophthalmus
How does a Pinguecula present? Risk factor?
Yellow/white deposit on conjunctiva, more commonly on nasal side.
-Associated with UV exposure
What is Hordeolum externum?
Purulent infection of one of the sebaceous glands of Zeis along the eyelid margin. Associated with staph aureus.
-Presentation of CMV retinitis?
-Associated disease?
-Opthalmoscopy shows what?
-Decreased visual acuity, floaters, loss of visual fields on one side
-HIV
-‘Pizza’ fundus- with RETINAL SPOTS & FLAME HAEMORRHAGES
Symptoms of keratoconjunctivitis sicca?
Disease associated with?
Reduced tear formation = gritty feeling in eyes.
Sicca = Sjögren’s syndrome!
Pt with preceding viral illness, with vertigo lasting days, no hearing loss/tinnitus. Likely Dx?
Vestibular neuritis
Acute urticaria (hives) main Mx? (If no angioedema)
Oral antihistamines
First line Tx for nasal polyps?
Intranasal corticosteroid spray ie fluticasone, for 3 months
Indications for tonsillectomy?
-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
Presentation of SCCs?
Typical patients to get SCC?
-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!)
Which retinal change is characteristic for age-related macular degeneration?
Choroidal neovascularisation
Which retinal change is characteristic for age-related wet macular degeneration?
Choroidal neovascularisation
Retinal changes characteristics of diabetic retinopathy? (3)
-microaneurysms
-dot and blot haemorrhages
-flame haemorrhages
If visual distortment, or rapid-onset visual loss, which type of AMD is more likely?
WET AMD
‘Wet = Worse!’
which type of AMD is more common?
DRY AMD (90%!)
Which virus is most commonly related to nasopharyngeal carcinoma?
EBV
Safest option for flare of acne vulgaris in pregnancy?
Topical benzoyl peroxide
(Isotretinoin is teratogenic, and tetracycline stains teeth of foetus!)
Older patient, watching TV in evening, sudden painful vision loss with headache/nausea/vomiting. Likely Dx?
Acute angle closure glaucoma (usually happens when pupil is in mid-dilation ie watching tv in dim conditions!)
Symptoms of retinal detachment?
Four Fs!
-floaters
-flashes
-field loss
-fall in acuity (painless, like curtain over vision)
1st line and 2nd line for atopic eczema? (Broad, not specific medications)
- Topical emollient
- Topical corticosteroids
Most likely cause for bloody nasal discharge in children!
Foreign bodies!!
1st and 2nd line for mouth ulcers (apthous ulcers)
- General advice ie avoid triggers. & Topical therapy ie topical anaesthetics (ie lidnocaine) or topical anti-inflammatories like benzydamine
- 2nd line: Topical CORTICOSTEROIDS
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?
Otosclerosis
Name for hot water bottle skin changes?
Erythema ab igne
How does closed angle glaucoma present?
Sudden painful red eye, dilated pupil, blurry vision in affected eye, nausea, pupil unreactive/minimally reactive to light
Severely painful red eye & reduced visual acuity in 40 y/o with rheumatoid arthritis. Likely Dx?
SCLERITIS
What eye condition is associated with inflammatory bowel disease?
Episcleritis
Cause of pityriasis versicolor?
Treatment?
Malassezia yeasts
Ketoconazole shampoo, or can consider oral anti fungal
Versicolor = ‘change of colour’ - often look hypopigmented or hyperpigmented
Midline cyst, in a child, that moves upwards with tongue protrusion - Dx?
Thyroglossal cyst
1 year old with soft transilluminable mass in posterior triangle?
Cystic hygroma
Child with solitary painless mass on Anterior Triangle of neck - DX?
Branchial cyst
Best treatment for keloid scarring?
Intralesional steroid therapy
What is Ramsay Hunt syndrome?
How does it present?
Varicella zoster becomes reactivated in nerve ganglion (usually 8th)
Deep pain in ear, sensorineural deafness, vertigo, facial paralysis, may be rash/blisters in ear canal
Most common organism causing Otitis Externa?
Pseudomonas aeruginosa
First sign of diabetic retinopathy when examining eye?
-microaneurysms
Which medication is licensed for male pattern hair loss (male androgenetic alopecia?)
Finasteride & minoxidil
Finasteride not licensed for women as risk of ambiguous genitalia in male fetus
Name for severe form of nodulocystic acne?
Acne conglobata
Examination finding with optic neuritis?
RAPD (rapid afferent pupillary defect)
Antidote for digoxin?
Digoxin-specific antibody fragments
Treatment for corneal abrasions?
Chloramphenicol ointment
(To prevent corneal ulceration)
How does acoustic neuroma present
UNILATERAL SENSORINEURAL HEARING LOSS
headaches
Tinnitus
Vertigo
Facial numbness/weakness
What are the characteristic retinal changes in age-related macular degeneration? And specifically
-dry AMD?
-Wet AMD?
Dry - GEOGRAPHIC ATROPHY
Drusen (Dry for Drusen!) (lipid material that collects beneath retinal pigment epithelium)
Wet - CHOROIDAL NEOVASCULARISATION
What are the characteristic retinal changes in age-related macular degeneration? And specifically
-dry AMD?
-Wet AMD?
Drusen (lipid material that collects beneath retinal pigment epithelium)
Dry - GEOGRAPHIC ATROPHY ‘dry desert’
Wet - CHOROIDAL NEOVASCULARISATION
Symptoms of AMD?
Blurred vision
Metamorphsia (straight lines appear crooked)
Scotoma - black patch in central vision
Light glare
Difficulty adjusting from bright to dim lighting
Decreased contrast sensitivity
Most common point of bleeding in epistaxis in children?
Little’s area - highly vascular area at anterior border of nasal septum
(Little’s for little people!)
What type of stain to use for corneal abrasions?
Fluorescein - makes abrasions green!
When to start abx in sinusitis?
Only for severe or prolonged infections (>5 days)
How to manage acne fulminans as GP?
Urgent referral to hospital dermatology team (to be seen within 24 hours)
What is Livedo reticularis and what conditions is it associated with?
Net-like discolouration of venules, typically on legs.
Cold, pregnancy, RA, SLE, TB, Polyaeteritis nodosa, lymphoma, polymyositis, Raynaud’s
What is acanthosis nigricans and what conditions is it associated with?
Velvety brown-black markings usually under neck, under arms/groin
Obesity
DM
Gastric carcinoma
Hodgkin’s lymphoma
Acromegaly
Cushing’s
What is dermatitis herpetiformis?
Treatment?
Itchy subepidermal blisters on elbows, scalps, shoulders & ankles
COELIAC DISEASE
Dapsone, gluten-free diet
Which way does nystagmus go in Ménière’s disease?
Away from affected ear
Kid with viral infection, now has Bullae/vesicles in ear. Likely Dx? Tx?
Bullous myringitis
Oral abx - amoxicillin
What organism is malignant otitis externa caused by?
Who commonly gets this condition?
Pseudomonas aeruginosa
Elderly diabetics, patients with AIDS
How does retinal vein occlusion present?
Painless, sudden unilateral vision loss
Retinal changes in diabetic retinopathy
‘No Money Can Help Failing’
NEOVASCULARISATION
Microaneurysms
Cotton wool spots
Hard exudates
Flame haemorrhages
Deteriorating vision - fundoscopy shows pale optic disc. Dx?
Optic nerve atrophy
How does labyrinthitis present?
Often secondary to viral/bacterial infection
Vertigo
Tinnitus & senorineural deafness
Nystagmus AWAY from affected ear
Way to remember which cranial nerves supply the eye muscles?
LR6 SO4 R3
Lateral rectus - 6th (Abducens)
Superior Oblique - 4th (Trochlear)
Rest are all 3rd - (Oculomotor)
Eye muscles - how to remember:
-What do obliques do?
-What rectus muscles do?
Oblique = ‘Out and opposite’ ie opposite of what they say - superior oblique is down and out!
Rectus = ‘Right way’ & IN - moves in the direction that it says it should!
Failure of lateral rectus muscle would cause what
Failure of eye abduction
Failure of CNIII would result in what?
Eye ‘down and out’ with ptosis
Palsy of 4th (Trochlear) nerve results in what?
Super oblique palsy - eyes deviated UPWARDS (usually makes look out and down)
Eye drop that CONSTRICTS pupil?
Pilocarpine (used in open-angle glaucoma)
Treatment for nappy rash
-general advice (frequent nappy changes, wash with warm water)
-barrier preparation ie zinc/metanium
-topical hydrocortisone if sore
-if suspecting candida - topical ANTIFUNGALS ie clotrimazole, miconazole
-may require abx if infected
Treatment for impetigo?
HYDROGEN PEROXIDE 1% cream
If unsuitable: topical abx ie fusidic acid or mupirocin 2%
If mention bloody stools, how to determine NEC from intussusception?
NEC: 2nd to 3rd week of life in generally PREMATURE babies
Intussusception: infants 3-12 months, drawing up legs
Associated skin condition with Polyarteritis nodosa?
Livedo reticularis - net like discolouration - typically on legs, triggered by cold
Also caused by:
Pregnancy
SLE
Lymphoma
TB
Polymyositis
Raynaud’s
Associated conditions with Acanthosis Nigricans?
GASTRIC CARCINOMA
HODGKINS LYMPHOMA
ACROMEGALY
CUSHINGS
DM
