Derm/Ophthalmology/ENT

Question 1

What are some specific symptoms you should ask about any skin lesion or rash?

Answer 1

Pain, itch, bleeding, discharge/crusting (also remember to ask about systemic symptoms)

Question 2

What are some risk factors that it is important to ask about in a dermatological history?

Answer 2

Sun exposure, sunbed use, skin type, previous sunburn (particularly blistering)

Question 3

If a patient presents with a generalised skin condition, what are some other areas that it is useful to examine?

Answer 3

Nails, scalp and mucus membranes

Question 4

What two terms can be used to describe a flat area of skin of altered colour? What is the difference between these terms?

Answer 4

Macule and patch - a macule is < 1cm diameter and a patch is > 1cm diameter

Question 5

What two terms can be used to describe a solid, raised, palpable lesion? What is the difference between these terms?

Answer 5

Papule and nodule - a papule is < 0.5cm diameter and a nodule is > 0.5cm diameter

Question 6

What term is used to describe a lesion with raised edges and a flat surface > 1cm diameter?

Answer 6

Plaque

Question 7

What two terms can be used to describe a raised, clear, fluid filled lesion? What is the difference between these terms?

Answer 7

Vesicle and bulla - a vesicle is < 0.5cm diameter and a bulla is > 0.5cm diameter

Question 8

What term is used to describe a pus containing lesion of < 0.5cm diameter?

Answer 8

Pustule

Question 9

When describing a rash or non-pigmented lesion, it is best to work through general inspection, morphology and any additional features. What things should you comment on under general inspection?

Answer 9

Isolated/widespread/generalised? Where is the lesion? If there are multiple- comment on symmetry/asymmetry and discrete/confluent

Question 10

When describing a rash or non-pigmented lesion, it is best to work through general inspection, morphology and any additional features. What things should you comment on under morphology?

Answer 10

Size and shape of the lesion? Raised or not? Fluid filled or not? Then come up with appropriate terminology to describe the lesion.

Question 11

When describing a rash or non-pigmented lesion, it is best to work through general inspection, morphology and any additional features. What things should you comment on under additional features?

Answer 11

Colour? Border? Additional things e.g. crusting, bleeding, weeping?

Question 12

What things should you comment on before going on to use the ABCDE approach to describing a pigmented skin lesion?

Answer 12

Isolated/widespread/generalised? Where is the lesion?

Question 13

Describe what is meant by the ABCDE approach to describing a pigmented skin lesion?

Answer 13

Asymmetry, border, colour, diameter, elevation

Question 14

If you suspected a bacterial skin lesion, what type of investigation should you do?

Answer 14

Bacterial swab (blue) for microscopy, culture and sensitivity

Question 15

If you suspected a viral skin lesion, what type of investigation should you do?

Answer 15

Viral swab (red) for PCR

Question 16

What is the most likely investigation to do for a skin lesion where malignancy is suspected or a non-infective rash where diagnosis is required?

Answer 16

Biopsy for histopathology

Question 17

What investigations are required for immediate IgE mediated allergic skin reactions?

Answer 17

RAST IgE levels and skin prick test

Question 18

What investigation is used for delayed type allergic skin reactions?

Answer 18

Patch testing

Question 19

Ideally, where should skin scrapings be taken from?

Answer 19

The periphery of the affected area

Question 20

What type of scalpel should be used to take skin scrapings?

Answer 20

A rounded scalpel, e.g. number 15

Question 21

If you suspect a fungal skin lesion, what type of investigation should you do?

Answer 21

Skin scrapings for mycology (microscopy and culture)

Question 22

If you suspect an infestation related skin lesion, what type of investigation should you do?

Answer 22

Skin scrapings for microscopy

Question 23

What specific symptoms should you ask about in an ophthalmic history?

Answer 23

Visual changes, red eye, eye pain/photophobia, discharge, headaches

Question 24

What additional questions should you ask in the past medical history of someone with an eye problem?

Answer 24

Have they ever had any problems with their vision or eye? Do they use glasses/contact lenses?

Question 25

Should patients wear glasses/contact lenses during assessment of visual acuity?

Answer 25

Yes

Question 26

If visual acuity is not 6/6, what should you do next? What is the purpose of this?

Answer 26

Repeat the examination using pinholes- if this improves the visual acuity, this suggests that a refractive error is likely the cause

Question 27

What should you do next if a patient is unable to read a Snellen chart, even with the pinholes?

Answer 27

1. Repeat at 3m, 2. Repeat at 1m, 3. Assess hand movements, 4. Assess light response

Question 28

What two questions should you ask before performing a visual field exam to ensure that gross vision is normal?

Answer 28

Can you see my whole face? Can you see both my hands?

Question 29

What are all of the different aspects of eye examination?

Answer 29

General inspection, visual acuity, visual fields, colour vision, pupillary reflexes, fundoscopy, eye movements

Question 30

What are the three aspects of visual field examination that you can test?

Answer 30

Movements of fingers in quadrants, moving a pin in from quadrants, blind spot testing

Question 31

In an ideal world, what would you want to do before starting examination with an ophthalmoscope?

Answer 31

Darken the room and give the patient dilating eye drops (e.g. tropicamide 0.5%)

Question 32

At what setting should you have the ophthalmoscope when assessing for the red reflex? Absence of the red reflex can be a sign of what?

Answer 32

0 / cataracts or retinal detachment

Question 33

Before starting to examine the back of the eye, at what setting should you have the ophthalmoscope?

Answer 33

10 (and then work down to keep it focussed)

Question 34

What three things should you comment on when describing the optic disc after fundoscopy or if presented with a picture?

Answer 34

Contour, colour, cup: disc ratio

Question 35

After doing a fundoscopy, what things should you comment on?

Answer 35

The optic disc, the vessels and the macula

Question 36

How do you look at the macula when performing fundoscopy?

Answer 36

Ask the patient to look directly into the light

Question 37

The swinging light reflex assesses for what? What is this caused by?

Answer 37

Relative afferent pupillary defect (RAPD) - caused by damage between the optic nerve and chiasm

Question 38

What is seen in a relative afferent pupillary defect?

Answer 38

There is paradoxical dilatation of the affected pupil when a light shines in it

Question 39

What should happen during the accommodation reflex?

Answer 39

The pupils should constrict and converge

Question 40

What are the different eye reflexes that should be assessed during examination?

Answer 40

Direct and consensual pupillary reflexes, swinging light reflex, accommodation reflex

Question 41

Describe the normal contour of the optic disc?

Answer 41

The border of the disc is clear and well-defined

Question 42

If the borders of the optic disc are blurred, what may this suggest?

Answer 42

Papilloedema (swelling of the disc) secondary to raised ICP

Question 43

Describe the normal colour of the optic disc?

Answer 43

Orange-pink coloured circle with a pale centre

Question 44

An optic disc that is more pale than usual is suggestive of what?

Answer 44

Optic atrophy (can be secondary to optic neuritis, advanced glaucoma or ischaemic events)

Question 45

Describe the normal cup: disc ratio of the optic disc?

Answer 45

The normal ratio is 0.3, with the cup taking up approximately 1/3rd of the height of the disc

Question 46

What does an increased cup: disc ratio suggest?

Answer 46

Loss of healthy neuro-retinal tissue which can occur in glaucoma

Question 47

What can be seen in this image?

Answer 47

Proliferative retinopathy

Question 48

What can be seen in this image?

Answer 48

Drusen, suggestive of dry ARMD

Question 49

What can be seen in this image?

Answer 49

Very pale retina, suggestive of central retinal artery occlusion

Question 50

What can be seen in this image?

Answer 50

Previously laser treated diabetic retinopathy

Question 51

What can be seen in this image?

Answer 51

Retinal detachment

Question 52

What can be seen in this image?

Answer 52

Retinal haemorrhages associated with central retinal vein occlusion

Question 53

What can be seen in this image?

Answer 53

Retinal haemorrhages, associated with central retinal vein occlusion

Question 54

When looking at an image on fundoscopy, how can you tell if it is the right or left side?

Answer 54

The disc will be on the side that it is (i.e. if disc is on the left side of the image, it is the left eye)

Question 55

What can be seen in this image?

Answer 55

Hypertensive retinopathy

Question 56

What can be seen in this image?

Answer 56

Hypertensive retinopathy

Question 57

What can be seen in this image?

Answer 57

Increased cup to disc ratio suggestive of glaucoma

Question 58

What are some signs of hypertensive retinopathy on fundoscopy?

Answer 58

Flame haemorrhages Cotton wool spots Papilloedema Hard exudates

Question 59

What can be seen in this image?

Answer 59

A pale optic disc, suggestive of optic atrophy (this has many possible causes including glaucoma, retinal damage, ischaemia)

Question 60

What sign of diabetic retinopathy can be seen here?

Answer 60

Microaneurysms

Question 61

What sign of diabetic retinopathy can be seen here?

Answer 61

Dot and blot haemorrhages

Question 62

What sign of diabetic retinopathy can be seen here?

Answer 62

Cotton wool spots

Question 63

What can be seen in this image?

Answer 63

Non-proliferative diabetic retinopathy

Question 64

What can be seen in this image?

Answer 64

Non-proliferative diabetic retinopathy

Question 65

What can be seen in this image?

Answer 65

Proliferative diabetic retinopathy

Question 66

What can be seen in this image?

Answer 66

Proliferative diabetic retinopathy

Question 67

Describe what type of hearing loss is depicted on this audiogram?

Answer 67

Mixed hearing loss on the left side

Question 68

What can be seen in this image?

Answer 68

Cholesteatoma

Question 69

Describe what type of hearing loss is depicted on this audiogram?

Answer 69

Conductive hearing loss on the right side

Question 70

What can be seen in this image?

Answer 70

A bulging tympanic membrane, suggestive of acute otitis media

Question 71

Describe what type of hearing loss is depicted in this audiogram?

Answer 71

Sensorineural hearing loss on the right side

Question 72

What can be seen in this image?

Answer 72

A red, bulging tympanic membrane suggestive of acute otitis media

Question 73

What can be seen in this image?

Answer 73

Otitis media with effusion

Question 74

What can be seen in this image?

Answer 74

Otitis media with effusion

Question 75

What can be seen in this image?

Answer 75

Perforated tympanic membrane

Question 76

What can be seen in this image?

Answer 76

Perforated tympanic membrane

Question 77

In children presenting with an ear or hearing problem, what should you specifically ask about?

Answer 77

Their language and hearing milestones

Question 78

What symptoms should you ask about in all patients presenting with ear problems?

Answer 78

Hearing loss, ear pain, discharge, tinnitus, vertigo

Question 79

What risk factor should you always ask about in patients presenting with hearing loss?

Answer 79

Loud noise exposure

Question 80

What are some ototoxic drug groups you should be aware of?

Answer 80

Aminoglycosides, quinines, platinum-based chemotherapy agents

Question 81

Describe the steps of examining the ear and vestibular system?

Answer 81

Examination of the external ear and ear canal Otoscopy (comment on appearance, cone of light, tympanic membrane) Rinne and Weber's tests (512Hz fork) CNVIII +/- cerebellar exam

Question 82

On an audiogram, what symbols are representative of the right side?

Answer 82

Circle (air conduction) and \< symbol (bone conduction)

Question 83

On an audiogram, hearing above what volume is considered normal?

Answer 83

20 DB

Question 84

On an audiogram, what symbols are representative of the left side?

Answer 84

X = left side air conduction, \> = left side bone conduction

Question 85

Which type of hearing loss will show only decreased air conduction and therefore an air-bone gap on an audiogram?

Answer 85

Conductive

Question 86

Which type of hearing loss will show decreased air and bone conduction on an audiogram?

Answer 86

Sensorineural

Question 87

On an audiogram, conductive hearing loss at 2000Hz is suggestive of what diagnosis?

Answer 87

Otosclerosis

Question 88

On an audiogram, sensorineural hearing loss at high frequencies bilaterally is suggestive of what diagnosis?

Answer 88

Prebycusis

Question 89

On an audiogram, sensorineural hearing loss at 4000Hz bilaterally is suggestive of what diagnosis?

Answer 89

Hearing loss due to loud noise exposure