Derm/Ophthalmology/ENT Flashcards
What are some specific symptoms you should ask about any skin lesion or rash?
Pain, itch, bleeding, discharge/crusting (also remember to ask about systemic symptoms)
What are some risk factors that it is important to ask about in a dermatological history?
Sun exposure, sunbed use, skin type, previous sunburn (particularly blistering)
If a patient presents with a generalised skin condition, what are some other areas that it is useful to examine?
Nails, scalp and mucus membranes
What two terms can be used to describe a flat area of skin of altered colour? What is the difference between these terms?
Macule and patch - a macule is < 1cm diameter and a patch is > 1cm diameter
What two terms can be used to describe a solid, raised, palpable lesion? What is the difference between these terms?
Papule and nodule - a papule is < 0.5cm diameter and a nodule is > 0.5cm diameter
What term is used to describe a lesion with raised edges and a flat surface > 1cm diameter?
Plaque
What two terms can be used to describe a raised, clear, fluid filled lesion? What is the difference between these terms?
Vesicle and bulla - a vesicle is < 0.5cm diameter and a bulla is > 0.5cm diameter
What term is used to describe a pus containing lesion of < 0.5cm diameter?
Pustule
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?
Isolated/widespread/generalised? Where is the lesion? If there are multiple- comment on symmetry/asymmetry and discrete/confluent
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?
Size and shape of the lesion? Raised or not? Fluid filled or not? Then come up with appropriate terminology to describe the lesion.
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?
Colour? Border? Additional things e.g. crusting, bleeding, weeping?
What things should you comment on before going on to use the ABCDE approach to describing a pigmented skin lesion?
Isolated/widespread/generalised? Where is the lesion?
Describe what is meant by the ABCDE approach to describing a pigmented skin lesion?
Asymmetry, border, colour, diameter, elevation
If you suspected a bacterial skin lesion, what type of investigation should you do?
Bacterial swab (blue) for microscopy, culture and sensitivity
If you suspected a viral skin lesion, what type of investigation should you do?
Viral swab (red) for PCR
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?
Biopsy for histopathology
What investigations are required for immediate IgE mediated allergic skin reactions?
RAST IgE levels and skin prick test
What investigation is used for delayed type allergic skin reactions?
Patch testing
Ideally, where should skin scrapings be taken from?
The periphery of the affected area
What type of scalpel should be used to take skin scrapings?
A rounded scalpel, e.g. number 15
If you suspect a fungal skin lesion, what type of investigation should you do?
Skin scrapings for mycology (microscopy and culture)
If you suspect an infestation related skin lesion, what type of investigation should you do?
Skin scrapings for microscopy
What specific symptoms should you ask about in an ophthalmic history?
Visual changes, red eye, eye pain/photophobia, discharge, headaches
What additional questions should you ask in the past medical history of someone with an eye problem?
Have they ever had any problems with their vision or eye? Do they use glasses/contact lenses?
Should patients wear glasses/contact lenses during assessment of visual acuity?
Yes
If visual acuity is not 6/6, what should you do next? What is the purpose of this?
Repeat the examination using pinholes- if this improves the visual acuity, this suggests that a refractive error is likely the cause
What should you do next if a patient is unable to read a Snellen chart, even with the pinholes?
- Repeat at 3m, 2. Repeat at 1m, 3. Assess hand movements, 4. Assess light response
What two questions should you ask before performing a visual field exam to ensure that gross vision is normal?
Can you see my whole face? Can you see both my hands?
What are all of the different aspects of eye examination?
General inspection, visual acuity, visual fields, colour vision, pupillary reflexes, fundoscopy, eye movements
What are the three aspects of visual field examination that you can test?
Movements of fingers in quadrants, moving a pin in from quadrants, blind spot testing
In an ideal world, what would you want to do before starting examination with an ophthalmoscope?
Darken the room and give the patient dilating eye drops (e.g. tropicamide 0.5%)
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?
0 / cataracts or retinal detachment
Before starting to examine the back of the eye, at what setting should you have the ophthalmoscope?
10 (and then work down to keep it focussed)
What three things should you comment on when describing the optic disc after fundoscopy or if presented with a picture?
Contour, colour, cup: disc ratio
After doing a fundoscopy, what things should you comment on?
The optic disc, the vessels and the macula
How do you look at the macula when performing fundoscopy?
Ask the patient to look directly into the light
The swinging light reflex assesses for what? What is this caused by?
Relative afferent pupillary defect (RAPD) - caused by damage between the optic nerve and chiasm
What is seen in a relative afferent pupillary defect?
There is paradoxical dilatation of the affected pupil when a light shines in it
What should happen during the accommodation reflex?
The pupils should constrict and converge
What are the different eye reflexes that should be assessed during examination?
Direct and consensual pupillary reflexes, swinging light reflex, accommodation reflex
Describe the normal contour of the optic disc?
The border of the disc is clear and well-defined
If the borders of the optic disc are blurred, what may this suggest?
Papilloedema (swelling of the disc) secondary to raised ICP
Describe the normal colour of the optic disc?
Orange-pink coloured circle with a pale centre
An optic disc that is more pale than usual is suggestive of what?
Optic atrophy (can be secondary to optic neuritis, advanced glaucoma or ischaemic events)
Describe the normal cup: disc ratio of the optic disc?
The normal ratio is 0.3, with the cup taking up approximately 1/3rd of the height of the disc
What does an increased cup: disc ratio suggest?
Loss of healthy neuro-retinal tissue which can occur in glaucoma
What can be seen in this image?
Proliferative retinopathy
What can be seen in this image?
Drusen, suggestive of dry ARMD
What can be seen in this image?
Very pale retina, suggestive of central retinal artery occlusion
What can be seen in this image?
Previously laser treated diabetic retinopathy
What can be seen in this image?
Retinal detachment
What can be seen in this image?
Retinal haemorrhages associated with central retinal vein occlusion
What can be seen in this image?
Retinal haemorrhages, associated with central retinal vein occlusion
When looking at an image on fundoscopy, how can you tell if it is the right or left side?
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)
What can be seen in this image?
Hypertensive retinopathy
What can be seen in this image?
Hypertensive retinopathy
What can be seen in this image?
Increased cup to disc ratio suggestive of glaucoma
What are some signs of hypertensive retinopathy on fundoscopy?
Flame haemorrhages
Cotton wool spots
Papilloedema
Hard exudates
What can be seen in this image?
A pale optic disc, suggestive of optic atrophy
(this has many possible causes including glaucoma, retinal damage, ischaemia)
What sign of diabetic retinopathy can be seen here?
Microaneurysms
What sign of diabetic retinopathy can be seen here?
Dot and blot haemorrhages
What sign of diabetic retinopathy can be seen here?
Cotton wool spots
What can be seen in this image?
Non-proliferative diabetic retinopathy
What can be seen in this image?
Non-proliferative diabetic retinopathy
What can be seen in this image?
Proliferative diabetic retinopathy
What can be seen in this image?
Proliferative diabetic retinopathy
Describe what type of hearing loss is depicted on this audiogram?
Mixed hearing loss on the left side
What can be seen in this image?
Cholesteatoma
Describe what type of hearing loss is depicted on this audiogram?
Conductive hearing loss on the right side
What can be seen in this image?
A bulging tympanic membrane, suggestive of acute otitis media
Describe what type of hearing loss is depicted in this audiogram?
Sensorineural hearing loss on the right side
What can be seen in this image?
A red, bulging tympanic membrane suggestive of acute otitis media
What can be seen in this image?
Otitis media with effusion
What can be seen in this image?
Otitis media with effusion
What can be seen in this image?
Perforated tympanic membrane
What can be seen in this image?
Perforated tympanic membrane
In children presenting with an ear or hearing problem, what should you specifically ask about?
Their language and hearing milestones
What symptoms should you ask about in all patients presenting with ear problems?
Hearing loss, ear pain, discharge, tinnitus, vertigo
What risk factor should you always ask about in patients presenting with hearing loss?
Loud noise exposure
What are some ototoxic drug groups you should be aware of?
Aminoglycosides, quinines, platinum-based chemotherapy agents
Describe the steps of examining the ear and vestibular system?
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
On an audiogram, what symbols are representative of the right side?
Circle (air conduction) and < symbol (bone conduction)
On an audiogram, hearing above what volume is considered normal?
20 DB
On an audiogram, what symbols are representative of the left side?
X = left side air conduction, > = left side bone conduction
Which type of hearing loss will show only decreased air conduction and therefore an air-bone gap on an audiogram?
Conductive
Which type of hearing loss will show decreased air and bone conduction on an audiogram?
Sensorineural
On an audiogram, conductive hearing loss at 2000Hz is suggestive of what diagnosis?
Otosclerosis
On an audiogram, sensorineural hearing loss at high frequencies bilaterally is suggestive of what diagnosis?
Prebycusis
On an audiogram, sensorineural hearing loss at 4000Hz bilaterally is suggestive of what diagnosis?
Hearing loss due to loud noise exposure
