Dermatology+ENT+Opthal (passmed) Flashcards
Pellagra?
Presents with 4 D’s:
-Diarrhoea
-Dermatitis
-Dementia
-Death
NB: Isoniazid(TB medication) is known to induce Pellagra.
Is caused by Nicotinic acid (Vitamin B3, Deficiency(niacin)
Erythema Nodosum presentation:
- Painful red bruises on shins and forearm; is an inflammation of the subcutaneous fat.
- Can also be associated with systemic diseases like: Sarcoidosis, Inflammatory Bowel Disease, Streptococcal Infection
- usually resolves within 6 weeks
ddx: ITP (however bruises are NOT painful in this)
Burns: for what type of burn is IV fluids required?
- Only give IV fluids for second/third degree burns that cover 15% of body surface or more for eg. For second degree(superficial DERMAL, partial thickness and more severe), NB: IV fluids are not required for first degree burns.
SLE skin manifestations:
-photosensitive butterfly rash
-discoid lupus
-alopecia
-livedo reticularis (net-like rash)
Sebborhoeic dermatitis complications:
- Otitis Externa (causes inflammation- redness and swelling to external ear canal; is also referred as swimmer’s ear)
-Blepharitis (inflammation along edge of eyelids) - Associated conditions include: HIV, Parkinson’s Disease
-1st line mx: Topical Ketoconazole
Erythema Multiforme:
- Giant NON-ITCHY target lesions on forearm
= The name of target lesions comes from the fact they have three concentric colour zones, a darker centre with a blister, a ring around this that is paler pink and raised due to oedema and a bright red outermost ring.
Most common medication causes:
- Aminopenicillins (such as co-amoxiclav), sulfonamides, carbamazepine, allopurinol, NSAIDs and oral contraceptive pill.
Psoriasis exacerbating factors:
- beta blockers for eg. Atenolol, lithium, NSAIDs, ACE-i
- trauma
-alcohol
Pathogen to trigger Guttate psoriasis:
Streptococcal infection
Rosacea acne triggers:
- Alcohol
- spicy food
- Hot drinks
Presents with: on nose, cheek, forehead with flushing, erythema, telangiectasia(papules and pustules)
- sunlight can worsen symptoms, if ocular involvement= Blepharitis( swollen, itchy eyelids)
Mx: 1st line- Topical Ivermectin +/- oral doxycycline. alternatives: Topical metronidazole/azelaic acid
-Simple: high factor sunscreen
- Topical Brimonidine gel
- can consider laser therapy if patient has prominent telangiectasia
Lichen Sclerosus:
Presents with: white patches affecting genitalia that may scar+ itch
Mx: topical emollients and steroids
- happens in elderly females
- clinical diagnosis can be made
Erythema ag igne:
happens due to application of hot water bottle on an area for a period of time.
- presents with an area of erythema
Acanthosis Nigricans:
- Skin with: dark, thickened patches of skin that appears on axilla
- Velvety, hyperpigmented rash
- is an early sign of Type 2 Diabetes
Ddx: Hidradenitis suppurativa: but this has painful lumps and more prone to recurrent abscesses under the skin.
Allergic Rhinitis:
Presents: Symptoms come on same time each year
- Bilateral nasal obstruction, cough at night, clear nasal discharge, post-nasal drip, sneezing, nasal pruritus
Mx: avoid allergen triggers
- oral/intranasal antihistamines
-severe: intranasal corticosteroids
Erythema Nodosum:
Presents:
- Painful red bumps under skin of SHIN
- can occur in pregnancy due to hormonal changes AND infection with strep.= common cause.
Sudden loss of vision + diabetes
Vitreous Haemorrhage: presents with= red hue to the vision
Also presents with:
- dark spots obscuring vision/complete of vision if bleed is big enough
Ddx: Retinal detachment
Central retinal artery occlusion:
- Sudden unilateral loss of vision in absence of pain
- O/E: RAPD (relative afferent pupillary defect) + fundoscopy: pale retina with cherry-red dot at macula.
Optic Neuritis other disease association: (Neuro)
-Multiple Sclerosis
Optic Neuritis:
- Pain on movement of the eye and often pain behind eye, funny colour, RAPD, reduced colour vision (red desaturation)
- Mx: high dose steroids, recovery usually takes 4-6 weeks
-Inv: MRI of brain; is usually diagnostic
Anterior Uveitis association disease:
- Ankylosing Spondylitis
Difference between: Anterior Uveitis vs. Acute angle closure glaucoma=
Glaucoma= severe pain, haloes, ‘semi-dilated’ pupil
Uveitis= small, fixed oval pupil, ciliary flush/congestion, often presents with nausea and vomiting, blurred vision+ sudden onset severe ocular pain.
Anterior Uveitis (same are Iritis):
- Presents with: unilateral eye pain, photophobia (often intense) , ciliary congestion
- Mx: Treated with steroid+ cycloplegic (mydriatic) drops
- Crohn’s Disease is associated with the condition
- Also needs URGENT review by ophthalmology
Episcleritis vs. Scleritis:
Episcleritis: PAINLESS red eye, injected vessels=mobile when gentle pressure is applied on sclera
-classically painless
-Mx: conservative, artificial tears may be used.
Scleritis: vessels are deeper and hence do not move
Managements for varying ophthalmology conditions:
- Bacterial conjunctivitis: Abx drops
- Allergic conjunctivitis: Antihistamine drops
- Episcleritis: Topical NSAID drops
- Acute closed angle glaucoma: Pilocarpine and beta blocker drops
- Corneal Ulcer: pain, reduction in visual acuity; is a sight-threatening condition that requires immediate management.
Retinal detachment:
- Cause of sudden, painless loss of vision
- presents with= dense shadow starting peripherally and then progressing centrally
- history of myopia= big risk factor
- Mx: urgent corrective surgery
Persistent mouth ulcer? what diagnosis:
Squamous Cell Carcinoma: Persistent, unexplained mouth ulcer for 4 weeks = should raise suspicion of oral cancer
- therefore mx: refer to secondary care under 2 week wait referral.
Acute glaucoma: what to do next?
- Refer immediately to hospital and admit immediately
Orbital Cellulitis:
- Is an emergency and requires admitting to hospital for IV antibiotics: due to high risk of cavernous sinus thrombosis
- Presents with: facial swelling and eye swelling and erythema and pain on eye movement.
- Risk factors: childhood, previous sinus infection, lack of Hib vaccination
Any patient with new onset flashes and floaters: management?
Referred urgently (less than 24 hours) to ophthal for assessment: with slit lamp to rule out vitreous haemorrhage and retinal detachment
Periorbital Cellulitis vs. Orbital cellulitis?
- Periorbital: absence of pain on eye movement
-Orbital: infection of orbit, Painful eye movements, visual disturbance, proptosis(also known as Exophthalmos)
- Investigation: need to do a CT scan with contrast of the orbits, sinuses and brain to assess posterior spread of infection.
Scleritis:
- Presents with a painful tender red eye with bluish hue
- often in patients who already have SLE/rheumatoid arthritis (autoimmune conditions)
- Presents with a gradual decrease in vision.
- is an eye emergency and patient needs urgent ophthalmology review
-1st line management: oral NSAIDs, for more severe presentations: oral glucocorticoid
Anterior Uveitis Management:
-Treated with: steroid+ cycloplegic (mydriatic) drops
Cellulitis management: if pregnant patient allergic to penicillin
Erythromycin: is first line that is also not harmful in pregnancy
Central Scotoma is a feature of which eye condition?
Optic Neuritis
Diabetic Retinopathy: complication of management(PRP)=
PRP (Pan-retinal Photocoagulation)
- commonly used technique in treatment of diabetic retinopathy
- side effect= causes a DECREASE in NIGHT vision. (Because: rods are responsible and majority is found in peripheral retina)
Diabetic retinopathy:
- Cotton wool spots: which represents areas of retinal infarction
- 2 types: Non-proliferative and proliferative
Differentiating between Optic Neuritis vs. Anterior Uveitis:
- Optic Neuritis: Subacute unilateral visual loss+ eye pain worse on movements (is a classical sign), colour vision (‘red desaturation’) is also affected
- Anterior Uveitis: causes red, painful eye with BLURRED vision, photophobia and watering of eye.
O/E: would have a red eye with unreactive/distorted pupil.
Acute angle-closure glaucoma: inv to do?
- Tonometry (test that measures intraocular pressure)
- Gonioscopy (special eye test that checks for glaucoma)
Scabies presentation:
- widespread pruritus (particularly at night), linear erythematous lesions between fingers
- is highly contagious and can spread easily through physical contact/sharing items.
- Mx: Permethrin= 1st line, Malathion= 2nd line
Features of Acne Vulgaris?
- will have: Open and closed comedones, pustules and nodules = all characteristic of acne vulgaris
What pathogen causes: Eczema Herpeticum?
- Herpes Simplex Virus 1
what cancer is associated with renal transplant patients?
- Squamous Cell Carcinoma
1st line medication for Cellulitis?
- Oral Flucloxacillin, if allergic then Oral Clindamycin
Guttate psoriasis presentation?
Tear drop papules on trunk and limbs, preceding streptococcal infection (ie sore throat)
-Mx: Self-limiting (resolves after around 6 weeks), most cases resolve spontaneously within 2-3 months, topical agents as per psoriasis.
Classical presentation of SCC (squamous cell carcinoma)
- Non-healing painless ulcer associated with a chronic scar
- Risk factors: immunosuppression following renal transplant, HIV, smoking
What is a side effect that topical corticosteroids could have in darker skin?
- Small patches of pale skin
- Clobetasone: is a corticosteroid
Cellulitis in pregnancy mx?
- if allergic to penicillin= Erythromycin
NB: Clindamycin is contraindicated in pregnancy - NB: Cellulitis is a clinical diagnosis, therefore 1st step= is to start oral antibiotics
Acute Urticaria Mx?
Cetirizine (non-sedating antihistamines)
- has distinctive wheals: which appear as red, raised lesions with surrounding redness
- NB: Chlorphenamine is a Sedating antihistamine.
- if Severe: need to add Oral Prednisolone for 5 days to Cetirizine for 6 weeks.
Management of Acne Vulgaris? + In pregnancy
- Use Oral Erythromycin if need antibiotic, don’t use Amoxicillin
psoriasis long term control?
- Calcipotriol (vitamin D analogue)
- NOT to give Topical betamethasone as should not use corticosteroids long term, only to give short term!
acne mx in males?
if not pregnant, no need for erythromycin= give tetracyclines (doxycycline)
what is the most aggresive type of melanoma? (4 types in total)
Nodular: invades aggressively and metastasises early
for treatment of acne, can you use topical and oral abx that are separate?
No.
- can consider a COCP.
Pyogenic granuloma?
Trauma is a common precipitant of pyogenic granuloma and contact bleeding and ulceration are common.
Molluscum Contagiosum?
The lesions have a pearly, flesh-coloured appearance, and some show central depressions.
cause: by a Pox virus.
Primary herpes simplex infection, caused by the Herpes Simplex Virus (HSV), can lead to a what derm condition?
Erythema multiforme.
Common causes of the different types of Erythma?
Erythema ab igne - Over exposure to infrared radiation
Erythema Nodosum - Sarcoidosis, IBD, TB
Erythema chronicum migrans - Lyme Disease
Erythema Marginatum - Rheumatic Fever
Erythema Multiforme - HSV
if involves nasolabial fold?
is likely rosacea NOT SLE
