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Finals > Dermatology+ENT+Opthal (passmed) > Flashcards

Dermatology+ENT+Opthal (passmed) Flashcards

1
Q

Pellagra?

A

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)

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2
Q

Erythema Nodosum presentation:

A
  • 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)

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3
Q

Burns: for what type of burn is IV fluids required?

A
  • 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.
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4
Q

SLE skin manifestations:

A

-photosensitive butterfly rash
-discoid lupus
-alopecia
-livedo reticularis (net-like rash)

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5
Q

Sebborhoeic dermatitis complications:

A
  • 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

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6
Q

Erythema Multiforme:

A
  • 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.

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7
Q

Psoriasis exacerbating factors:

A
  • beta blockers for eg. Atenolol, lithium, NSAIDs, ACE-i
  • trauma
    -alcohol
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8
Q

Pathogen to trigger Guttate psoriasis:

A

Streptococcal infection

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9
Q

Rosacea acne triggers:

A
  • 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

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10
Q

Lichen Sclerosus:

A

Presents with: white patches affecting genitalia that may scar+ itch
Mx: topical emollients and steroids
- happens in elderly females
- clinical diagnosis can be made

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11
Q

Erythema ag igne:

A

happens due to application of hot water bottle on an area for a period of time.
- presents with an area of erythema

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12
Q

Acanthosis Nigricans:

A
  • 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.

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13
Q

Allergic Rhinitis:

A

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

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14
Q

Erythema Nodosum:

A

Presents:
- Painful red bumps under skin of SHIN
- can occur in pregnancy due to hormonal changes AND infection with strep.= common cause.

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15
Q

Sudden loss of vision + diabetes

A

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

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16
Q

Central retinal artery occlusion:

A
  • 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.
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17
Q

Optic Neuritis other disease association: (Neuro)

A

-Multiple Sclerosis

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18
Q

Optic Neuritis:

A
  • 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
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19
Q

Anterior Uveitis association disease:

A
  • Ankylosing Spondylitis
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20
Q

Difference between: Anterior Uveitis vs. Acute angle closure glaucoma=

A

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.

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21
Q

Anterior Uveitis (same are Iritis):

A
  • 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
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22
Q

Episcleritis vs. Scleritis:

A

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

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23
Q

Managements for varying ophthalmology conditions:

A
  • 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.
24
Q

Retinal detachment:

A
  • 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
25
Q

Persistent mouth ulcer? what diagnosis:

A

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.

26
Q

Acute glaucoma: what to do next?

A
  • Refer immediately to hospital and admit immediately
27
Q

Orbital Cellulitis:

A
  • 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
28
Q

Any patient with new onset flashes and floaters: management?

A

Referred urgently (less than 24 hours) to ophthal for assessment: with slit lamp to rule out vitreous haemorrhage and retinal detachment

29
Q

Periorbital Cellulitis vs. Orbital cellulitis?

A
  • 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.

30
Q

Scleritis:

A
  • 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
31
Q

Anterior Uveitis Management:

A

-Treated with: steroid+ cycloplegic (mydriatic) drops

32
Q

Cellulitis management: if pregnant patient allergic to penicillin

A

Erythromycin: is first line that is also not harmful in pregnancy

33
Q

Central Scotoma is a feature of which eye condition?

A

Optic Neuritis

34
Q

Diabetic Retinopathy: complication of management(PRP)=

A

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)

35
Q

Diabetic retinopathy:

A
  • Cotton wool spots: which represents areas of retinal infarction
  • 2 types: Non-proliferative and proliferative
36
Q

Differentiating between Optic Neuritis vs. Anterior Uveitis:

A
  • 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.
37
Q

Acute angle-closure glaucoma: inv to do?

A
  • Tonometry (test that measures intraocular pressure)
  • Gonioscopy (special eye test that checks for glaucoma)
38
Q

Scabies presentation:

A
  • 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
39
Q

Features of Acne Vulgaris?

A
  • will have: Open and closed comedones, pustules and nodules = all characteristic of acne vulgaris
40
Q

What pathogen causes: Eczema Herpeticum?

A
  • Herpes Simplex Virus 1
41
Q

what cancer is associated with renal transplant patients?

A
  • Squamous Cell Carcinoma
42
Q

1st line medication for Cellulitis?

A
  • Oral Flucloxacillin, if allergic then Oral Clindamycin
43
Q

Guttate psoriasis presentation?

A

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.

44
Q

Classical presentation of SCC (squamous cell carcinoma)

A
  • Non-healing painless ulcer associated with a chronic scar
  • Risk factors: immunosuppression following renal transplant, HIV, smoking
45
Q

What is a side effect that topical corticosteroids could have in darker skin?

A
  • Small patches of pale skin
  • Clobetasone: is a corticosteroid
46
Q

Cellulitis in pregnancy mx?

A
  • 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
47
Q

Acute Urticaria Mx?

A

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.

48
Q

Management of Acne Vulgaris? + In pregnancy

A
  • Use Oral Erythromycin if need antibiotic, don’t use Amoxicillin
49
Q

psoriasis long term control?

A
  • Calcipotriol (vitamin D analogue)
  • NOT to give Topical betamethasone as should not use corticosteroids long term, only to give short term!
50
Q

acne mx in males?

A

if not pregnant, no need for erythromycin= give tetracyclines (doxycycline)

51
Q

what is the most aggresive type of melanoma? (4 types in total)

A

Nodular: invades aggressively and metastasises early

52
Q

for treatment of acne, can you use topical and oral abx that are separate?

A

No.
- can consider a COCP.

53
Q

Pyogenic granuloma?

A

Trauma is a common precipitant of pyogenic granuloma and contact bleeding and ulceration are common.

54
Q

Molluscum Contagiosum?

A

The lesions have a pearly, flesh-coloured appearance, and some show central depressions.
cause: by a Pox virus.

55
Q

Primary herpes simplex infection, caused by the Herpes Simplex Virus (HSV), can lead to a what derm condition?

A

Erythema multiforme.

56
Q

Common causes of the different types of Erythma?

A

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

57
Q

if involves nasolabial fold?

A

is likely rosacea NOT SLE

Finals (38 decks)

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