ENT/Eyes/Derm Flashcards
Describe a pterygium
A benign conjunctival growth, can be seen growing from the outer edge of the cornea
Describe a pinguecula
A benign conjunctival growth that does not overlap the cornea
What is a cholesteatoma?
A destructive lesion of keratinising squamous epithelium in the middle ear +/- mastoid process
What is alopecia aerata?
Non scarring hair loss of unknown aetiology
Name some treatment options for alopecia aerata
Watchful waiting
Intralesional steroid injections
Topical steroid creams
Minoxidil 5% - only helpful in extensive disease
What is retinal detachment?
A separation of the inner neurosensory retina and the outer retinal pigment epithelium
How can retinal detachment be sub-classified?
Rhegmantogenous - commonest and occurs when there is a retinal break
Non-rhegmatogenous: tractional and exudative
What are the 4 Fs of RD?
Floaters
Flashes
Field loss
Fall in acuity
What may you find on ophthalmoscopy with RD?
A grey opalescent retina ballooning forward
Name an important complication of blepharoplasty
Lagophthalmos - an inability to fully close the eyelid
What is bullous myringitis caused by?
Mycoplasma pneumoniae
Name some signs and symptoms of acute closed angle glaucoma
Periorbital pain, nausea, vomiting
O/e reduced visual acuity, sceral injection, cloudy cornea
How do you treat acute closed angle glaucoma?
IV acetazolamide
Topical pilocarpine or thymoxamine
Then surgical iridectomy once attack is controlled
What is erysipilas?
A superficial form of cellulitis caused by S. pyogenes
Name a complication of rosacea?
Rhinophyma
How do you treat rosacea?
Topical metronidazole
If widespread, oral oxytetracycline can be used
What are the clinical features of photokeratitis?
Pain, watering, blepharospasm and photophobia
What is BPPV caused by?
Inner ear dysfunction where otoliths are displaced from the maculae to the semicircular canals
What is furunculosis?
Infection of the hair follicle caused by Staph
What is the incidence of acoustic neuroma?
1:100,000
What is a rhinolith?
A firmly impacted and unrecognised foreign body that can become coated with calcium, magnesium or phosphate
What is rubeosis iridis?
Neovascularisation of the iris due to retinal ischaemia, normally caused by diabetic retinopathy
Name the indications for starting aciclovir in shingles?
Within 72 hours for anyone over 50
Immunocompromised
Ophthalmic involvement
Non truncal involvement
Name some treatments for acne during pregnancy
Benzoyl peroxide
Azelaic acid
Glycolic acid
Name some treatment options for keloid scars
Occlusive dressings with or without silicone
Silicone ointments
Compression therapy
Intralesional steroid injections
Which structures does anterior uveitis involve?
Iris
Ciliary body
What is Samter’s triad?
Asthma, nasal polyps and aspirin sensitivity
What is the difference between labrynthitis and vestibular neuritis?
Vestibular neuritis is inflammation of the vestibular apparatus but without tinnitus and loss of hearing
Name some features of an orbital blow out fracture
Diplopia
Enophthalmos
Hypo-ophthalmia
Hypoaesthesia of cheek and upper gum of affected side
How do you differentiate between pinna perichondritis and pinna cellulitis?
Perichondritis spares the ear lobe
What is the definition of acne vulgaris?
Androgen driven increase in sebum production in anatomically abnormal pilosebaceous units
What is pityriasis rosea?
A mild self limiting skin rash of unknown aetiology that characteristically presents itself with a ‘herald patch’
Name some key clinical features of diabetic retinopathy
Microaneurysms
Dot an blot haemorrhages
Flame haemorrhages
Retinal oedema
Hard exudates
Name a very potent steroid
Clobetasol propionate 0.05% (dermovate)
Name some potent steroids
Fluticasone propionate 0.05% (cutivate)
Betamethasone valerate 0.1% (betnovate)
What does wax consist of?
Viscous secretions from sebaceous glands
Less viscous secretions from modified apocrine sweat glands
Which sites are commonly affected in shingles?
Lower thoracic region
Ophthalmic division of the trigeminal nerve
Occasionally motor nerves
Which sites are commonly affected in shingles?
Lower thoracic region
Ophthalmic division of the trigeminal nerve
Occasionally motor nerves
Which form of contraception makes acne worse?
POP
What are the clinical features of a retinal vein occlusion?
Painless
Sudden
Unilateral loss of vision
Name some pharmacological agents that can help to treat an acute vestibular episode
Promethazine
Prochlorperazine
Cyclizine
What type of imaging can be useful for nasal polyps?
Coronal sinus CT
Name some features of a HIV seroconversion rash
Round/oval lesions
Slightly raised
Symmetrical
Lasts 1-3 weeks
Usually accompanied by a flu like illness
What is the MOA of betahistine?
Histamine agonist
Which skin conditions can be caused by androgen abuse?
Acne conglobata
Acne fulminans
What is a characteristic feature of tobacco alcohol ambylopia?
Central loss of vision for colours in the order of green, green and red, and white
What is drusen?
Lipid material that collects beneath the retinal pigment epithelium
What is the fovea?
An area at the centre of the macula that has the highest density of photoreceptor cells
Name some features of dry AMD
Drusen
Pigmentary changes
Areas of atrophy
Geographic atrophy
Name some features of wet AMD
Choroidal neovascularisation
What drug can be used to treat wet AMD and how is it given?
Intravitreal anti-VEGF
Example is ranibizumab
How may wax in ear present?
Itching
Hearing loss (conductive)
Tinnitus
Vertigo
Asymptomatic
What is the normal range for intraocular pressures?
10-20mmHg
Name some clinical features of rosacea
Flushing
Telangiectasia
Non itchy papules and pustules
Located on the cheeks, forehead, glabella, nose and chin
Normally spares the nasolabial folds
Name some clinical features of scleritis
Severe deep pain
Visual loss
Focal or diffuse redness due to vessel dilation
What is the episclera?
A thin layer of vascular tissue overlying the sclera
What disease is episcleritis associated with?
IBD
How can you treat episcleritis
Usually self limiting
Artificial tears may be used
Oral NSAIDs (ketorolac)
What is keratitis?
Inflammation of the cornea
What is the nature of dermatitis herpetiformis?
Itchy subepidermal blisters
Seen on the elbows, scalp, shoulders and ankles
Responds to dapsone and a gluten free diet
What is acanthosis nigricans associated with?
Gastric carcinoma
Hodgkin’s lymphoma
Acromegaly
Cushing’s
DM
What may livedo reticularis be caused by?
RA
SLE
PAN
Lymphoma
TB
Polymyositis
Raynaud’s
Name some features of posterior vitreous detachment
Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision
Describe the initial management of otitis externa
Topical antibiotic or a combined topical antibiotic with a steroid
If the tympanic membrane is perforated aminoglycosides are traditionally not used*
If there is canal debris then consider removal
If the canal is extensively swollen then an ear wick is sometimes inserted
After how many weeks should a TM perforation heal?
6-8 weeks
What is the management for scabies?
Permethrin 5% is first-line
Malathion 0.5% is second-line
Give appropriate guidance on use (see below)
Pruritus persists for up to 4-6 weeks post eradication
What are the characteristics of necrobiosis lipoidica?
Shiny, painless areas of yellow/red/brown skin typically on the shin
Often associated with surrounding telangiectasia
Describe the management for acne vulgaris
Single topical therapy (topical retinoids, benzoyl peroxide)
Topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid)
Oral antibiotics
COCP
Oral retinoids - under specialist advice
Name some features of a capillary haemangioma
Typically they increase in size until around 6-9 months before regressing over the next few years (around 95% resolve before 10 years of age).
Common sites include the face, scalp and back. Rarely they may be present in the upper respiratory tract leading to potential airway obstruction
What is the first line management for psoriasis?
A potent corticosteroid applied once daily plus vitamin D analogue applied once daily
What is the management for anterior uveitis?
Urgent review by ophthalmology
Cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate
Steroid eye drops
Describe the stages of hypertensive retinopathy
I Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring
II Arteriovenous nipping
III Cotton-wool exudates
Flame and blot haemorrhages
These may collect around the fovea resulting in a ‘macular star’
IV Papilloedema
Name some features of granuloma annulare
Papular lesions that are often slightly hyperpigmented and depressed centrally
Typically occur on the dorsal surfaces of the hands and feet, and on the extensor aspects of the arms and legs
Explain the pathophysiology of acanthosis nigricans
Insulin resistance → hyperinsulinemia → stimulation of keratinocytes and dermal fibroblast proliferation via interaction with insulin-like growth factor receptor-1 (IGFR1)
Name some features of erythema multiforme
Target lesions
Initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
Pruritus is occasionally seen and is usually mild
Which drops may be useful in the management of episcleritis?
phenylephrine drops may be used to differentiate between episcleritis and scleritis
phenylephrine blanches the conjunctival and episcleral vessels but not the scleral vessels
if the eye redness improves after phenylephrine a diagnosis of episcleritis can be made
Name some features of anterior uveitis
acute onset
pain
blurred vision and photophobia
small, fixed oval pupil, ciliary flush
Which scale can you use to assess hirsuitism?
Ferriman-Gallwey scoring system: 9 body areas are assigned a score of 0 - 4, a score > 15 is considered to indicate moderate or severe hirsutism
Name some causes of hypertrichosis
drugs: minoxidil, ciclosporin, diazoxide
congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis
porphyria cutanea tarda
anorexia nervosa
Describe the management of venous ulcers
compression bandaging, usually four layer (only treatment shown to be of real benefit)
oral pentoxifylline, a peripheral vasodilator, improves healing rate
small evidence base supporting use of flavinoids
little evidence to suggest benefit from hydrocolloid dressings, topical growth factors, ultrasound therapy and intermittent pneumatic compression
What is palmoplantar pustulosis?
Crops of sterile pustules affecting the palms and soles
The skin is thickened, red. Scaly and may crack
More common in smokers
What is keratoderma?
May be acquired or congenital
Describes a thickening of the skin of the palms and soles
Acquired causes include reactive arthritis (keratoderma blennorrhagica)
Name some risk factors for the development of glue ear
male sex
siblings with glue ear
higher incidence in Winter and Spring
bottle feeding
day care attendance
parental smoking
What is the treatment for glue ear?
grommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube. The majority stop functioning after about 10 months
adenoidectomy
How do you manage Meniere’s disease?
ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit
Name some features of otosclerosis
conductive deafness
tinnitus
normal tympanic membrane*
positive family history
*10% of patients may have a ‘flamingo tinge’, caused by hyperaemia
What is the first line management of open angle glaucoma?
Prostaglandin analogues
Name some features of a central retinal artery occlusion
due to thromboembolism (from atherosclerosis) or arteritis (e.g. temporal arteritis)
features include afferent pupillary defect, ‘cherry red’ spot on a pale retina
Describe the management of allergic conjunctivitis
first-line: topical or systemic antihistamines
second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil
