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Pre Reg > Eye, Nose, Ear, Skin, Vaccines and Anaesthesia > Flashcards

Eye, Nose, Ear, Skin, Vaccines and Anaesthesia Flashcards

1
Q

What are the clinical features of blepharitis?

A

Inflammatory conditions affecting lining the the eyelid - bilateral

Burning, itching and crusting of the eyelid

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2
Q

How do you manage blepharitis?

A

1st line: Eyelid hygiene

Posterior blepharitis - eyelid massage

Anterior blepharitis, consider prescribing a topical antibiotic (such as chloramphenicol) to be rubbed into the lid margin

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3
Q

Which drugs stain lenses orange?

A

Rifampicin
Salfasalazine

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4
Q

What drugs are used for allergy eye?

A

Sodium cromoglicate - mast cell stabiliser
Antazoline and azelastine - antihistamine
Xylometazoline and naphazoline - vasoconstrictors

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5
Q

What drugs are used for dry eyes?

A

Mild - hypermellose or carbomer/ polyvinyl alcohol QDS

Moderate-severe - carmellose or sodium hyaluronate

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6
Q

How do you treat bacterial infected eye?

A

Chloramphenicol

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7
Q

How do you treat a HSV eye infection?

A

Aciclovir 5 times a day until 3 days after healing

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8
Q

How do you treat glaucoma and cataracts?

A

Topical corticosteroids

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9
Q

What are the risks of using corticosteroids for ‘red eye’ caused by HSV?

A

Corneal ulcers and blindness

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10
Q

How should corneal ulcers be treated?

A

Ciprofloxacin intensive course

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11
Q

What is used to dilate pupils in eye examinations?

A

Cycloplegics and mydriatics e.g.

  • antimuscarinic: atropine (action up to 7 days)
  • Phenylephrine (MAOI interaction - risk of hypertensive crisis = avoid for 14 days after stopping MAOI): Mydriasis occurs within 60–90 minutes and lasts up to 5–7 hours
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12
Q

How is glaucoma characterised?

A

Raised intraocular pressure and loss of visual field

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13
Q

What are the symptoms of close-angle glaucoma?

A

Cloudy eyes
N/V
Headache
Intensive eye pain
Blurred vision
Sight loss
Rainbow rings around lights

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14
Q

How is open-angle glaucoma treated?

A

1st line: prostaglandin eye drops
‘-prost’
SE: long eye lashes, dark iris

then alternative postaglandin

2nd line: BB e.g. betaxolol, levobunolol or timolol

3rd line: carbonic anhydrase inhibitors e.g. brinzolamide or dorzolamide
OR
Topical sympathomimetics e.g. apraclonidine or brimonidine

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15
Q

What are the risks associated with corticosteroids for the eye?

A

Red eye
Steroid glaucoma
Steroid cataracts

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16
Q

What corticosteroid is licensed for macular oedema?

A

Intravitreal implant containing dexamethasone

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17
Q

What corticosteroid is licensed for visual impairment associated with chronic diabetic macular oedema

A

Intravitreal implant containing corticosteroids

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18
Q

What is the minimum gap you should leave between eye preperations?

A

5 minutes

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19
Q

What excipients in skin preperations cause be toxic yo neonates?

A

Salicylate - toxicity if applied in large areas

Benzyl alcohol - fatal toxicity

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20
Q

How is eczema treated?

A

Emollient + topical corticosteroid
- often as required
- directed of hair growth
- damp skin to maximise hydration

Use emollients first then wait 30 minutes before applying steroid cream

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21
Q

What is the MHRA warning for emollients?

A

Fatal burns with paraffin-based and paraffin-free products

  • do not smoke or go near naked flames
  • wash clothes at high temperatures to avoid build-up
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22
Q

Which corticosteroid is very potent?

A

Clobetasol

23
Q

Which corticosteroids are potent?

A

Bethamethasone 0.1%
Hydrocortisone Butyrate
Mometasone

24
Q

Which corticosteroids are moderately potent?

A

Clobetasone

25
Q

Which corticosteroids are mildly potent?

A

Hydrocortisone <2.5%

26
Q

What are the contraindications for topical corticosteroids?

A

Rosacea
Acne
Skin infections

27
Q

What are the side effects of topical corticosteroids?

A

Skin thinning
Discolouration
Withdrawal

28
Q

What are the MHRA warnings for topical corticosteroids?

A

Long-term use especially with moderately or highly potent = rebound flares
- use lowest potency, frequency and duration

29
Q

What counselling should be provided to a patient using topical corticosteroids?

A

Seek advise before using on new body area

If skin worsens <2 weeks of stopping - do not restart treatment unless advised by a doctor

30
Q

What is isotretinoin?

A

Vitamin A derivative

31
Q

What are the MHRA warnings for isotretinoin?

A

Erectile dysfunction and decreased libido

Oral retinoid medicines: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
- neuropsychiatric reactions reported with oral retinoids

Isotretinoin - reminder of risks

New safety meausres
- 2 independent prescribers when initiating for patient <18
- benefits and risks and given time to reflect and ask questions
- improved assessment and monitoring of mental health and sexual function before starting and during treatment
- reviewed one month after starting by specialist in retinoids
- compulsory risk minimising material: risk acknowledgement forms, patient reminder cards, and pharmacist checklists

32
Q

What are the rules for contraception when using isotreinoin?

A

Negative pregnancy test every month and 1 month after stopping
- same day prescribing and dispensing (30-day supply)

Effective contraception 1 month before, during and after - IUD or progesterone only implant

33
Q

What are the side effects of isotretinoin?

A

Neuropsychiatric reactions

Skin reactions: dry, red, photosensitive, fragile
- counsel: avoid wax, epilation, dermabrasion/ laser for 6 months after
- avoid UV light: SPF!!
- severe skin peeling - STOP

Erectile dysfucntion

Vision disorders

Haemorrhagic diarrhoea and pancreatitis
- risk if high triglycerides - STOP

34
Q

What allergy should you be careful of with the flu vaccine?

A

egg

35
Q

Which group of people should live vaccines be avoided in?

A

Immunocompromised patients

36
Q

Which vaccines should 2 month old babies be given?

A

6 in 1 (1st dose)

Rotavirus (1st dose) - oral vaccine: gastroenteritis

MenB

37
Q

Which vaccines should 3 month old babies be given?

A

6 in 1 (2nd dose)

Rotavirus (2nd dose)

Pneumococcal (PCV)

38
Q

Which vaccines should 4 month old babies be given?

A

6 in 1 (3rd dose)

MenB (2nd dose)

39
Q

What vaccines should 1 year old babies be given?

A

MMR (1st dose)

MenB (booster)

PCV (booster)

Hib/ MenC

40
Q

What vaccines should babies who are 1 year and 4 months be given?

A

4 in 1 pre-school booster

MMR (2nd dose)

41
Q

What vaccines should 12-13 year olds be given?

A

HPV (1st dose)
- 2nd dose 6-24 months later

42
Q

What vaccines should 14 year olds be given (year 9)?

A

3 in 1 teenage booster

Men ACWY

43
Q

What vaccines are recommended to people ages under 25 before entering uni?

A

Men ACWY if not had over age 10

44
Q

What vaccines are recommended for adults aged 65?

A

Pneumococcal vaccine (PPV)

Shingles Vaccines (VZV) - then again between the ages of 70-79

over 65 - flu’s yearly

45
Q

When should HepB vaccine be given?

A

At birth

12 weeks

12 months if mother infected

46
Q

When is the TB (BCG) vaccine given?

A

At birth in areas at high risk of TB

47
Q

What is the treatment for post-immunisation pyrexia?

A

Paracetamol (120mg/5ml)
- if they are 2 months and >4kg
- 1st dose 60mg ASAP
- Further dose: 60mg after 4 hours + PRN
- no more than 4 doses in 24 hours

Ibuprofen (100mg/5ml)
- if they are over 3 months and weight >5kg
- 1st dose 50mg ASAP
- 2nd dose 50mg after 6 hours PRN
- no more than 2 doses in 24 hours

48
Q

What is the interaction between corticosteroids and anaesthesia in adrenal insufficiency?

A

Severe hypotension

49
Q

What drugs should be stopped before surgery?

A

COC: risk of VTE
- stop 4 weeks before major surgery, leg surgery or prolonged immobility

HRT: VTE
- stop 4-6 weeks before surgery and restart when fully mobile

Antidepressants
- MAOI: hypertensive crisis
- TCA: arrhythmia and hypotension

Lithium: constant fluid and electrolyte imbalance
- stop 24 hours before major surgery

Oral anticoagulants: bleeding
- high VTE risk, bridge with heparin

Diabetes surgery: hyperglycaemia

ACEi/ARB - hypotension

50
Q

What diabetes medication should you stop before surgery?

A

Minor surgery - stop metformin, sulfonylureas and SGLT2

Major surgery - sliding scale insulin

51
Q

Which drugs should you not stop before surgery?

A

Antiepileptics
Antiparkinsons
Antipsychotics
Antixiolytics
Bronchodilators
Cardiovascular drugs
Glaucoma drugs
Immunosuppressants
Progesterone- only contraceptives
Thyroid and anti-thyroid drugs

52
Q

How is facial erythema associated with rosacea treated?

A

Brimonidine

53
Q

What are the MHRA warning associated with brimonidine?

A

Risk of systemic cardiovascular events
- bradycardia, hypotension, dizziness
- to minimise systemic absorption, avoid application to irritated or damaged skin including after laser treatment

Risk of exacerbation of rosacea
- initial treatment with small amount of gel for 1 week then increase gradually based on tolerability and response
- counsel not to exceed maximum daily dose

54
Q

How do you treat papules and pustules?

A

Mild-moderate:
- topical ivermectin for 8-12 weeks
- alternative: topical metronidazole 0.75% BD OR azelaic acid 15% BD

Moderate-severe:
- topical ivermectin + MR doxycycline 40mg OD for 8-12 weeks
- alternative Abx = oxytetracycline 500 mg twice daily or tetracycline 500 mg twice daily, or erythromycin 500 mg twice daily for pregnant or breastfeeding women

Pre Reg (14 decks)

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