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FFP Specialty Skills Flashcards

1
Q

Tonsillitis - Cause and presentation, management

A

Most commonly viral, but Strep pyogenes if bacterial
Viral insidious onset with URTI sx, bacterial sudden with fever, lymph nodes, headache, no cough

Simple analgesia + maintain fluid intake
Abx if high risk/bacterial; CENTOR criteria:
38oC, tender lymph, NO cough, exudate on tonsils
=> Oral phenoxymethylpenicillin (Penicillin V)

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2
Q

Criteria for giving Abx in tonsillitis

A

CENTOR criteria: if 3/4
38oC, tender lymph, NO cough, exudate on tonsils
=> Oral phenoxymethylpenicillin (Penicillin V)

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3
Q

Glandular fever - Cause, investigations, management

A

EBV
Tonsillitis sx + prodromal illness, organomegaly, abdo pain, rash, cervical lymphadenopathy

FBC, LFT, Monospot test

Simple analgesia + maintain fluid intake
avoid contact sport and alcohol
Do not give amoxicillin/ampicillin => macular rash

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4
Q

Peritonsillar abscess (Quinsy) - Cause, investigations, management

A

From infection e.g. tonsillitis
Unilateral swelling above and lateral to tonsil; tonsil and uvula shift
Fever, systemic illness, trismus (locked jaw) => URT obstruction

CT neck if ? spread

Abx: benzylpenicillin +- surgical or needle drainage

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5
Q

Signs of deep neck space infection

complications

A

Septic
Poor head/neck motility

Airway compromise
Lemierres syndrome - IVJ thrombosis + oropharynx inf.
Carotid artery erosion - sentinel bleeds

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6
Q

Parotitis - Cause, management

A

Mumps in children
Bacterial in elderly, poor hygeine
Treat with abx

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7
Q

Supra/epiglottis - Cause, investigations, management

A

Swelling of larynx
Fever, stridor/stertor, hot potato voice, resp. distress, drooling

Haem influenza

Do not directly visualise or irritate pt (if child)

Secure the airway, high flow O2
i.v. cephalosporins + MRSA coverage +- dexamethasone

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8
Q

Salivary gland tumours

A

pleomorphic adenoma - most common, benign
Warthins tumour - bilateral, benign

US + FNA

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9
Q

Fractured nose management

A

Acute: Check for other injuries
Septal haematoma -> drainage on the day

Clinic: 5-7 days later (maximum 3 weeks)
manipulate nose into correct position (only if its the bone)

cartilage requires surgical intervention

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10
Q

Epistaxis - causes/location, management

A

Littles area; ethmoidal, sphenopalatine and facial anastomosis
Woodruff’s area if posterior; SPA
Tumour
Hereditary haemorrhagic Telangiectasia

First aid; lean forward, pinch soft nose for 10 minutes +- fluid resus

Silver nitrate cautery - LA spray, then stick to bleeding point, then antiseptic

Anterior packing; refer to ENT for removal 24/48 hr after insertion

If still bleeding, admit for posterior packing

Then SPA ligation

Prescribe Naseptin (antiseptic) to prevent crusting/vestibulitis (contains nuts)

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11
Q

Rhinitis - causes and sx

A

Infective, allergic, gustatory, medicamentosa (decongestant overuse)

Discharge, blockage, sneezing etc.

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12
Q

Acute Rhinosinusitis - causes, sx, management, complications

A

Haem influ, S pneumoniae

Discharge, blockage, sneezing, facial pain, loss of taste/smell, (cough in children)
Defined as URTI symptoms that persist for >10 days, or worsen after 5 days
(common cold by definition lasts <10 days; chronic rhinosinusitis >3 months)

Mostly self limiting
Decongestants (head forwards, no sniff)
Co-amoxiclav after 7 further days

orbital cellulitis, intracranial inf., septic cavernous sinus thrombosis.

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13
Q

Chronic Rhinosinusitis - types, sx, investigations, management

A

3 months

Without polyps - post bacterial inf.
With polyps - high inflammatory cytokines -> inflamm

nasal discharge, blockage bilaterally ,pain, decreased smell/taste for 3 months

Anterior rhinoscopy, CT sinuses, endoscopy, allergy testing

Saline irrigation with corticosteroids for 3 months,
refer to ENT if still sx;
With polyps: oral steroids then ?surgery
Without polyps: co-amoxiclav + oral steroids then ?surgery

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14
Q

Obstructive sleep apnoea - sx, investigations/questionnaires, management

A

Interrupted and repeated collapse of the upper airway during REM sleep with hypopnea and hypoxia

wakes pt up, daytime sleepiness, snoring, gasping + in children; poor growth, hyperactivity, impulsivity.

STOP-Bang score/Epworth sleep score
Examine
Polysomnography gold standard or resp polygraphy at home
If +VE, ENT examination and pressure studies

Wt loss, decrease alcohol
CPAP, intraoral devices, surgery
adenotonsillectomy in children if identified cause

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15
Q

Hearing loss classification audiometry

A

<20dB normal
20-30 mild
30-60 moderate
60-90 severe
90 profound

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16
Q

Tympanometry findings

A

Type A - normal - curve with apex at 0

Type B - TM perf or effusion - flat

Type C - Poor eustachian tube function or early OM - curve with apex at -200

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17
Q

Pinna haematoma treatement

A

Drainage to prevent necrosis and cauliflower ear

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18
Q

Temporal bone fracture signs, tests and management

A

Bleeding, CSF leak (test it for beta 2 transferrin), battles sign, racoon eyes, facial palsy(give steroids), balance

ENT manage conservatively
pneumococcal vaccine given

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19
Q

Otitis externa sx, cause, rf, management and complications

A

Pain, discharge, itching, hearing loss, pinna tenderness, TM obscured

water exposure, hearing aids, trauma, skin conditions

Keep ear dry
topical acetic drops
topical Abx +- steroids

Faruncle OE - infection of hair follicles; treat as per OE

Malignant/Necrotising OE - seen in immunocompromised
infection spreads to the skull base
Severe pain +- palsy, granulomatous tissue on ear canal floor
CT + ENT for I.v. cipro/taz

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20
Q

Acute otitis media sx, cause, rf, management and complications

A

Most commonly bacterial: S. pneumoniae, H. influ, moraxella

pain, fever, discharge if perf., conductive hearing loss
White bulging TM
Recurrent if 3< in 6 months, 4< in a year

Conservative + safety netting +- back up amoxicillin
(If perforation; give oral amoxicillin)

Otitis media with effusion
Choleastoma
Hearing loss
CNVII palsy
Chronic suppurative OM
Mastoiditis
TM perf

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21
Q

Malignant/Necrotising OE

A

seen in immunocompromised
infection spreads to the skull base
Severe pain +- palsy, granulomatous tissue on ear canal floor
CT + ENT for I.v. cipro/taz for 6 weeks
Gallium scan for ?resolution

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22
Q

Otitis media with effusion

A

Glue ear
Hearing loss, aural fullness, balance
Leads to social/developmental issues if untreated

Mostly self limiting
If 3 months+ and bilateral/causing issues - grommets

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23
Q

Choleastoma

A

Keratinized, desquamated epithelial collection in the middle ear
Foul smelling discharge, deep retraction pockets in TM, white mass behind TM, granulation in the attic

CT temporal bone

Surgical excision

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24
Q

Chronic suppurative otitis media

A

Hypertrophic and hypersecretory mucosa leading to micro abscesses
Purelent drainage for 6 weeks<, hearing loss, with perforation

Topical Abx with cleaning

Temporal CT if persistent for ?Choleastoma
Tympanoplasty if resistant

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25
Q

Acute bacterial mastoiditis signs, management, complications

A

AOM -> mastoid air cells —-> intracranial inf.
AOM does not settle; otalgia, otorrhoea, hearing loss,
Post auricular swelling with sulcus hidden, tender, auricular protrusion

i.v. abx
Surgical if complications or sx after 48 hours; Do a CT

Extradural abscess, subdural abscess (Lower GCS)
Sigmoid venous thrombosis
Meningitis

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26
Q

Post auricular swelling with sulcus hidden

A

Acute bacterial mastoiditis

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27
Q

Otosclerosis

A

?inheritable
Stapes becomes sclerosed -> conductive hearing loss (cohorts notch on audiometry)

Conservative management
hearing aids
stapedotomy

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28
Q

TM perforation treatment

A

Most heal within 6 weeks
Abx if inf.

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29
Q

True vertigo

A

Sensation of moving/spinning

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30
Q

Benign paroxysmal positional vertigo - diagnosis and treatment

A

Calcium debris in the semicircular canals

Short <60s episodes of vertigo provoked by head movements

Dix-hallpike manoeuvre - turn pt head 45 degrees whilst sat then move to supine with head extended over the bed
+ve if nystagmus and vertigo

Epley manoeuvre - from last step of Dix-hallpike turn head 90 degrees to other side and hold for 30 seconds. Ask pt to roll body onto side then rotate head to look at the floor for 30 seconds. Maintains head position, sit pt up and return head to midline

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31
Q

Acute labyrinthitis sx and management

A

2o to vital inf. or OM

Vertigo, tinnitus and hearing loss

Vestibular sedatives e,g prochlorperazine, in the very acute phase

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32
Q

Vestibular neuronitis sx and management

A

Often 2o to viral inf. or herpes zoster

Sudden onset severe vertigo

Vestibular sedatives may help e.g. prochlorperazine in the acute phase only

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33
Q

Ménière’s disease

A

Increase pressure in the endolymphatic system

Episodic vertigo, tinnitus, hearing loss
With aural dullness

Audiometry: low frequency loss

MRI to exclude acoustic neuroma, MS, TIA

Education
Low salt and caffeine intake

Betahistine to decrease attacks
Prochlorperazine in attacks

Vestibular rehab

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34
Q

Facial Nerve Palsy - House Brackman score

A

I normal
II mild weakness
III obvious weakness; eye can close
IV eye cannot close
V flickers
VI no movement

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35
Q

Facial nerve palsy causes and management

A

Bell’s palsy
Ramsay Hunt Syndrome
OM
Tumour
Moebius syndrome - congenital absence

Oral pred 50mg 10 days +-ppi

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36
Q

Sudden sensorineural hearing loss management

A

Oral steroids ASAP

Urgent ENT referral

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37
Q

Acoustic neuroma/vestibular schwannoma - sx, test, management

A

Benign tumour on CNVIII

Unilateral SNHL, tinnitus, vertigo

MRI; if bilateral cerebellarpontine angle lesion ?neurofibromatosis

Watch and wait
Surgery
Radiation

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38
Q

Congenital causes of nasal obstruction
Worse when, better when

A

Neonatal rhinitis
Pyriform aperture stenosis (front of nasal cavity)
Choanal atresia (rear of nasal cavity) -worse on feeding, better on crying

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39
Q

Choanal atresia

A

(rear of nasal cavity) -worse on feeding, better on crying

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40
Q

Laryngomalacia - sx and management

A

Collapse of supraglottic structures

Inspiratory stridor

Self resolving 18 months

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41
Q

Tracheomalacia

A

Collapse of trachea

In expiratory stridor

Self resolving 1 year
Cpap can be used

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42
Q

Blepharitis sx, examination findings and management

A

Two types - posterior; inner portion of the eyelid at dysfunctional meibomian glands
Anterior - Base of eyelashes; staphylococcus or seborrheic dermatitis

Red, itchy, swollen eyelids. Crusting of the eyelashes, gritty, burning, Mild conjunctival injection.

Lid hygiene: warm compress, lid wash and massage
Topical lubricants
Abx if severe

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43
Q

Hordoleum (Stye) sx, examination findings and management

A

Internum: Infection of Meibomian glands
Externum: Sebum producing glands of zies or sweat producing of moll

Swollen lump in eyelid

Lid hygiene: warm compress, lid wash and massage
Abx if severe

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44
Q

Chalazion sx, examination findings and management

A

Meibomian cyst - Chronic inflamm; painless lump

hot compress or drainage

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45
Q

Entropion
Extropion

A

Entropion - eyelid turns inwards
Extropion - eyelid turns outwards

Both caused by ageing

=> discomfort, corneal ulceration

Lubricants or surgery

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46
Q

Conjunctivitis sx, examination findings and management

A

Infectious - bacterial; S.Aureus. viral;Adenovirus, HSV, Molluscum
Non-infectious - Allergic; type I hypersensitivity. Toxic

Red eye; diffuse injection, painless, discharge, itchy (allergic), lid follicles (viral).

Prevent contagion
If bacterial; topical chloramphenicol / erythromycin; arrange follow up.
Viral; self limiting
Allergic; anti-histamines, mast cell stabilisers e.g. cromoglicate.

If hyperacute bacterial conjunctivitis
Profuse discharge, erythema and chemosis due to nesseria infection
immediate gram stain/PCR
ceftriaxone + azithromycin

If newborn, ?chlamydial
topical chloramphenicol + IM benzylpenicillin

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47
Q

Infective Keratitis sx, examination findings and management + common viral types.

A

Inflammation of the cornea; pseudomonas infection most common.
Strong association with contact lenses
Rapidly progressive painful eye, decreased visual acuity, photophobia. tearing, discharge, oedema.

Slit lamp: corneal epithelial deficit with underlying stromal infiltrate +- Hypopyon (pus)

Urgent ophthalmology referral
Remove contact lenses
Emperical broad spectrum topical Abx; every hour for 24
Avoid steroids

If untreated => enophthalmos, corneal ulcers, scars.

HSV keratitis - pain, blurriness, watery discharge, red eye, On slit lamp: conjunctivitis, decreased corneal sensation, dendritic ulcer
Aciclovir

HZV ophthalmicus
Shingles in CNV1
Hutchinson’s sign = rash on tip of nose = increased chance of ocular complications.

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48
Q

Anterior uveitis rf, sx, examination findings and management

A

Associated with systemic disease: inflamm arthritis, IBD, sarcoidosis, SLE, vasculitis
HSV, HZV, TB, Syphillis

Ache pain, redness at limbus, miosis or irregular pupil. photophobia, decreased visual acuity,

Leukocytes in the anterior chamber cells or keratic precipitates
+- hypopyon

Topical steroids if not infection
Topical mydriatic agent e.g cyclopentolate (relieves spasms)

49
Q

Intermediate/posterior uveitis - sx, examination findings and management

A

Painless, decreased visual acuity, floaters, photophobia

active chorioretinal inflamm and/or leukocytes in VH

Refer to ophthalmology
May require periocular steroid injection

50
Q

Scleritis - rf, sx, examination findings and management

A

Associated with systemic disease: RA, GPa, HZV

gradual, severe, worsening pain with very red eye(not if posterior); worse on eye movement. Tender globe, violaceous erythema

Slit lamp: scleral oedema with deep episcleral plexus oedema

Autoimmune screen done if no previous diagnoses

Diffuse and nodular subtypes - Oral NSAIDS e.g. indomethacin
Necrotising or posterior - high dose oral steroids

51
Q

Episcleritis sx, examination findings and management

A

Milder version of scleritis (gradual, severe, worsening pain with very red eye(not if posterior); worse on eye movement. Tender globe, violaceous erythema); less red eye, less pain.

Self limiting or NSAIDs

52
Q

Primary Open Angle Glaucoma - RF, sx, examination findings and management, primary prevention

A

Optic nerve damage: bilateral progresssive loss of retinal ganglion axons; caused by unequal aqueous production and drainage.
RF: Increased IOP, myopia, age, FH, black, HTN, DM

Asymptomatic, until almost blind.

Dx: optic nerve structural abnormalities i.e. cupping.
+ typical visual field loss e.g. tunnel vision
IOP measurement

360 selective laser trabeculoplasty 1st line
Then topical:
Prostaglandin analogues e.g. latanoprost - increase outflow
B blockers e.g. timolol - decrease production
A agonists e.g. brimnidine - decrease production and increase outflow
Carbonic anhydrase inhibitors e.g. dorzolamide - decrease secretion
cholinergics e.g. pilocarpine - increase outflow

Screened for by opticians when over 40yo
If IOP >25 refer, if >30 urgent

53
Q

Open angle glaucoma treatments, MoA and side effects

A

360 selective laser trabeculoplasty 1st line

Then topical:
Prostaglandin analogues e.g. latanoprost - increase outflow; hyperaemia, eyelash growth , avoid in pregnancy/uveitis

B blockers e.g. timolol - decrease production

A agonists e.g. brimnidine - decrease production and increase outflow; increase in allergic conjunctivitis.

Carbonic anhydrase inhibitors e.g. dorzolamide - decrease secretion; taste and acidosis

cholinergics e.g. pilocarpine - increase outflow

54
Q

Acute angle closure Glaucoma - RF, sx, examination findings and management

A

Lens is too far forward against the iris, blocking outflow.
RF: FH, age, female, hyperopia, Asian.

Headache, severe eye pain, N+V, decreased visual acuity. conjunctival erythema, mild dilation with decrease reaction to light, cloudy cornea.

Initial, pilocarpine eyedrops, 500mg acetazolamide i.v., analgesia and anti-emetics.
Then laser peripheral iridotomy.

55
Q

Periorbital cellulitis - sx and management

A

Infection of anterior portion of the eyelid
Often 2o to sinusitis; S.Aureus.

Unilateral ocular pain, eyelid swelling, erythema; no conjunctival involvement.

Oral co-amoxiclav TDS 7 days

56
Q

Orbital cellulitis - sx and management

A

infection of extraocular muscles and fat
Often 2o to sinusitis; S.Aureus.

Unilateral ocular pain, eyelid swelling, erythema.
Ophthalmoplegia, pain on eye movement, proptosis
Chemosis and fever

CT orbit and sinuses with contrast

i.v. vancomycin + ceftriaxone

57
Q

Corneal foreign body sx and management

A

sudden onset irritation +- decreased visual acuity
Removal under slit lamp guidance
fluorescein used to look for epithelial defects

Topical abx on discharge +- daily reassessment

58
Q

Blow out fracture - investigations and management

A

orbital floor fracture into maxillary sinus
Severe oedema, ocular injury, pain on vertical eye movement + diplopia

CT

Conservative management
If “trap door” fracture, medial rectus is strapped -> ischaemia = surgical intervention.

59
Q

Hyphema - complication and management

A

Blood in anterior chamber
Can lead to acute angle closure glaucoma

Topical steroids and mydriatics.

60
Q

Retinal detachment - rf, sx, management

A

Neurosensory layer separates from retinal pigment epithelium
RF: myopia, FH, previous cataract surgery, age

Floaters, flashing lights from posterior vitreous detachment]Then, painless vision loss

Red reflex loss, RAPD, decreased visual acuity, corrugated retina

Urgent ophthalmology assessment
Surgical correction; pneumatic retinopexy

61
Q

Central retinal artery occlusion - sx, signs, investigations, management

A

Supply to inner retina and optic nerve surface occluded

Acute, profound loss of vision
RAPD, Cherry red spot on macula, retinal whitening

Echo for source of emboli
Fluoroscein angiography if ?dx
CRP/ESR to exclude GCA

Emergency thrombolysis or anterior chamber paracentesis (IOP decreased => emboli dislodged)
Whilst awaiting above, massage, nitrates, i.v. acetozolamide, hyperbaric 02

Discuss lifestyle and Coag

62
Q

Types of cataracts and signs/sx

A

Opacity within the lens
RF: age, smoking, alcohol, UV, diabetes, metabolic syndrome, uveitis.

Age related:
Nuclear sclerotic - myopic shift (second sight), brown/yellow
Subcapsular - associated with steroids, renal failure and diabetes. Younger patients and faster.
Cortical - often not in visual axis. spoke like.

Metabolic:
Diabetes - snowflake opacities

myotonic dystrophy - christmas tree

63
Q

Stages of cataracts

A

Immature - slightly opaque
mature - opaque with loss of red reflex
hypermature - lens shrinks
morgagnian - cortex liquid, lens sinks.

64
Q

Management of cataracts

A

phacoemulsification

65
Q

Dry Age related macular degeneration - sx, signs, rf, management

A

Most common; gradual blurry vision loss
Death of macula photoreceptors due to:
Drusens
Geographic atrophy

RF: smoking, age, genetics, CVD, hyperopia, HTN

Antioxidant/mineral supplementation AREDS2:
Vitamin C, E, betacarotene (not in smokers as increases risk of cancer), Zinc, Iron

66
Q

Wet Age Related Macular Degeneration - sx, signs, rf, management

A

Increased risk of blindness, but less common

Death of macula photoreceptors due to:
Drusens
Geographic atrophy
+ neovascularisation due to VEGF

Rapid loss of central vision

OCT or fluoroscein angiography

Intravitreal anti-VEGF therapy

67
Q

Diabetic retinopathy - types, sx/signs, management

A

Increased permeability and occlusion -> neovascularisation

Investigations: fundoscopy, slit lamp, fluoroscein angiography, OCT

Non proliferative - often asymptomatic:
Microaneurysms, dot/blot haemorrhages, exudates, cotton wool spots
Management: Good glucose control for all, annual photography

Pre-proliferative:
haemorrhages in all 4 quadrants or venous beading in more than 2 or microvascular abnormalities
Management: Pan-retinal photocoagulation

Proliferative:
neovascularisation
=> vitreous haemorrhages, retinal detachment, retinal fibrosis
Management: Pan-retinal photocoagulation or anti-VEGF

Diabetic maculopathy
Focal - leakage from microaneurysms -> focal retinal thickening and exudates
Diffuse - oedema of the macula
ischaemic - perifoveal occlusion
Management: focal photocoagulation and anti-VEGF

68
Q

Diabetic maculopathy types

A

Diabetic maculopathy
Focal - leakage from microaneurysms -> focal retinal thickening and exudates
Diffuse - oedema of the macula
ischaemic - perifoveal occlusion

Management: focal photocoagulation and anti-VEGF

69
Q

Management of proliferative diabetic retinopathy

A

Management: panretinal photocoagulation or anti-VEGF

70
Q

Signs of malignant hypertension in eyes

A

optic disc swelling, macular oedema, occlusions
+- headache, eye pain, visual disturbances

71
Q

Giant cell arteritis - sx, investigations, management

A

Granulomatous vasculitis
Initial fever, fatigue, wt loss
Headache over temples, jaw claudication, visual loss; Arteritic anterior ischaemic optic neuropathy

Pale disc, with obliterated margin and no cup. Fundal pallor.

Raised CRP/ESR
Temporal artery biopsy

High dose oral steroids; 60mg daily tapered down over years

72
Q

Fundoscopy - retinal vein occlusions

A

multiple haemorrhages, dilated tortuous veins, optic disc swelling

73
Q

Strabismus types and management

A

manifest: - tropias
Latent: -phorias

If convergent squint - convex lens
If divergent - concave lens

74
Q

DVLA vision requirements

A

6/12 (0.5) required with visual fields for type I driving
HGVs need 7.5/12 (0.8)

75
Q

Malignant melanoma - types, features, investigation, management

A

Melanocyte prolif.

Superficial spreading
Nodular
Lentigo maligna - pre-malignant
Acral - on palmar, plantars, nail surfaces

ABCDE
Glasgow 7 point checklist:
Changing colour (2), shape (2), or size (2), bleeding (1), inflamed (1), itching (1), diameter 7mm< (1) if more than 3 points 2WW

Biopsy 1-3mm margins:
TNM
T0 in situ, T1 <1mm breslow thickness, T2 1-2mm, T3 2-4mm, T4 4mm<

Sentinel node biopsy if >0.8mm
CT if 1.0mm<

Wide local excision with 1-2CM margins
MDT

76
Q

Skin lesion with stuck on appearance

A

Seborrheic Keratosis

77
Q

Basal cell carcinoma - types, features, investigation, management

A

Stratum basale carcinoma

Slow growing, no metastases
Pink or pigmented lesion with pearly white rolled edges

Nodular - “rodent ulcer”, central ulceration, telangiectasia
Superficial - irregular erythamatous patches
Pigmented
Morphoeic - resemble waxy scar tissue

Biopsy

If low risk;
excision with 4mm margins
Topical imiquimod cream (not for nodular)
Topical 5-FU (leaves a scar)
Cryotherapy
Photodynamic therapy

High risk:
excision
Moh’s micrographic surgery - repeated until margins are clear
Radiotherapy

78
Q

Squamous cell carcinoma - types, features, investigation, management

A

Keratinocyte prolif.

Well differentiated; hyperkeratotic papules, plaques and nodules
Poorly; fleshy papules, ulceration, bleeding, necrosis

Biopsy

Excision

Bowens disease:
SCC in situ
Treat as per BCC

Actinic Keratosis:
Pre-malignant
Old people bald head
Cryotherapy if sole lesion - 5-FU if multiple

Marjolin’s ulcer - SCC at previous wound/scar

79
Q

Skin signs in diabetes

A

Diabetic dermopathy - brown red macules on the shins

Necrobiosis lipoidica - granulomatous disorder, small red/brown papules that enlarge into yellow brown plaques with central atrophy and telangiectasia

Granuloma anulare - raised ring lesions

80
Q

Acanthosis nigricans - sx, causes

A

Hyperpigmentation and hyperkeratosis
Axilla and groin

Linked to T2DM, obesity, COC, Pregnancy, GI adenocarcinomaP

81
Q

Pyoderma gangrenosum - sx, causes

A

Benign inflamed nodules which then become rapidly enlarging painful ulcers +- fever

Associated with myeloma, leukaemia, IBD

Treat with oral immunosuppresion

82
Q

Erythema nodosum - sx, causes

A

inflammation of the subcutis; red tender nodules on the shins

Associated with IBD, URTI, TB, Chlamydia, COC, NSAIDs, sulfonamides, amoxicillin, pregnancy

83
Q

Urticaria - sx, causes, managment

A

Itchy wheals; dermal oedema. pruritic erythematous plaques.

Allergy, medication, infection, idiopathic

cetirizine/loratidine
oral steroids if severe or no response

84
Q

Eczema (atopic dermatitis) - sx, distribution through ages, management and complications

A

Dry skin, severe itch
Poorly demarcated areas of erythema, weeping, crusting, scaling, vesicles.

Infants - face , extensors. Child - flexors. Adult - hands. Elderly - legs

Emollients
Topical corticosteroids for flares
(Mild potency for face e.g. 1% hydrocortisone)
Can be used for maintenance - tacrolimus 2nd line

Antihistamines PRN
Phototherapy or immunosuppressants if resistant

If infective; topical fusidic acid, widespread oral fluclox

Eczema herpeticum: HSV infection of eczematous skin; Fever, pain, systemic illness
Admit for i.v. aciclovir.

85
Q

Eczema herpeticum cause, sx, management

A

HSV infection of eczematous skin; Fever, pain, systemic illness
Admit for i.v. aciclovir.

86
Q

Allergic contact dermatitis - cause, sx, investigations, management

A

Type IV hypersensitivity to e.g. metals, preservatives, fragrances, topical abx

Well demarcated acute eczematous area of skin; itchy and dry

Patch testing

Avoid allergen and treat as per eczema:
Emollients
Topical corticosteroids for flares
(Mild potency for face e.g. 1% hydrocortisone)
Can be used for maintenance - tacrolimus 2nd line
Antihistamines PRN
Phototherapy or immunosuppressants if resistant
If infective; topical fusidic acid, widespread oral fluclox

87
Q

Irritant contact dermatitis - cause, sx, investigations, management

A

Presents as per acute eczema

treat as per and avoid irritant:
Emollients
Topical corticosteroids for flares
(Mild potency for face e.g. 1% hydrocortisone)
Can be used for maintenance - tacrolimus 2nd line
Antihistamines PRN
Phototherapy or immunosuppressants if resistant
If infective; topical fusidic acid, widespread oral fluclox

88
Q

Seborrhoeic dermatitis sx and management

A

Erythamatous, scaly patches in areas with increased sebaceous glands e.g. scalp, nose, auricular folds

Cradle cap in child

Antifungal treatment; ketonazole

89
Q

Folliculitis sx and management

A

Inflammation of a hair follicle
S.aureus or ?pseudomonas if hot tub use
Inflamed pustules around hair follicle

Good hygiene + antimicrobial e.g. benzyl peroxide
If persistent, topical abx e.g. fusidic acid or mupirocin
Oral fluclox if extensive

90
Q

Psuedofolliculitis

A

razer burn

91
Q

Faruncle and carbuncle

A

Faruncle - necrotic infection of single hair follicle

Carbuncle - multiple follicles infected with deep abcess

Treat both with oral abx.

92
Q

Impetigo - sx/signs, cause, types, treatment

A

Superficial skin infection; S.aureus most common
Often in children on face and extremities

Non bullous; erythematous papules, then vesciles, then pustules then break down leaving a honey coloured thick crust.
Treat with topical hydrogen peroxide/fusidic acid; oral fluclox if widespread

Bullous; flaccid, fluid filled vesicles and blisters, which burst to leave a thin crust
Treat with oral fluclox

93
Q

Ecthyma

A

Rare ulcerative form of impetigo
Infection into dermis

Long oral abx course required

94
Q

Cellulitis - sx/signs, cause, treatment, compilcations

A

Infection of the dermis and subcutaneous fat
Strep Pyogenes
Erythema, calor, oedema, fever, abscess

Oral flucloxacillin
admit for I.V. if systemic, reapid progression, extensive erythema, immunosuppressed.

Necrotising fasciitis, sepsis, endocarditis, joint infection

95
Q

Erysipelas

A

Superficial form of cellulitis; inflamm of upper dermis and lymphatics

96
Q

Necrotising fasciitis; sx, signs, types, diagnosis, management

A

Rapidly progressive infection of deep soft tissues; muscle fascia and fat
Systemically unwell, erythema, crepitus, anaesthesia; eventual skin breakdown with bullae and cutaneous gangrene

Type 1 - ploymicrobial; aerobes and anaerobes. DM is a risk factor
Type 2 - monomicrobial; streptococci

Clinical diagnosis; confirmed by surgical exploration
CT if lower suspicion

Surgical debridement and i.v. clindamycin

97
Q

Cutaneous warts - cause, types, management

A

Hyperkeratotic lesions
HPV 1 - plantar
HPV 3 & 10 - Plane
HPV 6 & 11 - genital

Common - verruca vulgaris - cauliflower like papules
Verruca plantaris - tender, can grow inwards
filiform
periungal

Self limiting or cryotherapy/topical paints if painful, unsightly, persistent

98
Q

Tinea - sx, cause, types, management

A

Fungal infection of keratinised skin
Dematophytes e.g. Trichophyton, Microsporum, Epidermophyton

Corporis (ringworm) - annular scaly plaques, red border with central clearing
Manuum - hands
Pedis - athletes foot
ungium - nails - discolouration, hyperkeratosis, loss of the nail plate
capitis - scalp

Azole or terbinafine for local skin infection
Oral terbinafine if systemic, scalp or nail; itraconazole 2nd line (more for candida)

99
Q

Intertrigo

A

Fungal infection of skin folds
Candida albicans; erythema, pustules at advancing edge

Treat with topical azoles

100
Q

Pityriasis versicolour - sx, investigations, management

A

Superficial yeast infection; Malassezia (after transforming to pathogenic mycelial form)

Asymptomatic macules, patches, plaques +- hypopigmentation

Skin scrapings

Ketonazole cream
oral if immunosuppressed

101
Q

Scabies - sx, cause, management

A

Sarcoptes scabei mite; spread by direct contact
Itchy small erythematous papules
Can be crusted scabies in immunosuppressed; poorly defined plaques with crusting

2 doses of Topical permethrin 5% cream for pt and close contacts

Oral ivermectin if crusted + investigations for immunodeficiency

102
Q

Molluscum contagiosum

A

Pearly papules with central umbilication
Self limiting

103
Q

Head lice

A

Manage with wet combing, physical or traditional insecticides

104
Q

Erythamsa

A

Erythrasma is a superficial skin infection that causes a pink/brown rash in groin/axilla
Corynebacterium minutissimum bacteria, a normal part of skin flora.
treat with erythromycin. topical miconazole

105
Q

Types of psoriasis

A

Chronic plaque
Guttate
Pustular
erythrodermic

106
Q

Chronic plaque Psoriasis - cause, sx, management

A

Immune mediated inflamm disorder
erythematous plaques, well defined, silvery scale
Typically on scalp, extensors, gluteal cleft
Scratching can from new plaques - koebner phenomenon
Removal of plaques keaves pinpoint bleeding - Auspitz sign

Emollients
Corticosteroids e.g. betnovate, eumovate
Vitamin D analoues e.g. calcitriol
E + C used for face, E + C and Vit D for limbs/trunk

Coal tar, keratolytics e.g salicylic acid, antikeratinocytes e.g. dianthrol can also be used

Phototherapy - UV therapy 3 times a week

Systemic treatment
Methotrexate
Ciclosporin
Acitretin
Anti-TNFs

107
Q

Psoriasis systemic treatment options and side effects/Facts

A

Methotrexate; Folic acid antagonist
Bone marrow and liver, GI, and Resp toxicity
Teratogen; take folic acid with it
Don’t prescribe sulfonamides

Ciclosporin; calcineurin inhibitor
Good short term response. Long term cause HTN, nephrotoxity, carcinogenesis

Acitretin
Vit A derivative
Chelitis, alopecia, hepatotixic

Anti-TNFs e.g. infliximab
Contraindicated in TB

108
Q

Guttate Psoriasis - cause, sx, management

A

Abrupt appearance of small psoriatic papules and plaques
Strong association with recent infection (step throat) or new medications

Self resolving in 3-4 months; topicals abx if needed.
Phototherapy if 10%< skin involvement

109
Q

Pustular Psoriasis -, sx, management

A

Acute onset widespread erythema, scaling, pustules
Systemic sx, hepatic failure, sepsis

Same day assessment in hospital

110
Q

Erythrodermic Psoriasis - cause, sx, management

A

Whole body erythema and scaling
leading to skin failure

Same day assessment in hospital

111
Q

Acne vulgaris - cause, sx, subtypes, management

A

Inflammation of the pilosebaceous units; increased sebum, abnormal hyperkeratinisation cutibacterium acnes.

Closed comedomes (whiteheads), open comedomes (black), papules, pustules, noudules, cysts

Severe; nodules and cysts present; scarring atrophic or hypertrophic.

Conglobata - nodular acne with sinus formation

Fulminans - severe inflammation; ulceration, bleeding, systemically unwell

Avoid over cleaning, mkeupp etc.
Mild/moderate- topical combination therapy
e.g. benzyl peroxide, topical abx, retinoids e.g. tretinoin (photosensitivity, teratogen)

Moderate/severe - monotherapy + 12 weeks doxycycline (hormonal therapy if female e.g. co-cyprindiol; oestrogen + anti-androgen)
Severe/resistant - roaccutane

112
Q

Isotretinoin (roaccutane) facts/side effects

A

Used as monotherapy
Decreases sebum, gland size and follicular occlusion
Teratogen; females must be on double contraception
Dry skin, mood changes, initial flare of sx.
Hyperlipidaemia, hepatic transaminase derangement
Bloods done 1 month after initiation

113
Q

Acne rosacea

A

Flushing then papules, pustules and telangiectasia
Can lead to blepharitis

Topical brimonidine if flushing only
Topical ivermectin if mild papules/pustules
Oral doxy if severe

114
Q

Licehn planus

A

purple-ey lesions

Treat with potent steroids

115
Q

Pityriasis rosea

A

Initial single large patch; then many smaller pathces
Resolves in 2 months

116
Q

Erythroderma

A

Erythema of >90% of body surface
exacerbation of inflammatory conditions

Treat underlying cause

117
Q

Toxic epidermal necrolysis

A

Cytotoxic cell-mediated reaction against skin cells
Induced by drugs e.g. NSAIDs, Abx, anti-convulsants

Fever + 30%< erythema
If only 10%> = stephen-johnson syndrome

Nikolsky sign - blisters expand with lateral ptessure

Within 72 hours; full thickness necrosis can occur.

118
Q

Investigation required before starting terbinafine

A

LFTs need to be checked before commencing a patient on terbinafine (to treat a fungal nail infection)

GEM (18 decks)

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