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Year 3 revision > Ophthalmology and dermatology revision > Flashcards

Ophthalmology and dermatology revision Flashcards

1
Q

what are coloured haloes a sign of

A

acute angle closure glaucoma

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2
Q

pupil in AACG

A

fixed mid dilated

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3
Q

iris in AACG

A

hazy

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4
Q

2 surgeries for AACG

A

iridotomy

cataract surgery

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5
Q

type of blindness in GCA

A

amaurosis fugax or sudden unilateral blindness

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6
Q

4 blood tests which are increased in GCA

A

ESR
CRP
platelets
ALP

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7
Q

2 treatments for GCA

A

high dose steroids 2 years

aspirin

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8
Q

what is chemosis (swelling of conjunctiva) a sign of

A

orbital cellulitis

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9
Q

which CN palsy can diabetes and hypertension cause

A

CN III

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10
Q

infection causing CN palsy

A

Lyme disease

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11
Q

what CN lesion can a SoL cause

A

CN VI (abducens)

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12
Q

sign of meningeal/cavernous sinus tumour

A

multiple CN palsies

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13
Q

sign of a posterior communicating artery aneurysm

A

unreactive pupil

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14
Q

how can MS cause Horner’s syndrome

A

demyelination - 1st order nerve

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15
Q

2 other causes of Horner’s syndrome from 1st order nerve

A

neck trauma

meningitis

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16
Q

4 causes of Horners from 2nd order nerve

A

pancoast tumours
AAAs
neuroblastoma
lymphadenopathy

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17
Q

4 causes of Horners from 3rd order nerve

A

cluster headache
herpes
GCA
Raeders syndrome

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18
Q

2 viruses which can cause infectious conjunctivitis (usually bacterial)

A

adenovirus

HSV

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19
Q

2 abx for bacterial conjunctivitis

A

azithromycin

topical tetracycline

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20
Q

discharge in bacterial vs viral conjunctivitis

A 
bacterial = purulent
viral = watery
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21
Q

what type of corneal ulcers can HSV cause

A

dendritic ulcers

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22
Q

4 causes of iritis

A

RA
sarcoidosis
HSV
VZV

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23
Q

3 symptoms of iritis (anterior uveitis) AND posterior uveitis - 3 Ps

A

progressive blurred vision
pain and redness
photophobia

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24
Q

2 symptoms of intermediate uveitis

A

painless floaters

decrease in vision

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25
difference between iritis and posterior uveitis
``` anterior/iritis = unilateral posterior = bilateral ```
26
what ie herpetic uveitis
atrophy of iris - sign of iritis
27
2 signs of posterior uveitis
inflammation of retinal vessels | optic nerve oedema
28
5 investigations for uveitis
``` FBC, ESR ANA Mantoux test CXR urinalysis ```
29
why do ANA for uveitis
SLE?
30
why do Mantoux test for uveitis
TB? (intradermal injection of tuberculin = test for immunity)
31
4 ways to manage uveitis
cycloplegic drugs = paralyse ciliary body steroid eye drops immunosuppressors = cyclosporin, tacrolimus vitrectomy
32
treatment of episcleritis
NSAIDs
33
2 complications of posterior scleritis
RD | proptosis
34
4 symptoms of posterior scleritis
dull radiating pain movement makes pain worse decrease in vision severe inflammation and erythema
35
type of scleritis associated with RA
necrotising anterior scleritis
36
4 treatments for scleritis
oral NSAIDs prednisolone biologics surgery
37
4 treatments for necrotising anterior scleritis
artificial tears steroids immunosuppression surgery
38
what is conjunctival injection
enlargement of conjunctival vessels (redness) = sign of corneal abrasion
39
what is Seidel's test
fluorescein with blue light to see if aqueous fluid is coming out = epithelial defect seen in corneal abrasion
40
investigation for vitreous haemorrhage
IOP
41
what is a rhegmatogenous retinal detachment
from PVD
42
what is an exudative retinal detachment
serous and haemorrhagic fluid in sub retinal space
43
RAPD result if mac has detached in RD
positive
44
3 causes of retinal artery occlusion
atherosclerosis GCA prothrombotic problems
45
cause of amaurosis fugax
transient retinal ischaemia - from CRVO/BRVO/CRAO/BRAO
46
origin of embolus causing retinal occlusion
carotid/heart
47
4 risk factors for cataracts
smoking diabetes systemic steroids uveitis
48
pupil reflexes in cataracts
normal
49
3 optic disc signs of open angle glaucoma
cupping pallor splinter haemorrhages
50
what is an urgent IOP
>30
51
4 medications for open angle glaucoma
eye drops to reduce IOP prostaglandin analogues beta blockers selective alpha-2 receptor antagonists
52
type of eye drops to reduce IOP
carbonic anhydrase inhibitors
53
type of drug causing blocked nasolacrimal duct
chemotherapy
54
6 clinical features of blocked nasolacrimal duct
``` increased tearing redness of sclera eye infections crusting of eyelids blurred vision mucous/pus discharge from lids/eye ```
55
4 treatments for blocked nasolacrimal duct
antibiotics dilation/flushing stenting surgery (dacryocystorhinostomy)
56
3 causes of tear deficient dry eyes
sjogrens blepharitis lacrimal gland obstruction
57
4 causes of evaporative dry eyes
contacts allergic conjunctivitis blink disorders e.g. PD Meibomian glans dysfunction = decreased lipid in tear film
58
3 signs of blepharitis
sore/gritty bilateral edges of eyes red and swollen
59
3 risk factors for eyelid BCC
X-rays UV arsenic
60
5 treatments for eyelid BCC
``` excision (4mm margin) curettage/cautery cryotherapy creams photo/radiotherapy ```
61
2 creams for eyelid BCC
imiquimod | fluorouracil
62
2 risk factors for eyelid SCC
pipe smoking/tar | HPV
63
how to diagnose eyelid BCC
excisional biopsy + FNA of lymph nodes
64
treatment for eyelid BCC
radiotherapy | diclofenac for actinic keratoses
65
condition associated with Meibomian gland carcinoma (carcinoma of eyelid)
history of upper lid chalazia (benign painless lump on inside eyelid)
66
3 clinical features of Meibomian gland carcinoma
yellow eyelid thickening painless may spread to conjunctiva = remove eye?
67
treatment of Meibomian gland carcinoma
wide excision | SN biopsy
68
dots vs blots
``` dots = microaneurysms blots = haemorrhages ```
69
4 features of diabetic maculopathy
oedema ischaemia exudates retinal thickening
70
4 risk factors for diabetic eye disease
DM duration hypertension renal disease pregnancy
71
type of intravitreal steroid used to treat macular oedema
fluocinolone
72
2 treatments for exophthalmos from GD
prednisolone | lacrilube
73
5 causes of optic atrophy
``` chronic glaucoma optic neuritis trauma lesions CRAO/CRVO ```
74
3 signs of optic atrophy
axon loss myelin shrinkage optic cup widening
75
3 symptoms of choroidal melanoma
scotoma floaters decrease in visual field
76
derm condition associated with choroidal melanoma
xeroderma pigmendosum and naevi
77
2 investigations for choroidal melanoma
USS | LFTs
78
3 treatments for choroidal melanoma
laser photocoagulation radiotherapy enucleation/brachytherapy
79
4 steps in Keith Wagener Barker (KWB) grading of hypertensive retinopathy
1. vascular attenuation 2. AV nipping (Salu's sign) 3. retinal oedema, cotton wool spots, copper wiring 4. optic disc swelling, macular star (silver wiring)
80
3 causes of unilateral optic disc swelling
optic neuropathy retinal vein occlusion diabetic papillopathy
81
infection which can cause bilateral optic disc swelling
Lyme disease
82
what are honey-coloured crusted erosions a sign of
impetigo
83
3 risk factors for impetigo
atopic eczema scabies skin trauma e.g. bites, dermatitis
84
most common cause of impetigo
s. aureus
85
3 types of impetigo
``` non-bulbous = usually staph ecthyma = strep, necrotic bullous = strep, transparent bullae ```
86
3 complications of impetigo AND intertrigo
SSTI e.g. cellulitis staphylococcal scalded skin syndrome post-streptococcal glomerulonephritis
87
features of erysipelas
well-defined red raised border
88
2 signs OE for necrotising fasciitis
oedema | crepitus
89
4 risk factors for cellulitis and erysipelas
venous disease immunodeficiency pregnancy diabetes
90
2 bacteria causing cellulitis and erysipelas
s. aureus | s. pyogenes
91
2 antibiotics for cellulitis and erysipelas
flucloxacillin | benzylpenicillin
92
2 bacteria causing folliculitis
S. aureus | pseudomonas aeruginoas
93
2 viruses causing folliculitis
HSV | VZV
94
2 fungi causing folliculitis
candida | tinea capitis
95
2 infestations causing folliculitis
mites scabies
96
drug for viral folliculitis
acyclovir
97
what is intertrigo
rash in flexures - worsened by obesity and sweat
98
difference between infectious and inflammatory intertrigo
``` infectious = unilateral inflammatory = bilateral ```
99
symptom of adult chickenpox
prodromal symptoms 48 hours before rash (fever, malaise, headache, abdo pain)
100
treatment of chickenpox in immunocompromised
IV acyclovir
101
3 complications of chickenpox in children
bacterial infection viral pneumonia dehydration (D+V)
102
3 complications of chickenpox in immunocompromised and adults
disseminated varicella infection encephalitis thrombocytopenia and purpura
103
most common areas for shingles
chest neck forehead lumbar/sacral regions
104
drug for shingles
acyclovir
105
what is eczema herpeticum
severe and widespread infection, blisters
106
what is erythema multiforme
severe, symmetrical plaques on head, forearms, feet and lower legs, targeted lesions with central blisters
107
what are eczema herpeticum and erythema multiforme complicatiosn of
herpes simplex
108
skin manifestatino of HIV
pruritis papular eruption - form of prurigo
109
3 dermatological symptoms of acute HIV infection syndrome
erythematous maculopapular rash mucucutaneous ulceration rash symmetrical involving face, palms, soles
110
2 treatments for pruritic papular eruption
topicals e.g. steroids | phototherapy
111
incubation period of viral warts
up to 12 months
112
cause of molluscum contagiosum
poxvirus - skin to skin, indirect, auto-inoculation, sexual transmission common in children in warm/moist places e.g. flexures
113
2 medical treatments for molluscum contagiosum (otherwise do laser or cryotherapy)
hydrogen peroxide | salicylic acid
114
secondary infection in molluscum contagiosum
impetigo
115
topical and oral antifungal for tinea AND candida AND pityriasis versicolor
``` topical = terbinafine oral = itraconazole ```
116
why avoid topical steroids in tinea
can cause tinea incognito (less scaly)
117
3 types of candidiasis
oral intertrigo (in between fingers) vulvovaginal
118
cause of pityriasis versicolor
malassezia furfur (fungus) - in young adults and males
119
what is sign of Leser-Trelat
sudden eruption of multiple seb Ks = sign of underlying internal malignancy
120
difference between lipomas in men and women
``` men = multiple women = solitary ```
121
3 types of epidermoid cysts (epidermal cell proliferation, asymptomatic)
follicular infundibular epidermal keratin
122
4 features of epidermoid cysts
skin coloured/yellow firm round nodules central puncture?
123
what are dermatofibromas also called
histiocytomas - fibroblast proliferation
124
location and common cause of dermatofibromas
lower legs | after insect bite
125
4 features of dermatofibromas (no treatment required)
firm dermal nodules/papules usually <1cm skin dimples upon compression
126
what are skin tags called
fibroepithelial polyps
127
3 things contributing to skin tags
irritation insulin resistance HPV high levels of growth factor hormones
128
cells involved in BCC and SCC
epidermal keratinocytes
129
DNA mutation involved in BCC
PTCH tumour suppressor gene
130
syndrome increasing risk of BCC
Gorlin syndrome
131
most common type of BCC
nodular
132
more aggressive type of BCC
morphoeic (waxy plaque, ill-defined borders, sclerosing)
133
2 topical treatments for BCC
fluorouracil | imiquimod
134
pre-malignant skin disease associated with SCC
actinic keratoses - stratum basale contains atypical keratinocytes
135
virus associated with SCC
HPV
136
what is Bowen's disease
SCC in situ - usually one slowly enlarging scaly erythematous patch
137
rule of 2s for SCC
high risk if >2cm diameter and/or >2mm thickness
138
drug increasing risk of melanocytic naevi (moles)
BRAF inhibitor e.g. vemurafenib
139
3 types of naevi
junctional - flat compound - raised, hairy intradermal - hairy, paler
140
gene mutation contributing to melanoma
BRAF mutation
141
most common type of melanoma
superficial spreading
142
what is superficial spreading melanoma associated with
high intensity UV exposure - on legs?
143
3 other types of melanoma
- lentigo maligna (face, long term UV) - sacral lentiginous (palms, soles, nails) - nodular (deeper in skin, trunk, high UV)
144
2 treatments for widespread melanomas
immunotherapy e.g. IL-2 | biologics e.g. BRAF inhibitor
145
Breslow thickness for melanoma numbers
``` <1mm = low risk 1-4mm = medium risk >4mm = high risk ```
146
Clark levels for measuring risk of melanoma mets
``` 1 = in situ 2 = invasion papillary dermis 3 = complete invasion papillary dermis 4 = invasion reticular dermis 5 = invasion subcutaneous tissue ```
147
3 types of drug eruptions
morbilliform ACEP (acute generalised exanthematous pustulosis) DRESS (drug hypersensitivity syndrome)
148
2 features of morbilliform
fever | maculopapular rash
149
what can morbilliform progress to
erythroderma/TEN
150
6 drugs causing morbilliform
``` penicillin erythromycin carbamazepine allopurinol NSAIDs phenytoin ```
151
4 treatments for morbilliform, AGEP and DRESS
stop drug antihistamines emollients topical steroids
152
5 clinical features of AGEP
- starting in face and flexures - erythema with widespread pustules (sterile) - may have fever - rash present for 1-2 weeks - neutrophil leucocytosis
153
6 drugs causing AGEP
``` tetracyclines antifungals CCBs paracetamol hydroxychloroquine carbamazepine ```
154
3 drugs causing DRESS
antiepileptics sulphonamides allopurinol
155
6 features of erythroderma
``` exfoliative dermatitis pruritus hair loss hyperkeratosis palms/soles lymphadenopathy affects entire skin surface ```
156
5 complications of erythroderma
- secondary infection - loss of thermoregulation - high output cardiac failure - fluid and electrolyte imbalance - hypoalbuminaemia
157
5 drugs causing erythroderma
- drugs - psoriasis - dermatitis - cutaneous T-cell lymphoma, systemic malignancy - HIV
158
4 treatments for erythroderma
emollients thermoregulation, fluid balance antibiotics antihistamine
159
dermatological emergencies from mild to severe
EM < SJS < TEN
160
type of hypersensitivity in erythema multiforme EM
type IV
161
usual cause of EM
hypersensitivity reaction to HSV (but 50% idiopathic)
162
5 risk factors for EM
``` male pregnancy live vaccines IBD chemo/radiotherapy ```
163
type of lesions in EM
true target lesions, 70% have mucosal involvement
164
FBC result in EM
leukocytosis, atypical lymphocytes, eosinophilia, neutrophilia, anaemia/thrombocytopenia
165
2 treatments for EM
antihistamines | topical steroids
166
preventative treatment for EM
oral acyclovir 6-12 months
167
3 differences between features of EM vs SJS/TEN
EM = true target lesions, SJS/TEN = targetoid lesions EM = mucosal involvement, SJS/TEN = mucous membrane erosion and crusting also oedema, necrosis, epidermal detachment etc in SJS/TEN
168
common cause of EM major/SJS/TEN
drugs
169
what is SCORTEN
severity of illness score for TEN - 0-5, >3 = ICU
170
cause of generalised pustular psoriasis (GPP) - systemic illness + systemic symptoms
abnormalities in cytokine IL-36 receptor antagonist signalling - recessive IL35RN gene mutations
171
3 trigger factors for flares of GPP
sudden withdrawal of injected/oral corticosteroids drugs infection
172
5 drugs triggering flares of GPP
``` lithium aspirin indomethacin iodide some beta blockers ```
173
type of biopsy for GPP
skin biopsy - sub corneal pustules and neutrophilic infiltration
174
5 complications of GPP
``` cardiorespiratory failure = death? secondary bacterial infection anaemia low albumin, calcium and zinc renal and liver impairment ```
175
type of retinoid to use for GPP
acitretin NB: also use other drugs e.g. abx, steroids, immunosuppressors, biologics
176
3 skin manifestations of diabetes
acanthuses nigracans necrobiosis lipodica - granulomatous skin disorder thrush
177
what is erythema nodosum
tender bruise-like panniculitis (fat inflammation) - young women lower legs, 50% unknown cause
178
5 causes of erythema nodosum
infections (strep, TB) drugs (antibiotics, aspirin) pregnancy/OCP IBD
179
3 types of lupud
discoid (DLE) sub-acute cutaneous (SACLE) systemic (SLE)
180
what is morphoea
ivory oval sclerotic plaques + inflamed edge - usually result in post-inflammatory pigmentation and dermal atrophy
181
3 features of necrobiosis lipodica
tender yellow/brown patches lower legs centre of patch becomes shiny, pale, thinned + telangiectasia ulceration?
182
9 treatments for NL
- topical steroids, steroid injections or tablets - aspirin and dipyridamole combination - oxypentifylline tablets - niacinamide - oral ciclosporin - biologic agents - photochemotherapy (PUVA) - photodynamic therapy - fumaric acid esters
183
what is granuloma annulare (GA)
necrobiotic papulosis (smooth discoloured plaques) - delayed hypersensitivity reaction
184
condition associated with localised GA
Hashimoto's - doesn't clear up with thyroid replacement
185
5 conditions associated with extensive GA
``` DM hyperlipidaemia lymphoma HIV solid tumours ```
186
2 differences between localised and generalised GA
localised = children, generalised = adults localised = bumps over joints, generalised = patches in skin folds of trunk
187
4 local therapies for GA
topical steroids steroid injections cryotherapy laser ablation
188
5 systemic treatments for GA
``` systemic steroids isotretinoin methotrexate PUVA ciclosporin ```
189
most common location of lichen sclerosus
``` women = skin of anogenital region men = glans penis and foreskin ```
190
why can LS cause constipation in women
perianal lesions in 30%
191
2 symptoms of LS in men
dyspareunia, painful erections | poor urinary stream or dysuria
192
difference between LS in . men vs women
women = itchy, men = not itchy
193
treatment of female LS
clobetasol propinate reducing course
194
treatment of male LS
topical steroids OD then reduce
195
5 cutaneous features of dermatomyositis
- reddish/purple patches on sun-exposed areas - purple eyelids (heliotrope) - scaly scalp and thinned hair - purple papules or plaques on knuckles - ragged cuticles and prominent blood vessels on nail folds
196
2 treatments for dermatomyositis
oral steroids | immunosuppressors e.g. methotrexate
197
4 treatments for vitiligo
topical steroids topical pimecrolimus or tacrolimus narrow-band UVB phototherapy surgical
198
6 symptoms of cutaneous vasculitis
``` palpaple purpura petechiae urticaria ulcers livedo reticularis nodules ```
199
cause of bullous pemphigoid
autoimmune - against antigens between epidermis and dermis
200
4 conditions associated with diabetes
granuloma annulare necrobiosis lipodica pyoderma granulosum dermatomyositis (25% have underlying malignancy)
201
2 conditions associated with acanthosis nigricans
diabetes | gastric carcinoma
202
where are acral skin lesions
distal areas, hands and feet
203
ABCDE for naevi etc
``` asymmetry border colour diameter (>6?) evolution ```
204
what are confluent lesions
appear to be merging together
205
target vs annular lesions
target = concentric rings of varying colours e.g. erythema multiforme annular = ring-like
206
cause of erythema vs purpura
erythema = increased blood supply (blanches) purpura = bleeding into skin (doesn't blanch)
207
what are petechiae
small red/purple spots <2mm width - type of purpura
208
what is ecchymosis
larger red/purple lesions >2mm - type of purpura (bruise)
209
what is a macule
flat area of altered colour <1.5cm diameter
210
what is a patch
flat area of altered colour >1.5cm diameter
211
what is a papule
solid raised palpable lesion <0.5cm diameter
212
what is a nodule
solid raised palpable lesion >0.5cm diameter
213
what is a plaque
palpable flat lesion usually >1cm diameter, most raised, borders may be well defined or poorly defined
214
what is a vesicle
raised, clear fluid filled lesion <0.5cm diameter
215
what is a bulla
raised, clear fluid filled lesion >0.5cm diameter
216
what is a pustule
pus containing lesion <0.5cm diameter
217
what is a wheal
oedematous papule or plaque caused by dermal oedema
218
what is a boil/furuncle
staphylococcal infection around or within a hair follicle
219
what is a carbuncle
staphylococcal infection of adjacent hair follicles (multiple boils/furuncles)
220
excoriation vs lichenification
loss of epidermis - trauma | lichenification = thickening of epidermis
221
scales are
visible fragments of stratum corneum as it is shed from the skin (psoriasis?)
222
keloid vs hypertrophic scar
hypertrophic = hyperproliferation of scar tissue WITHIN wound boundary keloidal = hyperproliferation of scar tissue BEYOND wound boundary

Year 3 revision (9 decks)

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