Opthalmology, Derm, ENT

Question 0

eczema manageq

Answer 0

avoidance - stress, scratching, hot baths
psycho support

emollient - acqeous, diprobase, e45, nivea, soap substitutes
steroid - hydro-eumo-betno-dermo

look out for infection - abx

Question 1

eczema

Answer 1

ill defined erythema
dry scaly erosion excoriated
weeping crusting - infection
lichenification vesicles

atopic - young, flexural, symmetrical
exogenous: allergic or irritant
seborrhoeic
discoid
pompholyx
asteatotic
venous eczema

Question 2

psoriasis

Answer 2

chronic relapsing cond w epidermal inflam and thickening (keratocyte prolif)

subtypes

• plaque - most common
• flexural - lesions are smooth
• guttate - transient, teardrop lesions, post strep infec
• pustular - on palm and soles
• erythrodermic - severe whole body

koebners (also vitiligo, lichen planus)

complications

• nails
• arthritis
• CVD

Question 3

psoriasis treatment

Answer 3

avoidance - alcohol, stress, smoking

emollient, hydrocortisone
topical vitamin d - calcitriol
Dovabet (steroid plus vit d)
dithranol
Tar

light: uvb or puva
syst: methotrexate, anti-tnf

Question 4

skin cancer

Answer 4

bcc - common, rolled peraly edge telangect central crater, rodent ulcer, slow/local
- nodular, superficial, morphoeic, pigmented

scc - red scaling thickened ulcerate/beed/crust, growing.
may be preceeded by actinic keratosis (no ulcer)
- smoking is also rf
- wle w sentinal biopsy

melanoma - brown/balck (unless amelanotic), metastasizing (lung liver brain bone)
- wle w sentinel biopsy

Question 5

acne roseacea

Answer 5

flushing
pap/pust - nose cheek forehead
telangec
blehparitis
rhinophymia

mild: metronidazole
severe: tertracycline

Question 6

acne rosseacea

Answer 6

flushing, progressing to erythema w paps and pustules
ocular involve (belphitis, conjunctivitis)

rhinophymia

alcohol, sunlight exacerbates

t: metronidazole topical, oral if severe

Question 7

acne vulgaris mgmt

Answer 7

assess psychological impact

mild:
benzoyl peroxide
topical clindamycin

Also COCP

mod - sever:
oral abx - tetracycline
topical retinoid (adapalene)

severe:
oral retinoid (avoid pregnancy)

Question 8

leg rashes

Answer 8

Erythema nodosum

• in Crohns
• painful
• also in sarcoidosis

pyoderma gangrinosum

• in UC and RA
• ulcers**

neurobiosis lipodica diabetica -
shiny painless yelow/red telangectasia shin lesion

pyoerma gengrenosa - papule- ulcer, red, necrotic

pretib myxoedema - orange peel shiny thyroid

erythema nodosum - sym, red distinct tender nodules - strep, sarcoid, ibd, cocp, abx

Question 9

scabies

Answer 9

intense widespread pruritis starts 30 days post infec (from eggs)
- type 4 hypersensitivity

linear burrows in/betweeen fingers

t: permethrin
(or malathion)

Question 10

pityriasis versicolor

Answer 10

fungal
can be itchy scaly
hypopigmented, red or brown
common

t: terbinafine or selenium sulphate

Question 11

blistering bulous rashes in elderly

Answer 11

if affect mucosa - bullous pemphygus
- superficial - some deroofed and slough

if not - pemphygoid vulgaris
- dermal

t: oral steroids

Question 12

white areas in mouth

Answer 12

leukoplakia

• pre malignant —biopsy
• prolonged and asymptomatic

candida

• opportunistic
• may be sore, alter taste

lichen planus

• symet, white, lacy
• buccal mucosa

Question 13

skin abx

Answer 13

impetigo: fusidic acid, flucloxacillin, erythro
cellulitis: fluclox
erysipelas: phenoxymethylpenicillin
bite: coamoxiclav

Question 14

impetigo

Answer 14

golden crust

staph aureus
or strep pyog (erysipelas)

topical fusidic acid
2) oral flucox or top retapamulin

Question 15

derm history

Answer 15

Skin type - do you burn more easily than tan
Sun exposure? Work outdoors
Other skin prods
Prev skin cancer
Family

Question 16

5 differential of well defined red scaley lesion

Answer 16

psoriasis
fungal
discoid eczema
bowens disease ( scc in situ)
superficial bcc

Question 17

3 differentials of lesion w keratin plug

Answer 17

scc
hyperkaratotic solar keratosis
viral wart

Question 18

lichen simplex

Answer 18

Eczema from scratching self

Question 19

solar actinic keratoses

Answer 19

Premalignant
Rough lesions
Sun exposure

If single area - cryotherapy
If widespread - field treatment
- Diclofenac gel (solaraze)
- 5flourouracil

Question 20

seborrhoiec keratoses

Answer 20

Common warty or mole like growths

can have keratin horn

Assoc w age

Question 21

tetracycline in derm

Answer 21

Used vs acne vulg and rosseacea, folliculitiz

• avoid in pregnancy and children (bones/teeth)
• can cause skin pigment changes, renal impair

Question 22

facial rashe

Answer 22

Think

• acne rosseacea
• –pap, pust, oedema, eryth, rhinophymia, telangec
• eczema (seborrheic dermatitis)
  — often in nasolabial folds
  T: dactacort
• rarely - lupus, fungal, cellulitis (erysepalis)

Question 23

rash in pregancy

Answer 23

‘polymorphic eruption of pregnancy’
pruritic widespread (abdo/legs)
last trimester

‘pemphygoid gestationis’
periumbilical, patches
itchy, blistering

Question 24

vitiligo

Answer 24

autoimmune destruc of melanocytes

well defined macules and patches of hypopigmentation
- commonly around hands, eyes, mouth

koebners

poliosis - hypopigmented hair

assoc w other autoimmune
- addison, alopecia, pernic anaem, thyroid

Question 25

Fungal lesion

Answer 25

Ring worm - tinea capitis/pedis/corpus
Erythematous rings - get larger

Treat: miconazole or ketaconazole

Question 26

psoriatic arthiritis

Answer 26

70% asymmetrical oligoarthiritis
- may be dactylitis - sausage

also sym poly distal - like RA
just DIP
mutilans 5%

Question 27

red eyes

Answer 27

acute close angle glaucoma

• painful
• hazy cornea
• dilated pupil
• vision affected

uveitis

• acute onset
• assoc w IBD
• PHOTOPHOBIA
• SMALL FIXED PUPIL

scleritis

• severe pain worse w movement, tender
• UC, RA

conjunctivitis

• purulent: bacterial
• clear: viral

subconjunctival
- hx of trauma, coughing fits

Question 28

glaucoma

Answer 28

acute angle
- hypermetropia

open angle

• myopia, periph loss, red acuity, disc cupping
• 1) latanoprost, 2) bblock

Question 29

acute (closed) glaucoma

Answer 29

Emergency

• sudden painful red eye
• often at night
• alcohol can precipitate
• blurring of vision due to corneal oedema (see on slit lamp)
• eyeball feels rock hard

T:
iv mannitol
iv acetazolamide
- then later surgery - laser or stent

Question 30

chronic (open) glaucoma

90%

Answer 30

Inc aqueous humour causes chron inc pressure in eye

Causes cupping of head of optic nerve
- cup:disc ration approaches 1 if severe

Causes progressive non central loss of vision
= scotoma

NB normal intraoc pressure <15mmh

T: eye drops

• latanoprost (can change eye colour)
• b blocker (can cause bradycardia)
• alpha agonist
• acetazolamide drops
• -laser or stenting surgery

Question 31

macular degeneration

Answer 31

atrophy on central part of retina
bilarteral

stop smoking, vitamins: beta carotene, c e zinc

dry - drusen, yellow spots, no exudate, age
wet - neovasc, exudate, late age, poor prog
- phototherapy, ranizumab intervitreous

Question 32

sudden painless loss of vision

Answer 32

ishaemic neuropathy - gca (temporal arteritis)

occlusion of retinal art or vein

• art more common, cherry red on pale retina
• glaucoma polycyth htn

vitreous hem - sudden

vitreous detach - flashes and floaters

retinal detach - periph to entral, curving, veil

Question 33

iritis

anterior uveitis

Answer 33

Assoc ra, ibd, as

Painful eye w pericorneal redness (can be subtle)
* photophobia
Reduced acuity
Fixed abnormal pupil (due to adherence to lens)

T: drop to dilate pupil +- steroid drops
- cyclopentadine (mydriatic)

Question 34

webers and rhinnes

Answer 34

W lat towards conductive loss or away from sn loss

R bone>air suggests conductive loss

Question 35

vertigo

• labyrinthitis vs bppv vs menieres
• association w anxiety

Answer 35

labyrinth
- may also affect hearing, tinnitus, nystgamus
** recent URTI
T: Abx + proclorpromazine

bppv
- vertigo on changing head position
- detachment of otolith
- may see nystagmus - Hallpikes
T: epley manouvre

menieres
- diag of exclusion
- increase pressure in endolymph
- hearing loss and tinnitus feature
T: avoid triggers, antihistamine type of antiemetics
eg betahistine (prophy), cyclizine and prochlorpromazine

Question 36

deafness

Answer 36

presbycusis
- age related SNHL
“difficult to follow convo”

otosclerosis

• autosomal dominant
• CHL onset age 20-40
• w tinnitis, pink TM

menieres
- middle age VERTIGO
- w SNHL and tinnitis
"fullness in ear"
- episodic

ototoxic drugs

• furosemide
• gentamycin, aspirin

acoustic neuroma
- progressive SNHL, vertigo, tinnitis

Question 37

labyrinthitis

Answer 37

Dizzyness - severe vertigo

Assoc w head cold/ear ache
Assoc w anxiety

may see

• hearing loss, tinnitus
• middle ear effusion
• nystagmus (wallpike manouevre)

T: abx
–> prochlorpromazine vs dizzyness
(or cinnarizine)

Question 38

ent abx

Answer 38

otitis media: amoxicillin

otitis externa: fluclox

Question 39

presbycusis

Answer 39

loss of hearing with age
lose higher frequency sounds
ie difficulty following conversation when in crowd

Question 40

alport syndrome

Answer 40

sensory neural hearing loss and renal problems

x linked or auto recessive

Question 41

neurofibromatosis type 2

Answer 41

bilateral acoustic neuromas

may get vertigo, hearing loss, tinnitus