Opthalmology, Derm, ENT Flashcards
eczema manageq
avoidance - stress, scratching, hot baths
psycho support
emollient - acqeous, diprobase, e45, nivea, soap substitutes
steroid - hydro-eumo-betno-dermo
look out for infection - abx
eczema
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
psoriasis
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
psoriasis treatment
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
skin cancer
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
acne roseacea
flushing pap/pust - nose cheek forehead telangec blehparitis rhinophymia
mild: metronidazole
severe: tertracycline
acne rosseacea
flushing, progressing to erythema w paps and pustules ocular involve (belphitis, conjunctivitis)
rhinophymia
alcohol, sunlight exacerbates
t: metronidazole topical, oral if severe
acne vulgaris mgmt
assess psychological impact
mild:
benzoyl peroxide
topical clindamycin
Also COCP
mod - sever:
oral abx - tetracycline
topical retinoid (adapalene)
severe: oral retinoid (avoid pregnancy)
leg rashes
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
scabies
intense widespread pruritis starts 30 days post infec (from eggs)
- type 4 hypersensitivity
linear burrows in/betweeen fingers
t: permethrin
(or malathion)
pityriasis versicolor
fungal
can be itchy scaly
hypopigmented, red or brown
common
t: terbinafine or selenium sulphate
blistering bulous rashes in elderly
if affect mucosa - bullous pemphygus
- superficial - some deroofed and slough
if not - pemphygoid vulgaris
- dermal
t: oral steroids
white areas in mouth
leukoplakia
- pre malignant —biopsy
- prolonged and asymptomatic
candida
- opportunistic
- may be sore, alter taste
lichen planus
- symet, white, lacy
- buccal mucosa
skin abx
impetigo: fusidic acid, flucloxacillin, erythro
cellulitis: fluclox
erysipelas: phenoxymethylpenicillin
bite: coamoxiclav
impetigo
golden crust
staph aureus
or strep pyog (erysipelas)
topical fusidic acid
2) oral flucox or top retapamulin
derm history
Skin type - do you burn more easily than tan Sun exposure? Work outdoors Other skin prods Prev skin cancer Family
5 differential of well defined red scaley lesion
psoriasis fungal discoid eczema bowens disease ( scc in situ) superficial bcc
3 differentials of lesion w keratin plug
scc
hyperkaratotic solar keratosis
viral wart
lichen simplex
Eczema from scratching self
solar actinic keratoses
Premalignant
Rough lesions
Sun exposure
If single area - cryotherapy
If widespread - field treatment
- Diclofenac gel (solaraze)
- 5flourouracil
seborrhoiec keratoses
Common warty or mole like growths
can have keratin horn
Assoc w age
tetracycline in derm
Used vs acne vulg and rosseacea, folliculitiz
- avoid in pregnancy and children (bones/teeth)
- can cause skin pigment changes, renal impair
facial rashe
Think
- acne rosseacea
- –pap, pust, oedema, eryth, rhinophymia, telangec
- eczema (seborrheic dermatitis)
— often in nasolabial folds
T: dactacort - rarely - lupus, fungal, cellulitis (erysepalis)
rash in pregancy
‘polymorphic eruption of pregnancy’
pruritic widespread (abdo/legs)
last trimester
‘pemphygoid gestationis’
periumbilical, patches
itchy, blistering
vitiligo
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
Fungal lesion
Ring worm - tinea capitis/pedis/corpus
Erythematous rings - get larger
Treat: miconazole or ketaconazole
psoriatic arthiritis
70% asymmetrical oligoarthiritis
- may be dactylitis - sausage
also sym poly distal - like RA
just DIP
mutilans 5%
red eyes
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
glaucoma
acute angle
- hypermetropia
open angle
- myopia, periph loss, red acuity, disc cupping
- 1) latanoprost, 2) bblock
acute (closed) glaucoma
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
chronic (open) glaucoma
90%
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
macular degeneration
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
sudden painless loss of vision
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
iritis
anterior uveitis
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)
webers and rhinnes
W lat towards conductive loss or away from sn loss
R bone>air suggests conductive loss
vertigo
- labyrinthitis vs bppv vs menieres
- association w anxiety
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
deafness
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
labyrinthitis
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)
ent abx
otitis media: amoxicillin
otitis externa: fluclox
presbycusis
loss of hearing with age
lose higher frequency sounds
ie difficulty following conversation when in crowd
alport syndrome
sensory neural hearing loss and renal problems
x linked or auto recessive
neurofibromatosis type 2
bilateral acoustic neuromas
may get vertigo, hearing loss, tinnitus
