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Year 5 notes > Skin and eyes > Flashcards

Skin and eyes Flashcards

1
Q

what is acne fulminans

A

very severe acne associated with systemic symptoms - responds to oral steroids

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2
Q

which antibiotic can be used in pregnancy for acne

A

erythromycin - NB an antibiotic should be used for max 3 months

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3
Q

pathophysiology of atopic eczema

A

IgE-mediated, T-cell autoimmune response

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4
Q

treatment of persistently inflamed areas of eczema

A

topical steroids - use with emollients ratio 10:1

mild = 1% hydrocortisone

moderate = 0.025% betamethasone

potent = betamethasone 0.1%

dermovate most potent - don’t use on face/genitals

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5
Q

serious complication of eczema

A

eczema herpeticum - give IV acyclovir and probably also fluclox if ulcerations infections

this can cause herpes encephalitis and blindness

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6
Q

drugs which can exacerbate psoriasis

A
  • beta blockers
  • anti malarials
  • NSAIDs
  • ACE inhibitors
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7
Q

genes associated with psoriasis

A

HLA-B27
B13
CW6

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8
Q

what is guttate psoriasis

A

transient psoriatic rash, frequently triggered by strep infection

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9
Q

what is PASI

A

psoriasis area and severity index

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10
Q

1st line management for psoriasis

A

potent corticosteroid OD + vitamin D analogue OD (calipotriol, calcitriol)

up to 4 weeks as initial treatment

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11
Q

2nd line management for psoriasis

A

if no improvement after 8 weeks of 1st line treatment

give vitamin D analogue BD (short acting dithranol)

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12
Q

3rd line management for psoriasis

A

if no improvement after 8-12 weeks

potent corticosteroid BD for up to 4 weeks

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13
Q

when to refer for warts

A
  • persistent unresponsive to treatment in primary care
  • multiple warts in immunocompromised
  • facial warts
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14
Q

most common type of BCC

A

nodular - initially pearly with telangiectasia, may ulcerate later leaving a central crater

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15
Q

what is Mohs micrographic surgery

A

for BCC - excision of lesion and tissue borders progressively until specimens are microscopically free of tumour

for high risk/recurrent

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16
Q

what can be used for low risk BCC lesions

A

topical imiquimod or fluorouracil

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17
Q

when to use radiotherapy in BCC

A

if recurrent, incomplete excision, invasion of bone/cartilage

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18
Q

what 2 skin conditions increase the risk of SCC

A

actinic keratoses

Bowen’s disease (carcinoma in situ)

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19
Q

genetic condition increasing the risk of SCC

A

xeroderma pigmentosum

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20
Q

virus increasing the risk of SCC

A

HPV

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21
Q

surgical management of SCC

A

excision:
- if <20mm diameter do 4mm margins
- if >20mm diameter do 6mm margins
- Mohs in high risk patients/cosmetically important sites

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22
Q

ABCDE symptoms of melanoma

A
  • asymmetrical shape
  • border irregularity
  • colour irregularity
  • diameter >6mm
  • evolution of lesion

bleeding/itching

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23
Q

type of melanoma common on lower limbs

A

superficial spreading

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24
Q

type of melanoma common on the trunk

A

nodular

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25
Q

type of melanoma common on the face

A

lentigo maligna

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26
Q

type of melanoma common on the palms, soles and nail beds

A

acral lentiginous (no clear relation with UV exposure)

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27
Q

when to refer in melanoma

A

weighted checklist - score of 3+

MAJOR (2 points each)

  • change in size
  • irregular shape
  • irregular colour

MINOR (1 point each)

  • largest diameter 7mm+
  • inflammation
  • oozing
  • change in sensation
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28
Q

when to do sentinel node biopsy for melanoma

A

if Breslow thickness >1mm

29
Q

most common type of leg ulcer and most common cause

A

venous (80%)

- most due to venous hypertension, secondary to chronic venous insufficiency

30
Q

signs of venous insufficiency

A 
leg pain
heavy legs
aching 
itching
oedema
brown pigmentation
lipodermatosclerosis
eczema
haemosiderin deposition
31
Q

which type of leg ulcer is painful

A

arterial - particularly at night, relieved by dangling legs out of bed, may be areas of gangrene

features of chronic ischaemia incl low ABPI measurements

32
Q

investigations for venous leg ulcers

A

doppler USS to look for reflux

duplex USS to look at anatomy/flow of vein

33
Q

investigations for arterial leg ulcers

A

ABPI

<0.9 = likely PAD 
<0.8 = refer
<0.5 = urgent referral
>1.2 = stiff, calcified arteries
34
Q

when to consider Marjolin’s ulcer

A

if in areas of scar tissue - malignant

35
Q

management of venous leg ulcers

A
  • 4 layer compression banding after exclusion of arterial disease
  • if >10cm or fail to heal after 12 weeks - might need skin graft
  • debridement and cleaning
36
Q

management of arterial leg ulcers

A
  • lifestyle
  • platelets
  • revascularisation if critical limb ischaemia
37
Q

how can keloid scars be treated

A

intralesional steroids/excision

most commonly affects sternum, shoulder, earlobe and cheek

38
Q

what can spider telangiectasia indicate

A

oestrogen
pregnancy
liver disease

39
Q

what is Kaposi’s sarcoma

A

connective tissue cancer due to HHV 8 and immunosuppression e.g. HIV

treat with radiotherapy and resection

40
Q

how can Kaposi’s sarcoma affect GI/respiratory tract

A

haemoptysis and pleural effusion

41
Q

what does a herald patch indicate

A

pityriasis rosea

42
Q

treatment of pityriasis rosea

A

emollients, steroids, antihistamines

but usually clears without treatment in 3 months

43
Q

management of acute angle closure glaucoma

A
  • urgent referral
  • acetalozamide 500mg IV over 10 mins (reduce aqueous secretions)
  • topical pilocarpine (pupillary constriction)
  • topical beta blockers, prednisolone
  • surgery - peripheral iridotomy (both eyes)
44
Q

what drugs can cause cataracts

A

long-term corticosteroids

45
Q

complications following cataracts surgery

A
  • posterior capsule opacification (thickening of lens capsule)
  • retinal detachment
  • posterior capsule rupture
  • endophthalmitis (inflammation of aqueous/vitreous humour)
46
Q

cause of dendritic corneal ulcers

A

herpes - use acyclovir

47
Q

investigations for corneal ulcers

A
  • fluorescein staining

- urgent diagnostic smear/gram stain and scrape

48
Q

management of corneal ulcers

A
  • refer immediately
  • until cultures known, use chloramphenicol drops alternated with ofloxacin drops
  • admit if diabetes/ immunosuppressed
49
Q

usual cause of infection in a stye

A

staphylococcal infection in lash follicle - may also include glands of Moll and Zeis

50
Q

when should gonococcal conjunctivitis be suspected

A

if within first 48 hours of live - purulent discharge, swelling of eyelids

51
Q

treatment of gonococcal conjunctivitis

A

cephalosporin

notifiable

52
Q

when does chlamydial conjunctivitis usually present

A

end of first week of life (7-10 days)

53
Q

how is chlamydial conjunctivitis diagnosed

A

specific monoclonal antibody test - performed on conjunctival secretions

54
Q

organisms causing bacterial conjunctivitis

A

h. influenzae

gram +ve cocci

55
Q

organism causing viral conjunctivitis

A

adenovirus - preauricular lymph nodes

56
Q

when is chloramphenicol immediately started for conjunctivitis

A
  • sexual disease suspected
  • contact lens wearers
  • immunocompromised
57
Q

1st and 2nd line treatments for allergic conjunctivitis

A

1st line = topical/systemic antihistamines

2nd line = topical mast-cell stabilisers

58
Q

mild non-proliferative diabetic retinopathy

A

1 or more micro aneurysm

59
Q

moderate non-proliferative diabetic retinopathy

A
  • micro aneurysms
  • blot haemorrhages
  • hard exudates
  • cotton wool spots, venous beading/looping and mild intraretinal microvascular abnormalities
60
Q

severe NPDR

A
  • blot haemorrhages and micro aneurysms in 4 quadrants
  • venous beading in at least 2 quadrants
  • IRMA in at least 1 quadrant
61
Q

type of diabetes more likely to cause proliferative retinopathy

A

T1DM - 50% blind in 5 years

62
Q

type of diabetes more likely to cause maculopathy

A

T2DM

63
Q

stages 1-4 of hypertensive retinopathy

A

1 = arteriolar narrowing and tortuosity, increased light reflex (silver wiring)

2 = arteriovenous nipping

3 = cotton wool exudates, flame and blot haemorrhages

4 = papilloedema

64
Q

conditions associated with acute anterior uveitis

A

Crohn’s/UC
ankylosing spondylitis
sarcoidosis
Bechet’s disease

65
Q

management of acute anterior uveitis

A
  • cycloplegics to dilate pupil

- steroid eye drops

66
Q

what can be done to distinguish between episcleritis and scleritis

A

phenylephrine drops

phenylephrine blanches conjunctival and episcleral but not scleral - if redness improves after phenylephrine = is episcleritis

67
Q

treatment of scleritis (PAINFUL unlike episcleritis)

A
  • necrotising = eye surgery

- less severe = NSAIDs, corticosteroids, antibiotics

68
Q

at what age should a squint be investigated

A

any squint beyond 12 weeks

Year 5 notes (10 decks)

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