Skin, Eyes and Hormones Flashcards
diagnosis?
features to note?
acute anterior uveitis
- redness at the sclera/cornea junction
- hypopenon formation and inflammatory cells in the anterior chamber
- posterior synechiae
- adhesion of the iris onto the posterior chamber resulting in an irregularly contracted pupil
what is the likely organism for onychomycosis and what is the first line treatment?
trichophyton rubrum
terbinafine 6 weeks - 3 months (finger), 3 - 6 months (toe)
what is the complication and prognosis of uveitis?
temporary or permanent blindness
2/3rd patients in tertiary care qualify for prolonged visual loss during the course of their disease
22% qualify for blindness
what is the differential for a solitary thyroid nodule?
- thyroid adenoma/Plummer’s disease (toxic)
- thyroid cancer (papillary, medullary, follicular, anaplastic, lymphoma)
- thyroid cysts
where are the common sites of presentation for psoriasis?
extensor surfaces
behind the ear, on the scalp, navel and over sites of trauma (Koebner)
how do you manage pityriasis rosea?
itchy?
topical steroids and oral anti-histamines
non-intchy? (the majority)
no treatement needed
what are some of the features of anterior uveitis?
- pain
- lacrimation
- redness at the junction of the sclera and conjunctiva
- small/irregular pupil
- photophobia
what is an apraclonidine eye test?
apraclonidine - test for diagnosis of Horner’s syndrome
apraclonidine has no effect on the normal eye, but will dilate the pupil of an eye affected by Horner’s and reverse the ptosis
best appreciated in low light conditions
c/f cocaine eye test, will dilate the non-affected eye but have no effect on the eye affected by Horner’s (reuptake inhibitor, no catecholamines in the eye b/c sympathetic fibre disruption)
which has a worse prognosis: dry or wet ARMD?
wet ARMD
what is the skin condition associated with coeliac disease and what is the treatment?
dermatitis herpetiformis
dapsone PO daily
diagnosis?
cateract
what are the investigations of anterior uveitis?
slit lamp microscopy = inflammatory cells in the anterior chamber
fluorescein angiography to investigate retinal disease
what are the childhood conditions associated with cateract formation?
- congenital rubella
- carbohydrate metabolism disorders
- galactosaemia
- fructose intolerance
which medication are associated with exacerbation of psoriasis?
lithium, ACE-I, beta-blockers, anti-malarials
withdrawal of steroids
what is the significance of Horner’s syndrome without anhidrosis?
indicates a lesion of the preganglionic sympathetic nervous fibres after the bifurcation of the carotids
- or -
lesion of the postganglionic sympathetic nervous fibres
(investigate cavernous sinus with MRI head, or consider cluster headaches)
what should be investigated in sudden onset horner’s syndrome with associated neck or facial pain?
carotid artery dissection = MR angiography and referral to vascular surgeons
remember that preganglionic sympathetic nervous fibres travel up through the neck with the carotid artery to to cavernous sinus. dissection or aneurysm of the artery affects the preganglionic supply to the eye
what are some drops useful in the treatment of allergic conjunctivitis?
anti-histamine = emedastine or olopatadine
anti-inflammatory = prednisolone or sodium chromoglycate (mast cell-stabiliser)
artificial tears = carmellose, hypromellose
what are the causes of acanthosis nigracans?
-
malignancy
- GI cancer
-
endocrine
- diabetes mellitus
- PCOS
- Cushing’s disease
- acromegaly
- hypothyroidism
-
metabolic
- obesity
- familial
-
drugs
- OCP
- nicotinic acid
what are the preventative strategies against cataracts?
- stop smoking
- good diabetic control
- use sunglasses
- antioxidants (vitamin C and caffeine)
what are the bugs that can cause corneal ulcers?
bacteria - pseudomonas
viral - herpes simplex
fungal - candida, aspergillus
protozoal - acanthomoeba
how do you treat actinic keratoses?
- watchful waiting - pre-cancerous and should be monitored
- no treatment or emollient
- topical diclofenac (3%)
- topical 5-FU (5%) or imiquimod (5%)
- cryotherapy/photodynamic therapy
- surgical excision and curettage
how would you investigate cateracts?
examination: measure IOP, inspection of anterior chamber using slit lamp microscopy, fundoscopy
blood: glucose and HbA1c
what is the timing of the rash for Lyme disease?
bite, 7-10 days later will develop erythema multiforme
rash lasts 4-8 weeks
what is the treatment of cataracts?
conservative: observe the patient and plan ahead for surgery once acuity reaches a certain threshold
medical: mydriatic drops, good blood glucose control
surgical: lens removal and prosthetic lens implantation
(e.g. cannot read a number plate at 20 m and patient needs to drive)
what is the management of dry ARMD?
no medical treatment but can try to slow the progression
- stop smoking
- take antioxidants (beta-carotene, vitamin C)
what are the complications of cataract surgery?
immediate: 2% have major complications (rejection, haemorrhage, infection)
early: commonly will need long-distance glasses, dazzle/glare may persist
medium: post-operative posterior capsule thickening
late: higher risk of retinal detachment
what is the management of anterior uveitis?
call opthalmology immediately and ask for urgent review
need to be started on steroid drops (stop inflammatory changes and synechiae formation) and dilators (relieve spasm)
when do you get acanthomoeba keratitis?
poor contact lens hygene
e.g. swimming in a pool with them, sleeping in them, changing them with wet hands, not cleaning them with sterile wash solution
what are the features of Bechet’s disease?
-
ulcers
- oral
- genitoanal
-
skin
- erythema nodosum
- folliculitis
-
eyes
- anterior uveitis
- posterior uveitis
- optic neuritis
-
pathergy test
- skin prick, 48 hours review - ulcer formation
what are the causes of erythema nodosum?
infection (TB, streptococcus, brucellosis)
inflammation (sarcoidosis, Bechet’s, inflammatory bowel disease)
malignancy or lymphoma
drugs (penicillins, sulphonamides, COCP)
pregnancy
what is the treatment of psoriasis?
- emolients and topical potent corticosteroid (once daily) [betamethasone] and vitamin D analogue (once daily) [calcipotriol]
- no improvement after 8 weeks = vitamin D analogue [calcipotriol] 2x per day
- no improvement after 8-12 weeks = potent topical corticosteroid [betamethasone] 2x per day or coal tar preparation 1/2x per day
- if no response or cannot tolerate other treatments = topical calcineurin inhibitor [pimecrolimus, tacrolimus]
what are the major risk factors for the development of old age cateracts?
- diabetes millitus
- UV light exposure
- smoking & alcohol
- steroid use
diagnosis?
features to note?
- segmental redness of the sclera
- clear at the sclera/cornea margin
- inflammatory nodule
this is consistent with a diagnosis of nodular episcleritis**, most commonly reflecting an underlying rheumatological condition such as rheumatoid arthritis.
synechiae are features of what ocular condition?
anterior uveitis
diagnosis?
blepharitis
what are the treatments for hyperhydrosis?
- aluminium chloride
- iontophoresis
- botox injection
- sympathectomy
what is the differential diagnosis of a neck mass?
congenital
- thyroglossal cyst
- branchial cleft cysts
thyroid
- smooth/diffuse goitre
- multinodular goitre
- solitary nodule
lymphadenopathy
- bacterial
- viral - including HIV seroconversion
- granulomatous - sarcoidoss or TB
- malignant
vascular
- carotid artery aneurysm
- carotid body tumour
- jugular vein thrombosis
salivary
- sialadenitis
- salivary gland tumour
what are the complications of a large goitre?
- dysphagia
- dysponea/stridor/airway compromise
- recurrent laryngeal nerve compression
- Horner’s syndrome
- cerebrovascular steal syndromes
what are the types of thyroid cancer?
- papillary - differentiated, most common. associated with FAP/Gardner’s syndrome
- follicular - differentiated, needs core needle bx to determine from follicular adenoma
- anaplastic - elderly patientes, almost always fatal
- medullary - neoplasm of C cells, releases calcitonin that can be used as a biomarker. associated with MEN 2/phaeochromocytoma.
what is the management of differentiated thyroid cancers?
differentiated (papillary and follicular):
- surgical resection
- adjuvant chemotherapy
- radioiodine ablation
- levothyroxine - suppress TSH to below detectable on lab assay
what are the neurological signs of hypothyroidism?
- slow-relaxing reflexes (poor correlation)
- carpel tunnel syndrome
what are the features of Graves’ disease besides hyperthyroidism?
- thyroid eye disease
- thyroid acropatchy
- pretibial myxoedema
- goitre
what are the Rotterdam criteria for diagnosis of polycystic ovarian syndrome?
- polycystic ovaries (>12 follicles, or ovarian volume >10 cm3 on US)
- menstrual abnormalities (oligomenorrhoea or anovulation)
- hyperandrogenism (clinical and/or biochemical)
how do you treat PCOS?
cardiovascular
- weight loss
- metformin
gynae
- clomifene for ovulation induction
- 2nd line = ovarian drilling
- COCP to control the cycle
- if patient doesn’t want contraception then offer progesterone-only withdrawal bleed induction every 3-4 months to reduce the incidence of endometrial CA
derm
- depilation creme, shaving, laser, electolysis
- cytoproterone PO
- eflornithine topical (also anti-acne)
- spirnonlactone PO (CI: pregnancy)
what is the result of serum glucose in diabetes insipidus?
normal
must be ordered when working up for DI in order to rule out DM as a cause of the polyuria/polydypsia
what is the most common subtype of malignant melanoma?
what are the others (give brief description)?
-
superficial spreading (80%)
- irregular borders, colour variation
- white patients
- grow slowly, metastasise late
-
lentigo maligna
- elderly patients
- grows on face or scalp
-
acral lentiginous
- black patients
- palms or soles of feet
-
nodular melanoma
- worse prognosis
- grow deep quickly
- amelanotic
where does melanoma metastasise to ?
liver
lungs
brain
bone
VZV affecting which nerve will threaten eye-sight?
nasociliary branch of the trigeminal nerve
starts with a vesicular erruption on the nose tip, leading to imminent cornel involvement (ulceration)
how do you treat herpetic/VZV corneal ulceration?
aciclovir ointment
oral aciclovir (800 mg 5x per day)
cycloplegic eye drops to relieve ciliary muscle spasm (PRN)
are acids or alkali more damaging in a chemical ocular injury?
alkali
which structures are damaged in lateral, medial, inferior and superior orbital penetrating injury?
medial - lacrimal duct, canal and gland
lateral - lateral rectus
inferior - inferior oblique, infra-orbital nerve, tarsal plate
superior - levator palpabrae superioris, penetrate the orbital septum
