Special Senses Mock OSCE Content Flashcards
What are black charcoal wound swabs for? How do you use them?
bacterial infections e.g. infected venous ulcers
1) pop off the cap and moisten tip of the swab with some of the charcoal within
2) roll the swab 360 degrees in one direction (don’t go back on yourself) in the most purulent area of the wound
3) Reseal swab straight away to prevent cross contamination
What are green wound swabs for? How do you use them?
viral infections (e.g. throat swab, nose swab, swab of viral lesions e.g. HS1)
1) moisten swab with sterile saline
2) if swabbing intact vesicle then burst with gentle lateral pressure
3) roll the swab 360 degrees in one direction and reseal
How do you treat non bullous impetigo?
topical fusidic acid BD/TDS for 7 days
How do you treat herpes on the lips?
can leave to self resolve
or give topical aciclovir 5% cream for 5-7 days
give hygeine advice
If a culture report of a bacterial swab for a venous ulcer comes back with “mixed colliform” presence, what does this suggest?
it is not infected - this is normal bacteria that is present on the skin
How many types of UV rays are there?
Which are the main 2 to be aware of?
How can you explain this to patients?
there are 3 types of UV rays, the main ones being UVA and UVB
UVA: has a longer wavelength, can penetrate windows, causes sun damage and wrinkling
UVB: has a shorter wavelength, causes burns
There are 3 types of UV rays from the sun that can damage your skin and you need to avoid all of them - light clothing with long sleeves, wide brimmed sun hats, suncream which protects you against UVA and UVB e.g. Altruist, even sun protection when indoors
Why is it so important to admit children with eczema herpeticum to hospital for iV aciclovir?
risk of encephalitis
Outline the tx ladder for BCC
superificial lesion = topical agents
nodular lesion = surgical excision or radiotherapy
mixed morphology or special site = Mohs micrographic surgery
What topcial agents can be used in the tx of BCC?
Imiquimod
5-Flurouracil (Effudix)
How does 5-FU work?
topical chemotherapy
binds to surface of keratinocytes and arrests the cell cycle
warn patients that it will be very sore because it is killing the cancer cells in the top layer of the skin but that it will resolve in a few weeks
Outline the tx ladder for Actinic Keratoses
mild damage/ single lesion = urea based emollients and sunscreen
1-5 lesions = diclofenac gel
widespread damage = 5-fluorouracil, imiquimod, tirbanibulin ointment
Why is Diclofenac useful for pre-cancerous lesions?
reduces cell turnover and is anti-angiogenic
Outline the tx ladder for atopic dermatitis
1) topical therapy: soap substitutes, emollients, topical steroids
2) light therapy : nbUVB
3) systemic therapy
4) biologic therapy
Should you routinely offer allergy tests for atopic dermatitis?
No
How can you calculate disease severity for atopic dermatitis?
EASI score
How can you calculate disease severity for psoriasis?
PASI score
How can you calculate disease impact on QoL for patients with skin conditions?
DLQI score
Outline the treatment ladder for psoriasis
1) topical therapy
2) light therapy
3) systemic therapy
4) biologic therapy
Give 3 topical therapies that may be used in psoriasis treatment.
What can be used in combination with all of these?
salicylic acid , calcipotriol , coal tar
topical steroid
What light therapies can be used in psoriasis management?
nbUVB
PUVA - more powerful than UVB, can be carcinogenic and cause GI side effects
What does PUVA light therapy involve?
Psoralen tablet (photosensitizers) followed by UVA exposure
When should you move onto biologic tx for psoriasis ?
2 of these options have failed:
light therapy
methotrexate, ciclosporin, astretin
What is the first line biologic in psoriasis mx?
TNF-alpha
What do you need to counsel psoriasis patients on?
metabolic syndrome risk factors - e.g. diet, BMI, smoking
psoriasis causes increased risk of metabolic syndrome due to inflammation of the vessels
all patients should receive a QRisk assessment
What areas do you need to check in patients with psoriasis?
nails , joints, scalp, genitals
24 year old surfer comes in complaining of reduced hearing in the right ear and repeatedly feeling water trapped in his right ear when surfing reduced hearing.
From the hx and otoscopy, what is your diagnosis?
How would you manage?
Osteoma - visible lesion in the ear canal, may see some tympanosclerosis
keep ear dry and if it is causing issues then can drill out
31 year old woman presents with ear pain and discharge. She was recently treated with antibiotics for an ear infection but it only seems to have gotten worse.
From the hx and otoscopy, what is your diagnosis?
How would you manage?
Fungal otitis externa - can see fungal hyphae and yellow spores, classical hx of being worsened by abx
requires microsuction clearing and potentially a tympanoplasty in the future
A 26 year old man presents with a ‘blocked’ left ear with reduction in hearing after having had a bad cold for the past few weeks.
From the hx and otoscopy, what is your diagnosis?
How would you manage?
otitis media with effusion- can see fluid bubbles and some patches of tympanosclerosis
carry out pure tone audiometry and tympanometry and can just do ‘watchful waiting’
if it doesn’t resolve can trial Otovent or surgery to insert grommets
What is your diagnosis for this patient based off of their otoscopy? How would you investigate?
**cholesteatoma **
audiometry, CT scan and mastoid exploration
An adult presents with sudden onset reduction in hearing.
What is your diagnosis for this patient based off of their otoscopy? How would you manage?
**Tympanic membrane perforation **
keep ear dry, follow up in 2 months and if unresolved or significant hearing loss consider tympanoplasty
don’t need ear drops in an adult as it should self resolve
An 8 year old presents because his parents are concerned that he doesn’t seem to be listening to them and they have to shout to get him to listen. His speech and language also appears delayed.
What is your diagnosis for this patient based off of their otoscopy? How would you manage?
Otitis media with effusion - may see grey, dull retracted membrane with radial vessels
audiometry, follow up within 3 months, referral for adenoidectomy and grommet insertion
This fundoscopy is taken from a 6 month old infant.
What is your diagnosis and how would you investigate further?
Multiple retinal haemorrhages
Shaken baby syndrome (NAI)
Also consider meningitis, SOL and haem disorders
Skeletal survey, CT head, haem investigations
What is seen on this fundoscopy?
How would you investigate it further?
Choroidal Naevus - large pigmented lesion on peripheral retina
Important DDx = Primary Ocular Malignant Melanoma!!!
B Scan Ultrasound
Optomap Imaging
OCT
What is seen on this fundoscopy?
How would you investigate it further?
How would you manage?
Branch Retinal Vein Occlusion - haemorrhages along specific vascular arcade
DDx: diabetic retinopathy, hypertensive retinopathy
Do OCT to assess for macular oedema
Consider fluorescein angiography
Give Anti-VGEF medications and ensure any diabetes is well controlled
What is seen on this fundoscopy?
How would you investigate it further?
How would you manage?
Drusen on the macula - dry AMRD
Ix: OCT, fluorescein angiography if wet ARMD suspected
Mx: monitor vision, smoking cessation, healthy diet, vitamin supplementation
A patient presents with a homonymous hemianopia and normal visual acuity and normal fundoscopy. They are also experiencing unilateral weakness.
What underlying diagnosis do you suspect?
How would you investigate?
homonymous hemianopia with macular sparing (good vision) = posterior circulation stroke
non-contrast CT head
can also do OCT and fundus photography but emergency mx comes first
What can be seen on this fundoscopy image?
peripapillary atrophy - pallor surrounding the optic disc
in Central Retinal Artery Occlusion there is usually an obvious clot and total or sectoral pallor
A young woman presents with blurring of vision and recurrent headaches. She is on the COCP and has nil significant PMH.
Based off of her history and fundoscopy what is your top ddx?
How would you investigate and manage?
Papilloedema due to venous sinus thrombosis
DDx: SOL, meningitis, IIH (dx of exclusion)
Ix: Ishihara colour vision, visual fields, OCT, CT/MRI, Venography
