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Year 3 revision > Ophthalmology and dermatology revision > Flashcards

Ophthalmology and dermatology revision Flashcards

1
Q

what are coloured haloes a sign of

A

acute angle closure glaucoma

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2
Q

pupil in AACG

A

fixed mid dilated

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3
Q

iris in AACG

A

hazy

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4
Q

2 surgeries for AACG

A

iridotomy

cataract surgery

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5
Q

type of blindness in GCA

A

amaurosis fugax or sudden unilateral blindness

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6
Q

4 blood tests which are increased in GCA

A

ESR
CRP
platelets
ALP

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7
Q

2 treatments for GCA

A

high dose steroids 2 years

aspirin

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8
Q

what is chemosis (swelling of conjunctiva) a sign of

A

orbital cellulitis

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9
Q

which CN palsy can diabetes and hypertension cause

A

CN III

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10
Q

infection causing CN palsy

A

Lyme disease

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11
Q

what CN lesion can a SoL cause

A

CN VI (abducens)

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12
Q

sign of meningeal/cavernous sinus tumour

A

multiple CN palsies

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13
Q

sign of a posterior communicating artery aneurysm

A

unreactive pupil

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14
Q

how can MS cause Horner’s syndrome

A

demyelination - 1st order nerve

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15
Q

2 other causes of Horner’s syndrome from 1st order nerve

A

neck trauma

meningitis

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16
Q

4 causes of Horners from 2nd order nerve

A

pancoast tumours
AAAs
neuroblastoma
lymphadenopathy

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17
Q

4 causes of Horners from 3rd order nerve

A

cluster headache
herpes
GCA
Raeders syndrome

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18
Q

2 viruses which can cause infectious conjunctivitis (usually bacterial)

A

adenovirus

HSV

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19
Q

2 abx for bacterial conjunctivitis

A

azithromycin

topical tetracycline

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20
Q

discharge in bacterial vs viral conjunctivitis

A 
bacterial = purulent
viral = watery
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21
Q

what type of corneal ulcers can HSV cause

A

dendritic ulcers

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22
Q

4 causes of iritis

A

RA
sarcoidosis
HSV
VZV

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23
Q

3 symptoms of iritis (anterior uveitis) AND posterior uveitis - 3 Ps

A

progressive blurred vision
pain and redness
photophobia

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24
Q

2 symptoms of intermediate uveitis

A

painless floaters

decrease in vision

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25
Q

difference between iritis and posterior uveitis

A 
anterior/iritis = unilateral
posterior = bilateral
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26
Q

what ie herpetic uveitis

A

atrophy of iris - sign of iritis

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27
Q

2 signs of posterior uveitis

A

inflammation of retinal vessels

optic nerve oedema

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28
Q

5 investigations for uveitis

A 
FBC, ESR
ANA 
Mantoux test
CXR
urinalysis
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29
Q

why do ANA for uveitis

A

SLE?

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30
Q

why do Mantoux test for uveitis

A

TB? (intradermal injection of tuberculin = test for immunity)

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31
Q

4 ways to manage uveitis

A

cycloplegic drugs = paralyse ciliary body
steroid eye drops
immunosuppressors = cyclosporin, tacrolimus
vitrectomy

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32
Q

treatment of episcleritis

A

NSAIDs

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33
Q

2 complications of posterior scleritis

A

RD

proptosis

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34
Q

4 symptoms of posterior scleritis

A

dull radiating pain
movement makes pain worse
decrease in vision
severe inflammation and erythema

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35
Q

type of scleritis associated with RA

A

necrotising anterior scleritis

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36
Q

4 treatments for scleritis

A

oral NSAIDs
prednisolone
biologics
surgery

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37
Q

4 treatments for necrotising anterior scleritis

A

artificial tears
steroids
immunosuppression
surgery

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38
Q

what is conjunctival injection

A

enlargement of conjunctival vessels (redness) = sign of corneal abrasion

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39
Q

what is Seidel’s test

A

fluorescein with blue light to see if aqueous fluid is coming out = epithelial defect seen in corneal abrasion

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40
Q

investigation for vitreous haemorrhage

A

IOP

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41
Q

what is a rhegmatogenous retinal detachment

A

from PVD

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42
Q

what is an exudative retinal detachment

A

serous and haemorrhagic fluid in sub retinal space

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43
Q

RAPD result if mac has detached in RD

A

positive

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44
Q

3 causes of retinal artery occlusion

A

atherosclerosis
GCA
prothrombotic problems

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45
Q

cause of amaurosis fugax

A

transient retinal ischaemia - from CRVO/BRVO/CRAO/BRAO

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46
Q

origin of embolus causing retinal occlusion

A

carotid/heart

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47
Q

4 risk factors for cataracts

A

smoking
diabetes
systemic steroids
uveitis

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48
Q

pupil reflexes in cataracts

A

normal

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49
Q

3 optic disc signs of open angle glaucoma

A

cupping
pallor
splinter haemorrhages

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50
Q

what is an urgent IOP

A

> 30

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51
Q

4 medications for open angle glaucoma

A

eye drops to reduce IOP
prostaglandin analogues
beta blockers
selective alpha-2 receptor antagonists

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52
Q

type of eye drops to reduce IOP

A

carbonic anhydrase inhibitors

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53
Q

type of drug causing blocked nasolacrimal duct

A

chemotherapy

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54
Q

6 clinical features of blocked nasolacrimal duct

A 
increased tearing
redness of sclera
eye infections
crusting of eyelids
blurred vision
mucous/pus discharge from lids/eye
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55
Q

4 treatments for blocked nasolacrimal duct

A

antibiotics
dilation/flushing
stenting
surgery (dacryocystorhinostomy)

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56
Q

3 causes of tear deficient dry eyes

A

sjogrens
blepharitis
lacrimal gland obstruction

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57
Q

4 causes of evaporative dry eyes

A

contacts
allergic conjunctivitis
blink disorders e.g. PD
Meibomian glans dysfunction = decreased lipid in tear film

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58
Q

3 signs of blepharitis

A

sore/gritty
bilateral
edges of eyes red and swollen

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59
Q

3 risk factors for eyelid BCC

A

X-rays
UV
arsenic

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60
Q

5 treatments for eyelid BCC

A 
excision (4mm margin)
curettage/cautery
cryotherapy
creams
photo/radiotherapy
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61
Q

2 creams for eyelid BCC

A

imiquimod

fluorouracil

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62
Q

2 risk factors for eyelid SCC

A

pipe smoking/tar

HPV

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63
Q

how to diagnose eyelid BCC

A

excisional biopsy + FNA of lymph nodes

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64
Q

treatment for eyelid BCC

A

radiotherapy

diclofenac for actinic keratoses

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65
Q

condition associated with Meibomian gland carcinoma (carcinoma of eyelid)

A

history of upper lid chalazia (benign painless lump on inside eyelid)

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66
Q

3 clinical features of Meibomian gland carcinoma

A

yellow eyelid thickening
painless
may spread to conjunctiva = remove eye?

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67
Q

treatment of Meibomian gland carcinoma

A

wide excision

SN biopsy

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68
Q

dots vs blots

A 
dots = microaneurysms
blots = haemorrhages
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69
Q

4 features of diabetic maculopathy

A

oedema
ischaemia
exudates
retinal thickening

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70
Q

4 risk factors for diabetic eye disease

A

DM duration
hypertension
renal disease
pregnancy

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71
Q

type of intravitreal steroid used to treat macular oedema

A

fluocinolone

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72
Q

2 treatments for exophthalmos from GD

A

prednisolone

lacrilube

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73
Q

5 causes of optic atrophy

A 
chronic glaucoma
optic neuritis
trauma
lesions
CRAO/CRVO
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74
Q

3 signs of optic atrophy

A

axon loss
myelin shrinkage
optic cup widening

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75
Q

3 symptoms of choroidal melanoma

A

scotoma
floaters
decrease in visual field

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76
Q

derm condition associated with choroidal melanoma

A

xeroderma pigmendosum and naevi

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77
Q

2 investigations for choroidal melanoma

A

USS

LFTs

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78
Q

3 treatments for choroidal melanoma

A

laser photocoagulation
radiotherapy
enucleation/brachytherapy

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79
Q

4 steps in Keith Wagener Barker (KWB) grading of hypertensive retinopathy

A
  1. vascular attenuation
  2. AV nipping (Salu’s sign)
  3. retinal oedema, cotton wool spots, copper wiring
  4. optic disc swelling, macular star (silver wiring)
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80
Q

3 causes of unilateral optic disc swelling

A

optic neuropathy
retinal vein occlusion
diabetic papillopathy

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81
Q

infection which can cause bilateral optic disc swelling

A

Lyme disease

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82
Q

what are honey-coloured crusted erosions a sign of

A

impetigo

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83
Q

3 risk factors for impetigo

A

atopic eczema
scabies
skin trauma e.g. bites, dermatitis

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84
Q

most common cause of impetigo

A

s. aureus

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85
Q

3 types of impetigo

A 
non-bulbous = usually staph
ecthyma = strep, necrotic
bullous = strep, transparent bullae
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86
Q

3 complications of impetigo AND intertrigo

A

SSTI e.g. cellulitis
staphylococcal scalded skin syndrome
post-streptococcal glomerulonephritis

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87
Q

features of erysipelas

A

well-defined red raised border

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88
Q

2 signs OE for necrotising fasciitis

A

oedema

crepitus

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89
Q

4 risk factors for cellulitis and erysipelas

A

venous disease
immunodeficiency
pregnancy
diabetes

90
Q

2 bacteria causing cellulitis and erysipelas

A

s. aureus

s. pyogenes

91
Q

2 antibiotics for cellulitis and erysipelas

A

flucloxacillin

benzylpenicillin

92
Q

2 bacteria causing folliculitis

A

S. aureus

pseudomonas aeruginoas

93
Q

2 viruses causing folliculitis

A

HSV

VZV

94
Q

2 fungi causing folliculitis

A

candida

tinea capitis

95
Q

2 infestations causing folliculitis

A

mites scabies

96
Q

drug for viral folliculitis

A

acyclovir

97
Q

what is intertrigo

A

rash in flexures - worsened by obesity and sweat

98
Q

difference between infectious and inflammatory intertrigo

A 
infectious = unilateral
inflammatory = bilateral
99
Q

symptom of adult chickenpox

A

prodromal symptoms 48 hours before rash (fever, malaise, headache, abdo pain)

100
Q

treatment of chickenpox in immunocompromised

A

IV acyclovir

101
Q

3 complications of chickenpox in children

A

bacterial infection
viral pneumonia
dehydration (D+V)

102
Q

3 complications of chickenpox in immunocompromised and adults

A

disseminated varicella infection
encephalitis
thrombocytopenia and purpura

103
Q

most common areas for shingles

A

chest
neck
forehead
lumbar/sacral regions

104
Q

drug for shingles

A

acyclovir

105
Q

what is eczema herpeticum

A

severe and widespread infection, blisters

106
Q

what is erythema multiforme

A

severe, symmetrical plaques on head, forearms, feet and lower legs, targeted lesions with central blisters

107
Q

what are eczema herpeticum and erythema multiforme complicatiosn of

A

herpes simplex

108
Q

skin manifestatino of HIV

A

pruritis papular eruption - form of prurigo

109
Q

3 dermatological symptoms of acute HIV infection syndrome

A

erythematous maculopapular rash
mucucutaneous ulceration
rash symmetrical involving face, palms, soles

110
Q

2 treatments for pruritic papular eruption

A

topicals e.g. steroids

phototherapy

111
Q

incubation period of viral warts

A

up to 12 months

112
Q

cause of molluscum contagiosum

A

poxvirus - skin to skin, indirect, auto-inoculation, sexual transmission

common in children in warm/moist places e.g. flexures

113
Q

2 medical treatments for molluscum contagiosum (otherwise do laser or cryotherapy)

A

hydrogen peroxide

salicylic acid

114
Q

secondary infection in molluscum contagiosum

A

impetigo

115
Q

topical and oral antifungal for tinea AND candida AND pityriasis versicolor

A 
topical = terbinafine
oral = itraconazole
116
Q

why avoid topical steroids in tinea

A

can cause tinea incognito (less scaly)

117
Q

3 types of candidiasis

A

oral
intertrigo (in between fingers)
vulvovaginal

118
Q

cause of pityriasis versicolor

A

malassezia furfur (fungus) - in young adults and males

119
Q

what is sign of Leser-Trelat

A

sudden eruption of multiple seb Ks = sign of underlying internal malignancy

120
Q

difference between lipomas in men and women

A 
men = multiple 
women = solitary
121
Q

3 types of epidermoid cysts (epidermal cell proliferation, asymptomatic)

A

follicular infundibular
epidermal
keratin

122
Q

4 features of epidermoid cysts

A

skin coloured/yellow
firm
round nodules
central puncture?

123
Q

what are dermatofibromas also called

A

histiocytomas - fibroblast proliferation

124
Q

location and common cause of dermatofibromas

A

lower legs

after insect bite

125
Q

4 features of dermatofibromas (no treatment required)

A

firm
dermal nodules/papules
usually <1cm
skin dimples upon compression

126
Q

what are skin tags called

A

fibroepithelial polyps

127
Q

3 things contributing to skin tags

A

irritation
insulin resistance
HPV
high levels of growth factor hormones

128
Q

cells involved in BCC and SCC

A

epidermal keratinocytes

129
Q

DNA mutation involved in BCC

A

PTCH tumour suppressor gene

130
Q

syndrome increasing risk of BCC

A

Gorlin syndrome

131
Q

most common type of BCC

A

nodular

132
Q

more aggressive type of BCC

A

morphoeic (waxy plaque, ill-defined borders, sclerosing)

133
Q

2 topical treatments for BCC

A

fluorouracil

imiquimod

134
Q

pre-malignant skin disease associated with SCC

A

actinic keratoses - stratum basale contains atypical keratinocytes

135
Q

virus associated with SCC

A

HPV

136
Q

what is Bowen’s disease

A

SCC in situ - usually one slowly enlarging scaly erythematous patch

137
Q

rule of 2s for SCC

A

high risk if >2cm diameter and/or >2mm thickness

138
Q

drug increasing risk of melanocytic naevi (moles)

A

BRAF inhibitor e.g. vemurafenib

139
Q

3 types of naevi

A

junctional - flat
compound - raised, hairy
intradermal - hairy, paler

140
Q

gene mutation contributing to melanoma

A

BRAF mutation

141
Q

most common type of melanoma

A

superficial spreading

142
Q

what is superficial spreading melanoma associated with

A

high intensity UV exposure - on legs?

143
Q

3 other types of melanoma

A
  • lentigo maligna (face, long term UV)
  • sacral lentiginous (palms, soles, nails)
  • nodular (deeper in skin, trunk, high UV)
144
Q

2 treatments for widespread melanomas

A

immunotherapy e.g. IL-2

biologics e.g. BRAF inhibitor

145
Q

Breslow thickness for melanoma numbers

A 
<1mm = low risk
1-4mm = medium risk
>4mm = high risk
146
Q

Clark levels for measuring risk of melanoma mets

A 
1 = in situ
2 = invasion papillary dermis
3 = complete invasion papillary dermis
4 = invasion reticular dermis
5 = invasion subcutaneous tissue
147
Q

3 types of drug eruptions

A

morbilliform
ACEP (acute generalised exanthematous pustulosis)
DRESS (drug hypersensitivity syndrome)

148
Q

2 features of morbilliform

A

fever

maculopapular rash

149
Q

what can morbilliform progress to

A

erythroderma/TEN

150
Q

6 drugs causing morbilliform

A 
penicillin
erythromycin
carbamazepine
allopurinol
NSAIDs
phenytoin
151
Q

4 treatments for morbilliform, AGEP and DRESS

A

stop drug
antihistamines
emollients
topical steroids

152
Q

5 clinical features of AGEP

A
  • starting in face and flexures
  • erythema with widespread pustules (sterile)
  • may have fever
  • rash present for 1-2 weeks
  • neutrophil leucocytosis
153
Q

6 drugs causing AGEP

A 
tetracyclines
antifungals
CCBs
paracetamol
hydroxychloroquine
carbamazepine
154
Q

3 drugs causing DRESS

A

antiepileptics
sulphonamides
allopurinol

155
Q

6 features of erythroderma

A 
exfoliative dermatitis
pruritus
hair loss
hyperkeratosis palms/soles
lymphadenopathy
affects entire skin surface
156
Q

5 complications of erythroderma

A
  • secondary infection
  • loss of thermoregulation
  • high output cardiac failure
  • fluid and electrolyte imbalance
  • hypoalbuminaemia
157
Q

5 drugs causing erythroderma

A
  • drugs
  • psoriasis
  • dermatitis
  • cutaneous T-cell lymphoma, systemic malignancy
  • HIV
158
Q

4 treatments for erythroderma

A

emollients
thermoregulation, fluid balance
antibiotics
antihistamine

159
Q

dermatological emergencies from mild to severe

A

EM < SJS < TEN

160
Q

type of hypersensitivity in erythema multiforme EM

A

type IV

161
Q

usual cause of EM

A

hypersensitivity reaction to HSV (but 50% idiopathic)

162
Q

5 risk factors for EM

A 
male
pregnancy
live vaccines
IBD
chemo/radiotherapy
163
Q

type of lesions in EM

A

true target lesions, 70% have mucosal involvement

164
Q

FBC result in EM

A

leukocytosis, atypical lymphocytes, eosinophilia, neutrophilia, anaemia/thrombocytopenia

165
Q

2 treatments for EM

A

antihistamines

topical steroids

166
Q

preventative treatment for EM

A

oral acyclovir 6-12 months

167
Q

3 differences between features of EM vs SJS/TEN

A

EM = true target lesions, SJS/TEN = targetoid lesions

EM = mucosal involvement, SJS/TEN = mucous membrane erosion and crusting

also oedema, necrosis, epidermal detachment etc in SJS/TEN

168
Q

common cause of EM major/SJS/TEN

A

drugs

169
Q

what is SCORTEN

A

severity of illness score for TEN - 0-5, >3 = ICU

170
Q

cause of generalised pustular psoriasis (GPP) - systemic illness + systemic symptoms

A

abnormalities in cytokine IL-36 receptor antagonist signalling - recessive IL35RN gene mutations

171
Q

3 trigger factors for flares of GPP

A

sudden withdrawal of injected/oral corticosteroids
drugs
infection

172
Q

5 drugs triggering flares of GPP

A 
lithium
aspirin
indomethacin
iodide
some beta blockers
173
Q

type of biopsy for GPP

A

skin biopsy - sub corneal pustules and neutrophilic infiltration

174
Q

5 complications of GPP

A 
cardiorespiratory failure = death?
secondary bacterial infection
anaemia
low albumin, calcium and zinc
renal and liver impairment
175
Q

type of retinoid to use for GPP

A

acitretin

NB: also use other drugs e.g. abx, steroids, immunosuppressors, biologics

176
Q

3 skin manifestations of diabetes

A

acanthuses nigracans
necrobiosis lipodica - granulomatous skin disorder
thrush

177
Q

what is erythema nodosum

A

tender bruise-like panniculitis (fat inflammation) - young women lower legs, 50% unknown cause

178
Q

5 causes of erythema nodosum

A

infections (strep, TB)
drugs (antibiotics, aspirin)
pregnancy/OCP
IBD

179
Q

3 types of lupud

A

discoid (DLE)
sub-acute cutaneous (SACLE)
systemic (SLE)

180
Q

what is morphoea

A

ivory oval sclerotic plaques + inflamed edge - usually result in post-inflammatory pigmentation and dermal atrophy

181
Q

3 features of necrobiosis lipodica

A

tender yellow/brown patches lower legs
centre of patch becomes shiny, pale, thinned + telangiectasia
ulceration?

182
Q

9 treatments for NL

A
  • topical steroids, steroid injections or tablets
  • aspirin and dipyridamole combination
  • oxypentifylline tablets
  • niacinamide
  • oral ciclosporin
  • biologic agents
  • photochemotherapy (PUVA)
  • photodynamic therapy
  • fumaric acid esters
183
Q

what is granuloma annulare (GA)

A

necrobiotic papulosis (smooth discoloured plaques) - delayed hypersensitivity reaction

184
Q

condition associated with localised GA

A

Hashimoto’s - doesn’t clear up with thyroid replacement

185
Q

5 conditions associated with extensive GA

A 
DM
hyperlipidaemia
lymphoma
HIV 
solid tumours
186
Q

2 differences between localised and generalised GA

A

localised = children, generalised = adults

localised = bumps over joints, generalised = patches in skin folds of trunk

187
Q

4 local therapies for GA

A

topical steroids
steroid injections
cryotherapy
laser ablation

188
Q

5 systemic treatments for GA

A 
systemic steroids
isotretinoin
methotrexate
PUVA
ciclosporin
189
Q

most common location of lichen sclerosus

A 
women = skin of anogenital region
men = glans penis and foreskin
190
Q

why can LS cause constipation in women

A

perianal lesions in 30%

191
Q

2 symptoms of LS in men

A

dyspareunia, painful erections

poor urinary stream or dysuria

192
Q

difference between LS in . men vs women

A

women = itchy, men = not itchy

193
Q

treatment of female LS

A

clobetasol propinate reducing course

194
Q

treatment of male LS

A

topical steroids OD then reduce

195
Q

5 cutaneous features of dermatomyositis

A
  • reddish/purple patches on sun-exposed areas
  • purple eyelids (heliotrope)
  • scaly scalp and thinned hair
  • purple papules or plaques on knuckles
  • ragged cuticles and prominent blood vessels on nail folds
196
Q

2 treatments for dermatomyositis

A

oral steroids

immunosuppressors e.g. methotrexate

197
Q

4 treatments for vitiligo

A

topical steroids
topical pimecrolimus or tacrolimus
narrow-band UVB phototherapy
surgical

198
Q

6 symptoms of cutaneous vasculitis

A 
palpaple purpura
petechiae
urticaria
ulcers
livedo reticularis
nodules
199
Q

cause of bullous pemphigoid

A

autoimmune - against antigens between epidermis and dermis

200
Q

4 conditions associated with diabetes

A

granuloma annulare
necrobiosis lipodica
pyoderma granulosum
dermatomyositis (25% have underlying malignancy)

201
Q

2 conditions associated with acanthosis nigricans

A

diabetes

gastric carcinoma

202
Q

where are acral skin lesions

A

distal areas, hands and feet

203
Q

ABCDE for naevi etc

A 
asymmetry
border
colour
diameter (>6?)
evolution
204
Q

what are confluent lesions

A

appear to be merging together

205
Q

target vs annular lesions

A

target = concentric rings of varying colours e.g. erythema multiforme

annular = ring-like

206
Q

cause of erythema vs purpura

A

erythema = increased blood supply (blanches)

purpura = bleeding into skin (doesn’t blanch)

207
Q

what are petechiae

A

small red/purple spots <2mm width - type of purpura

208
Q

what is ecchymosis

A

larger red/purple lesions >2mm - type of purpura (bruise)

209
Q

what is a macule

A

flat area of altered colour <1.5cm diameter

210
Q

what is a patch

A

flat area of altered colour >1.5cm diameter

211
Q

what is a papule

A

solid raised palpable lesion <0.5cm diameter

212
Q

what is a nodule

A

solid raised palpable lesion >0.5cm diameter

213
Q

what is a plaque

A

palpable flat lesion usually >1cm diameter, most raised, borders may be well defined or poorly defined

214
Q

what is a vesicle

A

raised, clear fluid filled lesion <0.5cm diameter

215
Q

what is a bulla

A

raised, clear fluid filled lesion >0.5cm diameter

216
Q

what is a pustule

A

pus containing lesion <0.5cm diameter

217
Q

what is a wheal

A

oedematous papule or plaque caused by dermal oedema

218
Q

what is a boil/furuncle

A

staphylococcal infection around or within a hair follicle

219
Q

what is a carbuncle

A

staphylococcal infection of adjacent hair follicles (multiple boils/furuncles)

220
Q

excoriation vs lichenification

A

loss of epidermis - trauma

lichenification = thickening of epidermis

221
Q

scales are

A

visible fragments of stratum corneum as it is shed from the skin (psoriasis?)

222
Q

keloid vs hypertrophic scar

A

hypertrophic = hyperproliferation of scar tissue WITHIN wound boundary

keloidal = hyperproliferation of scar tissue BEYOND wound boundary

Year 3 revision (9 decks)

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