ENT/derm/ophthal

Question 1

Malignant tumour of epidermal keratinocytes

Answer 1

SCC

Question 2

What is a +ve Rinnes test

Answer 2

NORMAL i.e. air conduction is better than bone conduction

Question 3

Weber test - what is the result if the LEFT ear is a) SN loss b) conductive loss

Answer 3

a) louder in the right ear
b) louder in the left ear

Question 4

Telogen vs anagen effluvium

Answer 4

Telogen - stress (physiological)
Anagen - chemo

Question 5

Pterygium vs Pinguecula

Answer 5

Pterygium grow over the edge of the cornea, pinguecula don’t

Question 6

Complications of peritonsillar abscess

Answer 6

• necrotising fasciitis of deep neck tissues
• spread to cause pericarditis, mediastinitis, pleural effusion

Question 7

Chalazion vs stye

Answer 7

Chalazion - blocked meiobian gland, usually painless
Stye - infected eyelash follicle, painful, edge of eyelid

Question 8

Clinical fx of keratoconus + management

Answer 8

• bilateral blurred vision + myopia
• Munsons sign

contacts/glassess –> corneal transplant

Question 9

Management of fungal nail infection

Answer 9

1. Conservative (if asymptomatic)
2. if mild (<2 nails, <50% nail involved) - topical amorolfine 5%
   3) if >2 nails, >50% nail involved: oral terbinafine for months

Question 10

Most frequently used drugs which are ototoxic are..?

Answer 10

Aminoglycosides: gentamicin
Loop diuretics

Question 11

Location of lesion associated with homonymous hemianopia

Answer 11

optic tract (posterior to optic chiasm)

Question 12

Location of lesion associated with homonymous hemianopia with macular sparing

Answer 12

Optic radiation

Question 13

Metamorphosia, grey patch in central field of vision, abnormal dark adaptation - diagnosis?

Answer 13

AMD

Question 14

Molluscum - cause?
Conservative management advice?

Question 15

Glasgow 7 of melanoma signs

Answer 15

size
shape
colour
diameter >7mm
inflammation
exudate/bleeding
itch/odd sensation

Question 16

4 conditions associated with nasal polyps

Answer 16

Asthma
Hayfever
Aspirin hypersensitivity
CF

Question 17

What is Horners syndrome?
- Signs?
- Causes?

Answer 17

Interrupted sympathetic supply to eye
- ptosis, miosis, anhydrosis
- CENTRAL cause - stroke/ MS
- PREGANGLIONIC causes: Pancoast tumour, mediastinal/thyroid mass, neck surgery/trauma
- POSTGANGLIONIC cause: carotid artery dissection, otitis media, head/neck trauma

Question 18

CN3 palsy
- 3 features?
compressive vs ischemic

Answer 18

1. down and out pupil
2. ptosis
3. dilated pupil in COMPRESSIVE causes (fibres are superficial of nerve)

Question 19

Optic vs oculomotor nerve action

Answer 19

Optic nerve detects light entry to the eye
Oculomotor nerve causes pupillary constriction

Question 20

Argyll Robertson vs Holmes Adie Pupil

Answer 20

• ARP = accomodation reflex present (brisk), sluggish light reflex. SMALL pupils
• HAP = large irregular pupils, with . also responds normally to accom and poorly to light

Question 20

Pemphigoid gestationis
- distribution?

Answer 20

Periumbilical region, then spreads to trunk/back/buttocks/arms

Question 21

Scabies
1st line treatment?

Answer 21

Permethrin 5%

Question 22

2 topical treatments for superficial BCCs

Answer 22

imiquimod, 5 FU

Question 23

A lesion which mimics SCC?

Answer 23

Keratoacanthoma

Question 24

Keratitis from UV exposure - typical presentation? - management?

Answer 24

Presentation: 6 hours post UV exposure with pain and watery eye. Punctate erosions on fluoroscein staining Management: ointment, artificial tears, analgesia, topical abx

Question 25

Best imaging for suspected nasal polyps

Answer 25

coronal sinus CT

Question 26

4 signs/symptoms of retinal detachment

Answer 26

4Fs Flashes Floaters Fall in acuity Field loss

Question 27

Developmental defects --> neck lumps Likely dx if lump is: - anterior triangle - posterior triangle - midline

Answer 27

anterior triangle: branchial cyst (often in young adults) posterior triangle: cystic hygroma (babies) midline: thyroglossal cyst, dermoid cyst

Question 28

pinna cellulitis vs perichondritis

Answer 28

perichondritis - redness SPARES the ear lobe

Question 29

Holmes Adie vs Argyll robertson pupil

Answer 29

Accommodation reflex intact in both, but poor light reflex Argyll Robertson - pupils small (like argyl in scotland) and irregular Holmes Adie -Huge Ass pupil, v dilated

Question 30

central retinal artery occlusion - appearance of the retina? how does it present?

Answer 30

pale retina, cherry red spot sudden painless loss of vision

Question 31

what acne treatment can be given in pregnancy?

Answer 31

topical benzoyl peroxide

Question 32

topical therapies for superficial BCCs?

Answer 32

imiquimod, 5FU

Question 33

what is lichen simplex chronicus

Answer 33

NOT a primary process - thickening and lichenification of skin due to excess scratching

Question 34

1st line treatment for scabies

Answer 34

permethrin 5%

Question 35

Management of acne rosacea?

Answer 35

if flushing is predominant - topical brimonidine if papules/pustules predominant - topical IVERMECTIN

Question 36

Lump on lateral aspect of eyebrow in a child - diagnosis? when to worry?

Answer 36

dermoid cyst if in the midline --> see if it extends into CNS

Question 37

Acanthosis nigricans - two important causes to consider?

Answer 37

Diabetes - do HbA1c Gastric Ca

Question 38

pizza pie appearance of the retina diagnosis?

Answer 38

CMV retinitis

Question 39

Cellulitis near the eyes or nose Abx of choice?

Answer 39

Co-amoxiclav

Question 40

treatment of dermatitis herpetiformis

Answer 40

dapsone gluten free diet

Question 41

1st sign of diabetic retinopathy? subsequent signs

Answer 41

microaneurysms then dot and blot hamorrhages, hard exudates, cotton wool spots Neovascularisation

Question 41

rare but important adverse effect of chloramphenicol

Answer 41

Bone marrow suppression

Question 41

Treatment of erythema ab igne

Answer 41

topical retinoid or laser

Question 42

define chronic suppurative otitis media

Answer 42

otorrhoea >6 week most commonly due to pseudomonas

Question 43

stages of hypertensive retinopathy

Answer 43

I: silver wiring II: AV nipping III: haemorrhages IV: papilloedema