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MSRA > ENT/Eyes/Derm > Flashcards

ENT/Eyes/Derm Flashcards

1
Q

Describe a pterygium

A

A benign conjunctival growth, can be seen growing from the outer edge of the cornea

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2
Q

Describe a pinguecula

A

A benign conjunctival growth that does not overlap the cornea

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3
Q

What is a cholesteatoma?

A

A destructive lesion of keratinising squamous epithelium in the middle ear +/- mastoid process

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4
Q

What is alopecia aerata?

A

Non scarring hair loss of unknown aetiology

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5
Q

Name some treatment options for alopecia aerata

A

Watchful waiting
Intralesional steroid injections
Topical steroid creams
Minoxidil 5% - only helpful in extensive disease

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6
Q

What is retinal detachment?

A

A separation of the inner neurosensory retina and the outer retinal pigment epithelium

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7
Q

How can retinal detachment be sub-classified?

A

Rhegmantogenous - commonest and occurs when there is a retinal break

Non-rhegmatogenous: tractional and exudative

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8
Q

What are the 4 Fs of RD?

A

Floaters
Flashes
Field loss
Fall in acuity

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9
Q

What may you find on ophthalmoscopy with RD?

A

A grey opalescent retina ballooning forward

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10
Q

Name an important complication of blepharoplasty

A

Lagophthalmos - an inability to fully close the eyelid

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11
Q

What is bullous myringitis caused by?

A

Mycoplasma pneumoniae

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12
Q

Name some signs and symptoms of acute closed angle glaucoma

A

Periorbital pain, nausea, vomiting
O/e reduced visual acuity, sceral injection, cloudy cornea

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13
Q

How do you treat acute closed angle glaucoma?

A

IV acetazolamide
Topical pilocarpine or thymoxamine
Then surgical iridectomy once attack is controlled

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14
Q

What is erysipilas?

A

A superficial form of cellulitis caused by S. pyogenes

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15
Q

Name a complication of rosacea?

A

Rhinophyma

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16
Q

How do you treat rosacea?

A

Topical metronidazole
If widespread, oral oxytetracycline can be used

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17
Q

What are the clinical features of photokeratitis?

A

Pain, watering, blepharospasm and photophobia

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18
Q

What is BPPV caused by?

A

Inner ear dysfunction where otoliths are displaced from the maculae to the semicircular canals

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19
Q

What is furunculosis?

A

Infection of the hair follicle caused by Staph

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20
Q

What is the incidence of acoustic neuroma?

A

1:100,000

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21
Q

What is a rhinolith?

A

A firmly impacted and unrecognised foreign body that can become coated with calcium, magnesium or phosphate

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22
Q

What is rubeosis iridis?

A

Neovascularisation of the iris due to retinal ischaemia, normally caused by diabetic retinopathy

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23
Q

Name the indications for starting aciclovir in shingles?

A

Within 72 hours for anyone over 50
Immunocompromised
Ophthalmic involvement
Non truncal involvement

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24
Q

Name some treatments for acne during pregnancy

A

Benzoyl peroxide
Azelaic acid
Glycolic acid

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25
Q

Name some treatment options for keloid scars

A

Occlusive dressings with or without silicone
Silicone ointments
Compression therapy
Intralesional steroid injections

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26
Q

Which structures does anterior uveitis involve?

A

Iris
Ciliary body

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27
Q

What is Samter’s triad?

A

Asthma, nasal polyps and aspirin sensitivity

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28
Q

What is the difference between labrynthitis and vestibular neuritis?

A

Vestibular neuritis is inflammation of the vestibular apparatus but without tinnitus and loss of hearing

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29
Q

Name some features of an orbital blow out fracture

A

Diplopia
Enophthalmos
Hypo-ophthalmia
Hypoaesthesia of cheek and upper gum of affected side

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30
Q

How do you differentiate between pinna perichondritis and pinna cellulitis?

A

Perichondritis spares the ear lobe

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31
Q

What is the definition of acne vulgaris?

A

Androgen driven increase in sebum production in anatomically abnormal pilosebaceous units

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32
Q

What is pityriasis rosea?

A

A mild self limiting skin rash of unknown aetiology that characteristically presents itself with a ‘herald patch’

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33
Q

Name some key clinical features of diabetic retinopathy

A

Microaneurysms
Dot an blot haemorrhages
Flame haemorrhages
Retinal oedema
Hard exudates

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34
Q

Name a very potent steroid

A

Clobetasol propionate 0.05% (dermovate)

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35
Q

Name some potent steroids

A

Fluticasone propionate 0.05% (cutivate)
Betamethasone valerate 0.1% (betnovate)

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36
Q

What does wax consist of?

A

Viscous secretions from sebaceous glands
Less viscous secretions from modified apocrine sweat glands

37
Q

Which sites are commonly affected in shingles?

A

Lower thoracic region
Ophthalmic division of the trigeminal nerve
Occasionally motor nerves

37
Q

Which sites are commonly affected in shingles?

A

Lower thoracic region
Ophthalmic division of the trigeminal nerve
Occasionally motor nerves

38
Q

Which form of contraception makes acne worse?

A

POP

39
Q

What are the clinical features of a retinal vein occlusion?

A

Painless
Sudden
Unilateral loss of vision

40
Q

Name some pharmacological agents that can help to treat an acute vestibular episode

A

Promethazine
Prochlorperazine
Cyclizine

41
Q

What type of imaging can be useful for nasal polyps?

A

Coronal sinus CT

42
Q

Name some features of a HIV seroconversion rash

A

Round/oval lesions
Slightly raised
Symmetrical
Lasts 1-3 weeks
Usually accompanied by a flu like illness

43
Q

What is the MOA of betahistine?

A

Histamine agonist

44
Q

Which skin conditions can be caused by androgen abuse?

A

Acne conglobata
Acne fulminans

45
Q

What is a characteristic feature of tobacco alcohol ambylopia?

A

Central loss of vision for colours in the order of green, green and red, and white

46
Q

What is drusen?

A

Lipid material that collects beneath the retinal pigment epithelium

47
Q

What is the fovea?

A

An area at the centre of the macula that has the highest density of photoreceptor cells

48
Q

Name some features of dry AMD

A

Drusen
Pigmentary changes
Areas of atrophy
Geographic atrophy

49
Q

Name some features of wet AMD

A

Choroidal neovascularisation

50
Q

What drug can be used to treat wet AMD and how is it given?

A

Intravitreal anti-VEGF
Example is ranibizumab

51
Q

How may wax in ear present?

A

Itching
Hearing loss (conductive)
Tinnitus
Vertigo
Asymptomatic

52
Q

What is the normal range for intraocular pressures?

A

10-20mmHg

53
Q

Name some clinical features of rosacea

A

Flushing
Telangiectasia
Non itchy papules and pustules
Located on the cheeks, forehead, glabella, nose and chin
Normally spares the nasolabial folds

54
Q

Name some clinical features of scleritis

A

Severe deep pain
Visual loss
Focal or diffuse redness due to vessel dilation

55
Q

What is the episclera?

A

A thin layer of vascular tissue overlying the sclera

56
Q

What disease is episcleritis associated with?

A

IBD

57
Q

How can you treat episcleritis

A

Usually self limiting
Artificial tears may be used
Oral NSAIDs (ketorolac)

58
Q

What is keratitis?

A

Inflammation of the cornea

59
Q

What is the nature of dermatitis herpetiformis?

A

Itchy subepidermal blisters
Seen on the elbows, scalp, shoulders and ankles
Responds to dapsone and a gluten free diet

60
Q

What is acanthosis nigricans associated with?

A

Gastric carcinoma
Hodgkin’s lymphoma
Acromegaly
Cushing’s
DM

61
Q

What may livedo reticularis be caused by?

A

RA
SLE
PAN
Lymphoma
TB
Polymyositis
Raynaud’s

62
Q

Name some features of posterior vitreous detachment

A

Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision

63
Q

Describe the initial management of otitis externa

A

Topical antibiotic or a combined topical antibiotic with a steroid
If the tympanic membrane is perforated aminoglycosides are traditionally not used*
If there is canal debris then consider removal
If the canal is extensively swollen then an ear wick is sometimes inserted

64
Q

After how many weeks should a TM perforation heal?

A

6-8 weeks

65
Q

What is the management for scabies?

A

Permethrin 5% is first-line
Malathion 0.5% is second-line
Give appropriate guidance on use (see below)
Pruritus persists for up to 4-6 weeks post eradication

66
Q

What are the characteristics of necrobiosis lipoidica?

A

Shiny, painless areas of yellow/red/brown skin typically on the shin
Often associated with surrounding telangiectasia

67
Q

Describe the management for acne vulgaris

A

Single topical therapy (topical retinoids, benzoyl peroxide)
Topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid)
Oral antibiotics
COCP
Oral retinoids - under specialist advice

68
Q

Name some features of a capillary haemangioma

A

Typically they increase in size until around 6-9 months before regressing over the next few years (around 95% resolve before 10 years of age).

Common sites include the face, scalp and back. Rarely they may be present in the upper respiratory tract leading to potential airway obstruction

69
Q

What is the first line management for psoriasis?

A

A potent corticosteroid applied once daily plus vitamin D analogue applied once daily

70
Q

What is the management for anterior uveitis?

A

Urgent review by ophthalmology
Cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate
Steroid eye drops

71
Q

Describe the stages of hypertensive retinopathy

A

I Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring
II Arteriovenous nipping
III Cotton-wool exudates
Flame and blot haemorrhages
These may collect around the fovea resulting in a ‘macular star’
IV Papilloedema

72
Q

Name some features of granuloma annulare

A

Papular lesions that are often slightly hyperpigmented and depressed centrally
Typically occur on the dorsal surfaces of the hands and feet, and on the extensor aspects of the arms and legs

73
Q

Explain the pathophysiology of acanthosis nigricans

A

Insulin resistance → hyperinsulinemia → stimulation of keratinocytes and dermal fibroblast proliferation via interaction with insulin-like growth factor receptor-1 (IGFR1)

74
Q

Name some features of erythema multiforme

A

Target lesions
Initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
Pruritus is occasionally seen and is usually mild

75
Q

Which drops may be useful in the management of episcleritis?

A

phenylephrine drops may be used to differentiate between episcleritis and scleritis
phenylephrine blanches the conjunctival and episcleral vessels but not the scleral vessels
if the eye redness improves after phenylephrine a diagnosis of episcleritis can be made

76
Q

Name some features of anterior uveitis

A

acute onset
pain
blurred vision and photophobia
small, fixed oval pupil, ciliary flush

77
Q

Which scale can you use to assess hirsuitism?

A

Ferriman-Gallwey scoring system: 9 body areas are assigned a score of 0 - 4, a score > 15 is considered to indicate moderate or severe hirsutism

78
Q

Name some causes of hypertrichosis

A

drugs: minoxidil, ciclosporin, diazoxide
congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis
porphyria cutanea tarda
anorexia nervosa

79
Q

Describe the management of venous ulcers

A

compression bandaging, usually four layer (only treatment shown to be of real benefit)
oral pentoxifylline, a peripheral vasodilator, improves healing rate
small evidence base supporting use of flavinoids
little evidence to suggest benefit from hydrocolloid dressings, topical growth factors, ultrasound therapy and intermittent pneumatic compression

80
Q

What is palmoplantar pustulosis?

A

Crops of sterile pustules affecting the palms and soles
The skin is thickened, red. Scaly and may crack
More common in smokers

81
Q

What is keratoderma?

A

May be acquired or congenital
Describes a thickening of the skin of the palms and soles
Acquired causes include reactive arthritis (keratoderma blennorrhagica)

82
Q

Name some risk factors for the development of glue ear

A

male sex
siblings with glue ear
higher incidence in Winter and Spring
bottle feeding
day care attendance
parental smoking

83
Q

What is the treatment for glue ear?

A

grommet insertion - to allow air to pass through into the middle ear and hence do the job normally done by the Eustachian tube. The majority stop functioning after about 10 months
adenoidectomy

84
Q

How do you manage Meniere’s disease?

A

ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit

85
Q

Name some features of otosclerosis

A

conductive deafness
tinnitus
normal tympanic membrane*
positive family history
*10% of patients may have a ‘flamingo tinge’, caused by hyperaemia

86
Q

What is the first line management of open angle glaucoma?

A

Prostaglandin analogues

87
Q

Name some features of a central retinal artery occlusion

A

due to thromboembolism (from atherosclerosis) or arteritis (e.g. temporal arteritis)
features include afferent pupillary defect, ‘cherry red’ spot on a pale retina

88
Q

Describe the management of allergic conjunctivitis

A

first-line: topical or systemic antihistamines
second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil

MSRA (13 decks)

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