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Year 5 notes > Skin and eyes > Flashcards

Skin and eyes Flashcards

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1
Q

what is acne fulminans

A

very severe acne associated with systemic symptoms - responds to oral steroids

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2
Q

which antibiotic can be used in pregnancy for acne

A

erythromycin - NB an antibiotic should be used for max 3 months

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3
Q

pathophysiology of atopic eczema

A

IgE-mediated, T-cell autoimmune response

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4
Q

treatment of persistently inflamed areas of eczema

A

topical steroids - use with emollients ratio 10:1

mild = 1% hydrocortisone

moderate = 0.025% betamethasone

potent = betamethasone 0.1%

dermovate most potent - don’t use on face/genitals

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5
Q

serious complication of eczema

A

eczema herpeticum - give IV acyclovir and probably also fluclox if ulcerations infections

this can cause herpes encephalitis and blindness

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6
Q

drugs which can exacerbate psoriasis

A
  • beta blockers
  • anti malarials
  • NSAIDs
  • ACE inhibitors
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7
Q

genes associated with psoriasis

A

HLA-B27
B13
CW6

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8
Q

what is guttate psoriasis

A

transient psoriatic rash, frequently triggered by strep infection

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9
Q

what is PASI

A

psoriasis area and severity index

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10
Q

1st line management for psoriasis

A

potent corticosteroid OD + vitamin D analogue OD (calipotriol, calcitriol)

up to 4 weeks as initial treatment

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11
Q

2nd line management for psoriasis

A

if no improvement after 8 weeks of 1st line treatment

give vitamin D analogue BD (short acting dithranol)

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12
Q

3rd line management for psoriasis

A

if no improvement after 8-12 weeks

potent corticosteroid BD for up to 4 weeks

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13
Q

when to refer for warts

A
  • persistent unresponsive to treatment in primary care
  • multiple warts in immunocompromised
  • facial warts
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14
Q

most common type of BCC

A

nodular - initially pearly with telangiectasia, may ulcerate later leaving a central crater

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15
Q

what is Mohs micrographic surgery

A

for BCC - excision of lesion and tissue borders progressively until specimens are microscopically free of tumour

for high risk/recurrent

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16
Q

what can be used for low risk BCC lesions

A

topical imiquimod or fluorouracil

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17
Q

when to use radiotherapy in BCC

A

if recurrent, incomplete excision, invasion of bone/cartilage

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18
Q

what 2 skin conditions increase the risk of SCC

A

actinic keratoses

Bowen’s disease (carcinoma in situ)

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19
Q

genetic condition increasing the risk of SCC

A

xeroderma pigmentosum

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20
Q

virus increasing the risk of SCC

A

HPV

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21
Q

surgical management of SCC

A

excision:
- if <20mm diameter do 4mm margins
- if >20mm diameter do 6mm margins
- Mohs in high risk patients/cosmetically important sites

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22
Q

ABCDE symptoms of melanoma

A
  • asymmetrical shape
  • border irregularity
  • colour irregularity
  • diameter >6mm
  • evolution of lesion

bleeding/itching

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23
Q

type of melanoma common on lower limbs

A

superficial spreading

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24
Q

type of melanoma common on the trunk

A

nodular

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25
type of melanoma common on the face
lentigo maligna
26
type of melanoma common on the palms, soles and nail beds
acral lentiginous (no clear relation with UV exposure)
27
when to refer in melanoma
weighted checklist - score of 3+ MAJOR (2 points each) - change in size - irregular shape - irregular colour MINOR (1 point each) - largest diameter 7mm+ - inflammation - oozing - change in sensation
28
when to do sentinel node biopsy for melanoma
if Breslow thickness >1mm
29
most common type of leg ulcer and most common cause
venous (80%) | - most due to venous hypertension, secondary to chronic venous insufficiency
30
signs of venous insufficiency
``` leg pain heavy legs aching itching oedema brown pigmentation lipodermatosclerosis eczema haemosiderin deposition ```
31
which type of leg ulcer is painful
arterial - particularly at night, relieved by dangling legs out of bed, may be areas of gangrene features of chronic ischaemia incl low ABPI measurements
32
investigations for venous leg ulcers
doppler USS to look for reflux duplex USS to look at anatomy/flow of vein
33
investigations for arterial leg ulcers
ABPI ``` <0.9 = likely PAD <0.8 = refer <0.5 = urgent referral >1.2 = stiff, calcified arteries ```
34
when to consider Marjolin's ulcer
if in areas of scar tissue - malignant
35
management of venous leg ulcers
- 4 layer compression banding after exclusion of arterial disease - if >10cm or fail to heal after 12 weeks - might need skin graft - debridement and cleaning
36
management of arterial leg ulcers
- lifestyle - platelets - revascularisation if critical limb ischaemia
37
how can keloid scars be treated
intralesional steroids/excision most commonly affects sternum, shoulder, earlobe and cheek
38
what can spider telangiectasia indicate
oestrogen pregnancy liver disease
39
what is Kaposi's sarcoma
connective tissue cancer due to HHV 8 and immunosuppression e.g. HIV treat with radiotherapy and resection
40
how can Kaposi's sarcoma affect GI/respiratory tract
haemoptysis and pleural effusion
41
what does a herald patch indicate
pityriasis rosea
42
treatment of pityriasis rosea
emollients, steroids, antihistamines but usually clears without treatment in 3 months
43
management of acute angle closure glaucoma
- urgent referral - acetalozamide 500mg IV over 10 mins (reduce aqueous secretions) - topical pilocarpine (pupillary constriction) - topical beta blockers, prednisolone - surgery - peripheral iridotomy (both eyes)
44
what drugs can cause cataracts
long-term corticosteroids
45
complications following cataracts surgery
- posterior capsule opacification (thickening of lens capsule) - retinal detachment - posterior capsule rupture - endophthalmitis (inflammation of aqueous/vitreous humour)
46
cause of dendritic corneal ulcers
herpes - use acyclovir
47
investigations for corneal ulcers
- fluorescein staining | - urgent diagnostic smear/gram stain and scrape
48
management of corneal ulcers
- refer immediately - until cultures known, use chloramphenicol drops alternated with ofloxacin drops - admit if diabetes/ immunosuppressed
49
usual cause of infection in a stye
staphylococcal infection in lash follicle - may also include glands of Moll and Zeis
50
when should gonococcal conjunctivitis be suspected
if within first 48 hours of live - purulent discharge, swelling of eyelids
51
treatment of gonococcal conjunctivitis
cephalosporin notifiable
52
when does chlamydial conjunctivitis usually present
end of first week of life (7-10 days)
53
how is chlamydial conjunctivitis diagnosed
specific monoclonal antibody test - performed on conjunctival secretions
54
organisms causing bacterial conjunctivitis
h. influenzae | gram +ve cocci
55
organism causing viral conjunctivitis
adenovirus - preauricular lymph nodes
56
when is chloramphenicol immediately started for conjunctivitis
- sexual disease suspected - contact lens wearers - immunocompromised
57
1st and 2nd line treatments for allergic conjunctivitis
1st line = topical/systemic antihistamines 2nd line = topical mast-cell stabilisers
58
mild non-proliferative diabetic retinopathy
1 or more micro aneurysm
59
moderate non-proliferative diabetic retinopathy
- micro aneurysms - blot haemorrhages - hard exudates - cotton wool spots, venous beading/looping and mild intraretinal microvascular abnormalities
60
severe NPDR
- blot haemorrhages and micro aneurysms in 4 quadrants - venous beading in at least 2 quadrants - IRMA in at least 1 quadrant
61
type of diabetes more likely to cause proliferative retinopathy
T1DM - 50% blind in 5 years
62
type of diabetes more likely to cause maculopathy
T2DM
63
stages 1-4 of hypertensive retinopathy
1 = arteriolar narrowing and tortuosity, increased light reflex (silver wiring) 2 = arteriovenous nipping 3 = cotton wool exudates, flame and blot haemorrhages 4 = papilloedema
64
conditions associated with acute anterior uveitis
Crohn's/UC ankylosing spondylitis sarcoidosis Bechet's disease
65
management of acute anterior uveitis
- cycloplegics to dilate pupil | - steroid eye drops
66
what can be done to distinguish between episcleritis and scleritis
phenylephrine drops phenylephrine blanches conjunctival and episcleral but not scleral - if redness improves after phenylephrine = is episcleritis
67
treatment of scleritis (PAINFUL unlike episcleritis)
- necrotising = eye surgery | - less severe = NSAIDs, corticosteroids, antibiotics
68
at what age should a squint be investigated
any squint beyond 12 weeks

Year 5 notes (10 decks)

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