AKT Questions

1. A 52 year old woman presents with unpleasant tingling in the right thumb, forefinger and middle finger. The sensation wakens her at night. She finds that shaking her wrist gives some relief. On examination, there is thenar eminence wasting. Her symptoms are reproduced by tapping on the volar aspect of her wrist. Which single treatment is likely to be beneficial?

a ) Oral loop diuretic
b ) Oral non steroidal anti-inflammatory
c ) Steroid injection into the wrist
d ) Topical non steroidal anti-inflammatory
e ) Oral pyridoxine

Answer: C

Clinical Evidence" reports that, for carpal tunnel syndrome, steroid injection and systemic corticosteroid therapy are likely to be beneficial. Non-steroidal anti-inflammatories and pyridoxine are of unknown effectiveness and diuretics are unlikely to be beneficial.

2. A 25 year old man attends with a history of constant itch and mild discomfort in his left ear. Examination reveals an erythematous rash of the ear canal. He also has a large, chronic tympanic membrane perforation. Which single treatment should be avoided in this case?

a ) Clotrimazole ear drops
b ) Flumetasone and clioquinol ear drops
c ) Hydrocortisone and gentamicin ear drops
d ) Aluminium acetate ear drops
e ) Prednisolone ear drops

Answer: C

Otitis externa causes itch and discomfort. A precipitant should be sought, e.g. swimming, skin conditions etc. Treatment of the inflammation is by topical corticosteroids. If bacterial infection is suspected, corticosteroid drops containing antibiotics may be used. However, those containing aminoglycosides are contraindicated in chronic tympanic perforation (due to risk of absorption and ototoxicity) unless initiated by a specialist.

3. A 36 year-old female hairdresser attends complaining of an intensely itchy rash affecting her wrists and hands. This has developed over the last seven days. On examination, there is a symmetrical eruption of small (less than 5mm), discrete, flat-topped, violet-coloured papules affecting the palmar surface of both wrists. There are also some small translucent papules on the palms themselves. Closer inspection of the surface of the lesions on the wrists reveals some whitish lines. On direct questioning, she admits that she has felt some discomfort in her mouth when eating for the last couple of days. On inspection of the buccal mucosa, you notice some faint, lacy, white lines and a few shallow erosions. Which is the single most likely diagnosis?

a ) Atopic eczema
b ) Hand, Foot and Mouth Disease
c ) Irritant Contact Dermatitis
d ) Lichen Planus
e ) Pompholyx

Answer: D

Lichen planus (LP) is an intensely itchy eruption of essentially unknown aetiology which is commonest between the ages of 20-50 years. The white lines are known as Wickham's Striae, and although not always seen, are good indicators of LP. If palms and soles are involved, the classic 'violaceous' colour is lost, and the lesions are translucent. Most cases resolve spontaneously within 12 months. Treatment is with high potency steroids, or occasionally oral steroids.