Common conditions Flashcards
1
Q
Who to report any medical diseases from the notifiable officer?
A
Registered medical practitioners must notify the proper officer at their local council or local health protection team of any patient(s) suspected of suffering from any of the diseases listed below;
NHS ENGAND
2
Q
What 20-30 diseases should be reported to the notifiable officer?
A
Anthrax
Botulism
Brucellosis
Cholera
COVID-19
Diarrhoea (infectious bloody)
Diphtheria
Encephalitis (acute)
Food poisoning
Haemolytic uraemic syndrome (HUS)
Haemorrhagic fever (viral)
Hepatitis (acute infectious)
Legionnaires’ disease
Leprosy
Malaria
Measles
Meningitis (acute)
Meningococcal septicaemia
Mpox (monkeypox)
Mumps
Paratyphoid fever
Plague
Poliomyelitis (acute)
Rabies
Rubella
Severe acute respiratory syndrome (SARS)
Scarlet fever
Smallpox
Streptococcal disease (Group A, invasive)
Tetanus
Tuberculosis
Typhoid fever
Typhus
Whooping cough
Yellow fever
3
Q
What to also give with IV aciclovir for shingles?
A
IV fluids - as the drug can crystalise
4
Q
What are threadworms + symptoms?
A
Itching in bum due to to threadlike worm laying eggs in bowel.
5
Q
What 3 cases to refer threadworm?
A
Recent travel abroad
secondary bacterial infection
If tx fails
6
Q
What is threadworm treatment?
A
Mebendazole
7
Q
What is OVEX (mebendazole) age limit?
A
Can be used in 2 and over
8
Q
How is mebendazole taken?
A
100mg single dose
repeat in 2 weeks if reinfection risk
Treat all family members
9
Q
Can mebendazole be used in pregnancy?
A
NO - instead follow hygiene measures for 6 weeks
10
Q
What 5 non-pharmacological advice for threadworm prevention?
A
Wash hands often
shower morning to wash away eggs
regularly wash/iron bedding
DO NO share towels
cut nails short
11
Q
What is mouth ulcer symptoms?
A
White centres with outer red ring
around tongue, cheecks and lips
12
Q
When to refer mouth ulcers? (5)
A
If >3 weeks
Painless
> 10mm diameter
> 5 ulcers
Weight loss/ diarrhoea or medication SE - sulfazalazine
13
Q
What age is bonjela used for mouth ulcers?
A
16 and over
14
Q
What are 4 OTC products for mouth ulcers?
A
Chlorhexidine - 12+
Benzydamine - 12+ rinse/ 6+ spray
Bonjela - 16+
hydrocortisone Buccal tabs - 12+
15
Q
What 3 advice to give about mouth ulcers?
A
Avoid spicy, salty hot food,
Increase iron, folate, b12
Brush teeth before chlorhexidine - prevent staining
16
Q
What are 6 Symptoms of Cold + flu?
A
Blocked runny nose,
cough
sore throat
fever
pain, headache, ear ache
watery eyes
17
Q
What 4 criteria to refer cold + flu?
A
No improvement in 2 weeks
middle ear pain not improving with mild analgesia
persistant productive cough + fever
vulnerable patients- DM, Asthma, young <3 months, elderly
18
Q
What is given for cold + flu?
A
Paracetamol
ibuprofen
aspirin
Sudafed
19
Q
What nasal congestants can be given?
A
Pseudoephedrine, phenylephrine
20
Q
What is max amount of Pseudoephedrine, phenylephrine that can be bought OTC?
A
Max 720mg - so 12 tabs of 60mg each
21
Q
How long to use nasal decongestant xylometazoline?
A
Max 7 days - can cause rebound congestions
22
Q
What conditions to avoid decongestants?
A
HTN
DM
CVD
Glaucoma
Prostatic enlargement
23
Q
What 3 drug classes interact with pseudoephridine ?
A
MAOI
TCA
BB
24
Q
What can antihistamines do for cold + flu?
A
Dry up nasal secretions
25
What is non- pharma afvice for children under 6 for cold and flu?
steam inhalation
saline drops
26
What are 2 types of cough?
Productive - chesty, sputum
Non-productive- dry, tickly
27
What are 10 cough red flags that need referral?
More than 3 weeks
chest pain
SOB
wheeze
Pain when inspiration
Recurrent night time cough
Whooping cough
croup
coloured sputum
blood in sputum
28
What are some 1st line OTC medicines for dry cough for over 12+ (antitussives)
Dextromethorphan
29
Can codeine linctus be used in cough as OTC?
No now it is a POM
only for 18+
30
What 3 expectorants are used OTC for chesty cough in patients 6 and over?
Guaifenesin (most common)
Ipecacuanha - covonia
Squill
31
What is moa of expectorants?
Decrease sputum viscosity
32
What 4 antihistamines are used for chesty coughs as OTC in 6 and over years?
Diphenydramine- benylin
promethazine - night nurse
Brompheniramine
33
What 2 cough OTC medications are used in patients under 6 + safe in pregnant women, elderly?
Glycerol
Simple linctus
34
Can chesty coughs be treated with anti-tussive?
NO- mucus can build up, chest infection
35
Are dry coughs self limiting?
Yes- viral
36
What treatment should be given 1st line for cough in children 6-12?
Lifestyle advice first
37
What are 5 symptoms of BPH?
Chronic urinary retention
difficulty peeing
weak urine
difficulty fully emptying bladder
frequent need to pee
38
What are 4 criteria for referral of BPH?
Last less than 3 months
No peeing, blood in pee or cloudy urine in past 3 months
fever -UTI?
If on alpha blockers- hypotension
39
What 6 medical conditions mean that BPH needs to be referred?
Postural hypotension
Heart, liver, kidney issues
uncontrolled DM
Incontinence
previous prostate surgery
Undiagnosed cloudy vision
Surgery for cataract or glaucoma planned
40
What is OTC treatment for BPH?
Tamsulosin 400mcg
41
What age is tamsulosin licensed for?
45-75 years
42
What 3 criteria to supply tamsulosin?
Symptoms 3 months or more
Give 2 week supply first
Further 4 week supply if improvement after 1 4 days.
43
How to take tamsulosin?
Take a 400mcg capsule swallow whole after same meal each day
44
How many days tamsulosin initial supply?
14 days - 2 weeks
45
What are 2 SEs of tamsulosin?
Drowsiness, dizziness
46
What 3 advice to give patient with BPH?
Go to GP after 6 weeks to continue
Every year see doctor to review more OTC supply
DOES NOT increase risk of prostate cancer
47
When is orlistat given ?
If BMI 28 or more
48
What 5 drugs to not give orlistat with?
Levothyroxine - can increase hypo
Amiodarone + ciclosporin - reduce plasma levels
Warfarin
Acarbose
anti- epileptics
49
Orlistat and ADEK vitamins?
Reduced absorption of fat soluble vitamines- take vits night or 2 hours after orlistat
50
What drug is cautioned in orlistat?
Oral contraceptives- additional protection maybe needed if diarrhoea there.
51
What 6 cases to refer patients who want orlistat?
If DM, HTN, High cholesterol
Chronic malabsorption syndrome, cholestasis
pregnancy/breastfeeding
Kidney disease
Does not lose weight after 3 months
52
What is licensed age for orlistat (alli)?
18+
With BMI 30 or 28 and DM HTN or High cholesterol.
53
How long is orlistat used OTC?
6 months max
54
How to take orlistat?
1 60mg Capsule TDS before meals or after up to 1 hour.
Skip dose if meal missed or has no fat
55
What is lifestyle advice for patients on orlistat?
5 portion fruit/ veg
Alcohol 2-3 units day , 14 units max
2.5L fluids
18-30g fibre day
Not substitute for healthy diet/exercise
56
Why is patient referred to GP for orlistat if they have If DM, HTN, High cholesterol?
conditions help with Weight loss so lower prescribed doses may be given.
57
What are 4 symptoms of constipation?
Small hard stools passed less frequently
<3 times a week
straining
Nausea
Cramps/bloat
58
What is 5 referral criteria for constipation?
Bloody stools
unexplained weight/appetite loss
Patients over 40 with change in bowel habit.
Med SE- opioids, TCA, SSRI, aluminium antacids.
Constipation, lethargy, dry skin - hypothyroidism.
stimulant laxative use.
Obstruction
More than 2 weeks
59
What is 1st line for constipation?
Life style
60
What is 2nd Line for constipation?
BOS laxatives
Bulk, osmotic, stimulant
61
What age is bulk forming laxatives used in?
6+
62
Give 3 examples of bulk laxatives?
Isphagula husk
sterculia
methylcellulose
63
How do bulk laxatives work?
Increase fecal mass
64
How long does it take for bulk laxatives to work?
2-3 days full effect
24 hrs some change
65
What are 2 SE of laxatives?
Intestinal obstruction
flatulence
66
When to NOT take laxatives in the day?
Before bed
67
What age is lactulose allowed in?
3 month and older
68
What age is macrogol allowed in?
12+ years
Movicol - 2-11 years
69
MOA of osmotic laxatives?
Increase water in colon , draw fluid from body
70
How long does it take for osmotic laxatives to work?
2-3 days
71
How long does it take for lactulose to work?
48 hrs
72
What is SE of osmotic laxatives?
Discomfort, flatulence
cramps
73
List 4 stimulant laxatives?
senna
bisacodyl
sodium picosulfate
74
How long does it take for glycerol suppositories to work?
15-30 mins
75
What are doses for glycerol?
4g 12 + and adults
2g children under 12
1g infants
76
What are 3 SE of stimulant laxatives?
hypokalaemia
lazy bowel
diarrhoea
77
What is counselling for stimulant laxative?
Take at night to go in morning.
78
What age is liquid paraffin used as a stool softener in OTC?
3+
79
What to give pregnant woman with constipation?
BULK or lactulose
Avoid stimulant
80
What is cautioned to give elderly for constipation?
Bulk - increase risk of gut obstruction + hard to increase fluid.
81
what is given in children for constipation?
Lactulose
82
What is given in children for constipation?
life style first
Lactulose
83
What is advice for constipation?
Life style first line- takes 2 weeks
5 portion fruit/ veg
Alcohol 2-3 units day , 14 units max
2.5L fluids
18-30g fibre day
exercise 30 mins 5 x week
Toileting habit- squat, don't hurry
84
What is dyspepsia?
Group of abdo symptoms
85
Causes of dyspepsia?
Indigestion
GORD- heartburn
gastritis
GI ulcers
86
6 Symptoms of dyspepsis?
Vague abdo pain above belly button
bloating, flatulence
feeling full early
N + V
Heart burn - GORD
87
What are 5 ALARM signs for dyspepsia?
Anaemia
Loss weight
anorexia
Recently changed/new unexplained dyspepsia in over 55 years
Malena, vomiting, blood in vomit
88
What else requires referall in dyspepsia?
If treatment for 4 weeks or more
Med SE- NSAID, CCB, warfarin, metformin
Refusing PPI, H2 antagonist if has C13 test in 14 days as test will not show
Children
Jaundice
Previous GI surgery
89
What symptom is linked to peptic ulcer?
Persistant boring poitn from 1 point of abdo
90
What symptom is linked to GASTRIC ulcer?
Pain linked to food- 30 mins after eating
91
What symptom is linked to duodenal ulcer?
Pain when stomach empty- 2-3 hrs after eating.
92
What is OTC product for dyspepsia?
Antacids- gaviscon
Alginates- raft on top of stomach contents
93
What is used in GORD heart burn?
Alginates
94
Is alginates ok in pregnancy?
Yes
95
What can antacids do with tetracyclines, bisphosphonates, quinolones?
Impair absorption
leave 2 hr gap
96
What does antacids do to fluid retention?
High Na content
avoid in HTN, HF, KIDNEY issues
97
Is pepto-bismal , ranitidine or bismuth salts safe in pregnancy for dyspepsia?
Nope
98
What PPI can be given OTC for dyspepsia?
Nexium- esomeprozole
Omeprazole+ pantoprozole too
99
What is max OTC supply of Esomeprozole?
14 days supply
Max 4 weeks use
100
Is PPI recommended in pregnancy for dyspepsia?
Not in preg/ breastfeeding.
101
When to refer to GP for dyspepsia after tx?
More than 2 weeks of tx failure
> 4 weeks use
102
What 2 long term PPI SE?
Low mg
Osteoporosis
103
Omeprazole and warfarin?
Increased bleeding
104
Omeprazole and Phenytoin?
Toxicity
105
Advice for dyspepsia?
Smoking cessation
avoid exceess alcohol, coffee , chocolate,
Raise head of bed
Eat 3 hrs before bed- small meals
Avoid spicy/fatty meals
Lose weight
Avoid tight clothing
106
What are haemorrhoids symptoms?
Dull pain when sitting/defacation
slight bleeding
swelling
107
When to refer haemmorhoids? (10)
Blood in stools- dark tarry stools (GI bleed)
Bright red stools
Abdo pian, vomiting, fever,
change in bowel habit
tenesmus - urge to poo when no stool
Sharp stabbing pain pooing - anal tear REFER
More than > 3 weeks
>1 week otc failure
Constipating medicine
108
What are bright red stool meaning?
Anal fissue
109
What OTC products are there for haemorrhoids?
Soothing agents- anusol
Mild astringents- bismuth
Local anaesthetics -12+
Anusol + HC -18+
110
What age is anusol allowed?
18+
111
What is max duration of use for anusol with HC?
7 days - avoid pregnancy/breastfeeding
112
Age limit for (local anasthetics) lidocaine in haemorrhoids?
12+
113
advice to prevent haemorrhoids?
Increase fibre
treat constipation
114
What is diarrhoea?
Frequent loose stools
dehydration
N +flatulence
abdo cramps
115
When to refer to GP in diarrhoea?
Blood mucus
Change in bowel habit >50 years
weight loss
fecal impaction
sever vom + fever
recent travel abroad
Diarrhoea >3 weeks
Med SE - mg antacids, nsaids,
116
What is 1st line diarrhoea OTC in all ages?
Oral rehydration packets
117
For under 1 years old with diarrhoea how is oral rehydration sachet made up?
Use boiled + cooled water to make it
118
How long to store oral rehydration sachet mixture in fridge?
Make immediately before use + store for 24 hrs
119
What age is loperamide allowed otc?
12 +
120
What is max tabs of loperamide allowed per day?
8 tabs
121
Is loperamide allowed in preg/breastfeeding?
NO
122
What age is bismuth salicylate allowed in for diarrhoea?
16+ -
123
When to avoid bismuth salicylate?
If allergic to aspirin
124
What advice for babies with diarrhoea?
Dilute formula feeds to quarter strength + build up to normal over 3 days
feed more than normal + fluids.
125
What type of drinks to avoid in diarrhoea?
Sugary drinks + milk
drink bottled water when abroad
126
When to refer in acute diarrhoea? (3)
If babies <3 months have it ASAP
Under 1, diabetic or elderly - refer if more than 1 day
If under 3 years > 2 days
127
How many days diarrhoea before referring?
If 3 or more days
128
What are 4 signs of dehydration?
Dry skin/tongue
sunken eyes
less pee
depressed fontanelle in babies (head)
129
What is scabies symptoms?
Intense itching
worse at night
small grey lines, red ish.
130
What 4 cases to refer scabies?
Unclear diagnosis
babies and children
secondary infection
Tx failure
131
What is used as OTC for scabies?
Permetrin 5% cream
(lyclear)
132
What age is permethrin allowed OTC for scabies?
2 months and over
133
How to use permethrin?
Apply and leave for 8-12 hrs before washing off
134
What is 2nd OTC product for scabies?
Malathion - use in 6 months
135
How long to leave malathion before washing off?
12 hrs
136
How to treat scabies?
Apply to entire body.
2 treatments, 7 days apart
Treat all contacts at same time
137
When can adults + children return to work/school after scabies?
After 1st treatment
138
What is non- pharma advice for scabies?
Avoid close contact with others
itch will not stop immediately
Wash clothes + bed linen at >50 degrees
139
What is live lice?
Grey brown insects
140
What are nits?
Cream eggs- does not mean infestation
141
What is OTC for head lice?
Dimeticone 1st line
Malathion- alternative
142
What otc med for head lice has resistance to it?
Malathion
143
How to apply Dimeticone for headlice?
2 applications a week apart to get rid of hatched lice
Repeat after 7 days
Leave on for 8 hrs
144
What type of head lice prep to avoid in asthma/eczema?
Alcoholic prep- but more effective
145
What is a mechanical method of removing head lice?
fine tooth comb, every 4 days for 2 weeks until they gone.
146
Why are headlice shampoos not good?
Too diluted
147
How long to leave head lice liquids or lotions?
8–12 hours or overnight treatment is recommended.
148
Why to not use insecticides to prevent headlice?
Resistance
149
What are 2 Symptoms of hayfever?
Itchy watery eyes
Nasal symptoms
150
When to refer hayfever?
If chest tightness
Wheeze
SOB
Cough
Purulent conjunctivitis - eye infection
Painful ear/sinuses
151
What is otc use for hayfever?
non sedating Antihistamines e.g. cetitirizine, opticrom, beconaze.
152
What is a SE of older antihistamines?
More sedating
153
What 3 conditions should patients be cautioned when taking anti-histamines?
Epilepsy
Glaucoma
BPH
154
What antidepressant class is CI with sedating antihistamine?
MAOI + up till 14 days of stopping MAOI.
155
What age is benadryl (acrivastine) allowed in?
12-65 years
TDS
156
What age can loratadine be used in?
2 and older - liquid
2+ for tab
157
What age can cetirizine be used in?
licensed for 2 and over for liquid
158
What is age limit for piriton tabs?
6+ years tabs
159
What is age limit for steroid nasal sprays?
18+
160
Examples of steroid nasal sprays?
Fluticasone
beclometasone
161
How to reduce risk of hayfever?
Close windows, stay inside if pollen count high
Wrap around glasses
avoid grassy areas
162
3 symptoms of sore throat?
Pain from back of throat, swallowing, swollen lymphW
163
When to refer sore throat?
More than 1 week
dysphagia
horse voice for more than 3 weeks
extreme pain + no improvement within 24-48 hrs
MED SE- carbimazole, MTX
oral thrush- miconazole
High fever, red tonsils
164
What 4 types of otc meds used for sore throat?
Pain releif - ibuprofen, paracetamol
Losenges
NSAIDs- anti-inflammatory e.g. benzdamine difflam spray
Lidocaine - numb pain
165
What 4 ingrediates do antibac + antifunal lozenges have?
Chlorhexidine
thryothricin
benzalkonium chloride
cetylpyridinum chloride
166
Advice for sore throat?
Gargle salt water, fluids, eat cool soft food,
diabetics- use sugar free
avoid smoking
167
List 4 types of fungal infections? Slide
Tinea pedis
Tinea corporis - body
Tinea capatis
Tinea cruris - jock itch
168
What age is lidocaine for in sore throat?
12+
169
What is max use of flurbiprofen?
3 days max
Max 5 lozenges in 24 hrs
170
What 6 criteria to refer fungal infection?
Face/scalp inolved
Toenails affected in athletes
Large area
Broken skin
Bacterial infection
Diabetes/immunocomp
OTC failed after 2 weeks
171
What is 1st line OTC for fungal infections in all ages?
Clotrimazole or miconazole
172
What is 1st line OTC for fungal infections in adults??
Ketokonazole - not anymore I think due to MHRA alert recall.
173
What is terbinafine age (lamisil?)
16+
174
What is terbinafine age (Lamisil once?)- solution
18+
175
What is daktacort 15g licensing for use , age?
10 + years
7 day use only
Apply thinly BD
176
What powder can be used prophylactically for athletes foot?
Mycota, mycil
177
What 4 advice to give for fungal infection?
Contine at least 7 days after symptoms disappear
contagious
avoid towel sharing
Change socks often
178
What is a corn/callus?
Yellow thick skin caused by friction on skin
179
What 4 criteria to refer corn/callus?
Diabetic
treatment failed
impaired circulation
soft corns
180
What otc product given for corns?
Corn plaster
181
What is cradle cap?
Yellow scales on scalp - 6 months
182
What to do for cradle cap?
Self limiting
goes away in weeks
183
What 2 products for Cradle cap?
Olive oil
capasal shampoo
184
When to refer cradle cap? (3)
Severe on face/body
Swelling, scratching, bleeding
infected/ inflamed - need abx?
185
What is meningitis main symptom?
Non blanching rash
others - flu , fever, muscle ache, N + V
186
What are 5 specific meningitis symptomd?
Stiff neck
severe headache
cold hand/feet
confusion, drowsiness
photophobia- hate bright lights.
187
What are some meningitis symptoms in infants?
Floppiness
Dislike being handled
not eating, waking up
rapid breathing
unusual cry
bulging fontanelle
188
What to do in meningitis?
REFER serious
189
What type of meningitis does not need refering?
Viral - treated at home
paracetamol, ibu
190
What are 4 measles symptoms?
Koplik spot - white in tongue
Cold like
fever
conjunctivitis
191
What are 3 symptoms of mumps?
FEVER
headache
malaise
192
What is rubella symptom?
lymphadenopathy
193
How does measles rash start?
Red blotchy, confluent rash starts behind ears and moves
194
Where does rubella rash start?
Start in face + spread to limbs
Pink, non confluent rash
195
What to do if Measles, mumps, rubella?
Refer -notifiable disease
Only pain relief
196
What 5 advice in MMR?
rest
hydrate
keep AWAY from school during contagious period
Avoid acidic drinks. - mumps
Rubella - away from pregnant women
197
What drink to avoid in mumps?
Fizzy
198
How long to keep children off school in measles?
4 DAYS AFTER RASH forms
most dangerous - otitis media, pneumonia
199
How long to keep children off school in mumps?
5 days after swelling happens
200
How long to keep children off school in rubella?
5 days after rash
201
Why should rubella patients stay away from pregnant women?
Foetal damage
202
What is 4 nappy rash referral criteria?
Broken skin
yellow crust- infection
Other parts affected
After otc tx fails> 1 week
203
What to give as OTC for nappy rash?
Antifungal - clotrimazole, miconazole
Barrier preps- metanium
204
What advice for nappy rash?
Change pampers asap
avoid waterproof nappies
Wash area well.
205
What is fungal nappy rash symptom?
Satelite rash- small spots on outer area of rash.
206
What 3 criteria to refer oral thrush?
Children/adults
Recurrent
OTC fails
207
What is OTC for oral thrush?
Daktarin
208
What is daktarin age limit?
4 months +
209
How to apply daktarin?
Apply qds in oral thrush
Continue 1 week after symptoms go.
do not apply to back of throat - choking
210
What virus causes slapped cheek ?
Parovirus
210
What does miconazole interact with?
Warfarin
211
What are slapped check symptoms?
Bright rash on cheeks
Light pink rash on limb
cold like symptoms - most contagious period
212
When to refer slapped cheek?
If pregnant woman exposed
Blood disorder
severe anaemia symptoms
213
What is OTC product for slapped cheek?
Paracetamol/ ibu
antihistamine - piriton
214
When is slapped cheek condition contagious?
During cold symptoms phase
After rash = not contagious
215
Do you need to keep child off school for slapped cheek?
No- rash appears so it is fine
216
What are 3 fungal nail infection symptoms?
Dull yellow
Nail thickens
brittle
217
When to refer fungal nail?
DM
Circulatory diseas
Immunocomp
Other nail infection or nail breaking away - need terbinafine
More than 2 nails affected
218
What is OTC fungal nail infection tx?
Amorolfine nail lacquer (18+)
219
What indication is Amorolfine used in?
DLSO - distal lateral subungal onchomycosis
220
Can pregnant women use amorolfine?
NO CI in preg/breastfeeding
221
How long does it take for nail fungal to go with amorolofine nail laquer?
Toe - 9-12 month
finger -6 months
222
1 pack of amorolofine?
3 month supply
223
How to use amorolofine?
Apply 1 weekly
file nail surface
clean well + apply lacquer
224
CAN the amorolofine nail laquer treat whole nail?
No only the sides/and under nails
224
What are 4 symptoms of psoriasis?
red plaques
silvery scales
225
When to refer psorias?
If mod-sever
undiagnosed
226
What otc products for psoriasis?
Emollient
12+ coal tar solution
227
What are 2 SE of coal tar solution?
Photosensitive + skin irritation
228
What virus is cold sore caused by?
HSV1
229
What 2 symptoms of cold sore?
Tingling sensation
blister mouth, lips
230
Wjen to refer cold sore?
painless
babies
Immunocomp
Eye affected
Cold sore> 2 weeks
Sore inside mouth
Pt with atopic eczema
231
What otc is used for cold sores
Aciclovir- zovirax
Apply 5 times daily for 4 days
Max 10 days
232
What age is penciclovir used?
12+
8 TIMES day for 4 days
2 hrly intervals
233
What advice to prevent cold sores?
contagious
wash hands after applying cream
infection -can spread to eye so stop touching
avoid kissing, oral sex, sharing cutlery
reccurent- for life
234
Is cold sore contagious?
YES - until crust forms
235
How do warts look like?
Flesh coloured, raised surface
236
How do verrucae look like?
Flat, occur on sole of feet
Black dots in middle
Can be painful
237
When do warts disappear?
Naturally within 6 months to 2 years
238
When to refer warts/verrucae?
Facial warts
Multiple warts
diabetic/ immunocomp
Itching/bleeding
change in size colour
OTC failed >3 months
239
How long does it take for warts to go with OTC?
12 WEEKS ISH
240
What otc product is used for warts/verruca?
Salicylic acid - bazuka
soften + destroy the wart
241
How to use salicylic acid for wart/veruca?
Soak affected area in warm water for 5 mins
Apply daily, protect healthy skin
Remove dead skin every week
242
When to refer patients who want EHC? (4)
>5 days sinces UPS
Changes in period
Severe liver dysfunction
Enzyme inducers - phenytoin, carba, rifamp
243
Levonorgestrel and ciclosporin?
Increase toxicity
244
Can advanced supply of EHC be given?
Yes
245
What are 4 symptoms of cystitis?
pain peeing
urinary freq + urgency
incomplete bladder emptying
dark, cloudy, strong smelling urine
246
When 4 criteria to refer patients with cystitis?
Under 16 or over 70
men + children -rare
recurrent attacks -2 or more in 6 months or 3 in 1 year
duration >48
SEVERE symptoms
flank pain
systemic
Haematuria
Med SE
pregnant
Diabetic. immunocomp
247
What to do if cystitis symptoms for >48 hours?
refer
248
What to give OTC in cystitis?
Potassium citrate or sodium citratr
249
How many days to use OTC for cystitis?
2 days only
250
Advice for cystitis?
Cranberry juice
Water
pee after sex
wipe front to back
251
What does recurrent attacks refer to in cystitis?
recurrent attacks -2 or more in 6 months or 3 in 1 year
252
What is menorrhagia?
Heavy periods
253
When to refer menorrhagia (heavy period)?
Under 18 or over 45 years
OTC failed - used 3 cycles and not working
intermenstrual bleed
renal fail
Med - warfarin
family endo cancer hx
VTE/preg/obesity/diabetes/
COC or PCOS
254
What is otc used in menorrhagia?
Tranexamic acid
255
What is otc licensing for tranexamic acid?
18-45 years
and regular 21 to 35 day cycles
No MORE THAN 3 DAYS variation
256
What is dose of tranexamic acid?
2 x 500mg tabs TDS max 4 days
Heavy - take 4 times day
257
What is SE of tranexamic acid?
N, V, D
Rare = visual or thromboembolic
258
What are 3 contraindications of Tranexamic acid?
Hypersensitivity, haematuria, Renal failure
259
How often to change tampoms?
2 hourly
260
Symptoms of dysmenorrhea (period pain)?
Lower abdo pain
back pain , N,V, D + fatigue
261
What criteria to refer period pain?
pain increases during pain
woman > 30 years
Vaginal bleeding post-menopause
Taking oral contraceptives
intermenstrual pain/bleed
Fever
262
What is OTC product for dysmenorrhoea?
Feminax - NSAIDS
263
Naproxen medicine type?
P med now
264
What age to use ibuprofen for period pain?
12+
265
What is OTC licensing age of naproxen for period pain?
15-50 years
266
What is dose of naproxen for period pain?
500mg (2 tabs) and 1 further 250mg tab 6 to 8 hrs later PRN.
Max 3 tabs a day
Max 3 day use in 1 month
267
What is 1 caution of using naproxen for period pain?
Asthma
268
What are contraindications of feminax?
GI events
Severe HF, Kidney liver disease
stroke
anticoagulants
allergies
pregnant
269
What are some symptoms of vulvovaginal thrush?
Itching sore, cottage cheese discharge, NO SMELL.
Pain during sex
stinging of skin when peeing due to scratching
270
When to refer vaginal thrush? (7)
Abnormal vaginal discharge- smell and colour, fishy, yellow green (trichomoniasis)
Low abdo pain, vaginal spotting, bleeding
Vulval sores, ulcers, blisters
STI
Med SE - Abx, contraceptive, immunosuppressant.
271
What 3 patient group predisposed to thrush and need referring?
Pregnancy
Diabetic
immunocomp
272
What 2 otc products for vaginal thrush?
clotrimazole pessary + internal cream
Oral fluconazole - single dose
273
What otc product better for immediate relief of thrush?
clotrimazole pessary
274
What age is clotrimazole thrush cream for?
16-60 years
275
TX for men with penile thrush whose female partner has thrush?
Men with symptoms caused by female partner's thrush can use oral fluconazole
276
Advice for vaginal thrush?
Cotton underwear loose clothing
avoid perfume soap
wipe front to back
change pads often
Yoghurt - apply to vag?
277
What is whooping cough?
Pertussis
278
What 2 symptoms of whooping cough?
Initial - runny nose, watery eyes, sore throat.
Intense cough bouts- thick mucus, vomiting
whoop - gasp air
279
What to do if whooping cough?
Refer - all cases abx if <3 weeks
A + E if breathing difficulties
fever - paracetamol/ibu
280
Is whooping cough contagious?
YES
stay away from school 5 days after starting abx
or 3 weeks after cough started.
281
What is chicken pox symptoms?
Small red spots, itchy, infectious blister- crusts.
Prodromal symptoms
282
What are prodromal symptoms of chicken pox?
Happens 3 days before chicken pox
Fever, sore throat, myalgia, malaise
283
What 4 criteria to refer chicken pox?
Preg women
Weak immune system
Adults
Infants under 4 weeks - high risk
Shingles- over 50, pregnant, severe rash pregnant.
Re-infection with Varicella zoster virus
Blisters on one side of body
284
What are 3 OTC option for chicken pox itching?
calamine lotion
Crotamiton/eurax
1+ chlorphenamine- piriton
285
What is OTC option for chicken pox for fever?
Paracetamol only
286
What drug to avoid during chicken pox for fever?
Ibuprofen - can cause serious skin reaction
287
When are chicken pox lesions contagious?
Infectious until spots have crusted over
Direct contact with blister + air droplets -- coughing
288
What is eczema symptoms?
Sore inflammed rash
dry flaky
irritated, itchy skin
289
What is contact dermatitis?
Caused by irritants or allergic reaction
290
What 6 criteria to refer in eczema/dermatitis?
infected skin
severe rash
broken skin
on face/genital area
Symptoms > 2 weeks or otc failed> 7 days
291
What are some otc treatments for eczema protection?
Emolients
Ointment -hydrating
Soap substitutes
Calamine/eurax for itching - GSL
292
What is use of steroid in eczema?
Reduce inflammation
Mild to moderate
293
What age is clobetasone used in for eczema?
12+
294
What is steroid licensing for eczema?
Max 15g pack size
Max use 7 days - not in broken skin, no face, Not in pregnancy
295
What 3 skin conditions are steroids CI in?
Acne
rosacea
skin infections -cold sore, impetigo
296
What are 4 symptoms of acne?
White head -closed comedones
black head - open
Spots - red papules
Pustules - pus filled
297
Who to refer with acne?
Otc failed > 8 weeks
children under 12
Adults over 25 - first time
Acne rosacea
Appears back chest NOT fac
Med SE- phenytoin, progestogen
Mod-severe
298
What is otc product for acne?
Benzoyl peroxide
start low strength then increase to 10%
299
How to apply benzoyl peroxide?
Wash skin before applying
8 weeks to improve- 4-6 month for full effect
Apply to whole area affected.
300
What are Benzoyl peroxide SE?
Bleaches clothes, avoid direct sun, can cause stinging, red, peeling
301
What is 3 symptoms of irritable bowel syndrome?
Lower abdo cramp
bloating
constipation + diarrhoea
302
What factors can cause IBS?
Stress, depression, lack of fibre, anxiety
303
What 6 criteria to refer ibs?
Children
over 45 - first time symptom
blood in stoot
Bowel obstruction
Unexplained weight loss
Pregnant
Fever, nausea, vomiting, Severe pain - IBD
depression - ssris
304
What 3 anti-spasmodic drugs that help with IBS?
Mebeverine 18+
Alverine 12+
Peppermint oil 12+/15+
305
What is a common SE of peppermint oil?
Heartburn
306
What 2 antimuscarinics for IBS?
Hyoscine - 12+
dicycloverine 12+
307
What interaction can happen with anti-muscarinics?
High ACB due to TCA, antihistamine effect
308
What 2 condition to avoid anti-muscarinics?
Glaucoma
Prostatic enlargement
309
What age limit for loperamide in Irritable bowel syndrome?
Has to be for tx of acute diarrhoea linked to IBS (after initial diagnosis by a doctor) in adults over 18 years.
310
What is otitis media symptoms?
Throbbing ear ache
Discharge
311
When does otitis media go away?
After 3 days self limiting
312
What is otitis externa?
Swimmers ear
inflammation ear canal,
itchy
313
When to refer otitis media?
when analgesia does not fix pain
systemic symptoms
no improvement after 3 days
high risk - immuno comp
children <2 years with both ears
314
When to refer otitis externa?
Deafness
tinitis
blocker ear
N + V
children under 12
315
When to refer ear wax build up?
OTC failed
tinnitis
persistant pain
316
What is treatment for otitis media?
Self limiting
simple analgesia
317
What is 1st line otc otitis externa?
Ear calm spray- acetic acid
318
What is age limit for ear calm?
12+
319
When to refer otitis externa?
after 2 days of no improvement with otc tx.
320
What to give for ear wax build up?
Olive oil
arachis oil
321
What are symptoms of fever?
High temp above 38 degrees
high grade is over 39.
322
When to refer fever in children?
<3 months - fever 38 and over
3-6 months - fever 39 or over and lasts more than 24 hrs.
If > 6 months and lasts > 3 days.
Dehydrations, floppiness, drowsiness, vom, rash, convulsions.
323
What to give for fever?
paracetamol ibu
324
What is non bullous impetigo?
Small red sores around nose and mouth
can become blisters + burst
325
What is bullous impetigo?
Common in neonates
start as fluid fill blister on arm legs
SPREADS more
Paun
fever + swollen lymph common
326
What to do with impetigo?
REFER
topical fusidic in mild cases - which is pom
OTC- paracetamol
327
Is impetigo contagious?
YES
328
What are symptoms of scarlet fever?
Pink red itchy rash
develops 12-48 hrs after initial symptoms
329
What are some initial symptoms of scarlet fever before the rash?
Sore throat, headache, high temp , flushed cheeks, swollen tongue
330
What is needed for scarlet fever?
Abx phenoxymethylpen for 10 days
331
What otc helps with itching and fever in scarlet fever?
Paracetamol
antihistamine
332
How many days off school for scarlet fever
at least 24 hrs after starting abx
333
What 6 diseases to stay off school?
MMR
Scarlet fever
Impetigo
Whooping cough
Chicken pox
scabies
334
What is symptom of cluster headache?
intense pain in 1 eye
335
What is tension headache?
Tight band , constant
336
What is migraine?
Unilateral throbbing pain
N +V
Migraine with/without aura
photosensitivity
337
When to refer in migraine?
1st migraine 50+
4 or more attacks a month
migraine symptoms have changed
more than 24 hr headache
renal/cvd/liver failure/epilepsy
338
When is sumatriptan cautioned?
Epilepsy
339
When is sumatriptan avoided?
Liver or renal impair
CVD disease, HTN
340
When to refer headache?
Neck stiff
under 12
recent head injury
>4 hrs
taking COC
Severe when lying down.
341
What is used for otc migraine + headaches?
Analgesia- paracetamol, ibuprofen, aspirin.
Codeine
Antiemetics - prochlorperazine/ buclizine
sumatriptan
342
What age is sumatriptan given as P?
18-65 years
343
What is otc licensing for sumatriptan?
Migraine with or without aura
Previously tried analgesia
Established
diagnosed- by either doc or pharm
344
How to take sumatriptan?
50mg asap after migraine
Second one can be taken 2hrs if migraine reoccurs
Max 2 tabs in 24 hrs
345
What is insomnia referral?
Chronic >3 weeks
under 16
MED SE
suspected depression
346
What otc drugs can be given for insomnia?
Diphenydramine
promethazine
both 16+
347
What 2 crtieria to refer motion sickness?
Symptom after stopping tavel
Pt taking other anticholinergic drugs - TCA
348
What OTC meds for journey under 4 hrs?
Hyoscine - take up to 30 mins before
Kwells, kwells kids, joy ride
349
What age can kwells be used in?
10 +
350
What age can kwells kids be used in?
4+
351
What is given for motion sickness if journey longer than 24 hrs?
Hyoscine patch 10+ years
Lasts 72 hrs
352
What 2 conditions are hyoscine contraindicated in?
Glaucoma
Prostatic enlargement
353
What 2 antihistamines can be given for motion sickness for journeys 4-8 hrs?
Cinnarizine - 5+ (last 8 hrs)
Promethazine - 2+ (last 6-8 hrs)
354
What alternative methods for motion sickness ?
Acupressure wristband
ginger
Good for preg/BF women
355
What is symptom of bacterial conjunctivitis?
Both eyes
Sticky, purulent
redness
grity
356
What is viral conjunctivitis symptoms?
Both eyes
watery discharge
redness
gritty
cold- flu syx
357
What is allergic conjunctivitis symptoms?
Both eyes
clear watery discharge
red eyes
ITCHY
Hayfever, sneezing.
358
When to refer conjunctivitis?
True eye pain
photophobia
vision affected
contacts
foreign body
eyes/head trauma
laser eye
glaucoma, keratitis, uveitis
359
What is glaucoma symptom?
sudden sever eye pain
N + V
cloudy eye, blurred v + halos
360
What symptoms in keratitis?
Loss of vision
photophobia
redness iris
361
What are symptoms of uveitis?
Affect 1 eye
Irregular shaped pupil
photophobia
unreactive to light
362
What is 1st line otc bacterial conjunct?
2+ years- chloramphenicol
363
How to store chloramphenicol eye drops and apply it?
fridge
every 2 hrs for first 48 hrs then every 4 hours during waking hours for 5 days.
364
How to apply eye ointment?
3-4 times daily for 5 days
365
When to refer bacterial conjunctivits after tx?
after 48 hrs of not working
366
What is a CI with chloramphenicol?
Family hx of blood disorders, hx of myelosupression
367
What is piriton liquid age?
1+
368
What is Diphenhydramine age?
16
369
Who to not give sildenafil to? (3)
CVD- nitrates,
low BP
Those advised not to
370
How to use miconazole?
use until 10 days after lesions clear for a minimum of 2 weeks
371
How to use hydrocortisone cream?
Apply BD thin amount, not on face/ broken skin.
7 day max use
372
Gap to leave between doxycycline and antacids.
oral Antacids greatly decrease the absorption of oral Doxycycline. Manufacturer advises separate administration by 2 to 3 hours.
373
What criteria to not take coco-domol?
Head injury
sleep apnoea/ tonsillitis removed
Preg/breastfeeding
Adrenal gland/liver issues
breathing issues
374
When can gina be used for HRT?
vaginal atrophy in postmenopausal women over 50 years and who have not had a period for at least 1 year.
Not allowed in past endo cancer
375
What 2 vitamins not affected by orlistat?
B + C
376
What is glandular fever caused by?
Epstein barr virus
377
How long are you infectious with glandular fever for before symptoms?
You're infectious for up to 7 weeks before you get symptoms, and you may be infectious for several months after being unwell.
378
How to treat glandular fever?
self limiting,- paracetamol/ibu pain relief.
379
Hows does glandular fever get passed?
Kissing, cutlery, spit
