L18, 19, 20b, 22 Minor ailments Flashcards
GI issues, womens health, travel health, skin conditions (151 cards)
1
Q
18
What GI conditions are commonly encountered in community pharmacy, and what approach is used for patient assessment?
A
Common conditions: Dyspepsia, GORD, Constipation, Diarrhoea, Nausea & Vomiting, Haemorrhoids, IBS. Use the WWHAM framework (Who, What, How long, Action taken, Medication used).
2
Q
18
What are the symptoms and causes of dyspepsia and GORD, and how are they managed?
A
- Dyspepsia: Bloating, burping, cramps, flatulence.
- GORD: Gastric/abdominal pain, nausea, reflux, acidity.
- Causes: Food, timing, caffeine, alcohol, smoking, obesity, pregnancy, hernia, medications.
- Lifestyle: Avoid large/spicy meals, stop smoking, raise bed head, avoid lying down post-meal, lose weight.
- Refer: Dysphagia(swallowing difficulty), haematemesis (bleeding in upper GI tract), weight loss, vomiting, masses, new/recurrent symptoms.
3
Q
18
What OTC treatments are used for dyspepsia and GORD, and how do they work?
A
- Antacids (e.g., Rennie, Gaviscon): Neutralise acid. Aluminium = constipation, Magnesium = diarrhoea.
- Alginates (e.g., Gaviscon Advance): Form protective raft in oesophagus.
- H₂ Blockers: Inhibit histamine-induced acid (e.g., ranitidine – withdrawn; famotidine = POM).
- PPIs (e.g., omeprazole): Inhibit proton pump, prevent acid secretion, interact with drug metabolism.
4
Q
18
What causes diarrhoea, how is it managed, and when should patients be referred?
A
- Causes: Infection, antibiotics, PPIs, metformin, alcohol, anxiety, laxatives, travel.
- Symptoms: >3 loose stools/day, cramps, fever, nausea, appetite loss.
- Management: Fluids, high-carb diet, stop causative meds, ORS (e.g., Dioralyte), Loperamide, antibiotics only if bacterial.
- Refer: Lasts >3 days, blood, elderly/dehydrated, travel history, drug-induced.
5
Q
18
What are the causes and treatments for constipation?
A
Causes: Low fibre/fluids/activity, age, illness, meds.
Management: Fibre-rich diet, fluids, exercise.
Laxatives:
- Bulk-forming (e.g., isphagula): Increase mass, need water.
- Stimulants (e.g., senna): Speed motility, bedtime dose.
- Osmotics (e.g., lactulose): Draw in water, soften stool.
- Softeners (e.g., docusate): Lubricate, short-term only.
Refer: Sudden onset, regular use needed, bleeding, severe pain, misuse.
6
Q
18
What causes nausea and vomiting, and how is it treated?
A
- Causes: Infection, alcohol, motion sickness, pregnancy, migraine, medications, renal failure.
- Management: Treat cause, diet changes, ORS (e.g., Dioralyte), Pepto-Bismol.
- Refer: Vomiting >2 days, blood, weight loss, severe pain.
7
Q
18
What are haemorrhoids, and how are they treated?
A
Symptoms: Bleeding, itching, fullness, incomplete emptying.
Causes: Constipation, straining, pregnancy.
Treatment: Fibre, fluids, avoid straining.
- External: Creams/ointments (e.g., Germoloids).
- Internal: Suppositories (e.g., Anusol).
- Corticosteroids for inflammation.
8
Q
18
What is IBS, and how is it managed?
A
Symptoms: Cramping, bloating, fatigue, diarrhoea/constipation.
Causes: Unknown; may relate to stress, diet.
Management: Identify triggers, lifestyle adjustment.
- Antispasmodics (e.g., hyoscine, mebeverine, peppermint oil).
- CBT, hypnotherapy, acupuncture.
OTC only if IBS is diagnosed.
9
Q
18
Which of the following drugs is most associated with diarrhoea as a side effect?
A. Aluminium hydroxide
B. Magnesium salts
C. Ranitidine
D. Isphagula husk
A
✅ Answer: B
Explanation: Magnesium salts increase bowel motility, leading to diarrhoea. Aluminium has the opposite effect, causing constipation. Ranitidine is no longer OTC. Isphagula is a bulk-forming laxative that can cause bloating but not usually diarrhoea
10
Q
18
A patient with chronic GORD should avoid which of the following behaviours?
A. Elevating the head of the bed
B. Eating 3 hours before sleep
C. Smoking
D. Using alginate-based formulations
A
✅ Answer: C
Explanation: Smoking weakens the lower oesophageal sphincter, worsening reflux. The other options are beneficial in GORD management.
11
Q
18
Which of the following is a reason to refer a patient with suspected constipation?
A. Taking senna for 2 days
B. First episode of constipation in a young adult
C. Constipation induced by iron supplements
D. Sudden onset in an elderly patient with no clear cause
A
✅ Answer: D
Explanation: Sudden-onset constipation in the elderly can suggest serious conditions (e.g. bowel obstruction or cancer). This needs referral.
12
Q
18
What is the mechanism of action of proton pump inhibitors (PPIs)?
A. Block dopamine receptors
B. Stimulate mucous production
C. Inhibit the hydrogen-potassium ATPase system
D. Block serotonin receptors in the brain
A
✅ Answer: C
Explanation: PPIs irreversibly inhibit the proton pump (H⁺/K⁺ ATPase) in gastric parietal cells, reducing acid secretion.
13
Q
18
A patient requests omeprazole for heartburn and takes clopidogrel. What is the concern?
A. Risk of constipation
B. Drug interaction reducing clopidogrel efficacy
C. Severe diarrhoea
D. Risk of rebound hyperacidity
A
✅ Answer: B
Explanation: Omeprazole inhibits CYP2C19, the enzyme required to activate clopidogrel, reducing its antiplatelet effect.
14
Q
18
Which is true regarding oral rehydration salts (ORS) in diarrhoea management?
A. Should be mixed with cold tap water for best results
B. Are hyperosmotic solutions that slow diarrhoea
C. Rehydrate and correct electrolyte imbalances
D. Should only be used in children
A
✅ Answer: C
Explanation: ORS solutions contain the correct osmolarity of glucose and electrolytes to facilitate water and sodium absorption via the gut.
15
Q
18
Which agent forms a physical barrier on the surface of the stomach contents to protect the oesophagus during reflux?
A. Aluminium hydroxide
B. Lactulose
C. Gaviscon Advance
D. Ranitidine
A
✅ Answer: C
Explanation: Gaviscon Advance contains alginates which form a viscous ‘raft’ that floats on top of stomach contents, preventing reflux.
16
Q
18
Which of the following best describes how stimulant laxatives work?
A. Increase stool bulk to stimulate peristalsis
B. Draw water into the bowel
C. Stimulate enteric nerves to increase motility
D. Soften stool via lubricating action
A
✅ Answer: C
Explanation: Stimulants (e.g., senna, bisacodyl) directly stimulate enteric nerves to enhance colonic motility.
17
Q
18
A 70-year-old woman presents with bloating and reduced bowel movements. She’s on codeine, calcium carbonate, and ferrous sulphate. Which is the most likely cause of her constipation?
A. Her age
B. Ferrous sulphate
C. Calcium carbonate
D. All of the above
A
✅ Answer: D
Explanation: All listed factors contribute—elderly patients often have reduced gut motility; codeine and iron both cause constipation; calcium is also constipating.
18
Q
18
A man presents with acute diarrhoea, abdominal cramps, and recent antibiotic use (clindamycin). What’s the likely cause?
A. Viral gastroenteritis
B. Laxative overuse
C. Clostridioides difficile infection
D. Anxiety
A
✅ Answer: C
Explanation: Clindamycin is a high-risk antibiotic for C. difficile, which presents after recent antibiotic use with abdominal symptoms.
Recent clindamycin use + watery diarrhea + abdominal cramps + possible leukocytosis = think C. diff infection
19
Q
18
A patient presents with burning chest pain after meals, regurgitation, and a sour taste. He takes ibuprofen daily. Which is the most appropriate OTC recommendation?
A. Alginates
B. Loperamide
C. Codeine phosphate
D. Isphagula husk
A
✅ Answer: A
Explanation: These symptoms suggest GORD. Alginates (e.g., Gaviscon) form a protective raft. Ibuprofen may be exacerbating symptoms due to gastric irritation.
20
Q
18
Which of the following is a reason to avoid liquid paraffin as a laxative?
A. Causes rebound acidity
B. Can cause fat-soluble vitamin malabsorption
C. Is ineffective
D. Only works via fermentation
A
✅ Answer: B
Explanation: Liquid paraffin interferes with absorption of fat-soluble vitamins (A, D, E, K) and may cause seepage.
21
Q
18
A patient with IBS reports worsening bloating and cramps with increased bran intake. Why?
A. Bran increases fat absorption
B. Bran causes bacterial overgrowth
C. Bran may ferment in the colon, producing gas
D. IBS requires low-fibre diet
A
✅ Answer: C
Explanation: Insoluble fibres like bran can worsen bloating in IBS due to fermentation by colonic bacteria producing gas.
22
Q
18
In IBS, which of the following treatments is used for symptomatic abdominal cramping?
A. Bulk-forming laxatives
B. Antispasmodics like hyoscine
C. Loperamide
D. Docusate sodium
A
✅ Answer: B
Explanation: Antispasmodics relax intestinal smooth muscle, relieving cramp-like pain in IBS.
23
Q
18
A pregnant woman presents with piles and constipation. Which is the most appropriate first-line treatment?
A. Glycerol suppositories and corticosteroid cream
B. Bulk-forming laxatives and sitz bath
C. Liquid paraffin and bisacodyl
D. Codeine phosphate and fibre tablets
A
✅ Answer: B
Explanation: Safe, first-line measures include increasing dietary fibre (bulk-forming agents) and warm sitz baths for comfort. Stimulants and paraffin carry more risks.
24
Q
19
What are important principles in approaching women’s health consultations in pharmacy?
A
Be sensitive, offer confidentiality, build rapport, take a thorough and accurate history including sexual health if relevant.
25
# 19
What is BV, and what causes it?
| Bacterial vaginosis
Overgrowth of anaerobes (e.g., Gardnerella vaginalis) and loss of lactobacilli. pH > 4.5. Not sexually transmitted but sexually associated.
26
# 19
What are the symptoms and risk factors of BV?
| Bacterial vaginosis
Symptoms: Fishy-smelling, thin/grey/white watery discharge. Usually no soreness, itching, or irritation.
Risk factors: Douching, sexual activity, STIs, menstruation, smoking, copper IUD.
27
# 19
How is BV managed?
- Asymptomatic → no treatment
- OTC lactic acid-based products
- 1st line (POM): Oral metronidazole 400 mg BD for 5–7 days (or 2 g single dose)
- 2nd line: Intravaginal metronidazole gel or clindamycin cream
28
# 19
What causes vaginal candida, and how common is it?
Candida albicans overgrowth; 75% of women affected once, 20% carry candida as normal flora. Overdiagnosed. Recurrent = 4+ episodes/year.
29
# 19
What are the symptoms and risk factors of candida?
Symptoms: White, odourless discharge; itching; dysuria; dyspareunia.
Risk factors: Antibiotics, irritants, pregnancy, uncontrolled diabetes, immunosuppression, COCP.
30
# 19
How is candida managed?
1st line (P): Fluconazole 150 mg cap OR clotrimazole 500 mg pessary
External symptoms: Clotrimazole 2% cream
Partner treated if symptomatic
Consider personal preference and drug interactions
31
# 19
Key advice for pessary administration?
Insert at night while lying supine with knees bent; press applicator until it stops; dispose; stay lying down for a while.
32
# 19
What self-care advice is useful for vaginal health?
Avoid fragranced products, tight clothing, bubble baths, and irritants.
33
# 19
When should referral occur for vaginal infections?
Age <16 or >60
Recurrent or treatment-resistant infection
Fever/systemic symptoms
Suspected PID (pain, bleeding, dyspareunia)
Pregnant, diabetic, STI history
34
# 19
What are vaginal home test kits used for?
What other vaginal OTC products are available?
Differentiating BV vs. thrush based on pH and symptoms; results in 10 seconds via swab.
Cleansing wipes/washes, probiotics (vaginal use), lidocaine cream (e.g., Vagisil).
35
# 19
What is cystitis, and why is it more common in women?
Lower UTI involving urethra and bladder, usually E. coli. Women have a shorter urethra.
36
# 19
Symptoms and risk factors for cystitis?
Symptoms: Dysuria, urgency, frequency, nocturia, haematuria, back pain, cloudy urine.
Risk factors: Pregnancy, prior UTIs, catheters, diabetes, sex, anatomical abnormalities.
37
# 19
How is cystitis managed?
Usually self-limiting
OTC alkalinisers (P): Sodium/potassium citrate or bicarbonate (2-day course). Avoid in renal/cardiac disease or HTN.
1st line (POM): Nitrofurantoin MR 100 mg BD or trimethoprim 200 mg BD × 3 days
Dipstick/culture for diagnosis
Self-care: Fluids, analgesia (paracetamol or ibuprofen)
38
# 19
Referral criteria for cystitis?
Children <12, elderly, men
Lasts >7 days
Pregnancy
Pyelonephritis (Kindey disease - fever, flank pain, nausea)
Haematuria
Diabetic
Vaginal discharge present
39
# 19
What is primary dysmenorrhoea and who does it affect?
Painful menstruation due to prostaglandin-mediated uterine contractions. Affects 16–91% of menstruating women, common in adolescents.
40
# 19
Symptoms and risk factors of PD?
| Primary dysmenorrhoea
Symptoms: Lower abdominal cramps (before/during period, last up to 72 hrs), may radiate to back/thighs, nausea, vomiting, irritability, headache
Risk factors: Early menarche, family history, heavy flow, nulliparity
41
# 19
How is PD managed? How is PD managed?
| Primary dysmenorrhoea
Local heat (hot water bottle), TENS
1st line (GSL/P): Ibuprofen 200–400 mg TID, paracetamol 1 g QID
Hormonal contraception
42
# 19
When should you refer PD cases?
Age >30
Fever/malaise
Pain not linked to menstruation
Pain worsens at onset
Unexplained or heavy bleeding
43
# 19
Define menopause and perimenopause.
Menopause: 12 months of amenorrhoea due to loss of ovarian function (avg. age 51)
Perimenopause: Transition period before menopause, lasting ~4 years
44
# 19
What symptoms and impacts are associated with menopause?
90% experience symptoms
Symptoms: Hot flushes, sleep disturbance, mood changes, vaginal dryness
10% leave work; only ~14% in UK use HRT
45
# 19
What is HRT and what forms are available?
| Hormone replacement therapy
Replaces oestrogen ± progesterone ± testosterone
Forms (POM): Tablets, gel, patch, spray, vaginal tablets
OTC (P): Gina (estradiol vaginal tablet)
Non-HRT: SSRIs, lifestyle changes
46
# 19
What is the most common cause of abnormal vaginal discharge in women of childbearing age?
A. Candida
B. Trichomoniasis
C. Bacterial vaginosis
D. Chlamydia
✅ Answer: C
Explanation: BV is the leading cause of abnormal discharge in this group, due to an imbalance in vaginal flora and pH > 4.5.
47
# 19
Which symptom best differentiates candida infection from BV?
A. Grey-white discharge
B. Fishy odour
C. Vaginal itching
D. Watery discharge
✅ Answer: C
Explanation: Candida typically causes intense itching, whereas BV has fishy-smelling discharge with minimal irritation.
48
# 19
What OTC option is appropriate for a patient with itching and external irritation from vaginal thrush?
A. Fluconazole 150 mg capsule
B. Clotrimazole 2% cream
C. Metronidazole gel
D. Vagisil (lidocaine)
✅ Answer: B
Explanation: Clotrimazole 2% cream addresses fungal-related external symptoms. Vagisil provides symptomatic relief but doesn’t treat the infection.
49
# 19
What is the standard dose of fluconazole for uncomplicated vaginal thrush?
A. 100 mg daily for 7 days
B. 150 mg once
C. 150 mg BD for 3 days
D. 500 mg once
✅ Answer: B
Explanation: A single 150 mg oral fluconazole capsule (P) is the standard dose for uncomplicated candidiasis.
50
# 19
Which organism is most commonly implicated in cystitis?
A. Gardnerella vaginalis
B. Candida albicans
C. Escherichia coli
D. Chlamydia trachomatis
✅ Answer: C
Explanation: E. coli is the predominant uropathogen due to its proximity to the urinary tract from the GI tract.
51
# 19
A woman presents with fishy-smelling discharge and no itching or pain. What is the most appropriate OTC product?
A. Fluconazole
B. Clotrimazole
C. Lactic acid vaginal gel
D. Metronidazole tablets
✅ Answer: C
Explanation: BV, likely here, may be managed with OTC lactic acid products if mild and uncomplicated. Metronidazole is a POM.
52
# 19
Which of the following is a risk factor for recurrent vaginal candidiasis?
A. Smoking
B. Copper IUD
C. Recent antibiotic use
D. Late-onset menarche
✅ Answer: C
Explanation: Antibiotics disrupt normal flora, allowing candida overgrowth. The others are linked to BV or unrelated.
53
# 19
What advice is appropriate for administering a clotrimazole pessary?
A. Insert while standing
B. Take with food
C. Insert at bedtime, remain lying down
D. Insert after bowel movement
✅ Answer: C
Explanation: Lying down reduces expulsion and ensures optimal contact with vaginal tissues overnight.
54
# 19
Which UTI treatment should be used cautiously in a patient with renal impairment?
A. Sodium citrate
B. Paracetamol
C. Trimethoprim
D. Ibuprofen
✅ Answer: A
Explanation: Alkalinising agents like sodium citrate can alter electrolyte balance and should be used cautiously in renal conditions.
55
# 19
Which is not a referral criterion for uncomplicated cystitis?
A. Male patient
B. Symptoms lasting 2 days
C. Diabetic woman
D. Presence of haematuria
✅ Answer: B
Explanation: 2-day symptom duration is still within the self-limiting phase. The other options require referral due to increased risk of complications.
56
# 19
A 35-year-old presents with burning, dysuria, and urgency. She also reports abnormal discharge. What should you do?
A. Recommend sodium citrate
B. Offer fluconazole
C. Refer due to possible STI
D. Recommend cranberry juice
✅ Answer: C
Explanation: The presence of discharge with UTI symptoms suggests STI or PID, needing referral for investigation and possible swab testing.
57
# 19
A woman using a copper IUD reports watery discharge with fishy odour but no irritation. She is not sexually active. Which diagnosis is most likely?
A. Candida
B. PID
C. BV
D. UTI
✅ Answer: C
Explanation: Discharge with fishy smell and no irritation suggests BV. Copper IUD increases risk due to disruption of vaginal flora.
58
# 19
A 17-year-old girl with severe menstrual pain and no other symptoms asks for help. She uses no contraception. What is first-line management?
A. Paracetamol
B. Combined oral contraceptive pill
C. Ibuprofen
D. TENS
✅ Answer: C
Explanation: NSAIDs like ibuprofen are first-line for primary dysmenorrhoea due to their prostaglandin-inhibiting action. COCP is considered later or if contraception is needed.
59
# 19
A 52-year-old woman has not had a period for 13 months and presents with hot flushes. What stage is she likely in?
A. Menarche
B. Perimenopause
C. Menopause
D. Follicular phase
✅ Answer: C
Explanation: Amenorrhoea for 12+ months in a woman over 50 defines menopause.
60
# 19
A woman on warfarin wants to take cranberry supplements for cystitis prevention. What is the correct advice?
A. Safe to take
B. Refer to GP
C. Recommend twice daily
D. Use with sodium citrate
✅ Answer: B
Explanation: Cranberry may interact with warfarin by increasing bleeding risk. Refer for monitoring or safer alternatives.
61
# 19
A 59-year-old woman has recurrent vaginal dryness and dyspareunia. What OTC treatment may be offered?
A. Metronidazole cream
B. Gina (estradiol) vaginal tablets
C. Clotrimazole
D. Fluconazole
✅ Answer: B
Explanation: Gina is a vaginal oestrogen available OTC for postmenopausal vaginal atrophy symptoms.
62
# 19
A 48-year-old woman with hot flushes, poor sleep, and mood swings refuses HRT. What non-hormonal options can be suggested?
A. Ibuprofen
B. Clotrimazole
C. SSRIs
D. Metronidazole
✅ Answer: C
Explanation: SSRIs are non-HRT alternatives shown to reduce vasomotor menopausal symptoms. CBT and lifestyle changes also help.
63
# 19
Which statement about the NHS HRT prepayment certificate (2023) is correct?
A. It’s only for transdermal HRT
B. It covers private prescriptions
C. It offers unlimited supply of selected HRTs for 12 months
D. It is only for women over 50
✅ Answer: C
Explanation: The certificate provides unlimited access to certain HRT prescriptions via the NHS for a single yearly payment.
64
# 20
Travel Health Risk Assessment & High-Risk Groups
- Assessment Factors: Mode of transport, journey length, destination, stay duration, trip purpose, accommodation.
- Timing: 6-8 weeks before travel (vaccines, malaria prophylaxis).
- High-Risk Groups: Children, elderly, pregnant women, immunocompromised, chronic conditions (respiratory, renal, hepatic, diabetes).
65
# 20
Travel Sickness: Causes & Management
Cause: Brain can’t process conflicting sensory signals.
Common In: Children, women, migraine sufferers.
Symptoms: Nausea, vomiting, dizziness, sweating, drowsiness, headache, pallor.
Pharmacological:
- Sedating antihistamines (Cinnarizine 15mg, Promethazine 25mg) for long journeys.
- Hyoscine hydrobromide 300mcg for up to 4 hours (caution: glaucoma).
- Acupressure bands (limited evidence), Ginger (better than placebo).
Non-Pharmacological: Focus on horizon, fresh air, avoid heavy meals/alcohol/devices, front seat, slow breathing, regular breaks.
66
# 20
Sun Protection & Sunscreens
UV Damage: UVA (tanning), UVB (burning), DNA damage → skin cancers.
Preventive Measures: Avoid sun (11am–3pm), sunglasses, brimmed hats, long sleeves.
Sunscreens:
- SPF: UVB protection (e.g., SPF 50 = 500 mins protection).
- UVA Star Rating: 0–5 stars.
- Apply 20-30 mins before exposure, reapply after water, before repellents.
67
# 20
Sunburn cause, symptoms & Management
Cause: Inflammatory response to UV damage.
Symptoms: Redness, soreness, peeling skin (7-day recovery).
Management: Cool skin (showers, compresses), fluids, aftersun/aloe vera, leave blisters, pain relief (paracetamol, ibuprofen).
68
# 20
Travellers’ Diarrhoea: Causes & Treatment
Cause: Bacteria (E. coli, Campylobacter, Salmonella, Shigella), contaminated food/water.
Symptoms: 3+ unformed stools in 24h + abdominal pain, N/V, fever.
Management:
- Hydration, Oral rehydration salts (Dioralyte).
- Loperamide (12+ years) for mild/moderate cases.
- Antibiotics only for high-risk (Ciprofloxacin prophylaxis).
- Hygiene: Handwashing, safe food & water practices.
69
# 20
Deep Vein Thrombosis (DVT) & Prevention
Risk Factors: Long travel, previous DVT/PE, heart/lung disease, >60y, obesity, pregnancy.
DVT Symptoms: One-leg redness, swelling, warmth, throbbing pain.
PE Symptoms: Breathlessness, chest pain, coughing blood.
Prevention: Move frequently, calf exercises, hydration, avoid alcohol, compression stockings. Aspirin not recommended.
70
# 20
Malaria & ABCD Prevention
Cause: Parasite from female Anopheles mosquito (bites at night).
High-Risk Areas: Tropics, especially Africa.
ABCD:
- A: Awareness of risk.
- B: Bite prevention.
- C: Chemoprophylaxis (anti-malarial tablets).
- D: Diagnosis (early recognition & treatment).
71
# 20
Malaria: Bite Prevention & Chemoprophylaxis
Bite Prevention: DEET 50% (best), clothing, screened/AC rooms, mosquito nets (insecticide-treated).
Repellents: DEET, Icaridin, Eucalyptus citriodora oil, IR3535.
Chemoprophylaxis Regimens:
- Chloroquine/Proguanil (P): weekly/daily, discontinued in UK 2023 DUE TO WIDESPREAD RESISTANCE
- Atovaquone/Proguanil: Daily, start 1-2 days before, continue 1 week after.
- Mefloquine: Weekly, start 2-3 weeks before, continue 4 weeks after. NEUROPSYCHIATRIC SIDE EFFECTS
- Doxycycline: Daily, start 1-2 days before, continue 4 weeks after. RISK OF PHOTOSENSITIVITY
72
# 20
Travel Vaccinations & First Aid Kit Essentials
Vaccines for: Hep A, Meningitis, Polio, Tetanus, Typhoid, Yellow fever.
First Aid Kit: Bandages, dressings, plasters, antiseptics, painkillers (paracetamol, ibuprofen), antihistamines (cetirizine, loratadine), creams (mepyramine, hydrocortisone), thermometer, eye wash.
73
# 20
Travel Medication & Documentation
Medications Abroad: Check destination rules, contact embassy, carry in hand luggage, original packaging.
Documentation: Prescription list, GP letter for controlled drugs, vaccine records, travel insurance proof, next of kin contact card.
74
# 20
28-year-old woman with a history of migraine plans a 6-hour ferry trip. She complains of nausea and dizziness during previous travels. She has no contraindications except a known history of closed-angle glaucoma. Which is the most appropriate pharmacological option to prevent her travel sickness?
A) Hyoscine hydrobromide 300mcg
B) Cinnarizine 15mg
C) Promethazine 25mg
D) Ginger supplements
B) Cinnarizine 15mg
Explanation: Hyoscine is contraindicated in glaucoma. For longer journeys (4-8h), sedating antihistamines like Cinnarizine are preferred. Ginger can help but is less potent.
75
# 20
17-year-old male returns from a beach trip with painful, red, blistering sunburn. His skin is hot to touch. He attempts to pop the blisters for faster healing. What is the correct advice regarding his management?
A) Drain blisters to reduce pressure
B) Apply topical corticosteroids immediately
C) Advise cold compress, hydration, analgesia, and leave blisters intact
D) Use antiseptic wipes aggressively on the blisters
C) Advise cold compress, hydration, analgesia, and leave blisters intact
Explanation: Blisters should be left intact to prevent infection. Topical corticosteroids are not first-line. Focus is on cooling, fluids, and pain relief.
76
# 20
64-year-old woman develops diarrhoea (4 loose stools/day) with mild abdominal cramps on her 3rd day in India. She has no fever, no blood in stools, and no significant past history. What is the most appropriate immediate management?
A) Start empirical ciprofloxacin
B) Oral rehydration salts and Loperamide
C) Prescribe metronidazole for 5 days
D) No treatment needed, observe only
B) Oral rehydration salts and Loperamide
Explanation: Most traveller’s diarrhoea is self-limiting. Antibiotics not routinely indicated without severe symptoms. Hydration + Loperamide for symptom relief is best.
77
# 20
A 55-year-old obese smoker with controlled hypertension is flying to Australia (20h flight). Which prophylactic measure is NOT recommended to reduce DVT risk?
A) Staying well hydrated
B) Graduated compression stockings
C) Prophylactic low-dose aspirin
D) Regular calf exercises during flight
C) Prophylactic low-dose aspirin
Explanation: Aspirin is not recommended for travel-related DVT prophylaxis. Hydration, movement, and compression stockings are evidence-based.
78
# 20
A 30-year-old backpacker with a history of depression is travelling to sub-Saharan Africa. Which of the following malaria prophylaxis drugs is most appropriate, considering her mental health history?
A) Mefloquine
B) Doxycycline
C) Atovaquone/Proguanil
D) Chloroquine
Answer: C) Atovaquone/Proguanil
Explanation: Mefloquine is contraindicated due to neuropsychiatric side effects. Atovaquone/Proguanil is safer for patients with psychiatric history.
79
# 20
A 35-year-old pregnant woman is advised on malaria prevention while visiting Nigeria. Which is the correct statement regarding DEET use for her?
A) DEET should be avoided in pregnancy
B) DEET 30% is preferred to reduce skin irritation
C) DEET 50% is safe and most effective
D) Citronella-based repellents are safer in pregnancy
C) DEET 50% is safe and most effective
Explanation: DEET up to 50% is safe in pregnancy. Concentrations above 50% irritate skin. Citronella is ineffective for malaria prevention.
80
# 20
A patient returns from Ghana and develops fever, chills, and flu-like symptoms two months later. He insists he took all his malaria precautions. What should be the pharmacist’s advice?
A) Malaria unlikely due to prophylaxis adherence
B) Reassure and advise symptomatic flu treatment
C) Immediate referral for malaria testing
D) Malaria ruled out beyond 4 weeks of travel
C) Immediate referral for malaria testing
Explanation: Malaria can present within 1 year of exposure, especially within first 3 months. Prophylaxis reduces risk but is not 100% effective.
81
# 20
A patient asks how SPF 50 sunscreen works. Which is the correct explanation to provide?
A) SPF 50 means total protection from UVB rays
B) SPF 50 allows you to stay in the sun 50 times longer before burning
C) SPF 50 only protects against UVA rays
D) SPF 50 reduces your vitamin D production to zero
B) SPF 50 allows you to stay in the sun 50 times longer before burning
Explanation: SPF indicates UVB protection factor, prolonging time to sunburn. It does not block 100% UVB, nor does it eliminate vitamin D production.
82
# 20
A patient asks if untreated mosquito nets are sufficient protection for malaria. What is the most accurate advice?
A) Untreated nets are equally effective as insecticide-treated ones
B) Any net is ineffective; only repellents work
C) Insecticide-treated nets offer superior protection
D) Nets are only needed outdoors
Answer: C) Insecticide-treated nets offer superior protection
Explanation: Impregnated nets provide better protection. Indoor use during sleep is essential. Repellents complement, not replace nets.
83
# 20
A 48-year-old diabetic is travelling to the USA with insulin pens. Which is the correct documentation and transport advice?
A) Insulin can be carried in checked luggage for convenience
B) Remove insulin packaging to reduce baggage bulk
C) Carry insulin in hand luggage with prescription list and GP letter
D) No need for documentation within developed countries
C) Carry insulin in hand luggage with prescription list and GP letter
Explanation: Medications must be in original packaging, in hand luggage, with proper documentation to avoid customs issues and temperature risks.
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# 22
Skin Assessment & Terminology
Lesion: Single area of abnormal skin.
Rash: Multiple lesions, widespread.
Dermatosis: Skin disease.
Key Assessment Factors:
- Age, area affected, rash distribution, appearance, duration.
- Occupation/contact history, associated symptoms, asthma/hay fever.
- Treatments tried.
Pharmacy First service: Enables pharmacists to treat certain skin conditions (e.g. infected insect bites).
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# 22
Meningitis & Septicaemia: Recognition & Action
Meningitis: Inflammation of meninges (brain/spinal cord lining).
Septicaemia: Blood poisoning (bacterial, viral, fungal causes).
Risk: Life-threatening, rapid worsening, all ages (esp. children/babies).
Rash:
Starts as red pinpricks → progresses to red/purple blotches.
Non-blanching (glass test does NOT fade rash).
For darker skin: check pale areas (palms, soles).
Blanching rashes can progress to non-blanching.
Action: Medical emergency → Call 999 immediately.
86
# 22
Eczema (Atopic Dermatitis): Pathology & Triggers
Definition: Long-term, relapsing inflammatory skin condition.
Types:
- Atopic eczema (most common).
- Contact dermatitis (trigger-related).
Pathophysiology: Thinning of lipid skin barrier → water loss → inflammation.
Triggers: Irritants/allergens (external), genetics (internal), emotional, environmental.
Symptoms: Redness, dryness, itchiness (esp. flexures, symmetrical), lichenification (skin thickening), scratch marks.
Natural Course: Improves with age but no cure.
87
# 22
Eczema Management: Emollients & Topical Steroids
Emollients: First-line.
- Hydrate, soothe, protect skin barrier, occlusive layer.
- Types: Creams, ointments (most effective), lotions, gels, sprays.
- Apply ≥4x/day, in direction of hair growth.
- Soap substitutes only (bath additives ineffective).
- Safety: Paraffin fire hazard, slipping risk, aqueous cream irritation warning (MHRA).
Topical Steroids: Reduce inflammation.
- Apply 20–30 min before emollients.
- OTC: Hydrocortisone 1% (10+ years, not face). Eumovate (Clobetasone 0.05%) (12+ years).
- Stepped up/down by severity, area, age.
- Max 7 days use to prevent atrophy/thinning.
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# 22
Eczema Supportive Measures & Referral
Other Measures:
- Paste bandages, cotton gloves for itching.
- Antihistamines (chlorphenamine—limited efficacy).
- Alternative therapies: Limited evidence (homeopathy, acupuncture).
- Avoid scratching, triggers, synthetic fibres, detergents (e.g. bubble baths).
Refer if:
- Bacterial infection (pus, weeping, warmth).
- Eczema herpeticum (vesicles, fever, rapid worsening).
- Systemically unwell (fever, malaise).
89
# 22
Acne: Pathophysiology, Types & Impact
Definition: Chronic inflammatory skin disorder, common in adolescence.
Pathology: Sebum & keratin clogging hair follicles → comedones → papules/pustules.
Lesions:
- Comedones (plugs), Papules (<1cm solid), Pustules (<1cm pus-filled), Nodules (>1cm solid), Cysts (fluid/semi-fluid filled).
Complications: Scarring, hyperpigmentation, psychological effects (depression, anxiety).
- Psychological impact = Severe acne.
90
# 22
Acne Management & Referral
Mild Acne (OTC):
- Benzoyl Peroxide (2.5%, 5%, 10%): First-line, antibacterial, anti-inflammatory.
- Nicotinamide 4% gel: Anti-inflammatory for redness, tenderness.
- Start low, apply 1-2x/day post washing.
- Expected irritation: Stinging, redness, peeling → will settle.
- Form selection: Creams/lotions for dry/sensitive skin, gels for oily skin.
Self Care:
- Gentle cleansing (non-alkaline), avoid over-cleaning, exfoliants.
- Non-oil based makeup, sunscreen.
- Remove makeup daily.
- Avoid picking to prevent scarring.
Refer if:
- Moderate/severe acne, scarring, pigmentation.
- Psychological distress.
- OTC ineffective.
91
# 22
Insect Bites & Stings: Reactions & Management
Reaction: Rapid erythema, swelling, itchy papules.
Allergic Reaction: <24h onset.
Infection: 24–48h onset (pus, warmth, fever).
Complications: Urticaria, anaphylaxis, malaria.
Treatment:
- Remove stinger, wash with soap & water.
- Antihistamines:
Oral (sedating chlorphenamine / non-sedating loratadine).
Topical (mepyramine cream).
- Hydrocortisone 1% cream (P).
- Pain relief: Paracetamol, ibuprofen.
- Ice packs (20 min).
- Avoid scratching to prevent infection.
92
# 22
Pharmacy First Service & Referral for Bites/Stings
Pharmacy First:
Infected insect bites (≥1 year old).
Can supply POMs:
- Flucloxacillin.
- Clarithromycin (penicillin allergy).
- Erythromycin (pregnancy).
Refer if:
- Anaphylaxis (999).
- Systemic illness.
- Human/animal bites.
- Severe wound pain.
- Lyme disease suspicion (bullseye rash).
- Travel-related bites.
- Significant pus, fluid exudate.
93
# 22
Warts & Verrucae: Pathophysiology & Treatment
Cause: Human Papilloma Virus (HPV).
Stimulates basal cell division → skin growths.
Warts: Anywhere on body (common in children/teens).
Verrucae: Sole of foot, with black dots.
Transmission: Skin contact & contaminated surfaces.
Treatment:
- Reassurance: Often resolve spontaneously.
- Topical salicylic acid ± lactic acid (Bazuka, Salatac).
1. Soak, abrade with emery board, protect surrounding skin, apply daily (up to 12 weeks).
- Cryotherapy (liquid nitrogen freezing).
- Self care: Avoid picking, waterproof plasters for swimming.
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# 22
Warts & Verrucae Referral Criteria
Refer if:
Facial/anogenital warts.
Diabetic, elderly, immunocompromised patients.
Warts that itch, bleed, change colour, grow.
Large or painful verrucae.
95
# 22
A 4-year-old child presents with a high fever, irritability, vomiting, and a red rash that does not fade when a clear glass is pressed against it. The rash appeared 2 hours ago and is rapidly spreading. What is the next best action?
A) Supply oral chlorphenamine
B) Refer to GP urgently
C) Provide hydrocortisone 1% cream
D) Call 999 for emergency services
Answer: D) Call 999 for emergency services
Explanation: A non-blanching rash in a child with systemic symptoms is a red flag for meningococcal septicaemia — requires immediate emergency response.
96
# 22
A 32-year-old woman with atopic eczema asks how to apply her emollient correctly. Which statement is correct?
A) Apply after using steroid cream, rub vigorously into skin
B) Apply in direction of hair growth, at least 4 times daily
C) Use bath additives as they are effective moisturisers
D) Only apply when skin is visibly dry
Answer: B) Apply in direction of hair growth, at least 4 times daily
Explanation: Emollients are applied liberally, following hair growth, regularly to maintain skin hydration. Bath additives are ineffective.
97
# 22
Topical Steroids: OTC Limitations
Which of the following is TRUE regarding OTC topical steroid use for eczema?
A) Hydrocortisone 1% can be used on the face in adults
B) Eumovate is licensed from age 10+
C) Hydrocortisone 1% is licensed for use in patients aged 10 and over
D) Betnovate is available OTC
Answer: C) Hydrocortisone 1% is licensed for use in patients aged 10 and over
Explanation: Hydrocortisone 1% is licensed OTC for ≥10 years old (not face). Eumovate (Clobetasone) is licensed from 12+. Betnovate is POM.
98
# 22
A mother reports her child’s eczema has worsened with painful, clustered vesicles, fever, and distress. What is the pharmacist's best course of action?
A) Recommend chlorphenamine for itching
B) Suggest increased emollient use
C) Refer immediately for emergency care
D) Advise over-the-counter hydrocortisone
C) Refer immediately for emergency care
Explanation: Eczema herpeticum is a dermatological emergency caused by HSV infection. Immediate medical attention is required.
99
# 22
Acne First-Line OTC Treatment
A 17-year-old with mild acne is seeking treatment. Which is the most appropriate first-line OTC recommendation?
A) Nicotinamide 10% gel
B) Topical clindamycin
C) Benzoyl Peroxide 5% gel
D) Hydrocortisone 1% cream
C) Benzoyl Peroxide 5% gel
Explanation: Benzoyl Peroxide is first-line OTC for mild acne. Clindamycin is POM. Nicotinamide is used (4% preferred), but benzoyl peroxide is more effective.
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# 22
Which counselling point is correct regarding benzoyl peroxide use?
A) Apply liberally twice daily immediately before sun exposure
B) Expect immediate results within 48 hours
C) May bleach fabrics and increase skin photosensitivity
D) Continue application even if severe irritation develops
C) May bleach fabrics and increase skin photosensitivity
Explanation: Benzoyl Peroxide bleaches fabrics and sensitizes skin to UV. Results take 6-8 weeks. Irritation can occur; start low strength to reduce.
101
# 22
A 25-year-old presents with an insect bite showing pus and warmth. Under the Pharmacy First service, which antibiotic is supplied if penicillin allergy is documented?
A) Flucloxacillin
B) Erythromycin
C) Clarithromycin
D) Amoxicillin
C) Clarithromycin
Explanation: Clarithromycin is preferred in penicillin allergy. Flucloxacillin is first-line if no allergy. Erythromycin used in pregnancy.
102
# 22
A man presents with an insect bite acquired abroad that now shows signs of infection and a spreading rash. He is systemically unwell. What is the appropriate pharmacist action?
A) Recommend oral antihistamines
B) Supply topical hydrocortisone
C) Refer urgently to medical services
D) Advise analgesia and rest
C) Refer urgently to medical services
Explanation: Systemic symptoms post-travel insect bite = potential serious infection (e.g. malaria, Lyme disease). Urgent referral needed.
103
# 22
Which statement is TRUE regarding verrucae?
A) Verrucae occur on the hands and have no black dots
B) Verrucae are plantar warts found on the sole, often with black dots
C) Verrucae clear within 48 hours with OTC salicylic acid
D) Verrucae are caused by bacteria transmitted via contaminated surfaces
B) Verrucae are plantar warts found on the sole, often with black dots
Explanation: Verrucae are warts on the soles caused by HPV, appearing with black dots. Treatment can take weeks.
104
# 22
Which is correct when advising a patient on salicylic acid treatment for a wart?
A) No preparation is needed before application
B) Application should be discontinued if no improvement after 3 days
C) Soak wart, abrade with emery board, protect surrounding skin, apply daily
D) Use hydrocortisone instead of salicylic acid for faster resolution
C) Soak wart, abrade with emery board, protect surrounding skin, apply daily
Explanation: Proper preparation increases efficacy of salicylic acid treatment for warts.
105
# 22
A patient has symmetrical itchy red patches on flexures of arms with no silvery scales. What is the likely diagnosis?
A) Psoriasis
B) Contact dermatitis
C) Atopic eczema
D) Seborrhoeic dermatitis
C) Atopic eczema
Explanation: Typical presentation of eczema: symmetrical flexural involvement, itchy, without scales.
106
# 22
Which advice would be inappropriate for eczema management?
A) Avoid synthetic fibres and harsh detergents
B) Apply emollients multiple times daily
C) Use bath oils regularly for hydration
D) Avoid scratching and keep skin cool
C) Use bath oils regularly for hydration
Explanation: Bath oils/additives are ineffective for eczema. Soap substitutes and emollients are preferred.
107
# 22
Which acne patient scenario warrants urgent GP referral?
A) Mild comedonal acne responding to OTC treatment
B) Moderate acne with psychological distress
C) Mild acne with temporary redness from treatment
D) Comedones without papules or pustules
B) Moderate acne with psychological distress
Explanation: Psychological impact or moderate/severe acne requires GP referral.
108
# 22
Which of the following is NOT appropriate for symptomatic relief of an uncomplicated insect bite?
A) Oral chlorphenamine
B) Hydrocortisone 1% cream
C) Diclofenac gel
D) Mepyramine cream
Answer: C) Diclofenac gel
Explanation: Diclofenac (NSAID gel) is not indicated for insect bites. Antihistamines and topical steroids are appropriate.
109
# 22
Which sign is most indicative of bacterial infection in a patient with eczema?
A) Skin dryness
B) Red papules
C) Pus-filled lesions and warm skin
D) General itchiness
C) Pus-filled lesions and warm skin
Explanation: Signs of secondary bacterial infection include pus, warmth, and weeping lesions.
110
# 22
A patient develops facial swelling, wheezing, and hypotension after an insect sting. What should you do?
A) Supply antihistamines and monitor
B) Administer oral corticosteroids
C) Call 999 for emergency services
D) Reassure and observe for progression
Answer: C) Call 999 for emergency services
Explanation: Classic signs of anaphylaxis require immediate emergency response.
111
# 22
Which counselling point is important when dispensing Bazuka gel for verrucae?
A) It can be safely applied to face
B) It will resolve the lesion within 3 days
C) Protect surrounding healthy skin with vaseline
D) Use hydrocortisone alongside to reduce inflammation
C) Protect surrounding healthy skin with vaseline
Explanation: Salicylic acid can irritate healthy skin — protection is vital.
112
# 22
Which advice is most appropriate for a teenager with acne-prone oily skin?
A) Cleanse face aggressively with exfoliants twice daily
B) Use oil-based moisturisers for hydration
C) Use non-alkaline cleansing products twice daily
D) Apply hydrocortisone cream to reduce acne
C) Use non-alkaline cleansing products twice daily
Explanation: Gentle, non-alkaline cleansing avoids irritation and maintains skin barrier.
113
# 22
What is the correct definition of erythema?
A) Fluid-filled vesicle on the skin
B) Solid nodule larger than 1cm
C) Redness of the skin caused by injury or inflammation
D) Pus formation in infected wounds
C) Redness of the skin caused by injury or inflammation
Explanation: Erythema refers to skin redness due to inflammation or injury.
114
# 22
Which skin condition is covered under the Pharmacy First service for POM supply?
A) Non-infected insect bites
B) Infected insect bites in patients over 1 year old
C) Psoriasis flare-ups
D) Mild acne treatment
Answer: B) Infected insect bites in patients over 1 year old
Explanation: Pharmacy First allows POM supply for infected insect bites in patients ≥1 year.
115
# 22
Fungal Infections Overview
Cause: Candida yeast or dermatophytes (invade stratum corneum & keratinocytes).
Presentation:
- Skin: Itchy, scaly, eczema-like patches with inflamed edges, normal central area (e.g., toe webs, groin, under breasts).
- Nails: Thickened, discoloured, starts at edge and spreads inwards.
Highly contagious.
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# 22
Types of Dermatophyte Infections
Tinea pedis: Athlete’s foot (foot webs).
Tinea cruris: Jock itch (groin).
Tinea corporis: Ringworm (body).
Tinea capitis: Scalp ringworm.
Tinea unguium (Onychomycosis): Fungal nail infection.
117
# 22
Fungal Infections Management
Topical Antifungals:
- Imidazoles: Clotrimazole, Miconazole, Ketoconazole (GSL/P).
- Combined with hydrocortisone (Canesten HC, Daktacort) — for >10 years.
Other agents: Terbinafine, Tolnaftate, Undecenoates.
Use even after lesion clears.
Forms: Cream, solution, spray, powder.
118
# 22
Fungal Nail Infections Treatment
Treatment:
- Amorolfine 5% nail lacquer (GSL) for mild infection (≤2 nails, ≥18y).
- Apply weekly after filing and cleansing.
- Treatment duration: Fingernails (6m), Toenails (9–12m).
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# 22
Fungal Infections: Referral Criteria
Facial/scalp involvement.
Large areas of skin affected.
Diabetics/immunocompromised with nail infections.
- 2 nails affected.
OTC treatment failure.
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# 22
Impetigo Overview
Cause: Superficial bacterial infection (Staph/Strep).
Types:
- Non-bullous (70%): Sores, golden crusts.
- Bullous: Fluid-filled blisters (~2cm).
Common in: Children (0–4y), highly contagious.
Lesions: Vesicles rupture → golden crusts (face, mouth, nose).
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Impetigo Management
Self-limiting (2–3 weeks untreated).
Topical:
- Hydrogen peroxide 1% (P).
- Fusidic acid 2% (POM) if topical fails.
Widespread: Oral flucloxacillin, clarithromycin (penicillin allergy), erythromycin (pregnant) — 5 days.
Pharmacy First service covers localised non-bullous impetigo (≥1y).
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# 22
Impetigo: Self Care & Referral
Hygiene: Wash hands, towels, toys; no scratching/sharing towels.
Exclusion: Off school until 48h after starting treatment or lesions heal.
Refer if:
- Bullous impetigo: a contagious bacterial skin infection characterized by large, fluid-filled blisters (bullae) that rupture and ooze yellow fluid, leaving a scaly rim.
- Systemically unwell.
- Recurrent episodes (>2/year).
- Immunocompromised.
- Rapid worsening symptoms.
123
# 22
Cold Sores (Herpes Simplex)
Cause: HSV-1.
Symptoms: Tingling/burning 48h before vesicles appear (usually lower lip).
Triggers: Stress, UV light, menstruation, minor trauma, colds.
Contagious: From prodrome to healing.
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# 22
Cold Sores: Management & Referral
Treatment: Aciclovir 5% cream (GSL), apply 5x/day for 5–10 days.
Start at first symptom.
Self care: Hygiene, avoid contact with neonates, sunblock to prevent.
Refer if:
- Large, painful, recurrent sores.
- Babies, pregnant women, immunocompromised.
125
# 22
Hand, Foot & Mouth Disease
Cause: Coxsackie A16 virus.
Common in: Children <10y.
Symptoms: Sore throat, fever, painful mouth ulcers, vesicles on hands/feet (±thighs, buttocks).
Contagious: Standard hygiene needed. Not related to animal disease.
126
# 22
Hand, Foot & Mouth: Management & Referral
Management: Symptomatic.
- Analgesia (paracetamol/ibuprofen), hydration, soft foods.
- No school exclusion unless too unwell.
Refer if: Pregnant women, dehydration signs (dark urine, dry mouth, sunken eyes).
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# 22
Chickenpox (Varicella Zoster)
Incubation: 10–21 days.
Contagious: 48h before rash, until vesicles crusted over (~5d).
Symptoms: Itchy papules → vesicles → scabs (scalp, face, trunk, limbs).
More severe in adults.
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# 22
Chickenpox Management & Referral
Itch relief: Crotamiton cream, calamine lotion, cooling gels (limited evidence).
Antihistamines: Chlorphenamine (sedating).
Analgesia: Paracetamol only (avoid ibuprofen → infection risk).
Hydration. School exclusion until vesicles crusted.
Refer if:
- Lesions with redness, warmth, pain (infection).
- Immunocompromised, pregnant women, babies <4wks.
129
# 22
Shingles (Herpes Zoster) Overview
Cause: Reactivation of dormant varicella zoster virus.
Triggers: Immunosuppression, stress, age.
Symptoms:
- Tingling/pain → rash (macules, papules → vesicles).
- Unilateral, dermatomal distribution (e.g., chest).
- Weeping vesicles crust over (2–4 weeks).
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# 22
Shingles: Management & Referral
Antivirals (within 72h):
- Aciclovir 800mg (5x/day, 7 days).
- Valaciclovir if immunocompromised.
Keep rash dry (no lotions).
Pain relief: Paracetamol, ibuprofen, co-codamol.
Pharmacy First Service for adults ≥18y.
Refer if:
- Systemically unwell.
- Pregnant.
- New blisters after 7d.
- Recurrent shingles.
- Severe pain.
- Eye involvement.
131
# 22
A 35-year-old gym-goer presents with itchy, red, scaly patches with a clear central area on his groin. He is otherwise healthy. What is the best first-line treatment?
A) Oral terbinafine tablets
B) Miconazole 2% cream
C) Flucloxacillin 500mg tablets
D) Amorolfine 5% nail lacquer
B) Miconazole 2% cream
Explanation: This is tinea cruris (jock itch). Topical imidazoles like miconazole are first-line. Oral antifungals reserved for severe/refractory cases. Amorolfine is for nails.
132
# 22
Which of the following best describes onychomycosis?
A) Papules and pustules around the nail bed
B) Thickened, discoloured nail starting at the edge
C) Vesicles forming beneath the nail
D) Non-blanching rash on nail folds
B) Thickened, discoloured nail starting at the edge
Explanation: Fungal nail infections typically begin at the distal edge, progressing inwards with thickening and discolouration.
133
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134
# 22
A healthy 42-year-old man presents with mild fungal infection in one toenail. What is the most appropriate OTC treatment?
A) Oral fluconazole
B) Amorolfine 5% nail lacquer
C) Clotrimazole cream
D) Terbinafine tablets
B) Amorolfine 5% nail lacquer
Explanation: For mild onychomycosis (≤2 nails, ≥18y), amorolfine lacquer is first-line OTC. Oral antifungals require prescription.
135
# 22
Which of the following warrants referral to a GP?
A) Athlete’s foot limited to toe webs
B) Ringworm covering small area of arm
C) Scalp ringworm in a 5-year-old child
D) Fungal nail infection affecting one toenail
Answer: C) Scalp ringworm in a 5-year-old child
Explanation: Scalp (tinea capitis) requires systemic antifungals and GP referral.
136
# 22
A 3-year-old presents with golden-crusted lesions around the mouth. No systemic symptoms are present. What is the most likely diagnosis?
A) Cold sore
B) Eczema herpeticum
C) Impetigo (non-bullous)
D) Contact dermatitis
C) Impetigo (non-bullous)
Explanation: Classic presentation of non-bullous impetigo in children.
137
# 22
A 30-year-old presents with 2 small impetigo lesions on the cheek. What is the first-line Pharmacy First treatment?
A) Oral flucloxacillin
B) Hydrogen peroxide 1% cream
C) Fusidic acid 2% cream
D) Clindamycin gel
B) Hydrogen peroxide 1% cream
Explanation: Localised non-bullous impetigo is treated with hydrogen peroxide 1% cream (P). Fusidic acid is next step if ineffective.
138
# 22
Which impetigo case should be referred to a GP?
A) First episode, 2 lesions on chin
B) Widespread impetigo across both cheeks
C) Single lesion responding to hydrogen peroxide
D) Child 48 hours into treatment with drying lesions
B) Widespread impetigo across both cheeks
Explanation: Widespread disease requires oral antibiotics, hence GP referral.
139
# 22
Which statement is correct regarding cold sore treatment?
A) Start aciclovir cream after vesicles crust over
B) Apply aciclovir cream five times daily at first symptom
C) Oral antibiotics are first-line
D) Delay treatment until lesions are painful
B) Apply aciclovir cream five times daily at first symptom
Explanation: Early application during prodromal phase gives best outcome.
140
# 22
Which cold sore case requires referral?
A) First-time lesion on lower lip
B) Mild sore resolving within 5 days
C) Cold sore in a neonate
D) Cold sore triggered by UV exposure
C) Cold sore in a neonate
Explanation: Neonates with cold sores require urgent referral due to risk of severe infection.
141
# 22
A 4-year-old has mouth ulcers and vesicles on hands and feet but is eating and drinking well. What is the correct management?
A) Oral aciclovir
B) Topical clotrimazole
C) Symptomatic relief with analgesia and hydration
D) Immediate hospital referral
C) Symptomatic relief with analgesia and hydration
Explanation: Hand, foot & mouth is self-limiting. Supportive care is adequate.
142
# 22
When should a child with hand, foot & mouth be referred?
A) Rash limited to hands and feet
B) No dehydration signs
C) Pregnant woman in close contact
D) Child with mild mouth ulcers only
C) Pregnant woman in close contact
Explanation: Though generally mild, pregnant contacts should be assessed due to rare complications.
143
# 22
A 5-year-old presents with itchy papules that develop into vesicles and scab over, starting on the trunk. What is the likely diagnosis?
A) Measles
B) Chickenpox
C) Eczema herpeticum
D) Impetigo
B) Chickenpox
Explanation: Classic progression of chickenpox lesions: papule → vesicle → scab.
144
# 22
Which is appropriate advice for managing chickenpox itch?
A) Ibuprofen for inflammation
B) Paracetamol and calamine lotion
C) Hydrocortisone cream on lesions
D) Oral aciclovir for all children
B) Paracetamol and calamine lotion
Explanation: Paracetamol preferred (avoid ibuprofen). Calamine lotion/crotamiton for itch relief.
145
# 22
Which patient with chickenpox should be referred?
A) Healthy 8-year-old with crusted lesions
B) 3-week-old neonate with new lesions
C) Teenager with mild itching
D) Adult with no systemic symptoms
B) 3-week-old neonate with new lesions
Explanation: Babies under 4 weeks are high-risk and need urgent referral.
146
# 22
A 62-year-old reports tingling pain on the right chest followed by a unilateral vesicular rash. What is the likely diagnosis?
A) Eczema
B) Shingles (Herpes Zoster)
C) Chickenpox reinfection
D) Impetigo
B) Shingles (Herpes Zoster)
Explanation: Dermatomal vesicular rash with neuropathic pain is shingles.
147
# 22
Which statement about shingles treatment is correct?
A) Antivirals are ineffective after 24 hours
B) Aciclovir 800mg is first-line within 72 hours
C) Topical antivirals are preferred
D) Antibiotics prevent post-herpetic neuralgia
B) Aciclovir 800mg is first-line within 72 hours
Explanation: Oral antivirals reduce severity & post-herpetic neuralgia if started early (≤72h).
148
# 22
Which shingles scenario warrants referral?
A) Lesions dry and crusting at day 5
B) Second episode of shingles
C) Mild pain, resolving rash
D) Localised rash on chest in healthy patient
B) Second episode of shingles
Explanation: Recurrent shingles requires further investigation for immunosuppression.
149
# 22
Which skin condition is NOT currently covered under the NHS Pharmacy First Service for POM supply?
A) Non-bullous impetigo
B) Infected insect bites
C) Shingles in adults ≥18y
D) Cold sores in pregnancy
D) Cold sores in pregnancy
Explanation: Pharmacy First covers impetigo, insect bites, shingles but not cold sores in pregnancy.
150
# 22
Which is correct self-care advice for impetigo?
A) Avoid washing lesions to prevent spreading
B) Stay off school for 7 days after antibiotics
C) Wash flannels and towels at high temperatures
D) Use antiseptic mouthwash for facial lesions
C) Wash flannels and towels at high temperatures
Explanation: Good hygiene is essential. School exclusion until 48h after starting treatment.
151
# 22
Which is the correct analgesic option for shingles pain?
A) Topical NSAIDs
B) Co-codamol or paracetamol
C) Hydrocortisone cream
D) Diclofenac gel
B) Co-codamol or paracetamol
Explanation: Oral analgesia for systemic relief. Topical NSAIDs and corticosteroids are not recommended.
