01. KFP Insights: Formats and Cases Flashcards
Characteristics of migraine?
- Recurrent attacks that last 4-72 hours
- Typically on sided, pulsating, moderate to severe intensity, aggravated by routine physical activity
Characteristics of migraine with aura?
Migraine
- Recurrent attacks that last 4-72 hours
- Typically on sided, pulsating, moderate to severe intensity, aggravated by routine physical activity
Aura:
- Reversible focal neurological symptoms that usually develop over 5-20 minutes and last for less than 60 minutes
- Symptoms can affect vision, sensors, speech and/or , motor function, brainstem and retina
Characteristics of tension type headache?
- Last from 30 minutes to seven days
- Usually bilateral, feels like pressure or tightness in their head
- Not associated with nausea
- May be associated with photophobia
Management of medication over-use headache?
- Commence NSAID e.g. naproxen
- Cease/gradually reduce offending medication
Options for prophylaxis in migraine?
- Candesartan
- Amitriptyline
- Verapamil SR
- Propranolol
- Pizotifen
Characteristics of pityriasis rosea?
- Self limiting inflamamtory skin condition
- Cause: viral infection (reactivation of human herpesvirus 6 or 7)
- Starts with a herald patch and then 2 weeks later, multiple scaly, oval, salmon-coloured macules appear
- Macules confined to the trunk and proximal limbs, Christmas tree appearance as it follows the skin tension lines
- Rx: no specific treatment is required as it is benign and not contagious
- DDx: guttate psoriasis, secondary syphilis
What exam findings would you search for when assessing for an alternative cause of frequent urination other than urge urinary incontinence?
- Appearance of frailty
- Problems with mobility, problems with transfers
- Cognitive impairment, cognitive function
- Presence of enlarged bladder
- Presence of pelvic mass
- Presence of Atrophic vulval or vaginal changes
- Presence of pelvic organ prolapse
- Loss of urine observed at the urethral meatus on coughing
- Presence of constipation, faecal impaction on digital rectal examination
- Presence of altered perineal sensation on digital rectal examination
- Presidents of altered anal tone
- Presence of perineal skin disease (e.g. Dermatitis, thrush)
- Presence of lower limb weakness
- Presence of upper motor neuron signs On lower limb neurological examination
- Signs of other conditions associated with incontinence(eg diabetes, neuropathy, cerebro vascular disease, parkinson’s disease)
Risk factors for overactive bladder syndrome?
Non-modifiable risk factors:
* Age
* Female
* Metabolic syndrome
* Post menopausal
* Benign prostatic hyperplasia
* Pelvic organ prolapse in women
Modifiable risk factors
* Alcohol
* Smoking
* Obesity
* Caffeine intake
* Carbonated beverages
* Spicy foods
* Bladder stones
Differentials for overactive bladder?
Neurological (neurogenic detrusor overactivity):
* Stroke
* Multiple sclerosis
* Dementia
* Diabetic neuropathy
* Spina bifida
* Spinal trauma
* Reversed diurnal rhythm
Malignancy
* Urothelial carcinoma
Lower urinary tract
* Recurrent urinary tract infection
* Bladder outlet obstruction (Including benign prostatic hyperplasia, urethral stricture)
* Foreign body in lower urinary tract’s (eg eroded synthetic mesh)
* Overflow incontinence
Systemic pathologies
* Obstructive sleep apnea
* Congestive heart failure
* Diabetes resulting in polyuria
Medications
* Diuretics
* Anticholinergics
* Narcotics
Management for overactive bladder?
Non-pharmacological:
* Treatment of modifiable risk factors eg weight reduction
* Reduction of exposure to bladder stimulants (eg alcohol, caffeine, smoking, carbonated beverages)
* Constipation avoidance - aiming for soft stools passing every one to two days, increasing daily fibre intake, using stool softeners and laxatives
* Fluid optimization - Restricting fluid intake to 6-8 glasses of water per day, avoiding prepared hydration by two hours
* Pelvic floor exercises bladder training with physiotherapy
* Containment devices eg incontinence pads
* Bladder training - Scheduling voiding times, using urge control techniques
Pharmacological:
* Topical estrogen - post menopausal female
* Anticholinergic, nonselective - oxybutynin
* Anticholinergic, M3 selective - solifenacin
* Beta 3 agonist - mirabegron
Non-pharmacological management of urge urinary incontinence?
- Advise appropriate fluid intake of 15 to two litres per day
- Advise limit caffeine intake
- Advise to avoid constipation
- Advise regular toileting
- Advise good posture when toileting
- Advise to allow adequate time for emptying when toileting
- Advise bladder retraining programme
- Advise pelvic floor exercises
- Advice the use of incontinence products
- Advice use of mobility aids
- Advise the use of toileting aids (bedside commode)
- Advise to plan her outings by identifying local toilets
Differentials for pelvic discomfort, mildly tender uterus anne milky vagina discharge?
- STI infection: Pelvic inflammatory disease / Chlamydia / Gonorrhoea
- Non-STI infection: Bacterial vaginosis / vagina thrush / simplex virus
- Ectopic pregnancy
- Ovarian Torsion
- Endometriosis
Pharmacological management for pelvic inflammatory disease?
- Ceftriaxone 500mg in 2mL of 1% lidocaine IM
- Metronidazole 400mg BD PO for 14 days
- Doxycycline 100mg BD PO for 14 days
- Paracetamol or NSAID (ibuprofen)
Non-pharmacological management of pelvic inflammatory disease?
- Contact tracing for any partner in the last six months
- Avoid alcohol was metronidazole
- Avoid sexual intercourse for one week following completion of treatments Or until symptomatically better
- Review after three to seven days to ensure response to treatment
- Arranged test of cure after three to four weeks
- Advice regarding barrier contraception such as condoms
- Provide fact sheet regarding pelvic inflammatory disease
Typical presentation of pelvic inflammatory disease?
- Bilateral pelvic pain but may localise to right or left iliac fossa
- Deep dyspareunia
- Abnormal bleeding or discharge
- Cervical motion tenderness
- Fever, nausea, vomiting
Possible causes of pelvic inflammatory disease?
- Polymicrobial
- Sexually transmitted infections eg neisseria gonorrhoea, chlamydia trachomatis, mycoplasma genitalium
- Vaginal facultative bacteria and other vaginal bacteria associated with bacterial vaginosis
- Disruption of the cervical epithelium eg intrauterine device insertion
Pharmacological treatment of uncomplicated genital or pharyngeal chlamydia?
- First line: Doxycycline 100mg BD PO for 7 days
- Second line: Azithyromycin 1g PO STAT
Pharmacological treatment of asymptomatic anorectal chlamydia?
- First line: Doxycycline 100mg BD PO for 7 days
- Second line: Azithyromycin 1g PO STAT, then repeat in 12-24 hours
Pharmacological treatment of symptomatic anorectal chlamydia?
- First line: Doxycycline 100mg BD PO for 21 days
- Second line: Azithyromycin 1g PO STAT, then repeat in 12-24 hours
Which chlamydia patients should get a test of cure atleast 3 weeks after starting treatment?
- Pregnant
- Anorectal infection
- PID
What examination features do you search for when assessing erectile dysfunction?
- Penile plaques
- Small testicular size; low testicular volume - signs of androgen deficiency
- Lack of secondary sexual characteristics (eg lack of hair)
- Weak peripheral pulses
- Enlarged prostate
- Lower limb neurological deficits (eg anal tone, reflexes)
- Penile sensation
- Breast enlargement, gynecomastia
- Obesity
Initial investigations for erectile dysfunction?
- Fasting blood glucose
- Follicle stimulating hormone
- Lipid profile
- Liver function tests - NASH/MAFLD
- Luteinising hormone
- Morning testosterone
- Prolactin
Non-pharmacological management for erectile dysfunction?
- Increase exercise
- Refer to a psychologist; psychotherapist; sex therapist
- Appropriate dietary advice - Mediterranean diet
- Referral to physiotherapist for pelvic floor exercises
- Consideration of penile pump use
- Shared decision making/couple therapy
Management of acute paraphimosis?
- Arrange for transfer to emergency department of a hospital with urology specialist cover by ambulance
- Anaesthetise the penile head eg local anaesthetic topical, penile nerve block, ring block
- Apply circumferential pressure to the glans of the penis to disperse oedema (eg gloved hand or cling film or compression bandage)
- Apply ice intermittently to the head of the penis to reduce the swelling
- Aspiration of blood from the head of the penis with a needle
- Apply granulated sugar to the head of the penis
Risk factors for erectile dysfunction?
- Increased age
- Cardiovascular disease and its risk factors: sedentary lifestyle, obesity, diabetes, hypertension, dyslipidaemia, obstructive sleep apnoea, smoking
- Endocrine: diabetes, androgen deficiency, thyroid disorders, hyperprolactinaemia
- Neurological: brain, spinal cord, or autonomic nervous system
- Medication: beta blockers, thiazides, antidepressants, antipsychotics, antiandrogens
- Prostate cancer therapy
- Penile disorders: Peyronie disease
- Recreational drug or alcohol use
Management options for erectile dysfunction?
Optimise modifiable risk factors and related comorbidities
* Lifestyle - smoking cessation, healthy diet, exercise, reduce alcohol intake, avoid recreational drugs
* Reinforce blood pressure, dyslipidemia, diabetes control
* Assessable cardiovascular disease
Treat reversible causes
* Low testosterone
* Medication induced erectile dysfunction - Consider alternatives
* Psychogenic erectile dysfunction - consider referral to a therapist
First line therapy: phosphodiesterase type 5 inhibitor
Referral to Urologist
* Second line: penile injections, vacuum erection devices, external shock wave lithotripsy
* Third line: penile prosthesis
Pharmacological management options for bone pain from bony metastases?
- Paracetamol
- Non steroidal anti inflammatory
- Opioid
- Bisphosphonate therapy: pamidronate, zoledronic acid
- Glucocorticoid therapy: dexamethasone
- Stool softening agents
What advice would you provide if a patient was concerned about Future loss of capacity to make decisions relating to their health care?
- Prepare an advance health directive; advance care plan; living well
- Appoint a Medical Enjuring Power of Attorney
- Appoint an Enduring Guardian
What are some signs and symptoms of hypercalcemia?
- Confusion/delirium
- Nausea and vomiting
- Pain
- Constipation
- Thirst
- Polyurea
Management actions for a young female sexual assault victim from two days ago who was released from prison weeks ago. No contraception. Intermittently used Intravenous heroin. She does not consent for further physical examination
- Offer referral to sexual assault referral centre
- Offer emergency contraception: levonorgestrel, ulipristal
- Refer to sexual assault community support group or counsellor
- Offer empirical sexually transmitted infection treatment
- Undertake sexually transmitted infection investigation screen
- Offer human immunodeficiency virus post exposure prophylaxis
- Provide education regarding safe needle use
- Offer referral to drug and alcohol service
- Undertake mental health assessment and suicide risk assessment
- Offer referral to homeless support service
Non pharmacological management for aggressive behaviour in an elderly patient In a nursing home?
- Identify and reduce triggers of his aggression
- Anxiety management techniques (eg reassurance, talking about anxiety provoking thoughts, cognitive interventions)
- Provide calm, low stimulating environments
- Simplify instructions (Ie clear, concise, neutral volume/tone) when conversing
- Offer positive reinforcement for good behaviour
- Provide familiar environment (eg photos of family, consistent staff/routine)
- Time orientation aids (eg whiteboards with instructions routine, clocks in vision, offering natural light during daytime)
- Touch therapies (eg massage, acupuncture)
- Integrate regular leisure activities (eg arts, craft, gardening)
What are some possible causes of erythema multiforme?
- Food additives/food allergy
- Idiopathic
- Infection - Eg herpes/hepatitis and other viruses, tuberculosis, leprosy, fungal infection, mycoplasma
- Neoplasia - eg hodgkin’s disease, myeloma, carcinoma
- Medications - Eg sulphonamides, barbiturates, penicillin, anticonvulsants
- Systemic disease eg systemic lupus erythematosus
Differentials for a three month generalised itch with no obvious rash?
- Renal failure / uremia
- Jaundice, hyperbilirubinemia, cholestasis, liver disease
- Diabetes
- Thyroid disease (hyper or hypo)
- Hyperparathyroidism
- Iron deficiency anaemia
- Psychogenic
- Malignancy, solid (eg lung, colon, brain)
- Malignancy, haematological (lymphoma, multiple myeloma, leukaemia)
- Malignancy with paraneoplastic syndrome
- Polycythemia
- Macroglobulinemia
- Neurological condition (cerebral infarct, brain abscess, multiple sclerosis, parkinson’s disease)
- Infectious cause (human immunodeficiency virus, hepatitis c)
Initial investigations for a three month generalised itch with no obvious rash?
- Fasting blood glucose level
- Full blood count
- Electrolytes, urea and creatinine
- Iron studies
- Liver function tests
- Parathyroid hormone level
- Serum calcium
- Thyroid function tests
- Chest xray
Risk factors for erectile dysfunction?
- Increased age
- Cardiovascular disease and its risk factors including sedentary lifestyle, obesity, diabetes, hypertension, dyslipidemia, obstructive sleep apnea, smoking
- Endocrine disorders such as diabetes, androgen deficiency, thyroid disorders, hyperprolactinemia
- Neurological conditions affecting the brain, spinal cord, autonomic nervous system
- Medication eg beta blockers, thiazides, antidepressants, antipsychotics, anti-androgens
- Prostate cancer therapy
- Penile disorders eg fibrous penile plaques in Peyronie’s disease
- Recreational drug or alcohol use
What must you assess for in males with erectile dysfunction?
Assess exercise tolerance to determine whether they’re at risk of death or significant morbidity from sexual exertion
Males are generally considered at low risk of death or significant mobility from sexual exertion if they:
- Do you not have uncontrolled hypertension
- Have not had a recent myocardial infarction (within the last eight weeks)
- Can climb two flights of stairs in 10 seconds (13 to 16 steps each)
Males are generally considered at high risk of death or significant mobility from sexual exertion if they have any of the following (needs cardiology assessment before engaging in sexual intercourse):
- An acute coronary syndrome in the last two weeks (without revascularization)
- High risk arrhythmias eg exercise associated ventricular tachycardia, poorly controlled atrial fibrillation, implanted cardioverter defibrillator delivering frequent shocks
- Severe aortic stenosis
- Symptomatic hypertrophic obstructive cardiomyopathy
- New York Heart Association class IV symptoms (symptoms of heart failure rests and increasing discomfort with any physical activity
Management of erectile dysfunction?
- Consider referral for socket sexual or relationship therapy, particularly with strong psychogenic component is likely
- Oral Phosphodiesterase type 5 inhibitors - first line for fit and not taking nitrates
- Vacuum erection devices
- Intracavernosal therapy
- Penile implants
- If androgen deficiency: testosterone therapy
Adverse effects of phosphodiesterase 5 inhibitors such as sildenafil?
- Priapism
- Vision loss due to NAION
- Migraine
- Seizures
- Sudden hearing loss
- Transient amnesia
What advice do you provide for priapism?
If an erection has lasted more than two hours:
* Have a cold shower
* Go for a gentle jog
* Take the pseudoephedrine immediate release 120 mg oral, single dose
If the erection persists 4 hours after it started, advise the person to seek medical attention for aspiration and drainage of the corpora cavernosa
What are some contraindications to PDE5 inhibitors?
- On other nitrate medication
- Severe congestive cardiac failure
- Unstable angina
- Resting hypertension
- Recent stroke and myocardial infarction
- Recreational nitrate use
How long should a male be abstinent to give an accurate sperm sample?
- After two to three days abstinence
- It needs to be analysed within one hour
What instructions would you give for a repeat semen analysis collection?
- After two to three days abstinence - too short affects sperm count; too long affects sperm motility
- It needs to be analysed within one hour
- It should be analysed data specialise andrology laboratory
- If mild to moderate derangement: repeat after 1-3 months
- If severe oligospermia or azoospermia: repeat within 2-4 weeks
- If leuks >1 x10^6 —> needs urine culture, urine PCR for chlamydia and gonorrhoea, semen culture
What initial investigations are required for male infertility?
- Serum follicle stimulating hormone
- Morning testosterone levels
What investigations are required for patients with initial low serum testosterone?
- Repeat serum morning testosterone
- Free testosterone
- Luteinizing hormone
- Prolactin
What are some differentials for low testosterone?
- Hypogonadotropic hypogonadism
- Testicular failure or hypergonadotropic hypogonadism
- Prolactinoma
What are the initial investigations for haematospermia?
- Urine mcs and cytology
- Full blood count
- Coagulations studies
What are some red flag risk factors when assessing hematospermia?
- Age > 40
- Recurrent or persistent hematospermia
- Prostate cancer risk factors Eg positive family history or African heritage
- Constitutional symptoms eg weight loss, anorexia, bone pain
What are some differentials for haematospermia?
- Urinary tract infection
- Sexually transmitted infection
- Prostatitis - Pain on ejaculation
- Ejaculatory tract obstruction - Pain on ejaculation
- Recent urological procedure
- Prolonged sexual intercourse or ejaculation
- Prolonged abstinence
- Tuberculosis
- Schistosomiasis
- Anticoagulants
- Bleeding disorder
Which antibiotic has reduced efficacy if combined with Ural?
Nitrofurantoin
Which antibiotic class has increased risk of crystalluria when combined with Ural?
Quinolones e.g. ciprofloxacin
Define chronic bacterial prostatitis
- Recurrent UTI with culture of a recognised uropathogen or sexually transmitted organism from urine or prostatic fluid
- History of intermittent symptomatic episodes that resemble acute bacterial prostatitis, except fever is usually absent
- Diagnosis is confirmed by comparing leukocyte count and the results of culture of pre with post prostatic massage urine samples
Management of chronic bacterial prostatitis?
First line:
* Ciprofloxacin 500mg 12 hourly PO for 4 weeks
Second line:
* Norfloxacin 400 mg 12 hourly PO for 4 weeks
* Trimethoprim 300 mg daily PO for 4 weeks
What conditions are associated with chronic nonbacterial prostatitis/Chronic pelvic pain syndrome?
- Irritable bowel syndrome
- Chronic fatigue syndrome
- Fibromyalgia
What are some symptoms of prostatitis?
- Dysuria
- Urinary urgency
- Urinary frequency
- Painful ejaculation
- Lower back pain
- Perineal pain
- Chills and/or fever
- Muscular pain
- Lethargy
What is klinefelter syndrome?
- A clinical syndrome in males caused by the presence of two or more X chromosomes
- It is characterised by impaired testosterone production and spermata genesis
- The only consistent feature is small testes volume (<4mL)
Clinical features of Klinefelter syndrome?
- Taller than average height
- Reduced facial hair
- Reduced body hair
- Breast development (gynecomastia)
- Feminine fat distribution
- Osteoporosis
- Small testes (testicular atrophy)
- Varicose veins
Approach to evaluation of benign prostatic hyperplasia?
Symptoms
* Voiding (bladder emptying) symptoms eg weak stream, hesitancy and intermittency of flow
* Storage (bladder filling) symptoms eg urgency, daytime frequency and nocturia
Complicating factors
* Urinary retention
* Microscopic haematuria
* Urinary tract infection
* Personal or family history of prostate cancer
Initial investigations
* Urinalysis - Exclude leukocytosis, haematuria, proteinuria, pyuria and glycosuria
* eGFR - Exclude renal injury from primary renal dysfunction or high-pressure bladder outflow obstruction
* Urinary tract ultrasound - Assessment of prostate volume, bladder wall and residual urine; years to exclude hydronephrosis
* Prostate specific antigen - exclude prostate cancer
Management of benign prostatic hyperplasia?
Nonpharmacological
* Behaviour modifications eg reducing diuretics (caffeine, alcohol), bladder irritants (acidic, spicy foods), evening fluid intake and constipation
* Bladder training and pelvic floor exercises
* Yearly GP review of symptoms with urinanalysis and eGFR to monitor for progression
Medical therapy
* Alpha-1-adrenoceptor blockade results in smooth muscle relaxation in the prostate and bladder neck
* Uroselective agents eg tamsulosin
Risk factors for urinary tract malignancy in patients with haematuria?
- Age
- History of gross haemateria
- Irritative lower urinary tract symptoms
- Smoking (current or past history)
- Occupational exposure (Dyes, benzenes, aromatic amines)
- Cyclophosphamide exposure
- History of chronic urinary tract infection
- History of pelvic irradiation
Clinical presentation of acute bacterial prostatitis?
- Urinary tract infection symptoms eg acute dysuria, urinary frequency, urinary urgency
- Systemic features eg fever, chills, sweats
- Obstructive urinary symptoms eg Weak stream, dribbling, hesitancy or urinary retention
- Symptoms suggestive of prostatic involvement eg pelvic or perineal pressure, or prostate tenderness on gentle digital rectal examination
What organisms may cause acute bacterial prostatitis?
- Urinary pathogens eg e coli, proteus species, klebsiella
- Sexually transmitted pathogens eg chlamydia trachomatis, neisseria gonorrhoea
First line management for acute bacterial prostatitis?
Trimethoprim 300 mg daily PO for two weeks
Management of uncomplicated genital and anorectal gonorrhoea infection?
Ceftriaxone 500mg IM stat, in 2mL 1% lignocaine PLUS azithromycin 1g PO stat
What instructions would you give to a patient with gonorrhoea?
- Advise no sexual contact for seven days after treatment is commenced, or until the course is completed and symptoms resolved, whichever is later
- Advise no sex with partners from the last two months until the partners have been tested and treated if necessary
- Recommend partner notification
- Provide patient with a fact sheet
Clinical features and causes of urethritis?
Features:
* Urethral irritation
* Dysuria
* Discharge
Causes:
* Most common bacterial causes: Chlamydia trachomatis, Neisseria gonorrhoea, Mycoplasma genitalium
* Other pathogens: adenoviruses, herpes simplex virus, Trichomonas vaginalis
* In 50% or more of cases, no pathogen is identified
Note: ureaplasma urealyticum, ureaplasma parvum and mycoplasma hominis are part of the normal genital flora
What is the treatment for chlamydia trachomatis conjunctivitis?
Azithromycin 1g PO stat, as a single dose
Why is gonococcal conjunctivitis an ophthalmic emergency?
- Usually presents with acute onset of copious,. And discharge
- Gonococcal conjunctivitis can cause ulceration and perforation of the cornea
Treatment of gonococcal conjunctivitis?
Ceftriaxone 1g IM or IV, as a single dose
Which demographic groups are at a higher risk of having a sexually transmitted infection?
People who:
* Had sex overseas
* Had been sleeping rough or homeless
* Worked as a street based sex worker
* Had tattoos, especially overseas
* Injected drugs or use methamphetamine, especially if they shared needles or any other equipment used for injecting
* Had been in prison
* Have been a refugee or recent migrant
* Identify as Aboriginal or Torres Strait Islander
* Experienced violence from a partner
* Had been on PrEP
* Had been sexually assaulted or had sex they didn’t want to have
Management of uncomplicated genital or pharyngeal chlamydial infection?
- First line: Doxycycline 100mg BD PO for seven days
- Second line: azithromycin 1g PO, stat
What advice would you give for a patient diagnosed with chlamydia?
- Advise no sexual contact for seven days after treatment is commenced, or until the course is completed and symptoms resolved, whichever is later
- Advised no sex with partners from the last 6 months until the partners have been tested and treated if necessary
- Contact tracing makes line provide patient with factsheet
- Consider presumptive treatment if there has been such a contact within the past two weeks or in the person’s individual circumstances mean later treatment may not occur
What do you advise a patient if they have missed their combined oral contraceptive pill - Less than 24 hours late (not more than 48 hours since you took your last pill?
- Take it as soon as you remember
- Then take the next one at the usual time - you may end up taking 2 pills on the same day
- You will still be protected against pregnancy
What do you advise a patient if they have missed their combined oral contraceptive pill - More than 24 hours late (more than 48 hours since you took your last pill)?
- Take it as soon as you remember
- Then take the next one at the usual time - you may end up taking 2 pills on the same day
- Keep on taking the pills as usual and use another form of contraception (such as condoms) or don’t have sex for the next seven days
- If there are less than 7 hormone pills left in your pack and missed one or more pills: Continue to take the remaining home and pills and don’t have the break or take the non hormone pills —-> go straight on the hormone pills in the next pack
While having the combined oral contraceptive pill as contraception, when should emergency contraception be considered?
Consider using the emergency contraceptive pill if you:
* Miss more than one pill in the first seven days of a new pack of pills and have had unprotected sex in the previous five days
* Start a new pack more than 24 hours late and have had unprotected sex in the previous five days
* Have unprotected sex in the seven days after missing more than one pill
Management of mild initial episode of oral mucocutaneous herpes in an immunocompetent patient?
- Benzydamine 1% gel Q2-3hourly TOP on lesions
- Children should be excluded from daycare
- Barrier cream (e.g. petroleum jelly) applied to the lips can help prevent adhesions
Management of mild recurrences of oral mucocutaneous herpes in an immunocompetent patient?
Aciclovir 5% cream 5 times per day, TOP only on lesions on the skin around the mouth for 5 days
Management of infrequent but severe occurrences of oral mucocutaneous herpes (e.g. difficulty eating or swallowing) in an immunocompetent patient?
- Famiciclovir 1500mg PO, as a single dose OR
- Valaciclovir 2g Q12hourly PO for 1 day
Management of frequent and severe occurrences of oral mucocutaneous herpes (e.g. difficulty eating or swallowing) in an immunocompetent patient?
- Famiciclovir 250mg BD PO for 6 months then review OR
- Valaciclovir 500mg daily PO for 6 months then review
