All treatments

Question 1

does flucloxacillin cover beta haemolytic strep

Answer 1

yes

Question 2

what for skin does doxycycline cover

Answer 2

staph aureus inc MRSA

beta haemolytic strep

Question 3

what does co-trimoxazole cover

Answer 3

staph aureus inc MRSA

65% of coliforms inc e coli

Question 4

what treatment for cellulitis

Answer 4

Flucloxacillin, or Doxycycline if Penicillin allergic.

Refer to infectious diseases if: systemically unwell, or not responding to treatment.
May be suitable for outpatient IV therapy (OHPAT).

If recurrent boils, or abscesses, consider swabbing for PVL

Question 5

what are the causative organisms of cellulitis

Answer 5

Staph aureus.

group A and other Beta haemolytic Strep.

Question 6

Tx for athletes foot

Answer 6

topical 1% terbinafine

Question 7

Tx for dermatophyte infection

Answer 7

Small area infected: clotrimazole cream (canestan), topical nail paint (amorolfine)

Scalp: terbinafine orally, itracinazole orally

Question 8

Tx for candida impetigo

Answer 8

clotrimoxazole cream, oral fluconazole

Question 9

Tx for scalies

Answer 9

Malathion lotion (overnight)
Benzyle Benzoate

Question 10

tx for lice

Answer 10

Malathion

Question 11

Tx for diabetic foot infection

Answer 11

Mild: Flucloxacillin (1st line) or Doxycycline (2nd line) 7 days

Moderate: Flucloxacillin + metronidazole (or doxycycline + metronidazole)

Question 12

causative organisms for diabetic foot infection

Answer 12

acute= s aureus

acute on chronic= s aureus, coliforms, anaerobes

Question 13

tx for impetigo

Answer 13

Localised lesions: topical Fusidic acid.

Not localised: (both 7 days)
1st Line – oral Flucloxacillin.
2nd Line – oral Clarithromycin.

Question 14

tx for syphillis

Answer 14

penicillin

Question 15

tx for lyme disease

Answer 15

doxycyline or amoxicillin

Question 16

tx for chicken pox

Answer 16

Prescribe antiviral if patient presents <24hours of onset of rash: Aciclovir (oral)

Question 17

tx for shingles

Answer 17

Must present within 72hr of onset of rash: Aciclovir or Valaciclovir

Question 18

tx for bites

Answer 18

1st line: Co-amoxiclav.

2nd line: Metronidazole + doxycycline

Question 19

tx for rosacea

Answer 19

Reduce aggravating factors (diet, sun, AVOID topical steroids)
1st line: topical metronidazole, ivermectin (to reduce demodex mite)

2nd line: oral therapy: oral tetracycline long term, low dose isotretinoin

Telangiectasia: vascular laser
Rhinophyma: surgery/ laser shaving

Question 20

tx for psorias

Answer 20

1. Emollients
2. Vit D analogues (calcipotriol, calcitriol)
3. Vit D analogue + potent corticosteroid (beware of rebound flare)
   (If on face, genitalia or flexures= mild steroid )
4. Refer:
   - phototherapy UVB (if don’t want to be admitted)
   -coal tar/ dithranol
   - systemic therapy 1st : methotrexate (ciclosporin if family planning)
   2nd: biologics (-umabs)

Question 21

what are the severities of acne

Answer 21

Mild- scattered papules and pustules, comedones
Moderate - numerous papules, pustules &
mild atrophic scarring
Severe - cysts, nodules and significant scarring

Question 22

hat advice for acne vulgaris

Answer 22

avoid over cleaning (not caused by poor hygiene), 2x daily cleaning w/ gentle soap, use make up/ moisturisers that don’t clog up pores, avoid picking/ squeezing= scarring, healthy diet

Question 23

what is the topical treatment for acne

Answer 23

• Topical retinoid (Vit A) (has drying effect, contraindicated in pregnancy/ breast feeding)
• & benzoly peroxide (keratolytic, antibacterial)
• Topical antibiotics (anti inflammation and antibacterial)- clindamycin (ALWAYS in combo with topical retinoid/ benzoyl peroxide to prevent resistance)
• Azelic acid

Question 24

what treatment for acne not responding to topical treatment

Answer 24

• Oral antibiotic (lymecycline/ doxycycline) (need to take for 6 months, always co prescribe topical retinoid benzoyl peroxide for resistance prevention)
• Combined oral contraceptive pill
• Oral isotretinoin (oral retinoid) (affects sebaceous gland activity)

Question 25

tx for lichen planus

Answer 25

Treat symptomatically – topical steroids | last 12-18 months, self limiting

Question 26

ix for bullous disorders

Answer 26

skin biopsy with immunofluorescence | Indirect immunofluorescence

Question 27

tx for bullous disorders

Answer 27

systemic steroids - Pemphigoid: tetracycline antibiotics - Other immunosuppressive agents - Topicals: emollients, topical steroids, topical antisepsis/ hygiene measure

Question 28

tx for eczema

Answer 28

- Emollients - Avoid irritants (shower gel soaps) - Topical steroids - Tx infections - Phototherapy UVB - Systemic immunosuppression - Biologics (cyclosporin, methotrexate, azathioprine) - If itch/ urticaria= sedative antihistamines

Question 29

ux for photodermporphyrias

Answer 29

Porphyria cutanea tarda Ix- woods lamp Erythropoietic protoporphyria Ix- check for anaemia, biliary tract USS (for stones), RBC porphyrins, fluorocytes, transaminases

Question 30

tx for porphyria cutanea tarda

Answer 30

treat underling cause (alcohol, viral hepatitis, oestrogens, haemochromatosis) - Relieve skin disease

Question 31

tx for erythopoietic protoporphyria

Answer 31

6 monthly LFTs and RBC porphyrins - Visible light photoprotection measures (protective clothing, visible light suncream, behavior) - Anti oxidants - Only cure bone marrow transplant, may have liver failure so might need transplant for that too

Question 32

tx for pruritis

Answer 32

- sedative antihistamine - emollients - anti depressants - anti epileptics - phototherapy - opiate agonists, ondansetron

Question 33

tx for non melanoma skin cancer

Answer 33

Surgery | 5% imiquimod cream

Question 34

tx for pre cancers

Answer 34

``` Cryotherapy Solaraze 5 FU PDT Imiquimod Resurfacing ```

Question 35

tx for melanoma

Answer 35

Surgery | Chemo/ radiotherapy may be needed

Question 36

types of surgery for skin cancer

Answer 36

electrosurgery, snip excision, curettage, shave excision, punch biopsy, elliptical excision

Question 37

Ix for leg ulcers

Answer 37

Ix- ABPI (to establish if there is arterial disease) | Wound swap ONLY if signs of infection

Question 38

what are the ABPI parameters

Answer 38

- 1= normal - 0.8-1.3= compress - <0.8 = vascular disease - >1.5 = calcification

Question 39

tx for venous ulcers

Answer 39

- Pain control - Clean with warm tap water and soap substitute (not sterile wound) - Non adherent dressing - De-sloughing (hydrogel, honey, biological, sharp debridement, surgical) - 4 layer compression bandaging (cone shaped leg) (last 6 months) - Leg elevation - Once healed emollients and compression stockings