Booklet Exam Flashcards

Question

Lifestyle advice for heartburn and indigestion

Answer 1

Diet: - Moving to a lower fat diet. - Avoid trigger foods and drinks; such as chocolate, alcohol, caffeine, spicy or rich foods, fatty foods, citrus fruits, and onions. - Eat smaller meals, more frequently - eat more slowly. - Avoid eating late at night. Weight loss: - In overweight patients, weight loss may help relieve symptoms and so advice on how to safely achieve this can be given. Smoking Cessation: - Stopping smoking may reduce symptoms. Raising Head of the Bed: - Raising the head of the bed may help to reduce symptoms in patients with GORD as gravity may help prevent acid regurgitation.

Answer 2

is the infrequent passing of stools. It occurs when a patient experiences a reduction in their normal bowel habit, and so may mean different things to different people. Therefore, constipation is when there is a change from the usual for each specific patient. Constipation may or may not be painful and will often result in hard faeces.

Answer 3

Poor diet - Not including enough fibre in the diet, or changing dietary habits suddenly. Inadequate fluid intake - Not drinking enough or eating enough fibres Pregnancy - Growing baby can put extra pressure on the intestines Lack of exercise - Exercise is essential for regular bowl movements. Abdominal walls in diaphragm play a crucial role in defecation. Medication - Medications can affect the muscles in the gut and the nervous system or can cause dehydration. Some can affect water absorption in stools. Increasing age - More frequent with age. Decreased mobility, more medications, underlying diseases and rectal sensory-motor dysfunction. Lack of muscle tone in the bowel. Cancer - Tumours in the abdomen can squeeze, squash or narrow the bowel and rectum making bowl movement difficult. A tumour in the lining of thw bowel can affect nerve supply to the muscles.

Answer 4

- PAIN - AGE: All children. - BLEEDING: Bright red specks in the toilet, or on the tissue, can suggest haemorrhoids (piles). - DURATION: Constipation which has lasted for over a week or is recurring. - WEIGHT LOSS: If the patient has been losing weight unintentionally. - MEDICATION: If the patient has already tried an over the counter (or prescription) product unsuccessfully. - ONSET: Refer sudden onset of constipation with no cause - OTHER SYMPTOMS: If constipation is accompanied with other symptoms, such as diarrhoea or vomiting - Pregnancy/Breastfeeding

Answer 5

1st is always dietary changes Bulk form laxatives - Mimics increase in fibre consumption. Swells in bowel and increases faecal mass therefore encourages GI tract to move faster. Also tends to hold water which increases stool softness. - methylcellulose Stimulant laxatives - Speed up the movement of Bowles by stimuting the nerves that control the muscles lignin the digestive tract - bisacodyl Osmotic laxatives - Draw water from the rest of the body into the bowel - lactulose Faecal softeners - Emollient laxative helps mix liquids into stools to revert dry masses forming - docusate calcium

Answer 6

Bulk Forming Laxatives : Tablets, sachets, granules - 24-36 hours - Take with plenty of water. Stimulant Laxatives: Tablets, suppositories,syrup - 8-12 hours - (Glycerin suppositories take 15 mins - 1 hour) - Recommended to take 1st dose at night due to onset of action (effect then in morning). Can cause cramping. Only suitable for short-term use to treat occasional constipation. Osmotic Laxatives: Solutions, sachets 1-3 days Gentle option - can cause flatulence but usually settles after a couple of days. Take with plenty of water. Faecal Softeners: Solutions, capsules - 1-2 days Often also has weak stimulant properties.

Answer 7

Diet: - Increase fibre Fluids: - Increase fluid intake Exercise: - Regular exercise is important to get things moving. Other: - Avoid ‘holding on’ as can make it worse. - If you feel the urge to go, do not delay. - Try to go somewhere quiet, and private, where you don’t feel rushed. - Raising feet on a low stool while going to the toilet may make passing stools easier (keep knees above hips).

Answer 8

1. Read the instructions on the label 2. Wash and dry your hands 3. Remove suppository from wrapper 4. Lie on your side with your top leg bent upwards towards your stomach, or squat downs or stand with one leg raised on a sea (whichever is easiest) 5. Use your finger to gently push the suppository, round end first, into your rectum (back passage) as high as it will comfortably go. A water based lubricant might make this process easier 6. You may feel the urge to push it out straight away but lay or stand still, clenching your buttocks together for a few minuted and the feeling should go away. 7. Wash your hands

Answer 9

is the increased frequency of bowel movements, with soft or watery stools. As with constipation, it is relative to what is considered normal for the patient. Acute: less than 7 days. Persistent: more than 14 days. Chronic: longer than a month.

Answer 10

Diarrhoea is usually caused by a viral or bacterial infection. Bacterial infections are normally a result of drinking contaminated water or eating contaminated food. Some medicines can cause diarrhoea and is a common side effect. Other causes of diarrhoea could include: - Faecal impaction. - Stress, upset or anxiety. - Increased intake of alcohol or caffeine. - Colorectal cancer. - Long-term conditions such as: o Ulcerative Colitis. o Crohn’s Disease. o Malabsorption syndromes. o Irritable bowel Syndrome (IBS).

Answer 11

* signs of dehydration - dark or smelly urine or urinating less than usual * lasts more that 4 days for adults and 2 days for children with or without treatment * Accompanied Edith’s every stomach pains * Blood in stools * Excessive thirst * Rectal pain * Change in bowl habit * Suspected drug induced diarrhoea Recent travel (last 3 months) to non-western countries, particularly with tropical or subtropical climates. - Accompanied with a fever.

Answer 12

- can be offered Fluid Replacement. Oral rehydration solutions (ORS) decrease the risk of dehydration and replace lost fluids and salts. They are usually a sachet of powder that is made up with safe, clean water. Despite diarrhoea often being self-limiting with no alarm symptoms, patients often also ask for something to help stop the passing of frequent stools. Loperamide is the most common anti-diarrhoeal used. Other options to help halt the diarrhoea include: - Bismuth Subsalicylate o Coats and sooths the stomach and intestines. o Slows the growth of any bacteria present.

Answer 13

Sip water throughout the day to stay hydrated. - Have plenty of rest to allow the body to recover. - If OTC medication fails to work, it is important the patient sees the GP. - There is no need for the patient to stop eating. o Eat a light diet with easy to digest food i.e. soup, rice, pasta, bread. o Babies should have their usual feeds. o Avoid foods high in fat, fibre or sugar. o Minimise dairy intake until feeling better. o Fruit juices help increase glucose and potassium levels, while soups help increase sodium. This is useful if patients do not wish to use ORS.

Answer 14

Preventing diarrhoea when abroad can be achieved by: - Ensuring food is cooked through. - Maintaining good food hygiene. - Wash hands in hot, soapy water regularly. - Use bottled water, or cooled boiled water. - Avoid ice in drinks and ice creams. - Avoid washing salads in tap water.

Answer 15

condition which starts in infants when they are new born. It normally stops around 4 months old. Colic can be defined as excessive crying, in an otherwise healthy baby, for more than 3 hours a day, for more than 3 days a week, for more than 3 weeks. However, new parents will rarely wait 3 weeks prior to seeking help and advice. Therefore a diagnosis of colic may be suspected before this timescale is reached.

Answer 16

No one knows exactly what causes colic, but some theories include: - Trapped wind from feeding or crying. - Lactose sensitivities - Painful cramps due to an underdeveloped GI system. Other signs the baby may have colic are: - An inability to be soothed. - Drawing up of legs or arching the back. - Flushed face. - Crying or fussing at similar times of day (very often morning or evening).

Answer 17

Referral to pharmacist is messesary. Treatments have no evidence base but are safe Infacol, reduces surface tension of bubbles and allows elimination of gas Lactase enzymes, e.g. Colief, help break down the lactase present in milk. Other options to help ease colic are worth trying. You could suggest: - Swaddling the baby - Feeding as upright as possible to help prevent them swallowing excess air. - Burping the baby well following a feed. - Using white noise as a distraction. - Rocking the baby o Correct teat size if bottle fed – larger hole in the teat may be needed. o Correct latch if breast feeding.

Answer 18

Coughing is the body’s way of attempting to clear the airways via a forced, expulsive manoeuvre. It is an extremely common symptom of respiratory abnormalities. Although it is common, it can be extremely upsetting, debilitating and irritating for the patient. There are two types of common cough. Productive o ‘Chesty’: produces phlegm. Non-productive o ‘Dry’: not producing phlegm.

Answer 19

coughing reflex to clear the airways. For example, this may be due to the presence of a foreign matter or mucus. Long-term conditions, such as Asthma or COPD lead to a reduction of airflow in the lungs and this will initiate the coughing reflex too. Multiple medications have a cough as a side effect of the drug.

Answer 20

- Mucus is not clear or white. - Mucus is thin and frothy. - There is blood in the mucus (including a red-tint). - The patient has chest pain, shortness of breath, wheezing or any difficulty breathing. - The cough has lasted for more than 3 weeks. - There is a cough with no obvious cause - High fever present. - The patient is asthmatic or has COPD. - The patient has a reoccurring cough.

Answer 21

three main types of cough mixture: 12+ - Expectorants - chesty coughs. - Suppressants - dry coughs. - Demulcents - any type of cough but particularly useful if tickly or irritating. - Bronchostop, a traditional herbal product containing thyme and marshmallow root

Answer 22

They reduce the stickiness of phlegm and makes it looser and easier for the body to cough up Squill

Answer 23

Block the natural coughing reflex Menthol

Answer 24

Coat the pharynx and help reduce irritation ans soreness temporarily Simple linctus

Answer 25

- Increase fluids. - Rest as much as possible. - Inhalation of steam may help to loosen and bring up phlegm. - Good hygiene measures will help prevent the spread of germs. o E.g. cover mouth when coughing. - stop smoking

Answer 26

collection of mild symptoms which affect the Respiratory System. -runny nose -sore throat - Sneeze - headaches - fever

Answer 27

- The patient has ear pain. - Suspected influenza (Flu). o Joint pain. o Fever. o Severe headache. o Exhaustion o Very unwell generally. o Often a representative will present as the patient is too ill to attend the Pharmacy. - Weakened immune system, e.g. a patient with cancer. - Any difficulty breathing or swallowing. - Skin rash. - Unintentional wright loss. - The cold has lasted more than two weeks. - There are spots on the tongue or throat. - Children.

Answer 28

Only symptomatic relief

Answer 29

Ibuprofen Paracetamol Aspirin Naproxen

Answer 30

Antihistamines Pseudoephedrine Acetaminophen

Answer 31

Benzocaine spray Acetaminophen Glycerin with glucose

Answer 32

Illegal to sell or supply any product that contains more than 720mg Pseudoephedrine or 180mg ephedrine. It is illegal to sell or supply a combination of products that between them add up to more than 720 mg pseudoephedrine or 180 mg ephedrine without a prescription It was taken off the market because of abuse by manufacturers of methamphetamine Can be bought in 12 pack tablets or 100ml liquid but any more will need to be prescribed.

Answer 33

- Use tissues instead of handkerchiefs as they can then be disposed. - Wash hands often, particularly after you have blown your nose. - “Catch” a sneeze in a tissue. - Avoid sharing cutlery, drinks and towels. Other advice could include: - Rest. - Drink plenty of water. - Inhale steam to loosen mucus. - Warm drinks with honey and lemon may be soothing. - Reassure the patient that colds are self-limiting

Answer 34

commonly occurs in babies and young children due to a viral infection affects the larynx, trachea and bronchi - Barking cough - Hoarse voice - Breathlessness/difficulty breathing. - A rasping sound when breathing symptoms are worse at night and can be further exacerbated by agitation and crying also have cold-like symptoms such as sore throat, cough, runny nose and fever

Answer 35

Strains of: - parainfluenza virus - influenza A and B - rhinovirus Less common: - allergic reactions - Inhalation of chemical irritants

Answer 36

- The patient is struggling to breath - The patient’s skin or lips are looking pale or have a blue-ish ting. - The patient is unusually quiet and still. - The patient is unusually sleepy and drowsy. - Sudden high temperature. - Unable to take in and drink fluids.

Answer 37

In mild cases, croup can be a self-limiting condition – i.e. it will get better on its own. - sitting the patient upright - encourage them to drink plenty of fluids - give paracetamol or Ibuprofen if temperature In more severe cases, patients would be referred to GP surgery and/or hospital where they may be treated with oral corticosteroids.

Answer 38

also known as seasonal allergic rhinitis. It is often worse in the mornings, when pollen rises into the air, and later in the evening, when the pollen falls again. * Sneezing * Coughing * Runny/blocked nose * Itchy, red and watering eyes * Itchy mouth, throat, nose and ears * Loss of smell * Pain around temple and forehead * Headache * Earache

Answer 39

When pollen is released into the air, it may be breathed in and can also lay on skin and get in the eyes. The pollen in and around the body triggers the immune system to release chemicals to fight this foreign matter and it is these chemicals which cause the irritation and inflammation

Answer 40

- The patient is wheezing or has shortness of breath. - The patient is taking medication or has other medical conditions.

Answer 41

Block effects of histamine Ceterizine, loratidine,feoxfeidine, chlorophenamine Tablets, liquids

Answer 42

Block calcium channels, preventing release of histamine Olopatadine, ketotifen Eye drops, inhalers, nasal sprays and oral

Answer 43

Repression of genes encoding the multiple inflammatory cytokines Prednisolone, dexamethsone Tablets, inhalers, nasal sprays, njections, creams, lotions ans gels

Answer 44

Create a physical barrier, providing a extra layer of protection against allergens that are inhaled into the nasal cavity Cellulose Wipes, balm, spray

Answer 45

- Keeping windows and doors shut - Checking the weather forecast for the pollen count is - Avoid cutting grass. - Wearing sunglasses, - Avoid drying clothes on the washing line outside, if possible. - Use Petroleum Jelly around the nostrils to trap pollen and prevent it entering the body. - Vacuum regularly and dust using a damp cloth.

Answer 46

Signals sent from body to brain.

Answer 47

Episodic or Chronic. Infrequent or frequent. Generalised and non-throbbing. Described as a tightening or weight pressing down. Gradual onset that gets progressively worse. Often due to posture, stress,tiredness etc.

Answer 48

Sensory symptoms, flashes of light, blind spots or tingling int he hands and face. aura is a warning sign of migraine

Answer 49

Most common. No warning sign

Answer 50

Pressure like pain in one specific area of face or head. Worsens with sudden movements. High temperature, toothache.

Answer 51

Rare type of severe headache. Severe pain in one side of head often around eye. Triggered by alcohol, strong smells.

Answer 52

Drinking lowers blood sugar levels so fatigue may be from brain working without enough of its main fuel.

Answer 53

Develops and gets worse with frequent use of any medication treatment for pain. Rebound headache. Occurs for more than 15 days a month.

Answer 54

- Prescription or over the counter medication has not worked. - The pain had lasted for more than a week. - The patient is buying large quantities of analgesics regularly. - The patient is on other medication or has other health conditions. - Head injuries. - Slurred speech. - Any numbness. - Any nausea/vomiting or fainting. - prevents movement. - The pain keeps reoccurring. - Pain without an obvious cause.

Answer 55

Inhibit production of prostaglandins and reduce fever 8 tabs max in 24hrs No other produts that may contain paracetamol

Answer 56

Block NSAIDs decrease the synthesis of prostaglandins which cause inflammation 400mg every 6-8 hours

Answer 57

Opioids attatch to receptors on nerve cells in brain and blocks pain messages sent from body. Combining opioids with other mediations can improve pain management and so need a lower does of opioid.

Answer 58

Sometimes added to pain killers. Weak stimulant. Reduce chance of drowsiness and enhance effect of pain killer

Answer 59

Applied to skin at site. Gets to source fast and works locally so reduce side effects

Answer 60

- NSAID creams/ointments/gels: work same as oral NSAID - Counter Irritants: Adds a feeling of warmth to the skin which can distract the brain from the pain signals. - Heat Patches: The heat dilates the blood vessels; increase circulation and reduced muscle spasms - Cooling Therapies: Creates a cold sensation on the skin. Useful immediately after an injury. Helps to reduce the swelling. - TENS: machines send small electrical pulses through the area to block pain signals.

Answer 61

Short term and low dose Not for broken or irritated skin

Answer 62

- Protect, Rest, Ice, Compress and Elevate (PRICE) the injury for 48hours after a sprain or strain. - Compression for swelling. - Weight loss will help ease pressure on joints and muscles. - Good posture can help avoid back pain.

Answer 63

An infant’s first tooth can appear anytime from birth to their first birthday, and sadly, teething is often a painful process. Gums become sore as the tooth cuts through. Symptoms that can indicate an infant is teething include: - Dribbling (leading to a rash on the cheeks, or a sore chin). - Disturbed sleep. - Swollen, red and even bleeding gums. - Hot cheeks (sometimes one sided). - Infant chewing objects. - Upset infant with no apparent, obvious cause.

Answer 64

- The infant has a rash on their body. - The infant has a fever. - The infant is vomiting. - The infant is breathless or wheezing. - The infant is refusing feeds/food (can be due to teeth but needs further discussion and advice). - The infant is floppy or unresponsive. - The parent/guardian seems overly concerned and worried for the infant.

Answer 65

Paracetamol and ibuprofen age dependant Teething gel

Answer 66

- Teething rings that can be cooled can help soothe the infant’s gums as they apply pressure and help reduce swelling. - If over 6 months old (weaning age), raw, chilled vegetables can be offered to chew. - Similarly, frozen fruit (i.e. banana and melon) are other cooling options. - The parent/guardian should comfort and try to distract the infant with playing etc. - The child should be registered with a dentist once the first tooth appears. - Clean teeth with a fluoride toothpaste once teeth start to come through. - Petroleum Jelly around the mouth and chin may help prevent rashes from dribbling.

Answer 67

Nauseous when travelling - sweating - excess saliva - headaches - pale - fatigue

Answer 68

Occurs due to repeated movements in Tavel. Brian recieve conflicting signals from eyes ans ears from movement and position and balance. Ear detect movement by eyes detect stillness

Answer 69

- Pregnant/breastfeeding. - Children under 3 years. - Patient is on other medication. - Patient has any medical conditions, including glaucoma. - The patient is the driver (or other vehicle operator).

Answer 70

Antihistamines : - block receptors and dull inner ears ability to sense motion. Block messages to part of brain that controls nausea - 2hrs before journey and 8 hours alter if needed. After food - gradual and can take up to 4 hours Hycosine hydrobromide: - work by affecting your inner ear and your brain to control vomiting. It also relaxes the muscles in the walls of your stomach. - 30 mins to start and can be repeated every 6 hours, - take 6 ours to work fully

Answer 71

* Dizzy * Sleepy * Dry mouth * Constipation * Fast heart rate * Blurred vision * Problems uritnating * dont drive or use tools * Avoid alcohol * Sugar free gum or sweets * Eat more high fibre foods and drink plenty of water * Speak to Dr, may need to change meds * Avoid during and using tools, more than a day speak to Dr * Relax, dont force and try again later

Answer 72

- Avoid rear facing seats, if possible. - Avoid alcohol. - Avoid large or fatty meals. - Avoid reading or focussing on games. - Ensure the vehicle is well ventilated (preferably with fresh air). - Suck boiled sweets, or mints. - Focus on distant objects (or on the horizon). - If possible, make regular stops and walk around outside.

Answer 73

Threadworms are tiny parasites, 2-13mm long. The female worms lay eggs in an irritant mucus, around the anus, at night. Threadworms are very common in children and symptoms include: - Itchiness around the anus, worse at night. - Disturbed sleep, leading to irritability and tiredness. - Visual confirmation of threadworms If left untreated, ongoing cases of threadworms can lead to appetite loss, weight loss, and skin infections due to persistent scratching.

Answer 74

Threadworms are contracted by the patient swallowing the worm eggs. This may occur if the patient eats undercooked meat, plays with toys from an infected person, or shares bed linen and towels etc. with an infected person. Children will often get stuck in a cycle of reinfection as they have less care over person hygiene. The threadworms lay the eggs around the anus, the child then itches and lodges the eggs under their fingernails. They then ingest the eggs through finger sucking or eating and these then hatch in the gut again to restart the cycle.

Answer 75

- Pregnant/breastfeeding. - Children under 2 years. - Patient has previously tried over the counter medication, unsuccessfully. - The skin around the anus is broken or weeping. - Reoccurring cases. - There is blood in the stools.

Answer 76

Mebendazole Stops the worms using sugar, without glucose they lose their energy supply and die. Doesn’t kill eggs so need another does 2 week later - chewable or liquid - If you have it then one dose and same if you live with anyone else. Repeat after 2 weeks

Answer 77

- rigorous hygiene measures - wash hands and scrub under nails after visiting the toilet, carrying out nappy changes, before meals - Wear underwear under pyjamas to help prevent night-time scratching.Ensure the underwear is changed in the morning. - Shower and wash around the anus, upon waking, to rinse of the eggs.

Answer 78

Head lice are small insects They live on the hair of the patient, close to the warmth of the scalp. Head lice eggs (also called nits) are also visible Once they have hatched, they appear white. They can be found attached to the hair near the follicle. Head lice can be found by combing the hair with a fine-toothed comb. Symptoms of head lice include: - Visible lice and eggs in the hair, particularly in the nape of the neck and behind the ears. - Itchy scalp.

Answer 79

transmitted by head to head contact. jump across from person to person as they need warmth to survive. The lice can live for around one month and a female will lay several eggs per night. The eggs hatch after 7-10 days. The itching that patients sometimes experience is caused by the lice biting the scalp. Over time, the patient becomes allergic to the saliva.

Answer 80

- There is flaky skin, yellow scales, or crusts on the scalp. - The patient has already tried a treatment but it has been unsuccessful. - The patient has had regular, repeated infestations. - Resistance to products is suspected.

Answer 81

Malathion - kills insects by preventing their nervous system from working properly. Paralyse and kills lice and eggs. 8-12 hours on hair Permethrin - by overexciting the nervous system of insects, eventually causing the insect to die. 8-12 hours on hair Dimeticone - It is not an insecticide, but eradicates adult and nymph lice via disruption of water homeostasis and suffocation. 8hours or overnight - wet combing 2-3 days after treatment - treat again after 7 days to catch unhached eggs

Answer 82

condition that is caused by a parasitic mite. Female mites burrow into the surface of the skin where they lay their eggs. The eggs hatch and develop in 14 days, where the cycle begins again, therefore an infestation can take as little as 15-20 days to occur. The main symptoms of scabies are intense itching (especially at night) and a rash.

Answer 83

Passed through prolonged and skin thr skin contact because the mites cannot fly or jump between hosts

Answer 84

- Children under 2years old - Patient has and/or is receiving treatment for other skin conditions (i.e. Eczema, psoriasis) - Patients that have a compromised immune system (i.e. cancer, HIV/AIDS) - Severe itching with widespread rash - Excessive scratching has broken the skin - Patient has had regular repeated infestations

Answer 85

- Permethrin 5% cream can used to treat scabies as it contains a type of insecticide that kills the mite. An alternative to permethrin is Malathion. - Do not apply the treatments after a hot bath or shower as it affects the absorption of the cream/lotion on the skin.

Answer 86

Permethrin Child Apply once weekly for 2 doses, apply over whole body including face, neck, scalp and ears then wash off after 8–12 hours. Adult - same Malathion Child Apply once weekly for 2 doses, apply preparation over whole body, and wash off after 24 hours. Adult - same

Answer 87

highly contagious virus which causes cold sores, type 1 and genital herpes, type 2. Patients may experience an itching or tingling sensation before HSV1 cold sores erupt. self-limiting and resolve in 7-10 days. Blisters scab over in 24hrs

Answer 88

Spread via contact with saliva at sites of broken skin. Someone with cold sore kisses someone with a cracked lip

Answer 89

- Pregnant/breastfeeding. - The cold sores are present in another location (not lips). - It is the patient’s first cold sore. - The blisters are yellow and weeping (may indicate infection). - The patient is on medication, or has other medical conditions. - There are a large number of sores at once. - The cold sores are inside the mouth. - The blisters appear to be spreading. - Infants and babies. - The cold sores have been present for more than 14 days. - The symptoms have suddenly worsened for no obvious reason. - The patient has other symptoms (i.e. fever).

Answer 90

Treatment is not necessary as typical cold sores are self-limiting. However, due to discomfort and the physical appearance, patients will often seek relief. Aciclovir and Penciclovir, oral pain killers

Answer 91

Avoid salty or acidic foods. Avoid contact with children. Cool soft foods, fluids. See GP if it hasn’t healed in 10 days

Answer 92

caused by two types of organisms; dermatophytes (variety) or yeast (commonly Candida albicans). The organisms thrive in warm, moist areas and are easily transmitted. The likelihood of contracting a fungal skin infection is increased with sweating,friction and skin moisture Athletes foot and ringworm Symptoms: - Red and itchy, sore skin. - Skin later becomes white, inflamed, and ‘soggy’ and may weep. - Skin may crack and peel, possibly even bleed if severe. - Typically it starts between the fourth and fifth toes in the toe webs. - Skin may start to smell. - It may spread to other toe webs, the sole and instep of the foot, and in time the nail.

Answer 93

- Pregnant/breastfeeding. - Children under 16 years old. - It has spread beyond the toe webs. - The patient has other skin conditions. - The patient has another medical condition (especially Diabetes). - The patient is taking medication. - The patient is elderly (and unable to check bottom of own feet easily). - The skin is cracked, bleeding, weeping or producing pus. - The patient is in considerable pain. - The patient has tried treatment already, unsuccessfully.

Answer 94

Topical application - imidazoles - as the outer layer of the skin is shed so is the fungus

Answer 95

- Avoid sharing towels to minimise spread of infection and wash them regularly. - Dusting powders in socks and shoes can help prevent re-infection. - Wash and dry feet (in particular, in between toes) daily. - Wear open, breathable shoes. - Change socks and hosiery daily. - Cotton socks and leather shoes are the most breathable. - Use flip-flops or plastic shoes in communal areas, like showers or changing rooms, to prevent re-infection and reduce spread to others. - Wash shoes, if possible.

Answer 96

Onychomycosis - toes nails more than fingers Symptoms: - Nail appears thickened or discoloured. - May then become white or yellow as the nail lifts from the nail bed. - Eventually, the whole nail may lift away. - The nail may also become brittle, crumble, or become soft. - Debris can accumulate under the nail. - The nail may appear misshapen. - Normally, the infection starts at the tip of the nail and spreads towards the base as it progresses. - Untreated, the nail bed can become painful.

Answer 97

- Pregnant/breastfeeding. - Children under 18 years old. - The patient has other skin conditions. - The patient has another medical condition (especially Diabetes). - The patient is taking medication. - The patient is elderly (and unable to check own feet easily). - The patient has tried treatment already, unsuccessfully. - More than two nails are affected. - There has been trauma to the nail(s). - It is affecting the finger nails. - It is causing pain. - It is affecting surrounding skin. - More than 50% of the nail is affected, or if the nail bed is affected.

Answer 98

Amorolfine lacquer is a broad-spectrum antifungal used in fungal nail infections. It is painted on to the affected nails once a week and this is applied until the nail(s) have completely regrown and are clear of infection

Answer 99

Nothing to do with worms. Fungal skin infection. Ring like rash Symptoms: - Small circular patches with red, scaly, clearly defined edges. - Less scaling and redness in the centre. - May be itchy. - Patches may multiply, grow and/or merge together. - Rings may feel raised to the touch. - Can occur anywhere on the body, depending on where contact with the fungal spores was.

Answer 100

Imidazole creams tend to be the main choice of treatment, but Terbinafine cream can also be used.

Answer 101

inflammation of the bladder. Commonly the urethra is also involved. Increased urination - desire and urgency Pain and burning sensation

Answer 102

Caused by bacteria from rectum to urethra. UTI. Moe common in women

Answer 103

- Pregnant/breastfeeding. - Children under 16 years old - Patients over 70 years old. - The patient is male. - The patient has another medical condition. - The patient is taking medication. - The patient has tried some form of treatment already, unsuccessfully. - It is the patient’s first time with Cystitis. - Frequent, recurring Cystitis. - The symptoms have persisted for more than 3 days. - Any pain in the lower back or abdomen. - There is blood in the urine. - The patient has a fever or has been sick. - There has been a change in vaginal discharge.

Answer 104

Clear on its own 2-3 days Painkillers for discomfort Fluids to promote urination Sachets

Answer 105

- Increase fluids (water is best) to 8 glasses of water in 24 hours, minimum. - Avoid tea, coffee or alcohol as these can aggravate symptoms. - When visiting the toilet, wipe front to back to reduce bacterial spread. - Avoid scented products (talc/soaps) around the vaginal area. - The patient should ensure they visit the toilet if they feel the urge to urinate as this reduces the stress on the bladder. - Practice double micturition. (Once finished urinating, try to urinate a little more to ensure an empty bladder.) - Urinate after sexual intercourse. - Wear cotton, breathable underwear. - Avoid tight trousers or tights. - Some foods may trigger Cystitis in some patients and so, if identified, these should be avoided. (I.e. spicy food, caffeine, fruit juice.) - Avoid sexual intercourse until an attack of Cystitis has cleared up. - A hot water bottle may help ease pain.

Answer 106

caused by a yeast infection. increased discharge (often thick, white, and ‘curd-like’ or cottage cheese like, with no abnormal odour) and itching around the vaginal area. Scratching often leads to soreness and so there may also be stinging and pain during sex or when the patient urines.

Answer 107

The yeast fungus is present on our bodies but grows excessively to cause thrush Antibiotic use Hormones changes Tight clothing

Answer 108

Pregnant/breastfeeding. - Children under 16 years old. - Patients over 60 years old. - The patient is male. - The patient has another medical condition. - The patient is taking medication. - The patient has tried some form of treatment already, unsuccessfully. - It is the patient’s first time with thrush. - Frequent, recurring thrush. (2 episodes in 6 months.) - The symptoms have persisted for more than 5 days. - Any pain in the lower back or abdomen. - There is blood in the urine. - There is spotting or bleeding after intercourse, or between periods. - The patient has a fever, or has nausea or vomiting. - Vaginal discharge is frothy, yellow, green or grey. - Vaginal discharge has an odour.

Answer 109

treated with a topical antifungal (e.g. imidazoles, typically Clotrimazole) and/or an oral antifungal (e.g. a triazole, specifically Fluconazole) which aims to eradicate the fugus

Answer 110

1. Hold your pessary firmly between your fingers and your thumb and fold it in half. The curved part should be facing the ceiling when you are ready to insert it. It will look like the shape of a taco 2. Place a small amount of water-soluble lubricant on the pessary edge only that will be inserted first into your vagina. Do not cover the whole pessary with lubricant because it will be difficult to hold. You can purchase the lubricant at most pharmacies. Some examples are K-Y Jelly® or Astroglide® Do not use Vaseline or any other non-water soluble product. 3. Holding the folded pessary in your dominant hand, spread the lips of your vagina apart with your other hand. It is important to spread the lips in a sideways motion, not in an upward motion, which will only stretch the lips and not help to open the vagina. 4. Gently push the folded pessary, lubricated end first, into the vagina. The pessary should be inserted lengthwise into the vagina. The vagina is a closed area, so it cannot go anywhere else inside the body. 5. Release the pessary once inside. It will unfold and return to its normalshape. 6. If it does not feel comfortable, use your index finger to gently push it in a little farther. You can’t hurt yourself or the pessary doing this. The rim of your pessary should sit just under the pubic bone at the front of your vagina.

Answer 111

1. Remove the applicator from the packaging. Keeping the cap in place, insert the tip of plunger A into the applicator B (approximately 1cm). 2. Twist and pull to remove the cap C. Be careful not to press the plunger in any further before you have inserted the applicator into the vagina. This will avoid wasting any cream. 3. Carefully put the applicator as deep as is comfortable into the vagina (this is easiest when lying on your back with your knees bent up). Holding the applicator in place, slowly press the plunger until it stops so that the pre-measured dose of cream is deposited into the vagina. 4. Remove the applicator. Dispose of the applicator in a safe place, out of the reach of children. The applicator cannot be flushed down the toilet.

Answer 112

Period pain Primary and secondary Symptoms are the most severe on the day prior to menstruation, or in the first 24 – 48 hours of menses. Secondary Dysmenorrhoea is when there is an identifiable cause, e.g. fibroids or endometriosis.

Answer 113

Before menstruation starts, Progesterone hormones drop. This allows the production of hormones called Prostaglandins to increase. The overproduction of Prostaglandins in the uterus have a role in the uterine contracting and therefore seem to be the main cause of the pain and cramping in Primary Dysmenorrhoea.

Answer 114

- Pregnant/breastfeeding. - Patients over 30 years old, presenting for the first time. - The patient has another medical condition. - The patient is taking medication. - The patient has tried some form of treatment already, unsuccessfully. - The patient is in severe or intense pain. - The severity of the pain does not decrease as menses progress. - The pain starts more than 24 hours before menses. - The pain lasts for more than 3 days (per period). - There is blood in the urine. - The patient has irregular bleeding or irregular menstrual cycles. - The patient’s periods have changed from the normal in any way.

Answer 115

Pain killers are the mainstay of treatment in Primary Dysmenorrhoea. Non- Steroidal Anti-Inflammatory Drugs (NSAIDs) are the best choice as they work by reducing Prostaglandins and thereby may assist in treating the cause of the pain, not just the pain itself. Ibuprofen is the most sensible choice as it has the least side effects of the NSAIDs, however Naproxen is also licensed for Dysmenorrhoea over the counter

Answer 116

when the walls lining the vagina become thinner, drier, and inflamed. This as a result causes women to experience vaginal dryness, itchiness and the area can become quite sore. It can also cause sex to be quite painful

Answer 117

often caused by a reduction in oestrogen hormone levels both during and after menopause, which result in changes to the vagina and associated tissues. The tissues become inflamed, and less mucus is produced resulting in associated dryness

Answer 118

- Patients less than 50 years old - The patient has another medical condition. - The patient is taking medication. - The patient is on hormone replacement therapy - The patient has tried some form of treatment already, unsuccessfully. - The patient is in severe pain or discomfort in the vaginal area - There is unusual vaginal discharge or bleeding - The patient is experiencing bleeding after sex - A history of breast, ovarian, uterine, or endometrial cancer

Answer 119

There are water-based lubricants available that can be used around and inside the vagina, e.g K-Y jelly©. There are also vaginal moisturisers that can be inserted into the vagina that help reduce dryness – one example is Replens MD vaginal gel©(22) . A new hormone replacement product has recently become available over the counter licensed for the treatment of vaginal atrophy. It contains Estradiol in 10mcg vaginal tablets (pessaries), and its brand name is Gina©

Answer 120

condition where a man is unable to get or maintain an erection through sexual intercourse. It is more common in men over 40 years of age but can happen at any age

Answer 121

various causes of erection problems, some of which are temporary that include stress, tiredness, anxiety, and alcohol related. Other causes are linked to high blood pressure, high cholesterol, hormone problems or potentially as a side effect of a medicine

Answer 122

Sildenafil and tadalafil, both previously prescription only medicines are now available as P medicines over the counter. gel-based product available known as ‘Eroxon Stimgel©’stimulates nerve endings locally, which then increases blood flow to the region to help maintain an erection

Answer 123

- Regular exercise – this will help patients keep physically fit - Lose weight – weight can have an effect on erectile dysfunction - Stop smoking as smoking can affect and be harmful to your blood vessels - Having a health balanced diet - Reducing stress and anxiety

Answer 124

* Feeling like there's something in your eye. * Burning or stinging eyes. * Watery eyes. * Itchy eyes. * Sensitivity to light. * Red and swollen eyes or eyelids. * Tears that are foamy or have small bubbles in them. * Dry eyes.

Answer 125

* clean your eyelids twice a day to start with and then once a day as your symptoms improve * continue to clean your eyes, even if your symptoms clear up A GP might suggest using an antibiotic cream or ointment that you rub on your eyelid if your blepharitis does not clear up after cleaning your eyelids regularly. If blepharitis has caused other problems, such as a lump of fluid under the skin (cyst), antibiotic eyedrops or tablets may be recommended.

Answer 126

- Pain in the eye, as distinct from superficial soreness, grittiness or itchiness - Redness localised to one area of the eye surface - Disturbance of vision - Pupils of abnormal shape or uneven pupils - Pupils reacting unevenly to light - Eye symptoms with headache and/ or nausea/ vomiting - Recurrent subconjunctival haemorrhage - Dry eyes - Children and elderly

Answer 127

1 Tilt your head back and look up. 2 With 1 hand, pull your lower eyelid down and away from your eyeball — this makes a “pocket” for the drops. 3 With the other hand, hold the eye drop bottle upside down with the tip just above the pocket. 4 Squeeze the prescribed number of eye drops into the pocket.

Answer 128

Externa = inflammation of outer ear Canal Pin and discharge Aluminium acetate

Answer 129

infection of middle ear compartment Pain and temporary deafness. Perforated eardrum Antibiotics

Answer 130

Wax blocking ear Oily fluid or dry discharge, temporary deafness Olive oil, hydrogen peroxide, syringe

Answer 131

Fluid in ear is stagnant Pain radiating to jaw, swimming related children Ear plus in water, swim hats

Answer 132

When you use a cotton bud to try and remove ear wax, you are just pushing it further down the ear canal. This can cause the wax to build up and become impacted. When your eardrum is impacted with ear wax, it can cause pain and hearing loss. Cotton buds can also damage the delicate skin in the ear canal.

Answer 133

Risk of containing peanut protein

Answer 134

Stress, dentures, poor hygiene, dehydration Pastilles, with local anaesthetic , corticosteroids,

Answer 135

Creamy white bumps Low immunity, poor hygiene, yeast infection, Miconazole - Daktarin Fluconazole

Answer 136

* Cold sore cream - lipsore * Aciclovir tablets - antivirals

Answer 137

Ski becomes itchy, inflamed, red, cracked. Can be small or widespread Cause is unknown but can be allergies, family history or as a result of asthma and hayfever

Answer 138

Treats the itching and dry skin Emolients and topical hydrocortisone and antipruritic

Answer 139

Mild hydrocortisone skin cream can be bought over the counter but stronger such as beclosetasone are POM Creams for nappy rash and other skin problems for children under 10 are also POM Over counter = hydrocortisone 1% Prescription = hydrocortisone 2.5% Mostly used for short periods of time and can wrk within days but for a bite or contact dermatitis it may need to be used for a week Not recomended for children under 2yrs

Answer 140

Occurs within a few hours of skin exposure to irritant or allergen. Dry, blistered and cracked Most common with soap and detergents Emolients, topical hydrocortisone and antipruritics

Answer 141

Mainly affects scalp but also face. Occur in area of rich supply of sebaceous glands causing scaly patched, red skin and dandruff Ketocnazole shampoo 1st line Selenium sulphide 2nd line

Answer 142

Difficult to diagnose. Exact cause is unknown but can be genetically and environmentally influenced Skin is inflamed, red scaly patches and sore over elbow or knee. Symmetrical patches Emulsifying ointment for hydration Calciptrol and topical steroids

Answer 143

Hives Itchy skin companied by swelling of the area Skin is blistered and red but can disappear within 24 hours Use antihistamines

Answer 144

Certerizine - non - OD Loratidine - non - OD Fexofenadine - non - OD Chlorophenamine - drowsy - one 4-6hours

Answer 145

Cause by viral infection Warts are raised lesion with rounded surface and flesh colours Can disappear in 6m to a year

Answer 146

Face Diabetic Pregnant Change in appearance size and colour Genital Bleeding Salicylic acid produces - soften and destroy Cryotherapy - freezing

Answer 147

Rash Contact with urine and faecies with skin Emollient Frequency nappy change Castor oil

Answer 148

Common in children 10years under Caused by a VZV virus . Contagious

Answer 149

Confused with chicken pox and cold sore More widespread without blisters but a honey crust Doesn’t require topical or antibiotic treatment Contagious

Answer 150

small white spots like grains can be seen on the inner cheeks and gums. The measles rash then follows. Measles is caused by infection with the rubeola virus. The virus lives in the mucus of the nose and throat of an infected child or adult.

Answer 151

Meningococcal meningitis is a rare but serious bacterial infection. It causes the membranes that cover the brain and spinal cord to become inflamed Bacteria and viruses are the two main causes of meningitis. The bacterium Neisseria meningitidis, also called meningococcus, causes meningococcal meningitis.

Answer 152

first sign of slapped cheek syndrome is usually feeling unwell for a few days. Symptoms may include: a high temperature of 38C or more, a runny nose and sore throat and headache. Slapped cheek syndrome is caused by a virus called parvovirus B19. This is found in the droplets in the coughs and sneezes of someone with the infection.

Answer 153

Fever, Sore throat, Feeling of being unwell (malaise), Painful, red, blister-like lesions on the tongue, gums and inside of the cheeks, A red rash, without itching but sometimes with blistering, on the palms, soles and sometimes the buttocks, Irritability in infants and toddlers, Loss of appetite Hand, foot, and mouth disease is a highly contagious infection. It's caused by viruses from the Enterovirus genus, most commonly the coxsackievirus. These viruses can spread from person-to- person through direct contact with unwashed hands or surfaces contaminated

Answer 154

Catarrhal symptoms, the whooping sound is not initially present. The bout of coughing prevent normal breathing and the whoop represents the desperate attempt to get breathe in. Caused by a bacteria called Bordetella pertussis. This is contagious and can be caught by an infected person coughing and sneezing, and tiny germs-droplets sprayed in to the air and breathed into the lungs of anyone nearby.