Counter Prescribing Flashcards by Ambra Copping

What are the symptoms of scabies?

Intense generalized itch that is usually worse at night
Erythematous papules found on the periumbilical area, waist, genitalia, breasts, buttocks, axillary folds, fingers (including interdigital spaces), wrists, and extensor aspects of the limbs.
The back is often not involved, and the head is spared, except in children.
Palms and soles are also affected in the elderly and in infants and young children.
The papules are small and are often excoriated with haemorrhagic crusts on top.
Thin brown grey line of burrows
Recent onset of itchy rash in family

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How to test for scabies?

Ink burrow test
Back or blue ink is applied to the suspected papule and then wiped off with alcohol to remove surface ink. If the person has scabies, a dark zigzagged line running across and away from the lesion appears, due to ink tracking down the mite burrow.

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What could be alternative diagnosis’ instead of scabies?

Pubic/ head lice
Insect bites
Other dermalogical conditions e.g contact dermatitis

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What is the treatment for scabies and give details:

Permethrin 5% cream
Under two years refer, not suitable for 2 months or under
Apply once a week for two weeks, everyone in the household
All over body apart from head/face for adults (elderly and children all over)
Wash off after 8/12 hours, if wash hands apply again
Apply to cool dry skin, NOT after bath/shower
Wash bedding and clothes 50ºC or more

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What are the symptoms of eczema?

Itchy
Dryness
On hands and flextures
Episodic
Atopic history
Starts when younger

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What could be alternative diagnosis’ instead of eczema?

Psoriasis- silvery scales
Fungal infection
Seborrhoeic dermatitis- greasy scales

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What is the treatment of eczema and give details:

Emollients- apply liberally and as frequently as needed, especially after bath/ shower and down with hair growth
Topical corticosteroids- thinly using fingertip units to affected area, short term use
Apply 30 mins after emollient

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What are the symptoms in contact dermatitis?

Erythema and vesiculation — dryness, scaling and bullae may also be present
Irritant- stinging, burning, dryness, tightness and chapping on places had contact
Allergic- main one is itching on different places to contact

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What are the treatment for contact dermatitis and describe:

Avoidance, can take a while 8-12 weeks
Can also use emollients to help with rehydration of skin barrier

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What are the symptoms of oral herpes simplex 1?

Pain, burning, tingling, itching, and paraesthesia
This can be from 6-48 hours before crops appear (precede lesion)
Crops of vesicles that rupture, leaving superficial ulcers that crust over and heal

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What could be an alternative diagnosis of cold sores?

Impetigo- yellow crusting (bacterial)

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What is the treatment for coldsores and describe:

Aciclovir
Most effective when applied at initial onset of symptoms (5 days)
Blistex to dry up the sore
Compeed patches to reduce spread

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What are the symptoms of bacterial conjunctivitis?

Discomfort which may be described as ‘grittiness’, ‘foreign body’ or ‘burning
Purulent or mucopurulent discharge with crusting of the lids which may be stuck together on waking.

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What is the treatment for bacterial conjunctivitis and describe:

Chloramphenicol
One drop 3-4 times a day to infected eyes

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What are the symptoms of allergic conjunctivitis?

Itchy
Red eye
Watery discharge
Associated with other allergies and in the right season

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What is the treatment for allergic conjunctivitis?

Sodium cromligate eye drops
Apply 4 times a day

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What is the treatment for threadworm?

Mebendazole

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Describe a Bulla lesion:

Large blisters with clear fluid

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Describe a Macule lesion:

Well defined mark on skin, flat, not raised

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Describe a Papule lesion:

Small, raised lesion

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Describe a Nodule lesion:

Large, raised lesion (papule)

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Describe a Petechia lesion:

Purple, red or brown round spots, due to bleeding

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Describe a Pustule lesion:

Small blister containing pus

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Describe a Vesicle lesion:

Small blister containing serum

Describe what causes Roseola Infantum, how its spread and the incubation period:

Viral Aerosols in mouth, nose 5-15 days

Describe the rash in Roseola Infantum:

Pink/ red spots, patches, or bumps Starts on chest, tummy and back Spreads to face, neck, and arms Not itchy

Describe the other symptoms in Roseola Infantum:

High temperature Cold like symptoms Swollen eyelids and neck glands Loss of appetite

Describe the treatment for Roseola Infantum:

No treatment just pain relief Common in babies and toddlers Most contagious stage is high temperature so can attend nursery after temperature has passed

Describe what causes Glandular Fever, how its spread and the incubation period:

Viral Saliva 1-2 months

Describe the rash in Glandular Fever:

Maculopapular rash (small flat lesions slightly raised) Pink/ red flat spots Mainly on trunk, can extend to rest of body

Describe the other symptoms in Glandular Fever:

High temperature Sore throat Swollen glands Tiredness/ exhaustion

Describe the treatment for Glandular Fever:

No treatment just pain relief Avoid alcohol as liver is already weak Can go to workplace after feeling better Do not take penicillin- causes rash after

Describe what causes Chicken Pox, how its spread and the incubation period:

Viral Droplets in resp tract and contact to lesions 10-24 days

Describe the rash in Chicken Pox:

Small, itchy vesicles surrounded by redness Mainly on trunk rather than limbs and face

Describe the other symptoms in Chicken Pox:

Nausea Headache Fever Malaise Loss of appetite

Describe the treatment for Chicken Pox:

No therapy Just pain relief, NOT ibuprofen antihistamines for itching and gels for soothing Vaccine for high risk patients Stay off work/ school until vesicles have crusted over

Which way round is it that you can catch chicken pox from shingles or the other way around?

Can catch chicken pox from someone with shingles but not the other way around

Describe what causes Shingles, how its spread and the incubation period:

Virus From chicken pox 14-16 days

Describe the rash in Shingles:

Macular at first (Flat at first) then forming pustules and vesicles Upper abdomen or chest, trunk and back Doesn’t cross the midline- only stays on one side of the body

Describe the other symptoms in shingles:

Fever Malaise

Describe the treatment for shingles:

Antivirals: acyclovir, valacyclovir, and famciclovir Shingles vaccine for over 70s Antiviral medication can be efficacious if in the first three days Only other time to refer is if rash within the first week and they are in severe pain, immunocompromised Maybe co- codomol for nerve pain Don’t go near pregnant people and people who haven’t had chicken pox e.g babies With shingles can be left with pain

Describe what causes German Measles (Rubella), how its spread and the incubation period:

Virus Aerosols 1 week

Describe the rash in German Measles (Rubella):

Spotty rash starting on face and ears, spreads to neck and body

Describe the other symptoms in German Measles (Rubella):

Swollen glands Aching joints High temperature Coughs/ sore throats

Describe the treatment for German Measles (Rubella):

No treatment but MMR vaccine for prevention Stay off work or school five days after rash appears Contact health protection team

Describe what causes Measles, how its spread and the incubation period:

Virus Droplet infection 7- 14 days

Describe the rash in Measles:

Flat red spots found on face and trunk Can join together under chin

Describe the other symptoms in Measles:

Fever URTI White spots behind mouth Red, sore watery eyes

Describe the treatment for Measles:

No treatment but MMR vaccine for prevention 4 days off after rash appears Contact health protection team

Describe what causes Slapped Cheek Syndrome, how its spread and the incubation period:

Virus Aerosols 4-14 days

Describe the rash in Slapped Cheek Syndrome:

Bright red rash on cheeks Can go down to neck looking like a spider web

Describe the other symptoms in Slapped Cheek Syndrome:

High temperature Runny nose Sore throat Malaise

Describe the treatment for Slapped Cheek Syndrome:

No therapy Just pain relief, antihistamines for itching Don't need to stay off school/ work

Describe what causes Mumps, how its spread and the incubation period:

Virus Droplets, aerosols direct saliva contact 12-25 days

Describe the rash in Mumps:

Flat, red rash on face Eventually spreading to body

Describe the other symptoms in Mumps:

Swelling of paratoid glands Headache Joint pain Fever Nauseous

Describe the treatment for Mumps:

No treatment but MMR vaccine for prevention Notify the health protection team Can go back to work after 5 days from initial symptoms

Describe Impetigo and its treatments:

Bacterial infection Yellow crusting, stay off school until it has crusted over, highly infectious Doctors for Fusidic acid or oral flucoxiciilin

Describe the rash in meningitis and how would you determine it is meningitis:

Small, red pinpricks before spreading quickly and turning into red or purple blotches Glass test- make sure skin goes white when pushing glass over it, it doesn’t if its meningitis