Counter Prescribing Flashcards
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
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.
What could be alternative diagnosis’ instead of scabies?
Pubic/ head lice
Insect bites
Other dermalogical conditions e.g contact dermatitis
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
What are the symptoms of eczema?
Itchy
Dryness
On hands and flextures
Episodic
Atopic history
Starts when younger
What could be alternative diagnosis’ instead of eczema?
Psoriasis- silvery scales
Fungal infection
Seborrhoeic dermatitis- greasy scales
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
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
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
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
What could be an alternative diagnosis of cold sores?
Impetigo- yellow crusting (bacterial)
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
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.
What is the treatment for bacterial conjunctivitis and describe:
Chloramphenicol
One drop 3-4 times a day to infected eyes
What are the symptoms of allergic conjunctivitis?
Itchy
Red eye
Watery discharge
Associated with other allergies and in the right season
What is the treatment for allergic conjunctivitis?
Sodium cromligate eye drops
Apply 4 times a day
What is the treatment for threadworm?
Mebendazole
Describe a Bulla lesion:
Large blisters with clear fluid
Describe a Macule lesion:
Well defined mark on skin, flat, not raised
Describe a Papule lesion:
Small, raised lesion
Describe a Nodule lesion:
Large, raised lesion (papule)
Describe a Petechia lesion:
Purple, red or brown round spots, due to bleeding
Describe a Pustule lesion:
Small blister containing pus
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
