FINAL - Skin infections, Hemorrhoids, Supplements (73)

Question 1

Minor wounds - exclusions for self tx of minor wounds

Answer 1

-Bleeding > 5 minutes
-Wound from animal/human bite
-Deep/acute wounds
-Chronic wounds
-Immunocompromised
-Diabetes (foot wounds)
-Signs of infection
-Contain foreign matter

Question 2

Skin Minor wounds: Self treatment

Answer 2

Irrigants
-Tap water +/- soap, chlorhexidine, hydrogen peroxide, saline

Topical Antibiotics
-Prevent infection

Bandage
-HUGE selection, important to not tear healing skin/scab; consider water-proofing

Monitoring
-Change dressing if needed for cleanliness or adherence

Question 3

Sunburn

Answer 3

Cause: Excessive exposure to UV radiation
Resolution: typically <7 days
Prevention: sunscreen lotion, sunblock clothing or hats, limited sun exposure
Complications: Pain, redness, blistering, peeling, itching

Question 4

Skin: Sunburn - Exclusion of self tx

Answer 4

Extensive Burns (>20% body surface affected w/blistering)
Infants
Severe blistering (swelling, pus, yellow/red blisters)
Intense Pain

Question 5

Sunburn self tx

Answer 5

Clean with mild soap and water
Cool compresses
Consider use of aloe, calamine, silver gel, lotion
Blisters may require bandaging
Pain control with PO medications

Question 6

Foot care - warts

Answer 6

Cause: HPV entrance through damaged skin
Resolution: Months to years w/o treatment
Prevention: Proper hygiene
Complications: Pain, impaired function social stigma

Question 7

Exclusions for self-treatments of wart -IMPORTANT

Answer 7

-Suspicion growth is not wart
-Warts on face or genitalia
-Many warts
-Warts that hurt, itch burn, or bleed
-Weakened immune system
-Diabetes

Question 8

Warts Tx

Answer 8

Salicylic Acid (Liquid or patch)
-Tape (usually over pad or acid)
-OTC “Cryotherapy”

Question 9

Skin: Foot Care - Corns and Calluses

Answer 9

Cause: dead skin hardened by friction, often ill-fitting shoes
Callus: Can appear anywhere, larger area - typically involved
Corn: Commonly small, tops and sides of toes or balls of feet

Question 10

Skin: Foot care - Corns and Calluses Tx

Answer 10

-Soak in warm water for 5-10 minutes
-File/scrape with pumice stone/scraper
-Lotion/ointment/cream to moisturize
-Shoes that fit properly
-Keep toenails clipped

Question 11

Athletes foot

Answer 11

Cause: Fungal infection, direct contact with organism
Prevention: Good hygiene, moisture wicking shoes/socks, desiccating foot powders, tx of hyperhidrosis, proper footwear
Complications: Erosions, ulcers, malodor, secondary infections
Exclusions to self-treatment: recurrent, failed prior treatment; expansive infection, including genitalia

Question 12

Athletes foot tx - Antifungals

Answer 12

-Zeasorb (miconzaole)
-Lotrimin (Clotrimazole)
-Lamisil (Terbinafine)
-Tinactin (Tolnafate)

Question 13

Lice

Answer 13

Cause: The head louse (Pediculus humanus capitus), transmission requires direct contact
Presentation: Itching/scratching, redness, small wounds
Considerations:
-Often overtreated as diagnosis requires distinguishing between inactive and active forms of lice
-Low threshold for referral (recurrent, refractory, age <2 months, involvement of hair outside the scalp region)

Question 14

Lice treatment
IMPORTANT

Answer 14

Rid = pyrethrin + Piperonyl butoxide
-Does not kill unhatched eggs (nits), tx MUST be repeated in 7-10 days

Age >2 YEARS

Nix = Permethrin
-Likely also needs repeated in 7-10 days, dependent on initial clinical response
Age, >2 MONTHS

Question 15

Lice - post treatment

Answer 15

Wet combing
-With a fine comb that comes in most OTC lice tx packages
-Repeat Q2-3 days for up to 2-3 weeks, assess for dead lice

Other Considerations:
-Machine wash bedding, clothes
-Soak combs/brushes in hot water for 5-10 minutes
-Vacuum area where patient has been
-Children do not have to be kept out of school after undergoing tx

Question 16

Which of the following is NOT an OTC tx for warts?

Answer 16

D. Aloe

Question 17

What causes Athlete’s foot

Answer 17

B. Fungal infections

Question 18

Hemorrhoids - Exclusions for self tx

Answer 18

No relief after one week of OTC tx
Severe pain
Bleeding
Sensitivity to OTC meds
Change in bowel patterns
Family history of IBD

Question 19

Hemorrhoids - Self tx nonpharmacologic

Answer 19

-Eat high-fiber foods
-Stool softener or fiber supplement
-Increase water consumption
-Use topical tx
-Soak regularly in warm bath/sitz bath
-Take oral pain relievers

Question 20

Hemorrhoids self tx - Pharmacologic

Answer 20

Anesthetics
-Dibucaine or pamoxine; often in combo products like “Preparation H”

Astringents
-Witch Hazel (TUCKS Pads), dries, soothes, relieves irritation

Corticosteroids
-Hydrocortisone 1% in cream or suppository; relieves itching

Vasoactive Agents
-Phenylephrine topical ointment or suppository; shrinks tissues to relieve discomfort

Question 21

Which of the following recommendations would be most helpful for managing symptoms of hemorrhoids?
A. Soak in cold sitz water
B. Consume a clear liquid diet
C. Apply Lamisil (terbinafine) cream
D. Take a stool softener

Answer 21

D - Take a stool softener

Question 22

Supplements - Fish oil

Answer 22

Uses:
-Hypertriglyceridemia

Considerations:
-GI upset, heartburn, indigestion, “fishy” taste
-Caution with anticoagulants/platelets, active bleed, or PUD

Question 23

Supplements - Niacin
IMPORTANT - FLUSHING

Answer 23

Uses:
-Dyslipidemia (will increase HDL and decrease TG); not commonly used

Considerations:
Flushing occurs with ~80% of patients, but improves after two weeks of continued use
-To mitigate flushing, slowly increase dose, patients can pretreat w/aspirin, take with meals, use ER formulation, or take at bedtime

Question 24

Supplements - Ginger

Answer 24

Uses:
-Typically used for nausea and vomiting (especially pregnancy)
-No use in CINV or motion sickness

Considerations:
-Generally well tolerated, ADRs with doses > 3 g/day
-Can increase bleeding risk
G’s make you bleed

Question 25

Supplements - St. John’s Wort

Answer 25

Uses:
-Tx of mild-moderate depression, NOT MAJOR
-Extensive use some efficacy

Considerations:
-Vivid dreams, HA, dizziness
-GI upset, dry mouth, photodermatitis
-Significant medication interactions: CYP inducer, PGP inducer, Digoxin, HIV meds, Warfarin - clotting
-Interacts with A LOT of things

Question 26

Supplements - Cranberry

Answer 26

Uses
-Thought to interfere w/bacteria’s ability to adhere to urinary tract wall
-Used for prevention, no role in treatment of UTI

Considerations:
-Caution w/aspirin allergy, has small amount of salicylic acid
-Can cause kidney stones
-Some patients will use cranberry juice, low cranberry concentration, but high sugar concentration

Question 27

Supplements - Saw Palmetto

Answer 27

Uses:
-BPH
-Medication inhibits 5-alpha reductase
-Does NOT decrease prostate size or PSA

Considerations
-Can cause GI upset

Question 28

Supplements - Echinacea

Answer 28

Uses:
-Some evidence that it can decrease URTI by 1 day
-Must be started at onset of symptoms, taken for 7 days
-No antibacterial or antiviral properties

Considerations:
-GI upset, rash, allergic rxn (ragweed, marigold, daises)

Question 29

Supplements - Melatonin

Answer 29

Use:
-Insomnia
-Shift disorder
-Jet lag

Considerations
-Should be taken 2 hours prior to bed time

Question 30

Which supplement and use pair is INCORRECT?
A. Melatonin - Insomnia
B. Niacin - Dyslipidemia
C - AZO cranberry Upper RTI
D. Saw Palmetto - BPH

Answer 30

C - Azo Cranberry - Upper RTI

Question 31

Which supplement and potential adverse effect is INCORRECT?
A. Echinacea - Allergic rxn
B. Niacin - Flushing
C. Saw Palmetto - Gi Upset
D. Ginger - Nausea

Answer 31

D . Ginger - Nausea