GP part 2 Flashcards

Question

how will Lyme disease present

Answer 1

bulls eye rash cognitive impairment ]fatigue fever and sweats headache malaise migratory joint or muscle aches and pain neck pain or stiffness paraesthesia swollen glands uveitis facial palsy or other nerve palsies unexplained radiculopathy

Answer 2

1-2 weeks post exposure typically and lasts several weeks untreated

Answer 3

adults and children aged 12 and over: - doxycycline 100mg twice daily for 21 days - amoxicillin 100g three times daily for 21 days if doxycycline isnt suitable - azithromycin 3rd line in younger children still use doxycycline but it in dependent on body weight

Answer 4

it is a reaction that can present in 15% of people in the first 24 hours of treatment with any antibiotic for lyme disease. symptoms include fever, chills, muscle pains and headache

Answer 5

it is a metabolic disease defined as an excessive accumulation of body fat that poses a risk to an individuals health

Answer 6

poor diet and lack of physical activity underlying medical conditions - cushings, PCOS, hypothyroidism, GH deficiency medications - antidepressants and corticosteroids socio-economic status mental health - depression, eating disorders genetics - Prader Willi syndrome, Bardet Bieldl syndrome

Answer 7

excess body fat weight above average for individuals height breathlessness sleep apnoea skin issues osteoarthritis hypertension diabetes hyperlipidaemia

Answer 8

measure BMI - weight divided by height squared central obesity by measuring waist to height ratio or waist circumference

Answer 9

fasting blood glucose - obesity lipid profile - hyperlipidaemia LFT - non alcoholic fatty liver disease TSH - hypothyroidism U+E - chronic kidney disease dexamethasone suppression test for cushings ultrasound for PCOS

Answer 10

weight loss: target of 5 - 10% reduction lifestyle changes: healthy eating, alcohol recommendations, smoking cessation, therapy medications

Answer 11

Orlistat and liraglutide are the only medications approved by NICE for weight loss in the UK - Orlistat prevents absorption of dietary fat - Liraglutide is a GLP-1 analogue and delays gastric emptying and induces early satiety

Answer 12

nausea and vomiting diarrhoea pancreatitis thyroid cancer

Answer 13

weight loss surgery in those who are severely obese (BMI > 40 or between 35-40 with co-morbidities) Bariatric surgery - Roux-en-Y gastric bypass, sleeve gastrectomy and gastric bypass

Answer 14

a group of symptoms caused by food rapidly emptying or being 'dumped' from the stomach into the small intestines. this results in undigested food within the small intestine that the body finds difficult to absorb symptoms include sweating, bloating, abdominal cramps, diarrhoea, nausea

Answer 15

cardiovascular disease dyslipidaema diabetes stroke obstructive sleep apneoa cancer pancreatitis abnormal periods and infertility arthritis inflamed veins gout gallstones liver disease lung disease

Answer 16

it is inflammation of the external ear canal and can be either acute (less than 3 weeks) or chronic (more than three weeks)

Answer 17

bacterial - pseudomonal aeruginosa or staphylococcus aureus fungal - candida albicans and aspergillus niger

Answer 18

atopic dermatitis psoriasis acne

Answer 19

hot and humid climates swimming older age dermatological issues narrow ear canals (downs syndrome) previous ear surgery previous radiotherapy to the head and neck any history of immunosuppression including diabetes previous topical treatments for otitis externa or otitis media

Answer 20

ear pain discharge itch hearing loss fever

Answer 21

skin changes or tenderness at the tragus or pinna erythema, oedema and narrowing of the ear canal which may progress to complete occlusion serous or purulent discharge inflammation of the tympanic membrane which may be hard to visualise regional lymphadenopathy in pre/post auricular nodes conductive hearing loss secondary to obstruction

Answer 22

clinical findings - history and exam swabs for microbiology

Answer 23

strict water precautions to keep the ear dry avoid itching or using cotton buds which further traumatise the ear canal

Answer 24

topical antibiotic ear drops - antibiotic + steroid treatment is administered for a minimum of 7 days avoid aminoglycosides in patients with perforated tympanic membrane analgesia prescribed based off severity of pain ENT can do microsuction to remove infected debris from canal and insert an otowick

Answer 25

necrotising otitis externa - infection spreads beyond the soft tissue of the ear canal resulting in osteomyelitis pinna or peri-auricular cellulitis

Answer 26

diabetes mellitis age over 65 recurrent otitis externa immunosuppression radiotherapy to head or neck

Answer 27

it is the name given to an infection in the middle ear - space that sits between the tympanic membrane and the inner ear

Answer 28

bacterial infection which enters from the back of the throat through the eustachian tube

Answer 29

streptococcus pneumoniae - most common haemophilus influenzae morazella catarrhalis staphylococcus aureus

Answer 30

ear pain reduced hearing in the affected ear general symptoms of upper airway infection: fever, cough, coryzal symptoms, sore throat, general malaise balance issues and vertigo if tympanic membrane is perforated there can be discharge

Answer 31

bulging, inflamed red tympanic membrane if there is perforation you may see discharge in the ear canal and a hole in the tympanic membrane

Answer 32

refer for specialist assessment and admission in infants younger than 3 months with a temp above 38, or 3-6 months with a temp higher than 39 most cases resolve without antibiotics - normally within 3 days but can last a week give simple analgesia to help with pain and fever

Answer 33

1. immediate antibiotics - initial presentation with significant co-morbidities, systemically unwell or immunocompromised 2. delayed antibiotics - collected and used after 3 days if the symptoms havent improved or have gotten worse first line choice of antibiotic is amoxicillin 5 days 3. no antibiotics

Answer 34

Otitis medial with effusion Hearing loss (usually temporary) Perforated eardrum Recurrent infection Mastoiditis (rare) Abscess (rare)

Answer 35

it is a chronic health condition that causes pain and tenderness throughout the body which occurs in flares. It causes musculoskeletal pain and fatigue

Answer 36

people assigned female at birth people older than 40

Answer 37

muscle pain or tenderness fatigue face and jaw pain - temporomandibular joint disorders headaches and migraines digestive issues including diarrhoea and constipation bladder control issues memory issues anxiety depression insomnia and other sleep disorders

Answer 38

age - over 40 sex - more common in women living with other chronic illnesses infections stress trauma

Answer 39

emotional stress - job, finance, social life changes in daily routing changes in diet or nutrition hormonal changes not getting enough sleep or change in sleep weather or temperature changes illness starting new medication or treatments

Answer 40

history and examination diagnosis of exclusion - may do bloods and other tests to rule out other causes of fatigue

Answer 41

over the counter or prescription pain medication exercises like stretches or strength training sleep therapy cognitive behavioural therapy stress management antidepressants

Answer 42

non pharmacological treatments - exercise and strength training psychological treatments pharmacological treatments daily functioning - occupational therapist

Answer 43

it is progressive degenerative joint disorder, referred to as a dysfunctional wear and repair process within a joint

Answer 44

knees hips hands

Answer 45

chondrocytes are responsible for maintaining the homeostasis between synthesis and degradation of the extracellular matrix within articular cartilage. Over time, continuous wear or trauma to the joint causes local inflammation and stimulation of chondrocytes to release degradative enzymes. these enzymes break down collagen and proteoglycan and ultimately destroy the articular cartilage

Answer 46

increasing age female sex obesity less commonly articular congenital deformities or trauma to the joint

Answer 47

joint pain stiffness: typically worse after activity and at the end of the day limitation in day to day activities in some cases patients will experience referred pain

Answer 48

reduced active and passive range of movement secondary to pain tenderness of the the joint lines crepitus on movement

Answer 49

sparing of the metacarpophalangeal joints bony enlargements of the proximal interphalangeal joints known as bouchards nodes bony enlargement of the distal interphalangeal joints known as heberdens nodes squaring of the first carpometacarpal joint (base of the thumb) reduced functional movement

Answer 50

bodyweight and BMI labs - serum CRP/ESR imaging - Xray

Answer 51

loss of joint space osteophytes subchondral sclerosis subchondral cysts

Answer 52

if a person meets the criteria: over 45 and has activity related joint pain and has either no morning joint related stiffness or morning stiffness that lasts no longer than 30 minutes

Answer 53

education and advice about the condition exercise: muscle strengthening and general aerobic fitness weight loss (if overweight or obese)

Answer 54

First line: topical NSAIDS second line: paracetamol and topical analgesia third line: NSAID, paracetamol and topical capsaicin fourth line: opioid, NSAID, paracetamol and topical capsaicin intra-articular corticosteroid injection can be offered for acute exacerbation of pain despite regular use of analgesia

Answer 55

joint replacement - arthroplasty fusion of the joint - arthrodesis

Answer 56

this refers to the narrowing of the arteries supplying the limbs and the periphery, reducing the blood supply to these areas. It usually refers to the lower limbs, resulting in symptoms of claudication

Answer 57

it is a symptoms of ischaemia in a limb, occurring during exertion and relieved by rest. It is typically a crampy, achy pain in the calf, thigh or buttock muscles associated with muscle fatigue when walking beyond a certain intensity

Answer 58

it is end stage peripheral arterial disease, where there is an inadequate supply of blood to a limb to allow it to function normally at rest. there is a significant risk of losing the limb

Answer 59

pain at rest non healing ulcers gangrene pain is worse at night when the leg is raised as gravity no longer helps to pull blood into the foot

Answer 60

it refers to a rapid onset of ischaemia in a limb, typically it is due to thrombosis blocking the arterial supply of a distal limb, similar to a thrombus blocking a coronary artery in myocardia infarction

Answer 61

stiffening of artery walls leading to hypertension and strain on the heart stenosis leading to reduced blood flow plaque rupture resulting in a thrombus

Answer 62

older age family history male

Answer 63

smoking alcohol consumption poor diet low exercise/sedentary lifestyle obesity poor sleep stress

Answer 64

diabetes hypertension chronic kidney disease inflammatory conditions such as rheumatoid arthritis atypical antipsychotic medications

Answer 65

pain pallor pulseless paralysis paraesthasia perishingly cold

Answer 66

it occurs with occlusion of the distal aorta or proximal common iliac artery. There is a clinical triad of: thigh/buttock claudication absent femoral pulses male impotence

Answer 67

radial brachial carotid abdominal aorta femoral popliteal posterior tibial dorsalis pedis

Answer 68

skin pallor cyanosis dependent rubor (deep red colour when limb is lower than the rest of the body) muscle wasting hair loss ulcers poor wound healing gangrene

Answer 69

reduced skin temperature reduced sensation prolonged capillary refill time (>2 seconds) changes during buergers test

Answer 70

ischaemia secondary to an inadequate blood supply

Answer 71

smaller than venous deeper than venous well defined borders punched out appearance occur peripherally have reduced bleeding are painful

Answer 72

impaired drainage and pooling of blood in the legs

Answer 73

occur after a minor leg injury are larger than arterial ulcers more superficial than arterial ulcers irregular, gently sloping borders affect the gaiter area of the leg (mid-calf down) less painful than arterial ulcers occur with other signs of chronic venous insufficiency

Answer 74

ankle-brachial pressure index duplex ultrasound angiography

Answer 75

lifestyle changes - manage modifiable risk factors exercise training

Answer 76

atorvastatin 80mg clopidogrel 75mg once daily naftidrofuryl oxalate (5-HT receptor antagonist that acts as a peripheral vasodilator)

Answer 77

endovascular angioplasty and stenting endarterectomy - cutting vessel open and removing the atheromatous plaque bypass surgery

Answer 78

urgent referral to the vascular team - endovascular angioplasty and stenting - endarterectomy - bypass surgery - amputation

Answer 79

age immobility obesity prolonged standing deep vein thrombosis

Answer 80

this occurs when blood does not efficiently drain from the legs back to the heart. Usually this is a result of damage from the valves inside the legs

Answer 81

skin changes - haemosiderin staining venous eczema due to chronic inflammatory response in the skin lipodermatosclerosis atrophie blanche - porcelain white scar tissue on skin cellulitis poor healing after injury skin ulcers pain

Answer 82

1. keeping the skin healthy - monitor skin health, regular use of emollients, topical steroids to avoid flares of venous eczema, very potent topical steroids to treat flares of lipodermatosclerosis 2. improving venous drainage - wt loss, keeping legs elevated and compression stockings 3. management of complications- antibiotics, analgesia and wound care

Answer 83

it is an inflammatory condition that causes pain and stiffness in the shoulders, pelvic girdle and neck there is often a strong association with giant cell arteritis

Answer 84

may have relatively rapid onset of symptoms from days to weeks pain and stiffness of the shoulders, pelvic girdle and the neck worse in the morning worse after rest or inactivity interferes with sleep can take at least 45 minutes to ease in the morning somewhat improves with activity can have systemic symptoms - wt loss, fever, fatigue muscle tenderness carpel tunnel syndrome peripheral oedema

Answer 85

Osteoarthritis Rheumatoid arthritis Systemic lupus erythematosus Statin-induced myopathy Myositis (e.g., polymyositis) Cervical spondylosis Adhesive capsulitis (frozen shoulder) Hyperthyroidism or hypothyroidism Osteomalacia Fibromyalgia Lymphoma or leukaemia Myeloma

Answer 86

based on clinical presentation, its response to steroids and excluding differentials labs - FBC, U+E, LFT, calcium, serum protein electrophoresis (myeloma), TSH, creatinine kinase (myositis), rheumatoid factor, urine dip also consider: antinuclear antibodies for SLE anti-cyclic citrullinated peptide (CCP) for RA urine bence jones for myeloma chest X ray

Answer 87

steroids: 15mg prednisolone daily initially and then follow up after 1 week (patients with PR should have a dramatic improvement in a week) treatment with steroids usually lasts for 1-2 years and then follow the reducing regime of prednisolone

Answer 88

15mg until symptoms are fully controlled then 12.5mg for 3 weeks then 10mg for 4-6 weeks then reducing by 1mg every 4-8 weeks

Answer 89

Dont STOP Dont - steroid dependence occurs after three weeks of treatment, and abruptly stopping risks adrenal crisis S- sick rules, steroids doses need to be increased if the patient becomes unwell T- treatment card, patients should carry a card which tells others they are steroid dependent O- Osteoporosis prevention may be required with bisphosphonates and calcium and vit D P- proton pump inhibitors are considered for gastro protection

Answer 90

the inferior vesical (primary), middle rectal and internal pudendal arteries

Answer 91

sympathetic = hypogastric nerve parasympathetic = pelvic nerve

Answer 92

age over 50 black ethnicity family history of prostate cancer family history of other heritable cancers such as breast or colorectal high levels of dietary fat

Answer 93

lymph nodes and bones

Answer 94

Lower urinary tract symptoms - frequency, urgency, nocturia, hesitancy, dysuria, post void dribbling haematuria haematospermia systemic symptoms - weight loss, weakness, fatigue bone pain

Answer 95

on a DRE - asymmetrical prostate, nodular prostate, indurated prostate

Answer 96

Serum prostate specific antigen U+E FBC testosterone levels LFTs MRI and biopsy DEXA, CT and PMSA PET to look for metastasis

Answer 97

the gleason grading system the TNM staging is also used for prostate cancer to help stage the cancer

Answer 98

by adding the two most prevalent differentiation patterns together

Answer 99

its a stage 1 tumour low grade, sometimes clinically insignificant

Answer 100

7 (3+4) is stage 2, intermediate grade 7 (4+3) is stage three, intermediate grade tumour but less favourable outcome than 3+4

Answer 101

stage 4, high grade tumour

Answer 102

stage 5, highest grade tumour

Answer 103

multiparametric MRI

Answer 104

reported on a Likert scale and scored as: 1 – very low suspicion 2 – low suspicion 3 – equivocal 4 – probable cancer 5 – definite cancer

Answer 105

transrectal ultrasound guided biopsy transperineal biopsy

Answer 106

Prostate cancer Benign prostatic hyperplasia Prostatitis Urinary tract infections Vigorous exercise (notably cycling) Recent ejaculation or prostate stimulation

Answer 107

PSA <10, gleason score <6, T1-2a - watchful waiting with regular DRE and PSA tests, if anything significantly changes then palliative care may be initiated - active surveillance with regular DRE, PSA and often biopsies annually, if anything changes then active treatment may be initiated

Answer 108

PSA 10-20, OR gleason score 7/T2B stage - Active surveillance - surgery: removal of the prostate - radiotherapy: external beam radiotherapy, or brachytherapy

Answer 109

PSA >20 OR gleason score 8-10/T2c or above - active surveillance - surgery: radical prostatectomy - radiotherapy: external beam radiotherapy - Hormone therapy: GnRH therapy, androgen receptor blockers, androgen blockers targeting the adrenal glands, bilateral orchiectomy, oestrogen therapy

Answer 110

hot flushes decreased bone density fractures low libido erectile dysfunction altered lipids - gnaecomastia fatigue

Answer 111

it is a chronic autoimmune condition that causes recurrent symptoms of psoriatic skin lesions

Answer 112

they are dry, flaky, scaly, faintly erythematous skin lesions that appear in raised and rough plaques, commonly over the extensor surfaces of the elbows, knees and scalp

Answer 113

rapid generation of new skin cells, resulting in an abnormal buildup and thickening of skin in those areas

Answer 114

it causes thickened erythematous plaques with silver scales, commonly seen on extensor surfaces and the scalp this is the most common form of psoriasis in adults

Answer 115

it is common in children it causes main raised small papules across the trunk and the limbs. They are mildly erythematous and can be scaly. Over time they can turn into plaques

Answer 116

streptococcal throat infection stress medications

Answer 117

it is where pustules form under areas of erythematous skin. the pus is non infectious - should be treated as medical emergency and those with it should require hospital admission

Answer 118

it is a rare form of psoriasis with extensive erythematous inflamed areas covering most of the surface area of the skin the skin comes away in large patches resulting in raw exposed areas - treated as a medical emergency and patients require admission

Answer 119

plaque psoriasis guttate psoriasis pustular psoriasis erythrodermic psoriasis

Answer 120

Auspitz sign: small points of bleeding when plaques are scraped off Koebner phenomenon: development of psoriatic lesions to areas of skin affected by trauma residual pigmentation of the skin after lesions resolve

Answer 121

dependent on the severity of the condition 1. topical steroids 2. topical vitamin D analogues (calcipotriol) 3. topical dithranol 4. topical calcineurin inhibitors (adults) 5. phototherapy with narrow band ultraviolet B light

Answer 122

may be started in systemic treatment (unlicensed in children) which might include methotrexate, cyclosporin, retinoids or biologics there are two products that are both a potent steroid and vitamin D analogue (not licensed in children and guided by specialist) which are dovobet and enstilar

Answer 123

nail psoriasis psoriatic arthritis psychosocial implications - depression and anxiety obesity hyperlipidaemia hypertension type 2 diabetes

Answer 124

an organism called Treponema pallidum, a spirochete

Answer 125

between initial infection and symptoms is about 21 days

Answer 126

sexually transmitted infection - oral vaginal or anal sex vertical transmission IV drug use blood transfusions and other transplants

Answer 127

primary secondary latent tertiary neurosyphilis

Answer 128

this involves a painless ulcer called a chancre at the original site of infection

Answer 129

systemic symptoms, particularly of the skin and mucous membranes. These symptoms can resolve after 3 – 12 weeks and the patient can enter the latent stage.

Answer 130

after the secondary stage of syphilis, where symptoms disappear and the patient becomes asymptomatic despite still being infected. Early latent syphilis occurs within two years of the initial infection, and late latent syphilis occurs from two years after the initial infection onwards.

Answer 131

can occur many years after the initial infection and affect many organs of the body, particularly with the development of gummas and cardiovascular and neurological complications.

Answer 132

this occurs if the infection enters the central nervous system and presents with neurological symptoms

Answer 133

A painless genital ulcer (chancre). This tends to resolve over 3 – 8 weeks. Local lymphadenopathy

Answer 134

Maculopapular rash Condylomata lata (grey wart-like lesions around the genitals and anus) Low-grade fever Lymphadenopathy Alopecia (localised hair loss) Oral lesions

Answer 135

Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones) Aortic aneurysms Neurosyphilis

Answer 136

Headache Altered behaviour Dementia Tabes dorsalis (demyelination affecting the spinal cord posterior columns) Ocular syphilis (affecting the eyes) Paralysis Sensory impairment

Answer 137

it is a specific finding of neurosyphilis. It is a constricted pupil that accommodates when focusing on a near object, but doesnt react to light

Answer 138

Antibody testing for T.pallidum antibodies referral to GUM clinic samples from infection site can be tested to confirm presence with dark field microscopy and PCR Rapid plasma reagin and venereal disease research laboratory tests are two non specific but sensitive tests used to assess for active syphilis - assesses the quantity of antibodies

Answer 139

GUM referral - screening for other STIs, advice about avoiding sexual activity, contact tracing single deep IM dose of benzathine benzylpenicillin is the standard treatment - other regimes and types of penicillin are used in late and neurosyphilis. Ceftriaxone, amoxicillin and doxycycline are alternatives

Answer 140

acute inflammation of the mucosal linings of the nasal passage (rhinitis) and paranasal sinuses (sinusitis)

Answer 141

most common causes are viral organisms such as rhinovirus, influenza or adenovirus however they can be caused by bacterial organisms such as s.pneumoniae, H. influenzae or M.catarrhallis allergic precipitants that can cause rhinosinusitis are dust, pollen and cat or dog hair

Answer 142

they are hollow spaces within the bones of the face, arranges symmetrically around the nasal cavity

Answer 143

frontal sinus - within the frontal bone, most superior of the paranasal sinuses ethmoid sinus - in the ethmoid bone and are made up of 3 separate cavities sphenoid sinus - in the sphenoid bone, opening out into the nasal cavity maxillary sinus - largest, located laterally and slightly inferiorly to the nasal cavities and drain into them

Answer 144

cigarette smoking exposure air pollution anatomical variations such as septal deviation, nasal polyps or sinus hypoplasia atopic disease such as asthma or hayfever

Answer 145

symptoms lasting less than 12 weeks sudden onset of two or more of the following symptoms: nasal obstruction discoloured nasal discharge facial pain or pressure altered sense of smell

Answer 146

severe local pain discoloured discharge fever worsening after initial improvement (post viral)

Answer 147

viral upper respiratory tract infection allergic rhinitis facial pain syndromes nasal foreign body

Answer 148

clinical symptoms and history can have imaging such as CT if complications are suspected skin prick testing for allergy may be appropriate in patients with recurrent episodes

Answer 149

most cases are managed in the community and do not require antibiotics - for uncomplicated cases treat with simple analgesia, nasal douche and decongestants - for those with acute bacterial rhinosinusitis antibiotics will be required if there is no improvement after 7-14 days of treatment or the presence of red flag symptoms then refer to ENT

Answer 150

eye signs - swelling, erythema, displaced globe, visual changes, ophthalmoplegia severe unilateral headache, bilateral frontal headache or frontal swelling neurological signs or reduced consciousness

Answer 151

nasal endoscopy - look at any structural abnormalities or pathology CT scan of paranasal sinuses severe infections may require admission with oral steroids, IV antibiotics and surgery

Answer 152

peri-orbital cellulitis osteomyelitis - can lead to penetration into the skull Potts puffy tumour - osteomyelitis of the frontal sinus leading to soft boggy swelling over the overlaying tissue on the forehead

Answer 153

Waldeyers ring - ring shapes lymphoid tissue in the oropharynx which consists of four main groups of tonsils: adenoid, tuba, palatine and lingual (in clinical practice tonsilitis = palatine)

Answer 154

Viral causes Bacterial causes non infectious causes

Answer 155

rhinovirus - most common coronavirus parainfluenza epstein barr virus

Answer 156

Group A beta haemolytic strep (pyogenes) - most common haemophilus influenzae moraxella catarrhalis

Answer 157

Gastroesophageal reflux disease physical irritation (nasogastric tubes)

Answer 158

sore throat cough coryzal prodrome dysphonia pyrexia pain and malaise dysphagia halitosis

Answer 159

fever swollen erythematous palatine tonsils cervical lymphadenopathy tonsils covered with exudate peritonsillar abscess - usually a complication of acute tonsilitis

Answer 160

epiglottitis infection mononucleosis squamous cell carcinoma

Answer 161

acute episodes can be diagnosed using clinical features alone - key to determine whether its viral or bacterial which is done using the help of the CENTOR and FeverPAIN criteria

Answer 162

used to determine if its viral or bacterial looking at symptoms of tonsilitis - tonsillar exudate - tender anterior cervical lymphadenopathy - history of fever (>38) - absence of cough score of 0-2 has a low probability of a bacterial infection and should be managed conservatively score of 3-4 has a higher probability of bacterial infection and should be treated with antibiotics

Answer 163

it is a criteria which consists of five symptoms of acute tonsilitis each scoring 1 point, indicating the likelihood of a bacterial tonsillitis

Answer 164

Fever (during previous 24 hours) Purulence (pus on tonsils) Attend rapidly (within 3 days after symptom onset) severely Inflamed tonsils No cough or coryza A score of 0-2 has a low probability of bacteria infection and should be managed conservatively a score of 3-4 has a higher change of bacterial infection and is treated with antibiotics

Answer 165

they are not routinely performed, however they may be useful in confirming bacterial infection with other conditions such rheumatic fever and heart disease - throat swab for culture - rapid streptococcal antigen test - monospot test for EBV

Answer 166

supportive: hydration, fluids, ibuprofen plus paracetamol and rest prescribe antibiotics if suspected bacterial infection - phenoxymethylpenicillin for 10 days - if allergic to penicillin clarithromycin or erythromycin for 5 days

Answer 167

NICE advises that certain patients with recurrent episodes of tonsillitis can be referred for tonsillectomy: - more than 7 documented, adequately treated, sore throat episodes in 1 year - more than 5 episodes in 2 years - more than 3 episodes in 3 years - for whom there is no other explanation for recurrent symptoms

Answer 168

otitis media - most common sinusitis peritonsillar abscess scarlet fever

Answer 169

subscapularis supraspinatus infraspinatus teres minor

Answer 170

pain - insidious onset, often night pain, exacerbated by overhead activities, in traumatic tear the pain and weakness are acute weakness - loss of active range of motion with greater passive range of motion

Answer 171

additional weakness on the resisted movement of the rotator cuff muscles

Answer 172

clinical history and examination imaging - X-rays to look for any tear, tendonitis etc. Ultrasound and MRI

Answer 173

non surgical - physiotherapy, activity modification, NDAIDs, corticosteroid injections surgical- repair the rotator cuff +/- subacromial decompression

Answer 174

it is an overuse syndrome of the lateral epicondyle (tennis elbow) and medial epicondyle (golfers elbow)

Answer 175

it is due to eccentric overload at the common extensor tendon leading to tendinitis and inflammation at the origin of the ECRB commonly known as tennis elbow - same happens for golfers elbow just at the flexor pronator mass origin

Answer 176

pain - insidious onset, is localised over the medial or lateral epicondyle, worse with wrist and forearm motion and gripping

Answer 177

point tenderness distal and anterior to the medial epicondyle (golfers) and tenderness at the ECRB insertion into the lateral epicondyle (tennis) tennis elbow: resisted wrist extension with the elbow fully extended golfers: pain with resisted forearm pronation and wrist flexion

Answer 178

non surgical; rest, ice, physiotherapy, activity modification, bracing and NSAIDS surgical: open debridement of the origin

Answer 179

it refers to the loss of control of urination

Answer 180

urge and stress

Answer 181

it is overactivity of the detrusor muscle of the bladder (overactive bladder)

Answer 182

sudden feeling of the urge to pass urine having to rush to the bathroom and not arriving before urination occurs

Answer 183

the pelvic floor consists of a sling of muscles that supports the contents of the pelvic floor. When the muscles of the pelvic floor are weak, the canals become lax and the organs are poorly supported

Answer 184

incontinence due to weakness of the pelvic floor and sphincter muscles allowing urine to leak out at times of increased pressure on the bladder such as laughing, coughing or surprised

Answer 185

this is a combination of urge and stress incontinence - crucial to identify which is the bigger issue and treat that one first

Answer 186

this can occur when there is chronic urinary retention due to an obstruction to the outflow of urine. Chronic urinary retention results in overflow of urine and the incontinence occurs without the urge to pass urine

Answer 187

anticholinergic medications fibroids pelvic tumours neurological conditions - MS, diabetic neuropathy, spinal cord injuries

Answer 188

Increased age Postmenopausal status Increase BMI Previous pregnancies and vaginal deliveries Pelvic organ prolapse Pelvic floor surgery Neurological conditions, such as multiple sclerosis Cognitive impairment and dementia

Answer 189

Caffeine consumption Alcohol consumption Medications Body mass index (BMI)

Answer 190

pelvic organ prolapse atrophic vaginitis urethral diverticulum pelvic masses leakage from urethra if patient is asked to cough also look for strength of pelvic muscle contraction during bimanual and grade on the modified oxford grading system

Answer 191

0: No contraction 1: Faint contraction 2: Weak contraction 3: Moderate contraction with some resistance 4: Good contraction with resistance 5: Strong contraction, a firm squeeze and drawing inwards

Answer 192

a bladder diary urine dipstick testing post void residual bladder volume urodynamic testing - for urge incontinence not responding to treatment

Answer 193

it is a way of assessing the presence and severity of urinary symptoms - a thin catheter is inserted into the bladder and another into the rectum. They measure the pressures in the bladder and rectum and compare them

Answer 194

measures the detrusor muscle contraction and pressure

Answer 195

the flow rate

Answer 196

point at which the bladder pressure results in leakage of urine. The patient is asked to cough, move or jump when the bladder is filled to various capacities. This assesses for stress incontinence.

Answer 197

filling the bladder with contrast and taking xray images as the bladder is emptied. Theses are only performed where necessary and not a routine part of urodynamic testing.

Answer 198

lifestyle advice: avoid caffeine, diuretics and overfilling of the bladder. Avoid excessive exercise or restricted fluid intake. Weight loss if appropriate supervised pelvic floor exercises for at least three months before considering surgery surgery duloxetine - SNRI antidepressant

Answer 199

tension free vaginal tape - mesh sling under the urethra autologous sling procedures - strip of facia from patients abdominal wall is used colposuspention - stitches connecting the anterior vaginal wall and the pubic symphysis around the urethra intramural urethral bulking - injections around the urethra to reduce the diameter and add support

Answer 200

artificial urinary sphincter - pump inserted into the labia that inflates and deflates a cuff around the urethra allowing women to control their continence manually

Answer 201

bladder retraining for at least 6 weeks is first line anticholinergic medication (oxybutynin, tolterodine) mirabegron invasive procedures

Answer 202

dry mouth dry eyes urinary retention constipation postural hypotension cognitive decline, memory issues and worsening of dementia

Answer 203

it is used as an alternative treatment for urge incontinence with less anticholinergic burden

Answer 204

uncontrolled hypertension as it works as a beta 3 agonist leading to sympathetic nervous stimulation and raising blood pressure

Answer 205

Botulinum toxin type A percutaneous sacral nerve stimulation augmentation cystoplasty - using bowel tissue to enlarge the bladder urinary diversion

Answer 206

it involves synovitis in one or more joint in response to an infective trigger. Typically it causes acute monoarthritis, affecting a single joint.

Answer 207

gastroenteritis STI - chlamydia and gonorrhoea (typically causes septic)

Answer 208

bilateral conjunctivitis anterior uveitis urethritis arthritis cant see, cant pee, cant climb a tree - can also cause circinate balanitis (dermatitis of the head of the penis)

Answer 209

1st you need to exclude septic arthritis and antibiotics may be given until septic arthritis is excluded - require joint aspiration sent for MC+S, as well as crystal examination

Answer 210

treatment of the triggering infection NSAIDS steroid injections into the affected joints systemic steroids may be required, particularly where multiple joints are affected

Answer 211

it is also known as hives. It is small, itchy lumps that appear on the skin. They may be associated with a patchy erythematous rash. They may be localised to a certain area or widespread

Answer 212

Urticaria are caused the release of histamine and other pro-inflammatory chemicals by mast cells in the skin. This may be part of an allergic reaction in acute urticaria or an autoimmune reaction in chronic idiopathic urticaria.

Answer 213

Allergies to food, medications or animals Contact with chemicals, latex or stinging nettles Medications Viral infections Insect bites Dermatographism (rubbing of the skin)

Answer 214

it is an autoimmune condition where autoantibodies target mast cells and trigger them to release histamine and other chemicals. It can be sub classified depending on the cause

Answer 215

Chronic idiopathic urticaria Chronic inducible urticaria Autoimmune urticaria

Answer 216

recurrent episodes of chronic urticaria without a clear underlying cause or trigger.

Answer 217

describes episodes of chronic urticaria that can be induced by certain triggers, such as: Sunlight Temperature change Exercise Strong emotions Hot or cold weather Pressure (dermatographism)

Answer 218

chronic urticaria associated with an underlying autoimmune condition, such as systemic lupus erythematosus.

Answer 219

antihistamines are the main treatment - fexofenadine oral steroids may be considered as short courses for severe flares in very problematic cases referral to specialist may be required and consider treatment with: Anti-leukotrienes such as montelukast Omalizumab, which targets IgE Cyclosporin

Answer 220

it is the event of temporarily losing consciousness due to a disruption of blood flow to the brain, often leading to a fall

Answer 221

problem with the autonomic nervous system regulating blood to the brain. When the vagus nerve receives a strong stimulus it can stimulate the parasympathetic nervous system. this leads to a drop in blood pressure and hypoperfusion of the brain tissue, causing a faint

Answer 222

Hot or clammy Sweaty Heavy Dizzy or lightheaded Vision going blurry or dark Headache

Answer 223

Suddenly losing consciousness and falling to the ground Unconscious on the ground for a few seconds to a minute as blood returns to their brain There may be some twitching, shaking or convulsion activity, which can be confused with a seizure

Answer 224

Dehydration Missed meals Extended standing in a warm environment, such as a school assembly A vasovagal response to a stimuli, such as sudden surprise, pain or the sight of blood

Answer 225

Hypoglycaemia Dehydration Anaemia Infection Anaphylaxis Arrhythmias Valvular heart disease Hypertrophic obstructive cardiomyopathy

Answer 226

Features that distinguish a syncopal episode from a seizure After exercise? Syncope after exercise is more likely to be secondary to an underlying condition. Triggers? Concurrent illness? Do they have a fever or signs of infection? Injury secondary to the faint? Do they have a head injury? Associated cardiac symptoms, such as palpitations or chest pain? Associated neurological symptoms? Seizure activity? Family history, particularly cardiac problems or sudden death?

Answer 227

Are there any physical injuries as a result of the faint, for example a head injury? Is there a concurrent illness, for example an infection or gastroenteritis? Neurological examination Cardiac examination, specifically assessing pulses, heart rate, rhythm and murmurs Lying and standing blood pressure

Answer 228

ECG, particularly assessing for arrhythmia and the QT interval for long QT syndrome 24 hour ECG if paroxysmal arrhythmias are suspected Echocardiogram if structural heart disease is suspected Bloods, including a full blood count (anaemia), electrolytes (arrhythmias and seizures) and blood glucose (diabetes)

Answer 229

need to exclude other pathology once vasovagal episode is diagnosed, reassurance and simple advice can be given: - avoid dehydration - avoid missing meals - avoid standing for long periods of time - when experiencing prodromal symptoms such as sweating and dizziness, sit or lie down and have some water or something to eat

Answer 230

they are dilated tortuous veins which mainly occurs in the superficial venous system in the legs

Answer 231

varicose veins develop due to the incompetence of the one way valves, leading to leakage, retrograde flow and consequently pooing of blood in the superficial venous system additionally the thinner weaker walls of the superficial veins make them more prone to the effects of the high pressure build up of blood leading to distension and tortuosity o the affected segment, leading to bulging of the skin over the affected vein

Answer 232

mostly idiopathic secondary causes can be due to venous outflow obstruction due to intravascular (DVT) or extravascular (pelvic mass) reasons progesterone and oestrogen are also believed to have vasodilatory properties which can predispose or worsen varicose veins

Answer 233

family history of varicose veins older age (especially 40 years and above) pregnancy female sex history of DVT obesity prolonged standing or sitting previous lower limb fracture being caucasian

Answer 234

pain - dull ache or burning leg fatigue, discomfort, worsening pain after prolonged standing leg cramps restless legs skin discolouration over the affected areas heaviness of the legs itching after prolonged standing ankle oedema lipodermatosclerosis

Answer 235

ulceration haemorrhage especially if the variceal segments are large, traumatised or over bony prominences thrombophlebitis

Answer 236

clinical features - presence of tortuous veins and history of risk factors duplex ultrasound can confirm the diagnosis as well as ruling out DVT ABPI can exclude peripheral artery disease

Answer 237

referral to vascular services lifestyle changes - exercise and wt loss conservative - compression stockings using bandages or stockings however its NOT recommended by NICE unless surgical intervention is declined or inappropriate surgery - endovenous techniques or open surgery

Answer 238

aim to block faulty veins which has the same benefit as removing them - endothermal ablation (first line) - ultrasound guided foam sclerotherapy - glue, steam or mechanochemical devices

Answer 239

ligation and stripping: incompetent veins are ties off and removed phlebectomy: varicose veins are pulled out through small incisions

Answer 240

rotavirus norovirus adenovirus - tends to cause resp symptoms

Answer 241

dehydration

Answer 242

oral rehydration salt solution (dioralyte mixed with water) that helps to replace losses. It contains glucose, potassium and sodium

Answer 243

Lactose intolerance Irritable bowel syndrome Reactive arthritis Guillain–Barré syndrome Haemolytic uraemic syndrome

Answer 244

diarrhoea nausea and vomiting loss of appetite abdominal pain and cramping systemic symptoms: fever, chills, fatigue, body aches, headaches, lymphoedema

Answer 245

1. exposure 2. incubation - few hours to a few days 3. acute infection - from a day to weeks 4. recovery

Answer 246

most contagious during the acute phase of the infection and for a few days after

Answer 247

norovirus - leading in adults rotavirus - leading in children astrovirus - children younger than 3 adenovirus - affects all ages

Answer 248

it is a widespread rash that usually is accompanied by systemic symptoms such as fever, malaise and headache

Answer 249

usually due to viral infections: varicella, measles, rubella, herpes 6B and parvovirus B19 (there are many other causes such as HIV, smallpox, hepatitis, EBV etc) bacterial infection: staphylococcal and streptococcal toxin infections may also be due to medications and connective tissue disease (SLE, SJA etc)

Answer 250

non specific exanthemas appear as spots or blotches and can be itchy. The rash is widespread and may be more extensive on the trunk or extremities general symptoms: fever, malaise, headache, LOA, abdominal pain, irritability, muscle aches and pains

Answer 251

pattern of rashes and prodromal symptoms allowing for a clinical diagnosis viral swab - culture and PCR bloods - serology, PCR, ANA, tissue antibodies genotyping

Answer 252

paracetamol/simple analgesia to reduce fever moisturising emollients to reduce itch

Answer 253

Chickenpox (varicella-zoster virus). COVID-19 (coronavirus). Fifth disease (parvovirus B19). Hand, foot and mouth disease(coxsackievirus A16). Measles (morbillivirus). Roseola (human herpesvirus 6). Rubella (rubella virus). Other viruses that may cause viral exanthem rash include: Hepatitis, HIV, EBV

Answer 254

radiculopathies refer to the compression of irritation of a spinal nerve route causing pain with sensory changes (numbness, pins and needles etc) or motor changes (weakness, diminished deep tendon reflexes)

Answer 255

lumbar radiculopathy - tends to affect men and women in the 4th-6th decades of life

Answer 256

herniated disk degenerative changes = 2nd

Answer 257

ventral (anterior) - motor dorsal (posterior) - sensory

Answer 258

herniated disc - most common cause spinal stenosis and spondylolisthesis pelvic or lumbar fractures nerve root may become compromised due to peripheral nervus system syndromes (GBS) - polyradiculopathy cancer infection

Answer 259

smoking obesity strenuous physical activity whole body vibration

Answer 260

age history of lower back pain genetic factors such as variations in intragenic vitamin D receptor gene

Answer 261

most common symptom in radiating pain (sharp, stabbing, shooting, throbbing etc) that spreads distally from the lumbar spine pain is often unilateral but can be bilateral sensory change: numbness, paraesthesia motor change: weakness, loss of strength or power pain is worse after periods of inactivity can worsen with coughing or sneezing can be acute or insidiously can be consistent, worsening or relapsing remitting

Answer 262

amiodarone docetaxel carbamazepine

Answer 263

muscle atrophy diminished deep tendon reflexes gain disturbances

Answer 264

dermatomes: L1-S2 myotomes: L1-S2 using the MRC scale reflexes: L3-S1 special tests: slump test and straight leg test

Answer 265

majority of cases managed conservatively and dont need investigations Imaging: MRI (gold for herniation, prolapse or degenerative process), X-Ray EMG and nerve conduction tests

Answer 266

normally 1st line treatment 1. patient education: avoid triggers, information and reassurance 2. lifestyle modification 3. Paracetamol and NSAIDs. If pain persists use of steroid injections or oral steroids can be used. 4. referral to musculoskeletal physiotherapy 5. referral to psychological services if needed

Answer 267

given if conservative management ails, symptoms are worsening, if there is a serious pathology, or severe neurological deficits - discectomy - spinal decompression - open laminectomy with discectomy - microendoscopic discectomy

Answer 268

pain: functional mobility loss, loss of independence, inability to fulfil social or occupational roles Central sensitisation of nociplastic pain muscle atrophy and deconditioning progressive muscle weakness cauda equina syndrome

Answer 269

cauda equina - faecal incontinence, urinary retention, saddle anaesthesia infection - immunosuppression, IV drug use, unexplained fever fracture - significant trauma, osteoporosis, chronic steroid use malignancy - new onset after 50 metastatic disease - history of malignancy

Answer 270

neuropathic pain medications - amitriptyline, or pregabalin and gabapentin as alternatives patients who supper from muscle spasms may be managed with benzodiazepines or baclofen

Answer 271

pain in the neck, shoulder, upper back or arms

Answer 272

disc degeneration spondylosis - age related arthritis of the vertebra bone disease cancer herniated disc

Answer 273

lower cervical certebrae - C5-7

Answer 274

the spurling's maneuver where the individual tilts their head to the side, backwards and tries to pull their head back upright while the clinician pushes it down

Answer 275

droplet spread or direct skin contact with vesicle fluid

Answer 276

typically 10-14 days but can be up to 21 days

Answer 277

symptoms can last up to 4 days and include: high fever general malaise myalgia anorexia headache nausea

Answer 278

it begins as small erythematous macules on the scalp, face, trunk and proximal limbs these macules develop into papules, vesicles and pustules shallow oral and genital ulcers can occur which are painful crusting of the vesicles and pustules usually occurs within 5 days at which point new vesicle formation has ceased

Answer 279

adequate hydration avoidance of scratching avoidance of pregnant women, neonates and immunocompromised individuals

Answer 280

paracetamol for fever and discomfort NSAIDS should be AVOIDED! sedating antihistamines (chlorphenamine), emollients and calamine lotion for the itch if an adolescent or adult presents within 24 hours of rash onset, oral aciclovir may be considered

Answer 281

urgent specialist advice: antiviral medication with aciclovir intravenous immunoglobulin

Answer 282

scotland and northern ireland

Answer 283

until all the lesions have crusted over

Answer 284

dehydration secondary bacterial infection of the lesions scarring viral pneumonia encephalitis reyes syndrome - thought to be connected to aspirin use shingles

Answer 285

can lead to congenital varicella syndrome if contracted before 20 weeks: intrauterine growth restriction microcephaly limb hypoplasia ophthalmological defects cutaneous scarring

Answer 286

check done on a healthy person to pick up a condition before it develops or at a very early stage

Answer 287

1. there must be a test available which picks up a disease or condition before symptoms develop 2. the test must be reasonably accurate. It should not be positive for too many people who do NOT have the condition and must not miss many people who DO have the condition 3. the test must be reasonable simple to perform and acceptable to the people having the test 4. the benefits of screening but be greater than any potential risk or harm it could cause 5. the cost of the test, must not be more than the benefits it gives 6. there must be a treatment at the early stage of the condition or disease which will make a difference to the outcome 7. the condition being screened for must be important to health and wellbeing 8. there must be an organised, efficient plan for what happens next if the test is positive

Answer 288

1. in picking up problems early you can treat things earlier and increase survival 2. cancers picked up early, treatments are more likely to be successful 3. newborn baby screening allows things to be corrected if picked up early enough 4. screening in pregnancy helps to identify any serious abnormalities

Answer 289

1. no test can be 100% accurate 2. some people may have treatment which wasnt needed due to a false positive 3. tests can cause worry - if initially test is positive but further tests are normal 4. cost: screening large numbers of healthy people is expensive 5. for some conditions screened for, a negative result at one point in time doesnt rule out developing the condition in the future 6. screening tests can lead to difficult decisions

Answer 290

1. abdominal aortic aneurysm screening programme 2. bowel cancer screening 3. breast screening programme 4. cervical screening programme 5. diabetic eye screening programme 6. fetal anomaly screening programme 7. infectious diseases in pregnancy screening programme 8. newborn and infant physical examination screening programme 9. newborn blood spot screening programme 10. newborn hearing screening programme 11. sickle cell and thalassaemia screening programme

Answer 291

screening for infectious diseases (Hepatitis B, HIV and syphilis) screening for down's syndrome, pataus syndrome and edwards syndrome screening for sickle cell and thalassaemia 20 weeks screening scan diabetic eye screening

Answer 292

physical examination - eyes, heart, hips and testicles hearing screening a blood spot test

Answer 293

25 to 64 it is offered every 3 years for those aged 25-49 it is offered ever 5 years for those aged 50-64

Answer 294

from the age of 12, all people with diabetes are offered regular diabetic eye screening

Answer 295

to women between the ages of 50-70

Answer 296

it is offered to everyone aged 50-74 every 2 years if you are over 75 you can ask for a kit every 2 years by phoning

Answer 297

it is offered to men when the turn 65 to detect AAA, men over 65 fan self refer

Answer 298

it is a non infectious itchy rash that affects many areas of the body: arms, legs, trunk, mouth, nails, scalp, vulva, vagina, penis

Answer 299

clusters of shiny raised, purple blotches on your arms, legs or body white patches on gums, tongue, or the insides of the cheeks burning and stinging in the mouth bald patches on the scalp sore red patches on vulva rough thinning nails with grooves on ring shaped purple or white patches on the penis

Answer 300

gets better on its own in about 9-18 months steroid creams or ointments - topical corticosteroids antihistamines light treatments - UVB and PUVA acitretin - specialist prescribed and used in severe cases

Answer 301

avoid washing with soap or bubble bath wash hair over basin to stop shampoo on the skin use emollients to moisturise the skin if its in the mouth - avoid spicy food, avoid alcohol, stick to soft plain foods, avoid mouthwash if on genitals - avoid bubble bath, use emollients, apply ice packs, avoid tights

Answer 302

it is a response to the skin being repeatedly scratched or rubbed over a long period of time, causing single/multiple plaques of rough skin to form, sometimes with little bumps round the hair follicles

Answer 303

skin conditions, itchy infections, and persistent scratching - eczema, allergic dermatitis, insect bites, fungal skin infections, varicose veins and psoriasis - damage to nerves such as in shingles can also lead to lichen simplex

Answer 304

can be sore but is more often very itchy intense itch in bursts and may be worse at times of rest or at night itch prompts rubbing with then aggravates the skin and may lead to superficial skin infections

Answer 305

increased surface skin markings called lichenification - can appear as a bumpy skin rash skin may feel dry, thickened and rough to the touch affected skin often looks scaly or red over time skin becomes darker than surrounding skin

Answer 306

history and examination skin scrapings may be taken patch testing for allergy punch biopsy

Answer 307

need to break the scratch itch cycle - avoid soap, shower gel, bubble baths - cover affected skin with dressings - steroid ointments or cream - tacrolimus and pimecrolimus (topical calcineurin inhibitors) may reduce itch - coal tar creams or ointments - if the skin is broken may need antibiotics - treatment of itch: cooling creams, antihistamines, capsaicin cream, TENS

Answer 308

it is an intensely itchy skin infection caused by sarcoptes scaniei which is a mite that burrows into the epidermis and tunnels through the stratum corneum - life cycle lasts about 4-6 weeks

Answer 309

classical - infestation with a low number of mites crusted - hyperinfestation with thousands or millions of mites present in exfoliating scales of skin. due to insufficient immune response by the host

Answer 310

close/prolonged skin contact with an infested person - can be sexually acquired - transmission through casual contact is unlikely - symptoms begin 3-6 weeks after primary infestation Crusted scabies is highly contagious and can be transmitted via bedding, towels, clothes etc

Answer 311

close contact with infected person high levels of poverty and social deprivation crowded living conditions winder months crusted - immunosuppression, elderly, learning difficulties or neurological disorders

Answer 312

secondary bacterial infection secondary eczematization nodular scabies

Answer 313

history - itch worse at night, symptoms beginning 3-6 weeks after primary infestation examination - erythematous papules on the periumbilical area, waist, genitalia, breasts, buttocks, axillary folds, fingers, wrists and extensor aspects of the limbs. nodular lesions ink burrow test microscopy and skin scrapings

Answer 314

the burrow sign - thin brown grey line of 0.2-1cm in length - these are produced by moving mite

Answer 315

seek specialist advice if child is under 2 months in crusted scabies hospital admission may be needed, and may need topical insecticide and oral ivermectin for normal: prescribe permethrin 5% cream, advice all members of household and close sexual partners also be treated. Refer to GUM clinic treat post scabietic itch with crotamiton 10% cream or with topical hydrocortisone 1% if scabies have 100% been eradicated

Answer 316

Symptoms of scabies usually begin 4–6 weeks after infestation. Sometimes there are visible signs before symptoms begin. Symptoms of scabies include: severe itch, often worse at night; itchy lines (linear burrows) and bumps (papules) on the fingers, wrists, arms, legs and belt area; enflamed bumps on male genitalia and female breasts; and larger rash in infants and small children, including on the palms, soles of the feet, ankles and scalp.