INF1 - A. OTC MANAGEMENT-COVERED

Question 1

symptoms of infective conjunctivitis

Answer 1

starts in 1 eye, purulent discharge

Question 2

symptoms of allergic conjunctivitis

Answer 2

starts in both eyes, watery discharge

Question 3

management of bacterial conjunctivitis

Answer 3

bathe eyes with boiled and cooled water frequently during day (48 hrs) - 1st line
chloramphenicol 0.5% eye drops (P) - fridge, apply every 2 hours for 2 days then every 4 hours for 3 more days
chloramphenicol 1% eye drops (P) - longer retention time

Question 4

bacterial conjunctivitis red flags

Answer 4

children <2 (need Rx)
<28 days old - referral
pregnancy/breastfeeding
pain in eye
light sensitivity
vision problems/changes
contact lenses - acanthamoeba keratitis

Question 5

what bacteria causes non-bullous impetigo (bacterial)

Answer 5

staphylococcus aureus or streptococcus pyogenes

Question 6

signs and symptoms of non-bullous impetigo

Answer 6

sores around mouth and nose which burst to form thick, golden crusts which dry
itchy but no systemic symptoms
not contagious after 48 hours of treatment/sores healed

Question 7

management of impetigo

Answer 7

may resolve w/o treatment in 2-3 weeks
hydrogen peroxide cream 1% (Crystacide - P)
fusidic acid 2% cream (POM/PGD)
systemic antibiotics - erythromycin (POM)

Question 8

impetigo red flags

Answer 8

systemically unwell/high risk of complications - oral antibiotic
cellulitis symptoms - systemic antibiotics
bullous impetigo - fluid filled blisters on trunk, arms, legs in children which burst to leave yellow crust - oral antibiotic

Question 9

what is cellulitis

Answer 9

bacterial infection of deeper layers of skin and tissue
bacteria get in when skin is damaged and quickly spreads - sepsis
(not contagious)

Question 10

signs and symptoms of cellulitis

Answer 10

painful, hot, swollen skin
blisters and swollen glands

Question 11

management of cellulitis

Answer 11

raise affected area
keep joint moving
drink fluids
oral antibiotics - flucloxacillin, clarithromycin (POM) - PGD?

Question 12

cellulitis red flags

Answer 12

sepsis signs
facial/peri-orbital cellulitis (skin around eye/eyelid)
diabetic foot infection
immunosuppression

Question 13

signs and symptoms of bacterial meningitis

Answer 13

more common in babies, children, young adults
fever
vomiting
headache
rash - doesn’t fade under pressure
stiff neck
photophobia
drowsiness
CALL 999

Question 14

what causes oral candidiasis (fungal)

Answer 14

yeast candida

Question 15

signs and symptoms of oral thrush

Answer 15

white patches on tongue and in mouth
loss of taste/unpleasant taste
redness inside mouth and throat
cracks at corner of mouth
painful, burning sensation

Question 16

who is oral thrush common in

Answer 16

• people on inhaled corticosteroids and breast-feeding babies
• following course of antibiotics, denture wearers, poor oral hygiene, dry mouth, chemotherapy/radiotherapy
• immunocompromised

Question 17

management of oral thrush

Answer 17

treat breastfeeding mother with antifungal cream

• miconazole 2% oral gel (Daktarin) - 15g P, 80g POM
  4x daily, kept in mouth as long as possible before swallowing, continue for at least a week after symptoms resolved
• nystatin oral suspension (Nystan) - POM
  1ml 4x daily, kept in mouth as long as possible before swallowing, continue for at least 48 hours after symptoms resolved

Question 18

oral thrush red flags

Answer 18

• babies <4 months - gel is thick, choking hazard - not licensed
• no improvement after 1 week treatment
• difficulty/pain swallowing

Question 19

signs and symptoms of thrush (fungal)

Answer 19

• armpits, groins - red, itchy rash that scales over with white or yellow discharge
• genital thrush - white discharge, itchy
• can get after sys antibiotics as bacteria balance disrupted

Question 20

management of thrush

Answer 20

clotrimazole 1/2% cream
clotrimazole 500mg pessary
fluconazole 150mg capsule
avoid fragranced soaps, tight underwear

Question 21

thrush red flags

Answer 21

• symptoms for first time - can rule out diabetes
• <16 or >60
• reoccurrence (>4x in 12 months)
• treatment failure
• pregnancy or breastfeeding
• weakened immune system - esp diabetes

Question 22

what causes athlete’s foot (fungal) and what are the signs

Answer 22

dermatophytes
itchy white patches between toes and soles/sides of feet
can crack and bleed
can spread to nails
contagious

Question 23

athlete’s foot red flags

Answer 23

treatment failure
sig discomfort
foot/leg is hot and painful
spreads to other body areas
diabetes
weakened immune system

Question 24

management of athlete’s foot

Answer 24

creams - miconazole, clotrimazole, terbinafine hydrocortisone (P)
sprays - miconazole

Question 25

signs of fungal nail infection

Answer 25

thickened, soft, crumbly rails - discoloured on all/part of nail finger and toes

Question 26

management of nail infection

Answer 26

nail lacquers - OTC/P - max 2 nails affected tioconazole - Trosyl POM amorolfine - Loceryl/Omicur POM (3ml OTC/P) clotrimazole miconazole some create an inhospitable environment for fungus - no API 9-12 months treatment as nails grow out slowly >18 can use P meds continue after symptoms resolved dry between toes, separate towel for feet, take shoes off at home, clean and cotton socks

Question 27

nail infection red flags

Answer 27

topical treatment doesn't work infection is sig/base of nail need anti fungal tablets podiatrist referred for special laser treatment

Question 28

what is pityriasis/tinea versicolor (fungal)

Answer 28

skin infection caused by malassezia fungus yeast multiplies more than usual in warm, moist environments

Question 29

signs and symptoms of tines versicolor

Answer 29

patches of skin changes colour flat and can join clay and itchy not contagious

Question 30

management of pityriasis versicolor

Answer 30

ketoconazole 2% shampoo (POM) - for a large area clotrimazole 1% cream (P) - for smaller areas can takes months for skin to return to usual colour

Question 31

pityriasis versicolor red flags

Answer 31

doesn't resolve comes back will need anti fungal tablets

Question 32

what causes ringworm (fungal)

Answer 32

dermatophytes can be transmitted from animals to humans

Question 33

signs and symptoms of ringworm

Answer 33

red or silvery ring like rash scaly, inflamed, itchy, clear centre may lose hair in affected area anywhere on body very contagious

Question 34

management of ringworm

Answer 34

clotrimazole cream (P) miconazole cream (P) lengthy treatment - complete to avoid reoccurence wash towels and bedding, don't share towels don't scratch - easily spreads

Question 35

ringworm red flags

Answer 35

broken/irritated skin - secondary skin infection weakened immune system