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1
Q

What is the treatment for dyspepsia?

A

1) Antacids: best take when symptoms occur after meals. Dont take them at same time as other drugs (impair absorption)
2) Alginates: ranitidine 75mg over 16 yrs
3) PPI

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2
Q

Which tips help with dyspepsia?

A

Lose weight (orlistst) BMI >28

Smoking cessation

Avoid caffeine, alcohol, spicy food and chocolate

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3
Q

Triggers to GORD?

A

Citrus food, onions, coffee, fatty food

Drugs that relax lower esophageal sphincter (CCB, Theophylline and nitrates)

Alcohol obesity and smoking

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4
Q

Treatment for GORD?

A

PPIs which inhibit gastric acid by blocking hydrogen potassium adenosine triphophatase.

H2 antagosnt

Antacids

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5
Q

What symptoms of GORD do children have?

A

Recurrent vomiting and difficult to feed.

Frequent vomiting in infant less than 6 weeks.

Spontaneous resolution occur at 12-18 months

Half babies less than 3 months vomit once a day

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6
Q

What are GORD treatment for children

A

Thickened milk

Instant carobel powder

Gavsicon infant for regurgitation

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7
Q

What is colic and when does it start?

A

Starts at few weeks and stops at 4-5 months

May caused by lactose sensitivity

Baby cry for at least 3h for at least 3 weeks.

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8
Q

Advices for colic?

A

Hold the baby upright

Try a dummy

Finish one breast then move to other

If bottle feeding choose the right size to prevent air

If breast feeding: avoid spicy food, chocolate and dairy products.

Massage baby

Avoid jiggling or lifting <3 months.

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9
Q

Treatment for colic?

A

Anti-foaming (simethicone - Dentinox and infacol)

Gripe water

Nutramigen, Pepdite and Pepti-junior under specialist)

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10
Q

Constipation in children?

A

Drink Prune, pear or apple juice as they contain sorbitol ( work as stool softener)

Refer if child is dizzy or weak and pain

Osmotic or bulk forming

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11
Q

Constipation in pregnancy and breast feeding?

A

Bulk forming and osmotic

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12
Q

What causes diarrhoea?

A

Campylobacter, E-coli salmonella and shigella

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13
Q

What is ORT?

A

Dioralyte: 200ml with boiled and cold water after each lose motion.

Any unused portion can be kept for 24h

Dioralyte Relief contain rice

Loperamide which is not reccomend <12yrs max 8 tabs

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14
Q

When would refer diahheroa in children?

A

Last >24h in babies under 1 year.

> 48h under 3 years

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15
Q

Travellers diarrhoea?

A

Lopermide

Bismuth subsalicylare but causes blackened tongue and stools.

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16
Q

Symptoms of IBS

A

Abdominal pain, change in bowel habit, constipation or diarrhoea, bloating

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17
Q

Treatment for IBS?

A

Bulk forming for constipation

Lopermide for diarrhoea

Mebeverine for abdominal pain

Peppermint oil direct relaxant

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18
Q

Advices for IBS?

A

Exercise

Avoid: spicy, coffee, cheese, alcohol, wheat, onions, red meat, milk, chocolate, citrus fruits, beans, fatty food, green vegs

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19
Q

Triggers to haemorrhoids?

A

Pregnancy, constipation, diarrhoea and immobility.

Fresh blood and not mixed with it

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20
Q

Treatment for haemorrhoids?

A

Soothing agents help to prevent local irritation ( zinc oxide, Allantoin and Balsm of peru)

Local anesthetics ( lidocaine) alleviate pain

Topical ICS limited to only 7 days

Astrignents ( witch hazel, bismuth subgallate) - they form a protective layer to decrease inflammation and irritation.

Shark olive oil ( promise healing)

Same treatment apply to pregnant women

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21
Q

What is chronic cough?

A

Cough lasts 8 weeks.

If >3 weeks then refer

GORD may cause cough

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22
Q

What treatments for cough?

A

Demulcents: simple linctus has soothing effect

Expectotant : ipecacanha and ammonium chloride

Antitussives: contain codeine (avoid < 6yrs due to respiratory SEs) - not suitable for 12-18 who have respiratory problems. Pholcodine less SEs
Dextromethorphan is not sedating

Sedative antihistamine: diphenhydramine is good for cough at night.

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23
Q

What is croup?

A

Caused by parainfulenza virus.

Starts with could then barking cough.

“Inspiratoty stridor” breathing difficulties

Sit the child upright and drink fluids

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24
Q

Which drugs should be avoided with asthma?

A

NSAIDS and ASPIRIN

They precipitate attacks

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25
What is the therapeutic dose of codeine?
It is 30mg however, 8mg is usually the does that is combined with other analgesics.
26
What is the treatment for teething in children?
Paracetamol over 3 months Ibuprofen over 6 months Local anesthetics: Calgel Bonjela Ashton and Parson infant Powders : matrcaria 4mg related to chamomile Teetha granules: 1 sachet every 2 hours max 6 doses a day .
27
What is the treatment for the lower back pain?
NSAIDS Make sure you stay active especially walking If longer than 4-6 weeks then refer
28
What is tension headache?
Bilateral Dull ache Forehead pain
29
What symptoms of migraine?
Pulsating Throbbing headache Unilateral May accopmined with aura Photophobia Codeine should be avoided.
30
What is the treatment for motion sickness?
Hyoscine (k-wells and joy rides) given 30 min before the journey. Antimuscrincs SEs so avoid with prostate and glaucoma. ``` Cinnarzine (Stugeron) Promathzone teoclate ( Avomine) ``` Both take 2 hours before the journey.
31
How long do threadworms live in adults?
SIX weeks
32
Treatment for threadworms?
Mebendazole (ovex) for over 2 years. It may need to repeat after 2 weeks. It works by inhibiting reptuke of glucose and therefore worms death.
33
Tips for threadworms?
Wear close byjamas to avoid shedding eggs Avoid shaking lines as this will move eggs. They remain viable for 2 weeks.
34
Treatments for headlice?
They need to be left for 12 hours before rinse. Two application and 7 days apart between them If treatment failed use another insecticide at least 3 weeks after. Malathion ( Derbac-M) Permethrin ( Lyclear) Alcoholic lotion are preferred but use aquous liquid in asthmatic, eczema and broken skin "BUG BUSTING" = WET COMBING every 4 days for 2 weeks. Hedrin ( dimeticone) apply for 8 h and repeat after 7 days.
35
When do scabies die?
After 4-6 weeks
36
Treatment for scabies?
Treatment should not apply after shower as this increase systemic absorption. Permethrin ( Lyclear) Malathion (Derbac M) - 1st line for preganant and breast feeding Both apply to whole body and wash after 8- 12 h It should repeat after 7 days Crotamiton or Eurax may help skin irritation Sedative antihistamine
37
Which factors contribute to cold sores?
``` Menstruation Stress Colds Sunlight Recovery 10-14 days ```
38
Treatment for cold sore?
Aciclovir it should be applied 5 times a day for 5 days. Penciclovir: 2h up to eight times for 4 days.
39
Treatment in shingles?
Aciclovir 800mg five times a day for 7-10 days. In severe cases add prednisolone. Low dose amitriptyline may help for pain relieve. Pregabalin and gabapentin anti convulsion. Calamine lotion may help the area Wear loose clothes Keep clean and dry
40
Treatment for athletes foot?
``` Continue for one week Clotimazole ( canesten) Daktarin Gold ( ketoconazole) Terbinafine ( lamisil) - produces rapid effect if compliance is a problem Miconazole (Daktarin Activ) ``` Topical miconazole and clotimazole safe in preg and breast Potassium permangante 0.01% solution can use as foot soak but stain clothes.
41
Treatment for ringworm?
Clotimazole, miconazole and terbinafine first line and safe in pregnancy. Change underwear daily
42
Treatment for scalp ringworm?
Ketoconazole shampoo (pom) Selenium sulphide shampoo should leave at least 30 min for 2 - 7 times over 2 weeks.
43
What is sweat rash and treatment?
Infection under breast or groin or armpits Treamtent: imidazoles first line like clotimazole Dry skin after washing
44
What causes impetigo?
Staphylococcus aureus or streptococci Will resolve within 2- 3 weeks Crystacide cream 1% hydrogen peroxide is only otc Fusidic acid 2% tds pom
45
Should kids go go school with impetigo?
No until 48h after treatment
46
What are boils and carbuncles?
Infection of hair follicles ( staphyloccoi aureus) Pus is usually discharged Refer
47
What is acute paronychia?
Infection of nail fold | Staphylococus aureus
48
Staphylococcal whitlow?
Infection of pulp of the finger | Refer
49
Symptoms of lower urinary tract infection?
Burning Urine frequently Vomiting or fever then refer
50
Treatment of LUTI?
Three day Trimethoprim 200mg BD or Nitrofurtoin 50mg QDS For men: 7 day Trimethoprim or nitro K citrate but avoid drugs that also cause hyperkalemia Sodium citrate should avoid in pregnant women
51
Tips for LUTI?
Pass urine and wait for 10-15 sec after passing urine Wiping from front to back Micturation after intercourse Wear cotton underwear Cranberry reduced E-coli
52
What causes vagina thrush?
Candida albicans Itching, discharge is odorless, pain during urination Over 60 or under 16 always refer
53
Treatment for vaginal thrush?
Miconazole, clotrimazole Oral fluconazole 150mg ( avoid in pregnancy) Dont wear tight clothes
54
What are treatments for vaginal dryness?
Non hormonal moisturisers ( Replens MD, Sylk) KY Jelly
55
What is dysmennorhea?
Pain before or during the period or both
56
What is primary dysmenorrhoea?
Pain starts 24-48 of starting period
57
What is secondary dysmenorrhoe?
Pain that is caused throughout the period accompanied with bleeding. It caused by a factor such as PID or fibroids.
58
What is treatment for dysmenoohoea?
NSAIDS ( ibuprofen the choice) Add codeine if required Antispasmodics ( hysocie butlybromide) buscopan. TENS Some vitamins (thiamine, mg, pyridoxine, E, and fish oils).
59
Causes of bacteria conjunctivitis?
Staphylococcus or hemophils influenza. White- yellow discharge Absence of itching
60
Allergic conjunctivitis?
Itching often with odeam and watery discharge. Allergic rhinitis Eczema or asthma
61
Treatment for infective conjunctivitis?
Chlormphenicol every TWO h for the first two days and then 4h for 5 days. Ointment 3 or 4 times a day for 5 days. Brolene or Golden eye contain propamidine QDS
62
Treatment for allergic conjunctivitis?
Topical antihistamines ( Otrivine antistin contain antazoline + xylometazoline) Sodium cromoglycate ( opticrom) QDS take up fo 14 days to work. Contact lenses should avoid to wear during and for 24h when there is a sign of infection. Benzalkonium interacts with it. Cold compressor may help
63
What is blepharitis?
Its inflammation of the eyelids. | Dry eye can lead to chronic blepharitis.
64
Treatment for Dry eyes?
Hypromellose Carbomer Minims ( throw after 28 days) Ointment ( lacri-lube) Optrex
65
What is otitis externa?
Inflammation of the ear canal Itch, discharge and pain. Triggers water ( swimmers and shampoo)
66
Otitis media?
``` Inflammation of middle ear. Accompanied with upper respiratory tract. Common under 10yrs Crying Frequent tugging of ear Discharge Vomiting ```
67
Mouth ulcers?
They heal in 10-14 days. Lack of these cause aphthous ulcer: B12, folate, iron. Coeliac, crohn's & ulcerative. NSAIDS NICORNDIL Sodium lauryl sulphate in toothpastes. NRT ( nicotine)
68
Treatment for mouth ulcers?
Topical ICS hydrocortisone ( QDS) dissolve in mouth. Benzydamine ( Difflam) mouth wash or spray. It may cause stinging so dilute with equal parts of water. Mouthwash >12 yes Spray> 6 yrs Choline salicylate gel ( Bonjela) every 3h. Max 6 times. Chlorhexdine: stain teeth brown Povidone max 14 days Aloclair mouthwash
69
What causes dry mouth
Radiotherapy Anxiety Sjoren syndrome
70
Treatment for dry mouth?
Luborant artificial saliva. Taking frequent sips or sprays of cold water or ice. Sugar free chewing gum or boiled sweets Fresh pineapple or frozen melon Petroleum jelly
71
Treatment for oral thrush?
Miconazole 2% gel ( after food and hold as long as you can) continue treatment for 2 days after healing.
72
Angular stomatitis?
Clotimazole 1%
73
Treatment for eczema?
Emollients should apply frequently Mild potent can be used over 10 yrs for flare ups Hydrocortisone 1% or clobetasone 0.05% Topical ICS may worsen acne and rosacea When using ics wait 30 min before applying emollient. Avoid temperature Exclusive breastfeeding for at least 3 months may reduce risk of eczema
74
What is cradle cap caused by?
Malassezia ovale Usually occurs in conjunction with blepharitis Treatment: ketoconazole 2% (nizoral) One every three days. Selenium sulphide ( selsun) Pyrithione zinc Tar shampoos ( one or twice weekly) In infants olive oil or Dentinox
75
Treatment for psoriasis?
Emollient to soften skin Tar shampoo for scalp psoriasis (polytar) Keratolyic agents such as salicylic acid good for scaling. ``` Dithranol for chronic plaque psoriasis. Vitamin D ( calcipotirel) is a POM for chronic plaque psoriasis. ``` Topical otc only for short period
76
What is urticaria (hives)?
Rash occurs suddenly Blisters called ( weals) If hives >6 weeks then refer. Oral antihistamine 1st line. Non sedating are preferred ( cetrizine or loratidine). Avoid in pregnancy but chlorphenamine can be used if necessary. Calamine lotion Cool bath may help Aspirin and codeine may aggravate it so avoid.
77
What warts are caused by?
By HPV Plantar warts known as verrucas found on soles of feet. Plane warts found on face and back of hands. Salactol 1st line apply everyday Bazuka should be used at least 3 months Warts are contagious so use a waterproof plaster when u swim.
78
What is callous?
Caused by tight shoes that can lead to ulcer.
79
Treatment for nappy rash?
Sudocream ( zinc and castor oil) Metanium ( titanium) Conotrane ( dimethicone) Topical imidazoles ( clotimazole to prevent candida) twice or three a day and use for 7 -10 days after the rash disappear Change the nappy frequently Gel nappies are better than cotton ones Allow child to have some fresh air without the nappy.
80
Treatment for acnem
Brevoxyl ( benzoyl peroxide). Can bleach clothes and burning. Nicam ( nicotinamide) Tea tree oil Wash no more than twice with mild soup Oily creams make it worse so use water based.
81
Burns?
Thermal burn should be under cold water for 20-30 min within 3 h of injury. Alginate, paraffin quaze and clear film dressings.
82
Sunburn?
Painkillers | Calamine lotion or glycerin
83
Bites?
If a rash appear then appear as it could be a sign of lyme disease up to 4 weeks afterwards. ``` Antihistamine cream Crotamiton cream soothing cream Oral antihistamine Hydrocortisone 1% may help inflammation Local anaesthetic and antiseptic ```

NHS (8 decks)

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