OSCEs Flashcards
1
Q
What is considered high blood pressure and referral criteria?
A
140/90mmHg
2
Q
What is considered high random blood glucose and referral criteria?
A
> 11mmol/L
3
Q
What is considered to be low random blood glucose and referral criteria?
A
<3.5mmol/L
4
Q
What is considered to be high random blood cholesterol and referral criteria?
A
> 5mmol/L
5
Q
What BMI is considered to be underweight?
A
<18.5
6
Q
What BMI range is considered to be the normal range?
A
18.5-24.9
7
Q
What BMI range is considered to be overweight?
A
25-29.9
8
Q
What BMI range is considered to be obese?
A
> 30
9
Q
What are the symptoms of a runny/ blocked nose?
A
(1) Runny nose with thickening mucous
10
Q
What are the symptoms of a summer cold?
A
(1) Nasal congestion
(2) Sneezing
(3) Watery eyes
11
Q
What is usually the best treatment of acute otitis media?
A
Painkillers
12
Q
Are antibiotics recommended for acute otitis media?
A
No
60% of AOM resolves in 24hrs, 80% in 3 days
13
Q
When is GP referral appropriate for acute otitis media?
A
Recurrent infection, not resolving
14
Q
What are symptoms for direct referral in chest pain?
A
(1) Localised knifelike pain
- worsened by breathing/ coughing
15
Q
What are the different types of medicinal products for the skin?
A
(1) Emollients
(2) Topical corticosteroids
(3) Antihistamines
(4) Antiseptics
(5) Antifungal
16
Q
What are common side effects of topical corticosteroids?
A
(1) Skin thinning
(2) Skin vulnerability to infection
(3) Skin changing colour
17
Q
What are the age restrictions for hydrocortisone sale?
A
10+ years
18
Q
What are the age restrictions for clobetasone sale?
A
12+ years
19
Q
Where can a corticosteroid not be used?
A
(1) Broken/ infected skin
(2) Anogenital region
(3) Face
(4) Pregnancy
20
Q
What are the presenting features of eczema?
A
(1) Itchy skin
(2) Red/ scaly skin
(3) Cracked
(4) Inflammation
(5) Papules
(6) Rash
(7) Pruritus
21
Q
What is the treatment for eczema?
A
(1) Emollient
(2) Topical corticosteroid
22
Q
What is the referral criteria for skin?
A
(1) Bleeding
(2) Weeping
(3) Infection
(4) Non-blanching rash
23
Q
What non-pharmacological advice can be given for patients with eczema?
A
(1) Avoid irritant fabrics
(2) Avoid soaps/ detergents
(3) Avoid heat
24
Q
What are the referral criteria for contact dermatitis?
A
(1) Non-blanching rash
(2) Failure of treatment
(3) Lesions on face
(4) Child
(5) Pregnant/ breast-feeding
(6) Broken skin/ weeping/ bleeding
(7) Widespread
(8) Infection
25
What are the typical presenting symptoms of psoriasis?
(1) Salmon-pink
(2) Silvery-white scales
(3) Well-defined boundaries
26
What are the common presenting features of psoriasis?
(1) Raised
(2) Large
(3) Red
(4) Scaling
(5) Patches
(6) Plaques
(7) History
(8) Long-term
(9) Symmetry
27
What are the treatments of psoriasis?
(1) Emollients
(2) Coal-tar based preparations
(3) Keratolytics
28
What are the referral criteria for psoriasis?
(1) Non-blanching rash
(2) Bleeding
(3) Lesions with malaise/ fever/ swollen glands
(4) Hairloss
(5) Abnormal lumps
(6) Pregnant/ breastfeeding
29
What is the non-pharmacological advice for psoriasis?
(1) Continue treatment even after it feels better
(2) Regular review with dermatology team
(3) Maintain a healthy diet + exercise
30
What are the presenting factors of chicken pox?
(1) Fluid filled blisters
(2) Rash
(3) Itchy spots
(4) Fever
(5) Loss of appetite
(6) Aching body
(7) Presentation on trunk
31
What is the treatment for chicken pox?
(1) Analgesic
(2) Antipyretic
(3) Antihistamine/ emollient/ cooling gels
32
What are the referral criteria for chicken pox?
(1) Non-blanching rash
(2) Infected blisters
(3) Pregnant/ breastfeeding
(4) Immunosuppressed
33
What is the non-pharmacological advice for chicken pox?
(1) Hydration
(2) Cool clothing
(3) Stop virus spreading
- sterilise surfaces
34
What is the referral criteria for shingles?
(1) Antiviral treatment
(2) Non-blanching rash
(3) Severity of symptoms
(4) High risk of complications
35
What are the presenting symptoms of ringworm?
(1) Itchy
(2) Pink/ red
(3) Scaly
(4) Raised
(5) Patches
(6) Inflamed
(7) Defined border
(8) Central clearing
36
What is the treatment of ringworm?
Antifungal topical preparations
37
What are the referral criteria for ringworm?
(1) Large areas of the body
(2) Treatment failure
(3) Face
(4) Scalp
(5) Anogenital
(6) Pregnant/ breastfeeding
(7) Non-blanching rash
38
What are the presenting features of bites?
(1) Itching
(2) Papules
(3) Weals
(4) Pain
39
What are the presenting symptoms of stings?
(1) Intense burning pain
(2) Erythema
(3) Oedema
(4) Systemic response
- superficial reddening of the skin
40
What is the treatment for bites and stings?
(1) Analgesic - paracetamol
(2) Antihistamine - oral/ topical
(3) Topical corticosteroid
41
What is the referral criteria for bites and stings?
(1) Intense swelling
(2) Restriction to blood flow
(3) Bleeding
(4) Sting/ insect still present
(5) Anaphylaxis/ flu-like symptoms
42
What is the most serious type of meningitis?
Bacterial meningitis
Should be treated as a medical emergency
43
What are the presenting features of meningitis?
(1) Fever
(2) Vomiting
(3) Agitation
(4) Drowsy
(5) Grunt/ rapid breathing
(6) High-pitched moan/ cry
(7) Stiff neck
(8) Convulsions or seizures
(9) Dislike of bright light
(10) Non-blanching rash
44
What are the presenting features of melanoma?
(1) Increase in size
(2) Getting bigger
(3) Changing colour
(4) Itchy/ painful
(5) Bleeding/ becoming painful
45
What are the presenting features of cellulitis?
(1) N+V
(2) Shivering + chills
(3) Malaise
(4) Rapid redness spreading
(5) Fever
(6) Confusion
(7) Tachycardia
(8) Tachypnoea
(9) Dizziness
46
What are the presenting features of acne?
(1) Blackheads
(2) Whiteheads
(3) Papules
- small tender red bumps
(4) Pustules
- small tender red bumps with white head
(5) Nodules
- hard lumps underneath the skin
(6) Cysts
- look similar to boils + high risk of scarring
47
What is the treatment for acne?
(1) Topical retinoids
(2) Topical ABx
(3) Combined oral contraceptive pill, in women
48
What is benzoyl peroxide?
Prevents dead skin blocking follicles
Kills bacteria on skin
Treatment for acne
49
What is the referral criteria for acne?
(1) Weeping
(2) Bleeding
(3) Infection
(4) Cracked/ broken skin
(5) Pain
(6) Treatment failure
(7) Nodules/ cysts present
50
In what age group is rosacea most common?
30-50years
51
What are the signs and symptoms of rosacea?
(1) Flushing
(2) Persistent facial redness
(3) Visible blood vessels
(4) Papule + pustules
(5) Thickened skin
(6) Eye problems
(7) Sensitive skin
(8) Dry + rough skin
(9) Raised red patches on skin
(10) Facial swelling
52
What are the common triggers for rosacea?
(1) Exposure to sunlight
(2) Stress
(3) Strenuous exercise
(4) Hot/ cold weather
(5) Hot drinks
(6) Alcohol/ caffeine
(7) Medication
- amiodarone
- corticosteroids
(8) Spicy foods
53
What is the treatment for rosacea?
No treatment available OTC
Referral to GP is essential
Azelaic acid or metronidazole
54
What is the non-pharmacological advice for rosacea?
(1) Sunlight
- minimum SPF30
(2) Stress
(3) Food + drink
- have a food diary
- stop alcohol + spicy food
(4) Protect face from cold weather
(5) Skincare techniques
- cleanse skin OM + ON
55
How long does it usually take for cold sores to clear up without treatment?
7-10 days
56
What can activate cold sores?
(1) Fatigue + tiredness
(2) Feeling unwell
(3) Injury to area
(4) Menstrual cycle
(5) Having another infection
(6) Having fever
(7) Emotional upset
(8) Psychological stress
(9) Strong sunlight
57
What are the initial symptoms of a cold sore?
Asymptomatic to begin with
58
What are pharmacological treatments for cold sores if it does not spontaneously resolve?
(1) Aciclovir
| (2) Paracetamol + ibuprofen
59
What is the referral criteria for cold sores?
(1) Spread of infection
(2) Failure of treatment
(3) Dehydration
(4) Large numbers
(5) Babies/ infants
(6) Lasting >10 days
60
What are the two types of impetigo?
(1) Non-bullous impetigo:
- Around nose + mouth
- skin bursts leaving yellow-brown crusts
(2) Bullous impetigo:
- fluid filled blisters leaving a yellow crust
61
What are the signs and symptoms of impetigo?
(1) Red sores
(2) Sores bursting
(3) Red marks
(4) Itchiness
(5) Fever
(6) Swollen glands
62
Does impetigo self resolve?
14-21 days
63
What are the signs and symptoms of athlete's foot?
(1) Rash
(2) Itchiness
(3) Scaling
(4) Cracks
(5) Soreness
(6) Redness
(7) Flakey skin
(8) Dryness
64
What is the treatment for athlete's foot?
Topical antifungal treatment
Azoles/ terbinafine
- tolnaftate (Mycil)
- griseofulvin (Grisol)
- hydrocortisone (Canestan)
65
What is the referral criteria for athlete's foot?
(1) Treatment failure
(2) Diabetic failure
(3) Signs of bacterial infection
(4) Nails affected
(5) Pregnant/ breastfeeding
(6) Severe + affecting other parts of the foot
66
What is onchomycosis?
Fungal infection of the nail
67
What are the signs and symptoms of onchomycosis?
(1) Nail becomes thickened
(2) Nail is discoloured
(3) Pain/ brittle nail
(4) Skin becomes inflamed + painful
68
What is the treatment of onchomycosis?
GP's decision
Antifungal tablets
Curanail - amorolfine 5%
69
What is the referral criteria for onchomycosis?
(1) Affecting more than 2 nails
(2) Failure of treatment
(3) Immunocompromised
(4) Pregnant/ breastfeeding
(5) Diabetic
70
How long does onchomycosis take to treat?
6-12 months
9-12 months for toe nails
71
What are the signs and symptoms of warts?
(1) Knuckles/ fingers/ knees
(2) Round/ oval shaped
(3) Firm
(4) Raised
(5) Rough surface
(6) Irregular surface
(7) 1-10mm
72
What are the signs and symptoms of verrucas?
(1) Soles of the feet
(2) White patch of skin
(3) Black dot
(4) Flat
(5) Painful
73
What is the treatment for verrucas?
(1) Self resolution
(2) OTC treatment
- salicylic acid
- cryotherapy
74
How long does it usually take for warts to self-resolve?
2 years
75
How can normal skin be protected against salicylic acid?
(1) Petroleum jelly
| (2) Corn plasters
76
What must be done prior to first application of salicylic acid?
(1) Soak wart/ verruca for 5 minutes
| (2) File down with pumice stone
77
What must be done prior to the maintenance application of salicylic acid?
(1) Soak wart/ verruca for 2-3 minutes
(2) Apply directly to affected area
(3) Allow area to dry
(4) Peel off white patch from area following day
(5) File down with pumice stone once a week
78
What is the referral criteria for warts/ verrucas?
(1) Treatment failure - 12 weeks
(2) Multiple clusters
(3) Face
(4) Genitals
(5) Immunocompromised patients
(6) Diabetic patients
(7) Pregnant/ breastfeeding
79
What is the difference between corns and callouses?
Corns have a well defined edge
80
What is the referral criteria for corns and callouses?
(1) Treatment failure
(2) Diabetic patient
(3) Affecting walking
(4) Intense pain
(5) Affecting posture
81
What is the first line treatment for corns or callouses?
(1) Remove cause of friction/ pressure
(2) Removal of thickened skin
(3) Wear comfortable flat shoes + gloves
(4) Referral to podiatrist/ chiropodist
82
What is the pharmacological treatment for corns or callouses?
Salicylic acid to soften the top layer of skin
83
What are the three types of pain?
(1) Nerve/ neuropathic pain
(2) Organ/ visceral pain
(3) Body/ somatic pain
84
What is the maximum number of paracetamol tablets that can be sold in a pharmacy without prescription?
100 tablets
85
What is the maximum number of aspirin tablets that can be sold in the pharmacy without a prescription?
100 tablets
86
Why is caffeine often included in analgesic products?
(1) Shown to produce enhanced pain relief
| (2) Improves analgesic absorption by lowering gastric pH
87
What is lumbago?
Lower back pain
88
What analgesic should be avoided in management of a sport-related injury?
Aspirin
Can affect clotting
89
What should be avoided in management of a sport-related injury?
H - Heat
A - Alcohol
R - Running
M - Massage
90
What is the referral criteria for a sport-related injury?
(1) Severe/ prolonged
(2) Unable to bear weight
(3) Head injury
(4) Signs of infection
(5) Fevers/ chills/ malaise
(6) Joint instability
(7) Pins and needles
(8) Treatment failed
91
What is the symptomatic treatment of bruising?
(1) Heparinoid
(2) Arnica
(3) Witch hazel
92
What is a heparinoid?
Symptomatic treatment of bruising
Help disperse oedema
Reduce swelling and bruising
93
What is arnica?
Symptomatic treatment of bruising
Traditional herbal medicinal product
94
What is witch hazel?
Symptomatic treatment of bruising
Acts as astringent and anti-inflammatory
95
What is referral criteria for bruising?
(1) Unexplained
(2) Frequent
(3) Excessive
(4) Known clotting problems
(5) Hepatic impairment
(6) Taking warfarin/ NSAIDs/ steroids/ carbimazole
96
What is the first line treatment for back pain?
NSAIDs
97
What is the second line treatment for back pain?
Paracetamol
98
What is the referral criteria for back pain?
(1) Pain following major trauma
(2) Weight loss
(3) New pain in <20 or >50years
(4) Worst at rest + better after exercise
(5) Bladder/ bowel problems
(6) Widespread/ worsening weakness in legs
(7) Pain radiating down 1/2 legs
(8) Numbness/ tingling
(9) Fever
(10) Suspected OA/ OP
(11) No response to treatment
99
What are the common types of headache?
(1) Migraine
(2) Tension headache
(3) Cluster headache
100
Where does a cluster headache affect?
Around the eye
101
Where does a tension headache affect?
Temples and around the back of the head
102
Where does a migraine affect?
Over one eye and one side of the head
103
What is the referral criteria for headaches?
(1) Ongoing severe pain >4hrs
(2) Very sudden onset
(3) Suspected depression
(4) Signs of meningitis
(5) Recent trauma
(6) Cluster headaches
(7) Migraines occurring for 1st time >50yrs
(8) Eye strain/ severe eye pain
(9) Severe pain w/ N+V or confusion or malaise
(10) Failed treatment
104
What is the first line treatment for general and tension headaches?
NSAIDs
105
What is the second line treatment for general and tension headaches?
Paracetamol
106
What is the first line treatment for symptomatic relief of migraines?
Simple analgesics - as for general headaches
Liquid/ soluble preparations can act quicker
107
What are some specific over the counter products for migraines?
(1) Migraleve
- pink - paracetamol + codeine + buclizine
- yellow - paracetamol + codeine
(2) Sumatriptan (Imigran)
- licensed for patients who have a stable history of migraines
(3) Buccastem M
- contains prochlorperazine (buccal antiemetic)
108
What is the first line treatment for symptomatic relief of dental pain?
NSAID oral
109
What is the second line treatment for symptomatic relief of dental pain?
Paracetamol oral
110
What are some potential options for symptomatic treatment of dental pain, aside from first line treatments?
Orajel 20% benzocaine
Anbesol liquid or gel
111
What can cause conjunctivitis?
(1) Bacterial/ viral infection
| (2) Allergy
112
If a patient with conjunctivitis only has one eye being affected, what is the cause?
Bacterial
113
If a patient with conjunctivitis is experiencing itchiness, what is the cause?
Allergy
114
If a patient with conjunctivitis has cough/ cold symptoms, what is the cause?
Viral
115
If a patient with conjunctivitis has had it for 1-2 weeks, what is the cause?
Viral
116
What is the treatment for bacterial conjunctivitis?
Application of antibiotics
Chloramphenicol drops/ ointments
- store in fridge
117
What is the treatment for allergic conjunctivitis?
Systemic and topical treatments
(1) Sodium cromoglicate (Opticrom)
- Topical mast cell stabiliser
(2) Antihistamine eye drops
- xylometazoline + antazoline
118
What is the treatment for viral conjunctivitis?
Supportive therapies:
- hot/ cold compress
Decongestants to reduce surface swelling
Antihistamines to reduce itching
Vasoconstrictors to whiten the eye
119
In what type of conjunctivitis should contact lenses be avoided?
All types
120
What is a subconjunctival haemorrhage?
Burst blood vessels in eye
Red area on the eye, no other symptoms
121
What is macular degeneration?
Age-related macular degeneration
Affects the part of the eye responsible for central vision
122
What are cataracts?
Lens of the eye becomes increasingly opaque
Vision becomes misty/ blurred
123
What is the treatment for dry eyes?
Artificial tears
124
What is the treatment for macular degeneration (MD)?
No cure
High dose vitamins and mineral supplements to maintain eye health
125
What are the types of macular degeneration (MD)?
Dry AMD
| Wet AMD
126
What are two types of eyelid problems?
(1) Blepharitis
| (2) Stye
127
What is blepharitis?
Chronic inflammation of eyelid margins
Affects both eyes
Red/ scaly/ flakey
- eyelashes may fall out
128
What is a stye?
Red painful lump, may look like a pimple/ boil
129
What are the treatment options for blepharitis?
1st Line:
- washing with diluted baby shampoo
- 1 part shampoo to 10 parts water
Warm compress
Referral to GP for ABx
130
What is the treatment for a stye?
Warm compress for 5-10 minutes
- TDS/ QDS until resolves
Avoid very hot compresses
131
What is the referral criteria for an issue regarding the eye?
(1) Pain in the eye
(2) Visual disturbances
(3) Unusual pupil appearance
(4) Upper eyelid drooping
(5) Treatment failure
(6) Eye/ head injury
(7) Photophobia
(8) Contact lens wearers, if eye drops unsuitable
132
How do you counsel a patient on application of eye drops?
(1) Wash hands thoroughly
(2) Using index finger, pull eyelid down slightly to create a pocket, tilt head back and look up slightly
(3) Gently squeeze one drop into eye pouch
(4) Do NOT touch eye with dropper tip
(5) Do NOT blink, as it draws eyedrop into tear duct
(6) Close eye + gently press eyelid next to nose to prevent eye drop being cleared by tear duct
(7) IF using eye ointment concomitantly, apply eye drops first and wait 10 minutes
133
How long, after opening, are patients advised to bin their eye drop bottles?
1 month
134
What is otitis externa?
Inflammation of skin of pinna/ external ear
135
What is otitis media?
Infection of the middle ear
Cannot be treated in community
136
What are the treatment options for excessive ear wax?
(1) Products intended to loosen wax
- olive/ almond/ arachis oil
- urea hydrogen peroxide
(2) Ear irrigation
137
What are the treatment options for otitis externa?
Acetic acid 2% TDS
- IF >12yrs
Painkillers
Refer to GP if ABx or steroid ear drops required
138
What are the treatment options for otitis media?
Symptomatic treatment only
- painkillers
- warm flannel placed over ear
Referral to GP for ABx
- amoxicillin
- erythromycin
139
What are the referral criteria for ear issues?
(1) Severe pain
(2) Discharge
(3) Deafness
(4) Bleeding
(5) Foreign body in ear
(6) Treatment failure
(7) Abnormal lesions
(8) Suspected vertigo/ otitis media/ perforated ear drum
140
What is glue ear?
Middle ear becomes filled with fluid
Otitis media with effusion
Usually self-resolves in 3 months
141
When should intervention be made in glue ear treatment?
(1) Symptoms last longer than 3 months
| (2) Hearing loss affects child's language development
142
What is tinnitus?
Ringing in the ears
Always refer
143
What is vertigo?
Spinning sensation
Caused by inner ear issue
Refer, if not related to migraine
144
What is a perforated ear drum?
Decreased hearing with occasional discharge and possible pain
Can heal spontaneously or require surgery
145
When should a patient with a perforated ear drum be referred?
If symptoms persist with no improvement
146
How many drops should be applied to the eye?
1 drop
147
How many drops should be applied to the ears?
3+ drops
148
How many drops should be applied to the nose?
2-3 drops
149
What is the most common cause of vomiting in adults?
Gastroenteritis
150
What is the referral criteria for nausea and vomiting in children?
(1) Vomiting >24hrs
(2) Unable to keep fluids down for 8hrs
(3) Signs of dehydration
(4) Limp/ irritable/ change in character
(5) Refuse food
(6) Stick neck/ headache
(7) Severe tummy pain
151
What is the referral criteria for nausea and vomiting in adults?
(1) Vomiting >48hrs
(2) Unable to keep fluids down
(3) Vomit is green
(4) Signs of severe dehydration
(5) Loss of weight
(6) Regular occurrence
(7) Vomit with a faecal smell
152
What are signs of dehydration in children?
(1) Irritability/ drownsiness
(2) Pale skin
(3) Cold hands + feet
(4) Look unwell
153
What are signs of dehydration in adults?
(1) Cold hands + feet
(2) Pale skin
(3) Muscle cramps
(4) Tiredness + fatigue
(5) Sunken eyes
(6) Rapid heart rate
(7) Dry mouth/ tongue
(8) Loss of appetite
(9) Feeling lightheaded
154
What is the referral criteria in heartburn and indigestion?
(1) Treatment failure
(2) Child
(3) Pregnant/ breastfeeding
(4) >55yrs 1st presentation
(5) Medication adverse drug reaction
155
What are red flag symptoms of indigestion or heartburn?
(1) Chest pain
(2) Unintentional weightloss
(3) Difficulty swallowing
(4) Persistent vomiting
(5) Any radiation of pain
- e.g. back/ arm(s)
(6) GI bleeding
156
What is a useful acronym for red flag symptoms of indigestion and heartburn?
```
A - Age >55yrs
L - Loss of weight
A - Anaemia
R - Recurrent vomiting
M - Melaena
```
157
What is the treatment for heartburn or indigestion?
- Antacids
| - Alginates
158
What are some diet and lifestyle changes for heartburn and indigestion?
- Reduce smoking/ vaping
- Reduce alcohol
- Healthy weight
- Reduce caffeine
- Stress management
- Avoid eating before bed
- Medication review
- Avoid spicy foods
- Avoid fizzy drinks
- Small, regular meals
- Chew food more
159
What type of drug is ranitidine?
H2 Antagonist
160
What is the age restriction for ranitidine?
16+ yrs
161
What is the main issue with antacids?
Can mask early symptoms of gastric cancer
162
What is the age restriction for PPIs?
18+ yrs
163
What is the only GSL PPI?
Nexium
esomeprazole
164
What causes GORD?
Weakening of the lower oesophageal sphincter (LOS)
165
What is LOS?
Lower oesophageal sphincter
166
What medications are risk factors for weakened lower oesophageal sphincter (LOS)?
(1) NSAIDs
| (2) Steroids
167
Why is GORD more common in babies and infants?
Oesophagus is shorter and narrower
168
What are the signs and symptoms of GORD?
(1) Heartburn
(2) Acid reflux
(3) Dysphagia
- difficulty swallowing
(4) Nausea
(5) Tooth decay
(6) Cough worsening at night
(7) Laryngitis
- inflammation of the throat
(8) Taste disturbances
(9) Halitosis
- bad breath
169
What is halitosis?
Bad breath associated with acid reflux
170
What are some GORD signs and symptoms specific to children?
(1) Arching back
(2) Frequent crying
(3) Refusing to feed
(4) Regurgitation
171
What is the role of the pharmacist in GORD treatment?
Symptomatic relief
172
What are red flag symptoms for GORD?
(1) GI bleeding
(2) Unintentional weightloss
(3) Radiating pain
(4) Difficulty swallowing (dysphagia)
(5) Persistent vomiting
173
What is the definition of constipation?
Reduced frequency of bowel evacuation and the passage of hard stools
174
What are signs and symptoms of constipation?
(1) Reduction in frequency
(2) Straining
(3) Dry + hard + lumpy stools
(4) Stomach aches and cramps
(5) Feeling bloated
(6) Feeling sick
(7) Loss of appetite
175
What are some causes of constipation?
- Poor fibre intake
- Poor fluid intake
- Change in routine or lifestyle
- Ignoring the urge
- Immobility/ lack of exercise
- Fever
176
What are some medical conditions that can directly cause constipation?
(1) Anxiety
| (2) Depression
177
What are some medications that can cause constipation?
- Antacids
- Antidepressants
- Opioids
- Diuretics
- Antimuscarinics
- Iron
178
What are some complications of constipation?
(1) Haemorrhoids
| (2) Anal fissures
179
What are some red flag symptoms in constipation?
(1) Unexplained change in bowel habits
(2) Mass in lower right abdomen
(3) Persistent rectal bleeding
(4) Family history
(5) IBD
(6) Unexplained weight loss
(7) Anaemia
(8) Fever
(9) Nocturnal symptoms
(10) Unresponsive to treatment
180
What is the referral criteria for routine GP referral in constipation?
- Medication ADR
- Treatment failure
- 3rd trimester pregnancy
- Laxative dependence/ abuse
- N+V
- Passing mucous
- Signs of impaction
181
What is a red flag symptom of colorectal cancer in a man of any age?
Unexplained anaemia
182
What is a red flag symptom of colorectal cancer in a woman not menstruating?
Unexplained anaemia
183
What is a red flag symptom of colorectal cancer in any aged patient?
Right abdominal mass
184
What is a red flag symptom of colorectal cancer in a patient aged >40yrs?
Rectal bleeding WITH change in bowel habit
Looser stools + increase in stool frequency
For 6 weeks or more
185
What is a red flag symptom of colorectal cancer in a patient aged >60yrs?
Rectal bleeding for 6 weeks WITHOUT a change in bowel habit
Change of bowel habit to looser stools/ increased stool frequency
6 weeks or more WITHOUT bleeding
186
What is the treatment of constipation?
(1) Lifestyle and diet modifications
| (2) Laxatives
187
What type of laxative is Fybogel?
Bulk-forming laxative
188
What are the types of laxative?
(1) Bulk-forming
(2) Osmotic
(3) Stimulant
(4) Faecal softeners
189
What type of laxative is Senokot?
Stimulant laxative
190
What type of laxative is Dulcoease?
Faecal softener
191
How is diarrhoea defined?
An increase in bowel movement that results in loose/ watery stools
192
What duration of diarrhoea is defined as acute?
5-10 days
193
What duration of diarrhoea is defined as chronic?
More than 14 days
194
What are the referral criteria for diarrhoea?
- Blood/ mucous in the stool
- Black stools
- Persistent vomiting
- Loss of weight
- Fever
- Recent discharge from hospital
- Recent course of ABx
- Pregnancy
- Severe abdominal pain
195
What is the treatment for diarrhoea?
(1) Drink fluids
- small frequent sips
(2) Oral rehydration solution - ORS
(3) Anti-diarrhoeal medicines
196
What advice is important when counselling a patient with diarrhoea on rehydrating?
(1) Small frequent sips
- SFS
(2) Avoid fruit juices + fizzy drinks
197
What is loperamide?
An antidiarrhoeal
Slows down muscle movement + allows water reabsorption
198
What are some relevant brands of loperamide?
Imodium
199
What is dysmenorrhoea?
Period pain
Symptoms occur shortly before/ during menstruation
Pain in abdominal/ lower pelvic area
200
What are the types of dysmenorrhoea?
Primary
Secondary
201
What is primary dysmenorrhoea?
- No underlying pelvic pathological cause
| - Most common in age 15-25
202
What is secondary dysmenorrhoea?
- Underlying pathological pelvic cause
- Most common in age 30-45
REFER
203
What type of dysmenorrhoea must be referred?
Secondary dysmenorrhoea
Most common in 30-45yrs
204
What is the referral criteria for dysmenorrhoea?
- Pain/ bleeding between periods/ after sex or urination
- Sudden severe pain
- Fever
- Unpleasant discharge from vagina
- Post-menopausal women
- IUD insertion
- Painkillers used for 3-4 cycles unsuccessfully
205
Define menarche.
First appearance of menstruation
206
What is the treatment for dysmenorrhoea?
(1) Ibuprofen 200-400mg TDS
- Nurofen
- Feminax Express
(2) Naproxen 250mg tabs
- Boots Period Pain Relief
- Feminax Ultra
207
What is the treatment of dysmenorrhoea when NSAIDs are contraindicated?
(1) Paracetamol
(2) Codeine
- can be with paracetamol
(3) Dihydrocodeine with paracetamol
(4) Hyoscine butyl bromide
- 10mg tabs
- Buscopan Cramps tabs
208
What is the non-pharmacological advice for patients with dysmenorrhoea?
- Stop smoking
- Maintain healthy weight
- Exercise
- Local heat application
- Warm bath/ massage/ relaxation techniques
- Transcutaneous electrical nerve stimulations (TENS)
209
What is TENS?
Transcutaneous electrical nerve stimulation
210
What is menorrhagia?
Heavy periods
Excessive menstrual blood loss
211
What is the red flag referral criteria for menorrhagia?
- Irregular bleeding
- Increase in blood loss
- Postcoital bleeding
- Pelvic pain/ discharge during intercourse
212
What is the treatment for menorrhagia over the counter?
Tranexamic acid tabs
2x500mg tabs TDS
213
What age group is tranexamic acid licensed for?
18-45 years
214
What is pre-menstrual syndrome?
Collection of physical and mental symptoms related to menstruation cycle
215
What are some physical symptoms of pre-menstrual symptoms?
- Bloating
- Abdominal pain
- Headaches
- Backache
- Muscle and joint pain
- Breast pain
- Insomnia
- Weight gain
- Nausea
216
What are some behavioural and psychological symptoms?
- Mood swings
- Irritability
- Anxiety
- Difficulty concentrating
- Clumsiness
- Tiredness
- Loss of libido
- Food cravings
217
What is premenstrual dysphoric disorder (PMDD)?
More severe psychiatric symptoms than pre-menstrual symptoms
Symptoms are cyclical
218
What is the treatment for pre-menstrual syndrome?
Symptom specific:
- Paracetamol/ NSAID for breast pain
- Buscopan for cramps
219
What is thrush?
Common infection of vulval and vaginal area
220
What is vulvovaginal candidiasis?
Common infection of vulval and vaginal area
221
What are the risk factors for vulvovaginal candidiasis (thrush)?
- Age 20-30
- Pregnancy
- Diabetes mellitus
- Immunocompromised and debilitated patients
- ABx or immunosuppressant drug use
222
What are the symptoms of vulvovaginal candidiasis?
- Intense itching and burning
- Soreness
- Discharge (creamy, thick and curd-like)
- Dysuria (pain urinating)
- Dyspareunia (pain during sex)
223
What are the red flag referral criteria for vulvovaginal candidiasis?
- First occurrence of symptoms
- <16 or >60yrs
- Pregnancy
- History of STD
- Vaginal discharge, yellow/ greenish
- Vulval/ vaginal sores/ ulcers/ blisters
- Abnormal/ irregular bleeding
- Pain during sex
- Failure of treatment
224
What is the treatment for vulvovaginal candidiasis?
Topical imidazole
- clotrimazole
- miconazole
Oral triazoles
- e.g. fluconazole
225
In what groups are topical imidazoles contraindicated?
- Pregnancy
- Breastfeeding
- <16yrs
- >60yrs
226
What are some complimentary therapies for vulvovaginal candidiasis?
(1) Bathe genital area with diluted tea tree oil
(2) Bathe general areas with plain live yoghurt internally and externally
(3) Silk underwear
227
What is bacterial vaginosis?
Bacterial vaginal infection
Shift in bacterial flora of vagina
228
What are some symptoms of bacterial vaginosis?
- Discharge with fishy/ unpleasant odour
- White/ thin/ grey discharge
- Irritation around vulva
229
Is bacterial vaginosis sexually transmitted?
No
230
What are the main risk factors for bacterial vaginosis?
- Prolonged menstruation
- IUD
- Sexual intercourse without a condom
- Sex toys
- Frequent douching
- ABx
231
What are some complimentary therapies for vulvovaginal candidiasis?
(1) Bathe genital area with diluted tea tree oil
(2) Bathe general areas with plain live yoghurt internally and externally
(3) Silk underwear
232
How can bacterial vaginosis be prevented?
- Avoid excessive vulval washing/ vaginal douching
| - Use a condom if sex increases symptoms
233
What are some symptoms of bacterial vaginosis?
- Discharge with fishy/ unpleasant odour
- White/ thin/ grey discharge
- Irritation around vulva
234
Is bacterial vaginosis sexually transmitted?
No
235
What are the main risk factors for bacterial vaginosis?
- Prolonged menstruation
- IUD
- Sexual intercourse without a condom
- Sex toys
- Frequent douching
- ABx
236
What is the treatment for cystitis?
- Plenty of water
- Avoid alcohol/ caffeinated drinks/ fruit juices
- Avoid sex
- Paracetamol + ibuprofen
- Alkalising agents
237
How can cystitis be prevented?
- Plenty of water
- Empty bladder fully when urinating
- Wipe front to back after defecation
- Urinate after sexual intercourse
- Cranberry juice
238
What is the morning after pill?
Levonelle One Step
- levonorgestrel
EllaOne
- Ulipristal acetate
239
When must the morning after pill be used?
Levonelle One Step
- Within 72hrs of unprotected sex/ contraceptive failure
EllaOne
- Within 5 days of unprotected sex/ contraceptive failure
240
Who is the morning after pill licensed for?
>16yrs old
241
What are the common symptoms of pregnancy?
- Heartburn
- Morning sickness
- Constipation
- Haemorrhoids
- Itching/ skin irritation
- Backache
242
How can cystitis be prevented?
- Plenty of water
- Empty bladder fully when urinating
- Wipe front to back after defecation
- Urinate after sexual intercourse
- Cranberry juice
243
What is the morning after pill?
Levonelle One Step
| - levonorgestrel
244
When must the morning after pill be used?
Within 72hrs of unprotected sex/ contraceptive failure
245
How can hot flushes and night sweats be treated in menopause?
(1) Regular exercise
(2) Cool room
(3) Avoid caffeine, smoking, alcohol + spicy foods
246
What are the common symptoms of pregnancy?
- Heartburn
- Morning sickness
- Constipation
- Haemorrhoids
- Itching/ skin irritation
- Backache
247
At what age does menopause occur?
45-55 yrs
248
What is the referral criteria for cold/ flu?
- Chest pain
- Shortness of breathe
- Wheezing
- Sputum nature
- Severe pain on coughing
- Stiff neck/ non-blanching rash
- Treatment failure
249
What are the referral criteria for a sore throat?
- Babies/ infants
- Hoarseness
- Dysphagia
- White spots/ pus
- Coloured sputum
- Thrush in mouth area
- Treatment failure
- Recurrent infection
250
What is the referral criteria for a cough?
- >3 weeks
- Presence of blood
- Yellow/ green mucous
- Chest pain
- Persistent night time coughing, in children
- Wheezing
- SOB
- Whooping cough/ croup
- Weight loss
- Failure of treatment
- Suspected ADRs
251
What are the symptoms of flu?
(1) Prominent headache
(2) Sudden fever (3-4 days)
(3) Severe aches + pains
(4) Extreme fatigue + weakness
(5) Severe cough
(6) Chest discomfort
252
What are the red flag referral criteria for hayfever?
- Wheezing
- Shortness of breath
- Painful ear/ sinuses
- Purulent conjunctivitis
- Failed medication
253
What is sodium cromoglicate?
Mast cell stabiliser
