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SR PM4B > OSCEs > Flashcards

OSCEs Flashcards

1
Q

What is considered high blood pressure and referral criteria?

A

140/90mmHg

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2
Q

What is considered high random blood glucose and referral criteria?

A

> 11mmol/L

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3
Q

What is considered to be low random blood glucose and referral criteria?

A

<3.5mmol/L

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4
Q

What is considered to be high random blood cholesterol and referral criteria?

A

> 5mmol/L

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5
Q

What BMI is considered to be underweight?

A

<18.5

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6
Q

What BMI range is considered to be the normal range?

A

18.5-24.9

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7
Q

What BMI range is considered to be overweight?

A

25-29.9

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8
Q

What BMI range is considered to be obese?

A

> 30

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9
Q

What are the symptoms of a runny/ blocked nose?

A

(1) Runny nose with thickening mucous

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10
Q

What are the symptoms of a summer cold?

A

(1) Nasal congestion
(2) Sneezing
(3) Watery eyes

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11
Q

What is usually the best treatment of acute otitis media?

A

Painkillers

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12
Q

Are antibiotics recommended for acute otitis media?

A

No

60% of AOM resolves in 24hrs, 80% in 3 days

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13
Q

When is GP referral appropriate for acute otitis media?

A

Recurrent infection, not resolving

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14
Q

What are symptoms for direct referral in chest pain?

A

(1) Localised knifelike pain

- worsened by breathing/ coughing

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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

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16
Q

What are common side effects of topical corticosteroids?

A

(1) Skin thinning
(2) Skin vulnerability to infection
(3) Skin changing colour

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17
Q

What are the age restrictions for hydrocortisone sale?

A

10+ years

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18
Q

What are the age restrictions for clobetasone sale?

A

12+ years

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19
Q

Where can a corticosteroid not be used?

A

(1) Broken/ infected skin
(2) Anogenital region
(3) Face
(4) Pregnancy

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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

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21
Q

What is the treatment for eczema?

A

(1) Emollient

(2) Topical corticosteroid

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22
Q

What is the referral criteria for skin?

A

(1) Bleeding
(2) Weeping
(3) Infection
(4) Non-blanching rash

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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

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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

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25
Q

What are the typical presenting symptoms of psoriasis?

A

(1) Salmon-pink
(2) Silvery-white scales
(3) Well-defined boundaries

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26
Q

What are the common presenting features of psoriasis?

A

(1) Raised
(2) Large
(3) Red
(4) Scaling
(5) Patches
(6) Plaques
(7) History
(8) Long-term
(9) Symmetry

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27
Q

What are the treatments of psoriasis?

A

(1) Emollients
(2) Coal-tar based preparations
(3) Keratolytics

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28
Q

What are the referral criteria for psoriasis?

A

(1) Non-blanching rash
(2) Bleeding
(3) Lesions with malaise/ fever/ swollen glands
(4) Hairloss
(5) Abnormal lumps
(6) Pregnant/ breastfeeding

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29
Q

What is the non-pharmacological advice for psoriasis?

A

(1) Continue treatment even after it feels better
(2) Regular review with dermatology team
(3) Maintain a healthy diet + exercise

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30
Q

What are the presenting factors of chicken pox?

A

(1) Fluid filled blisters
(2) Rash
(3) Itchy spots
(4) Fever
(5) Loss of appetite
(6) Aching body
(7) Presentation on trunk

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31
Q

What is the treatment for chicken pox?

A

(1) Analgesic
(2) Antipyretic
(3) Antihistamine/ emollient/ cooling gels

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32
Q

What are the referral criteria for chicken pox?

A

(1) Non-blanching rash
(2) Infected blisters
(3) Pregnant/ breastfeeding
(4) Immunosuppressed

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33
Q

What is the non-pharmacological advice for chicken pox?

A

(1) Hydration
(2) Cool clothing

(3) Stop virus spreading
- sterilise surfaces

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34
Q

What is the referral criteria for shingles?

A

(1) Antiviral treatment
(2) Non-blanching rash
(3) Severity of symptoms
(4) High risk of complications

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35
Q

What are the presenting symptoms of ringworm?

A

(1) Itchy
(2) Pink/ red
(3) Scaly
(4) Raised
(5) Patches
(6) Inflamed
(7) Defined border
(8) Central clearing

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36
Q

What is the treatment of ringworm?

A

Antifungal topical preparations

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37
Q

What are the referral criteria for ringworm?

A

(1) Large areas of the body
(2) Treatment failure
(3) Face
(4) Scalp
(5) Anogenital
(6) Pregnant/ breastfeeding
(7) Non-blanching rash

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38
Q

What are the presenting features of bites?

A

(1) Itching
(2) Papules
(3) Weals
(4) Pain

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39
Q

What are the presenting symptoms of stings?

A

(1) Intense burning pain
(2) Erythema
(3) Oedema

(4) Systemic response
- superficial reddening of the skin

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40
Q

What is the treatment for bites and stings?

A

(1) Analgesic - paracetamol
(2) Antihistamine - oral/ topical
(3) Topical corticosteroid

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41
Q

What is the referral criteria for bites and stings?

A

(1) Intense swelling
(2) Restriction to blood flow
(3) Bleeding
(4) Sting/ insect still present
(5) Anaphylaxis/ flu-like symptoms

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42
Q

What is the most serious type of meningitis?

A

Bacterial meningitis

Should be treated as a medical emergency

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43
Q

What are the presenting features of meningitis?

A

(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

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44
Q

What are the presenting features of melanoma?

A

(1) Increase in size
(2) Getting bigger
(3) Changing colour
(4) Itchy/ painful
(5) Bleeding/ becoming painful

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45
Q

What are the presenting features of cellulitis?

A

(1) N+V
(2) Shivering + chills
(3) Malaise
(4) Rapid redness spreading
(5) Fever
(6) Confusion
(7) Tachycardia
(8) Tachypnoea
(9) Dizziness

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46
Q

What are the presenting features of acne?

A

(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

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47
Q

What is the treatment for acne?

A

(1) Topical retinoids
(2) Topical ABx
(3) Combined oral contraceptive pill, in women

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48
Q

What is benzoyl peroxide?

A

Prevents dead skin blocking follicles

Kills bacteria on skin

Treatment for acne

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49
Q

What is the referral criteria for acne?

A

(1) Weeping
(2) Bleeding
(3) Infection
(4) Cracked/ broken skin
(5) Pain
(6) Treatment failure
(7) Nodules/ cysts present

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50
Q

In what age group is rosacea most common?

A

30-50years

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51
Q

What are the signs and symptoms of rosacea?

A

(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

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52
Q

What are the common triggers for rosacea?

A

(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

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53
Q

What is the treatment for rosacea?

A

No treatment available OTC

Referral to GP is essential

Azelaic acid or metronidazole

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54
Q

What is the non-pharmacological advice for rosacea?

A

(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

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55
Q

How long does it usually take for cold sores to clear up without treatment?

A

7-10 days

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56
Q

What can activate cold sores?

A

(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

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57
Q

What are the initial symptoms of a cold sore?

A

Asymptomatic to begin with

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58
Q

What are pharmacological treatments for cold sores if it does not spontaneously resolve?

A

(1) Aciclovir

(2) Paracetamol + ibuprofen

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59
Q

What is the referral criteria for cold sores?

A

(1) Spread of infection
(2) Failure of treatment
(3) Dehydration
(4) Large numbers
(5) Babies/ infants
(6) Lasting >10 days

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60
Q

What are the two types of impetigo?

A

(1) Non-bullous impetigo:
- Around nose + mouth
- skin bursts leaving yellow-brown crusts

(2) Bullous impetigo:
- fluid filled blisters leaving a yellow crust

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61
Q

What are the signs and symptoms of impetigo?

A

(1) Red sores
(2) Sores bursting
(3) Red marks
(4) Itchiness
(5) Fever
(6) Swollen glands

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62
Q

Does impetigo self resolve?

A

14-21 days

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63
Q

What are the signs and symptoms of athlete’s foot?

A

(1) Rash
(2) Itchiness
(3) Scaling
(4) Cracks
(5) Soreness
(6) Redness
(7) Flakey skin
(8) Dryness

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64
Q

What is the treatment for athlete’s foot?

A

Topical antifungal treatment

Azoles/ terbinafine

  • tolnaftate (Mycil)
  • griseofulvin (Grisol)
  • hydrocortisone (Canestan)
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65
Q

What is the referral criteria for athlete’s foot?

A

(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

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66
Q

What is onchomycosis?

A

Fungal infection of the nail

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67
Q

What are the signs and symptoms of onchomycosis?

A

(1) Nail becomes thickened
(2) Nail is discoloured
(3) Pain/ brittle nail
(4) Skin becomes inflamed + painful

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68
Q

What is the treatment of onchomycosis?

A

GP’s decision

Antifungal tablets

Curanail - amorolfine 5%

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69
Q

What is the referral criteria for onchomycosis?

A

(1) Affecting more than 2 nails
(2) Failure of treatment
(3) Immunocompromised
(4) Pregnant/ breastfeeding
(5) Diabetic

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70
Q

How long does onchomycosis take to treat?

A

6-12 months

9-12 months for toe nails

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71
Q

What are the signs and symptoms of warts?

A

(1) Knuckles/ fingers/ knees
(2) Round/ oval shaped
(3) Firm
(4) Raised
(5) Rough surface
(6) Irregular surface
(7) 1-10mm

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72
Q

What are the signs and symptoms of verrucas?

A

(1) Soles of the feet
(2) White patch of skin
(3) Black dot
(4) Flat
(5) Painful

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73
Q

What is the treatment for verrucas?

A

(1) Self resolution

(2) OTC treatment
- salicylic acid
- cryotherapy

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74
Q

How long does it usually take for warts to self-resolve?

A

2 years

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75
Q

How can normal skin be protected against salicylic acid?

A

(1) Petroleum jelly

(2) Corn plasters

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76
Q

What must be done prior to first application of salicylic acid?

A

(1) Soak wart/ verruca for 5 minutes

(2) File down with pumice stone

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77
Q

What must be done prior to the maintenance application of salicylic acid?

A

(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

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78
Q

What is the referral criteria for warts/ verrucas?

A

(1) Treatment failure - 12 weeks
(2) Multiple clusters
(3) Face
(4) Genitals
(5) Immunocompromised patients
(6) Diabetic patients
(7) Pregnant/ breastfeeding

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79
Q

What is the difference between corns and callouses?

A

Corns have a well defined edge

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80
Q

What is the referral criteria for corns and callouses?

A

(1) Treatment failure
(2) Diabetic patient
(3) Affecting walking
(4) Intense pain
(5) Affecting posture

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81
Q

What is the first line treatment for corns or callouses?

A

(1) Remove cause of friction/ pressure
(2) Removal of thickened skin
(3) Wear comfortable flat shoes + gloves
(4) Referral to podiatrist/ chiropodist

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82
Q

What is the pharmacological treatment for corns or callouses?

A

Salicylic acid to soften the top layer of skin

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83
Q

What are the three types of pain?

A

(1) Nerve/ neuropathic pain
(2) Organ/ visceral pain
(3) Body/ somatic pain

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84
Q

What is the maximum number of paracetamol tablets that can be sold in a pharmacy without prescription?

A

100 tablets

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85
Q

What is the maximum number of aspirin tablets that can be sold in the pharmacy without a prescription?

A

100 tablets

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86
Q

Why is caffeine often included in analgesic products?

A

(1) Shown to produce enhanced pain relief

(2) Improves analgesic absorption by lowering gastric pH

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87
Q

What is lumbago?

A

Lower back pain

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88
Q

What analgesic should be avoided in management of a sport-related injury?

A

Aspirin

Can affect clotting

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89
Q

What should be avoided in management of a sport-related injury?

A

H - Heat
A - Alcohol
R - Running
M - Massage

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90
Q

What is the referral criteria for a sport-related injury?

A

(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

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91
Q

What is the symptomatic treatment of bruising?

A

(1) Heparinoid
(2) Arnica
(3) Witch hazel

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92
Q

What is a heparinoid?

A

Symptomatic treatment of bruising

Help disperse oedema

Reduce swelling and bruising

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93
Q

What is arnica?

A

Symptomatic treatment of bruising

Traditional herbal medicinal product

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94
Q

What is witch hazel?

A

Symptomatic treatment of bruising

Acts as astringent and anti-inflammatory

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95
Q

What is referral criteria for bruising?

A

(1) Unexplained
(2) Frequent
(3) Excessive
(4) Known clotting problems
(5) Hepatic impairment
(6) Taking warfarin/ NSAIDs/ steroids/ carbimazole

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96
Q

What is the first line treatment for back pain?

A

NSAIDs

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97
Q

What is the second line treatment for back pain?

A

Paracetamol

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98
Q

What is the referral criteria for back pain?

A

(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

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99
Q

What are the common types of headache?

A

(1) Migraine
(2) Tension headache
(3) Cluster headache

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100
Q

Where does a cluster headache affect?

A

Around the eye

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101
Q

Where does a tension headache affect?

A

Temples and around the back of the head

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102
Q

Where does a migraine affect?

A

Over one eye and one side of the head

103
Q

What is the referral criteria for headaches?

A

(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
Q

What is the first line treatment for general and tension headaches?

105
Q

What is the second line treatment for general and tension headaches?

A

Paracetamol

106
Q

What is the first line treatment for symptomatic relief of migraines?

A

Simple analgesics - as for general headaches

Liquid/ soluble preparations can act quicker

107
Q

What are some specific over the counter products for migraines?

A

(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
Q

What is the first line treatment for symptomatic relief of dental pain?

A

NSAID oral

109
Q

What is the second line treatment for symptomatic relief of dental pain?

A

Paracetamol oral

110
Q

What are some potential options for symptomatic treatment of dental pain, aside from first line treatments?

A

Orajel 20% benzocaine

Anbesol liquid or gel

111
Q

What can cause conjunctivitis?

A

(1) Bacterial/ viral infection

(2) Allergy

112
Q

If a patient with conjunctivitis only has one eye being affected, what is the cause?

113
Q

If a patient with conjunctivitis is experiencing itchiness, what is the cause?

114
Q

If a patient with conjunctivitis has cough/ cold symptoms, what is the cause?

115
Q

If a patient with conjunctivitis has had it for 1-2 weeks, what is the cause?

116
Q

What is the treatment for bacterial conjunctivitis?

A

Application of antibiotics

Chloramphenicol drops/ ointments
- store in fridge

117
Q

What is the treatment for allergic conjunctivitis?

A

Systemic and topical treatments

(1) Sodium cromoglicate (Opticrom)
- Topical mast cell stabiliser

(2) Antihistamine eye drops
- xylometazoline + antazoline

118
Q

What is the treatment for viral conjunctivitis?

A

Supportive therapies:
- hot/ cold compress

Decongestants to reduce surface swelling

Antihistamines to reduce itching

Vasoconstrictors to whiten the eye

119
Q

In what type of conjunctivitis should contact lenses be avoided?

120
Q

What is a subconjunctival haemorrhage?

A

Burst blood vessels in eye

Red area on the eye, no other symptoms

121
Q

What is macular degeneration?

A

Age-related macular degeneration

Affects the part of the eye responsible for central vision

122
Q

What are cataracts?

A

Lens of the eye becomes increasingly opaque

Vision becomes misty/ blurred

123
Q

What is the treatment for dry eyes?

A

Artificial tears

124
Q

What is the treatment for macular degeneration (MD)?

A

No cure

High dose vitamins and mineral supplements to maintain eye health

125
Q

What are the types of macular degeneration (MD)?

A

Dry AMD

Wet AMD

126
Q

What are two types of eyelid problems?

A

(1) Blepharitis

(2) Stye

127
Q

What is blepharitis?

A

Chronic inflammation of eyelid margins

Affects both eyes

Red/ scaly/ flakey
- eyelashes may fall out

128
Q

What is a stye?

A

Red painful lump, may look like a pimple/ boil

129
Q

What are the treatment options for blepharitis?

A

1st Line:

  • washing with diluted baby shampoo
  • 1 part shampoo to 10 parts water

Warm compress

Referral to GP for ABx

130
Q

What is the treatment for a stye?

A

Warm compress for 5-10 minutes
- TDS/ QDS until resolves

Avoid very hot compresses

131
Q

What is the referral criteria for an issue regarding the eye?

A

(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
Q

How do you counsel a patient on application of eye drops?

A

(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
Q

How long, after opening, are patients advised to bin their eye drop bottles?

134
Q

What is otitis externa?

A

Inflammation of skin of pinna/ external ear

135
Q

What is otitis media?

A

Infection of the middle ear

Cannot be treated in community

136
Q

What are the treatment options for excessive ear wax?

A

(1) Products intended to loosen wax
- olive/ almond/ arachis oil
- urea hydrogen peroxide

(2) Ear irrigation

137
Q

What are the treatment options for otitis externa?

A

Acetic acid 2% TDS
- IF >12yrs

Painkillers

Refer to GP if ABx or steroid ear drops required

138
Q

What are the treatment options for otitis media?

A

Symptomatic treatment only

  • painkillers
  • warm flannel placed over ear

Referral to GP for ABx

  • amoxicillin
  • erythromycin
139
Q

What are the referral criteria for ear issues?

A

(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
Q

What is glue ear?

A

Middle ear becomes filled with fluid

Otitis media with effusion

Usually self-resolves in 3 months

141
Q

When should intervention be made in glue ear treatment?

A

(1) Symptoms last longer than 3 months

(2) Hearing loss affects child’s language development

142
Q

What is tinnitus?

A

Ringing in the ears

Always refer

143
Q

What is vertigo?

A

Spinning sensation

Caused by inner ear issue

Refer, if not related to migraine

144
Q

What is a perforated ear drum?

A

Decreased hearing with occasional discharge and possible pain

Can heal spontaneously or require surgery

145
Q

When should a patient with a perforated ear drum be referred?

A

If symptoms persist with no improvement

146
Q

How many drops should be applied to the eye?

147
Q

How many drops should be applied to the ears?

148
Q

How many drops should be applied to the nose?

149
Q

What is the most common cause of vomiting in adults?

A

Gastroenteritis

150
Q

What is the referral criteria for nausea and vomiting in children?

A

(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
Q

What is the referral criteria for nausea and vomiting in adults?

A

(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
Q

What are signs of dehydration in children?

A

(1) Irritability/ drownsiness
(2) Pale skin
(3) Cold hands + feet
(4) Look unwell

153
Q

What are signs of dehydration in adults?

A

(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
Q

What is the referral criteria in heartburn and indigestion?

A

(1) Treatment failure
(2) Child
(3) Pregnant/ breastfeeding
(4) >55yrs 1st presentation
(5) Medication adverse drug reaction

155
Q

What are red flag symptoms of indigestion or heartburn?

A

(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
Q

What is a useful acronym for red flag symptoms of indigestion and heartburn?

A 
A - Age >55yrs
L - Loss of weight
A - Anaemia
R - Recurrent vomiting
M - Melaena
157
Q

What is the treatment for heartburn or indigestion?

A
  • Antacids

- Alginates

158
Q

What are some diet and lifestyle changes for heartburn and indigestion?

A
  • 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
Q

What type of drug is ranitidine?

A

H2 Antagonist

160
Q

What is the age restriction for ranitidine?

161
Q

What is the main issue with antacids?

A

Can mask early symptoms of gastric cancer

162
Q

What is the age restriction for PPIs?

163
Q

What is the only GSL PPI?

A

Nexium

esomeprazole

164
Q

What causes GORD?

A

Weakening of the lower oesophageal sphincter (LOS)

165
Q

What is LOS?

A

Lower oesophageal sphincter

166
Q

What medications are risk factors for weakened lower oesophageal sphincter (LOS)?

A

(1) NSAIDs

(2) Steroids

167
Q

Why is GORD more common in babies and infants?

A

Oesophagus is shorter and narrower

168
Q

What are the signs and symptoms of GORD?

A

(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
Q

What is halitosis?

A

Bad breath associated with acid reflux

170
Q

What are some GORD signs and symptoms specific to children?

A

(1) Arching back
(2) Frequent crying
(3) Refusing to feed
(4) Regurgitation

171
Q

What is the role of the pharmacist in GORD treatment?

A

Symptomatic relief

172
Q

What are red flag symptoms for GORD?

A

(1) GI bleeding
(2) Unintentional weightloss
(3) Radiating pain
(4) Difficulty swallowing (dysphagia)
(5) Persistent vomiting

173
Q

What is the definition of constipation?

A

Reduced frequency of bowel evacuation and the passage of hard stools

174
Q

What are signs and symptoms of constipation?

A

(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
Q

What are some causes of constipation?

A
  • Poor fibre intake
  • Poor fluid intake
  • Change in routine or lifestyle
  • Ignoring the urge
  • Immobility/ lack of exercise
  • Fever
176
Q

What are some medical conditions that can directly cause constipation?

A

(1) Anxiety

(2) Depression

177
Q

What are some medications that can cause constipation?

A
  • Antacids
  • Antidepressants
  • Opioids
  • Diuretics
  • Antimuscarinics
  • Iron
178
Q

What are some complications of constipation?

A

(1) Haemorrhoids

(2) Anal fissures

179
Q

What are some red flag symptoms in constipation?

A

(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
Q

What is the referral criteria for routine GP referral in constipation?

A
  • Medication ADR
  • Treatment failure
  • 3rd trimester pregnancy
  • Laxative dependence/ abuse
  • N+V
  • Passing mucous
  • Signs of impaction
181
Q

What is a red flag symptom of colorectal cancer in a man of any age?

A

Unexplained anaemia

182
Q

What is a red flag symptom of colorectal cancer in a woman not menstruating?

A

Unexplained anaemia

183
Q

What is a red flag symptom of colorectal cancer in any aged patient?

A

Right abdominal mass

184
Q

What is a red flag symptom of colorectal cancer in a patient aged >40yrs?

A

Rectal bleeding WITH change in bowel habit

Looser stools + increase in stool frequency

For 6 weeks or more

185
Q

What is a red flag symptom of colorectal cancer in a patient aged >60yrs?

A

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
Q

What is the treatment of constipation?

A

(1) Lifestyle and diet modifications

(2) Laxatives

187
Q

What type of laxative is Fybogel?

A

Bulk-forming laxative

188
Q

What are the types of laxative?

A

(1) Bulk-forming
(2) Osmotic
(3) Stimulant
(4) Faecal softeners

189
Q

What type of laxative is Senokot?

A

Stimulant laxative

190
Q

What type of laxative is Dulcoease?

A

Faecal softener

191
Q

How is diarrhoea defined?

A

An increase in bowel movement that results in loose/ watery stools

192
Q

What duration of diarrhoea is defined as acute?

193
Q

What duration of diarrhoea is defined as chronic?

A

More than 14 days

194
Q

What are the referral criteria for diarrhoea?

A
  • 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
Q

What is the treatment for diarrhoea?

A

(1) Drink fluids
- small frequent sips

(2) Oral rehydration solution - ORS
(3) Anti-diarrhoeal medicines

196
Q

What advice is important when counselling a patient with diarrhoea on rehydrating?

A

(1) Small frequent sips
- SFS

(2) Avoid fruit juices + fizzy drinks

197
Q

What is loperamide?

A

An antidiarrhoeal

Slows down muscle movement + allows water reabsorption

198
Q

What are some relevant brands of loperamide?

199
Q

What is dysmenorrhoea?

A

Period pain

Symptoms occur shortly before/ during menstruation

Pain in abdominal/ lower pelvic area

200
Q

What are the types of dysmenorrhoea?

A

Primary

Secondary

201
Q

What is primary dysmenorrhoea?

A
  • No underlying pelvic pathological cause

- Most common in age 15-25

202
Q

What is secondary dysmenorrhoea?

A
  • Underlying pathological pelvic cause
  • Most common in age 30-45

REFER

203
Q

What type of dysmenorrhoea must be referred?

A

Secondary dysmenorrhoea

Most common in 30-45yrs

204
Q

What is the referral criteria for dysmenorrhoea?

A
  • 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
Q

Define menarche.

A

First appearance of menstruation

206
Q

What is the treatment for dysmenorrhoea?

A

(1) Ibuprofen 200-400mg TDS
- Nurofen
- Feminax Express

(2) Naproxen 250mg tabs
- Boots Period Pain Relief
- Feminax Ultra

207
Q

What is the treatment of dysmenorrhoea when NSAIDs are contraindicated?

A

(1) Paracetamol

(2) Codeine
- can be with paracetamol

(3) Dihydrocodeine with paracetamol

(4) Hyoscine butyl bromide
- 10mg tabs
- Buscopan Cramps tabs

208
Q

What is the non-pharmacological advice for patients with dysmenorrhoea?

A
  • Stop smoking
  • Maintain healthy weight
  • Exercise
  • Local heat application
  • Warm bath/ massage/ relaxation techniques
  • Transcutaneous electrical nerve stimulations (TENS)
209
Q

What is TENS?

A

Transcutaneous electrical nerve stimulation

210
Q

What is menorrhagia?

A

Heavy periods

Excessive menstrual blood loss

211
Q

What is the red flag referral criteria for menorrhagia?

A
  • Irregular bleeding
  • Increase in blood loss
  • Postcoital bleeding
  • Pelvic pain/ discharge during intercourse
212
Q

What is the treatment for menorrhagia over the counter?

A

Tranexamic acid tabs

2x500mg tabs TDS

213
Q

What age group is tranexamic acid licensed for?

A

18-45 years

214
Q

What is pre-menstrual syndrome?

A

Collection of physical and mental symptoms related to menstruation cycle

215
Q

What are some physical symptoms of pre-menstrual symptoms?

A
  • Bloating
  • Abdominal pain
  • Headaches
  • Backache
  • Muscle and joint pain
  • Breast pain
  • Insomnia
  • Weight gain
  • Nausea
216
Q

What are some behavioural and psychological symptoms?

A
  • Mood swings
  • Irritability
  • Anxiety
  • Difficulty concentrating
  • Clumsiness
  • Tiredness
  • Loss of libido
  • Food cravings
217
Q

What is premenstrual dysphoric disorder (PMDD)?

A

More severe psychiatric symptoms than pre-menstrual symptoms

Symptoms are cyclical

218
Q

What is the treatment for pre-menstrual syndrome?

A

Symptom specific:

  • Paracetamol/ NSAID for breast pain
  • Buscopan for cramps
219
Q

What is thrush?

A

Common infection of vulval and vaginal area

220
Q

What is vulvovaginal candidiasis?

A

Common infection of vulval and vaginal area

221
Q

What are the risk factors for vulvovaginal candidiasis (thrush)?

A
  • Age 20-30
  • Pregnancy
  • Diabetes mellitus
  • Immunocompromised and debilitated patients
  • ABx or immunosuppressant drug use
222
Q

What are the symptoms of vulvovaginal candidiasis?

A
  • Intense itching and burning
  • Soreness
  • Discharge (creamy, thick and curd-like)
  • Dysuria (pain urinating)
  • Dyspareunia (pain during sex)
223
Q

What are the red flag referral criteria for vulvovaginal candidiasis?

A
  • 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
Q

What is the treatment for vulvovaginal candidiasis?

A

Topical imidazole

  • clotrimazole
  • miconazole

Oral triazoles
- e.g. fluconazole

225
Q

In what groups are topical imidazoles contraindicated?

A
  • Pregnancy
  • Breastfeeding
  • <16yrs
  • > 60yrs
226
Q

What are some complimentary therapies for vulvovaginal candidiasis?

A

(1) Bathe genital area with diluted tea tree oil
(2) Bathe general areas with plain live yoghurt internally and externally
(3) Silk underwear

227
Q

What is bacterial vaginosis?

A

Bacterial vaginal infection

Shift in bacterial flora of vagina

228
Q

What are some symptoms of bacterial vaginosis?

A
  • Discharge with fishy/ unpleasant odour
  • White/ thin/ grey discharge
  • Irritation around vulva
229
Q

Is bacterial vaginosis sexually transmitted?

230
Q

What are the main risk factors for bacterial vaginosis?

A
  • Prolonged menstruation
  • IUD
  • Sexual intercourse without a condom
  • Sex toys
  • Frequent douching
  • ABx
231
Q

What are some complimentary therapies for vulvovaginal candidiasis?

A

(1) Bathe genital area with diluted tea tree oil
(2) Bathe general areas with plain live yoghurt internally and externally
(3) Silk underwear

232
Q

How can bacterial vaginosis be prevented?

A
  • Avoid excessive vulval washing/ vaginal douching

- Use a condom if sex increases symptoms

233
Q

What are some symptoms of bacterial vaginosis?

A
  • Discharge with fishy/ unpleasant odour
  • White/ thin/ grey discharge
  • Irritation around vulva
234
Q

Is bacterial vaginosis sexually transmitted?

235
Q

What are the main risk factors for bacterial vaginosis?

A
  • Prolonged menstruation
  • IUD
  • Sexual intercourse without a condom
  • Sex toys
  • Frequent douching
  • ABx
236
Q

What is the treatment for cystitis?

A
  • Plenty of water
  • Avoid alcohol/ caffeinated drinks/ fruit juices
  • Avoid sex
  • Paracetamol + ibuprofen
  • Alkalising agents
237
Q

How can cystitis be prevented?

A
  • Plenty of water
  • Empty bladder fully when urinating
  • Wipe front to back after defecation
  • Urinate after sexual intercourse
  • Cranberry juice
238
Q

What is the morning after pill?

A

Levonelle One Step
- levonorgestrel

EllaOne
- Ulipristal acetate

239
Q

When must the morning after pill be used?

A

Levonelle One Step
- Within 72hrs of unprotected sex/ contraceptive failure

EllaOne
- Within 5 days of unprotected sex/ contraceptive failure

240
Q

Who is the morning after pill licensed for?

A

> 16yrs old

241
Q

What are the common symptoms of pregnancy?

A
  • Heartburn
  • Morning sickness
  • Constipation
  • Haemorrhoids
  • Itching/ skin irritation
  • Backache
242
Q

How can cystitis be prevented?

A
  • Plenty of water
  • Empty bladder fully when urinating
  • Wipe front to back after defecation
  • Urinate after sexual intercourse
  • Cranberry juice
243
Q

What is the morning after pill?

A

Levonelle One Step

- levonorgestrel

244
Q

When must the morning after pill be used?

A

Within 72hrs of unprotected sex/ contraceptive failure

245
Q

How can hot flushes and night sweats be treated in menopause?

A

(1) Regular exercise
(2) Cool room
(3) Avoid caffeine, smoking, alcohol + spicy foods

246
Q

What are the common symptoms of pregnancy?

A
  • Heartburn
  • Morning sickness
  • Constipation
  • Haemorrhoids
  • Itching/ skin irritation
  • Backache
247
Q

At what age does menopause occur?

248
Q

What is the referral criteria for cold/ flu?

A
  • Chest pain
  • Shortness of breathe
  • Wheezing
  • Sputum nature
  • Severe pain on coughing
  • Stiff neck/ non-blanching rash
  • Treatment failure
249
Q

What are the referral criteria for a sore throat?

A
  • Babies/ infants
  • Hoarseness
  • Dysphagia
  • White spots/ pus
  • Coloured sputum
  • Thrush in mouth area
  • Treatment failure
  • Recurrent infection
250
Q

What is the referral criteria for a cough?

A
  • > 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
Q

What are the symptoms of flu?

A

(1) Prominent headache
(2) Sudden fever (3-4 days)
(3) Severe aches + pains
(4) Extreme fatigue + weakness
(5) Severe cough
(6) Chest discomfort

252
Q

What are the red flag referral criteria for hayfever?

A
  • Wheezing
  • Shortness of breath
  • Painful ear/ sinuses
  • Purulent conjunctivitis
  • Failed medication
253
Q

What is sodium cromoglicate?

A

Mast cell stabiliser

SR PM4B (41 decks)

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