PAI

Question 1

Spread across back, radiate to butt / thigh
Top of pelvic / one side of spine
Worse on movement
Spread down leg
Trigger:
Injury during work

Answer 1

BACKPAIN

Question 2

When to refer BACKPAIN

Answer 2

Not related to movement
Bowel / bladder problems, blood in urine
Numbness
Severe at night
7 day OTC no help

Question 3

Treatment of BACKPAIN

Answer 3

Nurofen 200mg tabs - 1 or 2T tds
Paramol - 1 or 2T every 4-6 hrs
Do not use paracetamol alone
Rubefacients
Rest, continue work on improvement
Heat pad / water bottle (+towel)
Light exercise, massage
Get better within 7 days

Question 4

Advice for BACKPAIN

Answer 4

Avoid bending / stooping
Keep back straight

Question 5

Swollen and painful joints
Worse on movement
Eased on rest
Worse at end of day

Answer 5

OSTEOARTHRITIS

Question 6

Treatment of OSTEOARTHRITIS

Answer 6

1st: Paracetamol / topical NSAIDS + PPI: take regularly to control pain
2nd: Oral NSAIDS (Aspirin - >16 yrs)
3rd: Paracetamol / topical NSAIDS + oral NSAIDS
Rubefacients (Deep Heat)
Do NOT use topical NSAIDS together with oral NSAIDS

Question 7

Advice for OSTEROARTHRITIS

Answer 7

Advice:
exercise (muscle strengthening)
weight loss
suitable footwear (support and comfortable)

Question 8

Pain, stiff
Joint swelling
Joint deformity
Improve on movement

Answer 8

RHEUMATOID ARTHRITIS

Question 9

Treatment for injury (sprain, strain)

Answer 9

Rest, Ice (10-15mins every 2 hr), Compress, Elevation (reduce swelling)
Oral Analgesics - paracetamol, NSAID + aspirin (>16 yrs)
Don’t take anything else with paracetamol
Topical Analgesics
Topical Rubefacient

Question 10

When to refer for INJURY

Answer 10

Severe pain
Swelling
Numbness
Cannot bear weight
Immobalised
Old injury

Question 11

Advice for INJURY

Answer 11

Avoid overwork
If go gym have rest day between

Question 12

Treatment & Advice for DENTAL PAIN

Answer 12

Treat: paracetamol / ibuprofen
Help symptoms:
Rinse mouth with salt water
Eat soft food
Avoid chew at injured area
Prevent tooth ache:
Twice yearly checkup
Reduce sugar intake
Brush twice daily at least 2 mins with fluoride toothpaste
Floss

Question 13

Sore and red gums
Dribbling
Common in babies around 6 mths

Answer 13

TEETHING IN BABIES

Question 14

When to refer TEETHING

Answer 14

Stiff neck
Rash
Tiredness
Dehydration
Fever

Question 15

How to treat TEETHING

Answer 15

Paracetamol 120mg/5ml suspension
Do not give more than 3 days
Give after meal
Seek GP if not better after 3 days
Shake bottle
Bonjela teething gel

Question 16

Advice for TEETHING

Answer 16

6mths or older: raw fruit/ vege to chew to soothe gum
Wipe away dribble to prevent rash
Can give teething ring

Question 17

Earache
Fever
Itchy around ear
Rub / pull ear

Answer 17

OTITIS MEDIA

Question 17

Earache
Fever
Itchy around ear
Rub / pull ear

Answer 17

OTITIS MEDIA

Question 18

When to refer OTITIS MEDIA

Answer 18

Severe pain
Doesn’t get better in 3 days
Fluid coming from ear

Question 19

Treatment for OTITIS MEDIA

Answer 19

Last 3-7 days, self-limitting
Children: Paracetamol 250mg/5ml
Calpol suspension
Every 4-6hrs when required up to 4 doses in 24 hrs
Spoon / oral syringe
Adult: Paracetamol / Ibuprofen
Take when required

Question 20

Advice for OTITIS MEDIA

Answer 20

Avoid cotton buds
No need for eardrops
Remove discharge by wiping the ear with cotton wool

Question 21

Last 4-72 hrs
Throbbing, pulsating pain
N&V
Stress
Tired
Caffeine

Answer 21

MIGRAINE

Question 22

When to refer MIGRAINE

Answer 22

Attack last >24 hrs
Frequent, symptoms change
>3 attack per month, don’t recover
>50yrs old & first attack
<12 yrs with stiff neck
Prev trauma injury
Caused by meds

Question 23

Treatment of MIGRAINE

Answer 23

NSAID + Aspirin - Nurofen 200mg tablets
Paracetamol - Panadol Advance 500mg tablets
Compound analgesic - Migraleve Complete (not under 12 yrs) *may cause addiction due to codeine
Migraintan (Sumatriptan) (for 18-65 yrs)

Question 24

Advice for MIGRAINE

Answer 24

Keep migraine diary
Track triggers + Avoid
Manage stress

Question 25

Base of skull, top of head, eyes
Bilateral
Band-like
Few hrs → days
Tension
Anxiety
Fatigue

Answer 25

TENSION-TYPE

Question 26

When to refer TENSION TYPE

Answer 26

Attack last >24 hrs
Frequent, symptoms change
>3 attack per month, don’t recover
>50yrs old & first attack
<12 yrs with stiff neck
Prev trauma injury
Caused by meds

Question 27

Treatment of TENSION TYPE

Answer 27

NSAIDS + Aspirin - Nurofen 200mg tab
Paracetamol - Paracetamol Advance 500mg tab
Paracetamol - NSAID - opioids

Question 28

Advice for TENSION TYPE

Answer 28

Headache diary
Identify trigger
Rest - 6-8 hrs of sleep

Question 29

> 50yrs, 1st time
<12yrs, stiff neck, rash
Visual disturbance, drowsiness, vomit
1-3 mths trauma injury
NO improvement with analgesic
Chronic migraine

Answer 29

SECONDARY HEADACHE (REFER)

Question 30

Period pain occurs suddenly after years of painless periods, pain before, during, after menstruation

Answer 30

REFER (secondary period pain)

Question 31

Pain before menstruation, regular, up to 72 hrs, headache, N&V

Answer 31

DYSMENORRHOEA

Question 32

When to refer DYSMENORRHOEA

Answer 32

Period heavier than usual
Breakthrough period (bleeding between period)
Bleeding after sex
Smelly vaginal discharge
All above may be caused by IUD

Question 33

Treatment of DYSMENORRHOEA

Answer 33

Feminax Express
12yrs & above
1-2T every 4 hrs
MAX 6T in 24 hrs
Feminax Ultra
15-50 yrs
2T day 1, 1T 6-8 hrs later if necessary
1T every 6-8 hrs day 2&3
MAX 3 days
SE: headache, constipation
Panadol Period Pain (paracetamol + caffeine)
12yrs & above

Question 34

Advice for period pain

Answer 34

Gentle exercise: brisk walking
Heat packs
Warm bath/shower
Hydrated
Relaxation: yoga

Question 35

How to use and change TRANSDERMAL PATCH

Answer 35

How to Use:
Choose a hairless, dry, non-exposed area (upper arm, outer arm, upper back)
Open sachet & take out patch
Peel off one part of the transparent protective foil
Stick patch on area, remove remaining foil
Press patch onto skin & hold for 30 secs

How to Change:
Take off old patch
Fold it in half with sticky side inwards
Open new sachet, take out new patch
Put old patch in sachet and discard

Question 36

Counselling points for NSAIDS (3)

Answer 36

Avoid in patient with history of gastro problems
Avoid in patient with asthma
Must be taken with/after meal

Question 37

Paracetamol Counselling Point (1)

Answer 37

Avoid other meds containing paracetamol

Question 38

Counselling point for opioids (morphine, oxycodone) [3]

Answer 38

Constipation is a common side effect, does not go away
Stimulant laxative can be taken
Increase fluid intake, fibre and exercise to improve gut motility