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NES responsing to clinical conditions > responding to symptoms > Flashcards

responding to symptoms Flashcards

1
Q

when should a PPI be stopped before an endoscopy

A

2 weeks

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2
Q

colic tx

A

simeticone

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3
Q

constipation in children

when to refer?

A 
Pain on defecation
Blood in stools
anal pain
weak/dizziness
regular/repeat episodes
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4
Q

If new/ worsening constipation with no explanation?

A

Refer(any age)

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5
Q

GORD tx algorithm

A

999:
Breathing difficulty
vomiting blood/ coffee ground vomit
Cardiac pain.

A&E
malaemaia(black/tarry stools)
abdo pain radiating to the back

Urgent GP referral:
-dysphagia

Routine referral:
night time waking
unexpalined weight loss
ADR
OTC failure
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6
Q

Constipation tx algorithm

A

A&E:
rectal bleeding unrelated to bowel movement

Urgent GP/OOH referral:
malaena
bloody stools/clots
high fever 
rectal pain
swelling
abdo pain/fever
routine referral:
N&V
pregnancy (3rd trimester) 
passing mucus
alternating diarrhoea/constipation. 
self care failure
adr
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7
Q

should anti-motility drugs be used if there is blood in the diarrhoea?

A

NO

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8
Q

Diarrhoea:
When to refer:
<1 year old

<3years old

Most common cause?

A

<1 YO: >24H
<3YO:>48H

Virus- rotavirus

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9
Q

what should travellers avoid

A

unwashed salad
fruit without an outer skin/ layer to peal
ice cubes

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10
Q

Constipation

practicle tips

A

Drink 8 glasses water/day

avoid too much caffeine

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11
Q

Diarrhoea tx algorithm

A

999:
pale/cold/clammy- signs of severe dehydration

Urgent gp/OOH referral:

  • increased thirst, dark urine, light-headed
  • vomiting/not keeping fluid down
  • blood in stools
  • abdo pain/fever
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12
Q

routine referral

A 
continuous >72 hours or intermittent for 7 days
reduced fluid intake
recent travel
drug withdrawal
ADR
immuno-compromised
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13
Q

Does rectal bleeding from haemorroids need referred?

A

No- treat OTC.
blood on surface

in change in bowel habit/pattern- refer

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14
Q

best laxative for IBS?

A

Bulk forming

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15
Q

haemorroids management

A

warm baths sooth
wet wipes to clean
cold compress shrinks haemorroids

Tx

  • Soothing agents
  • local anaesthetics
  • topical corticosteroids
  • -astringent (bismuth)
  • bulk forming lax reduce need to strain
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16
Q

anusol age restriction

A

> 18

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17
Q

cough and cold remedies <6

A

Over-the-counter cough and cold medicines containing:

  • anti-tussives(dextromethorphan and pholcodine)
  • expectorants (guiaphenesin and ipecacuanha)
  • nasal decongestants (e.g. pseudoephedrine and phenylephrine)
  • antihistamines (e.g. Diphenhydramine)

NOT AVAILABLE TO CHILDREN UNDER 6 YEARS OLD
children >6 should only be given one at a time.

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18
Q

what causes croup?

A

parainfluenza virus. causes a barking cough.

Any child with stridor( unsual breathing sounds) needs referred.

19
Q

cough tx algorithm

A

999:

  • stridor
  • airway obstruction
  • difficulty breathing
  • pale/cold/clammy
  • unable to swallow saliva
  • drooling excessively

a&e:
inhaled/swallowed foreign body
coughing up pink frothy mucous

Routine referral to GP:

  • cough>3 weeks
  • pleuritic chest pain
  • immuocomp
  • signs of infecton
  • otc failed
20
Q

most common causes of the common cold

A

rhinovirus- 40%
coronavirus-10%

symptomatic relief only- self limiting
:Paracetamol, ibuprfen, saline nasal drops 0.9%,
topical nasal degongestants
oral decongestants (only >12)

21
Q

hayfever:

sedating and non- sedating antihistamines

A

sedating:
cinnarizine
chlorphenamine
promethazine

non-sedating:
loratadine
cetirizine
acrivastine

intranasal corticosteroids (onset of action 12 hours)
Beclometasone, budesonide, fluticasone and triamcinolone can all be sold to
adults over the age of 18 years, for a maximum period of use of three months

sodium cromoligate can be used in children

pregnancy- topical products only

22
Q

decongestant max

A

OTC oral decongestants are restricted to 720mg (the equivalent of 12 tablets
or capsule of 60mg or 24 tablets or capsules of 30mg) of pseudoephedrine or
ephedrine. There is also a limit of one pack per customer and it is recommended
that the sale should be carried out by a pharmacist.

23
Q

symptoms of meningitis

A

 excessive sleepiness or irritability
 vomiting or feeding poorly
 crying a lot (moaning or high-pitched crying)
 high temperature, but look pale or blotchy
 cold extremities
 bulging soft spot (fontanelle) on their head*
 being stiff, jerky, or have seizures (fits)*
 purpuric rash (one which does not blanch white on pressure)*

In adults and older children, symptoms are:
 high temperature
 headache
 stiff neck
 nausea
 vomiting
 trouble looking at bright lights
 confusion/delirious
 sleepiness
 seizures (fits)*
 rash which does not blanch under pressure*
24
Q

which analgesic should be avoided in migraine?

A

codeine- not proven to help

25
Q

why is caffeine in analgesic formulations

A

aid absorption of analgesic

26
Q

OTC sumatriptan restrictiont

A

only when simple analgesia with/ without antiemetics failed:

(Imigran) >18/ <65
only when there is a clear diagnosis

Take ASAP after onset
if no response- a second tablet should NOT BE TAKEN FOR THE SAME ATTACK.

if partial response or migraine reccurs- take another dose after 2 hours.

max 2 tabs (100mg) in 24 hour period.

27
Q

insomnia tx options

A

Diphenhydramine (nytol)

promethazine (sominex)

28
Q

Travel sickenss options

A

hyosciene hydrobromide: 30 min before journey

  • Antimuscarinic se/ drowsiness(avoid in galucoma/urinary retention)
  • effective 6-8 h

antihistamines: 2 hour before journey
- cinnarizine(stugeron), promethazine (avomine)
- effective 8h

29
Q

Caution s and CI for OTC sumatriptam

A

Cautions
Anyone who has three or more of these cardiovascular risk factors is not suitable
for OTC sumatriptan:
 men aged over 40 years
 post-menopausal women
 hypercholesterolaemia
 regular smoker (>10 cigarettes daily)
 obesity – body mass index more than 30 kg/m2
 diabetes
 family history of early heart disease – either father or brother had a heart attack
or angina before the age of 55 or mother or sister had a heart attack or angina
before the age of 65

Contraindications
 sumatriptan must not be used prophylactically
 known hypersensitivity to any component of the product
 known hypersensitivity to sulphonamides
 known hypertension
 previous myocardial infarction
 ischaemic heart disease, e.g. angina
 peripheral vascular disease
 coronary vasospasm/Prinzmetal’s angina
 cardiac arrhythmias (including Wolff-Parkinson-White syndrome)
 hepatic or renal impairment
 epilepsy or history of seizures
 atypical migraine (including hemiplegic, basilar or ophthalmoplegic migraine)
 a history of cerebrovascular accident or transient ischaemic attack
 concomitant administration with ergotamine, ergotamine derivatives, other
triptans, monoamine oxidase inhibitors

30
Q

conclusive diagnosis of headlice

A

live lice

tx failure- different insecticide after 3 weeks

31
Q

when to refer in scabies

A

<2 years old

note immunocomp higher risk

32
Q

what is herpes simplex.

A

cold sores

tx aciclovir/penciclovir

33
Q

what is herpes zoster

A

chickenpox/ shingles
shingles- treat within 72 hours of onset - aciclovir 800mg Five times a day for 7-10 days.

refer is immunocomprosied

34
Q

onchomycosis

A

fungal nail infection

refer if immunosuppressed or diabetic

> 2 nails- oral tx required

for fingernails- tx 6/12
toenail- tx 9/12

35
Q

ringworm

A

treat with topical imidazole antifunagls

ketoconazole shampoo(POM)

36
Q

what causes impetigo

A

staphylococcus aureus

tx 1% hydrogen peroxide
2% fusidic acid

37
Q

sjorgen’s syndrome

A

Sjörgen’s syndrome, an autoimmune disease causes dry mouth and eyes
as well as vaginal dryness. Patients with symptoms of dry eyes, dry mouth
and atrophic vaginitis should be referred to their GP.

38
Q

ear wax

A

warm tap water,
sodium chloride 0.9%
sodium bicarbonate
olive oil and almond oil as

39
Q

otitis externa

A

Otitis externa (inflammation of the external ear canal or surface of the ear)
or otitis media due to infection are more likely if there is pain present. Simple
analgesia will usually be sufficient as this will usually be a self-limiting condition.
Only if ear pain is severe or persisting for three or more days should referral be
necessary.

40
Q

oral ulcer- when to refer

A

lasting >3weeks. need to exclude oral cancer

tx: difflam (>12)
bonjela -choline salicylate gel 6 apps daily(>16)

41
Q

xerostomia

A

Dry mouth
¡ radiotherapy to the head or neck which can damage the salivary glands
¡ mouth breathing which can be due to a blocked nose or other causes
¡ anxiety
¡ dehydration
¡ Sjögren’s Syndrome

Taking frequent sips or sprays of cold water or sucking ice-cubes will help.
Sugar-free chewing gum is often helpful as this stimulates the production of
saliva Boiled sweets may also be helpfu
Eating fresh pineapple chunks or partly frozen melon is often soothing and
helpful.
Caffeine and alcohol can be dehydrating,
Petroleum jelly

42
Q

AXIAL CHEILITIS (ANGULAR STOMATITIS)

A

Antifungal cream, such as clotrimazole 1% should help. If this does not improve
symptoms within one week, refer to the GP as the cause is then more likely to
be bacterial.

43
Q

sore throat with fever

A

refer

44
Q

sore thrat algorithm

A

999:
breathing difficulty
unable to swallow saliva
meningeal rash

a&e:
swallowed foreign object

urgent referal gp/ooh :
dysphagia- difficulty swallowing
immunocomp
SUSPECTED DYSCRASIA

routine referral:
bacterial infection
glandular fever

NES responsing to clinical conditions (3 decks)

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