responding to symptoms

Question 1

when should a PPI be stopped before an endoscopy

Answer 1

2 weeks

Question 2

colic tx

Answer 2

simeticone

Question 3

constipation in children

when to refer?

Answer 3

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

Question 4

If new/ worsening constipation with no explanation?

Answer 4

Refer(any age)

Question 5

GORD tx algorithm

Answer 5

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

Question 6

Constipation tx algorithm

Answer 6

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

Question 7

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

Answer 7

NO

Question 8

Diarrhoea:
When to refer:
<1 year old

<3years old

Most common cause?

Answer 8

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

Virus- rotavirus

Question 9

what should travellers avoid

Answer 9

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

Question 10

Constipation

practicle tips

Answer 10

Drink 8 glasses water/day

avoid too much caffeine

Question 11

Diarrhoea tx algorithm

Answer 11

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

Question 12

routine referral

Answer 12

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

Question 13

Does rectal bleeding from haemorroids need referred?

Answer 13

No- treat OTC.
blood on surface

in change in bowel habit/pattern- refer

Question 14

best laxative for IBS?

Answer 14

Bulk forming

Question 15

haemorroids management

Answer 15

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

Question 16

anusol age restriction

Answer 16

> 18

Question 17

cough and cold remedies <6

Answer 17

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.

Question 18

what causes croup?

Answer 18

parainfluenza virus. causes a barking cough.

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

Question 19

cough tx algorithm

Answer 19

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

Question 20

most common causes of the common cold

Answer 20

rhinovirus- 40%
coronavirus-10%

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

Question 21

hayfever:

sedating and non- sedating antihistamines

Answer 21

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

Question 22

decongestant max

Answer 22

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.

Question 23

symptoms of meningitis

Answer 23

 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*

Question 24

which analgesic should be avoided in migraine?

Answer 24

codeine- not proven to help

Question 25

why is caffeine in analgesic formulations

Answer 25

aid absorption of analgesic

Question 26

OTC sumatriptan restrictiont

Answer 26

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.

Question 27

insomnia tx options

Answer 27

Diphenhydramine (nytol) | promethazine (sominex)

Question 28

Travel sickenss options

Answer 28

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

Question 29

Caution s and CI for OTC sumatriptam

Answer 29

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

Question 30

conclusive diagnosis of headlice

Answer 30

live lice tx failure- different insecticide after 3 weeks

Question 31

when to refer in scabies

Answer 31

<2 years old note immunocomp higher risk

Question 32

what is herpes simplex.

Answer 32

cold sores tx aciclovir/penciclovir

Question 33

what is herpes zoster

Answer 33

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

Question 34

onchomycosis

Answer 34

fungal nail infection refer if immunosuppressed or diabetic >2 nails- oral tx required for fingernails- tx 6/12 toenail- tx 9/12

Question 35

ringworm

Answer 35

treat with topical imidazole antifunagls ketoconazole shampoo(POM)

Question 36

what causes impetigo

Answer 36

staphylococcus aureus tx 1% hydrogen peroxide 2% fusidic acid

Question 37

sjorgen's syndrome

Answer 37

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.

Question 38

ear wax

Answer 38

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

Question 39

otitis externa

Answer 39

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.

Question 40

oral ulcer- when to refer

Answer 40

lasting >3weeks. need to exclude oral cancer tx: difflam (>12) bonjela -choline salicylate gel 6 apps daily(>16)

Question 41

xerostomia

Answer 41

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

Question 42

AXIAL CHEILITIS (ANGULAR STOMATITIS)

Answer 42

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.

Question 43

sore throat with fever

Answer 43

refer

Question 44

sore thrat algorithm

Answer 44

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