Osce Revision

8/18/2019 Osce Revision

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OSCE REVISION

Legal prescription requirements (Standard NHS, Private!"# Signature o$ prescri%er & Must match the prescribers name'# ddress o$ prescri%er)# *ate on prescription & valid for 6 months or 28 days if CD sch. 1,2,3,4+# Particulars o$ prescri%er & particulars that indicate the type of

appropriate practitioner e.. Dr. and !MC number# Name o$ patient-# ddress o$ patient & includin house number"name and full postcode, if

homeless #$%, not re&uired for ''%.# *ate o$ %irt/ or age o$ t/e patient i$ under "' 0ears ( if it says

Mr."Mrs. then assume patient is over 12 years but chec) ae in caseelderly

Legal prescription requirements (EE or S1it2erland!"# Patient details ( full name and date of birth

'# Prescri%er details ( prescribers name, professional &uali*cations, directcontact details includin email address, telephone"fa+ number ithinternational pre*+, or) address includin the country in hich theyor)

)# Prescri%ed medicines details ( name of the medicine -brand namehere appropriate, pharmaceutical form, &uantity, strenth, and dosaedetails

+# Prescri%er signature# *ate o$ issue ( valid for up to si+ months from the appropriate date,

schedule 4 CD for 28 days3 EVEN I4 5RI66EN IN *I444EREN6 LN787E, S6ILL LE7LL9

CCEP6:LE3 PHR;CIS6 NEE*S 6O HVE ENO87H IN4OR;6ION 6O EN:LE

S4E S8PPL9 O4 ;E*ICINES, CONSI*ERIN7 P6IEN6 CRE N*5ELL :EIN7

3 SCHE*8LE ", ' N* ) C*s N* ;E*ICINL PRO*8C6S 5I6HO86;R# 6otal quantit0 ( must be ritten in both ords and *ures e.. tablets,

capsules, ampoules, millitres

?# @uantit0 prescri%edAduration ( ma+ 3/ days"B# Name o$ patient


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""# ddress o$ patient ( if patient doesn0t have a *+ed address -e..homeless or itness protection scheme no *+ed abode0"0#$%0 isacceptable

"'# *ental prescriptions ( $or dental use onl0D")# Instalment direction ( here the prescription is intended to be

supplied in instalments a valid instalment direction is re&uired

Categories o$ Veterinar0 ;edicines3 PO;3V & rescriptiononly medicines that can only be prescribed by a

veterinary sureon and supplied by a veterinary sureon or pharmacistith a ritten prescriptions

3 PO;3VPS & rescriptiononly medicines that can be prescribed andsupplied by a veterinary sureon, a pharmacist or a suitably &uali*edperson or an oral or ritten prescription

3 N43VPS & % cateory of medicine for nonfood animals that can besupplied by a veterinary sureon, a pharmacist or a suitably &uali*edperson a ritten prescription is not re&uired

3 V;37SL & %n authorised veterinary medicine that is available oneneral sale

Veterinar0 Cascade3 5here available it is a leal re&uirement to suppl0 a licensed

veterinar0 medicine3 7nly here above is not possible an eisting licensed veterinar0

medicine $or anot/er species or diFerent condition can %econsidered

3 7nly here above is not possible a licensed /uman medicine or anE83licensed veterinar0 medicine can %e considered

3 7nly here the above is not possible etemporaneous or speciGcall0manu$actured medicines can %e considered

Prescription requirements $or PO;3V, PO;3VPS and medicinessupplied under t/e veterinar0 cascade!

"# Name, address, telep/one num%er, qualiGcation and signature o$t/e prescri%er

'# Name and address o$ animal o1ner)# IdentiGcation and species o$ t/e animal and its address -if

dierent from oner0s address+# *ate ( valid for - mont/s or s/orter i$ indicated %0 t/e prescri%er

-Sc/ ', ) and + C*s are valid $or '> da0s# Name, quantit0, dose and administration instructions o$ required

medicine-# %ny necessar0 1arnings and i$ relevant t/e 1it/dra1al period.# 5/ere appropriate a statement /ig/lig/ting t/at t/e medicine is

prescri%ed under t/e veterinar0 cascade ># 5/ere Sc/ ' or ) C*s /ave %een prescri%ed a declaration t/at

t/e item /as %een prescri%ed $or an animalA/erd under t/e careo$ a veterinarian

?# I$ prescription is repeata%le t/e num%er o$ times it can %erepeated

Clinical c/ec!3 Chec) dru is suitable for indication


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3 Correct dose, correct fre&uency3 9uitable formulation3 9uitable &uantity3 9uitable duration3 Dru is suitable for ae of patient3 Dose is suitable for ae of patient3 Dru is suitable for ethnicity of patient

3 Contraindications or cautions3 %ny interactions3 %ny arnins re&uired3 :o be ta)en before"after food

ccurac0 c/ec!"# La%el against prescription'# Product against prescription)# La%el against product

"# La%el and Prescriptiona. #ame of patient ( pre*+ e.. Mr."Mrs."Miss. 'tcb. #ame of the medicinec. Dosed. 9trenthe. $ormulationf. ;uantity. Durationh. Directions

i.


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Counselling

*ispensing a prescription overall!"# =ntroduction and con*rm the correct patient'# 5hat is the medicine and hy they are ta)in it)# Dosae+# Medicine related advice ( side eect, cautions, best ay to ta)e# ecap and con*rm the symptoms)# '+plain the dianosis+# '+plain the proposed cause of symptoms# '+plain type of treatment and ho to use it-# '+plain hat the type of treatment does.# 9uest one preparation># ropose additional advice?# 7ther speci*c condition related advice


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"B# Maintain eye contact""# ?uild rapport"'# 9pea) clearly")# @se appropriate, patient friendly lanuae"+# :B%# 24B>9

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Communication s)ills ( maintains eye contact

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Communication s)ills ( builds rapport

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Communication s)ills ( spea)s clearly

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Communication s)ills ( uses appropriate, patientfriendly lanuae

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Communication s)ills ( consultation had a loical Ao


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Cradle Cap

O%served %e/aviours ;R'$'> =$ ?%?F #7: >'97#D=#! :7 :>'%:M'#:9

"+ =#$


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Colic

O%served %e/aviours ;R


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and hormonal development"B

arental advice ( loo) after on ell bein, can be stressful, etfamily support or friends.

""

Bold your baby, in dierent positions

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@se fast Ao teat, preventin baby from salloin air by feedinupriht, alays burp the baby, ently massae baby tummy

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?athe baby in arm ater

"+

Chanes to diet, breastfeedin omen should avoid caeinatedand alcoholic drin)s.

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>'$'> if ea), hih pitched continuous cry, seem Aoppy henpic)ed up, ta)es less than a third of usual amount of Auids, passesless urine than normal

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6eet/ing

O%served %e/aviours ;R


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+ '+plains proposed cause of symptoms ( ne teeth '+plains type of treatment and ho to use ( teethin rins -place

in fride, paracetamol"ibuprofen, teethin els -localanaesthetic"mild antiseptic, teethin ranules

- '+plains hat treatment does ( bonGela relieves the pain,ibuprofen"paracetamol relieve pain

. 9uestions of one of the folloin ( bonGela,

ibuprofen"paracetamol, teethin rins> !ently rubbin over the aected um ith clean *ner may ease

pain? Cool, suar free drin)s"B

:ry chilled ater in a bottle"cup if can0t eat yet

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>ash on chin after dribblinH %pply petroleum Gelly as a barriercream

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>'$'> if hih temperature

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>'$'> if diarrhoea

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Conditions and treatments! responding to s0mptoms

Constipation3 %rises hen a patient e+periences a reduction in their normal boel habit

ith more diIcult defecation and"or hard stools3 Eery common ( all ae roups, most common in the elderly ( 2J4/K over

6J have constipation3 5omen 23 times more li)ely to suer than men and 4/K of omen in

late prenancy suer constipation

S0mptoms3 Discomfort on passin of stools3 %bdominal discomfort or cramps3 ?loatin3 $eelin of emptyin of rectum3 $eelin of obstruction or bloc)ae3 #eed to manually assist defecation

Causes o$ constipation3 Eating /a%itsAli$est0le & most liel0

o oor Auid inta)e

o :ravelo De*ciency in dietary *bre inta)e

o renancy as hormonal chanes slo don ut movements as thebaby ta)es up room and e+erts pressure on the boel

o >educed mobilityo Chane in lifestyle or environmento =norin of reAe+ to defecate

3 ;edication & liel0o Most e+ert action by decreasin ut motility thereby causin

constipationo 7piates

o %luminium saltso %ntidepressantso %ntiar)inson0s medication ( should be on la+atives

o %nticholineric ( antihistamineso =rono henothiaLine ( antipsychoticso


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*iagnosis3 'stablish the patients current boel habit compared to normal3 :his ill establish if the patient is suerin from constipation3 :hen concentrate on determinin the cause ( blood presentH ain on

passin stoolH 7ther symptomsH Chanes in dietH


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6rigger points & indicative o$ re$erral3 Pain on de$ecation causing patient to suppress t/e de$actor0

reJe ( chec) for anal *ssure3 Patients aged +B 0ears and over 1it/ a sudden c/ange in %o1el

/a%its 1it/ no o%vious cause ( could be a daner symptom for rectalcarcinoma

3 7reater t/an "+ da0s duration 1it/ no identiGa%le cause (suspects underlyin cause re&uirin fuller investiation by !

3 6iredness ( chec) for anaemia or thyroid dysfunction3 :lood in t/e stools3 I$ a c/ild re$er

6reatment3 9hould ta)e a stepped care approach3 @ncomplicated ( non dru treatment is 1st line for all patient roups3 9imple dietary and lifestyle modi*cations ill relieve maGority of cases3 %ny possible chanes to medication currently on3 Li$est0le measures

o =ncrease dietary *bres -3/ daily ( fruits, cereal, bron bread, rice,

pasta, bran Aa)eso =ncrease Auid inta)e minimum 1.6< -8 lasses for omen and 2<

-1/ lasses for men of ater a dayo =ncrease in e+ercise ( al)in to or), about 3/ mins a day if they

can ( ive the patient mobilityo :oiletin ( o hen needed, unhurried, establish a reular routine

and position3 O6C treatment

o :ul $orming agents

=ncreases faecal volume li)e *bre

>etains Auid in the stool thereby softenin the faeces

Must maintain Auids as could potentially cause ut

obstruction 9ide eects Aatulence and bloatin in the *rst fe ee)s

5or)s in ( 1224 hours

'.. heat bran, =sphaula hus) -$yboel, 9terculia,

Methylcelluloseo Stimulant laatives

9timulates nerves in lare intestine increasin peristalsis and

ut motility 5or)s in 812 hours ( ta)e at bedtime to o in the mornin

9ide eects abdominal cramps, diarrhoea, laLy boel

'.. senna, bisacodyl, lycerol, sodium picosulfate

o Osmotic laatives

Dra ater from intestinal all into the lumen

>aises intraluminal pressure increasin volume of contents

stimulatin peristalsis #ot for chronic use

42 hours to or)

9ide eects abdominal pain, bloatin


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'.. lactulose, macrools and manesium salts

o 4aecal so$tenersAlu%ricants

otavirus

o rotoLoa ( tropical3 Non in$ective cases

o %n+iety

o 'motional upseto ;edication 3 liel0

;et$ormin, irono %lcoholo Coee

o 9eets hih in sorbitol content3 I:S, giardiasis, $aecal impaction & unliel03 8lcerative colitis and Cro/nDs disease, colorectal cancer,

mala%sorption s0ndromes & ver0 unliel0

*iagnosis and SpeciGc @uestions3 4requenc0 and nature o$ t/e stools

o

5hat does it loo) li)e ( atery ithout blood, or is there blood andmucus presentHo 5atery ithout blood ( shos that it is infective and so self limitin


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o Diarrhoea associated ith blood and mucus ( referral to eliminate

invasive infectiono ?lood ( =?D

3 Periodicit0 ( previous history of recurrent diarrhoea should be referred3 *uration ( refer if reater than 4 days in adult, or 2"3 days in

child"elderly3 Onset o$ s0mptoms ( any ne foods"chanes to the diet

3 %dominal pain3 6ravelH3 Signs o$ de/0dration

o @nsatis*ed thirst

o Dry tonue"moutho oor urine outputo >apid breathino


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6reatments3 ;aintain oral /0giene & 1as/ /ands regularl0 to prevent spread

and transmission3 Oral re/0dration t/erap0 is "st line & dioral0te

o Can be iven to all ae roups

o 9mall liht mealso #o side eects

o 7ver 1 year oldo !lucose Jmmol"<

o

9odium Jmmol"<o otassium 2/mmol"<o Chloride 6Jmmol"<o Citrate 1/mmol"<

3 O6C provide s0mptomatic relie$ $or social reasons3 Loperamide & 'nd line

o 7pioid analoue, slos intestinal tract time by decreasin boelmotility throuh action on opioid receptors in the uy

o Can increase Auid absorption and electrolytes

o 7ver 12 years3 :ismut/ su%salic0late

o 'ective in travelers diarrhoeao >educes intestinal motilityo 7ver 16 years

3


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*0spepsia3 n um%rella term used generall0 used %0 /ealt/care

pro$essionals to re$er to a group o$ upper a%dominal s0mptomst/at arise $rom Gve main conditions

o #on ulcer"functional indiestion

o !astrooesophaeal reAu+ disease -!7>D, heartburno !astritiso Duodenal ulcerso

!astric ulcers3 '+tremely common 2J4/K in estern hemisphere e+perience symptoms3 Biher in omen than men

Causes3 Non ulcerA$unctional d0spepsia ( hen no speci*c cause can be found

for a patients symptoms3 7OR* decreased muscle tone leadin to oesophaeal sphincter

incompetence3 7astritis increased acid production attributable to B. pylori infection or

acute alcohol inestion

3 *uodenal (?K and gastric (>BK ulceration ( B. ylori, it producesto+ins that stimulate the inAammatory cascade, #9%=Ds and lo doseaspirin can medically induce ulcers

Clinical $eatures o$ *0spepsia3 Eaue abdominal discomfort -achin above the umbilicus associated ith

belchin3 ?loatin3 $latulence3 % feelin of fullness3 #ausea and"or vomitin3 Beartburn3 >etrosternal heartburn is the classic symptoms of !7>D

*iagnosis and speciGc questions3 ge

o =ncidence increases ith ae, youn adults ( dyspepsia ith no

speci*c patholoy, older ( speci*c patholoy3 Location

o ain above umbilicus and centrally located in the epiastric area

o ain belo the umbilicus ill not be due to dyspepsia

o ain behind sternum"breastbone most li)ely to be heartburno =f patient can point to speci*c area in abdomen unli)ely to be

dyspepsia3 Nature o$ pain


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o %chin, discomfort ( dyspepsia

o !nain, sharp, stabbin ( unli)ely to be dyspepsia3 Radiation

o ain that radiates to other areas of the body is indicative of more

serious patholoy ( referralo May be cardiovascular in oriin if pain is felt don the inside aspect

of the left arm

3 Severit0 o$ paino =f described as debilitatin or severe refer

o Mild to moderate for dyspepsia3 ssociated s0mptoms

o ersistent vomitin ith or ithout blood is suestive of ulceration

or even cancer ( refero ?lac) and tarry stools ( refer

3 ggravating or relieving $actorso ain shortly after eatin and relieved by food or antacids are classic

symptoms of ulcers

o 9ymptoms can be brouht on by certain types of food e.. caeinecontainin products, alcohol, spicy food

3 Social /istor0o ?outs of e+cessive drin)in associated ith dyspepsiao 'atin on the move"&uic)ly

6rigger points & Indicative o$ re$erral3 %M sins and symptoms

o %naemia

o ecent onset of proressive symptomso Melaena, dysphaia and haematemesis

3 ain described as severe, debilitatin or a)es them at niht


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3 ersistent vomitin3 >eferred pain

6reatment3 Li$est0le

o Don0t eat before bedtime

o 9tress reductiono 9maller portions

o 'at slolyo !ive enouh time for food to diest before underta)in activities

o Don0t ear tiht *ttin clothes that hold the stomach ino '+tra pillos hen sleepin ( elevate the head

o %lcohol reduction"smo)in cessation3 O6C treatments

o lginates & gaviscon, 3"BmL a$ter meals and %ed time

1st line treatment for !7>D

9pone li)e matri+ that Aoats on top of stomach contents

7ften in combination ith antacid to help neutraliLe acids

#ot to be used in children, no li)ely side eected

7 if prenant

o ntacids & rennies, ' ta%s c/e1ed " /our a$ter meal and at%edtime, no more t/an "' ta%lets in '+ /ours

#eutraliLe stomach acids

>elatively fast actin ( 1hour

!ood for isolated symptoms

May have some interactions

7 if prenant

o H' ntagonists & Ranitidine (2antac, over "-, " ta%let 1/ole

1/en needed, i$ s0mptoms persist $or more t/at an /ourcan tae anot/er, ma ' ta%lets in '+ /ours, no more t/an -da0s

?loc) actions of histamine hich activates sinal cells in

stomach to release BCl acids $ast actin ( 1 hour

%bdominal pain, diarrhoea and constipation

7 if prenant, can cause diarrhoea if breast feedin

o PPIs & =anprol (omepra2ole, over ">, ' ta%s once dail0

%e$ore $ood, see 7P i$ still needed a$ter + 1ees or not

1oring a$ter ' 1ees =nhibit the BO" O%:ase enLyme of parietal cells hich

secrete BCl acids


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:hey are potent and can be used for recurrin symptoms

Beadache, diarrhoea, constipation

%void if prenant or breastfeedin

E0e Conditions

Red E0e3 ConGunctivitis ( inAammation of the conGunctiva3 Characterised by redness, irritation, itchin and dischare3 >edness of eye and conGunctivitis is the most common ophthalmic

problem3 Can be viral or bacterial -collectively infective or alleric

Incidence o$ Red e0e3 ?acterial conGunctivitis, alleric conGunctivitis ( most li)ely3 Eiral conGunctivitis, subconGunctival haemorrhae li)ely

3 'piscleritis, 9cleritis, eratitis, @veitis ( unli)ely3 %cute closed anle laucoma ( very unli)ely

Causes o$ conunctivitis3 :acterial conunctivitis

o 9taphylococcus ( J/K O

o 9treptococcus pnuemoniae ( 2/Ko Mora+ella

o Baemophilus inAuenLa3 Viral conunctivitis

o %denovirus3 llergic conunctivitis

o ollen

SpeciGc questions to as a patient 1it/ Red E0e3 *isc/arge present

o Mostly seen in conGunctivitis

o 5atery ( viral and allerico urulent ( bacterial

3 Visual c/angeso %ny loss of vision or haloes should be vieed ith caution,

especially if scleral redness is present3 PainAdiscom$ortAitc/

o :rue pain associated ith conditions re&uirin referral


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o ain associated ith conGunctivitis is ( ritty"forein body type pain

3 Location o$ rednesso >edness concentrated near around coloured part of eye indicates

more sinister patholoyo !eneralised redness and redness toards corner of the eyes is

more indicative of conGunctivitis3 *uration

o Minor eye problems are self limited to a fe dayso 7cular redness apart from subconGunctival haemorrhae and

alleric conGunctivitis lastin loner than a ee) re&uires referral3 P/otop/o%ia

o %ssociated ith sinister patholoy3 Ot/er s0mptoms

o 9ins and symptoms of an upper respiratory tract infection point

toards a viral cause of conGunctivitiso Eomitin suest laucoma

S9;P6O;S :acterial Viral llergic

E0es aFected ?oth, but one eyeoften aected *rstby 2448 hours

?oth ?oth

*isc/arge urulent 5atery 5atery

Pain !ritty feelin !ritty feelin =tchin

*istri%ution o$redness

!eneralised anddiuse

!eneralised !eneralised butreatest infornices"corners

ssociateds0mptoms

#one commonly @pper respiratorytract

infection"cold"couh symptoms

>hinitis

Conditions to Eliminate3 Su%conunctival Haemorr/age

o =s the rupture of a blood vessel under the conGunctivao % sement or the hole eye ill appear briht red

o =t occurs spontaneously but can be precipitated by couhin,

strainin or liftino #o pain, symptoms resolve in 1/14 days ithout treatmento Can loo) more severe if ta)in aspirin or arfarino atient ith history of trauma should be referred

3 Episcleritiso =nAammation of the episcleral hich lies Gust beneath the

conGunctiva and adGacent to the sclerao :his results in only part of the eye becomin red and so is

sementalo @sually only one eye is aectedo @sually painless"dull ache

o More common in youn omeno 9elf limitin in 23 ee)s but can ta)e upto 8 ee)s for symptoms

resolve


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6reatments3 Viral conunctivitis

o #o 7:C products

o Bihly contaious so follo stict hyiene measureso #o sharin of toels and ash hands fre&uently

3 :acterial conunctivitiso 9elf limitin, 6JK have a clinical cure in 2J days ithout treatmento C/loramp/enicol & *ropsAointments & (7OL*EN E9E

N6I:IO6IC *ROPSAOIN6;EN6, OP6REM IN4EC6E* E9E*ROPSAOIN6;EN6


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Bas to be iven continuously hilst e+posed to the alleren

1 or 2 drops into each eye 4 times a day

6 years O

educes redness of the eye


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EarAOctic Conditions

Otitis ;edia 3 common3 >apidly accumulatin eusion in middle ear

3 Most common in children aed 363 =n older children, pain"earache is predominant feature and is throbbin3 =n youn children, pain is manifested as irritability and ear

tuin"rubbin3 $ever"loss of appetite3 hysical presentation of red"yello, bulin tympanic membrane3 ain resolves on the rupture of tympanic membrane releasin

mucopurulent dischare3 Mostly resolves in 3 days ith no treatment3 9hould be manaed ith analesia ( aracetamol or ibuprofen3 @nless systemically unell or under 2 years of ae and have dischare (

referral to !

Otitis Eterna & most common, caused %0 trauma3 >efers to eneralised inAammation throuhout the '%M3 7ften associated ith infection3 @sually acute but may become chronic -3 months O in children3 =ncidence increases durin the summer3 eople ho sim are J times more li)ely to develop it3 More common in adults and omen3 rimary infection, contact sensitivity can both cause it3


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3 Characterised by itchin and irritation ( dependin on severity canbecome intense

3 efer

o

Don0t use for loner than days

Ear1a impaction3 'ar a+ is produced in the outer third of the cartilainous portion of the

ear canal by the ceruminous lands3 @sed for mechanical protection of tympanic membrane, trappin dirt,

repellin ater and e+ertin protection aainst bacterial"funal infection3 Most common e+ternal ear problem3 Clinical features include ( radual hearin loss, ear discomfort, recent

attempts to clean ears, itchin, tinnitus and diLLiness

SpeciGc questions to as a patient! Ear 1a3 Course of symptoms

o !radual hearin loss ith ear a+ impaction


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3 %ssociated symptomso DiLLiness and tinnitus indicate inner ear problem so refero 'ar a+ impaction rarely causes tinnitus, vertio or true pain

3 Bistory of traumao Chec) if person has recently tried to clean ears

o :his often leads to a+ compaction3 @se of medicines

o =f a patient has used an 7:C medication correctly this ould re&uirereferral for further investiation

Re$erral o$ Ear 5a Impaction3 DiLLiness or tinnitus ( suests an inner ear problem3 ain oriinatin from the middle ear3 $ever or malaise in children3 %ssociated trauma related conductive deafness3 $orein body in the '%M3 7:C medication failure

O6C treatments $or Ear 5a Impaction3 Oil %ased products & Cerumol Ear drops & (arac/is & peanut oil,

.#)Ko J drops into aected ear 2"3 times daily for 3 dayso =n beteen, administration of cotton ool smeared in petroleum

Gelly should be applied to retain li&uid3 Oil %ased products & Cerumol Olive Oil *rops & (olive oil "BBK

o 2"3 drops instilled tice a day for upto dayso =n beteen, administration of cotton ool smeared in petroleum

Gelly should be applied to retain li&uid

Colic3 '+cessive cryin usually in the

*rst fe ee)s of life andusually resolves by ae of 3J

months3 De*ned as cryin for more than 3 hours a day for more than 3 days a

ee) for more than 3 ee)s

3 atients parents"carer may not necessarily ait for 3 ee)s as it can bevery distressin

S0mptoms o$ Colic3 '+cessive hih pitched cryin usually in late afternoon"evenin -6pm3 $ace may appear Aushed3 May pass as hen cryin3 Clench their *sts3 %rchin of the bac)3 Drain up of )nees to their tummy3 ?loated tummy

3 Cryin outbursts are not harmful ( the baby ill continue to feed and aineiht as normal

Causes

3 ero+ide based products ( e+teroland ote+

3 Docusate ( a+ol3 9odium bicarbonate3 !lycerin ( eara+ advance and

eare+ plus


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3 @n)non but thouht to be multifactorial3


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>eported to improve colic symptoms

9afe"natural and may help in short term lactose intolerance

?ottle 4 drops to bottle every time the baby is fed

?reastfeedin add fe tablespoons of breastmil) and 4

drops of Colief and ive to baby ( then continuebreastfeedin as normal

C/icenpo3 Mild, common childhood illness3 Caused by the varicella Loster virus3 :ransmitted by droplet infection ( couhin and sneeLin and, due to Auid

from blisters3 >emains dormant in the body for upto 14 days before any symptoms are

seen ( incubation period3 9potty blisterin red rash then appears hich can cover the hole body3 :hese normally appear in clusters ( behind ears, face, scalp, chest, belly,

arms and les3 %ppear as small red lumps hich turn into Auid *lled blisters and then

crusted spots3 Most infectious period is hen red rash appears3 5hen spots have crusted it is no loner contaious


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3 ?efore the rash appears there are Au li)e symptoms ( nausea, fever,achin, headache, feelin unell, loss of appetite

3 Most infectious 12 days after the rash appears -12 days until all blistershave crusted over -J6 days

6reatments o$ C/icenpo3 #o )non cures

3 Clears ithout the need for treatment3 9ymptomatic treatments e+ist ( fever, pain and hih temperature

o ;ild painiller & Paracetamol, Calpol & NSI*s 'nd line due to

potential sin pro%lemso Itc/ing & soot/ing emollient creams & calamine lotion

o Itc/ing & sedating anti/istamines & c/loramp/enamine &

piriton

7eneral advice3 Itc/ing

o 'nsure the child has short clean *nernails so doesn0t infect or scarfrom scratchin

o ut soc)s on hands overniht

3 4evero 5ear loose, smooth, cotton clotheso %void sponin ith cool ater ( may irritate further

3 H0drationo Maintain a hih Auid inta)eo 9uar free ice lollies

Prevention o$ spread

3 eep at home for at least J days3 9tay at home until the blister has crusted over3 %void contact ith prenant omen, ne borns or those ith ea)

immune systems3 Maintain hyiene ( ipe don toys, and surfaces3 5ash beddin"clothes more reularly

Re$erral o$ C/icenpo3 9uspected meninitis3 9ins of infection

3 >ash for over 2 ee)s3 $ever lastin loner than 24 hours3 Eomitin3 #ec) stiness

Cradle Cap3 %ppears as lare yello, reasy scales and crusts on the scalp3 :his can become thic) and cover the hole scalp3 Can aect other areas such as the face and nap)in area3 Common harmless condition ( doesn0t usually itch or cause discomfort

Causes o$ Cradle Cap3 Characterised by increased cell turnover rate3 Cause lin)ed to overactive sebaceous lands


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3 ?abies may also retain their mothers hormones for several ee)s"monthsma)in the babies lands more active

3 '+cessive sebum causes old cells to stic) to the scalp instead of dryinand fallin o

3 =t is not contaious and isn0t caused by poor hyiene or allery

S0mptoms

3 Barmless condition3 Doesn0t itch or cause discomfort to the baby3 7ccurs on scalp, face, nose, roin, ears, nec), s)in folds, )nees and

armpits3 !reasy yello patches on scalp3 9cales eventually start to Aa)e and eected area appears red3 Bair can come aay ith the scales"Aa)es

6reatment3 Most cases clear in on time3 !ently ashin ith shampoo can help prevent build up3 :a%0 oil, natural oil, almond oil, olive oil can %e used to loosen

crusts3 5ash more fre&uently, don0t pic) as it can cause infection3 Stronger s/ampoos can /elp loosen it

o *entino Cradle Cap s/ampoo & ' applications repeated at

eac/ %at/ time until scalp is clear & t/en use as necessar0o Contains sodium laur0l sul$ate 1/ic/ is a cleaning agent

t/at de3greases t/e sino 5as/ /air '3) times a 1ee

Re$erral3 9pea) to ! in case of uncertain dianosis3 9evere cradle cap3 9ellin3 ?leedin3 7n face or body3 =nAamed"infected3 7:C treatment failure

6eet/ing3 :eethin is hen a baby0s mil) teeth come throuh the ums at around

the ae of 6 months causin irritation

S0mptoms o$ 6eet/ing3 May have no pain or discomfort3 !um can be sore or red


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3 $lushed chee)s on the side of face here teethin is occurrin3 !nain"chein ums3 >ubbin of ear on same side as the tooth3 More fre&uent dribblin3 5a)in up at niht3 !enerally unsettled3 =nconsistent feedin

Cause o$ teet/ing is t/e emergence o$ ne1 mil teet/ t/roug/ t/egums

6reatments o$ 6eet/ing3 6eet/ing rings

o rovide somethin safe to che on, easin pain, distraction

techni&ueo Can be cooled in a frideo Can use a et Aannel

3 6eet/ing gels & %ongela teet/ing gelAcalgelo 7ver 4 months oldo 9uar free el can be rubbed on

o Contains a mild local anaesthetic hich can numb paino Can contain antiseptic to prevent infection

o >ub onto baby0s ums ith a clean *ner3 Can give %a%0 somet/ing /ealt/0 to c/e1 on & vegA$ruit

o 9tay near by in case they cho)eo %void items ith lots of suar ( decay ris)

3 Pain illers 3 Calpolo =f baby is in pain"hih temp

o 9mall doses of ibuprofen or aracetamolo 9hould be suar free

o #o aspirin3 6ips

o Cool drin)s ( suar free

o Comfort and play ith baby to distract ito revent teethin rashes by ipin e+cess dribble from the chin

Re$erral $or 6eet/ing3 9evere symptoms lastin loner than a fe days

3 18 months and no teeth3 Eisible sins of tooth decay3 Double ro of teeth3 9mall Ga defect3 $acial inGury

Private Prescription Registers"# Re$erence e.. ?oo) %, ae 8, =tem 1 or %"8"1'# Prescription date)# Suppl0 date+# ;edicine details

a. #ame


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b. ;uantityc. $ormulationd. 9trenth of medicine supplied

# Prescri%er detailsa. #ame and address of practitionerb. !MC numberc. :elephone number

-# Patient detailsa. #ame and address of patient

Controlled *rugs Register"# Class loo) for dru subtitle in the ?#$'# #ame of Dru"?rand ( hat is ritten on prescription"?#$)# 9trenth+# $orm ( dru formulation on prescription# Date supplied ( today0s date-# #ame and address of person"*rm supplied ( patient name"address.# rescribers details ( prescriber name and address># erson collectin"representative ( patient name"address?# roof of identity ( yes"B#roof of identity of person collectin provided ( yes""#;uantity supplied ( &uantity on the prescription"'#?alance ( ta)e aay the &uantity supplied from total")##ame of pharmacist ( Eive) atel, @C< 9o,


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*riving3 Drivers ith diabetes may be re&uired to notify the Driver and Eehicle


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3 !libenclamide ( lon actin, reater ris) of hypolycaemia, avoided inelderly,

3 !liclaLide or tolbutamide ( shorter actin alternatives3 Can encourae eiht ain, avoid in prenancy and hepatic impairment3 #ausea, vomitin, diarrhoea, constipation

H0pogl0caemia3 9ha)y, an+iousness, seatin

3 =nitially 1/2/ lucose ( either lass of lucoLade, co)e, 2 teaspoons ofsuar or 3 suar lumps

3 =f necessary repeat after 1J minutes3 :hen a snac) containin carbohydrate ( sandich, fruit, mil) biscuits

lendronic cid & (%isp/osp/onate3 6reatment o$ Postmenopausal osteoporosis ( 1/m daily"/m once

ee)ly3 Stops %rea do1n o$ %ones, %ut ne1 %ones are still made3 :ablets should be salloed hole ith plenty of ater hile sittin or

standin3 :o be ta)en on an empty stomach at least 3/ minutes before brea)fast3 atient should stand or sit upriht for at least 3/ minutes after ta)in

tablets ( can do some houseor) or o for a shoer in this time"et ready3 Side eFects ( oesophaeal reactions, abdominal pain, distension3 I$ pain 1/en s1allo1ing, severe oesop/ageal irritation occurs,

1orsening /eart %urn t/en see medical advice3 eular e+ercise ( al)in"cyclin"eiht bearin ( 3/ minuteso

Levot/0roine & (t/0roid /ormone3 H0pot/0roidism ( over 18 years, initially J/1// microrams once daily,

maintenance dose 1//2// microrams once daily3 7ver J/ ( initially 2J microrams 7D and maintenance dose of J/2//

microrams3 :a)e at least 3/ minutes before brea)fast or any caeine containin

li&uids"other medication3 9ide eect ( diarrhoea, vomitin, aninal pain

*o0c0cline & (tetrac0cline3 cne vulgaris (usuall0 ( 1// m 7D3 Capsules should be salloed hole ith plenty of Auid durin meals

hile sittin or standin to avoid reAu+"irritation

3 %void usin indiestion remedies3 %bsorption is aected by heavy metals3 9ide eects ( nausea, vomitin, diarrhoea


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3 @se sun screen -may ma)e s)in sensitive to sunliht, ash face reularly,be careful ith hat products you use in case it aravates the s)in

:en2o0l peroide (quinoderm cream & (topical preparations $or acne3 cne vulgaris ( apply 12 times daily, preferably after ashin face ith

soap and ater, start treatment ith loer strenth preparations3 May bleach clothin, hair, avoid bro)en s)in3 =f *rst time usin the product, patch test3 %pply a thin layer3 ?e careful not to use too many product as to dry the s)in out, causin a

rebound eect so the s)in produces more oil, aravatin the s)in3 9ide eects ( s)in irritation -if you et this, reduce the fre&uency until

irritation subsides3 $inish the entire course3 Clean sheets, clean toels, don0t )eep touchin the face

Loestrin & (com%ine oral contraceptive3 Com%ined oral contraceptive pill ( one tablet once daily and the same

time every day3 =f reasonably certain you aren0t prenant, can be started on any day of

the cycle, if not then day 1J of the cycle3 =f the pill is missed, ta)e as soon as possible and carry on ith the ne+t

pill at the correct normal time3 =f more than 2 pills are missed, you may not be protected, so abstain from

se+ or use an additional method of contraception3 =f you vomit ithin 2 hours of ta)in the pill, ta)e another3 Continual basis3 May have menstrual irreularities3 %fter 21 days there ill be a day brea) ( you should have your period in

this time3 =ncreased ris) of venous thromboembolism ( esp. hilst travellin ith 3

hours of immobility, ris) can be reduced by appropriate e+ercise durin Gourney and earin raduated compression hosiery ( travel soc)s

Co3%eneldopa & (" part %ensera2ide /0droc/loride and + parts

levodopa3 ParinsonDs disease ( J/m 34 times daily initially, maintenance 4//

8//m daily in divided doses, elderly J/m once or tice daily, increasedby J/ m every 34 days -

3 ith or after food, ith food helps reduce side eects such as nausea3 =ncreases the levels of dopamine in the brain3 Coformulation helps ith the side eects3 Ecessive da0time sleepiness and sudden onset o$ sleep can

occur 1it/ co3%eneldopa so eercise caution 1/en driving oroperating mac/iner0

3 Side eFects & nausea, vomiting, taste distur%ances3 Read additional in$ormation PIL3 ;a0 colour urine 1/ic/ is completel0 normal3 oin ParinsonDs 8< $or more in$ormation


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3 9ee) medical advice in case of une+plained muscle pain, tenderness orea)ness

3


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