pharmacy_first_flashcards

Question 1

What conditions are covered by NHS Pharmacy First?

Answer 1

Sinusitis (≥12 yrs), Sore throat (≥5 yrs), Acute otitis media (1‑17 yrs), Impetigo (≥1 yr), Infected insect bites (≥1 yr), Shingles (≥18 yrs), Uncomplicated urinary tract infections in women (16‑64 yrs).

Question 2

Pharmacy First: How is Acute Sinusitis diagnosed?

Answer 2

Typical symptoms: nasal obstruction or discharge, facial pain/pressure, reduction/loss of smell. Often following viral URTI.

Question 3

Pharmacy First: Inclusion/Exclusion for Acute Sinusitis?

Answer 3

Inclusion: ≥12 yrs, acute symptoms ≤10 days, bacterial features possible. Exclude: <12 yrs, recurrent sinusitis, severe/systemic illness, immunocompromised, pregnancy.

Question 4

Pharmacy First: Management of Acute Sinusitis?

Answer 4

Self-care: fluids, analgesia, nasal saline, steam inhalation. Antibiotics only if bacterial and criteria met (phenoxymethylpenicillin, doxycycline, clarithromycin). Safety-netting required.

Question 5

Pharmacy First: Differentials for Sinusitis?

Answer 5

Dental abscess, allergic rhinitis, migraine, tension headache, orbital cellulitis, nasal polyps.

Question 6

Pharmacy First: How is Sore Throat diagnosed?

Answer 6

Painful swallowing, fever, red/inflamed tonsils, possible exudates. Centor/McIsaac score guides bacterial likelihood.

Question 7

Pharmacy First: Inclusion/Exclusion for Sore Throat?

Answer 7

Inclusion: ≥5 yrs. Exclude: <5 yrs, recurrent tonsillitis, peritonsillar abscess, airway compromise, immunosuppression, pregnancy.

Question 8

Pharmacy First: Management of Sore Throat?

Answer 8

Most are viral: self-care, analgesia, hydration. Antibiotics if high Centor/McIsaac (phenoxymethylpenicillin, clarithromycin if allergic).

Question 9

Pharmacy First: Differentials for Sore Throat?

Answer 9

Infectious mononucleosis, peritonsillar abscess, epiglottitis, quinsy, oral candidiasis, reflux-related pharyngitis.

Question 10

Pharmacy First: How is Acute Otitis Media diagnosed?

Answer 10

Children 1-17 yrs. Ear pain, fever, irritability, poor feeding. Otoscopy: red/bulging tympanic membrane, possible perforation/discharge.

Question 11

Pharmacy First: Inclusion/Exclusion for Acute Otitis Media?

Answer 11

Inclusion: 1-17 yrs, acute symptoms. Exclude: <1 yr, recurrent AOM, severe systemic illness, mastoiditis, grommets.

Question 12

Pharmacy First: Management of Acute Otitis Media?

Answer 12

Self-care first. Antibiotics (amoxicillin, clarithromycin/erythromycin if penicillin-allergic) if severe symptoms or very unwell.

Question 13

Pharmacy First: Differentials for Acute Otitis Media?

Answer 13

Otitis externa, referred dental pain, foreign body in ear, mastoiditis, eustachian tube dysfunction.

Question 14

Pharmacy First: How is Impetigo diagnosed?

Answer 14

Characteristic honey-colored crusted lesions, often around mouth/nose. Localized skin infection.

Question 15

Pharmacy First: Inclusion/Exclusion for Impetigo?

Answer 15

Inclusion: ≥1 yr, non-bullous, localized (≤3 lesions). Exclude: widespread, bullous, recurrent, systemic illness, pregnancy under certain ages.

Question 16

Pharmacy First: Management of Impetigo?

Answer 16

First-line: hydrogen peroxide 1% cream. Alternatives: fusidic acid, flucloxacillin (oral), clarithromycin/erythromycin (if allergy).

Question 17

Pharmacy First: Differentials for Impetigo?

Answer 17

Herpes simplex, eczema with secondary infection, insect bites, scabies, contact dermatitis.

Question 18

Pharmacy First: How are Infected Insect Bites diagnosed?

Answer 18

Localized erythema, swelling, pain, sometimes pus. Distinguish from allergic-only swelling.

Question 19

Pharmacy First: Inclusion/Exclusion for Infected Insect Bites?

Answer 19

Inclusion: ≥1 yr, localized mild-moderate infection. Exclude: <1 yr, systemic illness, spreading cellulitis, facial/genital bites.

Question 20

Pharmacy First: Management of Infected Insect Bites?

Answer 20

Self-care: cool compress, antihistamines for itch, analgesia. Antibiotics if spreading/severe (flucloxacillin, clarithromycin/erythromycin).

Question 21

Pharmacy First: Differentials for Infected Insect Bites?

Answer 21

Cellulitis, contact dermatitis, impetigo, allergic reaction, shingles.

Question 22

Pharmacy First: How is Shingles diagnosed?

Answer 22

Painful, unilateral, dermatomal vesicular rash. Often preceded by pain/tingling.

Question 23

Pharmacy First: Inclusion/Exclusion for Shingles?

Answer 23

Inclusion: ≥18 yrs, within 72 hrs of rash onset with risk factors (pain, age >50, severe rash). Exclude: ophthalmic shingles, immunocompromised, pregnancy.

Question 24

Pharmacy First: Management of Shingles?

Answer 24

Antivirals (aciclovir/valaciclovir/famciclovir) if within 72 hrs and meets criteria. Analgesia. Urgent referral if eye/face involvement.

Question 25

Pharmacy First: Differentials for Shingles?

Answer 25

Herpes simplex, contact dermatitis, impetigo, insect bites, cellulitis.

Question 26

Pharmacy First: How is Uncomplicated UTI diagnosed?

Answer 26

Women 16-64 yrs. Dysuria, frequency, urgency, suprapubic pain. No need for dipstick.

Question 27

Pharmacy First: Inclusion/Exclusion for UTI?

Answer 27

Inclusion: Women 16-64 yrs, acute symptoms. Exclude: pregnant, male, <16 or >64 yrs, recurrent UTI, systemic illness, catheterized, immunocompromised.

Question 28

Pharmacy First: Management of UTI?

Answer 28

Self-care for mild symptoms. Nitrofurantoin 3 days if moderate/severe. Safety-netting: seek review if not improved in 48 hrs.

Question 29

Pharmacy First: Differentials for UTI?

Answer 29

Vaginitis, STI (chlamydia, gonorrhea), interstitial cystitis, pelvic inflammatory disease, kidney stones.