PHR2011 - OSCE S3 Station

Clobetasone 0.05% (Topical Corticosteroid Cream)

• Do not use on face, genital area, broken/infected skin, children < 12 years so recommend hydrocortisone 1%

• Do not use if patient has acne, tinea, skin ulcers, viral skin infections

• Refer if infection, affects genital area

• Tinea: circular red rash, apply thin layer of terbinafine 1% cream ONCE a day for 7 days (can cause local irritation so apply cool compress), dry affected skin area with different towel

• Acne: comedones, apply benzoyl peroxide 2.5% gel ONCE a day (can cause skin dryness so apply moisturiser), avoid touching face + use sunscreen

• Is the rash located anywhere else on your body? Is the skin broken, weeping, or filled with pus?

• Atopic dermatitis: dry/itchy/red patches on flexures/face/neck from family history of asthma/eczema/hay fever

• Irritant contact dermatitis: dry/red/cracked/inflamed skin on hands from chemical/physical agents

• Allergic contact dermatitis: red/itchy rash from nickel jewellery, fragrances, pollen

• Seborrheic dermatitis: dry/red/scaly/non-itchy patches on scalp/face/chest from yeast

• Dose: apply thin layer TWICE a day, maximum use 7 days

• Side effects: skin dryness so apply moisturiser

• Non-pharm: showering with lukewarm water, patting skin after showering

• Follow up in 3 days

Hydrocortisone 1% (Topical Corticosteroid Cream/Ointment/Solution/Spray)

• Do not use on genital area, broken/infected skin

• Do not use if patient has acne, tinea, skin ulcers, viral skin infections

• Refer if infection, affects genital area

• Tinea: circular red rash, apply thin layer of terbinafine 1% cream ONCE a day for 7 days (can cause local irritation so apply cool compress), dry affected skin area with different towel

• Acne: comedones, apply benzoyl peroxide 2.5% gel ONCE a day (can cause skin dryness so apply moisturiser), avoid touching face + use sunscreen

• Is the rash located anywhere else on your body? Is the skin broken, weeping, or filled with pus?

• Atopic dermatitis: dry/itchy/red patches on flexures/face/neck from family history of asthma/eczema/hay fever

• Irritant contact dermatitis: dry/red/cracked/inflamed skin on hands from chemical/physical agents

• Allergic contact dermatitis: red/itchy rash from nickel jewellery, fragrances, pollen

• Seborrheic dermatitis: dry/red/scaly/non-itchy patches on scalp/face/chest from yeast

• Dose: apply thin layer TWICE a day, maximum use 7 days

• Side effects: skin dryness so apply moisturiser

• Non-pharm: showering with lukewarm water, patting skin after showering

• Follow up in 3 days

Mometasone 0.1% (Topical Corticosteroid Cream/Ointment)

• Do not use on face, genital area, broken/infected skin, children < 12 years so recommend hydrocortisone 1% or clobetasone 0.05%

• Do not use in acne, tinea, skin ulcers, viral skin infections

• Refer if infection, affects genital area

• Tinea: circular red rash, apply thin layer of terbinafine 1% cream ONCE a day for 7 days (can cause local irritation so apply cool compress), dry affected skin area with different towel

• Acne: comedones, apply benzoyl peroxide 2.5% gel ONCE a day (can cause skin dryness so apply moisturiser), avoid touching face + use sunscreen

• Is the rash located anywhere else on your body? Is the skin broken, weeping, or filled with pus?

• Atopic dermatitis: dry/itchy/red patches on flexures/face/neck from family history of asthma/eczema/hay fever

• Irritant contact dermatitis: dry/red/cracked/inflamed skin on hands from chemical/physical agents

• Allergic contact dermatitis: red/itchy rash from nickel jewellery, fragrances, pollen

• Seborrheic dermatitis: dry/red/scaly/non-itchy patches on scalp/face/chest from yeast

• Dose: apply ONCE a day, maximum use 7 days

• Side effects: skin dryness so apply moisturiser

• Non-pharm: showering with lukewarm water, patting skin after showering

• Follow up in 3 days

Dexchlorpheniramine 2mg (Oral Sedating Antihistamine Tablet/Liquid)

• Do not use in glaucoma, breastfeeding, elderly, children < 2 years so recommend loratadine 10mg

• Refer if coloured mucus, impaired sense of smell, nosebleeds

• Drowsiness: take 1 tablet loratadine ONCE a day prn (12+), 10mL ONCE a day prn (>30kg), 5mL ONCE a day prn (<30kg), 2.5mL ONCE a day prn (1-2), can be taken with or without food

• Do you have issues with drowsiness?

• Allergic rhinitis: nasal congestion, sneezing, watery eyes from pollen/dust mites/animal hair

• Tablet dose: take 1 tablet every 6 hours prn (12+), can be taken with or without food

• Liquid dose: 5mL q6h prn (12+), 3mL q6h (6-12), 2mL q6h prn (4-6), 1.5mL q6h prn (2-4), can be taken with or without food

• Side effects: drowsiness so avoid driving + avoid drinking alcohol

• Non-pharm: shower after going outdoors, close car windows when driving and turn on air conditioning

• Follow up in 14 days

Promethazine 25mg (Oral Sedating Antihistamine Tablet/Elixir)

• Do not use in glaucoma, breastfeeding, elderly, children < 6 years so recommend loratadine 10mg

• Refer if coloured mucus, impaired sense of smell, nosebleeds

• Drowsiness: take 1 tablet loratadine ONCE a day prn (12+), 10mL ONCE a day prn (>30kg), 5mL ONCE a day prn (<30kg), 2.5mL ONCE a day prn (1-2), can be taken with or without food

• Do you have issues with drowsiness?

• Allergic rhinitis: nasal congestion, sneezing, watery eyes from pollen/dust mites/animal hair

• Tablet dose: take 1-3 tablets nocte (12+), take 1 tablet nocte (6-12), can be taken with or without food

• Elixir dose: 10-25mL nocte (6-12), can be taken with or without food

• Side effects: drowsiness hence why taken nocte so avoid driving + avoid drinking alcohol

• Non-pharm: shower after going outdoors, close car windows when driving and turn on air conditioning

• Follow up in 7 days

Diclofenac 25mg (Oral NSAID Tablet)

• Do not use in active PUD, asthma, aspirin, elderly, pregnancy so recommend paracetamol 500mg

• Refer if spreading/worsening pain, affects daily activities

• Safety: take 1-2 tablets paracetamol q6h, maximum 8 tablets in a day, can be taken with or without food

• Is the pain spreading or radiating to any other parts of your body?

• Inflammatory acute pain: redness, heat, swelling, loss of function from period pain, strains, sprains, headache

• Dose: swallow whole 1-2 tablets q8h (adult), swallow whole 1 tablet q8h (14-17), maximum 8 tablets in a day, best taken with food

• Side effects: stomach upset so take with food, dizziness so stay hydrated

• Non-pharm: use heat pack, get massage, low intensity exercise after 48 hours of rest

• Follow up in 3 days

Ibuprofen 400mg (Oral NSAID Tablet)

• Do not use in active PUD, asthma, aspirin, elderly, pregnancy so recommend paracetamol 500mg

• Refer if spreading/worsening pain, affects daily activities, new type of headache, ocular symptoms

• Safety: take 1-2 tablets paracetamol q6h, maximum 8 tablets in a day, can be taken with or without food

• Is the pain spreading or radiating to any other parts of your body?

• Inflammatory acute pain: redness, heat, swelling, loss of function from period pain, strains, sprains, headache, fever

• Dose: swallow whole 1 tablet q6h prn, maximum 3 tablets in a day, maximum use 3 days, best taken with food

• Side effects: stomach upset so take with food, dizziness so stay hydrated

• Non-pharm: get lots of rest, stay hydrated, meditation

• Follow up in 3 days

Pantoprazole 20mg (Oral PPI Tablet)

• Do not use in liver disease

• Refer if severe chest pain, GI bleeding, pregnant, breastfeeding, children < 12 years

• Constipation: straining to pass a stool, less than 3 loose stools in a week, mix 1.5 tsp psyllium powder in 250mL water and drink 1-3 times a day (can cause GI upset so stay hydrated), increase fibre intake (fruits, vegetables, wholegrains) + sit on toilet with knees above hip level using footstool, follow up in 3 days

• Diarrhoea: nausea/vomiting, passing 3+ loose stools a day, drink 200mL ORS liquid every 30 mins, maximum 4L in a day (can cause bloating so exercise 30 mins a day), increase intake of starchy foods (bread, rice, potatoes) + avoid food triggers, follow up in 3 days

• Do you have any issues with your bowel movements?

• GORD: heartburn, regurgitation from large meals, spicy/fatty foods, carbonated drinks

• Dose: swallow whole 1 tablet ONCE a day at the same time (adults), maximum use 14 days, best taken 30-60 mins before meal

• Side effects: headache so stay hydrated

• Non-pharm: avoid lying down or exercising 2-3 hours after eating, avoid food triggers if possible

• Follow up in 14 days

Pseudoephedrine 60mg (Oral Decongestant Tablet)

• Do not use in severe heart conditions, children < 6 years

• Refer if wheezing, severe pain

• Allergic rhinitis: nasal congestion, sneezing, watery eyes from pollen/dust mites/animal hair, 2-3 oxymetazoline sprays TWICE a day, maximum use 3 days (can cause rebound congestion), shower after going outdoors + close car windows when driving and turn on air conditioning, follow up in 3 days

• Pregnant/breastfeeding: 2-3 oxymetazoline sprays TWICE a day, maximum use 3 days (can cause rebound congestion), shower after going outdoors + close car windows when driving and turn on air conditioning, follow up in 3 days

• Can I get a form of ID from you?

• Common cold: blocked/runny nose, cough, mild headache/body ache from human contact

• Dose: take 1 tablet q6h (12+), maximum 4 tablets in a day, maximum use 7 days, can be taken with or without food

• Side effects: headache and dizziness so stay hydrated

• Non-pharm: shower after going outdoors, close car windows when driving and turn on air conditioning

• Follow up in 7 days

Salbutamol 100 microg (Inhaled SABA)

• Refer if using puffer 3+ times a week, night-time symptoms, chest pain

• How often do you use your puffer? How many puffs do you inhale each time? How long has it been since you were last supplied a puffer? Do you use any other puffers? Do you have an asthma action plan? When was the last time you reviewed your asthma with your doctor?

• Asthma: non-productive cough at night or after exercise, wheezing, SOB from allergens/exercise/occupation

• COPD: productive cough in the morning, wheezing SOB from smoking, air pollution, AATD

• Dose: shake well and inhale 1-2 puffs q6h prn, maximum 8 puffs in a day

• Side effects: throat irritation so stay hydrated

• Non-pharm: use 5-15 mins before exercise, avoid allergens where possible, review asthma action plan with doctor, trial smoking cessation if current smoker

• Follow up depends on severity and compliance to last review with doctor

Sumatriptan 50mg (Oral Triptan Tablet)

• Do not use in severe heart disease, severe liver impairment

• Refer if new type of headache, fever, migraine attack experienced 2+ times a month

• Tension-type headache: pressure/tightness as band around head, affects both sides, take 1-2 tablets paracetamol q6h, maximum 8 tablets in a day, can be taken with or without food, meditation + consistent sleep routine, follow up in 7 days

• Cluster headache: pain targeting one eye or temple, restlessness, eye redness, dissolve 1 rizatriptan wafer on tongue (can cause dizziness so stay hydrated), maximum 3 wafers in a day, can be taken with or without food, meditation + consistent sleep routine, follow up in 3 hours

• Refer if new type of headache

• Could you describe the pain? Is the pain located on one side of the head? Have you experienced this type of headache before? Has this been a formal diagnosis made by your doctor?

• Migraine: throbbing pain, nausea, vomiting, eye and ear sensitivity from stress, other medications

• Dose: swallow whole 1 tablet at first sign of migraine and another 2 hours later if migraine recurs (adults)

• Side effects: drowsiness so avoid driving

• Non-pharm: keep headache diary, rest in quiet and dark room, avoid movement, regular exercise

• Follow up in 3 days