10 - Notifiable Diseases Flashcards
When can you prescribe a medication off-licence?
Doctors can prescribe unlicensed medicine if they are satisfied that an alternative, licensed medicine would not meet the patient’s needs - not the case in these circumstances.
The doctor would need to take responsibility for overseeing the patient’s care including monitoring and any follow up treatment
Before disclosing information to social services about a parent what should you do?
Ask for consent
Ultimately will disclose info even if they refuse but need to consider reasons for refusal and weigh them up
If you have made every effort to encourage a patient to contact the DVLA about their fitness to drive and they are still driving, what should you then do?
Inform the DVLA but before contacting the DVLA you should try to inform the patient of your decision to disclose personal information.
You should then also inform the patient in writing once you have done so.
If a patient has no capacity so cannot give consent, can you update family members?
Unless they indicate otherwise, it is reasonable to assume that patients would want those closest to them to be kept informed of their general condition and prognosis
If they have capacity then will need to get their consent
Can you respond to a news report criticising your practice?
Media reports or social media discussions might cause patients to be concerned about your practice, or that of a health service you are associated with. In such cases it may be appropriate to give general information about your normal practice. You must be careful not to reveal personal information about a patient, or to give an account of their care, without their consent
When asking a family member of a sick patient what the patient would want, what is important to reassure them?
You are not asking them to make the decision just give us information to help us to make the best decision
When should you report issues with basic hospital care to the CQC?
Always try to resolve locally first
Contact CQC if you think the issue is with your management or board
In which situations do you not need to ask to consent to use patients information?
- Images of internal organs or structures
- Images of pathology slides
- Laparoscopic and endoscopic images
- Recordings of organ functions
- Ultrasound images
- X-rays
When should you have a lower threshold for antibiotic prescribing?
- Immunocompromised
- Multiple morbidities
- Clinically unwell
Why should you avoid broad spectrum antibiotics (e.g co-amoxiclav, quinolones and cephalosporins) when narrow spectrum antibiotics remain effective?
Increased risk of:
- C.Diff
- MRSA
- Resistant UTIs
Quinolones should be avoided where possible due to the irreversible risk of neuro- muscular and skeletal side effects. If you have to use one hwat is the preferred one in the class?
Clarithromycin as less side effects and greater compliance
Erythromycin in pregnancy
What can scarlet fever turn into if antibiotics are not given?
- Streptococcal toxic shock syndrome (TSS)
- Necrotising fasciitis
- Invasive GAS (iGAS)
What are the indications for abx with an acute sore throat and what antibiotic should you use?
Use FeverPAIN or Centor to assess symptoms:
FeverPAIN 0-1 or Centor 0-2: no antibiotic
**
FeverPAIN 2-3:** no or back-up antibiotic
FeverPAIN 4-5 or Centor 3-4: immediate or back-up antibiotic.
Systemically very unwell or high risk of complications: immediate antibiotic
Influenza in ‘at risk’ patients should be treated with with 5 days oseltamivir ideally within 48 hours of onset. Who is classed as ‘at risk’?
- Pregnant (and up to 2 weeks post-partum)
- Children under 6 months
- Adults 65 years or older
- Chronic respiratory disease (including COPD and asthma)
- Significant cardiovascular disease (not hypertension)
- Severe immunosuppression
- Chronic neurological, renal or liver disease
- Diabetes
- BMI>40
What are the indications for abx in scarlet fever and which antibiotic is used?
What are the indications for abx in the following situations and what abx are given?
What are the indications for abx in sinusitis and what antibiotics are used?
What antibiotics should you use for a COPD and bronchiectasis exacerbation?
- Amoxicillin or Doxycycline or Clarithromycin
- If severe then co-amoxiclav
What self-help treatments can you offer someone with an acute cough?
- Honey (in over 1s)
- Herbal medicine pelargonium (over 12s)
- Cough medicines containing the expectorant guaifenesin (in over 12s) or cough medicines containing cough suppressants, except codeine
What antibiotics are prescribed in CAP after the severity is calculated?
Low-severity
Amoxicillin (first-line) or doxycycline or clarithromycin for 5 days
Moderate-severity
Dual antibiotic therapy is recommended with amoxicillin and clarithromycin for 7-10 days. Replace amoxicillin with doxycyline if allergic.
Severe
Co-amoxiclav, ceftriaxone or Tazocin and a macrolide
If pneumonia starts after 48h of hospital admission it is classified as HAP. What abx is prescribed?
Non-severe:oral co-amoxiclav
Severe: tazocin plus vancomycin if suspect MRSA
Which abx should you prescribe in a lower UTI?
Advise paracetamol or ibuprofen for pain
Non-pregnant women: back up antibiotic (to use if no improvement in 48 hours or symptoms worsen at any time) or immediate antibiotic.
Pregnant women, men, children or young people: immediate antibiotic.
Which abx are given for acute prostatitis and for how long?
14 days and review to see if need another 14
Which abx are prescribed for acute pyelonephritis?
What antibiotic should be given for suspected meningococcal disease?
What antibiotic is given for traveller’s diarrhoea?
IT IS NOT!
Self-limiting
How is threadworm treated?
What antibiotics are used for C-Diff? (think about first and second episode) (stop abx if cultures come back negative)
Review the need to continue PPIs, other medicines with gastrointestinal activity or adverse effects (such as laxatives), medicines that may cause problems if people are dehydrated (such as NSAIDs)
Do not offer antimotility medicines such as loperamide
Give abx for 10 days
You should always test for H-Pylori before giving the eradication regime. What is the eradication regime?
7 days MALToma
14 days otherwise
When are antibiotics given for acute diverticulitis and which ones are given? (depending on severity)
Acute diverticulitis and systemically well:
Consider no antibiotics, offer simple analgesia (for example paracetamol), advise to re-present if symptoms persist or worsen
Acute diverticulitis and systemically unwell, immunosuppressed or significant comorbidity: offer an antibiotic for 5 days. PO if community, IV if in hospital
What antibiotic is given for chlamydia and what should you advise people when having treatment for this?
Doxycline for 7 days
Can have azithromycin stat but need test of cure after 3 weeks as risk of resistance
What advice can you give for treatment of genital herpes?
What antibiotic is given for gonorrhoea?
TOC IS ESSENTIAL
Often co-infection with chlamydia so test and treat for this
What antibiotics are used for PID?
You should not take a swab of eczema for a bacterial infection as it is often colonsied. What antibiotic should be used if there is signs of infection though?
What antibiotic is used for impetigo?
What antibiotic is used for Lyme disease and for how long?
Treat erythema migrans empirically; serology is often negative early in infection
What antibiotic is used in scabies?
When do you need to prescribe antibiotics for a human/animal bite and which antibiotic would you use?
- Symptoms or signs of infection, such as increased pain, inflammation, fever, discharge or an unpleasant smell
- Do not offer antibiotic prophylaxis if a human or animal bite has not broken the skin.
- Offer antibiotic prophylaxis if the bite has broken the skin and drawn blood
What antibiotic and which route should you give for a dermatophyte infection?
When should you report a notifiable disease?
When should you report a notifiable disease?
Complete a notification form immediately on diagnosis of a suspected notifiable disease
Don’t wait for laboratory confirmation of a suspected infection
What are notifiable diseases that are often contracted from travel?
- Acute infectious hepatitis
- Acute poliomyelitis
- Anthrax
- Botulism
- Brucellosis
- Cholera
- Enteric fever (typhoid or paratyphoid fever)
- Food poisoning
- Infectious bloody diarrhoea
- Legionnaires’ disease
- Leprosy
- Malaria
- Measles
- Monkeypox
- Plague
- Rabies
- SARS
- Smallpox
- Tetanus
- Tuberculosis
- Typhus
- Viral haemorrhagic fever (VHF)
- Yellow fever
What are some notifiable diseases that are often found in the children patient group?
- Acute encephalitis
- Acute meningitis
- Acute poliomyelitis
- Diphtheria
- Haemolytic uraemic syndrome (HUS)
- Invasive group A streptococcal disease
- Measles
- Meningococcal septicaemi
- Mumps
- Rubella
- Scarlet fever
- Whooping cough
- Yellow fever
What is the full list of notifiable diseases from PHE?
What short story can you tell yourself to remember some key notifiable diseases?
