3. Minor Illness Flashcards
Outline Chicken Pox
- Varicella zoster
- Incubation is 10 days-3 weeks
- Conservative treatment
Aciclovir considered in immunosupressed
How is itching controlled in CP?
Cut nails of child
Calamine lotion
What is shingles?
- VZ virus lies dormant in sensory dorsal root ganglion cells
- Gets reactivated = shingles
- YOU CANNOT get shingles from someone with chicken pox
- Can get chicken pox from someone with shingles if you haven’t had it before
Chicken pox in pregnancy
- Dangerous if before 28 weeks gestation can cause development defects
- If around time of delivery, can lead to life threatening neonatal infection
- Treat this with varicella zoster immunoglobilins and aciclovir
What do you do do if a pregnant women < 28 weeks gestation presents with CP exposure?
- Establish immunity - have they had it before?
- If they have -do not need to worry, immunity will protect
- If they are unsure test for IgG and IgM levels
- If no IgG detected - not had before and needs immunoglobulins and aciclovir
How does shingles present?
- Neuropathic pain in dermatome before rash occurs usually
- Can be mistaken for MI pain if in chest pain
- Electric shock description of pain
What is Ramsay Hunt syndrome?
VZ affecting the facial nerve
Can cause facial paralysis
What is fifth disease?
- Viral illness caused by human parvovirus B19
- Causes red rash on cheeks - aka slapped cheek/erythema infectiousum
- Spreads respiratory droplets and vertically
How does Fifth’s disease present?
- Children 5-14
- High fever
- Runny nose and sore throat
- Headache
- Red rash on cheeks
- Few days later get spotty rash on trunk
- CLINICAL diagnosis - if atypical can test for antibodies
Treatment for fifth disease?
- Encourage rest and fluid intake
- Get better within 3 weeks
- Can attend school - not infectious once rash emerges
- If under 16 children should not have aspirin - risk Reyes syndrome
Safety netting for fifth disease?
Severe cases can get aplastic crisis - need hospital
What are childhood exanthems with examples?
- Skin rashes commonly associated with viral infections in children
- Measles, chickenpox, roseola infantum, hand foot and mouth disease
What is first second and third disease?
- Scarlet fever
- Measles
- Rubella
Outline Scarlet fever
- Bacterial infection
- Group A streptococcus
- Red rash, fever sore throat strawberry tongue
- Can cause rheumatic heart disease
Outline Measles
- Very contagious 1:15
- Red blotchy rash on face, other parts of body
- Fever, cough, runny nose
- Can become disabled after infection
- Vaccination MMR is important
Outline Rubella
- Mild infection
- AKA german measles
- Fever and swollen lymph nodes with spotty rash
- Concerning during pregnancy, can cause rubella syndrome in foetus
- Those in fertility clinics get tested for immunity
What is conjuctivits?
- Inflammation of conjuctival membrane - cornea clear and spared
- Causes discomfort and gritty feeling
- Usually viral but can be bacterial (get pus and dishcarge)
- No visual changes on exam and eye is bloodshot and watery
Treatment for conjuctivitis
- Conservative
- Chloramphenicol eye drops if nursery needs for attendance (risk of aplastic anaemia with eye drops)
- Usually improves within 5 days
- Bathe with cooled boiled water
Advice for conjuctivitis?
- Very contagious
- Can spread between eyes and people easily
- Can go to community pharmacist for treatment
What is a stye?
- Eyelash follicle infection- block gland of zeis
- Swelling at edge of eyelid
- Caused by staphylococcus aureus bacteria
- Painful red lump with white punctum
How are styes treated?
- Self limiting
- Resolve within 3 months - a lot longer than conjuctvitis
- Warm compress
- Oral abx for severe cases
- Consider marsupialisation if does not go within 3 months (incision and drainage)
How does orbital cellulitis present?
- Post septal is most severe - sight and intracranial structures threatened
- Deep to orbital septum
- Periorbital is confined to superficial
- Large orbital swelling, proptosis, reduced vision, painful eye movements
How is orbital cellulitis treated?
- Antibiotics
- Sometimes given in primary care
- Post-septal will always need secondary care, eye casualty
How are sprains managed?
PRICE
* Protect - from further injury eg using support
* Rest
* Ice - for 15/20 mins every 2-3hrs
* Compression - elastic bandage, snug but not tight and removed for sleep (controls swelling and supports)
* Elevation - on pillows until swelling is controlled, for severe may need to immobilise
What to avoid doing in sprain?
HARM
* Heat - worsens bruising and inflammation by encouraging blood flow
* Alcohol - increases bleeding and swelling and decreases healing
* Running - or any other exercise which will further damage
* Massage - increases bleeding and swelling
When can you return to activity after a sprain?
- As soon as you can tolerate without excessive pain
- Athletes may return when full ROM without pain
What is the management of a sprain?
- Paracetamol/topical NSAIDs
- Oral NSAIDs
- Short term use of codeine if needed
- Can medically review after 5-7 days if lack of expected improvement or worsening
- Consider physio referal if ongoing
- Consider ortho referral if slower recovery, worsening or new symptoms, out of proportion symptoms
Safety netting for sprains
- Septic arthiritis/haemoarthrosis - fever, maialise, heat from ankle and tenderness
- Compartment syndrome - pallor, paralysis, pulselessness, parasthesia
What is aphthous ulcer?
- Small erythematous ulcerations usually found in mouth but can be genitals (rarer)
- NOT linked to systemic disease
- Genetic predisposition, smoking cessation, iron/folate/B12 def, autoimmune conditions, anxiety and trauma can cause
3 types of aphthous ulcer
Minor - 2-4mm diameter
Major - 1cm diameter
Herpetiform - multiple mini ulcers that can be very painful
Minor ulcers
- Mildly painful, annoying
- Heal in 7-10 days –> no scarring
- Recurr 3/4x per year
Major ulcers
- More painful
- Recurr frequently
- 10-30 days to heal
- Can scar
Herpetiform ulcers
- Typically affects females
- Tiny discrete ulcers that coalesce into ulcerated patches
- Heal in 10 days
- Recur frequently
Management of aphthous ulcer
- Mild - OTC like bonjela and reassure
- Severe pain - topical corticosteroid (hydrocortisone oromucosal tablets)
- Ask patient to return if not resolved within 2 weeks (up to 6 for major)
What to consider if non-resolving ulcer?
- FBC - rule out anaemia
- Iron and B12 levels
- ESR/CRP
- IgA-ttG for coeliac
- Malignancy suspicion - non resolving in 3 weeks, growing outwards, cervical lymphadenopathy or oral cancer RF
Oral cancer RF
- Betal nut chewing
- Smoking
- Alcohol
- Chewing tobacco
Headlice
- Parasitic infection - hairs on head and feeds on scalp blood
- Transmitted via head to head contact or sharing combs/towels
- Itchy scalp with visible nits (eggs) and lice
When can you diagnose active infestation headlice?
Not just if nits
Need to have live lice to diagnose
Treat if live louse found
Treatment headlice
- Wet combing with fine tooth head louse comb first line - eg Bug Buster kit
- Dimeticone 4% coats lice and suffocates them
- Malathion 0.5% liquid
- Detection combing should be done after treatment to confirm success
- Unsuccessful - check close conacts, repeat
Advice headlice
- Can still attend school
- No evidence of clean vs dirty hair lice prefers
- No need to treat clothing/bedding - lifespan 1-2 days off human head
- Children primary school age examined regularly as it not possible to prevent
What is nappy rash?
- Inflammation of babys skin caused by prolonged contact with damp nappy
- Scaly, dry skin, itchy/painful bottom, red/raw patches, skin that is sore/hot to touch and baby distressed
- Caused by nappy rubbing against babys skin, allergic reactions, irritations from wipes, urine/faeces contact with skin for prolonged time
Do’s for nappy rash
- Change wet nappies ASAP
- Keep skin clean and dry - pat and rub gently
- Leave nappies off when possible
- Use extra absorbant nappies
- Make sure they fit properly
- Clean baby’s skin with water/fragrance free/alcohol free wipes
- Bath baby daily but not more than twice a day –> dries skin out
Don’ts for nappy rash
- Dont use soaps, lotion or bubble bath
- Do not use talc/antiseptics
- Do not put nappies on too tight, irritates skin
Management nappy rash
- Advise as above
- Mild - OTC barrier cream eg Sudocrem
- Inflamed - topical 1% hydrocortisone for 7 days max
- Candida - topical clotrimazole and miconazole
- Bacterial infection - flucloxacillin
Saftey netting nappy rash
- No improvement within 7 days - book f/u
- Itching/burning discontinue medication
- Seek emergency help if allergic reaction to medication
What is impetigo?
- Superficial bacterial skin infection caused by either staphylococcus aureus or streptococcus pyogenes
- Can be primary or complication of existing condition eg eczema/scabies/insect bites
- Common in children esp during warm weather
Two types of impetigo
Bullous
Non-bullous
Spread of impetigo causes?
Skin injuries
Poor hygiene
Close contact
Crowded/close living conditons
Compromised immune system
What is the treatment for impetigo?
- 1% hydrogen peroxide cream or fusidic acid cream (topical mupirocin if allergy)
- If extensive -oral flucloxacillin/erythromycin
- Should not attend school until lesions are crusted and healed until 48hrs after antibiotics
Practical advice impetigo?
- Good hand hygiene
- Avoid scratching
- Keep nails short
- Isolate contaminated items
- Clean and disinfect items
Advice for outdoors for insect bites?
- Wear long sleeved tops and trousers
- Don’t lie on grass - use blankets
- Avoid bright clothes - can attract
- Insec repellent
Insect bite symptoms?
- Red swollen lump - can be painful +/- itchy
- Usually improves within few hours/days
- Some people have mild allergic reaction - larger red area, resolves within 1 week
Treatment insect bite
- Wash skin with soap and water to decrease chance of infection + cold compress
- Paracetamol/ibuprofen if painful
- Antihistamine for itching
- Hydrocortisone cream to decrease itching and swelling
- Avoid scratching - increase risk of infection
Safety netting advice insect bites
- Infected bites can lead to cellulitis/sepsis
- Advice patients to look out for red flags eg systemically unwell
- Call 999 if symptoms of anaphylaxis - ABC affected/widespread urticaria
