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GP > 3. Minor Illness > Flashcards

3. Minor Illness Flashcards

1
Q

Outline Chicken Pox

A
  • Varicella zoster
  • Incubation is 10 days-3 weeks
  • Conservative treatment

Aciclovir considered in immunosupressed

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2
Q

How is itching controlled in CP?

A

Cut nails of child
Calamine lotion

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3
Q

What is shingles?

A
  • 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
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4
Q

Chicken pox in pregnancy

A
  • 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
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5
Q

What do you do do if a pregnant women < 28 weeks gestation presents with CP exposure?

A
  • 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
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6
Q

How does shingles present?

A
  • Neuropathic pain in dermatome before rash occurs usually
  • Can be mistaken for MI pain if in chest pain
  • Electric shock description of pain
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7
Q

What is Ramsay Hunt syndrome?

A

VZ affecting the facial nerve

Can cause facial paralysis

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8
Q

What is fifth disease?

A
  • Viral illness caused by human parvovirus B19
  • Causes red rash on cheeks - aka slapped cheek/erythema infectiousum
  • Spreads respiratory droplets and vertically
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9
Q

How does Fifth’s disease present?

A
  • 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
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10
Q

Treatment for fifth disease?

A
  • 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
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11
Q

Safety netting for fifth disease?

A

Severe cases can get aplastic crisis - need hospital

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12
Q

What are childhood exanthems with examples?

A
  • Skin rashes commonly associated with viral infections in children
  • Measles, chickenpox, roseola infantum, hand foot and mouth disease
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13
Q

What is first second and third disease?

A
  1. Scarlet fever
  2. Measles
  3. Rubella
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14
Q

Outline Scarlet fever

A
  • Bacterial infection
  • Group A streptococcus
  • Red rash, fever sore throat strawberry tongue
  • Can cause rheumatic heart disease
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15
Q

Outline Measles

A
  • 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
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16
Q

Outline Rubella

A
  • 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
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17
Q

What is conjuctivits?

A
  • 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
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18
Q

Treatment for conjuctivitis

A
  • 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
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19
Q

Advice for conjuctivitis?

A
  • Very contagious
  • Can spread between eyes and people easily
  • Can go to community pharmacist for treatment
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20
Q

What is a stye?

A
  • Eyelash follicle infection- block gland of zeis
  • Swelling at edge of eyelid
  • Caused by staphylococcus aureus bacteria
  • Painful red lump with white punctum
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21
Q

How are styes treated?

A
  • 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)
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22
Q

How does orbital cellulitis present?

A
  • 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
23
Q

How is orbital cellulitis treated?

A
  • Antibiotics
  • Sometimes given in primary care
  • Post-septal will always need secondary care, eye casualty
24
Q

How are sprains managed?

A

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

25
Q

What to avoid doing in sprain?

A

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

26
Q

When can you return to activity after a sprain?

A
  • As soon as you can tolerate without excessive pain
  • Athletes may return when full ROM without pain
27
Q

What is the management of a sprain?

A
  • 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
28
Q

Safety netting for sprains

A
  • Septic arthiritis/haemoarthrosis - fever, maialise, heat from ankle and tenderness
  • Compartment syndrome - pallor, paralysis, pulselessness, parasthesia
29
Q

What is aphthous ulcer?

A
  • 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
30
Q

3 types of aphthous ulcer

A

Minor - 2-4mm diameter
Major - 1cm diameter
Herpetiform - multiple mini ulcers that can be very painful

31
Q

Minor ulcers

A
  • Mildly painful, annoying
  • Heal in 7-10 days –> no scarring
  • Recurr 3/4x per year
32
Q

Major ulcers

A
  • More painful
  • Recurr frequently
  • 10-30 days to heal
  • Can scar
33
Q

Herpetiform ulcers

A
  • Typically affects females
  • Tiny discrete ulcers that coalesce into ulcerated patches
  • Heal in 10 days
  • Recur frequently
34
Q

Management of aphthous ulcer

A
  • 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)
35
Q

What to consider if non-resolving ulcer?

A
  • 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
36
Q

Oral cancer RF

A
  • Betal nut chewing
  • Smoking
  • Alcohol
  • Chewing tobacco
37
Q

Headlice

A
  • 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
38
Q

When can you diagnose active infestation headlice?

A

Not just if nits

Need to have live lice to diagnose
Treat if live louse found

39
Q

Treatment headlice

A
  • 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
40
Q

Advice headlice

A
  • 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
41
Q

What is nappy rash?

A
  • 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
42
Q

Do’s for nappy rash

A
  • 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
43
Q

Don’ts for nappy rash

A
  • Dont use soaps, lotion or bubble bath
  • Do not use talc/antiseptics
  • Do not put nappies on too tight, irritates skin
44
Q

Management nappy rash

A
  • 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
45
Q

Saftey netting nappy rash

A
  • No improvement within 7 days - book f/u
  • Itching/burning discontinue medication
  • Seek emergency help if allergic reaction to medication
46
Q

What is impetigo?

A
  • 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
47
Q

Two types of impetigo

A

Bullous
Non-bullous

48
Q

Spread of impetigo causes?

A

Skin injuries
Poor hygiene
Close contact
Crowded/close living conditons
Compromised immune system

49
Q

What is the treatment for impetigo?

A
  • 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
50
Q

Practical advice impetigo?

A
  • Good hand hygiene
  • Avoid scratching
  • Keep nails short
  • Isolate contaminated items
  • Clean and disinfect items
51
Q

Advice for outdoors for insect bites?

A
  • Wear long sleeved tops and trousers
  • Don’t lie on grass - use blankets
  • Avoid bright clothes - can attract
  • Insec repellent
52
Q

Insect bite symptoms?

A
  • 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
53
Q

Treatment insect bite

A
  • 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
54
Q

Safety netting advice insect bites

A
  • 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

GP (37 decks)

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