8 - Minor Illnesses Flashcards
1
Q
How should you manage a pregnant woman who has never had chicken pox before and she comes into contact with chicken pox from her other child at nursery?
A
- Test IgG for varicella zoster with results within 2 days
- If no antibodies and <20 weeks administer VZIG
- If not antibodies and >20 weeks administer either VZIG or acyclovir
- Advise woman to contact if she develops a rash
Need this as otherwise may have fetal varicella syndrome or neonatal chicken pox
2
Q
How can you tell the difference between a viral and bacterial URTI?
A
Viral: runny nose, cough, low grade fever, trouble sleeping, shorter duration
Bacterial: higher fever that gets worse a few days into illness rather than better, longer course over 10-14 days, possible pus on tonsils
3
Q
How can you tell the difference between influenza and other viral URTIs?
A
- Influenza may have muscle aches and high fever
- Give oral oseltamivir or inhaled zanamivir if person in an at risk group within 48 hours
- Give oseltamivir if not at risk but could have complications e.g pregnancy
- If healthy treat conservatively. Will take 1-2 weeks of rest and fluids
4
Q
What are some URTIs you should either give no antibiotic prescribing or delayed prescribing to?
A
- Reassure patient they do not need as will not improve symptoms and side effects of abx e.g n+v
- Only prescribe immediately if patient systemically unwell, immunocompromised such as CF or patient at risk of complications
5
Q
What are some self care tips you can give patients with a cough that you are not prescribing an antibiotic for?
A
- Steam inhalation if adult
- Gargle salt water
6
Q
If prescribing antibiotics for an acute cough, what are the antibiotics of choice?
A
7
Q
If prescribing antibiotics for a sore throat (e.g pharnygitis or tonsillitis), what are the antibiotics of choice?
A
- Only prescribe immediately when fever pain >4/5 and absence of cough
- Explain usual course of sore throat is around 1 week
- Suggest paracetamol, NSAIDs, medicated lozenges with an NSAID/antiseptic/local anaesthetic (non-medicated have no evidence)
8
Q
What is the fever pain score?
A
9
Q
Who is more likely to benefit from antibiotic prescribing with otitis media?
A
- Under 18 with ottorhoea
- Under 2 with infections in both ears
- Usual course 3 days to 1 week so give paracetamol or ibuprofen, no evidence for anything else
- Give amoxicillin or clarithromycin then co-amoxiclav if not improving after 2 days
10
Q
When should you prescribe antibiotics for acute sinusitis?
A
- Usual course around 2-3 weeks so tell them to seek help if not improving after 3 weeks as may be dental infection or resistant bacteria
- At 10 days give nasal corticosteroid
- If systemically unwell or intracranial complications like mastoiditis or intraorbital complications give antibiotics
11
Q
When are UTIs classed as complicated?
A
- Immunosuppresed
- Recurrent (>2 in 6/12, >3 in 12/12)
- Children
- Men
- Pregnancy
- Impaired renal function
- Abnormal urinary tract
- Virulent organism e.g S.Aureus
12
Q
How would you investigate a suspected UTI?
A
- Take patients vital signs, check for any red flags like haematuria/loin pain/rigors.
Women
- If under 65 and non-complicated take dipstick. If + for blood, leukocytes and nitrates likely UTI
- If complicated, catheterised, or over 65 then MSU/CSU culture in boric acid or refrigerated up to 4 hours
Man
- MSU or CSU culture before antibiotics
- Check sexual history and rule out other causes e.g prostatitis
Child
- Dipstick if >3months and if leucocyte and nitrate +ve treat as UTI
- If <3 years send MSU
- If <3months, fever or at risk of complications refer urgently to paed specialist
- If cannot obtain sample don’t delay prescribing
13
Q
What questions do you need to ask a child with a UTI?
A
14
Q
How are UTIs managed once diagnosed?
A
Child
- For atypical arrange ultrasound in acute infection and DMSA within 4-6 months after infection
- Under 3 months refer to specialist
- Trimethoprim or Nitrofurantoin 1st line
Woman uncomplicated
- See image
- Do not give pregnant women trimethoprim
Man
- Nitrofurantoin 100mg BD 7 days or Trimethoprim 200mg BD 7 days (only if low risk of resistance)
- Check up after 48 hours
- Admit to hospital if systemically unwell
- Consider referral to urology
- Consider cancer nephrology referral if haematuria
15
Q
What self care advice can be given to people with a UTI?
A
No evidence for cranberry products
16
Q
How is pyelonephritis investigated?
A
- MSU culturing organism with fever and/or loin pain with other excluded causes is pyelonephritis
- Triad: usually unilateral flank pain, fever, N+V
17
Q
How is pyelonephritis treated?
A
- Admit to hospital if signs of sepsis or systemically unwell
- Urgent cancer referral if over 45 and haematuria
- If catheter consider changing/removing catheter and check not blocked
18
Q
How is community acquired pneumonia diagnosed (non-covid)?
A
Virtual consultation:
- Temp >38
- Resp rate >20
- HR>100
- New confusion
- Cough, chest pain, breathlessness, anorexia
- If O2 <92% very serious
19
Q
How can bacterial pneumonia be distinguished from viral COVID pneumonia?
A
20
Q
How is non-covid community acquired pneumonia managed?
A
- Decide whether a hospital admission is necessary for CXR, mucus sample, blood tests using CRB65
- Give antibiotics if bacterial within 4 hours of diagnosis (see image)
- Drink plenty of fluids and rest
- Safety net
21
Q
What are some complications of community acquired pneumonia?
A
- Sepsis
- Pleurisy
- Lung abscess (risk higher with other co-morbities and alcohol abuse)
22
Q
What is the difference between the presentation of acute bronchitis and community acquire pneumonia?
A
- No x-ray changes with bronchitis
- URTI signs with bronchitis e.g runny nose
- No pleuritic chest pain with bronchitis
- No fever, rigors, tachypne with bronchitis
23
Q
How do we manage acute bronchitis?
A
- Advise self care like analgesia, fluids, honey, Pelargonium, cough medicines containing guaifenesin as self limiting over 3 to 4 weeks
- Advise patient to stop smoking
- Advise patient to come back in 3 to 4 weeks if not resolved
- Consider delayed antibiotic prescribing if person at risk e.g diabetic, heart failure. Same antibiotics as pneumonia
- Do not offer inhaler or corticosteroids
24
Q
What are some differentials for a boil/carbuncle?
A
- Cystic acne
- Folliculitis
- Epidermoid cyst
- Dental abscess
- Hidradenitis suppurativa
- Anthrax
25
How do boils and carbuncles present?
**_Boil_**
**- Painful lump** usually in hair bearing sites that are subject to friction and perspiration e.g axilla, neck
- **Firm, tender, erythematous** nodules with possible cellulitis, which enlarge and become painful and fluctuant and **shiny**
- May rupture spontaneously, draining pus or necrotic material. - Heal and leave a violaceous macule or scar.
**_Carbuncle_**
- Very painful usually on neck, back thighs
- Malaise and systemic symptoms common
- Develop yellow-grey irregular crater centrally, caused by necrosis of the intervening skin
26
How are boils and carbuncles managed?
**_Non-fluctuant:_**
- Advise moist heat QDS for pain and to localise infection
- Maintain good hygeine
- Tell pt to come back if systemically unwell or turns fluctuant
- 7 day Flucloxacillin if carbuncle, cellulitis, fever, on face, in pain
**_Fluctuant:_**
- Same day incision and drainage unless small and may drain
- Consider admission and IV antibiotics if cellulitis or systemically unwell
- Consider swabs for MRSA
27
When should you swab a boil/carbuncle for MRSA and how should this be treated if positive for staphylococcal carriage?
- Do not start decolonisation until acute infection resolved
- **Naseptin** cream for 10 days QDS or **Mupirocin** 5 days TDS
**- Antiseptic preparation 5 days** e.g chlorhexadine 4%
- Tell patient about hygeine whilst decolonising, e.g changing bed sheets/towels daily, vaccuming
28
How is oral candidiasis diagnosed?
- Clinical features and exclude differentials as swabs will be positive in most healthy people as commensal
- Lots of different types
- Common in HIV, neonates, elderly, diabetics, poor diet, poor dental hygeine, smoking, hyposalivation
29
How is oral candidiasis treated?
**_Mild:_** topical **miconazole** 1st line (or *nystatin* 2nd) for 7 days
**_Severe:_** oral **fluconazole** 50mg 7 days and follow up
- Consider referral for biopsy if chronic plaque like
- Advise good dental hygeine, diabetic control, encourage to stop smoking
30
How is vulval candida diagnosed?
**- Symptoms:** vulval itching, dysuria, dysparaunia, vaginal discharge, vaginal soreness
- Consider UTI and STI also
- Can do high vaginal swab or vaginal pH but not necesary if isolated uncomplicated
31
How is vulval candidiasis treated?
**_- Pessary:_** clotrimazole, econazole, miconazole, or fenticonazole
**_- Oral antifunal:_** fluconazole or itraconazole
**_Vulval Symptoms:_** Clotrimazole 1% or 2% cream applied 2/3DS
- Tell patient not to douche, use soap in the vagina, wear tight clothing, use probiotics topically
- Get patient to return if not cleared up in 7-14 days
- Take culture and sensitivity if severe
32
How is a candidal skin infection diagnosed?
Clinical features no swabs
- Soreness and itching
- Thin-walled pustules with a red base
- Scales may accumulate, producing a white-yellow, curd-like substance over the infected are
In flexural areas skin fold is typically red and moist.
33
How is a candidal skin infection treated?
**- Topical imidazole** (clotrimazole, econazole, miconazole, or ketoconazole) or terbinafine
- If itch or inflammation give **mild potency topical corticosteroid** BD 7 days
- Give **oral fluconazole for 2 weeks** if immunocompromised, topical not working or wide spread
- Keep affected area dry and free of tight clothing e.g nappies
34
How does mechanical back pain present and how is it managed?
35
How does spondylosis/spinal stenosis back pain present and how is it managed?
- OA of the spine where there is degeneration narrowing spinal canal
- Common over 40, in manual labour, acromegaly
36
How does spondylolisthesis and a herniated disc present and how are they treated?
- Persistent lower back pain worse on moving and relieved by rest
- Radicular leg pain
- Possible weakness of legs
37
What is ankylosing spondylitis?
**Chronic inflammatory disease of spine and SI joint**. Associated with HLA-B27
- Chronic back pain and stiffness that improves with exercise, not rest.
- Sacroiliac joint and spinal fusion. Formation of syndesmophytes (bony growths in intervertebral joint ligaments)
- Arthritis and enthesitis mainly in lower limbs
- Dactylitis (swelling of a finger or toe).
- Fatigue.
- Extra-articular manifestations (uveitis, psoriasis, IBS).
38
How is ankylosing spondylitis investigated and managed?
**- ESR/CRP** may be raised
**- X-ray and MRI of spine/SI joint** to look for sacroiliitis, sclerosis (thickening of bone), erosions, and partial or total ankylosis (fusion of joints
- **Test for HLA-B27** and if positive refer to rheumatologist
39
What are some criteria for referring a patient with suspected ankylosing spondylitis for a HLA-B27 test?
40
How do you investigate a patient presenting with dyspepsia?
- Ask about stress/anxiety
- Check for any red flags for GI cancers e.g weight loss
**- Review meds** for anything that can precipitate (aspirin, alpha blockers, CCBs, benzos, beta blockers, anticholinergics NSAIDs, nitrates, corticosteroids)
**- Take FBC,** CRP and U's and E's for **anaemia** and platelet count
- Ask about **lifestyle factors** e.g obesity, smoking, trigger foods, alcohol consumption
41
What antibiotics are given in a bacterial sore throat?
- Penicillin V (Phenoxymethlypenicillin)
- Erythromycin or Clarithromycin
42
How is quinsy treated?
- IV antibiotics
- Surgical drainage
- Consider tonsillectomy within 6 weeks
43
How is dyspepsia managed?
**- Lifestyle:** weight loss, avoid triggers, smoking cessation
**- H.Pylori test** (ensuring no PPI or antibiotics 2 weeks before and no antacids 48 hours before)
- H.Pylori -ve then **1 month PPI trial or H2RA**
- H.Pylori +ve then **PPI, amoxicillin, clarithromycin/metronidazole BD for 7 days**
- Still not improving or recurrent then refer for **endoscopy**
44
If GORD is diagnosed what is the management?
- 6-8 week full dose PPI
- Regular endoscopy for Barrets
45
What is the difference between a sprain and a strain?
**_Sprain:_** stretch and/or tear of a **ligament**. Usually ankles, knees, wrists, thumbs.
Pain especially when weight bearing, tenderness, swelling, joint instability, decreased function
**_Strain:_** stretch and/or tear of **muscle fibres or tendon**. Usually back, hamstrings, foot.
Muscle pain, cramping, bruising, muscle weakness
46
How are sprains and strains investigated and managed?
**_Ix:_**
- Take Hx with mechanism of injury, usual activity level and previous history
- Examine joint instability and neurovascular status
- Take x-ray if Ottawa suspects fracture
**_Mx:_**
- Topical NSAID or paracetamol
- PRICE for 48-72 hours
- Possible review after 5 to 7 days
- Will feel better after 2 weeks but avoid strenous exercise and running for up to 8 weeks
- Refer to physio or orthopaedics if not improving with self management
47
What are Ottawa rules?
48
What are the differentials for a transient loss of consciousness and how do you distinguish between them?
**Vasovagal Syncope**: 3Ps of posture, pain, prodromal
**Orthostatic Hypertension:** medication or conditions related to it, lightheadedness, symptoms worse on standing, tunnel vision. Drop of 20 sys or 10 dia after standing for 3 mins diagnoses
**Cardiac abnormalities:** FH of sudden death before 40, abnormal ECG, occurs during exertion, palpatations before LOC
**Epilepsy:** head turning, prodromal deja vu, shaking/jerking, tongue biting
49
How are each of the following managed in primary care for transient LOC:
- Vasovagal syncope
- Orthostatic hypertension
- Cardiac abnormalities
- Epilepsy
- Given info and advice, possible trigger events, told prognosis is good
- Review drugs and remove any precipitating, drink lots of water, sit then stand after getting up from laying down, eat more salt unless hypertensive, small frequent meals, avoid constipation
- ECG and referral to cardiology immediately within 24 hours
- Specialised neurological assessment within 2 weeks. Inform DVLA cannot drive
50
How is a pilonidal sinus investigated and managed?
- Clinical features and risk factors e.g men and prolonged sitting, aid diagnosis
- If asymptomatic watch and wait and **good hygeine**
- Give antibiotics if abscess forms
- If acute send for same day I+D with paracetamol/NSAID.
- If discharging needs surgical excision leaving open and heal for 6-8 weeks
51
How are haemorrhoids diagnosed?
- Ask about red flags, family history and symptoms
- Look at perianal area
- Look for any skin tags, fissures etc
- Possible DRE
- Proctoscopy
- Consider FBC for anaemia
52
How are haemorrhoids treated in primary care?
- Refer to specialist or via cancer pathway if red flags
- Ensure **stools are soft** and easy to pass by eating more fruit, veg and lots of fluids
- Advise importance of **anal hygeine**
**- Advise against stool withholding**
- Refer to secondary care if conservative not working
53
How are migraines diagnosed?
**- Unilateral pulsating headache**
- Photo/phonophobia
- N+V
- Aura
- Allodynia
- Prodrome of yawning, changes in sleep, food cravings
54
How are migraines managed?
**_Acute_**
**- Ibuprofen**, paracetamol or aspirin
- Possible **triptan** when headache starts e.g sumatriptin
- Consider **antiemetic** e.g metoclopramide or prochlorperazine)
**_Prophylaxis_**
**- Avoid triggers** e.g cheese, stress, lack of sleep
- Consider **propanolol, amitriptyline or topiramate** to reduce frequency
- Suggest CBT, acupunture and riboflavin if not pregnant
55
How are tension headaches managed in primary care?
1. **Simple analgesia** (no opioids) and control other disorders e.g stress
2. 10 session of **acupuncture** over 5-8 weeks
3. Possible **low dose amitriptyline**
56
How are cluster headaches managed in primary care?
Need to confirm with neurologist if first attack
**_Acute Confirmed_**
- 100% O2 for 15 mins
- 6mg sumatriptin SC or IN
- Do not offer paracetamol, NSAIDs etc
**_Prophylaxis_**
- Verapamil
57
What is a medication overuse headache and how is it managed?
Due to overtaking opioids, triptans, ergots etc
58
How is trigeminal neuralgia managed?
**Carbamazepine** if no red flags!
59
How is constipation managed in primary care? (less than 3 stools a week with ?impaction if hard stools every 7-10 days or going a small amount every 2-3 days)
**_Non-pharmacological_**
- Increase fibre intake to 30g daily gradually
- Lots of fruit and veg particularly those high in sorbitol e.g prunes, apples
- Increase fluid intake
- Increase activity levels
- Healthy toilet routine and posture
**_Pharmacological_**
**1st line (unless opioid constipation):** Bulk forming laxative like Ispaghula with lots of fluids
**2nd line:** osmotic like macrogol
**3rd line:** if soft but tough to pass use stimulant
Reduce once 3 soft stools a week or if not improving manual evacuation
60
How is BV diagnosed and managed?
**Ix:**
- Abdominal/pelvic exam
- Test vagina pH
- Speculum and high vaginal swab
- Test for chlamydia, gonorrhoea, trichomonas to rule out others
**Mx:**
- Metronidazole PO BD 5-7 days
- Intravaginal metronidazole possible for 5 days
61
What are some investigations that should be done into chronic diarrhoea?
- CA125 testing
- C.Diff testing
- Faecal calprotectin (if raised suggests inflammation so IBD not IBS)
- C.Diff testing
- Examine for ova, cysts and parasites if travel history
- Test for blood in faeces
- HIV serology
62
How should you explain how to collect a stool sample to a patient?
- Make sure poo doesn't touch inside of toilet or wee so use clean sterile container
- Fill out details on pot and fill pot to 1/3 full
- Refrigerate or hand in straight away
63
How should you investigate and manage glandular fever (EBV)?
- Arrange FBC and EBV monospot test in the second week of illness. Look at LFTs
- If negative do EBV viral serology test
- Advise will last 2-4 weeks, tiredness will last longest, take analgesia, avoid contact sports, avoid spread by kissing/sharing utensils
- Admit to hospital if stridor, dehydration or complications
64
What vaccinations are given from aged 0-18?
**1 year:** Hib/MenC, MMR, PCV, Men B
**2-10 years**: flu vaccine
**3 years:** MMR, 4-in-1 booster
**12-13 years:** HPV
**14 years**: 3-in-1 booster, MenACWY
65
What is the 6-in-1, 4-in-1, 3-in-1 vaccination?
**3:** Diphtheria, Tetanus, Poliomyelitis
**4:** Above plus whooping cough
**6:** Above but Hep B, HiB, Pertussis (Whooping cough)
66
What is congenital rubella syndrome?
- When mother has rubella infection this can happen to the baby
- Often miscarriages and stillbirths also
67
How does rubella (German measles) present and how is it diagnosed?
- 2-3 weeks after exposure generic symptoms like rash, lymphadenopathy, arthritis/arthralgia, low grade fever, headache
- Can cause encephalopathy, neuritis, orchitis, thrombocytopenia
- Use viral serology
**- Inform PHE, avoid pregnant people,** avoid work/school for 5 days after rash, self limiting treatment such as paracetamol
68
What is Fifth disease and how is it diagnosed? (Childhood exanthem meaning eruptive skin rashes with fever and other symptoms)
**- Slapped cheek syndrome** caused by **parvovirus B19**
- Incubation of 1-2 weeks with prodrome of flu like symptoms and then rash across cheeks, trunks, arms and legs that may be red and itchy and resolve in 2 weeks
- Diagnosis on clinical features but can be viral serology for IgM
- If pregnant need to do a blood test to rule out rubella
69
How is Fifth disease/Erythema Infectiosum treated?
- Self limiting e.g fluids and analgesia
- Not contagious after rash appears so can return to work/school. Also don't need to avoid pregnant women
- Check rubella vaccination status
70
How is conjuctivitis diagnosed and managed?
**_Dx:_**
- Usually viral
- Conjunctival erythema
- Discomfort in eye e.g grittiness, burning
- Purulent discharge that may cause eyes to stick together on waking and cause transient vision blurring
- Should be no photophobia!
**_Mx:_**
- Reassure self limiting 7-10 days viral
- Advise cold compress and bathing in saline/sterile water
- Lubricating eye drops
- Inform pt it is contagious so don't share towels
- If bacterial and not clearing after 3 days give chloramphenicol or fusidic acid eye drops
71
How is a stye diagnosed and managed?
**_Dx_**
- Bacteria infecting eyelash follicle/gland, more likely if have recurrent blepharitis
- Acute-onset painful, localized swelling near the eyelid margin that develops over several days
- Unilateral
- May be watery eyes
- Can be internal or external
**_Mx_**
- Arrange admission if signs of orbital cellulitis
- Apply a warm compress to enourage drainage
- Do not try to puncture
- Avoid wearing makeup and contact lenses
- I+D in GP and pluck eyelash from follicle if really painful external
- Chloramphenicol if spreading infection
72
What are some signs of orbital cellulitis?
**_Dx:_**
- Systemic features of fever and malaise
- Often due to Strep species from ethmoidal sinus if behind orbital septum. If in front often S.Aureus
- Diplopia
- Difficulty moving eye
**_Mx:_**
- Emergency referral to hospital and co-amoxiclav or clindamycin if allergy
- CT of orbit and brain particularly in children to check for intracranial abscess
73
How is an aphthous ulcer managed?
- Often due to damage in the mouth e.g braces, biting cheek, and not associated with systemic disease
- Do FBC, Vit B12, Ferritin, Folate, IgA transglutaminase, viral serology for EBV/HIV if diagnosis uncertain
- Self limiting 10-14 days but **avoid trigger foods**. If painful can give topical corticosteroid e.g **hydrocortisone oro-mucosal tablets, beclomethasone spray**, or **topical local anaesthetics**
- If recurrent can give short course PO prednisolone.
- Refer for malignancy if doesn't clear in 3 weeks
74
How do you diagnose scabies?
- Caused by parasite Sarcoptes scabiei that burrows into the epidermis of the skin
- Linear burrows on several parts of the body that are itchy particularly at night
75
How is scabies managed?
**1st Line -** Permethrin 5% cream
**2nd line -** Malathion aqueous 0.5% cream if above not tolerated
- Apply to whole body on cold dry skin and allow to dry before dressing. Wash off 12 hours later and apply 2nd application a week later
- All household members and sexual partners need treatment even if asymptomatic
- Wash all clothes and bedding at 60 degrees and dry in hot dryer
- Itch may still occur for 2 weeks but if still present 2-4 weeks later see GP
76
How is nappy rash managed in primary care?
**_Self care:_**
- Use high absorbency nappies
- Leave nappies off for as long as possible to air out
- Change nappies every 3-4 hours and do not use soap
**_Pharmacological:_**
- If mild and asymptomatic advise **OTC barrier protection** e.g Sudocrem, every nappy change
- If inflamed and discomfort give **topical 1% hydrocortisone cream** for a max of 7 days
- If persists and candida topical **clotrimazole** and **miconazole**
- If persists and bacterial give **flucloxacillin** 1/52
77
How does plantar fascitis present and how is it diagnosed?
**_Hx:_**
- Intense heel pain during first steps after waking or after inactivity
- Pain that reduced with moderate activity but worse at the end of the day or after long walking
- Risk factors: aged 40-60, obese, running, woman
**_Dx: (clinical features)_**
- Positive Windlass test
- Tenderness on palpation of plantar heel
- Tightness of Achille's tendon
- Antalgic gait
78
How is plantar fascitis managed?
**- Reassure** most will resolve in a year
**- Rest** the foot where possible
- Wear shoes with good arch support or consider insoles
- Lose weight if obese
- Analgesia and ice packs
- Self physiotherapy to stretch
- If persisting then corticosteroid injection
- If still persisting physio, podiatrist and then surgeon to divide plantar fascia
79
How does impetigo present?
Bullous caused by S.Aureus, Nonbullous can be S.Pyogenes
May swab for MRSA if recurring but usally off of clinical features
Red blisters that quickly pop and form a crust. Lasts for 7-10 days and is very contagious
80
How is impetigo managed?
- Reassure will heal with no scarring. Stay away from schools and work **until crusted over** or till **48 hours after start of treatment**
**_Localised non bullous:_**
- Topical hydrogen peroxide 1% 2-3x a day for 5 days
- If unsuitable can give topical antibiotic like mupriocin or fusidic acid for same time
**_Widespread non bullous or bullous:_**
- Oral flucloxacillin 500mg QDS for 5 days or clarithromycin 500mg QDS for 5 days
81
How does rheumatic heart disease present?
- Usually 1-6 weeks after strep throat
82
How is quinsy treated?
- IV antibiotics like co-amoxiclav
- Needles aspiration or surgical drainage
- Consider tonsillectomy within 6 weeks
83
What is the likely diagnosis and what are some other symptoms?
**Post Op Ileus:** need to rearrange admission
- Distension
- Lack of bowel sounds
- Accumulation of gas
- Delayed flatulence and stool
- Common after abdominal surgery
84
**D**
SHOULD AVOID ALL ANTIHISTAMINES IN ELDERLY EVEN NON-SEDATING DUE TO THE RISK OF FALLS
85
What should you not prescribe to patients with glandular fever?
Amoxicillin as can cause a rash
86
What are the risks to the mother if she contracts chicken pox in pregnancy?
Pneumonitis
87
What is an important symptom to ask about in a ?UTI and what other pathology should it prompt you to consider?
Nocturia!
BPH or Prostate cancer
