Clinical Cases Flashcards
Chicken Pox What is Chicken Pox? How is it transmitted? What is the incubation period? How is it treated in GP? What are the symptoms? What happens if a pregnant woman gets chicken pox? Can you get shingles from chicken pox?
Chicken pox is a highly infectious, acute contagious disease predominantly of children under 10 years old, though it may occur at any age.
Transmission is through direct person to person contact, airborne droplet infection, through contact with infected items (e.g. clothing, bedding)
The incubation period is from 14 up to 21 days.
GPs usually recommend paracetamol or ibuprofen to reduce flu-like symptoms, fever and pain. They might also recommend the lesions are bathed in calamine lotion. In more serious cases, antivirals can be considered
Macular lesions which develop into papular or vesicular lesions, later becoming pustula, erythema, itchy
If a mother gets Chicken Pox during pregnancy, this is more serious and can lead to serious complications such as congenital varicella syndrome and increased maternal morbidity
You cannot catch shingles from someone with chickenpox, but you can catch chickenpox from shingles (if you haven’t had chickenpox before). If you have had chickenpox before, it can be reactivated if your immune system is low (e.g. stress, chemotherapy) and cause shingles.
Fifth Disease What is it also called? What group is it common in? What are the symptoms? How would you investigate? How is it treated by the GP? When is the patient no longer infectious? What is an exanthem and what are some other childhood exanthems?
Also known as Slapped Cheek Syndrome, Parvovirus B19 infection and erythema infectiosum.
Common in children 3-15 yrs. An estimated 50% of young people have antibodies for Parvovirus B19.
The rash may be preceded by 2–5 days of prodromal symptoms, such as low-grade fever, nasal discharge, headache, myalgia, and mild nausea and/or diarrhoea. The facial rash usually fades after 1–2 weeks and is often associated with perioral and periorbital pallor. An erythematous maculopapular rash on the trunk, back, and limbs may develop a few days after the facial rash, which fades to produce a lace-like, reticular rash. This usually resolves over a few days or weeks. There may be associated itching, for example of the soles of the feet.
Antibody testing for IgG or IgM is only required in pregnant women, immunocompromised or a haematological disorder.
Treated by GP with supportive treatment - rest, fluids, analgesia - at home and encouraged to minimise spread whilst symptomatic.
Patient is no longer infectious after the rash develops.
Exanthems’ are viruses causing red rashes . Measles, rubella, roseola infantum
Conjunctivitis
Symptoms
Cause
Treatment
Conjunctival redness, feeling of grittines, foreign body or burning, watering/ discharge and/or blurred vision
Adenovirus usually, bacterially can be S.Pneum, S.Aureus, N.Gonorrhoea
Cleansing drops - self limiting. If bacterial cause suspected. give chloramphenicol
Stye
Symptoms
Cause
Treatment
Acute onset, painful, red, localised swelling/lump near eyelid. Unilateral
Infected eyelash follicle or Meibomian gland, usually S Aureus
Self limiting - warm compress, avoid makeup, if recurrent use topical antibiotic
Orbital cellulitis
Symptoms
Cause
Treatment
Acute onset, swelling, redness, warmth of eyelid with oedema, fever, malaise, ptosis, gaze restriction, pain when moving eye
Extension of infection of periorbital structures, usually S.Pneum, S.Aureus, S.Pyog
Oral co-amoxiclav or refer to ENT for IV
Ankle Sprain
Symptoms?
Treatment?
Pain around the affected joint, tenderness, swelling, bruising, pain on weight-bearing, and decreased function.
Treatment for a sprained ankle depends on the severity of the injury. The treatment goals tare to reduce pain and swelling, promote healing of the ligament and restore function of the ankle.
Self-care should involve:
Rest - avoid activities that cause pain and discomfort
Ice
Compression - using an elastic bandage
Elevation - gravity helps reduce swelling by draining fluid
Paracetamol and ibuprofen can be used to manage any pain.
For severe injuries, patients may be referred to specialists (e.g. orthopaedic surgeon, physician).
Aphthous ulcers
What is it?
Causes?
Treatment?
An aphthous ulcer is an ulcer that forms on the mucous membranes.
FH, emotional stress and lack of sleep, mechanical trauma, nutritional deficiency, particularly of vitamin B, iron, and folic acid, certain foods, including chocolate.
Treatment: First line is a topical corticosteroid – hydrocortisone oral mucosal tablets. Local anaesthetics benzocaine and lignocaine (lidocaine) to reduce pain. Antibacterial mouthwashes to reduce secondary infection. Avoidance of foods that trigger or worsen the ulcers. Dietary supplements of vitamins or minerals if the diet is deficient. Stress reduction
Tetracycline suspension as a mouthwash. Topical corticosteroids as lotions, creams or paste
Head Lice What is the treatment? When should you seek advice? What OTC medication is available? What are some differentials? What are some myths?
Wet Combing ( or dry combing). Use shampoo and a lot of conditioner to comb through (2 types of combs). This should be done for 10 - 30 mins, every 3 days for at least 2 weeks/ 4 consecutive clear days. Be careful for infection from itching
Seek advice a 17 days.
OTC medications – Hedrin (dimeticone) but check instructions for age
Differentials – dandruff. Eczema, seborrheic dermatitis
Not associated with poor hygeine, don’t need to stay off school, don’t need to wash linen
Scabies
Symptoms?
Management?
Practical advice?
Pruritus, linear burrows, symmetric erythematous papules, nodules
Everybody in household should be treated, even if asymptomatic as well as anybody else who has had close physical contact. Permethrin 5% Cream 1st line and is applied all over body. This is repeated 1wk later
Wash all bedding + clothing at 50`c. Put non-washable clothing in a sealed bag for 3 days. Give gloves to young children to help with itching. Avoid close physical contact
Nappy Rash
What is it?
Self-management strategies?
Medications?
When should you be concerned about an infection?
An acute inflammatory reaction of the skin in the nappy area, which is most commonly caused by an irritant contact dermatitis
Consider using a nappy with high absorbency e.g. Disposable Gel Matrix Nappies compared to Non disposable nappies. Ensure the nappy fits properly. Leave Nappies off for as long as possible to help skin drying of the Nappy Area. Clean the skin and change the nappy every 3-4 hours or as soon as possible after wetting or soiling to reduce skin exposure to urine and faeces . Avoid potential irritants such as soaps and bubble bath
If baby is in distress or the rash is inflamed offer Hydrocortisone 1% Cream once a day until symptoms clear up or to a maximum of seven days. Advice parent to apply barrier preparation as well after waiting a few minutes after applying cream
Nappy Rash should resolve itself in 3 days if hygiene tips are followed. If rash doesn’t go away or the baby develops a persistent bright red,moist rash with white or red pimples into the folds of their skin, the baby may have an infection instead
Plantar Fasciitis
What is it? Risk factors? Symptoms Advice? Medications? Referrals?
Plantar fasciitis is a condition in which there is persistent pain associated with degeneration of the plantar fascia as a result of repetitive microtears in the contracted fascia. The plantar fascia is a tissue that runs between the heel and toes of the foot inferiorly. It is inflammation of this that causes pain.
40 - 60 years old, running and walking
Intense pain during the first steps after waking or after a period of inactivity. Pain that reduces with moderate activity but worsens later during the day or after long periods of standing or walking. Tenderness on palpation of the plantar heel area. Limited ankle dorsiflexion range. An antalgic gait or limping.
Reassurance that most people with plantar fasciitis will make a complete recovery within 1 year.
Conservative management to aid healing - resting the foot, wearing supportive shoes, using insoles, and regular stretching exercises.
Use of ibuprofen/paracetamol to manage pain, and use of an ice pack to reduce inflammation.
Referral to a physiotherapist if symptoms are severe.
Can give a steroid injection into foot, if pain is severe and previous steps have failed
Impetigo
What is it? What are the types? Causes? Treatment? Practical Advice?
Bacterial infection involving the superficial skin, (usually mouth and nose)
Non-bullous: S.aureus or S.pyogenes or both, thin walled vesicles releasing exudate
Bullous: caused by S. aureus, contains bullae (fluid filled lesion)
Poor nutrition, crowding, contact sports, diabetes, breaks in skin e.g. from mosquito bites, scabies, eczema or herpes
Non-bullous: topical hydrogen peroxide for 5 days
Bullous/severe: oral antibiotics flucloxacillin for 5 days
Encourage good use of hygiene to aid healing and prevent spreading. Stay away from school/work until lesions are dry/scabbed over
Insect Bites
Advice?
Insect bites are lesions to the skin caused by certain insects. Their local reaction usually resolves within hours to days but can last much longer if infected
Advise ptx to cover up or use bug repellent if sitting in sun for long periods and has a history of getting bitten/bad reactions. Tell them to not itch lesions and keep good hygiene, using otc analgesics prn.
If bites are growing and itchy, can advise oral antihistamines or topical corticosteroid creams (unless suspect infected). Advise patient to monitor for secondary infection as follow up will be required.
