Common GP Conditions Flashcards
What advice would you give a patient that you have diagnosed with the ‘common cold’?
Advise that the average length of illness is 10 days
Advise steam inhalation, vapour rubs, paracetamol/ibuprofen, intranasal decongestants
State the three different types of Urinary Tract Infections
Lower UTI - cystitis, prostatitis
Upper UTI - Pyelonephritis
Abacterial
State four features that would cause a UTI to be classed as ‘complicated’?
Structural Abnormality
Obstruction
Catheter
Renal Obstruction
Name two common causative organisms of UTI
E.Coli
Staphylococcus Saprophyticus
Other than immunosupression, give four risk factors for UTI
Sex
Spermicide use
Menopause
Dehydration
State 4 symptoms of Cystitis
Frequency
Dysuria
Urgency
Haematuria
State 4 symptoms of Pyelonephritis
Fever
Rigors
Loin Pain
Vomiting
State 4 symptoms of Prostatitis
Pain (perineurium,rectum, penis)
Fever
Malaise
Urinary Symptoms
When do you investigate a UTI?
Non pregnant, under 65 and less than 3 symptoms
Pregnant Women
Men
Children
Do you treat Asymptomatic Bacteruria?
Not unless pregnant
How do you treat non pregnant Women with UTI?
Lower UTI - 3 Day course of Trimethoprim/Nitrofurantoin
Upper UTI - 7 Day course of Co-amoxiclav
How do you treat pregnant Women with UTI?
As long as not 3rd term
Nitrofurantoin/Cephalexin for 7 days
How do you treat Men with UTI?
Nitrofurantoin for 7 days
If Prostatitis then consider 4 weeks of Ciprofloxacin - penetrates Prostatic fluid well
What is Acute Bronchitis?
Short term inflammation of the Bronchi, usually a viral cause in origin
Give 4 features of Acute Bronchitis
Productive Cough
SOB
May have been preceded by URTI
Generally no systemic symptoms (might indicate Pneumonia)
What is Bronchiolitis?
Acute viral illness of Lower Respiratory Tract occurring primarily in the very young.
RSV responsible for 80%
Give four risk factors for Bronchiolitis, and one protective factor
Older Siblings, Nursery Attendance, Passive Smoking, Overcrowding
Breast Feeding is protective
Describe four features of presentation of Bronchiolitis
1-3 day history of coryzal symptoms
Persistent cough/chest recession/crackles
Fever
Poor feeding
If you suspected Bronchiolitis in a child, when would you refer to Secondary Care?
Apnoea Chest recession/grunting RR>70 02<92% Central Cyanosis
How would you manage Bronchiolitis?
Self Limtiing
Fluids and nutrition
Anti - pyretics if child is in distress
Acute Conjunctivitis can be Viral/Bacterial/Parasitic/Allergic in origin. Give an example of a causative organism of each
Viral - Adenovirus
Bacterial - Staphylococcus
Parasitic - Lyme Disease
Allergic - Seasonal
Give 3 causes of Chronic Conjunctivitis
Recurrent Infective
Chlamydia
Toxic Reaction
Give 2 symptoms of Conjunctivitis
Red eye with irritation/grittiness
Discharge
Give 2 signs of Conjunctivitis
Conjunctival Oedema
Dilated Conjunctival Vessels
What are Conjunctival Follicles?
White nodules on inferior eyelids
If preauricular lymph nodes are enlarged - Toxic or Molluscum Contagiosum in causation
If preauricular lymph nodes are not enlarged - HSV or Chlamydia
What are Conjunctival Papillae?
Red dots of varying size on inferior eyelids (Cobblestone)
Allergic/Bacterial in cause
How would you manage BACTERIAL Conjunctivitis?
Advise self limiting nature (shouldn’t last longer than 2 weeks)
Lubricant eye drops
Antibiotics - Chloramphenicol (not in pregnancy), Fusidic Acid
Chlamydia - topical tetracycline and oral doxycycline
Gonococcal - 1g IM Ceftriaxone
How would you manage VIRAL Conjunctivitis?
Supportive unless HSV (Topical Acyclovir)
How would you manage ALLERGIC Conjunctivitis?
Avoid rubbing
Cool compreses
Topical Antihistamines
Oral Antihistamines (eg Chloramphenamine)
What is Blepharitis?
Inflammation of the edge of the eyelid
Usually a chronic condition that never fully resolves
Can be anterior (affecting eyelashes) or posterior (affecting meibomian glands)
Give 3 causes of Blepharitis
Staph Infection
Seborrhoeic Dermatitis
Meibomian Gland Dysfunction
Give 2 general symptoms of Blepharitis
Eyes are sore and gritty
Eyes may stick together in the morning
Symptoms are WORSE in the morning
Give 2 signs seen with each respective cause of Blepharitis
Staph Infection - Hyperaemia, Crusting of lash bases
Seborrheic - Erythema, Hyperaemia
Meibomian Dysfunction - oil globules on lid, chalazia
How would you manage Blepharitis?
Lid Hygiene (warm compress and massage to loosen meibomian content, and cleansing using cotton bud in baby shampoo) Abx only if evidence of unresolving infection
Give four causes of Cervical Back Pain
Cervical Spondylosis
Cervical Prolapse
Meningitis
Torticollis
What is Torticollis?
Acute spasm of neck (often after ‘sleeping funny’)
Give 3 red flags for Cervical Back Pain
Weakness in more than one myotome
Neurological symptoms
Malaise/Weight Loss
Give four causes of Thoracic Back Pain
Poor posture
Trauma
Herniation
Osteoporosis
What is Schuermann’s Disease?
Vertebrae grow unevenly in childhood, with the posterior growing faster leading to exaggerated kyphosis
Give three red flags for Thoracic Back Pain
Trauma
20>Age or >50
HIV/Drug abuse
How would you manage simple back pain?
Promote activity not bed rest
Low dose short course NSAIDs (paracetamol is ineffective)
Weak Opioids
How would a Tension Headache present?
Bilateral Squeezing Pain
May have associated neck pain
Responsive to OTC medication
How would a Migraine Headache present?
Unilateral and throbbing
Nausea
Photophobia
Aura (Zig Zag lines)
How would a Cluster Headache present?
Typically occurs at night
Excruciating/Sharp/Penetrating around one eye
Usually lasts 45-90 minutes
State four uncommon types of Primary Headaches
Valsalva Headache (when coughing) Primary Exertional (After exercise) Primary Sexual (Peaking at orgasm) SAH
State four types of SECONDARY headaches
Medication Overuse
Referred from TMJ/Sinusitis/Tooth Ache
Temporal arteritis
Hypertension
How would a medication overuse headache present?
- Present on atleast 15 days of the month
- History of regular use of Triptans/Opioids/Paracetamol/NSAIDs
- Often worse in the morning and after sleeping
- May coexist with depression and sleep disturbance
How would you manage a Tension Headache?
Reassurance and advice on stress management
Ibuprofen/Asparin/TCA (eg Amitryptylline if frequent - SE is dry mouth)
State 5 triggers of Migraines
Stress Sleep Deprivation Dietary (Cheese/Chocolate/Alcohol) Menstruation Weather
How would you manage a Migraine?
Address triggers
1) Asparin/Ibuprofen/Buccal Prochlorperzine for nausea
2) Rectal Diclofenac and Rectal Domperidone
3) Triptans (5HT1 Antagonists)
What situations are Triptans contraindicated?
Uncontrolled Hypertension, CHD, CVD
Describe the 3 prophylactic drugs for Migraines
Beta Blockers (Atenolol) Amitryptylline Sodium Valproate/Topirimate
How would you manage Cluster headaches?
Good sleep hygiene
Smoking Cessation
Acute Attack - Sumatriptans (Subcut), 02 (15 min up to 5 times a day)
What prophylactic drugs can you use in Cluster Headaches?
Verapamil
Prednisolone
Lithium
Describe a 5 step management plan for Medication Overuse Headache
1) Explanation
2) Advice (stop headache medication for atleast one month, 3 week course of ibuprofen, will get withdrawal headaches)
3) Follow Up
4) Prophylaxis (Prednisolone or Amitryptyline)
5) Review
Define Sprain and Strain
Sprain - Ligament injury
Strain - Overstretching of muscles or tendons
Describe the management of Sprains and Strains (PRICE, avoid HARM)
Protect from further injury, Rest for 48-72hrs, Ice (15-20mins every 3hrs), Compression, Elevation
Heat (encourages blood flow so increases bruising and inflammation), Alcohol, Running, Massage
What is Sinusitis? Name the four Sinuses
Inflammation of the lining of one or more sinuses
Ethmoidal, Frontal, Sphenoidal, Maxillary
State 4 risk factors for Sinusitis
URTI
Allergy
Asthma
Smoking
Name 3 causative organisms of Sinusitis
Streptococcus Pneumoniae
Haemophilus Influenza
Moraxella Catarrhalis
How would you classify Sinusitis by timescale?
Acute: 7-30d
Subacute: 4-12w
Chronic: >90d
How would Sinusitis present?
Non resolving cold
Pain over affected sinus (worse on bending forward)
How should you examine each Sinus respectively?
Frontal - Press upwards on medial side of supraorbital ridge
Maxillary - Press on anterior wall below inferior orbital margin
Ethmoidal - Press against medial wall of orbit
Describe four conservative managements for Sinusitis
- Reassure the patient that it will take a bit longer to resolve than a normal cold
- Warm face packs
- Nasal irrigation with warm saline
- Paracetamol/Ibuprofen
Describe two pharmacological managements for Sinusitis. When should these be used?
High dose nasal steroid for 2/52 Deferred Abx (5d of Pen V)
If unwell for >10d
What is the difference between Tonsilitis, Pharyngitis and Laryngitis?
Tonsilitis - Inflammation of the tonsils
Pharyngitis - Inflammation of the oropharynx
Laryngitis - Inflammation of the Larynx (associated with hoarseness)
Describe 5 possible presentations of Tonsillitis
Pain in throat (worse on swallowing) Referred pain to ears Headache Loss of Voice Abdo Pain (in children)
Give two differentials of Tonsilitis and how they would present?
Coxsackie Virus - Blisters on tonsils and roof of mouth
Glandular Fever - Extreme lethargy and enlarged spleen
Describe the features of the FEVER PAIN score, and how it is used.
Fever Pain Attend rapidly Inflamed tonsils No cough/coryzal symptoms
0 or 1 = No abx
2 or 3 = Delayed abx
4 or 5 = Abx
What antibiotics are given for Tonsillitis?
Phenoxymethylpenicillin 500mg QDS for 5-10d
What are the requirements for a Tonsillectomy?
Atleast 7 episodes in the past year
OR
5 episodes each year for the past 2 years
Give 3 complications of Tonsillitis
Peritonsillar Abscess
Acute Otitis Media
Guttate Psoriasis
