GP Flashcards
What are the causes of tonsillitis?
Viral → most cases
Bacterial:
- group A strep. pyogenes (most common)
- strep. pneumoniae
- haemophilus influenzae
- staph aureus
Describe the presentation of tonsillitis?
- sore throat
- fever ↑ 38
- pain on swallowing
- o/e tonsils will be red, inflamed & enlarged
- tonsils may or may not have exudates
- may be anterior cervical lymphadenopathy
What is the centor criteria?
Used to estimate the probability that tonsillitis is due to bacterial infection and will benefit from abx
A point is given for each of the following features:
- fever ↑ 38
- tonsillar exudates
- absence of cough
- tender anterior cervical lymph nodes
Score of 3 or more means appropriate to offer abx
What is the FeverPAIN score?
Alternative to Centor Criteria
Fever during previous 24 hours
Pus on tonsils
Attended within 3 days of onset of symptoms
Inflamed tonsils
No cough of coryza
4-5 points is ~65% probability of bacterial tonsillitis
Management of tonsillitis?
Admission if immunocompromised, dehydrated, stridor, respiratory distress or peritonsillar abscess/cellulitis
Viral –> analgesia, frequent hydration, safety net → patient to return if fever ↑38 or pain has not settled in 3 days
Bacterial → abx if centor is 3 or more of if FeverPAIN is 4 or more, OR young infant, immunocompromised etc consider delayed rx
- penicillin V (phenoxymethylpenicillin) for 5-10 days or clarithromycin if allergic to penicillins
Define hypertension
Persistently raised high blood pressure:
clinical BP of 140/90 or above
ambulatory/home BP of 135/85 or above
Primary vs secondary hypertension
Primary = no identifiable underlying cause (has risk factors)
Secondary = underlying disease process causing HTN
Causes of secondary hypertension?
ROPED:
Renal disease (commonly renal artery stenosis)
Obesity
Pregnancy (pre-eclampsia)
Endocrine (hyperaldonsteronism/Cushing’s)
Drugs (alcohol, stimulants, steroids, NSAIDs, oestrogen, liquorice)
Hypertension risk factors?
Non-modifiable: increasing age, african heritage, family history
Modifiable risk factors: obesity, sedentary lifestyle, alochol, smoking, high sodium, stress
What is malignant hypertension?
An acute, severe elevation of BP → usually diagnosed due to retinal signs eg papilloedema, flame shaped haemorrhages, hard exudates, cotton wool spots
What are the complications of hypertension?
IHD eg angina or acute coronary syndrome
CVA eg stroke or haemorrhage
Vascular disease eg peripheral arterial disease, aortic dissection, aortic aneurysm
Hypertensive retinopathy
Hypertensive nephropathy
Vascular dementia
LVH
Heart failure
What are the stages of hypertension?
Stage 1: clinic 140/90 home 135/85
Stage 2: clinic 160/100 home 150/95
Stage 3: 180/120
Diagnosing hypertension?
Patients with clinic BP of 14/90 or more should have 24 ambulatory BP or home readings to confirm diagnosis
NICE recommends measuring BP in both arms → if difference is more than 15, sue the reading from the arm with the higher pressure
What are the investigations all patients with newly diagnosed BP should have?
Calculate QRISK → if above 10%, should be offered a statin
Identify end organ damage:
Urine albumin:creatinine ratio for proteinuria & dipstick for microscopic haematuria to assess kidney damage
Bloods: HbA1C, renal function, lipids
Fundus exam: for hypertensive retinopathy
ECG: for cardiac abnormalities, including left ventricular hypertrophy
What is the drug management for hypertension?
Step One:
HTN w/ T2DM: ACEi (ramipril) or ARB (candesartan)
HTN age <55 not black: ACEi or ARB
HTN age >55: CCB (amlodipine)
HTN w/ black heritage, any age: CCB
Step Two:
Can combine an ACEi/ARB with CCB or thiazide-like diuretic (indapamide)
Can combine a CCB with ACEi or ARB or thiazide-like diuretic
Step Three:
Combine all 3 drugs
Stage 4:
Serum potassium <4.5 or equal: all 3 drugs PLUS spironolactone
Serum potassium >4.5: all 3 drugs PLUS alpha blocker (doxazosin) OR beta blocker (atenolol)
What is infectious mononucleosis?
Condition caused by EBV (most common manifestation of EBV) →virus found in saliva of infected individuals, infection spread by sharing saliva, can be infectious for several weeks, causes few symptoms in childhood, more severe in adulthood/teenagers
What are the signs and symptoms of infectious mononucleosis?
Fever
Sore throat
Fatigue
Lymphadenopathy
Tonsillar enlargement
Splenomegaly
EXAM TIP: teen who comes in with sore throat and gets rash after taking amoxicillin
Mono causes a very itchy maculopapular rash in response to amoxicillin or cefalosporins