GP Flashcards
Acute bronchitis: definition, cause, symptoms
Definition: inflammation of the bronchial airways without pneumonia
Causes: Rhinovirus, influenza parainfluenza and coronavirus
Symptoms: Breathlessness, wheeze, pleuritic pain, fever, sore throat, rhinorrhoea. Diagnosed clinically
Acute Bronchitis management
- outpatient, stop smoking, over the counter remedies
- Safety netted for worsening or persistent symptoms
- Doxycyline if CRP >100 or the person is >65 and/or has comorbidities
- If CRP >20 can offer delayed prescription
Acute bronchitis: complications and prognosis
Mild and self limiting, though cough may persist up to 6 months. Can be complicated by development of pneumonia
Anal fissure: risk factors
- constipation
- Pregnancy
- inflammatory bowel disease
- sexually transmitted infections e.g. HIV, syphilis, herpes
Anal fissures: features
- painful, bright red, rectal bleeding
- Anal spasms, skin tag can be visible
- Majority occur on posterior midline, if not consider Crohns
- Inv: clinical, can do digital rectal exam if tolerates
Management of acute anal fissure <1 weeks
- soften stool
- dietary advice: high-fibre diet with high fluid intake
- bulk-forming laxatives (Ispaghula husk) are first-line - if not tolerated then lactulose should be tried
- lubricants such as petroleum jelly may be tried before defecation
- topical anaesthetics: lidocaine cream
- analgesia
Management of a chronic anal fissure
- Laxatives and lubricants
- Topical GTN (nifedipine) is first line, second line is topicl calcium channel blockers or oral nifedipine
- If topical GTN isnt effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin
- If fissure <6 weeks they are acute if >6 weeks they are chronic
Bells palsy
Bell’s palsy is an idiopathic syndrome that causes damage to the facial nerve leading to a lower motor neuron facial palsy. Tends to affect 20-40 and pregnant women
No known cause might be due to viral reactivation of HSV-1 or EBV
Diagnosis is primarily clinical
Bell’s palsy signs and symptoms
- Acute but not sudden onset of unilateral lower motor neuron facial weakness, tends to affect the forehead
- Postauricular otalgia which might precede the paralysis
- Hyperacusis, dry eye
- Nervus intermedius symptoms, such as altered taste and dry eyes/mouth.
- ‘Numbness’ or ‘heaviness’
Management of Bell’s palsy
- 50mg of oral prednisolone followed by a taper
- Supportive treatment: artificial tears and lubricants and eye patch
- Long term: pain management, physical therapy, counselling
- Most people fully recover but a small proportion have incomplete recovery
- If paralysis not resolved in >3 weeks refer to ENT
Blepharitis
Inflammation of the eyelid, leading cause of dry eye disease. Symptoms: bilateral ocular irritation, foreign body sensation, burning, redness, crusting. Causes: atopic dermatitis, seborrheic dermatitis, acne rosacea, Demodex mites.
Blepharitis treatment
lid hygiene (warm compress, eyelid massage, cleaning), topical antibiotics (chloramphenicol), low-dose oral tetracyclines, omega-3 supplements.
Hordolum (stye) definition and treatment
Staphylococcal infection of an eyelash follicle (external) or meibomian gland (internal). Presents as tender, red eyelash follicle swellings.
- Treatment: warm compress, eyelash removal, incision with a sterile needle, topical/oral antibiotics if recurrent or severe.
Chalazion definition and treatment
Non-infectious granulomatous inflammation of a meibomian gland. Presents as painless red eyelid cysts. Often associated with blepharitis and acne rosacea.
- Treatment: warm compress, eyelid massage. Persistent cases require ophthalmology referral for incision and curettage.
Entropion definition and treatment
Inward turning of the eyelid, leading to corneal irritation and potential ulceration. Causes: age-related changes, eyelid irritation, scarring, trachoma.
- Treatment: examine for corneal abrasions/ulcers, prescribe lubricants, advise eyelid taping, refer for surgical correction.
Ectropion definition and treatment
Outward turning of the eyelid, often due to age-related changes or facial nerve palsy (Bell’s palsy). Presents with a sore, red, watery eye due to disrupted tear drainage.
- Treatment: lubricating eye drops, taping eyes shut at night, corrective surgery for severe cases. Urgent referral for exposure keratopathy.
Trichiasis definition and treatment
Inward-growing eyelashes due to damaged follicles, causing corneal irritation and potential ulceration. Often due to chronic blepharitis.
- Treatment: epilation of eyelashes, electrolysis, or laser ablation for more permanent solutions. Examine for corneal damage.
BPH: definition, symptoms and Investigations
Definition: non-malignant enlargement of the prostate gland. Occurs with age, can compression of the urethra and LUT’s symptoms.
Symptoms: Hesitancy, weak stream, frequency, urgency, nocturia, sensation of incomplete emptying
Investigations: assess IPSS score, digital rectal exam, do PSA if suspect prostate cancer.
Management of BPH
- Alpha blockers like Tamsulosin and 5-alpha reductase inhibitors i.e. Finasteride
- Alpha blockers offered if IPSS >8 provides symptomatic relief but doesn’t affect prostate size. Dont give if falls risk. First line
- High risk of progression and enlarged prostate: 5-alpha reductase inhibitors (reduce prostate size)
- Surgery: TURP or laser prostatectomy
Breast abscess: definition, cause, symptoms, investigations
The accumulation of pus within an area of breast tissue, often a complication of infectious mastitis
Cause: S.aureus
Symptoms: Fever, malaise, breast pain, erythema, fluctuant mass
Investigations: US, Needle aspiration (diagnostic and therapeutic)
