GP and primary healthcare

Question 1

what is chronic fatigue syndrome

Answer 1

AKA myalgic encephalomyelitis

extreme tiredness

Question 2

symptoms of CFS/ME

Answer 2

extreme tiredness all the time

tiredness after resting/sleeping

taking a long time to recover after physical activity

problems sleeping

waking often during the night

problems with thinking, memory, and concentration

Question 3

associated symptoms of CFS/ME

Answer 3

muscle/joint pain
headaches
sore throat
flu-like symptoms
feeling dizzy/sick
heart palpitations

Question 4

ME/CFS is more common in

Answer 4

women

Question 5

ME/CFS tends to develop

Answer 5

between mid 20s and mid 40s

Question 6

diagnosis of ME/CFS

Answer 6

clinical

no diagnostic test

bloods/urine test to eliminate other diagnoses

Question 7

causes/triggers of ME/CFS

Answer 7

viral infections
bacterial infections
immune system problems
hormone imbalance
genetic

Question 8

treatment and management of ME/CFS

Answer 8

lifestyle changes

specialist treatment

• CBT
• energy management

medication

• analgesia
• TCAs

Question 9

define acute bronchitis

Answer 9

• lower respiratory tract infection caused by inflammation of bronchial airways.
• Usually self-limiting (4 weeks)

Question 10

Causes of acute bronchitis

Answer 10

Viral (most common)

• rhinovirus
• enterovirus
• influenza A/B
• coronavirus
• respiratory synctial virus
• adenovirus

Bacterial

• Strep pneumonia
• Haemophilius infleunza
• Moraxella cattarhalis

Question 11

Hx of acute bronchitis

Answer 11

HPC:

• onset/ duration of cough (usually 2-3 weeks)
• type of cough (dry)
• midly ill: FEVER
• may have associated symptoms: difficulty breathing (dyspnoea), breathlessness, wheeze, pleuritic chest pain, sputum

SHx:

• smoking

Question 12

Differentials for acute bronchitis

Answer 12

• Community acquired pneumonia (productive cough - green sputum, CRB-65 confusion, raised RR, low bp >65, high HR, lethargy)
• Upper respiratory tract infection
• COVID
• acute asthma exacerbation
• COPD
• bronchiectasis
• PE
• pneumothorax

Question 13

Examination findings for acute bronchitis

*resp exam

Answer 13

• I: difficulty breathing, raised temp
• P:
• P:
• A: wheeze, rhonci (bubbling sounds in large airway)- improved with coughing

Question 14

Investigations for acute bronchitis

Answer 14

*Not essential in GP

Bedside:

• sputum culture (exclude pneumonia)

Bloods:

• FBC - raised WCC (infection)
• CRP (inflammatory marker)

Imaging:

• CXR (usually normal + exclude pneumonia)

Question 15

Management of acute bronchitis

Answer 15

• usually conservative treatment - keep hydrated, paracetomol/ibuprofen for symptomatic relief, home remedies (honey)
• Lifestyle: stop smoking
• Avoid antibioitic treatment if not serious as side effects/ antibiotics resistance
• Advise patient - symptoms usually resolve in 3-4 weeks, if they worsen seek help again

Question 16

When to offer antibiotics for acute bronchitis?

Answer 16

• seriously unwell
• CRP >100mg/L
• consider backup antibiotics prescriptions for- comorbidities (heart,lung, kidney, CF), >80 + on corticosteroids/ diabetes/previous hospital admissions

Question 17

What antibiotics are prescribed for severe acute bronchitis?

Answer 17

>18 = doxycycline (broad-spectrum tetracycline - inhibits bacterial protein synthesis by bindint to 30s ribosomes)

pregnant/ <18 = amoxicillin (broad-spectrum beta-lactam - inhibits bacterial cell wall synthesis)

Question 18

define tonsilitis

Answer 18

inflammation of tonsils

• acute (lasts 3-4 days)
• reccurrent (multiple times per year)

Question 19

risk factors for tonsilitis

Answer 19

• children (5-15) - mainly bacterial
• exposure to germs/kids (in schools/nurseries)

Question 20

causes of tonsilitis

Answer 20

• Streptococcus bacteria (most common)- Strep throat

Viral:

• adenovirus
• epstein-barr virus (infectious mononucleosis)
• herpes simplex virus
• influenza virus
• enterovirus

Question 21

Symptoms + signs of tonsilitis

Answer 21

Symptoms:

• sore throat
• fever
• difficulty swallowing
• difficult breathing
• bad breath
• headache
• ear infection/ pain

Signs:

• swollen/ inflammed tonsils
• yellow/red patches on tonsils
• ulcers/blisters on tongue

Question 22

investigations for tonsilitis

Answer 22

Bedside:

• throat swab (-ve = viral tonsilitis)

Bloods:

• FBC (raised WCC= infection)
• CRP - inflammation

Question 23

management for tonsilitis

Answer 23

Bacterial cause:

• antibiotics (5 days)

Viral cause: (home remedies to manage symptoms)

• rest
• drink warm/cold fluids for throat pain
• eat smooth foods
• take lozegnes with benzocaine (numb throat)
• humidifier
• gargle with salt water
• analgesia (ibuprofen)

Recurrent tonsilitis >7 times per year

• tonsilectomy (remove tonsils)

Question 24

complications of tonsilitis (only if it’s bacterial infection- strep throat)

Answer 24

• otitis media (ear infection)
• pus
• obstructive sleep apnoea (difficulty breathing)
• scarlet fever (strep throat => bacterial infection causing blotchy rash- sore throat + high fever)
• sinusitis (face pain, blocked/runny nose, headache)
• rhematic fever (untreated scarlet fever/strep throat=> arthritis, CHF, fatigue)

Question 25

How to prevent tonsilitis?

Answer 25

• good hygiene
• wash hands
• don’t share food/ toothbrushes/ drinks
• stay away from people with sore throats