GP - Year 3 Flashcards
Pharyngitis and Tonsillitis Pathophysiology: Causes: Symptoms: Investigations: Management: Complications:
Pathophysiology: Pharyngitis = oropharynx inflammation, tonsillitis = inflammation of the tonsils. Mostly viral.
Causes: Rhinovirus, Coronavirus, Influenza A/B, Streptococcus pyogenes (group a b-haemolytic strep) - can lead to scarlet fever, EBV
Symptoms: Sore throat, worse on swallowing, visible white patches or pus at the back of the throat, fever >38 degrees, headache, body aches, swollen lymph nodes, rash if scarlet fever
If EBV: Splenomegaly and LUQ pain, overwhelming fatigue, rash
Investigations: Examine the neck, particularly for pharyngeal exudate and cervical lymphadenopathy, fluid intake assessment
Management: identify if strep is the cause - FeverPAIN determines likelihood of strep infection:
If >3 then give Phenoxymethylpenicillin for 7 days, 500mg
Complications: Self-resolving within 2 weeks - EBV can lead to many months of lethargy, scarlet fever can lead to scarlet rash, otitis media, peri-tonsillar abscess, rheumatic fever
FEVER PAIN - define each section and what score would lead to risk of Strep
Fever > 38 degree Purulence of tonsils Attend rapidly within 3 days Inflamed tonsils No cough 1 point each, >3 = phenoxymethylpenicillin 500mg for 7 days
UTI (Lower) Pathophysiology: Infective organisms: Symptoms: Risk factors: Investigations: Management: Complications:
Pathophysiology: Infection
Organisms: E. coli (80%), Klebsiella
Symptoms: Fever, dysuria, frequency, lower back pain, burning when peeing, urgency, nocturia
Risk factors: Age >50, Female, Obstruction eg. BPH/Stones, Diabetes and immunosuppression, indwelling urinary catheter, ureteric reflux in children
Investigations: MSU sample in complicated cases, urine dipstick
Management: Increase fluid intake
Uncomplicated: Nitrofurantoin 3 days, Complicated: Nitrofurantoin 7 days
Complications: Pyelonephritis, Prostatitis, Sepsis, Renal Stones
Acute Bronchitis Pathophysiology: Signs: Investigations: Management: Complications:
Pathophysiology: Inflammation of the bronchi (LRTI). Usually a viral infection eg. rhinovirus, Influenza A/B, RSV.
Signs: Coarse crackles, bronchial breathing, increased vocal resonance, reduced air entry
Investigations: CURB-65, Pulse Oximetry, Auscultate lungs, CRP, CXR in secondary care
Management: Salf-care with fluid, paracetamol, cough medicines, no antibiotics, stop smoking, give safety netting advice
Complications: Mild and self-limiting, lasting around 2-3 weeks. Can become pneumonia or cause post-bronchitis syndrome (6 month cough).
Pneumonia Pathophysiology: Causative organisms: Investigations: Management: Complications:
Pathophysiology: Infection of the lung tissue in which the air sacs become filled with micro-organisms, fluid and inflammatory cells.
Organisms: Streptococcus pneumoniae (most common)
Others: H Influenzae, Moraxella Catarrhalis, Legionella pneumophila, Mycoplasma pneumoniae, Chlamydia
Investigations: CURB-65 (CRB-65 in GP), Pulse Ox, CRP, CXR in secondary care
On auscultation: Coarse crackles, bronchial breathing, increased vocal resonance, reduced air entry
Management: CRB-65 - Give Amoxicillin or Co-Amoxiclav based on score - >3 = urgent admission, >2 = give antibiotics
Complications: Pleural effusion, lung abscess, ARDS, sepsis
CURB-65 - define and give breakdown - what score leads to urgent admission?
Assess mortality rate from pneumonia:
- Confusion
- Urea >7mmol/L
- Respiratory rate > 30
- Blood pressure <90 or Diastolic <60
- > 65 years old
Conjunctivitis Pathophysiology: Types: Causative organisms (for each): Symptoms: Investigations: Management:
Pathophysiology: Infection/inflammation of the conjunctiva, the membrane lining the anterior part of the sclera, leading to dilatation of the conjunctival vessels, leading to hyperaemia and oedema of the conjunctiva
Types: Viral conjunctivitis (80%), Bacterial (mostly kids, can be very bad if gonorrhoea related), Ophthalmia Neonatorum (first 4 weeks, due to chlamydia or gonorrhoea), Allergic
Causative organisms:
Viral: Herpes, Varicella, Molluscum contagiosum
Bacterial: Strep pneumoniae/staph aureus
ON: Gonorrhoea/Chlamydia
Symptoms: Grittiness, eye redness, watery discharge
Investigations: Clinical diagnosis, refer to ophthalmology if red flags eg. trauma history, reduced visual acuity, neonate, photophobia, peri-orbital or orbital cellulitis
Management: Viral - self resolves within 7 days, Bacterial, give chloramphenicol eye drops delayed
Uveitis Pathophysiology: Causes: Symptoms: Investigations: Management: Complications:
Pathophysiology: Inflammation of the uveal tract (iris, ciliary body, choroid) - 5-10% of visual impairment worldwide, 25% of legal blindness
Causes: Autoimmune eg. Reiter’s, Ankylosing Spondylitis, RA, Infection eg. Herpes, CMV, Trauma
Symptoms: Eye redness, pain, light sensitivity, blurred vision, floaters - usually unilateral and gradual development of symptoms
Investigations: Vision assessment, fundoscopy, tonometry (measure IOP)
Management: Refer for same-day assessment by ophthalmologist if eye pain with reduced vision
Complications: Vision loss, Glaucoma
Back Pain (Mechanical) Differentials: Risk factors: Management: Presentations (of differentials): Investigations: Management: Complications:
Lumbosacral pain of the back, affects 60% of the pop
Differentials: MSK, Sciatica, Cauda Equina, Vertebral Fracture, Malignancy, Pancreatitis, Ankylosing Spondylitis, Infection eg. discitis
Risk factors: Obesity, Physical activity, Heavy Lifting, Depression
Management: Red flags = admit, STarT BACK tool to risk stratify, NSAIDs, Diazepam if muscle spasms present
Presentations (of differentials): Ankylosing spondylitis (worse at night, worse in the morning, >3 months), Osteoporosis (non-specific pain, risk factors), Shingles (dermatomal rash), Sciatica (unilateral leg pain, radiates, covered elsewhere)
Investigations: Rule out red flags for everything
Complications: Chronicity, depression, reduced productivity
Cauda Equina
Red flags:
Immediate management:
Red flags:
- Perianal numbness/loss of anal tone
- Faecal incontinence
- Urinary retention
- Bilateral sciatica
- Sexual dysfunction
- Motor weakness in legs
Management: MRI + Spinal Decompression
Sciatica
Pathophysiology:
Symptoms:
Investigations:
Pathophysiology: Impingement of any part of the nerve from L4-S3
Symptoms: Unilateral leg pain radiating below the knee to the foot or toes, numbness/tingling and paraesthesia
Investigations: Positive straight leg raising test (greater pain below the knee)
Acutely unwell child
A-E assessment of an unwell child:
A: Noisy breathing? Barking cough? Nasal flaring? Tripod position?
B: Sniffing/tripod position? Tachypnoea (>60 BPM), Stridor, Sats
C: Check for wet nappies, Mucous membranes, Anterior fontanelle, HR (up to 160 is normal)
D: Activity level? Usual self? High-five testing
E: Tugging ear (otitis media)? Pain on eating? Vomiting? Pyrexia and response to paracetamol? Rash?
Meningitis Pathophysiology: Causes: Symptoms: Signs: Risk factors: Investigations: Management: Complications:
Pathophysiology:
Causes:
Symptoms:
Signs:
Risk factors:
Investigations:
Management:
Complications:
Sepsis
Name the Red Flags of sepsis:
Define sepsis 6:
What is the risk stratifying score for Sepsis?
Name the Red Flags of sepsis:
Define sepsis 6:
What is the risk stratifying score for Sepsis:
What can affect child development rates?
Poverty Environment Health status eg. long-term disability Family (love) Gender Genetics eg. height
What can affect child development rates?
Poverty Environment Health status eg. long-term disability Family (love) Gender Genetics eg. height
Child Health Surveillance:
What are the aims of the healthy child programme?
What screening occurs?
Healthy child programme:
