Self limiting 3 - 7 days Paracetamol NSAIDS If systemically unwell: - amoxicillin immediately 5 -7 days - erythromycin if pregnant

Infection in primary care Flashcards by Anmol Landa

Differentials for rhinorrhoea, fever and yellow mucus discharge

Common cold - symptoms peak at day 3

Acute bacterial sinusitis > 10 days

Viral sinusitis

Allergic rhinitis

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What organism commonly causes acute bacterial sinusitis

Streptococcus pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

Staph aureus

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Ix for sinusitis

Anterior rhinoscopy

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Mx for sinusitis

High dose nasal steroid 14 days - fluticasone

Back up abx if symptoms worsen - phenoxymethylpenicillin

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S/E of fluticasone

CUSHINGOID

Cataracts

Ulcers

Striae, thinning and bruising

HTN, hirsutism, hyperlipidaemia

Infections

Necrosis - AVN of femoral heal

GI upset

Osteoporosis

Insomnia

Diabetes

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When to refer to hospital for sinusitis

Severe systemic infection

Orbital complications

Cranial complications

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Complications of sinusitis

Orbital:

cellulitis
abscess
cavernous sinus thrombosis

Intracranial:

meningitis
encephalitis
abscess
venous thrombosis

Bones:
- osteomyelitis

Progression to osteomyelitis

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Earache differentials

Otitis interna
Otitis media
Trauma

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Otitis media with effusion presentation

Commonly presents in children

Conductive hearing loss rather than pain

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Chronic suppurative otitis media presentation

Symptoms present for > 2 weeks

Ear discharge which relieves pain

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Otitis externa presentation

Red, swollen ear canal with shedding of scaly skin

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Diagnosis otitis media

History

Otoscopy

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Pathogens that cause otitis media

Haemophilus influenzae

Streptococcus pneumoniae

Streptococcus pyogenes

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Risk factors for otitis media in adults

Smoking

Increased contact with children

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Otoscopy findings for otitis media

Red yellow colour

Bulging

Loss of landmarks

Perforation with discharge

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Mx of otitis media

Self limiting 3 - 7 days

Paracetamol

NSAIDS

If systemically unwell:

amoxicillin immediately 5 -7 days
erythromycin if pregnant

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Immediate specialist referral for otitis media

Severe systemic
Mastoiditis
Meningitis
Intracranial abscess
Sinus thrombosis
Facial nerve palsy

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Complications of otitis media

Otitis media with effusion

Recurrence

Hearing loss

Tympanic membrane perforation

Labyrinthitis

Cough differentials

Croup

Common cold

Asthma

Epiglottitis

Foreign body obstruction

Peritonsillar abscess

Epiglottitis presentation

non barking cough

Drooling

Fever

Head extension

Peritonsillar abscess presentation

Very gradual onset

Dysphagia

Tachypnoea

Stridor

Neck stiffness

Unilateral cervical adenopathy

Croup

Inflammation of the upper airways due to parainfluenza

barking cough
stridor
chest wall indrawing

mx of mild croup

Mild - barking cough

1 immediate dose of dexamethasone

Paracetamol

How long does croup symptoms take to resolve

48 hours

or barking cough replaced by wet congested cough

Mx of moderate to life threatening croup

Consider hospital admission Oxygen Oral dexamethasone whilst awaiting admission or nebulised budesonide or IM dexamethasone

Moderate croup

Barking cough Stridor Sternal recession at rest

Severe croup

Barking cough Stridor Sternal recession at rest with agitation and lethargy

Impending respiratory failure with croup

Barking cough Stridor Sternal recession at rest With fatigue, pallor and cyanosis

Classifications of acne

Mild: Non inflamed lesions Moderate: widespread with increased no. of inflammatory papules and pustules Severe: widespread papules, pustules and nodules with scarring

Acne rosacea

Transient flushing and erythema associated with inflammatory papules and pustules on cheeks

Mx of acne vulgaris

1. Topical retinoid - contraindicated in pregnancy - contain benzoyl peroxide 2. Topical retinoid and topical abx - clindamycin 3. Oral abx - doxycycline for max 3 months 4. COCP - dyanette 5. Dermatology referral

Differentials for child rash

Atopic eczema Allergic contact dermatitis Milaira Rubra - heat rash

Atopic eczema in children

Red Itchy Dry skin Nappy area is spared FHx

Mx of nappy rash

Conservative: - creams to protect skin around groin area - hydrocortisone if inflamed - oral flucloxacillin 7 days if confirmed skin swab

Differentials for eye pain

Bacterial conjunctivitis Blepharitis Style Meibomian cyst Acute glaucoma Scleritis

Scleritis presentation

Intense eye pain Blurred vision Sensitivity to light

Blepharitis presentation

Inflammation of the eyelid Crust around roots of eyelids Infected sebaceous gland

Bacterial conjunctivitis presentation

Acute conjunctival erythema Grittiness and burning Purulent discharge Mild pruritis Pre - auricular lymphadenopathy

Mx of conjunctivitis

Self limiting within 5 - 7 days Can prescribe: Topical abx: - chloramphenicol drops or ointment - fusidic eye drops

Red flags for conjunctivitis

Reduced visual acuity Headache and photophobia red sticky eyes in a neonate within 30 days History of trauma Copious rapidly progressive discharge Infection with herpes

Mx of otitis externa

Topical ciprofloxacin/dexamethasone - otomise ear spray

Commonest bacteria for stye

Staphylococcus epidermidis

Vaccination 6 in 1

``` Diptheria Hep B Haemophilus influenzae Polio Tetanus Whooping cough ```