Infection in primary care Flashcards
Differentials for rhinorrhoea, fever and yellow mucus discharge
Common cold - symptoms peak at day 3
Acute bacterial sinusitis > 10 days
Viral sinusitis
Allergic rhinitis
What organism commonly causes acute bacterial sinusitis
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Staph aureus
Ix for sinusitis
Anterior rhinoscopy
Mx for sinusitis
High dose nasal steroid 14 days - fluticasone
Back up abx if symptoms worsen - phenoxymethylpenicillin
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
When to refer to hospital for sinusitis
Severe systemic infection
Orbital complications
Cranial complications
Complications of sinusitis
Orbital:
- cellulitis
- abscess
- cavernous sinus thrombosis
Intracranial:
- meningitis
- encephalitis
- abscess
- venous thrombosis
Bones:
- osteomyelitis
Progression to osteomyelitis
Earache differentials
Otitis interna
Otitis media
Trauma
Otitis media with effusion presentation
Commonly presents in children
Conductive hearing loss rather than pain
Chronic suppurative otitis media presentation
Symptoms present for > 2 weeks
Ear discharge which relieves pain
Otitis externa presentation
Red, swollen ear canal with shedding of scaly skin
Diagnosis otitis media
History
Otoscopy
Pathogens that cause otitis media
Haemophilus influenzae
Streptococcus pneumoniae
Streptococcus pyogenes
Risk factors for otitis media in adults
Smoking
Increased contact with children
Otoscopy findings for otitis media
Red yellow colour
Bulging
Loss of landmarks
Perforation with discharge
Mx of otitis media
Self limiting 3 - 7 days
Paracetamol
NSAIDS
If systemically unwell:
- amoxicillin immediately 5 -7 days
- erythromycin if pregnant
Immediate specialist referral for otitis media
- Severe systemic
- Mastoiditis
- Meningitis
- Intracranial abscess
- Sinus thrombosis
- Facial nerve palsy
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
- Topical retinoid - contraindicated in pregnancy
- contain benzoyl peroxide - Topical retinoid and topical abx - clindamycin
- Oral abx - doxycycline for max 3 months
- COCP - dyanette
- 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
