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GP block > Minor illness > Flashcards

Minor illness Flashcards

1
Q

What are the different ear infections?

A
  • Otitis media
  • Otitis externa
  • Otitis media w effusion
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2
Q

What is otitis media? Signs and sx

A

Middle ear infection common in children
Sx - otalgia, temp
Signs - red bulging TM, child pulls on ear, discharge in ex ear canal

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3
Q

What is the treatment of otitis media?

A
  • Amoxicillin/clarithromycin if allergy for 5 days
  • Reg paracetamol/ibuprofen for pain
  • If a child is < 3 months or 3-6 months w 39 degree temp + they need admitting
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4
Q

What is chronic suppurative otitis media?

A

Ongoing inflam and perforation of TM w discharge for more than 2 weeks, need referral to ENT.

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5
Q

What are the complications of otitis media?

A
  • Facial nerve involvement

- Mastoiditis (risk of osteomyelitis)

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6
Q

What is otitis externa? Signs and symptoms

A

External ear infection, also called swimmer’s ear.
Sx - otalgia, itchy ear, discharge, can get hearing loss
Signs - red ear canal (inflam), tender tragus or pinna, can get pinna cellulitis

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7
Q

How is otitis externa treated?

A
  • Aural toilet = topical treatments can be applied more effectively
  • Acetic acid spray for 7 days or Neomycin (topical abx) + corticosteroid 7 days
  • If pinna cellulitis = oral flucloxacillin or doxycycline
  • Keep ears dry and clean, avoid swimming until resolved
  • Simple analgesics as needed
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8
Q

What is otitis media w effusion?

A

Glue ear - fluid due to Eustachian tube dysfunc, can see bubbles and retracted TM. Fluid increases risk of infection.

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9
Q

How is otitis media w effusion managed?

A

3 months of watchful waiting in children as spont resolution is common - need to monitor childs hearing and lang development. Then:

  • Autoinflation to equilibrate pressure and drain fluid
  • Hearing aids if hearing loss
  • Grommets surgically inserted to allow pressure equilibrate
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10
Q

What is sinusitis?

A

Nasal blockage or nasal discharge w facial pain (worse on leaning forward) and reduced smell. Usually after a cold.
O/E - tenderness around sinuses, nasal inflam and mucosal oedema on rhinoscopy.

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11
Q

When should you suspect the causes of sinusitis is bacterial?

A
  • > 10 days sx
  • Purulent discharge
  • Severe local pain
  • > 38 degrees
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12
Q

What is the management of sinusitis?

A
  • Advise sinusitis normally takes 2-3 weeks to get better but use simple analgesics
  • Can suggest nasal saline or decongestants
  • Safety net - sx do not improve after 3 weeks or they become systemically unwell
  • If had sx >10 days no improvement could give nasal corticosteroid for 14 days to improve sx
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13
Q

How do you treat bacterial sinusitis?

A
  • Phenoxymethypenicillin /doxycycline for 5 days

- Systemic illness - Co-amoxiclav or clarithromycin, 5 days

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14
Q

What are the signs and symptoms of tonsilitis?

A

Signs - tonsillar exudate, enlargement and erythema

Sx - sore throat, not eating or drinking, temp

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15
Q

What are some differentials for sore throat?

A
  • Tonsilitis
  • Pharyngitis
  • EBV - glandular fever
  • Common cold/COVID
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16
Q

What is the feverPAIN score?

A 
Fever >38
Purulence
Attend rapidly
Severely inflam tonsils
No cough
>4 = immediate abx, 2-3 = delay abx for 3 days.
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17
Q

What is the treatment for bacterial tonsilitis?

A

Phenoxymethypenicillin/clarithromycin for 10 days

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18
Q

What are the signs and symptoms of UTIs in women?

A

Signs - suprapubic or flank tenderness, +ve urine dip
Sx - dysuria, increased freq and urgency, feel like need to go but don’t, haematuria, cloudy wee, suprapubic and back pain, loss of continence

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19
Q

How do you manage UTIs in men?

A

Nitrofurantoin or trimethoprim 7 days.

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20
Q

How do you manage UTIs in pregnant women?

A

Nitrofurantoin or cefalexin, 7 days. Can’t use trimethoprim as a its a folic acid sequestrant.

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21
Q

What are the signs and symptoms of UTIs in men?

A

Sx - dysuria, freq, urgency, nocturia, suprapubic pain
Signs - tender, odorous and cloudy urine, haematuria
Need to consider other causes of urinary sx - sexual hx.

22
Q

When do you suspect a UTI in children?

A

Fever, freq, dysuria, abdo pain, loin tenderness, vom, poor feeding, loss of continence, dysfunction voiding.

23
Q

How do you manage UTI in children?

A
  • <3 months = refer
  • > 3 months = cefalexin/nitrofurantoin 3 days
  • Pylonephritis >3 years = cefalexin 7-10 days or co-amoxiclav 7-10 days
24
Q

What are the symptoms of thrush and how is it caused?

A
  • Itching, soreness and irritation
  • Dysuria and dyspareunia
  • Vaginal discharge = white, cottage cheese
    Caused by Candida albicans, overwashing = removes good bacteria and bad fungus can overgrow.
25
Q

How do you manage thrush?

A
  • Canesten cream
  • Fluconazole PO, single dose
  • Pessary = clotrimazole
  • No sex until completely gone, 2 weeks
  • Avoid overwashing of vagina
26
Q

What is bacterial vaginosis?

A

Infection due to change in balance of vaginal bacteria. Half of people w it are asymptomatic but sx = smelly, thin, grey discharge w/o itching or soreness.

27
Q

What is the management of BV?

A
  • If high risk for STI to GUM clinic for testing

- Metronidazole 7 days or topical gel at night 5 days

28
Q

What is rubella? What are the clinical features?

A

Viral illness that is vaccinated against. It can be very serious during pregnancy.
CF - like red/pink maculopapular rash, lymphadenopathy, arthritis/arthralgia, non specific sx

29
Q

What is congenital rubella syndrome?

A

When new born babies get rubella from maternal infection during pregnancy.
In early pregnancy can cause pregnancy losses and causes severe birth defects - hearing impairment or cataracts mainly.

30
Q

What is the 6in1 vaccine?

A
  • Diphtheria
  • Hep B
  • Haemophilus influenzae type B
  • Polio
  • Tetanus
  • Whooping cough/pertussis
    Have 6 doses within first 16 weeks.
31
Q

What are the other childhood vaccines?

A
  • MMR
  • MenB and MenC
  • Rotavirus
  • PCV
  • 4in1 booster - diphtheria, polio, tetanus, whooping cough
32
Q

What are the teenage vaccines?

A
  • HPV vaccine
  • 3in1 booster - tetanus, diphtheria, polio
  • MenACWY to prevent against meningitis and sepsis when going to uni
33
Q

What can be a cause of sleep apnoea in children and what is the treatment?

A

Adenoid hypertrophy - get snoring when sleeps, wakes up in the night because not breathing, can get recurrent ear and sinus infections.
Treat = adenoidectomy and normally full recovery

34
Q

What is Fifth disease/slapped cheek syndrome?

A

Mainly in winter and spring, fever and rash on cheeks that is common in children. Rash can last 1-3 weeks.
Caused by parvovirus and spread through resp secretions.

35
Q

How do you treat slapped cheek syndrome?

A
  • Antihistamines
  • Paracetamol
  • Moisturisers
  • Self limiting
36
Q

What are childhood xanthems?

A

Rashes and fevers, mainly viral

These include measles, scarlet fever, rubella

37
Q

Why is parvovirus infection serious in pregnancy?

A

Can get problems with foetal growth and development

38
Q

Can you get chicken pox from shingles and shingles from chicken pox?

A

If you haven’t had chicken pox you can get it from chickenpox and shingles. Can’t get shingles from someone with chickenpox and can’t get shingles from someone with shingles. To get shingles you have to have had chickenpox and it becomes reactivated.

39
Q

Where does varicella zoster virus lay dorment

A

Dorsal root ganglia - shingles happens on dermatomes and causes rash in dermatome supplied by that nerve root.

40
Q

How do you treat chickenpox in adults or immunocompromised people?

A

Aciclovir, but don’t need to treat in children as it isn’t so severe.

41
Q

How do you treat chickenpox in children?

A
  • Paracetamol to bring down temperature

- Don’t use ibuprofen - causes necrotic spots in chickenpox, rare but don’t use

42
Q

What are the causes of primary and secondary headaches?

A

Primary - migraine, tension type, cluster

Secondary - trauma, infection, med overuse, neoplasm, vascular disorder

43
Q

What qs are important in hx of headaches?

A
  • Onset, duration, freq, pattern
  • Pain character
  • Associated = aura, N, tearing, eyelid swell/rhinorrhoea
  • Trauma and posture
  • PMH - immunosuppression and malignancy
  • DH for headaches
44
Q

What do you need to look for on examination of pt presenting with headaches?

A
  • BP, temp, sats
  • Fundoscopy
  • CN exam and PNS exam
  • Temporal arteries if >50
45
Q

What are the CF of cluster headaches?

A
  • Attacks last 15-180 mins
  • Restless, agitated, can’t lie still in attack
  • Attacks occur at same time in the day
  • Trigger for attacks eg. warm air, stress, cigarettes, poor sleep
  • Severe unilateral orbital pain
  • Eyelid swell and teary eye, rhinorrhoea
46
Q

What is the management of cluster headache?

A
  • Sumatriptan = PO, subcut, intranasal = seratonin agonist
  • Refer to neurologist if first presentation, breastfeeding or new sx
  • Record a headache diary
47
Q

What are the CF of med overuse headaches?

A

Headache that worsens in a person taking meds for treatment of previously diagnosed primary headache disorder

  • > 15 days per month
  • > 10 days opioids, analgesics, triptans per month = overuse
  • > 15 days simple analgesics per month = overuse
48
Q

What is the management of med overuse headache?

A

Explain what MOH is and that w/drawal of meds is the treatment for at least 1 month.
Warn pt that it will initially worsen sx and record headache diary.

49
Q

What are the clinical features of tension type headaches?

A
  • Bilateral headaches, tightening feeling
  • Pain not aggravated by ADL, no N or neurological sx
  • Pericranial tenderness on palpation
50
Q

What is the management of tension type headaches?

A
  • Simple analgesia, no opioids needed
  • Identify comorbidities and manage them
  • Low dose amitriptyline prophylaxis is a possibility
  • Keep a headache diary

GP block (14 decks)

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