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Primary care > Minor illness > Flashcards

Minor illness Flashcards

1
Q

define the common cold

A

the conventional term used to describe a mild, self limiting, viral, upper respiratory tract infection characterised by nasal stuffiness and discharge, sneezing and sore throat and cough. no know treatment improves course

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2
Q

what is the most common cause of the common cold?

A

rhinovirus

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3
Q

how does the common cold spread, incubation period and where is at most common?

A

direct contact or aerosol
can remain infectious for several weeks, reaches peak at day 2-3, can last up to 3 weeks, only 2 weeks in children
young children at pre school and primary school more at risk
smokers have more resp sx and infection prolonged

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4
Q

what are the most common complications of rhinovirus>

A

sinusitis, lower respiratory tract infections and acute otitis media

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5
Q

what are the sx of the common cold and how is a diagnosis made?

A

diagnosis made on clinical fx
- sore throat
- nasal irritation, congestion, rhinorrhoea, sneezing (discharge becomes thicker and darker as infection progresses)
- cough
- hoarse voice from associated laryngitis
- malaise
other: fever, headache, myalgia, loss of taste and smell, eye irritability, feeling of pressures in ears/sinuses, fever

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6
Q

how is a common cold managed?

A

reassurance - common cold is self limiting and complications rare
sx relief - paracetamol/ibruprofen, if <5 only if have fever, OTC meds
abx and antihistamine are ineffective and can cause sx
rest
safety netting

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7
Q

define glandular fever

A

infectious mononucleosis - most commonly caused by EBV

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8
Q

how is glandular fever spread and what is its incubation period?

A

saliva - kissing, food and drink utensils, sexual contact, blood, organ transplants and intrauterine - most common aged 15-24
inc is 4-7 weeks, can be contagious for up to 18 months after infection
leads to lifelong latent carrier state - virus may reactivate but does not always cause sx

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9
Q

what is the disease course and complications of glandular fever?

A

self limiting - lasts 2 -4 weeks
upper airways obstruction, splenic rupture, neutropenia
if immunocompromised = hodgkin’s lymphoma, nasopharyngeal carcinoma
fatigue is common and can last a while

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10
Q

what triad is indicative of glandular fever?

A

fever, lymphadenopathy, sore throat
unless >40 can present atypically - unexplained fever and/or jaundice
usually asx in children

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11
Q

what investigations can be used in glandular fever?

A

FBC - lymphocytosis, atypical lymphocytes
monospot test - heterophile antibodies in immuncompetent
EBV serology <12 and immunocompromised

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12
Q

what are the ddx of glandular fever?

A

strep throat
leukaemia and lymphoma
rubella, acute toxoplasmosis, mumps, HIV

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13
Q

how is glandular fever managed?

A

sx - paracetamol and ibruprofen
reassurance - self limiting, fatigue is common
return to school/work
avoid heavy lifting/contact sports due to risk of splenic rupture
advise on ways to limit spread
hospital admission if serious complications

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14
Q

define allergic rhinitis

A

ige mediated inflammatory disorder of nose which occurs when the nasal mucosa being exposed and sensitised to allergens

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15
Q

what are the sx of allaergic rhinitis?

A

sneezing, nasal itching, rhinorrhoea, congestion
can results in sinusuits, asthma and nasal polyps

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16
Q

how can allergic rhinitis be classified?

A

seasonal - hayfever
perennial - throughout yr, house dust mites
intermittent - <4 days a week or less than 4 consecutive weeks
persistent - > 4 days a week or more than 4 consecutive weeks
occupations - eg flour

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17
Q

how should a hx be taken of allergic rhinitis?

A

type, frequency, peristence of sx
associated condiions - allergic conjunctivits, asthma or eczema
severity
housing, pets, occupation
drugs

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18
Q

how is allergic rhinitis managed?

A

nasal irrigation with saline
allergen advice and identify
intranasal antihistamine or non sedating oral or intranasal chromone if moderate
if severe - intranasal cortiosteroid during exposure
review 2-4 weeks
possible add on of intranasal decongestant or anticholinergic and short course of oral corticosteroids

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19
Q

how is allergic rhinitis managed?

A

nasal irrigation with saline
allergen advice and identify
intranasal antihistamine or non sedating oral or intranasal chromone if moderate
if severe - intranasal cortiosteroid during exposure
review 2-4 weeks
possible add on of intranasal decongestant or anticholinergic and short course of oral corticosteroids

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20
Q

when should referral be made for allergic rhinitis?

A

to ENT when
red flags
persistent
allergy testing required if house dust mite or animal dander avoidance being considering or if just diagnosis uncertain

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21
Q

define croup

A

laryngotracheobronchitis
common
age between 6mnths to 3 yrs
caused by virus - typically parainfluenza type 1 or 3
swelling of upper airway and odeema - narrow of subglottic region

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22
Q

what are the sx of croup?

A

sudden onset of seal like barking cough
voice hoarseness, stridor and/or resp distress
sx worse at night
and increase with agitation
prodromal, non specific upper resp tract conditions - cough, rhinorrhoea etc
mild to severe
with intercostal/sternal recession and impending resp failure being worst

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23
Q

how is croup managed?

A

sx within 48 hrs to 7 days resolve - at home
paracetamol and ibrupfoen for fever
safety netting for deterioration
hospital admission - if chronic lung disease, congenital heart disease, immumodeficiecny, RR>60, high fever, inadequate fluid intake
all receive single dose oral dexamethasone or inhaled budesonide

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24
Q

define otitis externa

A

diffuse inflammation of skin and subdermis of external ear canal - can involve pinna or tympanic membrane
acute <6 weeks, pseudomonas aeruginosa or staph aureus
chronic > 3 months, aspergillus species or candida
malignant - life threatening progressive infection causing osteomyelitis of temporal bone and adjacent structures

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25
Q

what are the associations of acute otitis externa and chronic and malignant?

A

acute - underyling skin conditions - contact dermatitis, acute otitis media, trauma to ear canal, foreign body, obstruction or water
chronic - DM, immuncompromise, prolonged topical abx or corticosteroid use
malignant - DM or immunocompromise, older age, radiotherapy to upper structures, previous ear sirgery or irrigation

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26
Q

what are the sx of the different types of otitis externa?

A

acute - itch, pain, discharge, hearing loss, tenderness of tragus or pinna, red or oedematous ear canal, tympanic erythema
chronic - itch, dry scaly skin or red moist
malignant - unremitting pain, purulent ear discharge, systemic illness, hearing loss, granulation tissue in ear canal, facial nerve palsy

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27
Q

how is assessment of otitis externa performed?

A

onset, nature, severity, impact, risk fx, previous episodes, previous ear surgery, associated comorbidities
examine ear canal, pinna and local LN
ear swab for bacterial and fungal microscopy, culture, sensitivity if severe or reccurent or chronic

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28
Q

how is otitis externa managed?

A

advice and info
advice on self care measures = avoid ear trauma, keep ear clean and dry, consider use of acetic acid 2% ear drop or spray
manage underlying risk fx
analgesia
remove ear canal debris
topical abx or antifungal preparation +/- corticosteroid
follow up if persistent, severe or immunocompromised
seek specialist advice if required

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29
Q

define acute otitis media

A

presence of inflammation in the middle air - effusion and rapid onset
common
bacteria and viruses
frequent in children

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30
Q

what are the risk fx of children with acute otitis media?

A

subject to passive smoking
daycare/nursery
formula fed
craniofacial abnormalities - cleft palate

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31
Q

what are the complications of AOM?

A

recurrence
hearing loss
tympanic membrane perforation
mastoiditis
meningitis
intracranial abscess
sinus thrombosis
facial nerve paralysis

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32
Q

what are the sx of AOM?

A

older - earache
younger - hold or rub ear, fever, crying, poor feeding, restless, cough, rhinorrhoea
tympanic membrane red, yellow, cloudy and may be bulging

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33
Q

how is AOM managed?

A

managed with paracetamol or ibruprofen
many not require tx as usually resolve…unless if systemically very unwell, if more serious sx, high risk of complication…5-7 day course of amoxicillin or clarithromycin
hospital admission - serious systemic, suspected complication s such as meningitis, mastoidits, IC abscess, sinus thrombosis, facial nerve paralysis, <3 months or temp >38 degrees
if persistent - paediatric or ENT referral or admission
prevention - avoid exposure to smoking, use of dummies, flat supine feeding, up to date immunisations

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34
Q

define otitis media with effusion

A

collection of fluid within middle ear space without signs of acute inflammation
most common cause of hearing impairment in childhood usually resolves tho
between 6mths and 4 yrs and in winter usually
genetic factor + endogenous irritants such as smoking, pollution, allergy, reflux
over 50% follow an episode of acute otitis media

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35
Q

what is persistence of OME caused by?

A

impaired eustachian tube function
low grade viral or bacterial infection
persistent local inflammatory reaction
adenoidal infection

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36
Q

what are the risk fx for OME?

A

cleft palate
downs syndrome
CF
primary cilliary dyskinesia
allergic rhinitis
low socioeconomic group
parental smoking
frequent URTI

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37
Q

what are the complications of OME?

A

conductive hearing loss
speech and language development issues
communication skills difficulties
chronic damage to tympanic membrane

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38
Q

how is OME managed?

A

spontaneous resolution is common
active observation for 3 months
if persist or severe or downs syndrome - hearing test or specialist ENT

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39
Q

define sinusitis

A

symptomatic inflammation of paranasal sinuses
usually trigerred by viral URTI and defined by sx <12 weeks
adults - nasal blockage or nasal discharge with facial pain/pressure and/or reduction in smell
children - nasal blockage or discoloured nasal discharge with facial pain/pressure and/or cough

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40
Q

when should urgent referral for sinusitis be made?

A

acute - sx of neoplasm - unilateral polyp/mass, bloody nasal discharge
chronic - unilateral sx, epistaxis, blood stained discharge, orbital sx or neurological sx

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41
Q

how is acute sinusitis managed?

A

advice about course
analgesia for pain or fever
need for abx
high dose intranasal corticosteroids

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42
Q

how is chronic sinusitis managed?

A

avoid exacerbation - allergic triggers
nasal irrigation
intranasal corticosteroids
long term abx ?
urgent hospital admission if severe syetmic or any complications

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43
Q

what are two typesof a sore throat?

A

acute pharyngitis - inflammation of part of throat behind soft palate (oropharynx)
tonsillitis - inflammation of tonsils

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44
Q

what are the causes of sore throat?

A

viral or bacterial - common cold, influenza, strep, infectious mononucleosis, HIV, gonococcal pharngitis, diptheria
non infectious - physical irritation from GORD, chronic cigarette smoke, hayfever

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45
Q

what are the complications of sore throat?

A

otitis media, peri-tonsillar abscess (quinsy), parapharyngeal abscess

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46
Q

how is sore throat managed?

A

admit if stridor, breathing difficulty, dehydration, acute epiglottis, admit if cancer/HIV
supportive advice - paracetamol and ibruprofen, fluid
use of FeverPAIN and Centor clinical prediction score – should use abx?
specialist if recurrent tonsillitis

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47
Q

what assessment is requires for all people with tinnitus?

A

audiological assessment

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48
Q

when should an immediate referral be made for tinnitus?

A

high risk of suicide
sudden onset of neurological sx or signs
acute uncontrolled vestibular sx
suspected stroke
sudden onset pulsatile tinnitus
secondary to head trauma

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49
Q

how is tinnitus managed?

A

reassure - resolve by itself
address underlying cause - impacted wax
review meds - may be cause
sound therapy
psychological therapies if in distress
hearing aid if hearing loss
any associated depression, anxiety or insomnia
arrange follow up and safety net

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50
Q

define benign paroxysmal positional vertigo

A

disorder of the inner ear characterised by repeated episodes of positional vertigo
relapse and remitting

51
Q

what are the causes of BPPV?

A

head injury
prolonged recumbent position - dentist, hairdresser
ear surgery
following episode of inner ear pathology - vestibular neuronitis, labyrninthiis, meniers disease

52
Q

how is BPPV diagnosed?

A

ask pt about what brings on sx - turn head, look up
Dix-hallpike manouevre should be used to show characteristic findings
imaging to exclude others if nystagmus or neurological fidnings

53
Q

how is BPPV managed?

A

watchful waiting
Epley manoeuvre and Brandt-Daroff exercises
follow up in 4 weeks if sx not resolved
if atypical, affecting ADL, not resolved - refer to medically qualified balance specialist

54
Q

what is another ear pathology??

A

cholesteatoma - abnormal sac of keratinizing squamous epithelium and accumulation of keratin within middle ear of mastoid air cell spaces which can become infected and erode neighbororing structures
rare

55
Q

what are the two causes of hearing loss in adults?

A

conductive - abnormalities in outer and middle ear which impairs sound wave conduction to cochlea of inner ear
sensorineural - abnormalities in cochlea, auditory nerve, other structures in neural pathway from inner ear to auditory cortex

56
Q

how is hearing loss managed in primary care?

A

impacted wax, acute ear infection (acute otitis media and externa) or effusion due to URTI
consider need for referral to ENT or emergency department

57
Q

what are some red flag fx of hearing loss?

A

sudden onset unilateral or BL hearing loss which cannot be explained
unilateral with focal neurology
hearing loss associated with neck injury
otalgia or otorrhoea not responded and immunosupressed
suspected malignancy

58
Q

what are the two different types of vertigo?

A

central - uncommon, pathology in brainstem and cerebellum (stroke, TIA, cerebellar tumour, MS) - prolonged, severe vertigo, new onset headache or recent trauma, focal neurological signs and sx, central type nystagmus, unable to open eyes
peripheral - affecting inner ear - labyrinth or vestibular nerve (BPPV, vestibular neuronitis, labyrnthitis, menieres disease)-

59
Q

what examinations should be performed for pt with vertigo?

A

facial asymmetry, examine ear, CN’s, cerebellar function, examine eyes, signs of peripheral neuropathy, abnormal gait

60
Q

labyrinthitis v vestibular neuronitis

A

VN - inflammation of vestibular nerve and often due to viral infection, no hearing
labyrinthitis - inflammation of labyrinth, involves hearing loss

61
Q

what are the sx of VN?

A

spontaneous onset vertigo, N+v, unsteadiness, no hearing loss or tinnitus, no focal neurological sx
nystagmus

62
Q

how is VN managed?

A

buccal or IM propchlorperazine or IM cyclizine if severe or oral
admitted to hospital if not able to tolerate oral fluids
referred if atypical sx such as neurological

63
Q

what are the common organisms of UTI in children?

A

Escherichia coli, Klebsiella species, Staphylococcus saprophyticus

64
Q

what are the complications of UTI in children?

A

renal scarring
HTN

65
Q

what are the sx of UTI in different age groups of children?

A

under 3 mths - fever, vomit, lethargy or irritability, poor feeding or failure to thrive
over 3 mths- fever, frequency, dysuria, abdo pain, loin tenderness, vomit, poor deeding, dysfunctional voiding, changes to continence

66
Q

how should all children aged <3mths with suspected uti be managed?

A

referred urgently to a paediatric specialsit for tx with parenteral abx and urine sample for microscopy and culture

67
Q

how does urine dipstick guide UTI management?

A

if both leukocyte esterase and nitrite positive - abx
if leukocyte esterase and nitrite negative - urine sent for microscopy and culture, no abx
if both negative - urine sent for culture, start abx

68
Q

how are children with pyelonephritis managed?

A

referral to specialist - oral abx - co amoxiclav or cefalexin

69
Q

how are children with cystitis managed?

A

trimethorpim or nitrofurantoin

70
Q

when are UTI’s in men common?

A

BPH, urethral strictures etc
catheter
previous urinary tract surgery
immunocompromised

71
Q

what are the complications of UTI in men?

A

renal function impairment
prostatitis
pyelonephritis
sepsis
urinary stones

72
Q

what are the sx of uti in men?

A

dysudria, frequency, urgency, nocturia, suprapubic pain
odeorous or cloudy urine, haematuria
can present atypically -

73
Q

what are the ddx of uti in men?

A

acute prostatitis, bladder or renal malignancy, epidiymitis, pyelonephritis, urethritis

74
Q

how are uti’s in men managed?

A

empirical tx - trimethoprim, nitrofurantoin for 7 days (consider amoxicillin if catherised) and after 48 hrs check response to tx and urine culture results and review abx

75
Q

how can recurrent uti’s be managed?

A

trial of abx prophylaxis - trimetoprim 100mg at night or nitrofurantoin 50-100mg at night

76
Q

what are the complications of uti in women?

A

pyelonephritis, impaired renal function, urosepsis, pre delivery and low birthweight babies

77
Q

what are the ddx of uti in women/

A

STI
vaginal atrophy

78
Q

when should a urine culture instead of dipstick be sent for women?

A

urine culture - pregnant, >65, persistent sx, recurrent, catheterised/recently, risk fx for resistant or complicated uti, non visible or visible haematuria

79
Q

how is acute uncomplicated uti in women managed?

A

advice on analgesia and hydration
tx with abx
advice on when to seek medical review
review choice of abx

80
Q

how are pregnant women with uti managed?

A

asx + suspected/proven UTI - 7 day course of abx +follow up
recurrent UTI, catheter, atypical pathogens - urgent specialist review
antenatal service informed if group B strep

81
Q

when should malignancy be suspected in tx of uti?

A

persistent haemturia
recurrent

82
Q

what else can be offered to womenw ith recurrent UTI?

A

topical vaginal oestrogen, abx prophylaxis

83
Q

what are the complications of acute pyelonephritis?

A

sepsis
parenchymal renal scarring
recurrent UTI
renal abscess formation
preterm labour in pregnancy
emphysematous pyelonephritis

84
Q

what are the additional sx of pyelonephritis?

A

fever, N+V, flank pain

85
Q

how is pyelonephritis investigated?

A

MSU for culture and sensitivity
if present + flank pain = diagnosis

86
Q

how is pyelonephritis managed?

A

abx started when MSU sent off
ciprofloxacin, trimethoprim, co-amoxiclav
if pregnant - cefalexin
review when msu comes back
may have GI upset from abx
safety net
paracetamol for pain
increase hydration

87
Q

when should a referral for pyelonephritis be made?

A

dehydration or unable to take oral fluids
pregnant
higher risk of developing complications
recurrent

88
Q

how is acute bronchitis managed?

A

smoking cessation
adequate analgesia
fluid
abx if systemically unwell or high risk ofcomplications

89
Q

how is pneumonia managed?

A

CURB-65
>3 or more - urgent admission
1 or 2 - hospital assessment considered
0 - tx at home
then give abx

90
Q

what is the organism involved in vulvovaginal candidiasis?

A

Candida albicans

91
Q

what are the sx of thrush?

A

irritation
non offensive dyscharge
superficial dyspareunia and dysuria
recurrent if four or more episodes in one year

92
Q

what are the risk fx for thrush?

A

abx use
local irritanats
uncontrolled DM
immunosupression
pregnancy
COCP

93
Q

how is a women assessed with suspected vulvovaginal candidiasis?

A

ask about duration, frequency and severity of sx
risk fx
tx tried
risk of pregnancy
contraception use
examine external genitalia - inflammation, erythema, fissuring or excoriations
high vaginal swab for culture if diagnostic uncertainty or recurrent or poor tx response

94
Q

how is thrush managed?

A

advice on information and support
management of risk fx
antifungals - oral azoles etc
follow up if recurrent or tx failure
specialist if non typical or resistant candida

95
Q

define BV

A

overgrowth of predominantly anaerobic organisms and loss of lactobacilli
loses it normal acidity and pH increases

96
Q

what are the risk fx and factors that reduce BV?

A

risk fx - sexually active, STI, use of douches, vaginal washes, menstruation, presence of semen in vagina, cooper IUD, smoking
reduce risk - hormonal contraception, condom use, circumcised

97
Q

what are the complications of BV?

A

severe obstetric and gynae complications - late miscarriage, pre term labour, pre term birth, pre term premature rupture of membranes, low birthweight, postpartum endometritis

98
Q

what are sx of BV?

A

50% asx
fishy smelling discharge
thin white discharge

99
Q

ow is BV managed?

A

non pregnancy and asx - no tx
sx - oral metronidazole
asx and preg - oral metronidazole
all women with BV advuides to avoid exposure to contributing facotrs
if perisst or recur - adherenece checked and check alternative diagnosis

100
Q

define diarrhoea

A

passage of 3 or more loose or liquid stools per day or more frequently that is normal for that individual
acute <14 days
persistent - lasting longer than 14 days
chronic > 4 weeks

101
Q

what are the causes of acute diarrhoea?

A

bacteria or viral infection
drugs such as abx
anxiety
food allergy
acute appendicitis

102
Q

hat are the cuases of chronic diarrhoea?

A

IBS
diet
IBD
coeliac
bowel cancer

103
Q

what is imporant in hx of diarrhoea?

A

onset, duration, frequency, severity
their normal
red flag sx
underlying vause
complications - dehydration

104
Q

when shuld acute diahrroea be investigated with a stool specimen?

A

systemically unwell/ needs hospital and/or abx
blood or pus in stool
immunocompromised
recently received abx or PPI or recently been in hsopital (c.diff)
foreign travel related
if diarrhoea persisted for 14 days or more (amoebae, giardia, or cryptospordium)
need to exclude infectious diarrhoea

105
Q

what blood tests should be performed for eople with chronic diarrhoea?

A

FBC, UE, LFT, calcium, vit b12, folate, ferritin, TFT, CRP, ESR, coeliac

106
Q

pilonidal abscess managemtn in primary care

A

if lesion small and superficial with expertise and facilities available- urgent same day incision and drainage
paracetamol for pain and fever or NSAID
if associated cellulitis - abx

107
Q

define breast abscess

A

a localised collection of pus within the breast. severe complication of mastitis but can occur without preceding mastitis
other complications - sepsis, scarring and recurrent mastitis

108
Q

when should a breast abscess be suspected?

A

history of recent mastitis
painful, swollen lump in breast - redness, heat, swelling of skin
fever and/or malaise

109
Q

what should occur if a breast abscess is suspected?

A

urgent referral to general surgeon

110
Q

define pruritus ani

A

skin condition characterised by sensation of perianal itching or burning
a sx not diagnosis - can be primary(idiopathic) or secondary (specific cause)

111
Q

what is primary pruritus ani?

A

functional = small amount of faecal loss (anorectal dysfunction) causing itching and perianal erythema as presents irritants and allergens to perianal tissues
90% of cases

112
Q

what are the many possible causes of secondary pruritus ani?

A

skin conditions - dermatitis, psoriasis
infections - staph, scabies
colorectal and anal - anal fissure, haemorrhoids, colorectal cancer
systemic - DM, anaemia
psychological - depression
drugs - corticosteroids, colchicine
food and drink - spicy foods, nuts, beer, wine

113
Q

what are the complications of pruritus ani?

A

tear in skin, eczema, lichenificaation, ulceration, excoriation, secondary bacterial infection
embarassment, depression, anxiety, insomnia

114
Q

how is pruritus ani managed?

A

manage underlying cause if possible
lifestyle - avoid scratch, keep nails short, maintain good anal hygeine, avoid foods/drink that aggrevate
ensure stools are regular and formed
topical preparations - bismuth subgallate or zinc oxide
or midly potent topical corticosteroids and sedating antihistamines
refer if sx persist

115
Q

what are the risk factors for haemorrhoids?

A

constipation
straining
ageing
heavy lifting
chronic cough
pregnancy, childbirth

116
Q

what are the complications of haemorrhoids/

A

ulceration, skin tags, maceration of perianal skin, ischaemia, thrombosis, ganagrene, perianal sepsis and anaemia

117
Q

how are haemorrhoids managed?

A

ensure stools soft - laxative
minimise straining
good anal hygiene
analgesia or topic haemorrhoids prep
admit or referral if diagnosis unclear, sx not managed in primary care or not respond or recurrent

118
Q

what are the non surgical treatments of haemorrhoids?

A

rubber band ligation, injection sclerotherapy, IR coagulation/photocoagulation, bilpolar diathermy, directu current electrotherapy

119
Q

define pilonidal sinus disease

A

inflammatory skin condition that occur in midline of natal cleft
loose hairs in the natal cleft are driven in the natal skin, creating chronic sinus tract which can become infected

120
Q

what are the risk fx of pilonidal sinus disease?

A

male
15-40
white
hirscutism
obesity

121
Q

what are the complications of pilonidal sinus disease?

A

cellulitis, sepsis, chronic pain, altered body image and self esteem

122
Q

how is pilonoidal sinus disease managed?

A

asx - watch and wait, reassurance, give advice on perianal hygiene
referral surgical exicision if required

123
Q

what are the perianal manifestations of crohns?

A

skin tag, fissure, fistula, abscess

Primary care (15 decks)

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