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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
what are the associations of acute otitis externa and chronic and malignant?
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
26
what are the sx of the different types of otitis externa?
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
27
how is assessment of otitis externa performed?
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
28
how is otitis externa managed?
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
29
define acute otitis media
presence of inflammation in the middle air - effusion and rapid onset common bacteria and viruses frequent in children
30
what are the risk fx of children with acute otitis media?
subject to passive smoking daycare/nursery formula fed craniofacial abnormalities - cleft palate
31
what are the complications of AOM?
recurrence hearing loss tympanic membrane perforation mastoiditis meningitis intracranial abscess sinus thrombosis facial nerve paralysis
32
what are the sx of AOM?
older - earache younger - hold or rub ear, fever, crying, poor feeding, restless, cough, rhinorrhoea tympanic membrane red, yellow, cloudy and may be bulging
33
how is AOM managed?
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
34
define otitis media with effusion
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
35
what is persistence of OME caused by?
impaired eustachian tube function low grade viral or bacterial infection persistent local inflammatory reaction adenoidal infection
36
what are the risk fx for OME?
cleft palate downs syndrome CF primary cilliary dyskinesia allergic rhinitis low socioeconomic group parental smoking frequent URTI
37
what are the complications of OME?
conductive hearing loss speech and language development issues communication skills difficulties chronic damage to tympanic membrane
38
how is OME managed?
spontaneous resolution is common active observation for 3 months if persist or severe or downs syndrome - hearing test or specialist ENT
39
define sinusitis
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
40
when should urgent referral for sinusitis be made?
acute - sx of neoplasm - unilateral polyp/mass, bloody nasal discharge chronic - unilateral sx, epistaxis, blood stained discharge, orbital sx or neurological sx
41
how is acute sinusitis managed?
advice about course analgesia for pain or fever need for abx high dose intranasal corticosteroids
42
how is chronic sinusitis managed?
avoid exacerbation - allergic triggers nasal irrigation intranasal corticosteroids long term abx ? urgent hospital admission if severe syetmic or any complications
43
what are two typesof a sore throat?
acute pharyngitis - inflammation of part of throat behind soft palate (oropharynx) tonsillitis - inflammation of tonsils
44
what are the causes of sore throat?
viral or bacterial - common cold, influenza, strep, infectious mononucleosis, HIV, gonococcal pharngitis, diptheria non infectious - physical irritation from GORD, chronic cigarette smoke, hayfever
45
what are the complications of sore throat?
otitis media, peri-tonsillar abscess (quinsy), parapharyngeal abscess
46
how is sore throat managed?
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
47
what assessment is requires for all people with tinnitus?
audiological assessment
48
when should an immediate referral be made for tinnitus?
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
49
how is tinnitus managed?
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
50
define benign paroxysmal positional vertigo
disorder of the inner ear characterised by repeated episodes of positional vertigo relapse and remitting
51
what are the causes of BPPV?
head injury prolonged recumbent position - dentist, hairdresser ear surgery following episode of inner ear pathology - vestibular neuronitis, labyrninthiis, meniers disease
52
how is BPPV diagnosed?
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
how is BPPV managed?
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
what is another ear pathology??
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
what are the two causes of hearing loss in adults?
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
how is hearing loss managed in primary care?
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
what are some red flag fx of hearing loss?
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
what are the two different types of vertigo?
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
what examinations should be performed for pt with vertigo?
facial asymmetry, examine ear, CN's, cerebellar function, examine eyes, signs of peripheral neuropathy, abnormal gait
60
labyrinthitis v vestibular neuronitis
VN - inflammation of vestibular nerve and often due to viral infection, no hearing labyrinthitis - inflammation of labyrinth, involves hearing loss
61
what are the sx of VN?
spontaneous onset vertigo, N+v, unsteadiness, no hearing loss or tinnitus, no focal neurological sx nystagmus
62
how is VN managed?
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
what are the common organisms of UTI in children?
Escherichia coli, Klebsiella species, Staphylococcus saprophyticus
64
what are the complications of UTI in children?
renal scarring HTN
65
what are the sx of UTI in different age groups of children?
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
how should all children aged <3mths with suspected uti be managed?
referred urgently to a paediatric specialsit for tx with parenteral abx and urine sample for microscopy and culture
67
how does urine dipstick guide UTI management?
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
how are children with pyelonephritis managed?
referral to specialist - oral abx - co amoxiclav or cefalexin
69
how are children with cystitis managed?
trimethorpim or nitrofurantoin
70
when are UTI's in men common?
BPH, urethral strictures etc catheter previous urinary tract surgery immunocompromised
71
what are the complications of UTI in men?
renal function impairment prostatitis pyelonephritis sepsis urinary stones
72
what are the sx of uti in men?
dysudria, frequency, urgency, nocturia, suprapubic pain odeorous or cloudy urine, haematuria can present atypically -
73
what are the ddx of uti in men?
acute prostatitis, bladder or renal malignancy, epidiymitis, pyelonephritis, urethritis
74
how are uti's in men managed?
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
how can recurrent uti's be managed?
trial of abx prophylaxis - trimetoprim 100mg at night or nitrofurantoin 50-100mg at night
76
what are the complications of uti in women?
pyelonephritis, impaired renal function, urosepsis, pre delivery and low birthweight babies
77
what are the ddx of uti in women/
STI vaginal atrophy
78
when should a urine culture instead of dipstick be sent for women?
urine culture - pregnant, >65, persistent sx, recurrent, catheterised/recently, risk fx for resistant or complicated uti, non visible or visible haematuria
79
how is acute uncomplicated uti in women managed?
advice on analgesia and hydration tx with abx advice on when to seek medical review review choice of abx
80
how are pregnant women with uti managed?
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
when should malignancy be suspected in tx of uti?
persistent haemturia recurrent
82
what else can be offered to womenw ith recurrent UTI?
topical vaginal oestrogen, abx prophylaxis
83
what are the complications of acute pyelonephritis?
sepsis parenchymal renal scarring recurrent UTI renal abscess formation preterm labour in pregnancy emphysematous pyelonephritis
84
what are the additional sx of pyelonephritis?
fever, N+V, flank pain
85
how is pyelonephritis investigated?
MSU for culture and sensitivity if present + flank pain = diagnosis
86
how is pyelonephritis managed?
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
when should a referral for pyelonephritis be made?
dehydration or unable to take oral fluids pregnant higher risk of developing complications recurrent
88
how is acute bronchitis managed?
smoking cessation adequate analgesia fluid abx if systemically unwell or high risk ofcomplications
89
how is pneumonia managed?
CURB-65 >3 or more - urgent admission 1 or 2 - hospital assessment considered 0 - tx at home then give abx
90
what is the organism involved in vulvovaginal candidiasis?
Candida albicans
91
what are the sx of thrush?
irritation non offensive dyscharge superficial dyspareunia and dysuria recurrent if four or more episodes in one year
92
what are the risk fx for thrush?
abx use local irritanats uncontrolled DM immunosupression pregnancy COCP
93
how is a women assessed with suspected vulvovaginal candidiasis?
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
how is thrush managed?
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
define BV
overgrowth of predominantly anaerobic organisms and loss of lactobacilli loses it normal acidity and pH increases
96
what are the risk fx and factors that reduce BV?
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
what are the complications of BV?
severe obstetric and gynae complications - late miscarriage, pre term labour, pre term birth, pre term premature rupture of membranes, low birthweight, postpartum endometritis
98
what are sx of BV?
50% asx fishy smelling discharge thin white discharge
99
ow is BV managed?
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
define diarrhoea
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
what are the causes of acute diarrhoea?
bacteria or viral infection drugs such as abx anxiety food allergy acute appendicitis
102
hat are the cuases of chronic diarrhoea?
IBS diet IBD coeliac bowel cancer
103
what is imporant in hx of diarrhoea?
onset, duration, frequency, severity their normal red flag sx underlying vause complications - dehydration
104
when shuld acute diahrroea be investigated with a stool specimen?
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
what blood tests should be performed for eople with chronic diarrhoea?
FBC, UE, LFT, calcium, vit b12, folate, ferritin, TFT, CRP, ESR, coeliac
106
pilonidal abscess managemtn in primary care
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
define breast abscess
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
when should a breast abscess be suspected?
history of recent mastitis painful, swollen lump in breast - redness, heat, swelling of skin fever and/or malaise
109
what should occur if a breast abscess is suspected?
urgent referral to general surgeon
110
define pruritus ani
skin condition characterised by sensation of perianal itching or burning a sx not diagnosis - can be primary(idiopathic) or secondary (specific cause)
111
what is primary pruritus ani?
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
what are the many possible causes of secondary pruritus ani?
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
what are the complications of pruritus ani?
tear in skin, eczema, lichenificaation, ulceration, excoriation, secondary bacterial infection embarassment, depression, anxiety, insomnia
114
how is pruritus ani managed?
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
what are the risk factors for haemorrhoids?
constipation straining ageing heavy lifting chronic cough pregnancy, childbirth
116
what are the complications of haemorrhoids/
ulceration, skin tags, maceration of perianal skin, ischaemia, thrombosis, ganagrene, perianal sepsis and anaemia
117
how are haemorrhoids managed?
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
what are the non surgical treatments of haemorrhoids?
rubber band ligation, injection sclerotherapy, IR coagulation/photocoagulation, bilpolar diathermy, directu current electrotherapy
119
define pilonidal sinus disease
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
what are the risk fx of pilonidal sinus disease?
male 15-40 white hirscutism obesity
121
what are the complications of pilonidal sinus disease?
cellulitis, sepsis, chronic pain, altered body image and self esteem
122
how is pilonoidal sinus disease managed?
asx - watch and wait, reassurance, give advice on perianal hygiene referral surgical exicision if required
123
what are the perianal manifestations of crohns?
skin tag, fissure, fistula, abscess

Primary care (15 decks)

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