Minor illness Flashcards
What are the 5 different kinds of conjunctivitis and their mechanisms?
Allergic conjunctivitis:
- Type 1 immune response to allergen
- Allergen binds to mast cell > IgE cross linking > mast cell degranulation > initiation of inflammatory cascade
- histamine and bradykinin stimulate itching, increased vascular permeability, vasodilation, redness
Infective conjunctivitis:
common bacteria = pneumococcas, S aureus, M catarrhalis, H influenzae
Chlamydia, N gonorrhoea are rare
Common viruses = adenovirus, herpes simplex, epstein-barr, varicella zoster, enteroviruses
Mechanical conjunctivitis: chronic conjunctival irritation eg. floppy eyelid syndrome in sleep
Neoplastic conjunctivitis: Sebaceous gland carcinoma
Keratoconjunctivitis: Eg. prolonged contact lens wearing time, poor lens hygiene, allergenic lens solutions, poor fit of lenses, etc
How does conjunctivitis present?
- watery discharge (common in viral)
- conjunctival follicles (viral)
- tender pre-auricular lymphadenopathy (viral)
- vesicular skin rash (herpes zoster)
- eyelid stuck together in the morning (bacterial/ viral)
- corneal pannus (bacterial/ viral)
- purulent discharge (bacterial)
- itching (allergic)
- ropy mucoid discharge (allergic)
How would you manage conjunctivitis?
Allergic = artificial tear eyedrops, cool compress for symptomatic relief, topical/oral antihistamines
Bacterial = topical antibiotics (systemic if severe)
Viral = topical antihistamines, artificial tears, topical corticosteroids, Ganciclovir eyedrops for adenovirus
Contact lens related = topical corticosteroids, topical fluoroquinolones
Mechanical = artificial tears
Toxic/chemicals = eye irrigation until pH is 7, artificial tears
What are some common organisms for Laryngitis? Viral/Bacterial/Fungal
Viral = rhinovirus, parainfluenza virus, adenovirus
bacterial = moraxella catarrhalis, H influenza, strep pneumonia, staph aureus
Fungal = candida albicans, blastomyces, dermatitis, histoplasma capsulatum
What are some common pathophysiologies of laryngitis
- Bacterial/viral/fungal insult result in inflammation of endolaryngeal structures = oedema and erythema = increased bulk of vocal cords = lowered pitch
- reflux laryngitis = repeated exposure of laryngeal mucosa to refluxate eg. Hcl and pepsin result in irritation
- Patients with heavy vocal cord use cause intense friction and agitation on their vocal cords
How does laryngitis present?
- Hoarseness
- Dysphagia
- Sore throat
- Odynophagia
- Cough
- Hyperemia of the oropharynx
- History of heavy vocal use
- History of Gastroesophageal reflux
How would you investigate laryngitis?
Laryngoscopy (erythema and oedema of true vocal folds, white/yellow secretions in the glottis etc)
Biopsy during laryngoscopy
Orophagyneal cultures
Nasal swab for cultures Sputum cultures
How would you manage laryngitis?
- Vocal hygiene and analgesics - Corticosteroids to alleviate oedema (dexamethasone) Bacterial = acetaminophen antibiotics and vocal hygiene Diptheria confirmed = diptheria toxoid, antibiotics, isolation
What is the definition of tonsilitis and what is the typical patient?
Infection of the parenchyma of the palatine tonsils
5-15 year olds, people in contact with infected people in enclosed spaces eg. schools
What are the common viral and bacterial pathogens?
Most commonly Viral = Rhinovirus, then Coronavirus, then Adenovirus
Can be associated with influenza, enterovirus, herpes virus, infectious mononucleosis
Bacterial = B haemolytic strep (Group A, then C)
Mycoplasma pneumoniae or neisseria gonorrhoea in sexually active adolescents
What 4 specific ways would bacterial tonsilitis present and what criteria would you use to identify it?
Centor criteria
- Fever >38C
- Tonsillor exudate
- absence of a cough (presence of cough or runny nose suggests viral)
- Tonsillar enlargement
What would tonsillitis in general present?
Pain on swallowing, fever, sudden onset sore throat, headache, abdo pain, nausea and vomitting, tonsillar erythema, enlarged anterior cervical lymph nodes
How would you manage tonsillitis?
Paracetamol, NSAIDs Salt water mouthwash, etc.
If bacterial (Centor >3): 10 days oral penicillin for group A Beta Haemolytic Strep OR single IM dose of benzathine benzylpenicillin if cannot do oral. OR macrolides eg. erythromycin in penicillin allergy
Tonsillectomy for recurrent tonsillitis
What is this? How do you differentiate between internal and external?
These are styes.
Internal = infection of Meibomian gland. Less circumscribed as it is deeper in the tarsal plate
External = infection of Zeis and Moll Ciliary glands. More superficial and smaler glands so on infection it forms a swelling at the root of the eyelash
What is the difference between a stye and a chalazion?
A chalazion is a lump in the eyelid
A Stye will be on the edge of the eyelid, by the eyelashes
How would you manage a stye?
Self limiting in 5-7 days.
- Warm compress to speed up drainage
- topical antibiotic therapy for S aureus (topical erythromycin or bacitracin)
- Oral antibiotic if significant surrounding cellulitis eg. cephalosporin or co-amoxi
- Incision and drainage for very large styes that distort vision
How does a migraine present?
- Unilateral throbbing headache for 4-72 hours
- Nausea
- Headache worse with activity (unlike tension headache)
- photophobia
- phonophobia
- Aura (visual sparkles, flashing lights, OR negative like visual loss OR sensory like numbness and tingling)
Trigger factors for migraines?
- FHX
- caffeine
- lack of sleep
- stress
- diet (eg. high in artificial sweetener)
- female
- obese
- exposure to change in barometric pressure
- allergies or asthma
- hypothyroidism
- hypertension
How would you manage a migraine?
Mild-Moderate:
- NSAIDs (aspirin, ibuprofen, diclofenac, etc)
- Paracetamol if pregnant
- Magnesium sulfate as adjunct
- Antiemetics (metocloperamide, promethazine, prochlorperazine)
- High flow oxygen
Severe:
- Triptans or 5HT1 agonists (almotriptan, sumatriptan, etc)
- anti-emetics
How does a tension headache present?
- Tight band, around the head
- typically occipital and frontal regions
- bilateral throbbing pressure like dull pain
- sometimes SCM, trapezius, temporalis, masseter, latearl pterygoid tenderness
- worse on noise and touching scalp (Not worse on physical activity)
- Lasts for hours to days (worse at end of day)
- associated with stress, fatigue, missing meals or depression
How would cluster headache present?
- severe unilateral pain around one eye (or temporal pain)
- associated with ipsilateral conjunctival infection, lacrimation, rhinorrhoea/blockage
- can get transient horner’s syndrome
- lasts 10mins - 2 hours
- can wake them from sleep
How would you treat a cluster headache?
Antihistamines (the headaches are due to increase in serum histamine)
Prednisolone
Ca2+ blockers
Lithium carbonate
How would acoustic neuroma present?
- unilateral sensorineural hearing loss and vertigo
- tinnitus
- progressive episodes of dizziness
- headaches
- Compression on facial nerve (late) = facial numbness, altered taste, altered tearing, slow blink
- Compression on glossopharyngeal nerve = difficulties swallowing
- cerebellar signs (DANISH) if brainstem/cerebellar peduncles are compressed
-
How would you investigate an acoustic neuroma?
- MRI head enhaanced with gadolinium (dense mass extending into internal acoustic meatus. Absence of dural tail is diagnostic)
- CT head = enlarged internal acoustic meatus
- Audiogram showing sensorineural hearing loss
How would trigeminal neuralgia present?
- facial pain in trigeminal nerve distribution (usually bilateral)
- sharp, stabbing, intense pain lasting up to 2 mins
What would you look for in a history to suspect Trigeminal Neuralgia?
- recent herpetic outbreak (post-herpetic TN)
- Risk factors like old age, HTN, MS
- Prior face trauma or oropharyngeal trauma
- Sensory/Motor changes but no Neuro deficit
How would you treat trigeminal neuralgia?
Anticonvulsants:
- Carbamazepine (if it doesnt work, oxocarbazepine)
- Gabapentine in MS associated TN
If unresponsive to anticonvulsants:
- baclofen
Unresponsive to medications:
- microvascular decompression
- stereotactic radiosurgery
Neurostimulation as last resort
Describe the difference between a complicated/uncomplicated UTI
Uncomplicated = acute cystitis in a healthy, non pregnant woman without functional/anatomical urinary tract abnormalities
Complications = recurrent infections in patients with functional/anatomical impairments, where antimicrobial therapy is ineffective, kidneys are involved (pyelonephritis), or patient is pregnant
What predisposes you to a UTI?
- Female
- foreign bodies like catheters or stones
- spinal cord injuries, diabetes, MS, immunodeficiency diseases
- Urological abnormalities
- sexual activity
- spermicide use (reduce vaginal lactobacilli so allow E.Coli to colonise)
- Post menopause (alkalanisation of vaginal fluid)
How does a UTI present? + investigations
- dysuria
- polyuria and urgency
- haematuria
- costovertebral angle tenderness and back/flank pain (pyelonephritis)
- fever (pyelonephritis)
Urine dipstick = nitrites, leukocytes, haematuria
Urine culture/sensitivity
Renal ultrasound to check for hydronephrosis/stones
Abdo/pelvic CT if unresponsive to check for abscess
Cystoscopy if symptoms persist
How would you manage an uncomplicated UTI?
- Nitrofurantoin 100mg twice a day for 3 days
OR
- Trimethoprim 200mg twice a day for 3 days
OR
- Fosfomycin 3g single dose sachet
+ Fluids, ibuprofen/paracetamol
How would you manage a complicated UTI?
Pregnant:
- 1st line = Nitrofurantoin 7 days
- 2nd line = Amoxi 500mg 3x a day for 7 days
OR
Cefalexin 500mg 2x a day for 7 days
Men:
- Trimethoprim 7 days OR Nitrofurantoin 7 days
Recurrent:
- Low dose daily prophylactic antibiotics
- post coital prophylactic antibiotics
- intravesicular instillation of sodium hyaluronate and chondroitin sulfate
