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GP > Minor illness > Flashcards

Minor illness Flashcards

1
Q

What are the 5 different kinds of conjunctivitis and their mechanisms?

A

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

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2
Q

How does conjunctivitis present?

A
  • 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)
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3
Q

How would you manage conjunctivitis?

A

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

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4
Q

What are some common organisms for Laryngitis? Viral/Bacterial/Fungal

A

Viral = rhinovirus, parainfluenza virus, adenovirus

bacterial = moraxella catarrhalis, H influenza, strep pneumonia, staph aureus

Fungal = candida albicans, blastomyces, dermatitis, histoplasma capsulatum

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5
Q

What are some common pathophysiologies of laryngitis

A
  • 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
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6
Q

How does laryngitis present?

A
  • Hoarseness
  • Dysphagia
  • Sore throat
  • Odynophagia
  • Cough
  • Hyperemia of the oropharynx
  • History of heavy vocal use
  • History of Gastroesophageal reflux
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7
Q

How would you investigate laryngitis?

A

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

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8
Q

How would you manage laryngitis?

A
  • Vocal hygiene and analgesics - Corticosteroids to alleviate oedema (dexamethasone) Bacterial = acetaminophen antibiotics and vocal hygiene Diptheria confirmed = diptheria toxoid, antibiotics, isolation
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9
Q

What is the definition of tonsilitis and what is the typical patient?

A

Infection of the parenchyma of the palatine tonsils

5-15 year olds, people in contact with infected people in enclosed spaces eg. schools

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10
Q

What are the common viral and bacterial pathogens?

A

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

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11
Q

What 4 specific ways would bacterial tonsilitis present and what criteria would you use to identify it?

A

Centor criteria

  • Fever >38C
  • Tonsillor exudate
  • absence of a cough (presence of cough or runny nose suggests viral)
  • Tonsillar enlargement
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12
Q

What would tonsillitis in general present?

A

Pain on swallowing, fever, sudden onset sore throat, headache, abdo pain, nausea and vomitting, tonsillar erythema, enlarged anterior cervical lymph nodes

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13
Q

How would you manage tonsillitis?

A

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

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14
Q

What is this? How do you differentiate between internal and external?

A

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

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15
Q

What is the difference between a stye and a chalazion?

A

A chalazion is a lump in the eyelid

A Stye will be on the edge of the eyelid, by the eyelashes

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16
Q

How would you manage a stye?

A

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
17
Q

How does a migraine present?

A
  • 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)
18
Q

Trigger factors for migraines?

A
  • 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
19
Q

How would you manage a migraine?

A

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
20
Q

How does a tension headache present?

A
  • 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
21
Q

How would cluster headache present?

A
  • 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
22
Q

How would you treat a cluster headache?

A

Antihistamines (the headaches are due to increase in serum histamine)

Prednisolone

Ca2+ blockers

Lithium carbonate

23
Q

How would acoustic neuroma present?

A
  • 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

-

24
Q

How would you investigate an acoustic neuroma?

A
  • 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
25
Q

How would trigeminal neuralgia present?

A
  • facial pain in trigeminal nerve distribution (usually bilateral)
  • sharp, stabbing, intense pain lasting up to 2 mins
26
Q

What would you look for in a history to suspect Trigeminal Neuralgia?

A
  • 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
27
Q

How would you treat trigeminal neuralgia?

A

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

28
Q

Describe the difference between a complicated/uncomplicated UTI

A

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

29
Q

What predisposes you to a UTI?

A
  • 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)
30
Q

How does a UTI present? + investigations

A
  • 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

31
Q

How would you manage an uncomplicated UTI?

A
  • 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

32
Q

How would you manage a complicated UTI?

A

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

GP (4 decks)

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