Minor Illness Flashcards
State some symptoms of common cold
- Rhinitis
- Sore throat
- Headache
- Muscle aches
- Fever
- Loss of taste or smell
- Sinusitis
- Ear pain
Discuss how you can distinguish between common cold and flu
Influenza is usually a self-limiting illness, however in those who are at risk of increased complications you can offer treatment.
- State some examples of who is at increased risk
- What medicaiton would you give
- At risk groups: immunocompromised, chronic respiratory disease, chronic heart disease, diabetes, over 65yrs, under 6 months, prenant, CKD, morbid obesity
- Medication:
- First line= Oral oseltamivir
- Second line= Inhaled zanamivir
For conjunctivitis, state:
- What it is
- Causes
- Symptoms
- Treatment
- Inflammation of conjunctiva (can be due to infection but not always e.g. may be allergic)
- Causes:
- Viral
- Bacterial (e.g. can be due to STI)
- Allergic
- Foreign body
- Symptoms:
- Redness
- Swelling
- Discharge, crusting of lids, stuck together upon wakening
- Management:
- First line= self management
- If bacterial & severe offer topical antibiotics e.g. chloramphenicol (NOTE: even bacterial is self-limiting so may offer delayed course of topical antibiotics)
For a stye, state:
- What it is
- Symptoms
- Management
- Small abscess (painful collection of pus) on the eyelid and is an infection at the root of an eyelash; infection usually due to Staphylococcus aureus
- Symptoms:
- Small red spot on edge of eyelid
- Visible puss in spot
- Management:
- Warm compress held against eye
- Do not pop
- Avoid makeup & contact lenses
- Advise if not getting better or eyelid becomes red or swollen to contact GP
What is an alternative name for a meibommian cyst?
Chalazion
For a meibommian cyst/chalazion, state:
- What it is
- Symptoms
- Management
- Inflammatory granuloma caused by obstruction of meibommian gland in eyelid
- Symptoms:
- Loclaised eyelid swelling
- Tender or non tender swelling
- +/- mild conjunctivitis
- Management:
- Warm compress
- Information leaflet- how to massage after warm compress application
- Might give some topical chloramphenicol if moderate/severe conjuncitivis also suspected
For blepharitis, state:
- What it is
- Symptoms
- Management
- Blepharitis is an inflammatory eyelid condition caused by chronic staphylococcal infection and malfunction of the meibomian (lipid) glands. It can cause secondary conjunctivitis and dry eye and occasionally small corneal ulcers.
- Symptoms:
- Red eyes
- Gritty/sore eye
- Crusting on lashes
- Management:
- Eyelid hygiene
- Warm compress
- Topical chloramphenicol if moderate/severe conjunctivitis
- What is orbital cellulitis?
- Remind yourself of difference between pre and post orbital cellulitis
- Discuss management of pre and post orbital cellulitis
- Infection of soft tissue of orbit
- Pre= infection of soft tissues anterior to orbital septum. Post= infection of soft tissues posterior to orbital septum
- Managment:
- Pre: oral co-amoxiclav and review in eye clinic in 48hr
- Post: admit to hospital for IV antibiotics
Compare symptoms and signs of pre- and post- orbital cellulitis
What is an aphthous ulcer?
Describe the 3 types of aphthous ulcer
Aphthous ulcers are oral ulcers. Three types:
- Minor: <1cm
- Major: >1cm- often leave scar
- Herpetiform: pinhead sized uclers that are grouped together- very painful
State some potential causes of aphthous ulcers
- Trauma
- Smoking cessation
- Anxiety
- Fe, folate, B12 deficiency
- Crohn’s
- Cancer
Discuss the management of aphthous ulcers
Mostly self limiting therefore management is:
- Advice: avoid spicy foods, acidic fruit drinks, wash mouth with salt water
- OTC analgesics e.g. bonjela
- Topical cortiosteroids if causing lot of pain, not resolving
- If infected, topical abx
For scabies, discuss:
- What it is
- Symptoms
- Whether it is contagious
- Management
- Scabies is an intensely itchy skin infestation caused by the human parasite Sarcoptes scabiei
- Symptoms:
- Pruritis
- Linear burrows (grey irregular tracks)
- Erythematous papules often found in interdigital webspaces
- Nodules (violet in colour and very itchy)- common on penis and scrotum in men
- Highly contagious
- Management:
- Permethrin 5% cream
- Advice such as all close contacts should be treated (even if asymptomatic) wash clothes at high temperatures
Discuss how permethrin cream should be applied to treat scabies
- Product should usually be applied to the whole body from the chin and ears downwards paying special attention to the areas between the fingers and toes and under the nails, However, in people who are immunosuppressed, the very young, and elderly people, the insecticide should be applied to the whole body including the face and scalp.
- Apply to cool, dry skin
- Wash off after 8 hrs
- Apply second dose after 1 week
Discuss the presentation of nappy rash
State some possible causes
Localised skin irritation in nappy region (form of contact dermatitis):
- Erythema
- Sparing of folds & gluteal cleft
- Spots/pimples/blisters
- Baby distressed if sore
Potential causes:
- Infrequent nappy changes
- Insufficienty cleaning
- Wipes, soaps, detergents
- Antibiotics
Discuss the management of nappy rash
- Advice:
- Regular changing
- Leave nappy free as long as possible
- Water & cotton wool to clean or fragrance/alcohol free wipes
- Dry gently
- Barrier cream
- Avoid talcum powder
- NICE says if rash appears inflammed or is causing discomfort prescribe 1% hydrocortisone cream for application once daily
SEE YR3 MEDICINE- INFECTIONS for UTI info
What is impetigo?
Impetigo is a common superficial bacterial infection of the skin. The two main clinical forms are:
- Non-bullous impetigo — accounts for the majority of cases (about 70%). Caused by S.Aureus or S.Pyogenes or both
- Bullous impetigo — bullae are fluid filled lesions which are usually more than 5mm in diameter. Caused by S.Aureus
Impetigo can develop as a primary infection in otherwise healthy skin or as a secondary complication of pre-existing skin conditions such as eczema, scabies, or chickenpox.
Describe the appearance of non-bullous and bullous impetigo
Non-bullous: start as thin walled vesicles but burst very quickly that child often presents with yellow crusting- commonly on peri-oral or peri-nasal area.
Bullous: fluid filled vesicles which rupture after few days and leave yellow crust
Discuss the management of an insect bite in primary care
Advice & self-management:
- Apply cold compress
- Avoid itching
- Paracetamol
- Crotamiton cream (anti-pruritic)
- Seek medical attention if: appears infected, symptoms worsen, systemic symptoms develop, persisting after a week
Discuss the management of oral candidiasis; consider:
- Pharmacological managemetn of mild and severe
- Conservative
Pharmacological
- Infection mild & localised: topical miconazole for 7 days (or nyastatin 2nd line)
- Infection severe or widespread: oral fluconazole for 7 days
Conservative/advice:
- Good oral hygiene
- Smoking cessation
- Rinsing mouth after ICS
Dicuss the management of tension headaches in primary care
- Simple analgesia
- Advice:
- Enough sleep
- Hydration
- Regular vision checks
- Screen time
Discuss the management of medication overuse headaches in primary care
- Explain the diagnosis of MOH and that use of drugs is main cause
- Advise to stop taking all overused pain medication for at least one month
- Warn that symptoms may initially worsen
- You can discuss with/refer to neurology if overuse involves opiods or tranquilisers or there has been repeated failed withdrawal attempts
Discuss the management of migraines in primary care; inlcude conservative and pharmacological management
Conservative
- Signpost to information e.g. NHS website
- Advise to keep migraine diary to identify triggers so can avoid
- Educate regarding known triggers e.g. stress, lack of sleep, dehydration, lack of exercise etc… and promote healthy habits/changes
Pharmacological
- Simple analgesia e.g. paracetamol, ibruprofen
- Consider adding a triptan (or use triptan alone) e.g. sumatriptan. *NOTE: can be given intranasally if vomitting stops oral intake
- Antiemetic e.g. metoclopramide
*NOTE: triptans should be taken when pain starts NOT when aura starts (if they have one)
Discuss the management of cluster headaches in primary care
- SC or nasal triptan e.g.sumatriptan
- Short burst oxygen therapy (100% oxygen at 12-15L over 15 mins)
- Avoid paracetamol, NSAIDs, oral triptans
- Advice on avoidance of triggers
- Identify and manage comorbidities
Discuss the management of trigeminal neuralgia in primary care
- Carbamezapine (start at 100mg BD, then titrate up 100-200mg every 2 weeks until pain is controlled. Once in remission, gradually reduce dose to either lowest dose possible to maintain remission or to nothing and then restart when flare again)
Dicuss the management of consipation in primary care
Conservative
- Increase fibre intake (30g daily)
- Increase fluid intake
- Increase physical activity
Pharmacological
- Bulk forming laxative e.g. ispaghula husk
- Osmotic laxative e.g. macrogol
- Add stimulant e.g. senna
*NOTE: do not prescribe bulk forming laxative if opioid constipation
Discuss the management of haemorrhoids in primary care
- Consider if need referral e.g. extremely painful (suggesting thrombosed haemorrhoid) or too large for conservative
- Advice:
- Make sure stools soft and easy to pass (plenty water, fibre, exercise etc..)
- Anal hygience
- Advise against stool withholding
- Analgesia e.g. paracetamol
- Refer to secondary care if conservative not working
Describe the ottawa rules to determine if x-ray of ankle is needed
Compare symptoms of sprain and strain
State some signs & symptoms of shingles
- Prodromal phase:
- Tingling, pain in affected dermatome
- Headache
- Malaise
- Photophobia
- Fever
- Within few days maculopapular rash appears which then develops into clusters of vesicles; rash is usually painful, itchy and only on one side of body
- Vesicles burst and crust over within 7 days
Discuss the pathophysiology of shingles
- Varicella zoster virus lies dormant in dorsal root ganglia
- Reactivated later in life- thought due to immunocompromise
- When reactivated and causing shingles= herpes zoster
Discuss the management of shingles
Firstly, assess pt for severity; for example, are there any signs of occular involvement or further infection, are they severely immunocompromised, are they a child and immunocompromsied… If any of the above, consider admission to hosptial.
For others:
- Information & advice
- Pain management
- Consider prescribing oral antiviral e.g. aciclivor, famciclivor
Which pts, with shingles, would you consider prescribing an antiviral to?
Provide antibiotics to pt with rash onset within last 72 hrs and any of following:
- Immuncompromised
- Non-truncal involvement
- Moderate or severe pain
- Moderate or severe rash
- Consider in all those over 50 to reduce risk of post-herpetic neuralgia
