Minor illness peer work

Question 1

Management tonsillitis

Answer 1

• Calculate FeverPAIN or Centor score
  Decide whether to prescribe abx based on this
• Conservative - fluids, paracetamol if fever, lozenges, local anaesthetic spray to throat (Difflam)
• First line is Phenoxymethylpenicillin (Clarithromycin if intolerant/allergic)
• Safety net - seek help if become suddenly unwell or symptoms worsen

Question 2

How is Group A strep related to rheumatic fever?

Answer 2

• Group A streptococcus cause sore throat can lead to rheumatic fever if not treated adequately/untreated
• Bacteria circulate in body → bacteraemia
• Can then develop rheumatic fever → inflammatory condition of bones, joints, skin, heart and nervous system
• Rheumatic fever can damage heart valves from scarring

Question 3

What is Quinsy?

Answer 3

• Complication of tonsillitis
  If tonsillitis is bacterial (esp * Streptococcus pyogenes (Group A)) and untreated/inadequately treated can develop peritonsillar abscess
• Accummulation of pus in tissue surrounding tonsils
• Causes severe throat pain in one side, difficulty swallowing, muffled voice (hot potato voice) and sometimes referred ear pain, trismus (difficulty opening jaw)

Question 4

Treatment of Quinsy

Answer 4

• ENT specialists - incision and drainage of abscess under GA
• Broad spec abx eg Co-amoxiclav before and after surgery
• Some ENT surgeons give steroids to reduce inflammation

Question 5

Management UTI male vs female

Answer 5

• If male - 7 days of Nitrofurantoin/Trimethoprim (vs backup or immediate 3 days if decide to give abx in female)
• MSU for MC&S in males (only send in females if pregnant or hematuria)

Question 6

Safety netting for UTI

Answer 6

• Fever, vomiting, loin pain.
• Come back if become more unwell, symptoms worsen or do not improve within 48hrs of taking abx

Question 7

Investigation for diagnosing glandular fever

Answer 7

• FBC with differential WCC and monospot (heterophile antibody)
• Needs to be in 2nd week of illness
• Glandular fever is likely if monospot +ve
• OR FBC has more than 20% atypical or reactive lymphocytes
• OR 10% atypical lymphocyte count when lymphocytes are more than 50% of WCC

Question 8

Treatment and advice for glandular fever

Answer 8

• Paracetamol/ibuprofen to relieve pain
• Symptoms usually last 2-4 weeks
• Tiredness common and last symptom to resolve
• Can go to work/school
• Avoid kissing/sharing kitchen utensils - spreads via saliva.
• Avoid heavy lifting and contact/collision sports for first month of illness - risk of splenic rupture.

Question 9

Management of gastroenteritis - uncomplicated

Answer 9

• Conservative - fluids (can supplement with fruit juice and soups where necessary), can use oral rehydration solutions (if more at risk eg elderly)
• Ice lollies for children if difficulty having fluids and food
• Antiemetics/antidiarrhoeal are not recommended routinely - can buy OTC but not if bloody, mucus, pus or high fever or shiga.
• Keep hygiene good - wash hands, always flush toilet. Clean toilet door handles, flush handles, toilet seat, sink and taps etc once daily with disinfectant and disposable cloth.
• No work/school until 48hrs after vomitting/diarrhoea -

Question 10

When to do stool sample for gastroenteritis?

Answer 10

• If has not cleared up by expected timeframe eg 7days

Question 11

How to collect stool sample

Answer 11

• We will give you a sample pot. Ensure it has your name, DOB and all the details filled out on it.
• What you need to do is place a plastic container/potty/cling film under toilet seat to catch your stool.
• If you need to wee, try to do this first and not get any urine in the sample.
• Please do not let the stool touch the toilet bowl
• Once you have got your faeces in the pot, you need to use the scoop provided to fill the sample pot until you have about a walnut size amount of stool in the container.
• You need to bring the pot down to the surgery straight away with it inside a ziplock bag.
• If you cannot do this, place it ina ziplock bag in the fridge.