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General Practice YR3 > Minor Illness Presentation > Flashcards

Minor Illness Presentation Flashcards

1
Q

Background chicken pox

A
  • Varicella zoster causes
  • Incubation is 10 days-3 weeks –> then become symptomatic
  • Treatment conservative
  • Aciclovir considered in immunosupressed
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2
Q

How is itchiness controlled in CP?

A
  • Cut childs nails
  • Calamine lotion
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3
Q

What is shingles?

A
  • VZ virus lies dormant in sensory dorsal root ganglion cells
  • Gets reactivated = shingles
  • YOU CANNOT get shingles from someone with chicken pox
  • But you can get chicken pox from someone with shingles if you haven’t had it before
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4
Q

Chicken pox in pregnancy

A
  • Dangerous if before 28 weeks gestation –> development defects

-
* If around time of delivery -> can lead to life threatening neonatal infection
* Treat this with varicella zoster immunoglobilins and aciclovir

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5
Q

What to do if pregnant women <28 weeks gestation presents with CP exposure?

A
  • Establish immunity - have they had it before?
  • If they have -do not need to worry, immunity will protect
  • If they are unsure test for IgG and IgM levels
  • If no IgG detected - not had before and needs immunoglobulins and aciclovir
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6
Q

How does shingles present?

A
  • Neuropathic pain in dermatome before rash occurs usually
  • Can be mistaken for MI pain if on L of chest
  • Electric shock description of pain
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7
Q

What is Ramsay Hunt syndrome?

A

VZ affecting the facial nerve, can cause facial paralysis

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8
Q

What is fifth disease?

A
  • Viral illness caused by human parvovirus B19
  • Causes red rash on cheeks - aka slapped cheek/erythema infectiousum
  • Spreads respiratory droplets and vertically
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9
Q

Diagnosing fifth disease - presentation

A
  • Children 5-14
  • High fever
  • Runny nose and sore throat
  • Headache
  • Red rash on cheeks
  • Few days later get spotty rash on trunk
  • CLINICAL diagnosis - if atypical can test for Abs
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10
Q

Treatment for fifth disease

A
  • Encourage rest and fluid intake
  • Get better within 3 weeks
  • Can attend school - not infectious once rash emerges
  • If under 16 children should not haev aspirin - risk Reyes syndrome
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11
Q

Safety netting for fifth disease

A
  • Severe cases can get aplastic crisis - need hospital
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12
Q

What are childhood exanthems with examples?

A
  • Skin rashes commonly associated with viral infections in children
  • Eg Measles, chickenpox, roseola infantum, hand foot and mouth disease
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13
Q

What is first second and third disease?

A
  • 1st - Scarlet fever
  • 2nd - Measles
  • 3rd - Rubella
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14
Q

Scarlet fever

A
  • Bacterial infection
  • Group A streptococcus
  • Red rash, fever sore throat strawberry tongue
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15
Q

Measles

A
  • Very contagious 1:15
  • Red blotchy rash on face –> other parts of body
  • Fever, cough, runny nose
  • Can become disabled after infection
  • Vaccination MMR is important
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16
Q

Rubella

A
  • Mild infection
  • AKA german measles
  • Fever and swollen lymph nodes with spotty rash
  • Concerning during pregnancy –> can cause rubella syndrome in foetus
  • Those in fertility clinics get tested for immunity
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17
Q

What is conjuctivits?

A
  • Inflammationof conjuctival membrane - cornea clear and spared
  • Causes discomfort and gritty feeling
  • Usually viral but can be bacterial (get pus and dishcarge)
  • No visual changes on exam and eye is bloodshot and watery
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18
Q

Treatment for conjuctivitis

A
  • Conservative - do not need treatment
  • Sometimes give chloramphenicol eye drops if nursery needs for attendance (risk of aplastic anaemia with eye drops)
  • Usually improves within 5 days
  • Bathe with cooled boiled water
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19
Q

Advice for conjuctivitis

A
  • Very contagious
  • Can spread between eyes and people easily
  • Can go to community pharmacist for treatmetn
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20
Q

Stye - what is it?

A
  • Eyelash follicle infection - or oil gland of lids
  • Swelling at edge of eyelid
  • Caused by staphylococcus aureus bacteria
  • Painful red lump with white punctum
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21
Q

Treatment stye

A
  • Self limiting
  • Resolve within 3 months - a lot longer than conjuctvitis
  • Warm compress
  • Oral abx for severe cases
  • Consider marsupialisation if does not go within 3 months (incision and drainage)
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22
Q

Orbital cellulitis presentation

A
  • Post septal is most severe - sight and intracranial structures threatened
  • Deep to orbital septum
  • Periorbital is confined to superficial
  • Large orbital swelling, proptosis, reduced vision, painful eye movements
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23
Q

Treatment orbital cellulitis

A
  • Antibiotics
  • Sometimes given in primary care
  • Post septal will always need secondary care –> eye casualty in Leic
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24
Q

Management of sprain - what should you do

A

PRICE
* Protect - from further injury eg using support
* Rest
* Ice - for 15/20 mins every 2-3hrs
* Compression - elastic bandage, snug but not tight and removed for sleep (controls swelling and supports)
* Elevation - on pillows until swelling is controlled, for severe may need to immobilise

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25
Q

What to avoid doing in sprain?

A

HARM
* Heat - worsens bruising and inflammation by encouraging blood flow
* Alcohol - increases bleeding and swelling and decreases healing
* Running - or any other exercise which will further damage
* Massage - increases bleeding and swelling

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26
Q

When to return to activity after sprain?

A
  • As soon as you can tolerate without excessive pain
  • Athletes may return when full ROM without pain
27
Q

Management of sprain - medical

A
  • Paracetamol/topical NSAIDs
  • Oral NSAIDs
  • Short term use of codeine if needed
  • Can medically review after 5-7 days if lack of expected improvement or worsening
  • Consider physio referal if ongoing
  • Consider ortho referral if slower recovery, worsening or new symptoms, out of proportion symptoms
28
Q

Safety netting for sprains

A
  • Septic arthiritis/haemoarthrosis - fever, maialise, heat from ankle and tenderness
  • Compartment syndrome - pallor, paralysis, pulselessness, parasthesia
29
Q

What is aphthous ulcer?

A
  • Small erythematous ulcerations usually found in mouth but can be genitals (rarer)
  • NOT linked to systemic disease
  • Genetic predisposition, smoking cessation, iron/folate/B12 def, autoimmune conditions, anxiety and trauma can cause
30
Q

3 types of aphthous ulcer

A
  • Minor - 2-4mm diameter
  • Major - 1cm diameter
  • Herpetiform - multiple mini ulcers that can be very painful
31
Q

Minor ulcers

A
  • Mildly painful, annoying
  • Heal in 7-10 days –> no scarring
  • Recurr 3/4x per year
32
Q

Major ulcers

A
  • More painful
  • Recurr freq
  • 10-30 days to heal
  • Can scar
33
Q

Herpetiform ulcers

A
  • Typically affects females
  • tiny discrete ulcers that coalesce into ulcerated patches
  • Heal in 10 days
  • recur freq
34
Q

Management of aphthous ulcer

A
  • Mild - OTC like bonjela and reassure
  • Severe pain - topical corticosteroid (hydrocortisone oromucosal tablets)
  • Ask patient to return if not resolved within 2 weeks (up to 6 for major)
35
Q

What to consider if non-resolving ulcer?

A
  • FBC - rule out anaemia
  • Iron and B12 levels
  • ESR/CRP
  • IgA-ttG for coeliac
  • Malignancy suspicion - non resolving in 3 weeks, growing outwards, cervical lymphadenopathy or oral cancer RF
36
Q

Oral cancer RF

A
  • Betel nut chewing
  • Smoking
  • Alcohol
  • Chewing tobacco
37
Q

Headlice

A
  • Parasitic infection - hairs on head and feeds on scalp blood
  • Transmitted via head to head contact or sharing combs/towels
  • Itchy scalp with visible nits (eggs) and lice
38
Q

When can diagnose active infestation headlice?

A
  • Not just if nits
  • Need to haev live lice to diagnose active
  • Treat if live louse found
39
Q

Treatment headlice

A
  • Wet combing with fine tooth head louse comb first line - eg Bug Buster kit
  • Physical insecticide - eg Dimeticone 4%coats lice and suffocates them
  • Traditional insecticide - eg malathion 0.5% liquid
  • Detection combing should be done after treatment to confirm success (no live lice)
  • Unsuccessful - check close conacts, repeat
40
Q

Advice headlice

A
  • Can still attend school
  • No evidence of clean vs dirty hair lice prefers
  • No need to treat clothing/bedding - lifespan 1-2 days off human head
  • Children primary school age examined regularly as it not possible to prevent
41
Q

Scabies - what is it

A
  • Caused by mites burrowing into skin and lay eggs
  • These hatch and cause inflammatory response = itching
  • Spread is prolonged skin to skin contact or towels/clothing/bedding
42
Q

Treatment scabies

A
  • All members household treated
  • Close contacts/sexual contacts within last month treated too - may need GUM for contact tracing
  • Permethrin 5% cream - but cannot have this if broken/secondary infected skin
  • Can use sedating antihistamine eg piriton if sleep affected (chlorphenamine)
43
Q

How does permethrin cream work?

A
  • kills mites which cause scabies
  • Apply to whole body - esp between fingers, under nails, armpits - not to broken skin/eyes though
  • Cream is flammable - careful if smokers
  • Wash cream off after 8-12hrs
  • Side effect of tingling/stinging when apply but transient
44
Q

Advice scabies

A
  • Bedding, clothing and towels hot wash at 60 degrees
  • Then dry in hot dryer, dry cleaning or seal in bag for 72hrs
  • Itching can continue for up to 4 weeks after successful treatment
  • Avoid scratching if possible - prevent secondary bacterial infections
45
Q

What is nappy rash?

A
  • Inflammation of babys skin caused by prolonged contact with damp nappy
  • Scaly, dry skin, itchy/painful bottom, red/raw patches, skin that is sore/hot to touch and baby distressed
  • Caused by nappy rubbing against babys skin, allergic reactions, irritations from wipes, urine/faeces contact with skin for prolonged time
46
Q

Do’s for nappy rash

A
  • Change wet nappies ASAP
  • Keep skin clean and dry - pat and rub gently
  • Leave nappies off when possible
  • Use extra absorbant nappies
  • Make sure they fit properly
  • Clean baby’s skin with water/fragrance free/alcohol free wipes
  • Bath baby daily but not more than twice a day –> dries skin out
47
Q

Don’ts for nappy rash

A
  • Dont use soaps, lotion or bubble bath –> irritants
  • Do not use talc/antiseptics
  • Do not put nappies on too tight –> irritates skin
48
Q

Management nappy rash

A
  • Advice as above
  • Mild - OTC barrier cream eg Sudocrem
  • Inflamed - topical 1% hydrocortisone for 7 days max
  • Candida - topical clotrimazole and miconazole
  • Bacterial infection - flucloxacillin
49
Q

Saftey netting nappy rash

A
  • No improvement within 7 days - book f/u
  • Itching/burning discontinue medication
  • Seek emergency help if allergic reaction to medication
50
Q

What is plantar fasciitis?

A
  • Pain associated with degeneration of plantar fascia because of repetitive microtears
  • Common for 40-60yrs and females
  • RF inc prolonged standing occupations, obesity, diabetes and athletes
51
Q

Typical description plantar fasciitis

A
  • Initial gradual onset of heel pain
  • Intense pain during first few steps after waking/period of inactivity
  • Pain that reduces with moderate activity but worsens later during day or after long periods standing/walking
52
Q

Signs of plantar fasciitis

A
  • Tenderness on plantar heel region
  • Limited dorsiflexion
  • Tight achilles tendon
  • Antalgic gait - limping
53
Q

Management plantar fasciitis

A
  • Rest foot
  • Wear shoes with good arch support and heel cushioning +/- insoles
  • Avoid walking barefoot
  • Lose weight if overweight/obese
  • OTC analgesia - paracetamol/NSAIDs
  • Ice packs for 15-20 mins
  • Self exercises to stretch fascia
  • Referral to physio/podiatry if needed
  • Consider steroid injections as last resort
  • Can refer to orto surgery or extracorporeal shockwave therapy
54
Q

What is impetigo?

A
  • Superficial bacterial skin infection caused by either staphylococcus aureus or streptococcus pyogenes usually
  • Can be primary or complication of existing condition eg eczema/scabies/insect bites
  • Common in children esp during warm weather
55
Q

Two types of impetigo

A
  • Bullous
  • Non-bullous
56
Q

Spread of impetigo cause

A
  • Skin injuries
  • Poor hygiene
  • Close contact
  • Crowded/close living conditons
  • Compromised immune system
57
Q

Treatment impetigo

A
  • 1% hydrogen peroxide cream or fusidic acid cream often used
  • Topical mupirocin if fusidic acid allergic
  • If extensive disease oral flucloxacillin/erythromycin can be used
  • Children should not attend school until lesions are crusted and healed for until 48hrs after commencing abx
58
Q

Practical advice impetigo

A
  • Good hand hygiene
  • Avoid scratching
  • Keep nails short
  • Isolate contaminated items
  • Clean and disinfect items
59
Q

Advice for outdoors for insect bites

A
  • Wear long sleeved tops and trousers
  • Don’t lie on grass - use blankets
  • Avoid bright clothes - can attract
  • Insec repellent
60
Q

Sympotms of insect bite

A
  • Red swollen lump - can be painful +/- itchy
  • Usually imrpove within few hours/days
  • Some people have mild allergic reaction - larger red area, resolves within 1 week
61
Q

Treatment insect bite

A
  • Wash skin with soap and water to decrease chance of infection + cold compress
  • Paracetamol/ibuprofen if painful
  • Antihistamine for itching
  • Hydrocortisone cream to decrease itching and swelling
  • Avoid itching - increase risk of infection
62
Q

How to know if bite is infected

A
  • Redness/tenderness
  • Pus
  • Feeling unwell
  • Flucloxacillin used, Clarithromyin in allergy to penicillin
  • Consider abx lower threshold if diabetic/immunocompromised
63
Q

Safety netting advice insect bites

A
  • Infected bites can lead to cellulitis/sepsis
  • Advice patients to look out for red flags eg systemically unwell
  • Call 999 if symptoms of anaphylaxis - ABC affected/widespread urticaria
64
Q
A

General Practice YR3 (31 decks)

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