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
2
Q
How is itchiness controlled in CP?
A
- Cut childs nails
- Calamine lotion
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
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
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
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
7
Q
What is Ramsay Hunt syndrome?
A
VZ affecting the facial nerve, can cause facial paralysis
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
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
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
11
Q
Safety netting for fifth disease
A
- Severe cases can get aplastic crisis - need hospital
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
13
Q
What is first second and third disease?
A
- 1st - Scarlet fever
- 2nd - Measles
- 3rd - Rubella
14
Q
Scarlet fever
A
- Bacterial infection
- Group A streptococcus
- Red rash, fever sore throat strawberry tongue
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
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
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
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
19
Q
Advice for conjuctivitis
A
- Very contagious
- Can spread between eyes and people easily
- Can go to community pharmacist for treatmetn
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
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)
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
23
Q
Treatment orbital cellulitis
A
- Antibiotics
- Sometimes given in primary care
- Post septal will always need secondary care –> eye casualty in Leic
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
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
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
