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
What to avoid doing in sprain?
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
When to return to activity after sprain?
* As soon as you can tolerate without excessive pain
* Athletes may return when full ROM without pain
27
Management of sprain - medical
* 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
Safety netting for sprains
* Septic arthiritis/haemoarthrosis - fever, maialise, heat from ankle and tenderness
* Compartment syndrome - pallor, paralysis, pulselessness, parasthesia
29
What is aphthous ulcer?
* 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
3 types of aphthous ulcer
* Minor - 2-4mm diameter
* Major - 1cm diameter
* Herpetiform - multiple mini ulcers that can be very painful
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Minor ulcers
* Mildly painful, annoying
* Heal in 7-10 days --> no scarring
* Recurr 3/4x per year
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Major ulcers
* More painful
* Recurr freq
* 10-30 days to heal
* Can scar
33
Herpetiform ulcers
* Typically affects females
* tiny discrete ulcers that coalesce into ulcerated patches
* Heal in 10 days
* recur freq
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Management of aphthous ulcer
* 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)
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What to consider if non-resolving ulcer?
* 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
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Oral cancer RF
* Betel nut chewing
* Smoking
* Alcohol
* Chewing tobacco
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Headlice
* 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
When can diagnose active infestation headlice?
* Not just if nits
* Need to haev live lice to diagnose active
* Treat if live louse found
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Treatment headlice
* 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
Advice headlice
* 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
Scabies - what is it
* 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
Treatment scabies
* 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)
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How does permethrin cream work?
* 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
Advice scabies
* 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
What is nappy rash?
* 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
Do's for nappy rash
* 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
Don'ts for nappy rash
* Dont use soaps, lotion or bubble bath --> irritants
* Do not use talc/antiseptics
* Do not put nappies on too tight --> irritates skin
48
Management nappy rash
* 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
Saftey netting nappy rash
* No improvement within 7 days - book f/u
* Itching/burning discontinue medication
* Seek emergency help if allergic reaction to medication
50
What is plantar fasciitis?
* 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
Typical description plantar fasciitis
* 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
Signs of plantar fasciitis
* Tenderness on plantar heel region
* Limited dorsiflexion
* Tight achilles tendon
* Antalgic gait - limping
53
Management plantar fasciitis
* 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
What is impetigo?
* 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
Two types of impetigo
* Bullous
* Non-bullous
56
Spread of impetigo cause
* Skin injuries
* Poor hygiene
* Close contact
* Crowded/close living conditons
* Compromised immune system
57
Treatment impetigo
* 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
Practical advice impetigo
* Good hand hygiene
* Avoid scratching
* Keep nails short
* Isolate contaminated items
* Clean and disinfect items
59
Advice for outdoors for insect bites
* Wear long sleeved tops and trousers
* Don't lie on grass - use blankets
* Avoid bright clothes - can attract
* Insec repellent
60
Sympotms of insect bite
* 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
Treatment insect bite
* 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
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How to know if bite is infected
* Redness/tenderness
* Pus
* Feeling unwell
* Flucloxacillin used, Clarithromyin in allergy to penicillin
* Consider abx lower threshold if diabetic/immunocompromised
63
Safety netting advice insect bites
* 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
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