Minor Illnesses Flashcards
what are symptoms of the common cold?
- sore throat
- nasal irritation, congestion, discharge
- cough
- hoarse voice
- general malaise
- (fever, headache, loss of smell/taste)
what is the management of a common cold?
- self limiting !
- adequate fluid and healthy food
- adequate rest
- paracetamol/ibuprofen if antipyretic or have headaceh
- steam inhalation/nasal drops/cough medicine/decongestants
what are the differentials for a sore throat?
- tonsilitis (viral or bacterial)
- pharyngitis
- quinsy
- influenza
- hand foot and mouth disease
what is the feverPAIN prediction score?
score one point for each - with a higher score there is more likely chance of isolating streptococcus
- fever over 38 degrees
- Purulence
- Attend rapidly (3 dyas or less)
- severly Inflamed tonsils
- No cough
what would be the idfference ebtween pharyngitis and tonsilitis?
pharyngitis -> associated with pharyngeal exudate and cervical lymphadenopathy
tonsillitis -> associated with tonsillar exudate and enlargement and erythema of tonsils with anterior cervical lymphadenopathy
what other symptoms may you have with a sore throat?
- headache, nausea, vomiting, abdo pain
- fever
what is the treatment of bacterial tonsilitis?
phenoxymethylpenicillin 500g QID for 10 days
if penicillin allergy -> clarythromycin
what is teh managment of a sore throat in primary care?
- adequeate fluid
- ibuprofen and paracetamol
- salt water gargling, lozenges
how many times a year does a patient need to have recurrent tonsilitis to be referred to ENT?
x7
what are the symptoms of acute sinusitis?
- nasal blockage
- nasal discharge
- facial pain/pressure
- reduction in sense of smell
- cough
what is teh difference between acute bacterial and acute viral sinusitis?
acute bacterial:
- symtoms for longer than 10 days
- discolored or purulent nasal discharge
- fever >38 degrees
what is the management for acute viral sinusitis?
acute sinusitis usually cuased by virus and is self limiting
- ibuprofen/paracetamol fro pain/fever
- nasal saline/decongestants
what is teh managment for acute bacterial sinusitis?
- consider high dose nasal corticosteroid (mometasone) for 14 days
- can give ‘back up’ ABX prescription (phenyoxymethylpenicillin 500mg QID for 5 days) if sypmtoms worse rapidly for pt. or do not improve within 7 days
what are the main symptoms of acute bronchitis?
- cough
- sputum
- wheeze
- breathlessness
- chest wall pain when coughing
what are teh main ysmptoms of CAP?
dsypnoea sputum production plueral pain sweating fever shivers aches pains confusion tachypnoea tachycardia
what woudl be different when examining a chest with acute bronchitis vs CAP?
CAP;: focal chest signs, decreased breath sounds, dullness to percussion, coruse crepitations, vocal fremitus
whereas acute bronchitis would jsut present with a wheeze
what is the treatment fro acute bronchitis?
- OTC cough medicine
- stop smoking
- self limiting and cough usually lasts 3-4 weeks !
- if systemically unwell then offer: oral doxycycline 200mg first day, then 100mg for 4 more days
what is the treatment for CAP?
- do CURB 65 score first (if 3 or more = hospital, if 1/2 hospital considered)
- analgesia given, adequeate fluid intake, rest
- amoxicillin 500mg TID for 5 days (or doxycycline is penicillin allergic)
when would you consider prescribing antivirals for someone with influenza?
- if patient is ‘at risk’: asplenia, chronic resp/heart/kidney/liver/ neurological disease, diabetes, immunosuppression, obesity, >65y/o, <6 months, pregnant
- the person is able to start treatment within 48 hours of onset of symptoms
which antivirals would you prescribe for influenza?
oral oseltamivir
what are the causes of acute diarrhoea?
- virus’
- bacterial: parasitic
- drugs
- anxiety
- food allergy
- acute appendicitis
- intenstinal ischaemia
what are teh causes of chronic diarrhoea?
- IBS
- IBD
- diet
- microscopic colitis
- coeliac disease
- colorectal cancer
- causes of malabsorption
- bile acid diarrhoea
- drugs
what is the management of acute diarrhoea?
- self limiting
- ORT + fluids and electrolytes
- loperamide hydrochloride
how would you investigate diarrhoea in primary care?
- stool sample
- blood tests
what is teh presentation of a patient with gastroenteritis?
- sudden onset diarrhoea, blood or mucus in stools, feacal urgency
- nauseas or sudden onset vomitjng
- fever or general malaise
- abdo pain or cramps
- headahce, myalgia ,bloating, flatulence, weight loss, malabsorption
when woudl you arrange a stool culture for a patient with gastoenteritis?
- systemically unwell, or immunocomprimised
- acute painful diarrhoea or blood, mucus in stool
- recent ABX or PPI treatment
- not resolved by day 7
- suspected food poisoning
- recently travelled
what is the management of a person with gastroenteritis?
- drinks fluids + ORT
- antidiarrhoeals (loperamide hydrocholride)
- ABX only following stool culture if appropriate
- advice on isolating and good hand hygeine
what are the symptoms of a lower UTI?
- dysuria
- frequency
- urgency
- changes in urine appearance (cloudy, heamaturia)
- nocturia
- suprapubic discomfort/tenderness
what are the symptoms of pyelonephritis?
UTI symptoms + fever, loin pain or rigors
what results of a urine diptick would point towards a diagnosis of a UTI?
- positive nitrates
- positive leukocytes
- RBC (heamaturia)
which patients should a urine culture definiely be sent (what criteria when suspecting a UIT)?
- preggo
- oldder than 65 yrs
- symptoms persistant even with ABX
- recrurrent UTIs
- urinary catheter
in situ or recently had one - risk factors for resistance or complciated UTI
what is teh management of UTI (uncomplicated)?
- paracetamol/ibuprofen
- increase fluids
- nitrofurantoin 100mg BID 3 days OR trimethoprim 200mg BID for 3 days (if low risk of resistance)
what is the management of a UTI in s pregnant woman (with no heamaturia)?
- nitrofurantoin 100mg BID for 7 days
- secodn line: amoxicillin 500mg TID for 7 days or cefalexin 500mg BID for t days
what is the management of UTI in men?
trimethoprim 200mg BID for 7 days
or nitrofurantoin 100mg BID for 7 days
what is the treatment for reccruent UTIs?
consider single-dose antibiotic prophylaxis for use when exposed to an identifiable trigger:
- Trimethoprim 200mg single dose OR Nitrofurantoin 100mg single dose
Second choice: Amoxicillin 500mg single dose OR Cefalexin 500mg single dose
what is the treatment for pyelonephritis?
- cefalexin 500mg BID/TID for 7-10 days (for pregnant women)
- co-amoxiclav 500mg TID for 7-10 days
what are the symptoms of bacterial vaginosis?
- 50% asymptomatic
- fishy smelling, thin, grey/white homogenous discharge that is NOT associated with itching or soreness
what are the risk factors for bacterial vaginosis
- STI
- douches, bubble baths, deodrant, shampoo
- multiple partners
- exposure to semen
- IUD
- smoking
what investigations/examinations need to be perfromed on a aptient with suspected bacterial vaginosis?
- abdo exam
- vulval exma
- speculum examination
- test pH of vaginal discharge
- high vaginal swab fro gram staining
- STI testing if at risk
what is th management of bacterial vaignosis?
if symptomatic: oral metronidazole 400mg BID for 5-7 days OR topical intravaginal metronidazole gel 0.75% QD for 5 days
if asymptomatic treatment not required
what are teh symptoms of vulvovaginal candidiasis?
Vulval or vaginal itching Vulval or vaginal soreness and irritation. Vaginal discharge Superficial dyspareunia. Dysuria
what si teh managment fo vulvovaginal candidiasis?
fluconazole 150 mg oral capsule as a single dose first-line.
clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated
if vulval symptoms: topical clotrimazole 1% or 2% cream applied 2–3 times a day
*all can be bought OTC
if severe: repeat antifungal drug treatment after 72 horus
what is chicken pox?
acute, infectious disease caused by varicella-zoster virus
what is the management of chicken pox?
- paracetamol
- topical calamine to alleviate itch
- Chlorphenamine to treat itch
- for v severe: oral aciclovir 800mg 5x a day for 7 days
can you catch shingles from chicken pox and vice versa?
If you HAVENT had chicken pox you can catch it form chicken pox or shingles
if you havent or have had chicken pox you CANNOT ccatch shingles from chicken pix or shingles
as shingles is a reactivation of the varicella zoster virus which sits inactive in the dorsal root ganglion (when activated will affect a single dermatome)
what are teh clinical features of conjuctivitis?
itchy, sticky watery eye
usually bilateral
erythema of conjuctiva with (purulent) discharge
usually viral in adults and bacterial in children
what are the clinical features of a stye? what is a stye?
a stye is a blockage/infection of a eyelash follicle in the eye - lump may be yellow and erythematous
what is the management of conjuctivitis?
- cool compress/eye drops
- infection control advice
- if bacterial: chloramphenicol
what is the management for a stye?
- pain relief
- warm/cool compress for symptom relief
- antibiotic ointment
what are the symptoms of a meibomium cyst?
firm, painless, localized eyelid swelling that has developed slowly over several weeks
usually sited away from lid margin
treatment for meibomium cyst?
- warm compress and massage gently
what are some red flags with eye infection
- reduce visual acuity
- significant eye pain or headaches
- photophobia
- Hx of trauma
- XS and progressive discharge
- red sticky eye in neonate
what are teh two major complications of eye infections?
Periorbital cellulitis- infection anterior to the orbital septum does not cause visual impairment, limited or painful eye movements, oedema of the conjunctiva or protrusion of the eyeball. may be associated fever and malaise.
Orbital cellulitis - infection involving the deep soft tissue surrounding the eyeball, located posterior to the orbital septum usually presents as an acute onset of unilateral eyelid oedema, with a red and painful eye. associated with severe pain, blurred vision, double vision, limited and painful eye movements, protrusion of the eyeball, headache, fever, and malaise.
what are the clinical features of impetigo?
non bullous impetigo - thin walled vesicles or pustules that release exudate and then crusts leaving mild erythema
peri-oral and peri-nasal areas common
bullous impetigo - flaccid fluid filled vesicles and blisters which can persist for 2-3 days. Blisters rupture leaving a thin flat yellow/brown crust
what is the management of impetigo?
- good hygeine
localised non bullous: hydrogen peroxide 1% cream (apply two or three times daily for 5 days) for mild OR topical ABX Fusidic acid 2% OR Mupirocin 2% (apply three times a day for 5 days)
widespread non bullous: topical or oral antibiotic (oral = flucloxacillin 500 mg QID for 5 days) or clarythromycin in penicillin resistant
bullous impetigo: oral flucloxacillin (500 mg QID for 5 days) or clarythromycin in penicillin resistant
