Minor Illnesses Flashcards
What is fifth disease ?
Or slapped cheek
They may get a pink or red lace like rash on their arms. This rash comes and goes and ma spread to their legs, trunk and buttocks.
It is caused by an airborne virus called parvovirus B19.
What causes the common cold ?
Rhinoviruses
Influenza
what are the clinical features of a common cold ?
Sneezing
Dry sore throat
Rhinorrhoea
Headache
What are some complications of a common cold ?
Otitis media
Sinusitis
Pneumonia
What are the treatment options of the common cold ?
No specific treatment
Decongestants
Antihistamines
Analgesics
What is a cough ?
Non specific symptom and can be described as a forced expulsive manoeuvre usually against a close epiglottis with an associated sound.
What are some common airway irritants causing a cough ?
Smoke
Dust
Dandruff
Mucous
Infections
Allergens
Chemicals
What are some causes of an active cough ?
Viral URTI
Asthma
Pneumonia
Acute bronchitis
Bronchiectasis
COPD
What are some causes of a chronic cough ?
Asthma
Bronchitis
Bronchiectasis
CF
Use of ACEi
Smoking
What is important in to determine in the treatment of a cough ?
If it is life-threatening ( foreign body aspiration, pneumonia or PE ) or not ( URTI, allergy exposure )
When having a cough what are some features that patients may have which increase the risk of complications ?
Having a comorbidity
Older than 65
Having diabetes, congestive HF
Prematurely born children
What is otitis media ?
An inflammation of the middle ear sometimes associated with an upper respiratory tract infection
When should antibiotic treatment be offered for otitis media ?
Offer oral antibiotics to children with otitis media who are systemically unwell and to those at high risk of complications because of pre-existing comorbidity
What is acute mastoiditis ?
The result of extension of acute otitis media into the mastoid air cells with an accompanying suppuration and bone necrosis which may result in extra dural and subperiosteal abscesses.
What are the symptoms of acute mastoiditis ?
Earache, persistent and throbbing
A creamy, often profuse ear discharge
Increasing deafness
What are some signs of acute mastoiditis ?
Pyrexial and ill looking
Tenderness over the mastoid antrum
Pinna may be pushed down and forward
Tympanic membrane is either red or bulging or perforated
Conductive deafness
What is seen in some investigations for acute mastoiditis ?
Raised WCC especially neutrophils
Opacity and air coalescence seen on mastoid radiograph
Abscesses
What is the treatment of acute mastoiditis ?
Antibiotics IV
The aim is to drain the mastoid antrum and air cells without touching the middle ear, ossicles or external meatus - post-aural incision
What are some clinical features of pharyngitis ?
Sore throat
Dysphagia
Malaise
Redness
What are some causes of pharyngitis ?
Viral infections including flu and measles
EBV - glandular fever
Scarlet fever
Typhoid fever
What is the management of pharyngitis ?
Analgesia
If feverPAIN score is higher than 4 or 5 consider antibiotics
What are the complications of pharyngitis ?
Bacterial pharyngitis may lead to the development of peritonsillar or parapharyngeal abscess
What are some clinical features of tonsillitis ?
Sore throat
Otalgia
Headache and malaise
What is seen on examination in tonsillitis ?
Pyrexial
Enlarged tonsils - exuding pus
Inflammation of pharyngeal mucosa
Enlarged and tender cervical lymph nodes
What are some differentials for tonsillitis ?
Infectious mononucleosis
Scarlet fever
Diphtheria
What are some complications of tonsillitis ?
Otitis media
Peritonsillar abscess
Pulmonary infections
Acute nephritis
What is a UTI ?
Urinary tract infection is the presence and multiplication of micro-organisms in one or more structures of urinary tract with organisms invading the surrounding tissue.
What are some clinical features of a lower UTI ?
Dysuria, frequency, urgency and a sensation of incomplete bladder emptying
Lower abdo pain
Haematuria
What are some clinical features of upper UTI’s ?
Loin pain
Flank tenderness
Fever
Rigors
What are some risk factors for developing a UTI ?
Diabetes mellitus
Pregnancy
Genitourinary malformation renal stones
What are some investigations for a UTI ?
Urine dipstick
Urine microscopy, culture
What is the management for an uncomplicated UTI in woman ?
Consider a back up antibiotic prescription -
Review antibiotics after results return
First line - nitrofurantoin or trimethoprim
What is the management of UTI’s in men ?
Send midstream urine for culture and susceptibility
Immediate antibiotic treatment should be offered
Choice of antibiotics : trimethoprim or nitrofurantoin
What is candidiasis ?
An infection with the yeast candida albicans
It is a normal commensal in the GI tract, mouth and vagina but not on the skin
What is used to determine whether a patient with pneumonia is treated at home or in a hospital ?
Clinical judgement supported by the CURB-65 score
What is antibiotics are given for a community acquired pneumonia ?
First line - Amoxicillin 500mg 3 x a day
Doxycycline or clarithromycin are alternatives
What is the most common organism causing CAP ?
Streptococcus pneumoniae - a paired capsulated gram-positive organism often preceded by a viral infection.
What are some clinical features of CAP ?
More common in winter months
URTI’s are a predisposing factor
Sudden onset
Fever and rigors
Cough - sputum
Rapid and shallow breathing
What are some investigations performed for CAP ?
Chest radiology
FBC - raised WCC,
Raised CRP
Sputum culture
What is given for severe CAP ?
Intravenous antibiotics - co-amoxiclav
What preventative measures are there for CAP ?
Pneumococcal vaccination
What are some complications of CAP ?
Pleural effusion
Empyema
septic arthritis
pericarditis
endocarditis
peritonitis
cellulitis
meningitis
What is an abscess ?
A pus-filled lesion, arbitrarily defined as being less than 1 cm in diameter, enclosed in a pyogenic membrane.
What is the most common causes of abscesses ?
Staphylococcus infections within the skin
What are the general clinical features of an abscess ?
Erythema
Tender
Painful
If severe :
- pyrexia
- malaise
- sweating
What may be given for abscesses to obviate the need for surgery ?
Antibiotics - early and appropriate
Surgical treatment depends on the site of the abscess. What are some examples ?
Skin lesions may require simple incision and drainage with or without packing the cavity
Abdominal lesions may be approached with USS or CT guided percutaneous drainage or laparotomy and definitive drainage
Pancreatic abscess requires the entire wound to be left open and repeatedly packed.
What is influenza ?
An upper respiratory tract infection caused by a virus. There are 3 serotypes - A,B and C.
What are some clinical features of influenza ?
Fever
Malaise
Headache
Cough
Myalgia
Fatigue
Nasal congestion
Sore throat
What are some complications of influenza ?
Acute bronchitis
Influenza related pneumonia
Exacerbations of chronic lung diseases
Otitis media
Exacerbation of HF
What is the advice for management of influenza ?
Paracetamol for symptom relief
Drink plenty of fluids
Rest
Avoid smoking
Stay at home
How does vaginal candidiasis present ?
Irritation or itching
White Vaginal discharge
Dysuria or dyspareunia
Vulva is Red and oedematous
White lumps on vulva
What are some investigations for vaginal candidiasis ?
Microscopy and culture of exudate
Urine tested for sugars
What is the treatment of vaginal candidiasis ?
Apply anti fungal agents, avoid re-infection from sexual partner, keep vulva clean and dry as well as cool.
Medications :
Clotrimazole
Fenticonazole
Fluconazole
What are some factors that can pre-dispose someone to a candida infection ?
Immunosuppressive drugs
Endocrine disease
HIV
Hematinic deficiency
Old age, young age or pregnancy
Poor oral hygiene
Broad spectrum antibiotics
Heavy smoking
What are some clinical features of oral candidiasis ?
Dysphagia
Altered taste
White curd like pseudomembrane seen on tongue and upper mouth
Burning sensation
White plaques or patches
What is the management of oral candidiasis ?
Identify and correct any underlying causes or predispositions such as any deficiencies
Topical anti fungal treatment such as miconazole oral gel for 7 days or nyastin suspension
What are some risk factors for back pain ?
Heavy physical work
Frequent bending
Twisting
Poor lifting technique
Pulling or pushing
Repetitive work
Static posture
What is the management of back pain ?
Management mainly focuses on triaging patients into 3 categories :
Low back pain
Nerve root pain
Other serious causes
Analgesia is provided for people suffering
What is GORD ?
It is defined as symptoms or mucosal damage by abnormal reflux of gastric content into the oesophagus.
What are the typical symptoms of GORD ?
Heartburn
Acid regurgitation
What are some possible extra-oesophageal clinical features of GORD ?
Hoarseness
Sore throat
Sinusitis
Otitis media
Chronic cough
Laryngitis
What are some complications of GORD ?
Severe erosive oesophagitis
Barrett’s oesophagus
Oesophageal carcinoma
Haematemesis
Melaena
What is the management of GORD ?
Have an endoscopy
If damage seen - PPI given - omeprazole or lansoprazole
What is the definition of diarrhoea ?
The passage of abnormally liquid or unformed stools associated with increased frequency of defecation.
What are some basic investigations to carry out for chronic diarrhoea ?
FBC
ESR and CRP
Check for vit B12, folate, calcium and ferritin
TSH levels
Serological tests for coeliac - tTGA and endomysium antibody
Stool tests
Faecal calprotectin
What is the treatment for diarrhoea ?
Usually self limiting
Fluids and electrolyte replacement
Symptomatic relief to reduce bowel frequency and pain - opiates.
Antibiotics may be needed if infective cause
What is constipation ?
It is the infrequent or difficult evacuation of faeces.
what causes constipation ?
Organic obstruction
Medications - codeine
Diet
Metabolic imbalance
What are some clinical features of constipation ?
Infrequent, incomplete evacuation of stools
Anorexia
Abdominal discomfort
Abdominal pain
Tenderness
What are some investigations for chronic constipation ?
Sigmoidoscopy and barium enema to exclude carcinoma or diverticular disease.
Blood tests - thyroid hormone, calcium levels
Drug history reviewed
What management should be given for constipation ?
Treat underlying cause
Advise high fibre diet and increase fluid intake
Laxatives - not first line
If there is faecal impaction use an enema
What are the classifications of a headache ?
Primary headache disorders
- migraine
- tension headache
- cluster headache
Secondary headache disorders
-lesions causing it
What are some clinical features of a migraine ?
Periodic headaches with complete resolution
Stages - prodrome, aura, headache then resolution
What is the management of a migraine ?
Offer oral Triptan and an NSAID or paracetamol for acute attacks
what are some complications of migraines ?
Increased risk of stroke ( ischaemic )
Associated with depression, anxiety and panic disorders
What is syncope ?
A sudden loss of consciousness which is caused by inadequate blood supply to the brain.
Recovery is spontaneous
What is another differential for syncope ?
Epilepsy
What should be asked in the history of someone who had a syncopal episode ?
Did they having a warning sensation prior - blurring of vision, dizziness or nausea
Were they sitting or standing prior
How long were they unconscious
Were there convulsions
Any palpitations
Incontinence or tongue biting
What should be examined if someone has a history of faints ?
Pulse
BP - lying and standing
Cardiac murmurs
Neurological exam
Any signs of tongue biting or bruises
What is a sprain ?
Soft tissue damage of a joint - ligament out and capsular damage - localised condition
What is the management of a sprain ?
RICE
Analgesia
What is eczema ?
A common and chronic relapsing inflammatory skin disorder characterised by intense Pruritus and excoriation with erythematous, xerotic, fissured skin.
What are characteristic features of eczema ?
Itch
Hot skin
Oedema
Oozing or weeping
Crusting
Excoriation
What is the management of eczema ?
Emollients or topical corticosteriods
Topical calcineurin inhibitors
What is urticaria ?
A vascular reaction of the skin marked by transient appearance of slightly elevated patches which are red or pale swellings that are often attended by itching
May have angio-oedema
What are some causes of urticaria ?
Idiopathic
Drug induced
Allergic - food
What is the management of urticaria ?
Avoid triggers
Diet modifications
Use of antipruritic lotion
Antihistamines
What is psoriasis ?
A common chronic sin disease characterised by cutaneous inflammation and epidermal hyper proliferation particularly on the scalp, sacral area and over the extensor aspect of the knees and elbows.
What are some causes of psoriasis ?
Genetic
Infection
Stress
Trauma
Drugs
Smoking and alcohol
What is the treatment of psoriasis ?
Corticosteroids, vitamin D and vit D analogues
Phototherapies
