minor illnesses

Question 1

How can you tell the difference between a viral and bacterial URTI?

Answer 1

Viral: runny nose, cough, low grade fever, trouble sleeping, shorter duration

Bacterial: higher fever that gets worse a few days into illness rather than better, longer course over 10-14 days, possible pus on tonsils

Question 2

How can you tell the difference between influenza and other viral URTIs?

Answer 2

Influenza may have muscle aches and high fever
Give oral oseltamivir or inhaled zanamivir if person in an at risk group within 48 hours
Give oseltamivir if not at risk but could have complications e.g pregnancy
If healthy treat conservatively. Will take 1-2 weeks of rest and fluids

Question 3

If a patient is prescribed abx for an acute cough , which one is prescribed?

Answer 3

1st line doxycycline
2nd line amoxicillin

Question 4

Who is more likely to benefit from antibiotic prescribing with otitis media?

Answer 4

Under 18 with ottorhoea
Under 2 with infections in both ears
Usual course 3 days to 1 week so give paracetamol or ibuprofen, no evidence for anything else
Give amoxicillin or clarithromycin then co-amoxiclav if not improving after 2 days

Question 5

when do you give antibiotics in acute sinusitis?

Answer 5

• Usual course around 2-3 weeks so tell them to seek help if not improving after 3 weeks as may be dental infection or resistant bacteria
• At 10 days give nasal corticosteroid

If systemically unwell or intracranial complications like mastoiditis or intraorbital complications give antibiotics

Question 6

what are some complications of pneumonia?

Answer 6

Sepsis
Pleurisy
Lung abscess (risk higher with other co-morbities and alcohol abuse)

Question 7

What is the difference between the presentation of acute bronchitis and community acquire pneumonia?

Answer 7

No x-ray changes with bronchitis
URTI signs with bronchitis e.g runny nose
No pleuritic chest pain with bronchitis
No fever, rigors, tachypne with bronchitis

Question 8

differentials for a boil/carbuncle

Answer 8

Cystic acne
Folliculitis
Epidermoid cyst
Dental abscess
Hidradenitis suppurativa
Anthrax

Question 9

How is oral candidiasis treated?

Answer 9

Mild: topical miconazole 1st line (or nystatin 2nd) for 7 days

Severe: oral fluconazole 50mg 7 days and follow up

Consider referral for biopsy if chronic plaque like
Advise good dental hygeine, diabetic control, encourage to stop smoking

Question 10

how is quinsy treated?

Answer 10

IV antibiotics
Surgical drainage
Consider tonsillectomy within 6 weeks

Question 11

what is the difference between a sprain and a strain?

Answer 11

Sprain: stretch and/or tear of a ligament. Usually ankles, knees, wrists, thumbs.

Pain especially when weight bearing, tenderness, swelling, joint instability, decreased function

Strain: stretch and/or tear of muscle fibres or tendon. Usually back, hamstrings, foot.

Muscle pain, cramping, bruising, muscle weakness

Question 12

what are some causes of transient loss of conscoiusness?

Answer 12

Vasovagal Syncope: 3Ps of posture, pain, prodromal

Orthostatic Hypertension: medication or conditions related to it, lightheadedness, symptoms worse on standing, tunnel vision. Drop of 20 sys or 10 dia after standing for 3 mins diagnoses

Cardiac abnormalities: FH of sudden death before 40, abnormal ECG, occurs during exertion, palpatations before LOC

Epilepsy: head turning, prodromal deja vu, shaking/jerking, tongue biting

Question 13

How is a pilonidal sinus investigated and managed?

Answer 13

Clinical features and risk factors e.g men and prolonged sitting, aid diagnosis
If asymptomatic watch and wait and good hygeine
Give antibiotics if abscess forms
If acute send for same day I+D with paracetamol/NSAID.
If discharging needs surgical excision leaving open and heal for 6-8 weeks

Question 14

how are cluster headaches managed in primary care?

Answer 14

Need to confirm with neurologist if first attack

Acute Confirmed

100% O2 for 15 mins
6mg sumatriptin SC or IN
Do not offer paracetamol, NSAIDs etc
Prophylaxis

Verapamil

Question 15

list 3 symptoms of tension headaches and how they are managed in primary care

Answer 15

symptoms: tight band round head, not severe enough to prevent everyday activities, can last between 30 mins - several hours

mx: Simple analgesia (no opioids) and control other disorders e.g stress
10 session of acupuncture over 5-8 weeks
Possible low dose amitriptyline

Question 16

what is trigeminal neuralgia and how is it managed?

Answer 16

paroxysms of intense stabbing pain over mandibular or maxillary division of the cranial nerve 5. unilareral triggered by washing, shaving, eating, talking.

if no red flags give carbamazepine

Question 17

What are some investigations that should be done into chronic diarrhoea?

Answer 17

CA125 testing
C.Diff testing
Faecal calprotectin (if raised suggests inflammation so IBD not IBS)
C.Diff testing
Examine for ova, cysts and parasites if travel history
Test for blood in faeces
HIV serology

Question 18

how do you investigate/ manage someone with suspected EBV?

Answer 18

Arrange FBC and EBV monospot test in the second week of illness. Look at LFTs
If negative do EBV viral serology test
Advise will last 2-4 weeks, tiredness will last longest, take analgesia, avoid contact sports, avoid spread by kissing/sharing utensils
Admit to hospital if stridor, dehydration or complications

Question 19

how does rubella present and managed?

Answer 19

2-3 weeks after exposure generic symptoms like rash, lymphadenopathy, arthritis/arthralgia, low grade fever, headache
Can cause encephalopathy, neuritis, orchitis, thrombocytopenia
Use viral serology
- Inform PHE, avoid pregnant people, avoid work/school for 5 days after rash, self limiting treatment such as paracetamol

Question 20

how is orobital cellulitis diagnosed and managed?

Answer 20

Dx:

• Systemic features of fever and malaise
• Often due to Strep species from ethmoidal sinus if behind orbital septum. If in front often S.Aureus
• Diplopia
• Difficulty moving eye

Mx:

Emergency referral to hospital and co-amoxiclav or clindamycin if allergy
CT of orbit and brain particularly in children to check for intracranial abscess

Question 21

How is an aphthous ulcer managed?

Answer 21

Often due to damage in the mouth e.g braces, biting cheek, and not associated with systemic disease
Do FBC, Vit B12, Ferritin, Folate, IgA transglutaminase, viral serology for EBV/HIV if diagnosis uncertain
Self limiting 10-14 days but avoid trigger foods. If painful can give topical corticosteroid e.g hydrocortisone oro-mucosal tablets, beclomethasone spray, or topical local anaesthetics
If recurrent can give short course PO prednisolone.
Refer for malignancy if doesn’t clear in 3 weeks

Question 22

how is scabies managed?

Answer 22

1st Line - Permethrin 5% cream

2nd line - Malathion aqueous 0.5% cream if above not tolerated

Apply to whole body on cold dry skin and allow to dry before dressing. Wash off 12 hours later and apply 2nd application a week later
All household members and sexual partners need treatment even if asymptomatic
Wash all clothes and bedding at 60 degrees and dry in hot dryer
Itch may still occur for 2 weeks but if still present 2-4 weeks later see GP

Question 23

how does plantar fasciitis present and diagnosed?

Answer 23

Hx:

Intense heel pain during first steps after waking or after inactivity
Pain that reduced with moderate activity but worse at the end of the day or after long walking
Risk factors: aged 40-60, obese, running, woman
Dx: (clinical features)

Positive Windlass test
Tenderness on palpation of plantar heel
Tightness of Achille’s tendon
Antalgic gait

Question 24

how does impetigo present?

Answer 24

Bullous caused by S.Aureus, Nonbullous can be S.Pyogenes

May swab for MRSA if recurring but usally off of clinical features

Red blisters that quickly pop and form a crust. Lasts for 7-10 days and is very contagious

Question 25

hoe is impetigo managed?

Answer 25

Reassure will heal with no scarring. Stay away from schools and work until crusted over or till 48 hours after start of treatment
Localised non bullous:

Topical hydrogen peroxide 1% 2-3x a day for 5 days
If unsuitable can give topical antibiotic like mupriocin or fusidic acid for same time
Widespread non bullous or bullous:

Oral flucloxacillin 500mg QDS for 5 days or clarithromycin 500mg QDS for 5 days

Question 26

describe post op ileus

Answer 26

Post Op Ileus: need to rearrange admission

Distension
Lack of bowel sounds
Accumulation of gas
Delayed flatulence and stool
Common after abdominal surgery

Question 27

what should you not prescribe in patients with EBV?

Answer 27

Amoxicillin as can cause a rash

Question 28

What are the risks to the mother if she contracts chicken pox in pregnancy?

Answer 28

pneumonitis