Minor Illnesses

Question 1

what are the features of allergic conjunctivitis

Answer 1

• bilateral symptoms conjunctival erythema, conjunctival swelling
• prominent itch
• eyelids might be swollen
• hx of atopy

Question 2

what is the 1st line treatment of allergic conjuncitivitis

Answer 2

topical or systemic antihistamines

Question 3

what is the 2nd line treatment of allergic conjunctivitis

Answer 3

topical mast-cell stabilisers e.g. sodium cromogliocate and nedocromil

Question 4

what are the 2 forms of infective conjunctivitis

Answer 4

bacterial or viral

Question 5

what are the features of bacterial conjunctivitis

Answer 5

• purulent discharge
• eyes may be ‘stuck together’ in morning
• itchy, gritty sensation
• highly contagious

Question 6

what are the features of viral conjunctivitis

Answer 6

• serous discharge
• recent URTI
• preauricular lumph nodes

Question 7

what is the management of infective conjunctivitis

Answer 7

normally self-limiting within 1-2 weeks
- topical abx e.g. chloramphenicol drops 2-3 hourly

Question 8

what treatment should be offered to pregnant women with infective conjunctivitis

Answer 8

topical fusidic acid BD

Question 9

what is the management of infective conjunctivitis in those that use contact lenses

Answer 9

• topical fluoresceins should be used to identify any corneal staining
• treatment as above
• contact lens should not be worn during an episode of conjunctivitis

Question 10

what are causes of painful red eye

Answer 10

• Acute angle-closure glaucoma
• Anterior uveitis
• Scleritis
• Corneal abrasions or ulceration
• Keratitis
• Foreign body
• Traumatic or chemical injury

Question 11

what are causes of acute painless red eye

Answer 11

• Conjunctivitis
• Episcleritis
• Subconjunctival haemorrhage

Question 12

what is the management of neonatal conjunctivitis < 1 month

Answer 12

urgent opthalmology assessment

Question 13

what is entropion

Answer 13

in turning of eye with lashes pressed against the eye
- causes pain and can result in corneal damage and ulceration

Question 14

what is ectropion

Answer 14

eyelid turns outward
- usually affects bottom lid and can result in exposure keratopathy

Question 15

what are the 2 main presentations of a stye

Answer 15

• hordeolum externum: infection of glands of Zeis or Moll
• hordeolum internum: infection of Meibomian glands

Question 16

how are styes treated

Answer 16

hot compress and analgesia
- topical abx only if associated conjunctivitis

Question 17

what is a chalazion and how does it present

Answer 17

retention cyst of Meibomian gland
- presents as firm, painless lump in eyelid

Question 18

how is a meibomian cyst treated

Answer 18

warm compress and gently massage towards the eyelashes to encourage drainge
- rarely surgical drainage may be needed

Question 19

what is periorbital cellulitis

Answer 19

eyelid and skin infection in front of the orbital septum
- swollen, red, hot skin around the eyelid and eye

Question 20

what must periorbital cellulitis be differentiated from

Answer 20

orbital cellulitis which is a sight and life-threatening emergency
- urgent referral to opthal for CT to assess

Question 21

how is preorbital cellulitis treated

Answer 21

systemic abx oral or iV

Question 22

what is orbital cellulitis and how does it present

Answer 22

infection around the eyeball involving the tissues behind the orbital septum
- pain with eye movement
- reduced eye movements
- vision changes
- abnormal pupil reaction
- proptosis

Question 23

what is fifth disease caused by

Answer 23

viral infection common in children caused by parvovirus B19
- slapped cheek syndrome
- erythema infectiosum

Question 24

what are aphthous ulcers

Answer 24

small painful ulcers of the mucosa in the mouth

Question 25

describe the appearance of an aphthous ulcer

Answer 25

well-circumscribed, punched-out, white appearance

Question 26

what can aphthous ulcers be triggered by

Answer 26

- emotional or physical stress - trauma to mucosa - particular foods

Question 27

what underlying conditions might aphthous ulcers be a sign of

Answer 27

* Inflammatory bowel disease (Crohn’s disease and ulcerative colitis) * Coeliac disease * Behçet disease * Vitamin deficiency (e.g., iron, B12, folate and vitamin D) * HIV

Question 28

what is the general advice for aphthous ulcers

Answer 28

usually heal within 2 weeks and do not require intervention

Question 29

what are examples of topical treatments that can treat symptoms of aphthous ulcers

Answer 29

* Choline salicylate (e.g., Bonjela) * Benzydamine (e.g., Difflam spray) * Lidocaine

Question 30

what can be used to treat more severe aphthous ulcers

Answer 30

**topical corticosteroids** * Hydrocortisone buccal tablets applied to the lesion * Betamethasone soluble tablets applied to the lesion * Beclomethasone inhaler sprayed directly onto the lesion

Question 31

what is the guidance for referring aphthous ulcers

Answer 31

2WW to ENT/maxfax in patients with unexplained ulceration lasting > 3 weeks

Question 32

what are risk factors for nappy rahs

Answer 32

* Delayed changing of nappies * Irritant soap products and vigorous cleaning * Certain types of nappies (poorly absorbent ones) * Diarrhoea * Oral antibiotics predispose to candida infection * Pre-term infants

Question 33

how might nappy rash present

Answer 33

- **sore, red, inflamed skin** in nappy area - appears in individual patches on exposure areas - tends to **spare crease**s of skin - may be few red papules - longstanding rash --> erosions and ulceration

Question 34

what are signs that would point towards a candidal infection rather than simple nappy rash

Answer 34

* Rash extending into the skin folds * Larger red macules * Well demarcated scaly border * Circular pattern to the rash spreading outwards, similar to ringworm * Satellite lesions, which are small similar patches of rash or pustules near the main rash ## Footnote Check for oral thrush

Question 35

what are conservative measures than can be taken to treat nappy rash

Answer 35

* Switching to highly absorbent nappies (disposable gel matrix nappies) * Change the nappy and clean the skin as soon as possible after wetting or soiling * Use water or gentle alcohol free products for cleaning the nappy area * Ensure the nappy area is dry before replacing the nappy * Maximise time not wearing a nappy

Question 36

what treatment can be given for nappy rash

Answer 36

* apply **barrier cream** (e.g. Zinc and castor oil) * mild **steroid cream** (e.g. 1% hydrocortisone) in severe cases * management of suspected candidal nappy rash is with a **topical imidazole**. Cease the use of a barrier cream until the candida has settled