Minor Illnesses Flashcards
for how long can a cough be considered acute?
less than 3 weeks
what are the common causes of an acute cough?
- URTI
- croup
- LRTI
- exacerbation of asthma
what are the common symptoms of an URTI?
- acute cough
- +/- productive with sputum
- +/- fever
- feeling unwell
- +/- wheeze
what are the common signs of an URTI?
- pyrexia
- irritated throat
- no focal chest sounds on auscultation
how would you manage a URTI?
- explain to patient this is likely a viral infection and therefore does not require antibiotic treatment.
- advise on OTC medication, rest, and fluids
- advise to come back if issue does not resolve or get worse
when would you refer a patient for a chest xray?
- focal chest signs
- suspected inhalation of a foreign body
- suspected lung cancer
if a patient presents with signs of a LRTI, what would you prescribe them?
amoxicillin 500mg TDS
doxycycline 100mg OD
what is the most common organism causing a UTI?
e. coli
what are the risk factors for a UTI?
- prior infection
- DM
- stones
- dehydration
- sex
- urinary stasis
what are the common presentations of a lower UTI?
- urinary symptoms: frequency, dysuria, urgency, cloudy, smelly urine
- lower abdominal pain
what are the common presentations of pyelonephritis?
- loin pain
- fever
- feeling unwell
- haematuria
what are the differentials for a patient presenting with dysuria?
- UTI
- interstitial cystitis
- menopause
- tumour/ stone
what are the differentials for a patient presenting with frequency?
- UTI
- detrusor instability
- external pressure (e.g. pregnancy)
- enlarged prostate
- drugs (diuretics)
- fluid intake
- DM
what initial investigation would you do in a patient presenting with an uncomplicated UTI?
urine dip
when would you send an MSU sample for cultures and consider further investigations?
- infection unresolved post abx
- recurrent UTI
- man with a UTI
- pregnant woman
- child
- haematuria (frank or not)
how would you manage a patient with an uncomplicated UTI?
- increase fluid intake
- nitrofurantoin 100mg BD/3days
what is blepharitis?
chronic, low-grade inflammation of the meibomian glands and lid margins
how does blepharitis present?
long history of irritable, dry, burning, red eyes
eyelids will have red margins +/- scales on the eyelashes
how do you manage blepharitis?
long term treatment (2-3 months)
- warm compress to open up meibomian glands
- massage with cotton buds to move glands secretions
- clean with tea tree oil
- treat dry eyes with liquid tears
what are the red flag symptoms for a patient presenting with red eye?
- decreased visual acuity
- pain deep in the eye
- absent or slow pupil response
- history of trauma
what would you do if a patient has red flag red eye symptoms?
refer the patient immediately to be seen on the same day
how does conjunctivitis present?
- unilateral/ bilateral red eye with surface irritation
- eye discharge
- sticking of eyelids
how do you manage acute conjunctivitis?
most are self limiting and settle within a few days
- bathe eye in warm and cold water
- maintain good eye hygiene (no contact lenses)
- if not resolved give OTC chloramphenicol qds/5days
what is considered acute lower back pain?
a new episode of lower back pain <6 weeks in duration
what is considered chronic lower back pain?
back pain lasting >3 months
what are important associated symptoms to investigate in lower back pain?
numbness, weakness, bowel/bladder symptoms
what is important to look out for in an examination of the lower back?
- any deformity (kyphosis, loss of lumbar lordosis, scoliosis)
- check lower limbs for neurological changes and sciatica
what does a kyphosis deformity look like and what can it indicate?
concaved thoracic spine indicating ankylosing spondylitis
what does a loss of lumbar lordosis indicate?
acute mechanical back pain
how do you manage a patient presenting with acute back pain?
- prescribe analgesia
- advise for bed rest
- if not resolved in 4 weeks come back and request physio
what are common causes of back pain in people <30 years old?
- trauma
- ankylosing spondylosis
- prolapsed disc
what are the common causes of back pain in people 30-50 years old?
- prolapsed disc
- discitis
- degenerative joint disease
what are the common causes of back pain in people >50 years old?
- degenerative
- malignancy
- osteoporotic collapse
what are some other common causes of back pain in people of all ages?
- postural
- cauda equina
- referred pain
what are the common causes of heartburn?
- GORD
- peptic ulcer disease
- stomach cancer
- functional dyspepsia
true or false: functional dyspepsia is the most common cause of dyspepsia
true
what are some differential diagnoses for heart burn?
- cardiac pain
- gall stone disease
- pancreatitis
how does a patient with heart burn commonly present?
- epigastric/retrosternal pain
- fullness, bloating
- nausea and vomiting
- burning sensation up the oesophagus
what should you look at in a patient history before treating heart burn?
- drugs (NSAIDs, Ca2+ blockers)
- any palpable masses (2 week wait referral)
what do you prescribe to treat heart burn?
PPI - omeprazole 20mg OD for a month
what is the next step one month PPI treatment has not helped the heartburn?
test for H. pylori
what is the test for H. pylori?
urease breath test
what is the treatment for H. pylori?
PPI - omeprazole 20mg BD
amoxicillin 1g BD and clarithromycin 500mg BD for 1 wk
what other drugs can be given to treat heart burn?
H2 receptor antagonist rantidine 150mg BD
what lifestyle advice should be given to a patient with heartburn?
- smoking cessation
- decrease fatty/spicy foods
- decrease alcohol consumption
- eating earlier
what should you examine in a patient presenting with a headache?
- signs of infection (fever, skin rash)
- BP
- neurological exam (vision, sensation, gait)
- neck stiffness or tenderness
what are red flags in a headache history?
- fever with meningism and rash = meningitis
- thunderclap headache = subarachnoid haemorrhage
- recent head injury < 3months
- papilloedema = raised ICP
- change in cognition or personality
what are common causes for an acute new episode headache?
- meningitis
- encephalitis
- subarachnoid haemorrhage
- head injury
what are common causes for an acute recurrent headache?
- migraine
- cluster headache
- exertional headache
- trigeminal neuralgia
- glaucoma
what is the most common cause for a subacute headache?
giant cell arteritis
what are common causes for a chronic headache?
- tension headache
- medication overuse
- raised ICP
how does a headache caused by meningitis present and how should it be treated?
- fever, photophobia, stiff neck, rash
- IV/IM penicillin V and admission
how does a headache cause by encephalitis present and how should it be treated?
- fever, confusion, low GCS
- immediate admission
how does a SAH headache present and how should it be treated?
- thunder clap headache, stiff neck “worst headache ever”
- immediate admission
how does a head injury headache present and how should it be treated?
- bruising/injury, low GCS, lucid periods, amnesia
- consider admission
how does a migraine present and how should it be treated?
- aura, visual disturbances, nausea vomiting, triggers
- acute attack: sumatriptan 50mg
- prophylaxis: propranolol 80mg OD
how does a cluster headache present and how should it be treated?
- nightly pain in 1 eye, tearing, redness around the eye
- refer for specialist advice and imaging
- acute attack: sumatriptan 6mg SC and high flow O2
- prophylaxis: verapamil 80mg TDS if attacks are frequen
how does a exertional headache present and how should it be treated?
- suggested by history of association
- NSAIDs or propranolol before attacks
how does a trigeminal neuralgia present and how should it be treated?
- intense stabbing pain lasting seconds in the trigeminal nerve distribution
- refer to neurology if <50y and treat with carbamazepine
how does a glaucoma headache present and how should it be treated?
- red eye, haloes, loss of visual acuity, pupil abnormality
- requires regular optometry check ups to check intraocular pressures
how does a giant cell arteritis headache present and how should it be treated?
- > 50y, scalp tenderness, raised ESR, decrease in visual acuity
- prednisolone 40-60mg OD and refer to opthalmology or rheumatology for temporal artery biopsy
how does a tension type headache present and how should it be treated?
- band around the head, stress, low mood
- reassure no underlying pathology and to alleviate stress
- treat with paracetamol PRN
how does a medication overuse headache present and how should it be treated?
- rebound headache on stopping analgesia
- advise to stop overused medication abruptly for 1month
- consider specialist referral if taking strong opioids or failed recurrent attempts to stop meds
how does a raised ICP headache present and how should it be treated?
- worse on waking/ coughing, low pulse, high BP, neurological signs
- refer to specialist
what are common triggers of headaches?
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