Minor illnesses Flashcards
Sinusitis cause
Often post-URTI - Oedema + reduced cilia action - secondary bacterial infection. Polyps + septal deviation more risk as less drainage & higher risk in smokers as irritated mucosa + less ciliary function
H influenzae + S pneumoniae most common
Can also be S aureus, Pseudomonas, Moraxella, Fungal
Or, direct spread (dental infection, swimming), abnormal anatomy, ITU comps, systemic disease e.g. Kartagener’s
Sinusitis presentation
pain (maxillary-cheek/teeth, ethmoid-between eyes esp when bending, frontal headache), purulent rhinorrhoea, nasty taste from postnasal drip, tenderness, fever, anosmia, cacosmia (pt notices bad smell without a source), nasal congestion. Swelling uncommon-exclude cancer or dental
complications of sinusitis
pyoceles, orbital cellulitis/abscess (periorbital oedema, displaced globe, diplopia, ophthalmoplegia, reduced VA), osteomyelitis (Staph), subperiosteal abscess, meningitis/encephalitis, cerebral abscess, cavernous sinus thrombosis
Acute management of sinusitis
1 week to 1 month of Sx. Majority due to a virus and takes on average 2.5w to resolve (even if bacterial)
Adv para/ibu for sx, if systemically unwell give 5d of co-amoxiclav, if lasting >10d + severe sx then give phenoxymethylpenicillin.
Chronic sinusitis management
lasting >3 months, often S aureus/anaerobes. Adv it is a natural course, treat any allergic rhinitis/asthma/dental issues, simple analgesia, occasional intranasal decongestion for max of 1w, warm face packs, consider up to 3m of intranasal corticosteroids
What is not recommended for sinusitis?
antihistamines (unless already have allergic rhinitis, cos they thicken the mucus so makes it worse), steam inhalation (burns risk), oral steroids, mucolytics
Differentials for sore throat
- Pharyngitis
- Tonsillitis: often viral/even if bacterial with S pyogenes most common it usually resolves just a couple of days longer. Fever-PAIN score, if 4/5 give Abx, if 2/3 consider delayed prescription. Phenoxymethylpenicillin/macrolide if allergy. Nb there are also loads of rare causes of tonsillitis which you may suspect in immunocompromised pt
- EBV - causes tonsillitis, adenopathy. Abstain from contact sports for 8w
- Hand foot + mouth - a/w vesicles. Coxsackievirus
- Measles
- Scarlet fever - toxin produced by certain Strep in tonsillitis causes scarlatina rash + strawberry tongue
- otitis media-referred pain
- peri-tonsillar abscess
- acute epiglottis (HiB, v ill, don’t examine throat until hospital as can cause full obstruction)
- acute laryngitis: more in adults, complication of viral URTI esp para-influenza. Inflammatory oedema - hoarse voice, barking cough, stridor. may give steroids
Chest infection
- Acute bronchitis - transient inflammation of trachea + bronchi a/w mucus + oedema. Usually viral. Self-limiting but cough often lasts 3w. M-analgesia, fluids, stop smoking, hot water/honey + lemon may soothe throat, OTC stuff not recommended, consider Abx only if systemically unwell/high risk of complications, would use amoxicillin or doxycycline if allergic
- CAP: acute infection of parenchyma most commonly S pneumoniae, outbreaks of H influenza + Mycoplasma. Use CRB-65 to see if need hospital& general condition. CRB0/1 may treat at home but if sats<94% deffo send in. If >60+smoker do CXR to r/o cancer. Give amoxicillin +/- clarithro (or doxy if pen allergy)
Causes of UTI
GI organisms from retrograde spread/blood/direct (catheter/surgery). Organisms include E coli, S saprophyticus, Proteus mirabilis, Klebsiella pneumoniae
In children can also be caused by others e.g. Enterococcus
RF for recurrent UTI
- Adult: sexual intercourse, recurrent UTIs, urinary incontinence, atrophic vaginitis, catheterisation, older men, BPH/urinary tract stones/urethral stricture, DM, immunosuppression
- Child: <1y, female (except in first 3m), previous UTI, voiding dysfunction (structural, neurogenic bladder, withholding, chronic constipation), vesicoureteral reflux (25% of children <6y with first UTI have this), immunosuppression, no hx breastfeeding, sexual activity
Complications of UTI
- Ascending from LUTI to UUTI – pyelonephritis, abscess, impaired renal function, renal failure, urosepsis
- Urinary stones – Proteus infection
- In pregnancy (UTI + asymptomatic bacteruria) – preterm delivery, low birthweight
- Men – prostatitis
- Children – renal parenchymal damage (after upper), hypertension
Differentials for people presenting with ?UTI (F, M, children)
- Female: atrophic vaginitis/lichen sclerosis/lichen planus/interstitial cystitis, derm (psoriasis, dermatitis etc), spondyloarthropathies, gynae/uro cancers, STIs, trauma, ADR of drugs like cyclophosphamide/opioids/nifedipine
- Male: acute prostatitis (fever, low back/suprapubic/perineal pain, tender on DRE), bladder/renal cancer, epididymitis (scrotal pain, oedematous), STIs, urethritis, BPH
- Children: interstitial cystitis, Kawasaki disease, meningitis, renal stones, sepsis, threadworms (perianal itching), urethritis, voiding dysfunction, vulvovaginitis
Female UTI management
o Self-care – paracetamol, encourage fluids, cranberry doesn’t work. Safety net – return if worsen or doesn’t improve in 48h
o Abx if severe enough/risk of comps – usually nitrofurantoin MR or TMP for 3d (if TMP low risk of resistance), if not working there are other options. Could also delay for 48h. Avoid nitro if GFR<45 (it won’t work)
o If have haematuria re-test urine after the Abx
o Pregnancy UTI or asymptomatic bacteruria – nitrofurantoin (avoid at term-neonatal haemolysis), or if not amoxicillin/cefalexin. For 7d. If GBS identified needs to inform antenatal services.
o Breastfeeding – TMP/cefalexin. Avoid nitro in BF as small amounts but enough to cause haemolysis in G6PD-def infants
Male UTI management
- Male: TMP or nitrofurantoin for 7d. Avoid nitro if GFR<45 (it won’t work)
Child UTI management
- Children: if <3m need IV. If >3m and pyelo may need IV or give cefalexin (until culture). If lower UTI and >3m give trimethoprim or nitrofurantoin (for 3 days)
o Arrange US KUB if atypical, recurrent or <6m old
o Adv: bring back if not responding in 24-48h, complete course, paracetamol, fluids, encourage voiding
