Minor Illnesses Flashcards
Give 5 features of acute bronchitis infection which indicate need for abx
- co morbidity eg asthma, copd, bronchiectasis, immunosurpression
- extremes of age
- crackles on auscultation
- deranged obs (high temp. RR, HR etc)
- purulent sputum
How are viral upper resp tract infections managed?
- no abx needed
- advise may take 2-3 weeks to resolve
- advise good hygiene
- steam inhalation
- vaporub
- lozengers
- cough medicines (no evidence for or against use)
What most commonly causes an upper resp tract infection?
rhinovirus and coronavirus mostly, can also be influenza, adneovirus etc
Describe the symptoms of a lower UTI
- frequency
- urgency
- polyurea
- pain on urination
- haematuria
- suprapubic tenderness
If have 3 -empirical abx without need for dipstick
Give 3 risk factors for a UTI
- female
- catheters
- abnormal anatomy (duplex ureters etc)
- antibiotic use
- sexually active
- diabetes
- immunocompromised
What results on a urine dip indicate a uti is present (3)
- cloudy urine
- nitrites
- leukocyte esterase
- blood
When should a urine sample from a suspected UTI not be sent for MSU?
Non pregnant woman of child bearing age, who hasnt already been tried with empirical antibiotics
When should you refer someone for cystoscopy or imaging due to a UTI?
- persistantly not responded to treatment
- visible haematuria
- women with recurrent infections who are not responding to preventative measures
- men with two or more episodes in three months
- infant<3 months
What is management for uncomplicated UTI
pain relief
nitrofurantion (trimethoprim has lots of resistance) 3 days in females 7 in males
What is first line therapy for mild pyelonephritis
7-10 days ciprofloxacin
What is treatment option for recurrent UTIs with no structural abnormalities
if associated w/ sexual intercourse- low dose trimethoprim within 2 hrs
if not, low dose trimethoprim or nitro daily
What signs are concerning in UTI?
- delirium
- high fever
- loin pain
- N+V
- sepsis red flags
State the factors which score a point on the fever pain score and when are abx indicated?
- fever
- pus on tonsils
- attend within 3 days of symptom onset
- Inflammed tonsils
- No cough or coryza
Score> 2-3= delayed abx, score > 4 = immediate abx
What is major complication of tonsilitis
Peristonsilar abscess (cannot open mouth, drooling, foul breath, hot potato voice, uvula deviation. high risk of necrotising fascitiis, airway compromise, aspiration)
What abx is reccommended in bacterial tonsilitis
phenoxymethylpenicillin (penicillin v)
Which abx is used in acute bronchitis, if abx are indicated?
amoxicillin
How is community aquired pneumonia assesed? which abx is first line?
CURB 65
amox/ doxy
What abx are indicated for treating UTIs in pregnancy
1st tri= nitro
2nd= nitro or trimeth
3rd= trimeth
How does conjunctivitis present?
red eye
bilateral
gritty feeling
discharge- watery, purulent, sticky
What are red flags for red eye? (6)
- marked pain, photophobia, PMH autoimmune conditions (uveitis)
- marked redness in one eye
- reduced acuity (retinal involvement, uveitis. glaucoma)
- hazy cornea, extreme pain, N+V w/ pain (glaucoma)
- Rashes (herpes zoster ophthalmicus)
- trauma (mechanical or chemical)
- possible foreign body (invert eyelid)
What viruses commonly cause conjunctivitis?
- adenovirus
- herpes simplex virus
- herpres zoster ophthalmicus
- chlamydia (in neonates)
What bacteria commonly cause conjunctivitis? What symptoms point towards bacteria over virus
Staph species, strep pneumonia, haemophilus influenzae
Thick purulent discharge, mild photophobia (more severe= more likely viral), bilateral,
How is bacterial conjunctivitis managed?
Self limiting
Seek medical attention if not resolve in 2 weeks, eye pain, photophobia, loss of acuity
Lubricant OTC eyedrops
Avoid others
Remove contacts until 24 hrs after resolved
Topical abx (chloramphenicol) if not resolved or severe
What are the red flag symptoms of dyspepsia/ indigestion? (4)
- unintentional weightloss
- recurrant vomiting
- dysphagia
- evidence of GI bleeding (anaemia, coffee ground vomit, malaena)
How should dyspepsia be investigated?
- consider FBC
- consider barium swallow to look for hiatus hernia
- consider H pylori test
What things precipitate GORD? (5)
- increase intra abdo pressure
- alcohol
- smoking
- fat
- coffee
- pregnancy
- tight cloths
- NSAIDS
- hiatus hernia
- big meals
- lying down soon after meals
- anxiety and stress
REDUCE THESE THINGS FIRST BEFORE USING DURGS
What pharmacological treatment options are available for GORD
- antacids (gaviscon)
- Histamine antagonists (ranitidine)
- PPI (omeprazole)
How is H. pylori treated?
PPI + amoxicillin + metronidazole
What medicines may precipitate GORD?
Alpha-blockers, anticholinergics, aspirin, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, nitrates, nonsteroidal anti-inflammatory drugs (NSAIDs), theophyllines, and tricyclic antidepressants
Give 5 scenarios/ presentations where MSK injury needs immediate referral to A&E? (up to 9)
- fracture
- dislocation
- nerve or circulation damage
- tendon rupture
- wound penetrating joint
- known bleeding disorder
- signs of septic arthritis
- IM haematoma
- tear of > half of muscle belly
What is 1st and 2nd line pain relief for sprains and strains?
1st- paracetamol and topical NSAIDS
2nd- codeine oral NSAID (ibuprofen or naproxen)
What is the PRICE management strategy for sprains and strains?
Protection (supports or straps)
Rest (avoid activity for 48-72 hrs after)
Ice (20 mins every 2-3 hrs for 3 days after injury)
Compression (elastic bandage to help control swelling)
Elevation (for up to 3 days)
What should be avoided for first 72 hrs after a sprain/strain?
HARM
Heat - hot and cold therapy useful after >72hrs
Alcohol- increases bleeding and swelling, slows healing
Running- may cause further damage
Massage- causes bleeding and swelling, helpful after >72 hrs
Whats the difference between a sprain and strain?
sprain- ligament tear
strain- muscle tear
When should immobilisation be used for sprains and strains?
sprains: only in severe sprains and for short periods
Strains: only for a few days after injury, start active mobilization after a few days if the person has pain free use of basic movements and stretch is same as contralateral muscle
Are sprains and strains routinely referred for physio?
Sprains are only referred in severe injuries
Moderate strains may be considered for referral.
When should an ankle injury be xrayed? (ottawa rules)
- Pain in malleolar or midfoot regions
AND - unable to weight bear immediately and in A&E
OR - tenderness at base of 5th metatarsal / medial
How are sprains graded?
grade 1- ligament stretched with microscopic tearing. little/ no functional loss and no instability, pt partially weight bears
2- part tear, mod- severe swelling, functional loss, mild- mod instability, difficult weight bearing
3- complete rupture, severe swelling, cannot bear weight, unstable joint
What is a syndesmotic ankle sprain
a high ankle sprain of the interosseous ligament caused by dorsiflexion, eversion and internal rotation. healing takes longer than standard lateral lig sprains (>6 weeks)
