Minor Illnesses Flashcards
Common pathogen for bronchiolitis, croup, common cold, flu
Bronchiolitis- respiratory syncytial virus
Croup - parainfluenza virus
Common cold - rhinovirus
Flu - influenza virus
Presentation of URTI
Cough Stridor - croup General signs of infection: - fever - wheeze - Nasal discharge Clear chest examination Pharyngitis - sore throat Otitis media
Croup pathophysiology, presentation and tx
Pathophysiology: Upper airway obstruction due to viral infection
Presentation:
- Seal like barking cough
- Intercostal recession - respiratory distress
- Stridor
- Hoarse voice
Tx:
- Severe croup is treated with dexamethasone and nebulised adrenaline
UTI summary
Causes:
- Wiping back to front
- Uncontrolled DM
Presentation:
- Burning sensation when urinating and dysuria
- polyuria
- urgency
- haematuria
- foul-smelling, cloudy urine
- fever
Ix
- mainly clinical
- urine dipstick
- urine culture and microscopy
- USS - rule out obstruction
Mx:
- Wipe front to back
- increase fluids
- Nitrofurantoin/ trimethoprim 3 days for uncomplicated
Uncomplicated UTI
Typical pathogens in people with normal anatomy and no predisposing factors
Complicated UTI
UTI with increased of risk complications e.g.
- persistent infection
- treatment failure
- recurrent infection.
Risk factors for complicated UTI:
- urinary catheters
- virulent or atypical infecting organisms
- co-morbidities e.g. poorly controlled diabetes mellitus or immunosuppression
- men
Lower UTI
Cystitis - infection of blader
Tx: Nitrofurantoin/ trimethoprim 3 days for uncomplicated and 7 days for men
Upper UTI
Pyelonephritis - infection of the kidneys and ureters
Mx:
Mild uncomplicated pyelonephritis - oral ciprofloxacin for 7-10 days
co - amoxiclav alternative
The most common causative pathogen of UTI
E. coli
When to refer for 2ww with UTI
45 + yo with:
- Unexplained visible haematuria without UTI
- Visible haematuria which persists or recurs after successful treatment of UTI
60+ with:
- unexplained non‑visible haematuria and either dysuria or a raised serum WCC
Consider non-urgent referral to exclude bladder cancer in those aged 60+ with recurrent or persistent unexplained UTI.
UTI treatment in men
Nitrofurantoin/ trimethoprim for 7 days
Causative organism of pharyngitis
Streptococcus pyogenes
Tx of common cold
Conservative:
- fluids
- paracetamol
- rest
- salty gargle
Causes of chest infection
Infection that affects lower large airways (bronchi) and lungs.
Pneumonia - bacterial
Bronchitis - viral
Chest infection presentation
- Chesty cough - productive
- Dyspnoea and wheeze
- Chest pain or tightness
- Fever
- Headache
- Myalgia
- Malaise
- Tachycardia
Chest infection tx:
Mild (bronchitis)- Self limiting usually gets better on its own within 7-10 days
- Rest
- Fluids
- Paracetamol
Severe (pneumonia) based on CRB 65:
- 0 - treatment at home - amoxicillin 500 mg tds for 5 days
(allergic - doxycycline 200 mg)
- 1 - 2 - hospital assessment - amoxicillin 500 mg tds for 5 days AND clarithromycin 500 mg bds for 5 days
- 3 - urgent hospital admission
Pneumonia abx treatment mile stones
1 week — fever should have resolved.
4 weeks — chest pain and sputum production should have substantially reduced.
6 weeks — cough and breathlessness should have substantially reduced.
3 months — most symptoms should have resolved but fatigue might still be present.
6 months — symptoms should have fully resolved.
Thrush summary
Causative organism: Candida albicans
RF:
- pregnant
- diabetes.
- abx
- immunocompromised
Presentation:
Vaginal - white discharge, dysuria and pruritis, superficial dyspareunia
Oral - white plaques in mouth
Ix:
- Urine pH
- Swab
- Urine dipstick
Tx:
- miconazole cream - 7 days
- 60+ - fluconazole tablets
12 - 15 yo girls - clotrimazole 1% cream
Bacterial vaginosis summary
Causative organism: Gardnerella vaginalis
RF:
- abx use
- extreme washing
- copper IUD
Presentation:
- Fishy smelling discharge
Tx:
- Metronidazole 5-7 days
Osmotic diarrhoea
Soluble compound that cannot be absorbed therefore water in diffused into lumen by osmosis
Secretory diarrhoea
Increased secretion of fluid and electrolytes due to toxins released by e.g. E. coli or C. difficile
Common causes of diarrhoea
Viruses:
- Norovirus (winter virus) - causing gastroenteritis
- Rotavirus - young children
- Cytomegalovirus
Bacterial: - C. difficile Blood diarrhoea: - E. coli - Shigella - Campylobacter - poultry - Salmonella
Parasitic - cryptosporidium - giardia duodenalis - schistosomiasis - entamoeba histolytica Others: - Food allergy - Coeliacs - IBD - Acute appendicitis
Red flags for diarrhoea
Blood in stool
Weight loss
Dehydration
Diarrhoea hx
Anyone else symptomatic? THx What have they eaten recently? Fever Vomiting Frequency Job
RF for entamoeba histolytica
young, pregnant, corticosteroids, malnutrition and alcoholism
RF for Giardia duodenalis
Children, travellers, immunocompromised
Abscess summary
Causative organisms: Staphylococcus aureus or Streptococcus pyogenes
Presentation:
- swollen pus filled, smooth lumo under skin
- systemic symptoms such as fever
- localised pain and tenderness
Mx:
- large abscesses are surgically drained
- Small abscesses may drain naturally
- abx - flucloxacillin
Bartholin’s cyst
Accumulation of pus inside bartholin’s gland on each side of the vaginal opening
Quinsy
Peritonsillar abscess
- complication of tonsilitis
Causative organism: Streptococcus pyogenes
Presentation:
- Severe throat pain which may become unilateral
- Fever
- Drooling of saliva
- Foul-smelling breath
- Dysphagia
- Trismus (difficulty opening the mouth)
- Hot potato voice due to pharyngeal oedema and trismus.
- Earache on the affected side.
- Neck stiffness
- Headache and general malaise.
Mx:
- Fluids
- Analgesia
- IV Penicillin
- Needle aspiration, incision and drainage and quinsy tonsillectomy
GORD summary
Causes:
- Smoking and alcohol
- Obesity
- coffee.
- Pregnancy
- Big meals
- Hiatus hernia.
- Drugs- tricyclic antidepressants, anticholinergics, nitrates and calcium-channel blockers
Presentation:
- Heartburn
- regurgitation
- acidic taste in mouth
Mx: Conservative: - Weight loss - Smoking and alcohol cessation - Don't eat big, spicy meals at night
Pharmacological:
- PPI - omeprazole - 1 month
Constipation mx in adults
- bulk-forming laxative e.g. ispaghula husk
- osmotic agent e.g. macrogol
- Lactulose
- If tenesmus - add stimulant laxative e.g docussate sodium
opioid-induced constipation
Macrogol
Anal fissure summary
Pathophysiology: Small tear in skin of anus which can be caused by passing large faeces
Presentation:
- Pain when passing
- Fresh blood
- Pain when getting up
- Anal pruritis
Mx: Conservative: - Warm baths - Not holding urge in - Fluid - Fibre - Activity
Pharmacological:
- paracetamol
- laxative - ispaghula
- topical anaesthetic (lidocaine 5% ointment)
- consider prescribing rectal glyceryl trinitrate (GTN) 0.4% ointment - more than 1 week of symptoms
Haemorrhoids summary
Pathophysiology: Swollen blood vessels that are internal or external
Cause: straining due to:
- pregnancy
- weight lifting
- constipation
Presentation:
- rectal bleeding
- pain when passing
- Grade 2 - 4 - feel lump
- Mucous in stool
- anal pruritus
- tenesmus
- pain when getting up
Tx: Conservative: - fibre - fluids - activity
Pharmacological:
- Laxative
- paracetamol
- Anusol - corticosteroid cream
Surgical:
- Banding (non-surgical)
- Haemorrhoidectomy
- Stapled haemorrhoidopexy
- Haemorrhoidal artery ligation
Types of headaches
Tension Cluster Migraine Medication overuse Sinus Giant cell arteritis
Primary headache
Normally recurrent
Due to headache condition
Non life threatening
Secondary headaches
Due to another condition
Acute
Severe pain
More likely to be life or sight threatening
Tension headache summary
Sight: generalised frontal and occipital
Quality: tight band like pain +/- radiating into the neck
Intensity: mild or moderate
Time: worst at the end of the day, lasting for about 1 hour and recurrent
Aggravating factors: stress, poor posture, lack of sleep
Relief: analgesics
Secondary symptoms: slight nausea
Migraine summary
Sight: unilateral frontal or temporal
Quality: throbbing or pulsating
Intensity: moderate- severe, go to bed or avoid light
Time: prolonged headache
Aggravating factors: stress, certain food, lack of sleep, menstrual cycle, FHx
Relief: analgesics and triptans
Secondary symptoms: nausea and vomiting, aura, sensory deficit, neurological symptoms
Medication over use headache
Affects females more
Headache occurs for 15 + days per month
Occurs in patients with pre- existing headache disorders due to overuse of regular analgesics e.g. cocodamol for at least 10 days per month
Headache does not respond to medication or another type of headache
occurs
Co-exists with depression and sleep disturbances
Advice for medication over use headache
Shouldn’t take analgesics for more than 2 days per week
Discontinue medication if headaches become worse - headache will worsen before improves but normally resolved completely by 2 months
Cluster headache summary
Sight: unilateral around or behind the eye
Quality: sharp, stabbing and penetrative pain
Intensity: severe suicidal
Time: 15 mins - 3 hours, occurs in clusters with periods of remission
Aggregating factors: alcohol, smoking, warm temperature, volatile smells, lack of sleep
Relief: oxygen and triptans
Secondary symptoms: ipsilateral autonomic symptoms e.g. tears, red conjunctiva, ptosis, nasal congestion
Clinical exam: autonomic features
Temporal arteritis summary
Common in: females 50 +
Pathophysiology: Vasculitis involving small or medium sized arteries of the head most commonly the superficial temporal artery
Presentation:
- Pain and tendernessnear temples
- jaw claudication
- visual disturbances
- fever
- sometimes associated with polymyalgia rheumatic
Complication: Blindness due to optic nerve ischemia
Ix:
Bloods - CRP, ESR, biopsy
Tx: Prednisone and aspirin 75mg
Trigeminal neuralgia summary
Sight: unilateral felt in commonly Va distribution
Quality: sharp, shooting pain like stabbing electric shock
Intensity: severe
Time: 2 secs - 2mins sudden onset
Aggregating factors: light touch to face/ scalp, eating, cold wind, combing hair
Relief: difficult to treat
Secondary symptoms: preceding symptoms = numbness or tingling
Sinusitis time frame
acute - 4-30 days
subacute - 4-12 weeks
Chronic - 12 + weeks
Sinusitis summary
Pathophysiology: acute sinusitis develops after a cold, causing inflammation of the sinuses
Risks:
- allergic rhinitis
- polyps
- asthma
- smoking
Presentation:
- Pain and tenderness over the infected sinus
- Throbbing, worse when bending forwards
- Chewing may be painful.
- Blocked nose
- Yellow or green nose discharge
- Fever
Tx:
- Self limiting 2 - 3 weeks
- inhale steam
- nasal decongestants
- paracetamol
- avoid triggers
If 10 + days - high-dose nasal corticosteroid for 14 days for adults- mometasone/ fluticasone
