Minor Illnesses + Acute Presentations Flashcards
Define cough
Reflex response due to airway irritation
Acute = less than 3 weeks
Sub-acute = 3-8 weeks
Chronic = more than 8 weeks
Causes of acute cough
URTI
Acute bronchitis
Pneumonia
Acute exacerbations of asthma or COPD
Causes of sub-acute cough
Airway hyper-responsiveness following specific infections - Mycoplasma pneumoniae
Post-infectious cough - pertussis
Ongoing infections
Causes of chronic cough
Cigarette smoke exposure ACE-i Post-nasal drip syndrome Asthma GORD
Define common cold
Mild, self-limiting URTI characterized by nasal stuffiness and discharge, sneezing, sore throat and cough
Complications of URTI
Sinusitis
LRTI
Acute otitis media
Risk factors for complications of URTI
Comorbidities - asthma - COPD - DM - cystic fibrosis Older age and young children Immunocompromised Smoking
Clinical features of URTI
Sore/irritated throat Nasal irritation, congestion, discharge and sneezing Cough Hoarse voice General malaise Rapid onset over 1-2 days
Differential diagnosis of URTI
Meningitis Upper airway obstruction Nasal foreign body Influenza Streptococcal pharyngitis Allergic rhinitis Glandular fever Whooping cough (pertussis)
Management of URTI
Reassure self-limiting and complications are rare
Antibiotics and antihistamines are ineffective and may cause adverse effects
Adequate fluid
Healthy food
Adequate rest
Define urinary tract infection
Infection of any part of urinary tract usually by bacteria
- also fungi, viruses or parasites
Define lower UTI
Infection of bladder
Define cystitis
Inflammation of the bladder
Define upper UTI
Pyelitis, pyelonephritis
Define uncomplicated UTI
Infection by a usual pathogen in a person with normal urinary tract and normal kidney function
Define complicated UTI
One or more risk factors are present that predispose to persistent infection, recurrent infection or treatment failure
Define recurrent UTI
Repeated UTI which may be due to relapse or reinfection
3 or more UTIs in last 12 months
Causative organisms of UTIs
Escherichia coli - 80%
Staphylococcus saphrophyticus
Klebsiella pneumoniae
Proteus mirabilis
Routes of entry by bacteria into urinary tract
Direct - insertion of catheter into bladder, instrumentation or surgery
Via blood stream - immunocompromised
Retrograde - ascending through urethra into bladder
Risk factors for UTI in males
Over 50 BPH Catheterisation Previous urinary tract instrumentation or surgery Previous UTI
Anal sex Immunosuppression DM Recent hospitalisation Uncircumcised men Vaginal sex
Complications of UTI in males
Renal function impairment Prostatitis Pyelonephritis Sepsis Urinary stones
Clinical features of UTI in men
Temperature 1.5 degrees higher than normal New frequency or urgency New incontinence New or worsening delirium/debility New suprapubic pain Visible haematuria
Urine sample collection methods
Mid-stream (MSU) - routine recommended method
- first part of voided urine discarded and without interrupting flow 10ml collected
Clean-catch (CCU)
- whole specimen collected
Catheter urine sample (CSU)
Features of urine dipstick that suggests UTI
Positive for nitrite and leukocyte esterase
Management of UTI in men
Start empirical antibiotic
- trimethoprim or nitrofurantoin - 7 days
Risk factors for UTI in children
Age below 1 year Female sex White Previous UTI Voiding dysfunction Vesicoureteral reflux Sexual activity No history of breastfeeding Immunosuppression
Complications of UTI in children
Renal scarring/damage
Hypertension
Bacteriuria and hypertension during pregnancy
Renal insufficiency and failure
Complications of UTI in women
Ascending infection - pyelonephritis, renal and peri-renal abscess
Pre-term delivery and low birth weight if pregnant
Risk factors of complications of UTI in women
Pregnancy Older age Healthcare associated Presence of symptoms for more than a week before presentation Urologic instrumentation Pre-existing urological conditions Comorbidities
Management of UTI in women
Not recurrent
- advise on self-care methods
- simple analgesia
- avoid dehydration
- assess need for antibiotic
- nitrofurantoin for 3 days
- trimethoprim for 3 days
Recurrent
- personal hygiene
- avoid douching and occlusive underwear
- wipe front to back
- adequate hydration
- avoid delay of habitual and post-coital urination
- antibiotic prophylaxis
- trimethoprim or nitrofurantoin
- amoxicillinDefine acute bronchitis
Lower respiratory tract infection which causes inflammation of the bronchial airways
- cough resulting from acute inflammation of trachea and large airways without evidence of pneumonia
Define pneumonia
Infection of lung tissue in which the air sacs in the lungs become filled with microorganisms, fluid, inflammatory cells
- affects function of lungs
Organisms causing acute bronchitis
Viral infection
- rhinovirus
- enterovirus
- influenza A and B
- parainfluenza
- coronavirus
- adenovirus
Causative organisms of community-acquired pneumonia
Bacterial infection
- streptococcus pneumoniae
- haemophilus influenzae
- staphylococcus aureus
- group A streptococci
- moraxella catarrhalis
Complications of acute bornchitis
Usually mild and self-limiting
Cough lasts 2-3 weeks
Pneumonia may occur as a complications
Complications of pneumonia
Pleural effusion Empyema Lung abscess Acute respiratory distress syndrome Septic shock Disseminated infection
Parts of the CURB-65 scoring
1 point for each feature
- confusion - new disortietnation
- raised RR - 30 bpm or more
- low BP - 60 diastolic or 90 systolic
- over 65
Management of acute bronchitis
Conservative - adequate fluid intake - paracetamol or ibuprofen - stop smoking Offer antibiotics if systemically unwell or back up for those at higher risk - doxycycline - not for pregnant women - amoxicillin
Risk factors for complications of acute bronchitis
Pre-existing comorbid condition Older than 65 with 2 or older than 80 with one of the following - hospital admission in previous year - DM - history of congestive heart failure - current oral corticosteroids
Management of CAP
Conservative - rest - adequate fluid intake - simple analgesia Antibiotics - amoxicillin
Define blepharitis
Common chronic inflammatory condition affecting the margin of the eye
Usually bilateral
Categorises fo blepharitis
Anterior - inflammation of the base of the eyelashes
- bacterial - staphylococci
- seborrhoeic dermatitis
Posterior - inflammation of the meibomian glands
- meibomian glands run along posterior eye margin - produce lipid secretion which provides the lipid layer of the tear film
Complications of blepharitis
Meibomian cyst External stye Changes to eyelashes - loss, misdirection and depigmentation Eyelid thickening, ulceration and scarring Contact lens intolerance Dry eye syndrome Conjunctivitis Corneal inflammation
Clinical features of blepharitis
Burning, itching and crusting of eyelids Symptoms worse in morning Both eyes affected Recurrent hordeolum Contact lens intolerance
Management of blepharitis
Symptoms controlled with self-care
- eyelid hygiene - cleaned twice daily
- warm compress
Define a hordeola
Stye
Acute localised infection or inflammation of the eyelid margin
- bacterial infection of cilium and adjacent gland with local abscess formation
- usually staphylococcal`
Types of hordeola
External stye
- appears on eyelid margin
- caused by infection of eyelash follicle and associated sebaceous or apocrine gland
Internal stye
- occurs on the conjunctival surface of the eyelid
- caused by infection of Meibomian gland
Complications of hordeola
Infective conjunctivitis
Periorbital or orbital cellulitis
Meibomian cyst
Clinical features of hordeola
Acute-onset painful localised swelling near eyelid margin that develops over several days
Usually unilateral
External
- located at eyelid margin around eyelash follicle
- points anteriorly through the skin - small, yellow, pus-filled spot may be visible
Internal
- swelling tender and localised on internal eyelid
Management of stye
Self-care advice
- self limiting and rarely causes serious complications
- warm compress to closed eyelid for 5-10 mins 2-4 times daily
- do not attempt to puncture stye
- avoid contact lenses or eye makeup until area has healed
Define uveitis
Inflammation of uveal tract - iris, ciliary body and choroid
Causes of uveitis
Systemic autoimmune disorders - sarcoidosis - psoriatic arthropathy - MS Infection - herpes simplex - herpes zoster virus - CMV Trauma Neoplasia
Complications of uveitis
Vision loss
Visual impairment
Paediatric uveitis
Clinical features of uveitis
Pain or dull ache Red eye Diminished or blurred vision Watering of eye Photophobia Flashes and floaters Unreactive of distorted pupil
Management of uveitis
Refer to ophthalmologist Non-infectious - corticosteriods - cycloplegic-mydriatic drug Infectious - antimicrobial drug - corticosteriods - cycloplegics
Define conjunctivitis
Inflammation of conjunctiva
- conjunctiva is thin, transparent mucous membrane lining anterior part of sclera
Causes of conjuctivitis
Viral - adenovirus - herpes simplex - varicella zoster Bacteria - streptococcus pneumonia - staphylococcus aureus - haemophilus influenzae
Clinical features of conjuctivitis
Acute onset conjunctival erythema Discomfort - grittiness, burning Watering and discharge Bacterial - purulent or mucopurulent discharge Viral - mild to moderate erythema of conjunctiva and pruritis
Differential diagnosis of conjuctivitis
Acute glaucoma Scleritis Episcleritis Keratitis Uveitis Iritis Corneal ulcer Atopic of allergic conjunctivitis Nasolacrimal duct obstruction Subconjunctival haematoma Dry eye Blepharitis Thyroid eye disease
Features for referral for conjunctivitis
Suspected gonococcal or chlamydia conjunctivitis
Possible herpes infection
Suspected periorbital or orbital cellulitis
Recent intraocular surgery
Corneal involvement
Management of viral conjunctivitis
Reassure most cases self-limiting and do not require antimicrobials
Advise self-care
- bathing eyelids with cotton wool soaked in sterile saline to remove discharge
- cool compress
- lubricating drops or artificial tears
Avoid antibiotics
Inform infective so should prevent spread
- wash hands with soap and water
- separate towels and flannels
Management of bacterial conjunctivitis
Advise most cases resolve within 5-7 days
Treat with topical antibiotics if severe
- chloramphenicol 0.5% drops
- fusidic acid
Causes of lumbar back pain
Non-specific low back pain Sciatica Vertebral fracture Intra-abdominal pathologies Ankylosing spondylitis Cancer Infection
Risk factors for lumbar back pain
Obesity
Physical inactivity
Occupational factors - heavy lifting
Depression and other psychological factors
Red flags symptoms for cauda equina syndrome with back pain
Severe or progressive bilateral neurological deficit of the legs - major motor weakness with knee extension , ankle eversion or foot dorsiflexion
Recent-onset urinary retention or urinary incontinence
Recent-onset faecal incontinence
Perianal or perineal sensory loss
Unexpected laxity of anal sphincter
Red flags symptoms for spinal fracture with back pain
Sudden onset of severe central spinal pain which is relieved by lying down
History of major trauma
Structural deformity
Point tenderness over vertebral body
Red flag symptoms of cancer with back pain
Over 50
Gradual onset of symptoms
Severe unremitting pain that remains when person is supine, aching night pain that prevents of disturbs sleep
Localised spinal tenderness
No symptomatic improvement after 4-6 weeks conservative therapy
Unexplained weight loss
Past history of cancer
Red flag symptoms of infection with back pain
Fever Tuberculosis or recent UTI Diabetes History of IV drug use HIV infection Immunosuppressants
Management of non-specific back pain
Reassure Analgesia to manage pain - NSAID - do not offer paracetamol - benzodiazepine if has muscle spasms Physiotherapy for manual therapy Encourage to stay active, resume normal activities and return to work asap
Define dyspepsia
Complex of upper gastrointestinal tract symptoms which are typically present for four or more weeks including
- upper abdominal pain
- heartburn
- acid reflux
- N+V
Define GORD
Gastro-Oesophageal Reflux Disease
Reflux of gastric contents back into oesophagus
- causing predominantly heartburn and acid regurgitation
Risk factors for GORD
Stress and anxiety Smoking and alcohol Trigger foods - coffee, chocolate OBesity Drugs that increase LOS pressure - alpha-blockers, anticholinergics, benzodiazepines, beta-blockers Pregnancy Hiatus hernia FH
Risk factors for Barrett’s oesophagus
Male gender
Long duration or increased frequency of GORD
Previous oesophagitis or hiatus hernia
Previous oesophageal stricture or ulcers
Complications of GORD
Oesophageal ulcers Oesophageal haemorrhage Anaemia - chronic blood loss Oesophageal stricture Aspiration pneumonia Barrett's oesphagus
Management of GORD
Lifestyle measures - weight loss - avoid trigger foods - eat smaller meals - stop smoking - reduce alcohol consumption Sleep with head of bed raised Assess for stress and anxiety Review medication Ask about over the counter medication - antacids, alginates PPI for 4 weeks
Classification of headaches
Primary - migraine - tension - cluster Secondary - trauma - intracerebral haemorrhage - giant cell arteritis - malignancy - meningitis Cranial neuropathies - trigeminal neuralgia - optic neuritis
Features that indicate serious cause of headache
New severe
- intracranial haemorrhage
- venous sinus thrombosis
Progressive/persistent
- mass lesion
- subdural haematoma
Fever, impaired consciousness, neck pain or photophobia - meningitis or encephalitis
Papilloedema - SOL
Dizziness - ischaemia or haemorrhagic stroke
Visual disturbance - migraine, acute closure glaucoma, temporal arteritis
Vomiting - migraine, mass lesion, brain abscess or CO poisoning
Diagnostic criteria for migraine without aura
At least 5 attacks with following criteria - headache attacks lasting 4-72hrs Headache has at least 2 criteria - unilateral location - pulsating quality - moderate or severe pain intensity - aggravation by or causing avoidance of routine physical activity During headache at least 1 - nausea - vomiting - photophobia - phonophobial
Diagnostic criteria for migraine with aura
At least 2 attacks
One or more following reversible aura symptoms
- visual - zigzag lines or scotoma
- sensory - pins and needles
- speech and language - aphasia
- motor weakness
- brainstem - vertigo, diplopia
- retinal - monocular scintillations or scotoma
At least 2 of the following
- aura symptom spreads gradually over at least 5 mins
- each individual symptom lasts 5-60 mins
- unilateral
- aura accompanied or followed within 60mins by headache
Diagnostic criteria for tension-type headache
Recurrent episodes of headache lasting from 30mins to 7 days
- not associated with N/V
Headache consists of
- bilateral location
- pressing or tightening quality
- mild or moderate intensity
- not aggrevated by routine physical activity
Diagnostic criteria of cluster headache
5 severe or very severe attacks of unilateral orbital, supraorbital or temporal pain lasting 15-180mins
Associated with at least one
- ipsilateral conjunctival injection or lacrimation
- nasal congestion / rhinorrhoea
- eyelid oedema
- forehead and facial sweating
- forehead and facial flushing
- sensation of fullness in ear
- sense of restlessness or agitation
Attacks occur between every other day and 8 per day for more than half the time
Diagnostic criteria for medication overuse headache
Occurs on at least 15 days per month and pre-existing headache disorder
Regularly overused drugs for more than 3 months
- ergotamines
- triptans
- simple analgesics`
- opioids
