Minor & Major Illness Flashcards
Give 3 reasons why women in the 15-64 age group appear to consult GPs nearly twice as often as men?
- Screening - more women recalled for screening programs e.g. cervical smears, mammograms
- Pregnancy – women attending for antenatal care
- Fewer women working than men
What are the ‘top ten’ presenting conditions in children?
- Acute URT infections
- Chest symptoms e.g. cough/wheeze/asthma
- Infectious diseases
- Rashes
- GI symptoms e.g. vomiting & diarrhoea
- Generally unwell
- Ear problems
- Conjunctivitis
- Urinary symptoms
- Injuries
What are the ‘top ten’ presenting conditions in adults?
- Chest symptoms e.g. cough/wheeze/asthma
- Abdo pain
- Neck & back problems
- Joint pains (hips & knees)
- Rashes
- Genitourinary symptoms / menstrual disorders
- Depression, anxiety & stress
- Circulatory disorders incl heart disease and stroke
- Soft tissue swellings/lumps
- Headache
What condition is this? What are the features that lead you to this conclusion?
Chicken pox
- Distribution of lesions → central rather than peripheral
- Different ages of spots → small papules, progressing to vesicles and eventually scabbing
What condition is this? What are the features that lead you to this conclusion?
Shingles (Herpes Zoster)
- Distribution of lesions → unilateral and dermatomal
What is the most common complication of shingles? What is a potent risk factor for this complication?
Long-term nerve pain called post-herpetic neuralgia (PHN).
Age is a potent risk factor
What type of shingles is an emergency?
Ophthalmic shingles → can lead to sight loss
What % of cases does ophthalmic shingles make up?
10-25% of all shingles cases
Who is most at risk of ophthalmic shingles?
Immunocompromised and elderly
What % of people who have had chicken pox will go on to develop shingles?
20%
Where does the herpes zoster virus reside?
dorsal root ganglion
What class of medication can reduce the risk of post-herpetic neuralgia?
Antivirals → these should be given routinely to the over 50s as they are most at risk.
Guidelines for prescribing antivirals in shingles?
- Over 50s
- >50s but ophthalmic, non-truncal involvement, severe pain, moderate to severe rash, immunocompromised
Who is the shingles vaccine offered routinely to?
70-79 year olds
What condition is this? What are the features that lead you to this conclusion?
Molluscum contagiosum
- Typical appearance - raised, pearly papules with central dimples
Management & lifestyle advice for molluscum contagiosum?
- Does not usually require treatment in immunocompetent people → self-limiting condition
- Spontaneous resolution usually occurs within 18 months.
- Explain that lesions are contagious and it is sensible to avoid sharing towels, clothing, and baths with uninfected people, such as siblings.
- Exclusion from school, gym, or swimming is not necessary
Why should lesions in molluscum contagiosum not be squeezed?
to avoid spread of the infectious material as well as reducing the risk of super-infections
If itching in molluscum is problematic, what can be prescribed?
prescribe an emollient and a mild topical corticosteroid (such as hydrocortisone 1%).
If the skin looks infected in molluscum, what can be prescribed?
topical antibiotic (such as fusidic acid 2%)
What condition is this? What are the features that lead you to this conclusion?
Eczema
- Site - flexor surfaces
- Borders - blends into surrounding skin rather than discrete lesions
Why do some rashes not blanch under pressure?
A non-blanching rash is result of bleeding into skin
A blanching rash is due to hyperaemia of skin (engorgement of vessels with oxygenated blood)
In the pre-hospital management of meningococcal septicaemia, what drug should be given at the earliest opportunity (provided that it does not delay urgent transfer to hospital)?
Single dose of parenteral (IM or IV) benzylpenicillin
(If given IM, give as proximally as possibly)
In the pre-hospital management of meningococcal septicaemia, who should benzylpenicillin not be given in?
Withhold benzylpenicillin only in those with a clear history of anaphylaxis after a previous dose; a history of a rash following penicillin is NOT a contraindication
What condition is this? What pathogen is it caused by?
Herpes Labialis - caused by Herpes Simplex virus (usually HSV1)
In the context of herpes labialis, are antivirals routinely prescribed? What should be offered?
No, not routinely prescribed (use clinical judgement).
Consider prescribing in immunocompromised.
Offer paracetamol and/or ibuprofen to treat symptoms of pain and fever, if needed, and there are no contraindications.
What is the diagnosis? Defining features? What are the 2 most common causative organisms?
Impetigo - ‘honey crusted’ lesions
- Staph aureus
- Strep pyogenes
Why is impetigo more common in children?
Common in children, as they don’t (often) wash their hands, and they also scratch and pick
What is the pharmacological treatment for non-bullous impetigo?
1st choice → Hydrogen peroxide 1% cream
OR topical antibiotic (e.g. fusidic acid) if necessary
What class of drug is hydrogen peroxide?
Topical antiseptic
Benefit of using hydrogen peroxide over fusidic acid in the topical treatment of impetigo?
Antibiotic resistance
If impetigo is more widespread and patient appears systemically unwell, what oral antibiotic should be prescribed?
Flucloxacillin (or clarithromycin if penicillin allergic)
How long should children avoid school for with a case of impetigo?
Children and adults should stay away from school and other childcare facilities or work until lesions are healed, dry and crusted over or 48 hours after initiation of antibiotics.
What is the diagnosis? What are the features that lead you to this diagnosis? What is the treatment?
Acne vulgaris
- Age of patient
- Site of lesions
- Different lesions - papules, pustules and comedones
- Treatment depends on severity & cause (look at derm)
A common treatment for acne vulgaris is epiduo. What are the 2 ingredients found in this?
- Topical retinoid → adapalene
- Topical benzoyl peroxide
What is the diagnosis? What is the aetiology? What is the treatment? What is NOT the treatment?
Furuncle - this is an infected/blocked sebum gland that occurs in hairy areas
What are these? What is the treatment?
And why is one bigger than the other?
Head lice - the bigger one is female
Pharmacological treatment for headlice?
Insecticide e.g. dimeticone 4% gels
This is an extremely itchy condition.
What is this condition? What are the arrows pointing to? What is the treatment?
Scabies → VERY ITCHY
- •The arrows are pointing to the tracks made where the Scabies mite lays its eggs
- Treatment: insecticide, malathion liquid or permethrin cream
What is thread worm?
Who are they common in?
Threadworms are tiny worms found in faeces or around the anus.
They’re common in children and spread easily → common in children, who scratch their itchy anuses and then don’t wash their hands before eating…..
Symptoms of threadworms?
Produces itching only; no other ill effects.
Pharmacological treatment of threadworm?
Treatment is with an antihelminthic agent (treatment for a parasitic worm), e.g. Mebendazole
Consider treating the whole family, and then repeating the treatment after two weeks to ensure resolution of the condition
What is this condition? Who might get it?
Oral thrush/candidiasis
- May occur in elderly or debilitated patients
- Common in those with steroid treatment - inhalers or tablets
- May be opportunistic infection in diabetes, HIV etc
Pharmacological treatment of oral candidiasis?
Topical Nystatin or Miconazole Oral Gel, or oral Fluconazole
Pharmacological treatment of oral candidiasis?
Topical Nystatin or Miconazole Oral Gel, or oral Fluconazole
What is this condition called? Aetiology?
Aphthous ulcer
Cause unknown, but tends to occur in young people, and is linked to stress and poor diet
Aphthous ulcers tend to be self-limiting. What can be considered for symptom relief?
Hydrocortisone Pastilles
In patients with risk factors such as age, smoking, alcohol, length of time its been present, what diagnosis should you consider?
Oral cancer
What is this condition called? What skin condition is linked to?
Who is more likely to get it? What is the treatment?
- Rhinophyma - a skin disorder characterised by a large, red, bumpy or bulbous nose
- It is associated with untreated rosacea
- Cause - inflammation and hypertrophy of sebum glands on the nose, which also produces remodelling of the nasal cartilage
What are the 2 major risk factors for rhinophyma?
- Those exposed to UV light (e.g. homeless, work outside)
- Excess alcohol
Potential management for rhinophyma?
Treat the underlying Rosacea, and consider plastic surgery, to shave off the hypertrophied glands and inflamed skin
What is the acute management of epistaxis?
Acute management is pressure, or, if necessary, packing, to stop the bleeding.
Where should pressure be applied in a nosebleed?
You should apply pressure to the soft, anterior part of the nose, NOT the hard, bony nasal bridge
How should the patient with a nosebleed sit?
You should sit forward with your mouth open, so as not to swallow the blood
Cause of ear wax?
Caused by irritation to the ear canal, from items, such as dust or “in-ear” headphones
Management of ear wax? Why should cotton buds not be used?
Use Olive Oil drops to soften the wax, and consider gentle syringing with warm water
Do not use Cotton Buds, as they only serve to impact the wax and damage the lining of the ear canal
What is this condition? What features give it away?
Conjunctivitis - redness of whole conjunctiva with no apparent corneal or anterior chamber involvement.
Causes of conjunctivitis?
Viral infection, Bacterial infection, Allergy (hay fever) or Irritant (dust). The history will guide you to the cause.
Management of conjunctivitis?
Treatment depends on the cause, but is usually self-limiting.
What is this condition?
The top slide is the initial presentation and the bottom slide is after a couple of days.
Subconjunctival haemorrhage - this is a bleed beneath the conjunctiva, which is bounded by its attachment to the edge of the cornea.
Possible causes of a subconjunctival haemorrhage?
- Spontaneous capillary leak
- Straining (e.g. chronic constipation, childbirth, coughing)
- Also consider concurrent anticoagulant or anti-platelet therapy.
Is a subconjunctival haemorrhage a medical emergency?
Looks very dramatic, but is usually asymptomatic and completely harmless!
What is the cause of this red eye? Is this an emergency? Why?
Foreign body - history will lead you to cause
Note the slight irregularity of the cornea at the site of the foreign body → risk of being a penetrating eye injury (refer to Eye Casualty immediately!)
What is the diagnosis? What is the aetiology?
Hordeolum / Stye
This is an obstruction and infection of an eyelash follicle.
Treatment of a stye? Why are antibiotic eyedrops inappropriate?
Warm compress & analgesia
Only treat with oral Abx if severe and painful
Abx eyedrops are inappropriate, because it is really a skin problem, not an eye problem
What are the two conditions that you can see?
- Ingrowing toenail
- Paronychia - note redness
What is paronychia?
Paronychia is a skin infection around the fingernails or toenails.
Treatment of ingrowing toenail with paronychia?
Antibiotics for the infection and consider partial resection of the nail under local anaesthetic
What is the likely diagnosis? What are the features that you can see, which lead you to this diagnosis?
Fungal nail infection
Note the white, thickened, crumbly appearance of the nail, with onycholysis (areas of white where the nail has been lifted off the nail bed).
how is the diagnosis of a fungal nail infection confirmed?
Diagnosis is confirmed by sending nail clippings for Mycology
Differential diagnosis for a fungal nail infection?
onychogryphosis - this is a condition, where the nail is darker and thicker, caused by ageing or trauma
Treatment for a fungal nail infection?
ORAL antifungal e.g. terbinafine
What is the diagnosis? What is the causative organism? What is the treatment?
Diagnosis → Verucca / plantar wart
Causative organism → Human papilloma virus
Treatment → usually self-limiting, but, if required, treatment is weak topical salicylic acid.
Presentation of olecranon bursitis? Cause?
Presentation → non-tender swelling over elbow
Cause → continued pressure on elbow e.g. resting or table, acute trauma (blow to elbow)
Management of olecranon bursitis?
- Exclude infection – does the patient have systemic symptoms?
- Try NSAIDs
- Consider aspiration, followed by pressure bandage
What must be excluded in olecranon bursitis?
infection
What is the generic name for lateral epicondylitis?
Tennis elbow
What is the generic name for medial epicondylitis?
Golfer’s elbow
Management for epicondylitis?
- Rest
- NSAID – oral or topical
- Physiotherapy
- Splints – to immobilise the elbow, or to immobilise the wrist to prevent flexion/extension
- Steroid Injection
How does a ganglion cyst present?
A non painful swelling over the wrist - normally been present for several months before patient presents to GP
What is a ganglion cyst?
This is synovial cyst, which is associated with either a mobile joint, e.g. wrist or ankle, or with a tendon sheath.
Why are ganglion cysts difficult to aspirate?
They are difficult to aspirate as the synovial fluid is so viscous, and they tend to recur
What is the typical management for large and troublesome ganglion cysts?
If large or troublesome, they are best surgically excised
A 29-year-old pregnant lady has developed “pins and needles” in both hands, particularly at night.
What is the likeliest diagnosis?
Carpal tunnel syndrome
Why is carpal tunnel syndrome more common in pregnancy?
When you are pregnant, your hormone levels trigger fluid retention, which can cause swelling. This swelling can, in turn, push against the median nerve in the carpal tunnel – increasing pressure in the carpal tunnel and sometimes causing pain in your wrist and hand.
What is carpal tunnel syndrome?
Compression of the Median nerve at the wrist
Describe the distribution of pins and needles in carpal tunnel syndrome
Thumb and two and a half fingers on the palmar aspect of hand
What is the motor innervation of the median nerve?
Motor innervation is the thenar muscles and the lateral two lumbricals
Why is carpal tunnel syndrome worse at night?
Worse at night, because we tend to adopt a flexed posture, and hyperflexion of the wrists increases median nerve compression
Management options for carpal tunnel syndrome?
Splints, Steroid Injection, Surgery
What is the commonest form of joint disease?
Osteoarthritis
Presentation of osteoarthritis?
Progressive pain and swelling
Pain may radiate (e.g. from knee to hip)
Stiffness
What type of knee injury would a forward movement on a planted leg indicate (hyperflexion)?
ACL tear
This man presented with a red, hot, swollen right knee.
He is systemically unwell.
What is the likeliest diagnosis?
Septic arthritis
Management of septic arthritis?
Requires acute admission to hospital for intravenous antibiotics
Differential for septic arthritis if the patient is NOT systemically unwell?
Pre-patellar Bursitis
A young, fit man presented with a tender swelling just below the knee.
What is the most likely diagnosis?
Osgood-Schlatter Disease
What is Osgood-Schlatter disease?
This is an apophysitis of the tibial tuberosity.
The patellar tendon attaches to the tibial tuberosity, and pulls on it causing it to be become raised, painful and tender.
Who is Osgood-Schlatter disease most common in
This condition occurs in young people (aged 9 -14), particularly those who are more sporty.
Management of Osgood-Schlatter disease?
It is self-limiting, and is managed by rest and analgesia only.
What is a furbuncle?
Furuncles (boils) are skin abscesses caused by staphylococcal infection, which involve a hair follicle and surrounding tissue.
