Psych & Sore Throat Flashcards
Is there evidence that sore throats a result of a bacterial cause are more severe than viral ones or that the duration of the illness is significantly different in either case.
No
How does fever relate to pharyngitis and tonsillitis?
Common
How does sore throat relate to dehydration?
Can be caused by reduced fluid intake and also cause dehydration.
At what point is reduced fluid intake an issue in infants and children?
Down by 50%
What is the FeverPain/Centor score used to assess?
Likelihood fo Group A Streptococcus
What are the components of the FeverPain score?
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza
What are the components of the Centor score?
Tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever (over 38°C)
Absence of cough
What are the cut off scores for FeverPain/Centor?
4-5
5 common (non-step) causes of common sore throat
The common cold Influenza — Pharyngoconjunctival fever — Acute herpetic pharyngitis Infectious mononucleosis (glandular fever) ).
3 Rare but serious causes of sore throat?
Kawasaki
Epiglottitis
Measles
antibiotics for streptococcal sore throat decrease symptom duration by…?
Less than 1 day
For people not in a vulnerable group, and without severe symptoms, or who have a FeverPAIN score of 2 or 3, what would you consider?
Delayed antibiotic prescribing
What is the antibiotic of choice and allergy alternative for sore throat?
phenoxymethylpenicillin
Clarithromycin
Self care for sore throat
Fluids
NSAIDS for fever and pain relief
Avoid hot drinks
Medicated lozenges can give a bit of relief
How soon can kids return to school after sore throat?
Day after fever has resolved
Safety net for sore throat
Symptoms have not improved after 3 or 4 days of antibiotic therapy
Pain does not improve after 3 days, and/or there is fever over 38.3°C
It becomes difficult to swallow saliva or liquids, if any difficulty in breathing develops, or if there is any one-sided neck or throat swelling
Two core questions for depression?
During the last month have you often been bothered by feeling down, depressed, or hopeless?
Do you have little interest or pleasure in doing things?
How long do at least one of the “core” symptoms of depression have to be present for?
most days, most of the time, for at least 2 weeks
7 associated features of depression
Disturbed sleep (decreased or increased compared to usual).
Decreased or increased appetite and/or weight.
Fatigue/loss of energy.
Agitation or slowing of movements.
Poor concentration or indecisiveness.
Feelings of worthlessness or excessive or inappropriate guilt.
Suicidal thoughts or acts
Are investigations routinely indicated for depression?
No
5 Medical conditions that may present as depression?
Anxiety Bipolar Dementia Parkinson's Hypothyroidism
4 questions to assess risk of suicide?
Do you have thoughts about death or suicide?
Do you feel that life is not worth living?
Have you made a previous suicide attempt?
Is there a family history of suicide?
2 questions for suicide protective factors?
What keeps you from harming yourself?
Is there anything that would make life worth living?
3 questions about plans for suicide?
Have you considered a method?
Do you have access to the materials?
Have you made any preparations (for example, written a note)?
3 high risk groups for suicide
Young and middle-aged men.
People in contact with the criminal justice system.
Specific occupational groups, for example, doctors, nurses, veterinary workers, farmers, agricultural workers.
MGMT for mild to moderate depression
Improved Access to Psychological Therapies
CBT
Avoid anti-depressants
MGMT for mod-severe depression
Anti-depressant and high intensity psychological intervention
Safety net for depression
To be vigilant for worsening depressive symptoms and suicidal ideas, particularly when starting and changing medications, and at times of increased personal stress. Advise them to seek help promptly if they are concerned.
How long does it usually talk for symptoms to improve when starting antidepressants?
2-4 weeks
What happens if I suddenly stop taking antidepressants?
restlessness, problems sleeping, unsteadiness, sweating, abdominal symptoms, altered sensations (for example electric shock sensations in the head), or altered feelings (irritability, anxiety, confusion).
Are SSRIs addictive?
No, but you can get discontinuation symptoms
When should you arrange a review for someone with depression?
Risk of suicide - 2 weeks
and under 30 - 1 week
When should you suspect GAD?
a person who reports chronic, excessive worry which is not related to particular circumstances, and symptoms of physiological arousal
What are the physiological symptoms of GAD?
Restlessness
Insomnia
Muscle tension
In GAD the person experiences at least 3 of the following symptoms most of the time….
restlessness/nervousness, being easily fatigued, poor concentration, irritability, muscle tension , or sleep disturbance
What meds can cause anxiety as a side effect?
salbutamol
theophylline
beta-blockers
herbal medicines
What 4 features might you find on physical examination of a pt with GAD?
Increased heart rate.
Shortness of breath.
Trembling.
An exaggerated startle response.
GAD MGMT step 1
Monitoring and information to assess social functioning
GAD MGMT step 2 & 3
2 - CBT
3 - intensive CBT and SSRI/SNRI
Do you offer benzos to people with GAD?
No, except in particular crisis
Safety net for GAD
Monitoring with further appointment and if symptoms get worse/suicidal if starting drug treatment
Questions that form part of CAGE alcohol screen
Cut down
Annoyed when people comment
Guilty about drinking
Eyeopener
Symptoms of delirium tremens
confusion/delirium, generalised tonic-clonic seizures (this may be the first manifestation of alcohol withdrawal for some people), auditory, visual, or tactile hallucinations, hyperthermia subsequent to psychomotor agitation
Symptoms of mild alcohol withdrawal
hypertension and tachycardia, anorexia, anxiety, emotional lability, insomnia, irritability, diaphoresis, headache, and fine tremor.
Timescale of mild and moderate alcohol withdrawal
Onset in 4-6 hours
Peak at 24-36 hours
Red Flag referral for alcohol treatment
acute withdrawal or at risk of developing
Wernicke encephalopathy
MGMT of alcohol dependence and want to quit?
referral to specialist alcohol service
Do piss heads need to inform DVLA?
yes
MGMT options for problem drinking?
Advice
Referral to specialist service if they want to quit
Urgent admission if they are acutely withdrawing
What medication is possible for problem drinkers and what group do you offer it to?
Thiamine for harmful/dependent drinkers at risk of malnourishment
What questionnaire would you use to asses the level of someone’s drinking?
AUDIT
What do you offer to all problem drinkers?
Information about community support groups
If a drinker wants specialist medication to stop drinking what do you tell them?
No, needs to be prescribed by specialist service
Low tech advice for drinkers
Cut down alcohol but DON’T stop suddenly
Recognizing and avoiding high risk situations for drinking
Recognizing personal cues for drinking (for example stress and being alone).
Drinking a soft drink for every alcoholic drink, and eating before drinking.
Trying alternative activities to drinking (coping strategies)
Keeping a drinking diary
Avoid pub after work
Avoid joining in buying rounds
Symptoms of Wernicke’s encephalopathy
confusion,
ataxia,
ophthalmoplegia,
nystagmus
Risk assessment aspects in problem drinking
MOOD • Children at home • Domestic violence • Driving • Occupation
Safety net for problem drinking
o Ask patient to return if they find themselves struggling or they need more support
o Ask patient to return if they have symptoms of withdrawal (shaking, sweat,tremor)
o Direct them to Crisis Team Helpline or Samaritans out of hours.
