SLA 3 - Minor Illnesses Flashcards
What is acute bronchitis?
A self-limiting lower respiratory tract infection, causing inflammation of the bronchial airways.
Presentation of acute bronchitis.
- duration of cough <30 days
- productive cough
- no history of chronic respiratory illness
- fever
- wheeze
- rhonchi
Risk factors of acute bronchitis.
- viral or bacterial infection exposure
- cigarette smoking
Which class of organism most commonly causes acute bronchitis.
Viral infections (e.g. rhinovirus, coronavirus, respiratory syncytial virus, adenovirus).
Although rare, which bacterial species most commonly cause acute bronchitis.
- Chlamydia pneumoniae
- Mycoplasma pneumoniae
What is the management of acute bronchitis?
Reassure the pt it is usually a self-limiting illness and usually resolves within 4/52.
Advise the person on self-care strategies (e.g. fluid intake, paracetamol / ibuprofen for symptomatic relief, honey, OTC cough medicines).
Do not routinely offer an antibiotic unless the pt is systemically unwell or at high risk of complications (e.g. immunosuppressed).
Advise the pt to seek medical help if symptoms worsen rapidly or do not improve within 4/52.
Give 5 features of acute bronchitis infection that indicate the need for abx.
- Comorbidities (e.g. asthma, COPD, bronchiectasis)
- Extremes of age
- Crackles on auscultation
- Abnormal vitals (ie. fever, tachycardia, tachypnoea)
- Purulent sputum
What is acute sinusitis?
A symptomatic inflammation of the mucosal lining of the nasal cavity and paranasal air sinuses.
What is the aetiology of acute sinusitis?
Most commonly viral aetiology.
Note sx > 10/7 and fever indicate bacterial aetiology.
Presentation of acute sinusitis.
- cough
- myalgia
- purulent nasal discharge
- sore throat
- hyposmia
- facial pain or pressure
Outline the management of acute sinusitis.
Sx < 10 days do NOT offer abx prescription - symptomatic management incl. paracetamol and ibuprofen.
Sx > 10 days consider prescribing a high-dose nasal corticosteroid.
Note a back-up prescription can be considered if sx > 10 days, however there is evidence abx make little difference to how long symptoms last.
What is the aetiology of tonsillitis?
Viral aetiology most common (ie. rhinovirus, coronavirus, adenovirus).
Bacterial aetiology less common (~20%) but group A beta-haemolytic streptococci (GABHS) main bacterial cause.
Presentation of tonsillitis.
- pain on swallowing
- fever
- tonsillar exudate
- headache
- tonsillar erythema
- coryzal sx
Outline the management of tonsillitis, including the use of FeverPAIN score.
Calculate FeverPAIN score:
- Fever (+1)
- Purulence (+1)
- Attend within 3 days after onset of sx (+1)
- Inflamed tonsils (+1)
- No cough or coryza (+1)
FeverPAIN <4 do NOT prescribe abx as likely viral aetiology.
FeverPAIN >3 prescribe abx as GABHS likely.
If prescribing abx for tonsillitis, what is first line?
Phenoxymethylpenicillin
Note if there is true penicillin allergy, clarithromycin or erythromycin (ie. pregnant) is an alternative.
What is pneumonia?
Inflammation of the lungs with consolidation or interstitial lung infiltrates.
What is community acquired pneumonia (CAP)?
What is the most common causative orgaism?
Pneumonia acquired outside hospital or healthcare facilities.
Most commonly caused by Streptococcus pneumoniae or viral aetiology.
What is hospital acquired pneumonia (HAP)?
What is the most common causative organism?
Pneumonia acquired after >48 hours of admission to hospital.
What are the most common viral causes of pneumonia?
- influenza virus
- respiratory syncytial virus
- coronavirus
Give some causes of atypical pnuemonia.
Atypical bacterial pneumonia is caused by atypical organisms that are not detectable on Gram stain and cannot be cultured using standard methods.
The most common organisms are:
- mycoplasma pneumoniae,
- chlamydophila pneumoniae
- legionella pneumophila.
What is aspiration pneumonia?
Results from the inhalation of contents into the lower airways leading to lung injury and resultant bacterial infection.
Most commonly occurs in pts with impaired gag or swallowing reflexes (ie. brain injury, alcohol intoxication).
Presentation of CAP.
- productive cough
- dyspnoea
- pleuritic chest pain
- rigor / night sweats
- fever
- confusion
- tachypnoea
Which auscultatory findings would be consistent with a diagnosis of pneumonia.
Evidence of consolidation in lungs:
- crackles
- increased vocal resonance
- dull percussion note
Outline the management of CAP, including the use of CRB-65 score.
For all pts with CAP, offer abx:
- Amoxicillin
- Clarithromycin (if penicillin allergic)
- Erythromycin (as 2. and pregnant)
Calculate CRB-65 score:
- Confusion (+1)
- Respiratory rate > 30 breaths/min (+1)
- Blood pressure < 90/60mmHg (+1)
- Age > 65 (+1)
CRB-65 = 0, community treatment
CRB-65 = 1/2, hospital assessment
CRB-65 = 3/4, urgent admission to hospital
What are the features of uncomplicated influenza infection?
- fever
- coryza
- headache
- malaise
- myalgia
- arthalgia
- gastrointestinal symptoms
Note there are no features of complicated influenza.
What are the features of complicated influenza infection?
Influenza requiring hospital admission and/or symptoms and signs of LRTI:
- hypoxaemia
- dyspnoea
- neurological involvement
Note also includes influenza infection causing significant exacerbation of underlying condition.
Describe the pathogenesis of:
a) Influenza A
b) Influenza B
c) Influenza C
a) most common and cause of major influenza outbreaks
b) circulate with A in yearly outbreaks and cause less severe illness
c) causes mild or asymptomatic illness akin to the common cold
Name and describe the purpose of the surface antigens present on influenza A serotypes.
H (haemagglutinin) facilitates entry of the virus into the host respiratory cell.
N (neuraminidase) facilitates release of virons from the infected host cell.
Describe antigenic drift in relation to the pathogenesis of Influenza A.
Influenza A undergoes minor mutations to one or both of its surface antigens (A or N), causing seasonal epidemics where people only have partial immunity from previous inection.
Describe antigenic shift in relation to the pathogenesis of Influenza A.
Influenza A undergoes major and sudden mutations to the H and N surface antigens to produce a new virus subtype. There is little population immunity and subsequently major epidemics may ensue.
Describe the treatment of:
a) uncomplicated influenza infection
b) complicated influenza infection
a) advise pt the infection is self-limiting and no anti-viral treatment is indicated
b) offer antiviral (oseltamivir) first line and consider admission to hospital.
Define the following terms in relation to urinary tract infections (UTIs):
a) bacteriuria
b) lower UTI
c) upper UTI
d) recurrent UTI
e) uncomplicated UTI
f) complicated UTI
a) presence of bacteria in the urine (symptomatic or asymptomatic)
b) infection of the bladder (ie. cystitis)
c) infection of urinary tract above the bladder (ie. pyelitis and pyelonephritis)
d) >1 episode of UTI 6/12 or >2 episodes of UTI 12/12
e) UTI by a usual pathogen in a person with a normal urinary tract and normal kidney function
f) anatomical (ie. male), functional or pharmacological factors predispose the person to persistent infection, recurrent infection or treatment failure.
What is the most common causative organism of UTI?
Escherichia coli
Other causative organisms are:
- Staphylococcus saprophyticus
- Proteus mirabilis
- Enterococci
Suggest female anatomical features that predispose women to a greater incidence of UTI verus the male anatomy.
- shorter urethra
- vagina closer to the anus
Note poor wiping technique and receptive sexual intercourse increase risk.
Presentation of UTI.
- polyuria
- dysuria
- haematuria
- offensive / cloudy urine
- pyrexia
- nausea and vomiting
- acute confusional state (particularly in elderly pts)
NICE recommends which additional examination in men presenting with symptoms consistent with UTI?
PSA and DRE to assess for prostate cancer in men with lower urinary tract symptoms or visible haematuria.
Outline the management of UTIs for:
a) non-pregnant women with mild symptoms
b) pregnant women with mild symptoms
c) men
a) nitrofurantoin (or trimethoprim) BDS 3/7
b) nitrofurantoin BDS 7/7
c) nitrofurantoin (or trimethoprim) BDS 7/7
Presentation of pyelonephritis.
Symptoms of UTI and flank/renal angle pain.
The triad of flank pain (typically unilateral), fever, and nausea and vomiting occurs much more often in people with pyelonephritis than in those with lower urinary tract infection.
Outline the management of pyelonephritis.
Cefalexin or co-amoxiclav TDS 10/7.
What is the most common causative organism of vaginal candidiasis?
Candida albicans (approx 90%).