Tutorial 3 - Minor illnesses Flashcards
1
Q
Briefly describe:
a) the types of antibiotics out there
b) how they each respectively work
c) which antibiotic is best for what
A
- Beta lactams ( penicillins - penicillin v, flucloxacillin, amoxicillin, co - amoxiclav and cephalosporins - ceftriaxone) - these antibiotics work by inhibiting the peptidoglycan wall synthesis, these can help with meningitis / pneumonia / UTI’s and penicillins are especially good for skin and middle ear infections.
- Tetracyclines ( i.e tetracycline or doxycycline), these antibiotics inhibit key protein synthesis. Good for RTI’s and acne.
- Macroides (i.e. clarithromycin), these antibiotics also inhibit key protein synthesis. Good for most things that penicillin is and respiratory tract infections ( prescribe if allergic to penicillins class).
- Nitrofurans ( i.e. nitrofurantoin), these antibiotics also inhibit key protein synthesis. Good for UTI’s
- Quinolones (i.e. ciprofloxacin )
2
Q
Name 5 common upper respiratory tract infections ?
A
- Common cold
- Epiglotittis
- Laryngitis
- Pharyngitis
- Sinusitis
3
Q
- What is the common cold ?
- How does it present ?
- What are its risk factors ?
- What tests / exams / investigations can be done ?
- How is it managed ?
A
- Viral infection of the nose and throat.
- Cough, sneeze, blocked nose, headache, temperature.
- Infants, smokers, winter months, immunocompromised,
- Based on signs and symptoms alone, although other tests can be done to rule out other conditions.
- Plenty of rest, plenty of fluids, gargle salt water for sore throat, various OTC solutions to ease symptoms of cold, other than this self limiting 7 - 10 days.
4
Q
- What is epiglottis ?
- How does it present ?
- What are its risk factors ?
- What tests / exams / investigations can be done ?
- How is it managed ?
A
- Epiglotittis is inflammation and swelling of the epiglottis.
- Difficulty swallowing, difficulty breathing , drooling, muffled voice.
- Affects males more. Often caused due to infection from haemophilia influenzas or staph aureus, so lack of immunisation against HIB and being immunocompromised can increase risk.
- Neck x-ray - thumb print sign, throat culture ( HIB ), FBC.
- Urgent treatment. Tube inserted past epiglottis with high flow oxygen, if not possible then emergency tracheostomy - this secures airway. Broad spectrum antibiotic i.e. IV ceftriaxone and once causative organism is discovered more targeted antibiotic treatment can be given.
5
Q
- What is the pharyngitis ?
- How does it present ?
- What are its risk factors ?
- What tests / exams / investigations can be done ?
- How is it managed ?
A
- Inflammation of the pharynx
- Sneezing, runny nose, headache, sore throat, fever
- Smoker, immunocompromised.
- Throat culture
- Viral infection - goes away on its own, bacterial infection - treated with antibiotics
6
Q
- What is the laryngitis ?
- How does it present ?
- What are its risk factors ?
- What tests / exams / investigations can be done ?
- How is it managed ?
A
- Inflammation of voice box / voice cords.
- Hoarse voice, losing voice, cough, sore throat.
- Overusing voice i.e. shouting / singing, smoking.
- Laryngoscopy, throat culture
- Often goes away in its own, try speak as little as possible, gargle warm salt water, if bacterial infection - antibiotics can be prescribed.
7
Q
- What is the sinusitis ?
- How does it present ?
- What are its risk factors ?
- What tests / exams / investigations can be done ?
- How is it managed ?
A
- Sinusitis is inflammation of the sinuses ( ethmoidal, maxillary etc ). The sinuses are small gaps behind your cheek bones / forehead which connect to the nose.
- Yellow / green discharge from nose, blocked nose, pain in cheek / eye/ forehead region.
- Smoker, recent cold, nasal polyps, allergies ( allergic rhinitis )
- Allergy testing, nasal endoscopy.
- Depends on the cause of the sinusitis - infection - antibiotics, cold - rest / fluids / nasal decongesting sprays, allergic rhinitis - antihistamines, avoid allergic trigger. Refer to ENT if not responding to treatment within a week or 2, get recurrent sinusitis.
8
Q
- What is the tonsillitis ?
- How does it present ?
- What are its risk factors ?
- What tests / exams / investigations can be done ?
- How is it managed ?
A
- Tonsilitis is the inflammation of the tonsils.
- Sore throat, difficulity swallowing, bad breath, earache
- Young age, populated places such as nurseries where children frequently come into contact with viruses / bacteria which cause it.
- Swab, check palatine tonsils - inflamed / white / pus ( quinsy - abcess).
- Often caused by a viral infection, so should clear up on its own. If bacterial infection than course of antibiotics can be given.
9
Q
- What is the glandular fever ?
- How does it present ?
- What are its risk factors ?
- What tests / exams / investigations can be done ?
- How is it managed ?
A
10
Q
Name 3 common lower respiratory tract infections.
A
- Acute bronchitis
- Community acquired Pneumonia
- Tuberculosis
11
Q
- What is community acquired pneumonia ?
- How does it present ?
- What are its risk factors ?
- What tests / exams / investigations can be done ?
- How is it managed ?
A
- Pneumonia is the inflammation of lung parenchyma due to a bacterial / viral lung infection. Most commonly due to streptococcus pneumoniase.
- Pleuertic chest pain, difficulty breathing, cough ( productive - yellow / green / bloody mucus ), tachycardia, tachypnea.
- Babies, elderly, immunocompromised, smokers, pre - existing lung conditions i.e. asthma, COPD.
- Resp exam - crackles ( due to fluid in small air sacs ), decreased breath sounds, bronchial breathing, dull percussion, vocal fremitus . Xray - consolidation ( fluid build up ). Blood test (FBC). Sputum / blood culture. CURB - 65 to access risk.
- Antibiotic course - commonly a penicillin such as amoxicillin, if allergic can give macrolide such as clarithromycin or tetracycline such as doxycycline. The latter is bacteriostatic not bactericidal, so make take longer to clear the infection.
12
Q
- What is acute bronchitis ?
- How does it present ?
- What are its risk factors ?
- What tests / exams / investigations can be done ?
- How is it managed ?
A
- Acute bronchitis is inflammation of the bronchi.
- Cough ( dry or productive ), body aches, fatigue, headache, soreness of chest, sore throat.
- Smoking, gastric reflux, occupation i.e in contact of textiles known to inflame airway.
- Wheeze, rhonci, CXR ( rule out a pneumonia).
- Often a viral cause so rest, plenty of fluids and analgesia such as NSAIDS are recommended. Rarely can be bacterial case in which case course of antibiotics given.
13
Q
- What is tuberculosis?
- How does it present ?
- What are its risk factors ?
- What tests / exams / investigations can be done ?
- How is it managed ?
A
- TB is a lower respiratory tract infection caused by mycobacterium tuberculosis. It is spread by inhalation of droplets from someone who has active infectious TB. TB can also be described a latent - if the person is no longer infectious - due to granuloma production by patient to surround the bacteria.
- Persistent cough ( productive / bloody ), weight loss, night sweats, fatigue, appetite loss.
- Recent travel i.e. Pakistan, India, Romania. Younger children ( < 5 yrs ). Close contact with someone with diagnosed active infectious TB. Immunocompromised (i.e. HIV).
- Active - CXR, sputum culture
Latent - tuberculin skin test
Be careful of younger children / immunocompromised patients who might falsely flag as negative. - If treated in time often completely curable. 6 month course of antibiotic / antibiotics ( resistance ). Will still be infectious till around 2 -3 weeks of treatment - so be careful.
14
Q
Name 2 common urinary tract infections.
A
- Pyelonephritis ( UUTI )
- Cystitis ( LUTI )
15
Q
- What is pyelonephritis?
- Which micro - organism causes it ?
- How does it present ?
- What are its risk factors ?
- What tests / exams / investigations can be done ?
- How is it managed ?
A
- Pyelonephritis is infection of one or both kidneys, often bacterial infection tracking up from bladder.
- E - coli ( gram negative bacilli )
- Loin to groin pain, fever , painful / burning urination, cloudy urine, blood In urine.
- kidney stones, BPH, vesicouretral reflux ( secondary to inadequate bladder emptying - blockage / nervous system ), catheter.
- Mid stream urine sample for testing of bacteria, urine dipstick (if positive for nitrates and leukocytes - likely bacterial infection). Dipsticks not done for those over 65, or cathertised patients.
- Admit to hospital if any sins of sepsis ( tachcardyia, hypotension, confusion , impaired consciousness etc). Otherwise treat with appropriate antibiotic course i.e. a quinolone such as ciprofloxacin or trimethoprim or a penicillin agent such as co - amoxiclav.