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CFB > WCS14 Introduction To Common Problems: Differentiating The Normal From The Abnormal > Flashcards

WCS14 Introduction To Common Problems: Differentiating The Normal From The Abnormal Flashcards

1
Q

What is a disease

A

Departure from normal

Statistically:
- >2 SD from mean
- increased risk of morbidity / mortality

Socio-culturally:
- not culturally desirable

Individual perception:
- I don’t feel well

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2
Q

Recognising common problems

A
  1. Common things are common
    - URTI
    - DM
    - HT
    - GE
  2. Far more likely to encounter **uncommon presentations of common problems than **common presentations of uncommon problems
    - itchy feet in DM > Kayser-Fleischer rings in Wilson’s disease
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3
Q

Systematic in problem solving

A
  1. Probability diagnosis
  2. Red flags
  3. Often missed
  4. Masquerades
  5. Trying to tell me something else (hidden agenda / psychosocial problems)
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4
Q

Most common problems presenting in primary care

A
  1. URTI
  2. Hypertension
  3. DM
  4. GE
  5. Lipid disorder
  6. Dermatitis
  7. Acute bronchitis
  8. Immunisation / check-up
  9. Allergic rhinitis
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5
Q

Top 30 presenting symptoms in primary care

A
  1. Fatigue
  2. Low back pain
  3. Skin complaints
    - Atopic eczema
    - Asteatotic eczema
    - Stasis eczema
    - Discoid eczema
    - Lichen simplex chronicus
    - Contact dermatitis
    - Fungal infections
    - Skin growths
  4. Acute abdominal pain
  5. Headache
    - Sinus headache
    - Cluster headache
    - Migraine
    - Tension headache
    - Brain tumour
  6. Dizziness
  7. Chest pain
  8. Vaginal complaints
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6
Q
  1. Fatigue
A
  • Chronic fatigue is ***abnormal
  • fatigue from ***organic disease (15%) vs anxiety / depression
  • infectious, anaemia, endocrine, sleep disturbances, meds, malignancy
  • chronic fatigue syndrome (a specific clinical diagnosis)

Common diagnoses:
1. <45
- fatigue Not Yet Diagnosed (NYD) (45.8%)
- viral illness
- depression / anxiety / stress
- anaemia / sinusitis / mono

  1. > 45
    - fatigue Not Yet Diagnosed (NYD) (45.8%)
    - viral illness
    - depression / anxiety / stress
    - anaemia / CHF / medication / DM / COPD / IHD
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7
Q
  1. Low back pain
A

Common:
- Mechanical back pain

Red flags:
- **Neoplasm
- **Infections
- ***Cauda equina syndrome

Others:
- Visceral causes
- Inflammatory causes

Investigations:
- X-ray

> 45:
- Mechanical
- Sciatica
- Muscle strain
- Degenerative Disc Disease (DDD)

> 45:
- Mechanical
- DDD
- Sciatica
- Muscle strain

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8
Q
  1. Skin complaints
A
  • Itchy rash
  • Growth on skin
  • Mole

Top diagnoses:
1. Eczema
2. Seborrhoeic keratosis
3. Warts (exclude genital)
4. Tinea
5. Psoriasis

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9
Q

Atopic eczema

A

Symptoms:
- Characteristic morphology + distribution
- Prominent pruritis
- Chronic + Relapsing course
- Personal / Family history of atopy
- Dryness
- Hyperlinearity of palms
- Keratosis pilaris
- ***Raised IgE
- Early onset
- Tendency to cutaneous infection
- Cheilitis (Lip inflammation)
- Pityriasis alba

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10
Q

Asteatotic eczema / Dry skin dermatitis

A
  • Common in elderly
  • Dry season / Central heating
  • Limbs esp. legs
  • Dry, slightly scaly + criss-crossed
  • Itchy
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11
Q

Stasis eczema

A
  • over ***ankles
  • associated with ***Varicose veins

Etiology:
- Venous insufficiency
- Minor trauma e.g. scratching
- Allergy / Irritation by topical medications

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12
Q

Discoid (nummular) eczema

A
  • Circumscribed / Oval plaques of eczema
  • Common at extremities but can be generalised
  • Once established, individual lesions tend to remain in same area for ***long time
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13
Q

Lichen simplex chronicus (circumscribed neurodermatitis)

A
  • Thickened appearance of skin with accentuation of surface markings
  • Circumscribed
  • Resulted from ***repeated scratching / rubbing
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14
Q

Fungal infections

A

Dermatophytes (Tinea) / Yeasts (Candida)
- commensal, thrive in warm, moist environments
- contagious
- secondary bacterial infection

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15
Q

Skin growths

A

Benign skin growths
1. Warts
2. Moles
3. Corns

Malignant skin cancer
1. Malignant melanoma (ABCDE)
- Asymmetry: Irregular shape
- **Border: Ragged outline
- Colour: Variation
- Diameter: >6mm across / recent increase in size
- **Elevation: Raised above surface of skin
- Evolution: changes in size, colour, shape over time

  1. Basal cell carcinoma (BCC): **Raised pink borders, **Telangiectasia, ***Central ulceration
  2. Squamous cell carcinoma (SCC)
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16
Q
  1. Acute abdominal pain
A

Most likely: Viral GE

Red flags:
- Acute abdomen / Peritoneal signs (rigidity, guarding, absence of bowel sound)

Diagnosis:
- Does patient look toxic / seriously unwell? —> determine whether need hospitalisation
- Abdominal examination including muscle —> determine muscular / visceral nature
- Rectal exam if unsure —> look for blood
- Testes, Pregnancy test —> referred pain
- Other serious disease —> new onset of pain, change in bowel habit, weight loss, Virchow nodes (Troisier’s sign)
- Follow up next day if in doubt

17
Q
  1. Headache
A
  1. Sinus headache
    - ***recover from cold
  2. Cluster headache
    - **recurrent severe headaches on one side of the head
    - typically around the **    eye
  3. Migraine
    - female
    - usually ***long history (since little)
  4. Tension headache
  5. Brain tumour

Red flags:
- **worst headache (Subarachnoid haemorrhage)
- **visual loss / neurological deficits (Stroke)
- **new onset in elderly (Metastasis)
- **positional / worsening with valsalva (Brain tumour)
- **morning headache (Brain tumour)
- **headache in pregnancy (Pre-eclampsia)
- ***trauma / coagulation (Risk of bleeding e.g. Subdural haematoma)
- history of carcinoma (Metastasis)

Diagnosis:
- ask about drugs
- explore patient’s fears
- functional / psychiatric causes

Most common diagnoses:
<45:
- Headache NYD
- Sinusitis
- Tension
- Migraine
- Cervical disease

> 45:
- Headache NYD
- Cervical disease
- Tension
- Sinusitis

18
Q
  1. Dizziness
A
  • Light headed vs Spinning (Vertigo) vs Tiredness
  • Vertigo: Central (milder symptoms but more serious) vs Peripheral (profound symptoms)
  • Red flags: **Nystagmus, **Ataxia, ***Focal neurological signs
  • Most common diagnosis of true vertigo: Vertigo NYD
  • Acute vertigo:
    —> Viral labyrinthitis (inner ear infection)
    —> Benign paroxysmal positional vertigo (BPPV)
    —> Eustachian tube dysfunction
    —> Ménière’s disease (Vertigo + Tinnitus + Decreased hearing)
19
Q
  1. Chest pain
A

History is key:
- Risk factors
- Precipitating factor (Exertional?)
- Duration
- Location
- Pattern
- Effect of TNG
- **Levine’s sign: Clenched fist held over chest when asked to describe the pain —> Coronary artery disease
- **Normal resting ECG does not rule out ischaemia

Most common diagnoses:
<45:
- Anxiety
- IHD
- Chest pain NYD

> 45:
- IHD
- Anxiety
- Chest pain NYD
- CHF

20
Q
  1. Vaginal complaints
A

Presenting symptoms:
- **Itching (abnormal)
- **Odour
- Pain
- Discharge
- Bleeding (e.g. post coital)

Common diagnoses:
1. ***Atrophic vulvitis

  1. Infective
    - **Bacterial vaginosis
    - **    Thrush
    - ***Gonorrhoea
  2. ***Physiologic
  3. Retained products
  4. ***Cervical ectropion (variation of normal: glandular cells / columnar epithelium present on the ‘outside’ of the vaginal portion of the cervix)
  5. Cervical polyp
  6. Neoplasm
  7. Allergy

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