Week 2: Minor illness 2/3 Flashcards
UTI
A lower urinary tract infection (UTI) is an infection of the bladder (also known as cystitis) usually caused by bacteria from the gastrointestinal tract.
uncomplicated UTI
UTI caused by typical pathogens in people with a normal urinary tract and kidney function, and no predisposing co-morbidities.
complicated UTI
UTI with an increased likelihood of complications such as persistent infection, treatment failure and recurrent infection.
Risk factors for complicated UTI include
- structural or neurological abnormalities of the urinary tract,
- urinary catheters,
- virulent or atypical infecting organisms and co-morbidities such as poorly controlled diabetes mellitus or immunosuppression.
Pyelonephritis should be suspected in people with
fever, loin pain or rigors
causes of UTI
Most common pathogen is E.coli less commonly Staphylococcus saprophyticus and klebsiella species
RF for UTI
- Sexual intercourse
- PMH of UTI in childhood
- Family history
- Urinary incontinence
- Catheterisation
Presentation UTI
- Dysuria
- Frequency
- Urgency
- Cloudy/ haematuria
- Nocturia
- Suprapubic tenderness
- May be less typical symptoms in older people
diagnosis of UTI
- Urine dipstick: nitrite or leukocyte and RBC positive
- Urine culture should be taken in women who are: pregnant, >65yo, symptoms which don’t resolve with antibiotics
management of UTI
- Self care measures e.g. fluids, pain killers
- First line: Nitrofurantoin or trimethoprim for 3 days
- Second line: penicillin or fosfomycin
thrust
Vulvovaginal candidiasis (genital thrush) is a symptomatic inflammation of the vagina and/or vulva caused by a superficial fungal infection (usually yeasts that belong to the genus Candida)
- Candida yeasts are part of the normal flora of the mucous membranes of the female genital tract, but overgrowth can cause infection
Risk factors for thrush
- Recent antibiotic use
- Local irritants such as soaps/ douching
- Uncontrolled DM
- Immunosuppression e.g. HIV
presentation of thrush
- Vulval or vaginal itching
- Vaginal discharge ‘cheese-like’
- Superficial dyspareunia
- Dysuria
diagnosis of thrush
- Self-collected low vulvovaginal swab if exam of the eternal genitals is not possible or needed
- Consider STI screening
Bacterial vaginosis
Is characterized by an overgrowth of predominantly anaerobic organisms (such as Gardnerella vaginalis) and a loss of lactobacilli.
- BV is not generally regarded as a sexually transmitted infection; however, the prevalence is higher amongst sexually active women (than non-sexually active women), and it is considered by some experts to be ‘sexually associated’.
pH in women with BV
The vagina loses its normal acidity, and vaginal pH increases to greater than 4.5.
RF for BV
- Being sexually active
- Recent change in sexual partners
- Douching and vaginal washes
- Menstruation
- Semen in vagina
diagnosis fo BV
- Speculum exam- white/grey coating on vaginal walls and vulva with fishy odour
- Test pH of vaginal discharge
- High vaginal swab for gram staining
management of BV
oral metronidazole
history of discharge in women (questions to ask)
need to determine if physiological discharge or more likely to be infective
- Characteristics of the discharge (onset, duration, colour, odour, consistency, and associated symptoms)
- Exacerbating factors - such as sexual intercourse
- Relieving factors - prescription or over the counter
- The use of vaginal products such as douches, deodorants and vaginal washes.
- Cyclical symptoms, PMH, DH incl contraceptive use.
- Assess the woman’s risk of STI (sexual partner history, younger than 25 years or age, previous STI)
physiological discharge character
- white or clear
- non offensive discharge
- that can vary over time.
For example, it is thick and sticky for most of the menstrual cycle but becomes clearer, wetter and stretchy for a short period of time around ovulation. It is heavier and more noticeable during pregnancy, with contraceptive use, and with sexual stimulation.
vaginal candidiasis discharge
White, odourless, curdy discharge that may be associated with vulval itching and superficial soreness.
PH would be lower than 4.5
BV discharge
Fishy smelling, thin, grey/white homogenous discharge that is not associated with itching or soreness.
Ph would be higher than 4.5
trichomoniasis discharge
This is an STI caused by parasites. Fishy smelling, yellow/green frothy discharge that may be associated with itching, soreness, dysuria. Men who have this typically have no symptoms.
PH would be higher than 4.5
PID discharge
Characterised by vaginal discharge associated with post coital or intermenstrual bleeding, dysuria, deep dyspareunia or lower abdominal pain.
Examination and investigations for abnormal vaginal discharge
- Consider referring women at high risk of STI, or with characteristic features of trichomoniasis, cervicitis or PID to a GUM clinic or other local specialist sexual health service to facilitate screening for infections and partner notification.
- Palpate the abdomen to assess for tenderness or a mass.
- Inspect the vulva - for lesions, discharge, vulvitis, ulcers and any other changes.
- Test the pH of the vaginal discharge to help distinguish between BV, vaginal candidiasis and trichomoniasis.
- Take a vaginal swab for gram staining
most common chest infections
bronchitis and pneumonia
Pneumonia
is an infection of the lung tissue in which the air sacs in the lungs become filled with microorganisms, fluid and inflammatory cells, affecting the function of the lungs
causes of pneumonia: community acquired
- streptococcus pneumonia;
- haemophilus influenza,
- moraxella catarrhalis
causes of pneumonia: atypical organisms
- legionella pneumphila
- chlamydia pneumoniae
- mycoplasma pneumoniae
causes of pneumonia: hospital acquired
E.coli
RF for pneumonia
- Smoking, age>65, immuno-suppression, exposure to chemicals, and underlying lung disease
presentation of pneumonia
- Cough
- SoB
- Green sputum
- Sweating
- Fever
- Shivers
- Aches
- Pain
- Moderately to severely ill
- Decreased breath sounds
- Dullness to percussion
- Vocal fremitus
- Tachypnoea, tachycardia, dyspnoea
- Temp above 38
- Hypoxia
- Confusion
- Abnormal chest x-ray
what is used to classify pneumonia
CURB-65
Pneumonia investigations
- Key is prompt assessment and CXR on admission
- Consolidation on CXR (cant determine infection but can give clues)
- CURB 65 score useful to guide management and stratify risk
- Use local antibiotic prescriving guidelines
- ABCDE approach – do not ignore signs of sepsis
- No delay
- ITU referral if high CURB -65 score
- Blood tests: FBC, U&E and CRP
- Sputum sample
- ABG if sats low
management of pneumonia
amoxicillin (see other notes for 2nd/3rd line therapy)
Bronchitis
Is defined as a lower respiratory tract infection which causes inflammation in the bronchial airways
- It is a clinical diagnosis characterized by cough resulting from acute inflammation of the trachea and large airways but with no evidence of pneumonia
causes of bronchitis
- Viral infections e.g. rhinovirus, enterovirus, influenza A and B, coronavirus
RF for bronchitis
- smoking; females who smoke may be at more risk than males who smoke.
- childhood respiratory disease.
- family history of lung disease.
- exposure to pollutants.
- asthma.
- allergies.
- gastroesophageal reflux disease (GERD)
those who are older
presentation of bronchitis
- cough
- sputum, wheeze, breathlessness
- substernal/ chest pain
- normal CXR
investigations for bronchitis
- CXR
- Sputum sample
management of bronchitis
first choice- doxycycline,
second choice amoxicillin
Abscesses
An abscess is a painful collection of pus, usually caused by a bacterial infection. Abscesses can develop anywhere in the body.
- Skin abscesses- develop under the skin
- Internal abscesses- develop inside the body, in an organ or in spaces between organs
causes of abscesses
- Immune response to bacterial infection- WBC attack bacteria, some nearby tissue dies, creating hole which fills with pus to form abscess. Pus contains a mixture of dead tissue, WBC and bacteria
- Internal abscesses usually develop as a complication of an existing condition e.g. infection elsewhere in the body e.g. burst appendix
presentation of skin abscess
- Swollen
- Pus filled lump under the surface of the skin
- Could have a high temp and chills
presentation of internal abscess
- Pain in affected area
- High temp
- Generally feeling unwell
treatmetn of small skin abscess
- Small skin abscess may drain naturally or simply, dry up and disappear without any treatment
treatment of larger skin abscesses
larger abscesses may need to be treated with antibiotics to clear infection and may need to be drained e.g. clindamycin
treatment of internal abscesses
surgery
