week 2 minor illnesses

Question 1

what is a lower UTI?
risk factors?
presentation?
investigations?
treatment?

Answer 1

urinary tract infection
is an infection of the bladder (cystitis) often caused by bacteria from the G tract e.g. E. coli

sexual intercourse, female, wiping technique, catheter, urinary incontinence, PMH, fam Hx

Dysuria
Frequency
Urgency
Cloudy/ haematuria
Nocturia
Suprapubic tenderness
May be less typical symptoms in older people - delirium is common

vitals, palpate for backor suprapubic tenderness, urine dip - leukocyte, blood, nitrites, urine culture in pregnant, over 65, catheter, and or recurrent/resistant infection

pain killers
nitrofurintoin or trimethoprim 3 days
second line = Pivmecillinam (penicillin), fosfomycin

Question 2

tonsilitis
what is it?
risk factors?
presentation?
investigations?
treatment?

fever pain score??

Answer 2

inflammation of the tonsils

sore throat, pain when swollowing, fever, headache, malaise, nausea, vom

on examination = tonsillar exudate and enlargement and erythema of the tonsils. There may be anterior cervical lymphadenopathy, fever 38+

fluids, pain relief, gargling salt water, lozengers
phenoxymethylpenicillin
if allergy = clarithromycin
if pregnant + allergy = erythromycin

FeverPAIN criteria are: score 1 point for each (maximum score of 5) - assess need for abx
Fever over 38°C.
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza
3+ = abx

Question 3

epiglottis
what is it?
presentation?
investigations?
treatment?

Answer 3

inflammation of the epiglottis causes by high pitched stridor
haemophilus type B

high fever
sore throat
sitting up and leaning forward
drooling due to difficulty swallowing
dont examine childs throat- dont want to distress

IV antibiotics and secure airway
Hib vaccine is good for preventing

Question 4

sinusitis
what is it?
risk factors?
presentation?
investigations?
treatment?

Answer 4

symptomatic inflammation of paranasal sinuses

Viral upper resp tract infection, followed by bacterial infection - Sinus mucosa oedema + obstruction allow secretions to stagnate and give bacteria a suitable environment in which to grow
Allergic rhinitis
Smoking
Impaired ciliary motility

history of common cold, face pain and tenderness, worse on leaning forward, loss of smell , runny nose, cough
suspect bacterial if it lasts over 10 days + dicoloured discharge, 38+ fever, double sickening

vitals, inspect face, rhinoscopy

if 10 + = high dose nasal corticosteroid and amoxicillin

Question 5

pharyngitis
what is it?

Answer 5

inflammation of the pharynx often presenting as a sore throat commonly caused by a virus

Question 6

glandular fever
what is it?
presentation?
investigations?
treatment?

Answer 6

is an infection most commonly caused by the Epstein-Barr virus (EBV) effecting age 15 -24 , which is a human herpes virus. commonly spread via saliva , incubation period of 4-7 weeks and can cause symptoms for 18 months !!
we carry it in latent form and can be reactivated if immunocompromised

young adult with fever, lymphadenopathy and sore throat

• *A full blood count** for lymphocytosis and atypical lymphocytes.
• *Monospot test** (heterophile antibodies) in immunocompetent adults.
• *EBV serology** test in children younger than 12 years of age and in people who are immunocompromized.

LFT

reassurance as it is self limiting , pain relief, rest, try not to share food or kiss to limit spread, go to school, red flag education

Question 7

pyelonephritis
what is it?
causes?
presentation?
investigations?
treatment?

Answer 7

an infection in the kidney

• Escherichia coli (60-80% of uncomplicated infections).
• Klebsiella species (20%).
• Proteus mirablis (15%).

BPH, pregnant, immunocompromised, DM, renal stones

UTI symptoms, loin pain, fever, nausea and vom

medical history and examination, mid stream urine culture, urine dip

For women who are not pregnant, men, and people with an indwelling catheter –ciprofloxacin or trimethoprim

pregnant = cefalexin

Question 8

uncomplicated Vs complicated UTI?

Answer 8

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.

Question 9

pneumonia
what is it?

typical organisms

atypical organisms?

risk factors?
presentation?
investigations?
treatment?

Answer 9

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

• streptococcus pneumonia;
• haemophilus influenza,
• moraxella catarrhalis
• legionella pneumphila
• chlamydia pneumoniae
• mycoplasma pneumoniae

Smoking, age>65, immuno-suppression, exposure to chemicals, and underlying lung disease

cough, green sputum, sob, fever, muscle ache, headache,

crackles, dullness, lower breath sounds, tachy cardia, tachyponea, temp raised, consolidation on chest X ray, hypoxia, confused

CURB - 65 - confused, urea, RR (30), BP (90/60)

Self care - rest, adequate fluid intake, and the use of simple analgesia such as paracetamol for symptomatic relief

CURB65 0. = amoxicillin, if allergy clarithromycin, if pregnancy erythromycin

CURB65 1-2 = amoxicillin and clarithromycin , if penicillin allergy use doxycycline

CURB65 = 3 is ITU admission

Question 10

bronchitis
what is it?
risk factors?
presentation?
investigations?
treatment?

Answer 10

lower respiratory tract infection which causes inflammation in the bronchial airways. usually viral

smoking, chemicals pollution, childhood chest infections, genetics, GORD

• cough
• sputum, wheeze, breathlessness
• substernal/ chest pain
• normal CXR

suptum sample, chest X ray, CRP

Smoking cessation should be encouraged if relevant, and adequate analgesia and fluid intake advised.

Question 11

influenza
what is it?
risk factors?
presentation?
investigations?
treatment?

Answer 11

contagious viral chest infection - flu , spread mainly by tiny droplets made when people with flu cough, sneeze or talk

elderly, smoking, immunocompromised,

• fever* or feeling feverish/chills
• cough
• sore throat
• runny or stuffy nose
• muscle or body aches
• headaches
• fatigue (tiredness)
• some people may have vomiting and diarrhoea, though this is more common in children than adults.

history + rapid influenza diagnostic test

ostelamivir - tamiflu + flu vaccine prophylaxis

Question 12

Candidiasis
what is it?
risk factors?
presentation?
investigations?
treatment?

Answer 12

symptomatic inflammation of the vagina and/or vulva caused by a superficial fungal infection (usually yeasts that belong to the genus Candida) - usually harmless but can over grow:(

recent antibiotic use, COCP, pregnant, DM, irritants e.g. soaps

vulval or vaginal itch and irritation, a non-offensive vaginal discharge, superficial dyspareunia, and dysuria.

high vaginal swab, history, examination of vagina and rule out STI

Self care - use simple emollient. Avoid irritant soap, avoid tight clothes, avoid douching
Use OTC creams and including probiotics, yoghurt and tea tree

antifungals:
fluconazole oral
clotrimazole - intravaginal pessary

Question 13

GORD
what is it?
risk factors?
presentation?
investigations?
treatment?

Answer 13

Gastro-oesophageal reflux disease (GORD) is a chronic condition where there is reflux of gastric contents back into the oesophagus

obesity, hiatus hernia, alcohol, pregnancy, smoking, alcohol, stress

cough, acid burn, metal taste in mouth, worse after eating, heatburn, esophagitis

history

Self care - weight loss, avoid trigger foods, eat smaller meals, raise head in bed, avoid alcohol, reduce stress

Drug - PPI (omeprazole) or H2 antagonist (ranitidine)

Question 14

anal fissure
what is it?
risk factors?
presentation?
investigations?
treatment?

Answer 14

An anal fissure is a tear or ulcer in the lining of the anal canal which causes pain on defecation. usually on the posterior anal canal

primary cause: low blood flow to anal mucosa, high anal tone

secondary causes: anal trauma via sex, pregnancy, hard stool, ulcer caused by HIV and IBD

sharp pain when passing stool, bleeding red blood, tearing

PR examination

• Hydration, dietary fibre, analgesia
• Warm bath
• Medication to relax the internal anal sphincter e.g. GTN

Question 15

haemorrhoids
what is it?
risk factors?
presentation?
investigations?
treatment?

Answer 15

Haemorrhoids (also known as piles) are abnormally swollen vascular mucosal cushions in the anal canal.

straining during bowel, sitting for long periods on the loo, chronic diarrhoea or constipation, obesity, pregnancy, heavy lifting, anal

• Bright red blood after you poo
• Itchy anus
• Tenesmus
• Lump around anus
• Pain around anus
• Ensure stools are soft and easy to pass fibre and laxatives
• Anal hygiene – perianal cleansing
• Simple analgesia such as paracetamol

Question 16

grading of internal haemorrhoids

Answer 16

Question 17

internal vs external haemorrhoids

Answer 17

internal = arise above the dentate line and are covered by columnar epithelium, which have no pain fibres. Internal haemorrhoids are therefore not sensitive to touch, temperature, or pain (unless they become strangulated).

external = originate below the dentate line and are covered by modified squamous epithelium (anoderm), which is richly innervated with pain fibres. External haemorrhoids can therefore be itchy and painful.

Question 18

abcesses
what is it?
presentation?
investigations?
treatment, small, large?

Answer 18

An abscess is a painful collection of pus, usually caused by a bacterial infection. Abscesses can develop anywhere in the body.

it is caused by an 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

• Swollen
• Pus filled lump under the surface of the skin
• Could have a high temp and chills
• painful

Small skin abscess may drain naturally or simply, dry up and disappear without any treatment

larger abscesses may need to be treated with antibiotics to clear infection and may need to be drained e.g. Flucloxacillin, clarithro if allergy, erythromycin if preg and allergy

Question 19

sprain vs strain?
risk factors?
presentation?
investigations?
treatment?

Answer 19

A sprain is a stretch and/or tear of a ligament

A strain (or ‘pull’) is a stretch and/or tear of muscle fibres and/or tendon

mechanism of action and examination

Refer to ED if concerned about break - Xray
OTC analgesia
PRICE’ (protection, rest, ice, compression, and elevation)
Encourage them to use full ROM and flexibility if not pain
Physio

Question 20

migraine
what is it?
risk factors?
presentation?
treatment?

what is aura?

Answer 20

primary headache disorder

attacks of moderate - severe unilateral pulsing headache with associated photophobia, nausea and vom

triggers include: stress, specific foods, dehydration, missed meals or disturbed sleep

avoid triggers, simple analgesia (NSAID, paracetamol, triptans), An anti-emetic (prochlorperazine or metoclopramide)

preventative medicine - propranolol or topiramate

transient focal neurological symptoms (for example visual symptoms such as zigzag lines and or sensory symptoms such as pins and needles) which will precede or a-company the headache

Question 21

cluster headache
what is it?
risk factors?
presentation?
investigations?
treatment?

Answer 21

cluster - multiple attacks over 2-3 months of severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15 minutes to 3 hours (untreated) + eye nose and ear symptoms from redness to lacrimation or miosis

risk factors/triggers: alcohol, smoking, exposure to volatile substances

Avoid triggers, Sumatriptan injections sc or nasal spray, 100% high flow O2 at home

Question 22

tension headache
what is it?
risk factors?
presentation?
investigations?
treatment?

Answer 22

tension - band like tight headache lasting 30min - 7 days with no nausea + vom

bilateral location; pressing, tightening; mild or moderate intensity

genetics

avoid trigers e.g. stress, sleep issues, neck pain, caffine

Take NSAIDS, CBT and physio, if chronic advice acupuncture and physio. Also amitriptyline

Question 23

GCA
what is it? complications?
risk factors?
presentation?
investigations?
treatment?

Answer 23

chronic vasculitis characterized by granulomatous inflammation in the walls of medium and large arteries, CVD, vision loss and artery problems e.g. aneurysm are complications

50 + new onset of temporal headache, thickening or nodules or tenderness around temple, vision loss, diplopia, scalp tenderness, jaw claudication, systemic features, limb claudication

VISUAL DISTIRBANCE = EMERGENCY

specialist evaluation within 3 working days

40–60 mg oral prednisolone per day

Question 24

trigeminal neuralgia
what is it?
risk factors?
presentation?
investigations?
treatment?

Answer 24

unilateral short lived recurrent severe electric shock sharp pain in the trigeminal nerve dermatome, Provoked by factors such as light touch to the face, eating, talking, or exposure to cold air. may have some autonomic features

women, 40+ years, MS, HTN, stroke, fam hx

examine mouth to rule out dental causes of pain

carbamazepine - when in remission it should be reduced and withdrawn

Question 25

SOL headache
what is it?
presentation?
investigations?
treatment?

Answer 25

headache caused by increase pressure in brain

gradual progressive headache worsened by coughing or leaning down, worse in morning, may have neuological deficits too e.g. seizures, nausea, vom , weight loss

head CT

treat underlying cause e.g. tumor, abscess, haematoma

Question 26

diarrhoea
causes?

Answer 26

Diarrhoea is the passage of three or more loose or liquid stools per day (or more frequently than is normal for the individual).

• Acute diarrhoea is usually caused by a bacterial or viral infection. Other causes include drugs, anxiety, food allergy, and acute appendicitis.
• Causes of chronic diarrhoea include irritable bowel syndrome, diet, inflammatory bowel disease, coeliac disease, and bowel cancer.

us of abx e.g. clindamycin and cephalasporin can cause C. diff

keep hydrated, use loperamide

Question 27

otitis externa
what is it?

what is it caused by?

what is malignant otitis externa?
risk factors?
presentation?
investigations?
treatment?

Answer 27

inflammation of the skin and subdermis of the external ear canal, which may also involve the pinna or tympanic membrane.

acute = Pseudomonas aeruginosa or Staphylococcus aureus

chronic = Aspergillus species or Candida albicans.

life-threatening progressive infection of the external ear canal causing osteomyelitis of the temporal bone and adjacent structures.

swimmers are more at risk

itch, pain, or discharge of the ear canal; hearing loss; tenderness of the tragus and/or pinna; red and oedematous ear canal

OTC acetic acid 2% ear drops or spray., avoid trauma, avoid getting wet analgesia

topical antibiotic or antifungal preparation, with or without corticosteroid, depending on clinical judgement.

oral abx if immunocompromised

Question 28

otitis media
what is it?
causes?
presentation?
investigations?
treatment?

Answer 28

inflammation of the middle ear

mostly viral H.influenzae, Strep pneumoniae

painful, children will hold their ear, cough, runny nose

red/yellow bulging tympanic membrane

pain relief, can resolve by itself wo abx

If an antibiotic is required, a 5–7 day course of amoxicillin is recommended first-line. Clarithromycin or erythromycin are alternatives for people who are allergic to penicillin (erythromycin is preferred in pregnant women).

Question 29

otitis media with effusion
what is it?
risk factors?
presentation?
investigations?
treatment?

Answer 29

• Due to eustachian tube dysfunction
• Fluid and negative pressure in middle ear
  
  • Decreases mobility of TM and ossicles  affecting hearing
  • Also draws fluid from across the mucous membrane in the middle ear
  • can be due to adenoids

common in children due to size and angle of eustachian tube, cleft palate, Down’s syndrome, cystic fibrosis, primary ciliary dyskinesia, and allergic rhinitis, low socioeconomic group, parental smoking, and frequent upper-respiratory infections

hearing loss, learning delay

otoscopic examination, nose and throat examination, Tympanometry, assess audiometry = retracted tympanic membrane with fluid in it

spontaneous resolvement, if not grommets

Question 30

bacterial vaginosis
what is it?
risk factors?
presentation?
investigations?
treatment?

Answer 30

overgrowth of predominantly anaerobic organisms and a loss of lactobacilli. The vagina loses its normal acidity, and its pH increases to greater than 4.5. - BV is the most common cause of abnormal vaginal discharge in women of child-bearing age

• Being sexually active — BV is not a sexually transmitted infection (STI), but being sexually active or having concurrent STIs increases the risk of developing BV.
• The use of douches, deodorant, and vaginal washes; menstruation; and presence of semen in the vagina.
• Copper intrauterine device.
• Smoking.

fishy-smelling vaginal discharge

thin, white, homogeneous discharge coating the walls of the vagina and vestibule on examination, palpate abdomen, test pH of discharge, inspect vuluvla, use speculum, take high vaginal swab

oral metronidazole

Question 31

trichomoniasis
what is it?

complications?
presentation?
investigations?
treatment?

Answer 31

exually transmitted infection (STI) caused by the flagellated protozoan Trichomonas vaginalis. It is the most common non-viral STI worldwide.

Complications include perinatal complications (preterm delivery and/or low birthweight infant), infertility, and enhanced HIV transmission.

• Up to 50% of women with trichomoniasis have no symptoms. When present, common symptoms include vaginal discharge, vulval itching, dysuria, and offensive odour.
• Of men with trichomoniasis, 15–50% are asymptomatic and usually present as sexual partners of infected women. The most common symptoms are urethral discharge and/or dysuria.
• For women, a high vaginal swab (from the posterior fornix) should be sent for laboratory testing.
• For men, a urethral swab and/or urine sample should be sent for laboratory testing.
• The person should be offered tests for other STIs (chlamydia, gonorrhoea, HIV, and syphilis as a minimum)

metronidazole

Question 32

gonorrhoea
what is it?
complications?
presentation?
investigations?
treatment?

Answer 32

sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae.

affects the mucous membranes of the urethra, endocervix, rectum, pharynx, and conjunctiva

• In men, epididymitis, infertility, and prostatitis.
• In women, pelvic inflammatory disease (PID) and complications of pregnancy.
• In men, mucopurulent urethral discharge, dysuria, appearing 2–8 days after exposure, testicular and epididymal pain.
• In women, dysuria, increased or altered vaginal discharge, lower abdominal pain, and/or intermenstrual bleeding.
• Rectal and pharyngeal infections in men and women are usually asymptomatic

vulvovaginal swab in women and first pass urine in men then NAAT

refer to GUM - if susceptibility not known = cefatriaxone,

if know = ciprofloxacin

Question 33

chlamydia
what is it?
presentation?
investigations?
treatment?

Answer 33

the most common sexually transmitted bacterial infection in the UK.

causes inflammation of the urethra in men and inflammation of the cervix and/or urethra in women. It can also affect the conjunctiva, rectum, and nasopharynx.

• In women: post-coital or intermenstrual bleeding, increased or purulent vaginal discharge, mucopurulent cervical discharge, deep dyspareunia, dysuria, pelvic pain and tenderness, an inflamed or friable cervix.
• In men: dysuria, urethral discharge, urethral discomfort, epididymo-orchitis or reactive arthritis
• in women: a vulvo-vaginal swab is the sample of choice.
• In men: a first-void urine sample is the sample of choice. Alternatively a urethral swab can be taken.

GUM referral

doxycycline

if pregnant = azithromycin

Question 34

syphilis
what is it?

what are the stages of it?

if untreated, what are the complications?
risk factors?
presentation?
investigations?
treatment?

Answer 34

infectious disease caused by the spirochete bacterium Treponema pallidum - transmited by direct contact

• Early syphilis (within 2 years of infection) includes 3 stages — primary syphilis, secondary syphilis, and early latent syphilis.
• Late syphilis (more than 2 years after infection) includes 2 stages — late latent syphilis and tertiary syphilis
• Neurosyphilis — neurological involvement can occur at any stage of syphilis infection and affect the meninges, arteries, cranial nerves, eyes, brain and spinal cord.
• Cardiovascular syphilis — aortic aneurysm, aortic regurgitation and heart failure.
• Gummatous syphilis — granulomatous lesions with a necrotic centre most often affecting the skin and bones.
• Adverse outcomes in pregnancy.
• Facilitation of HIV transmission

solitary painless genital lesion, non-pruritic maculopapular rash typically involving the palms and soles, lymphadenopathy, moist wart like lesions

refer to GUM clinic, full STI screen, contact tracing , penicillin

Question 35

gential herpes
what is it?
risk factors?
presentation?
investigations?
treatment?

Answer 35

herpes simplex virus (HSV) 1 or HSV-2, which can cause oral, genital and ocular ulcers. spread via direct contact

new sexual partner, multiple partners, no condoms, under 25, previous sti

4-7 days after contact - bilateral multiple painful blisters, which quickly burst to leave erosions and ulcers, on the external genitalia (as well as on the cervix, rectum, thighs, and buttocks), discharge, dysuria, malaise - will then normally lie latent in a sensory ganglia

STI screens and examination + swab ulcer

aciclovir self care - topical anaesthetic, increasing fluid intake to produce dilute urine

Question 36

complications of otitis media?

Answer 36

sinus thrombosis

matoiditis

meningitis

intracranial abscess

facial nerve paralysis

hearing loss

labrynthitis