Week 5 Flashcards
What is an anal fissure? What are the classifications?
Anal fissures are longitudinal tears of the squamous lining of the distal anal canal.
Acute <6 weeks
Chronic >6weeks
What are the risk factors for anal fissures?
- constipation
- Inflammatory bowel disease
- STIs e.g. HIV, syphilis, herpes
What are the features of anal fissures?
Painful, bright red, rectal bleeding
Around 90% of anal fissures occur on the posterior midline.
What is the management of acute anal fissures?
Management of an acute anal fissure:
Soften stool
- dietary advice: high-fibre diet with high fluid intake
- bulk-forming laxatives are first-line - if not tolerated then lactulose should be tried
Lubricants such as petroleum jelly may be tried before defecation
Topical anaesthetics
Analgesia
What is the management of chronic anal fissures?
The management done in acute anal fissures should be continued
Topical glyceryl trinitrate (GTN) is first-line treatment for a chronic anal fissure
If topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin
What is acute bronchitis?
Acute bronchitis is a type of chest infection which is usually self-limiting in nature. It is a result of inflammation of the trachea and major bronchi and is therefore associated with oedematous large airways and the production of sputum.
What is the presentation of acute bronchitis? Include examination findings
Patients typically present with an acute onset of:
cough: may or may not be productive
sore throat
rhinorrhoea
wheeze
The majority of patients with have a normal chest examination, however, some patients may present with:
Low-grade fever
Wheeze
What investigations are done in acute bronchitis?
Investigations
acute bronchitis is typically a clinical diagnosis
however, if CRP testing is available this may be used to guide whether antibiotic therapy is indicated
What is the management of acute bronchitis?
Analgesia
Good fluid intake
Consider antibiotic therapy if patients:
are systemically very unwell
have pre-existing co-morbidities
have a CRP of 20-100mg/L (offer delayed prescription) or a CRP >100mg/L (offer antibiotics immediately)
The BNF currently recommends doxycycline first-line
doxycycline cannot be used in children or pregnant women
alternatives include amoxicillin
How would you differentiate acute bronchitis with pneumonia?
History: Sputum, wheeze, breathlessness may be absent in acute bronchitis whereas at least one tends to be present in pneumonia.
Examination: No other focal chest signs in acute bronchitis other than wheeze. Moreover, systemic features (malaise, myalgia, and fever) may be absent in acute bronchitis, whereas they tend to be present in pneumonia.
What is the treatment of oral candidiasis?
1st line is miconazole oral gel
2nd line is fluconazole oral tablet
What is the management of vaginal candidiasis?
Fluconazole 150mg single dose 1st line
If pregnant then only local treatments (e.g. cream or pessaries) as oral treatment is contraindicated
What antibiotic is used to treat chlamydia?
Doxycycline
What is the antibiotic used to treat gonorrhoea 1st line?
IM Ceftriaxone 1g
If needle phobic and refuses - oral definite + azithromycin both single dose
