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GP block (Y3) > Week 2: Minor illness 2/3 > Flashcards

Week 2: Minor illness 2/3 Flashcards

1
Q

UTI

A

A lower urinary tract infection (UTI) is an infection of the bladder (also known as cystitis) usually caused by bacteria from the gastrointestinal tract.

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2
Q

uncomplicated UTI

A

UTI caused by typical pathogens in people with a normal urinary tract and kidney function, and no predisposing co-morbidities.

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3
Q

complicated UTI

A

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.
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4
Q

Pyelonephritis should be suspected in people with

A

fever, loin pain or rigors

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5
Q

causes of UTI

A

Most common pathogen is E.coli less commonly Staphylococcus saprophyticus and klebsiella species

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6
Q

RF for UTI

A
  • Sexual intercourse
  • PMH of UTI in childhood
  • Family history
  • Urinary incontinence
  • Catheterisation
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7
Q

Presentation UTI

A
  • Dysuria
  • Frequency
  • Urgency
  • Cloudy/ haematuria
  • Nocturia
  • Suprapubic tenderness
  • May be less typical symptoms in older people
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8
Q

diagnosis of UTI

A
  • 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
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9
Q

management of UTI

A
  • Self care measures e.g. fluids, pain killers
  • First line: Nitrofurantoin or trimethoprim for 3 days
  • Second line: penicillin or fosfomycin
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10
Q

thrust

A

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
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11
Q

Risk factors for thrush

A
  • Recent antibiotic use
  • Local irritants such as soaps/ douching
  • Uncontrolled DM
  • Immunosuppression e.g. HIV
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12
Q

presentation of thrush

A
  • Vulval or vaginal itching
  • Vaginal discharge ‘cheese-like’
  • Superficial dyspareunia
  • Dysuria
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13
Q

diagnosis of thrush

A
  • Self-collected low vulvovaginal swab if exam of the eternal genitals is not possible or needed
  • Consider STI screening
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14
Q

Bacterial vaginosis

A

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’.
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15
Q

pH in women with BV

A

The vagina loses its normal acidity, and vaginal pH increases to greater than 4.5.

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16
Q

RF for BV

A
  • Being sexually active
  • Recent change in sexual partners
  • Douching and vaginal washes
  • Menstruation
  • Semen in vagina
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17
Q

diagnosis fo BV

A
  • Speculum exam- white/grey coating on vaginal walls and vulva with fishy odour
  • Test pH of vaginal discharge
  • High vaginal swab for gram staining
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18
Q

management of BV

A

oral metronidazole

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19
Q

history of discharge in women (questions to ask)

A

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)
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20
Q

physiological discharge character

A
  • 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.

21
Q

vaginal candidiasis discharge

A

White, odourless, curdy discharge that may be associated with vulval itching and superficial soreness.

PH would be lower than 4.5

22
Q

BV discharge

A

Fishy smelling, thin, grey/white homogenous discharge that is not associated with itching or soreness.

Ph would be higher than 4.5

23
Q

trichomoniasis discharge

A

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

24
Q

PID discharge

A

Characterised by vaginal discharge associated with post coital or intermenstrual bleeding, dysuria, deep dyspareunia or lower abdominal pain.

25
Q

Examination and investigations for abnormal vaginal discharge

A
  1. 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.
  2. Palpate the abdomen to assess for tenderness or a mass.
  3. Inspect the vulva - for lesions, discharge, vulvitis, ulcers and any other changes.
  4. Test the pH of the vaginal discharge to help distinguish between BV, vaginal candidiasis and trichomoniasis.
  5. Take a vaginal swab for gram staining
26
Q

most common chest infections

A

bronchitis and pneumonia

27
Q

Pneumonia

A

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

28
Q

causes of pneumonia: community acquired

A
  • streptococcus pneumonia;
  • haemophilus influenza,
  • moraxella catarrhalis
29
Q

causes of pneumonia: atypical organisms

A
  • legionella pneumphila
  • chlamydia pneumoniae
  • mycoplasma pneumoniae
30
Q

causes of pneumonia: hospital acquired

A

E.coli

31
Q

RF for pneumonia

A
  • Smoking, age>65, immuno-suppression, exposure to chemicals, and underlying lung disease
32
Q

presentation of pneumonia

A
  • 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
33
Q

what is used to classify pneumonia

A

CURB-65

34
Q

Pneumonia investigations

A
  • 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
35
Q

management of pneumonia

A

amoxicillin (see other notes for 2nd/3rd line therapy)

36
Q

Bronchitis

A

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
37
Q

causes of bronchitis

A
  • Viral infections e.g. rhinovirus, enterovirus, influenza A and B, coronavirus
38
Q

RF for bronchitis

A
  • 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

39
Q

presentation of bronchitis

A
  • cough
  • sputum, wheeze, breathlessness
  • substernal/ chest pain
  • normal CXR
40
Q

investigations for bronchitis

A
  • CXR
  • Sputum sample
41
Q

management of bronchitis

A

first choice- doxycycline,

second choice amoxicillin

42
Q

Abscesses

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

A
  • Skin abscesses- develop under the skin
  • Internal abscesses- develop inside the body, in an organ or in spaces between organs
43
Q

causes of abscesses

A
  • 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
44
Q

presentation of skin abscess

A
  • Swollen
  • Pus filled lump under the surface of the skin
  • Could have a high temp and chills
45
Q

presentation of internal abscess

A
  • Pain in affected area
  • High temp
  • Generally feeling unwell
46
Q

treatmetn of small skin abscess

A
  • Small skin abscess may drain naturally or simply, dry up and disappear without any treatment
47
Q

treatment of larger skin abscesses

A

larger abscesses may need to be treated with antibiotics to clear infection and may need to be drained e.g. clindamycin

48
Q

treatment of internal abscesses

A

surgery

GP block (Y3) (39 decks)

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