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Year 3 GP > Minor Illnesses > Flashcards

Minor Illnesses Flashcards

1
Q

Common pathogen for bronchiolitis, croup, common cold, flu

A

Bronchiolitis- respiratory syncytial virus
Croup - parainfluenza virus
Common cold - rhinovirus
Flu - influenza virus

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2
Q

Presentation of URTI

A 
Cough 
Stridor - croup 
General signs of infection:
- fever 
- wheeze 
- Nasal discharge 
Clear chest examination 
Pharyngitis - sore throat
Otitis media
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3
Q

Croup pathophysiology, presentation and tx

A

Pathophysiology: Upper airway obstruction due to viral infection

Presentation:

  • Seal like barking cough
  • Intercostal recession - respiratory distress
  • Stridor
  • Hoarse voice

Tx:
- Severe croup is treated with dexamethasone and nebulised adrenaline

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4
Q

UTI summary

A

Causes:

  • Wiping back to front
  • Uncontrolled DM

Presentation:

  • Burning sensation when urinating and dysuria
  • polyuria
  • urgency
  • haematuria
  • foul-smelling, cloudy urine
  • fever

Ix

  • mainly clinical
  • urine dipstick
  • urine culture and microscopy
  • USS - rule out obstruction

Mx:

  • Wipe front to back
  • increase fluids
  • Nitrofurantoin/ trimethoprim 3 days for uncomplicated
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5
Q

Uncomplicated UTI

A

Typical pathogens in people with normal anatomy and no predisposing factors

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6
Q

Complicated UTI

A

UTI with increased of risk complications e.g.

  • persistent infection
  • treatment failure
  • recurrent infection.

Risk factors for complicated UTI:

  • urinary catheters
  • virulent or atypical infecting organisms
  • co-morbidities e.g. poorly controlled diabetes mellitus or immunosuppression
  • men
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7
Q

Lower UTI

A

Cystitis - infection of blader

Tx: Nitrofurantoin/ trimethoprim 3 days for uncomplicated and 7 days for men

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8
Q

Upper UTI

A

Pyelonephritis - infection of the kidneys and ureters

Mx:
Mild uncomplicated pyelonephritis - oral ciprofloxacin for 7-10 days
co - amoxiclav alternative

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9
Q

The most common causative pathogen of UTI

A

E. coli

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10
Q

When to refer for 2ww with UTI

A

45 + yo with:

  • Unexplained visible haematuria without UTI
  • Visible haematuria which persists or recurs after successful treatment of UTI

60+ with:
- unexplained non‑visible haematuria and either dysuria or a raised serum WCC

Consider non-urgent referral to exclude bladder cancer in those aged 60+ with recurrent or persistent unexplained UTI.

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11
Q

UTI treatment in men

A

Nitrofurantoin/ trimethoprim for 7 days

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12
Q

Causative organism of pharyngitis

A

Streptococcus pyogenes

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13
Q

Tx of common cold

A

Conservative:

  • fluids
  • paracetamol
  • rest
  • salty gargle
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14
Q

Causes of chest infection

A

Infection that affects lower large airways (bronchi) and lungs.

Pneumonia - bacterial
Bronchitis - viral

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15
Q

Chest infection presentation

A
  • Chesty cough - productive
  • Dyspnoea and wheeze
  • Chest pain or tightness
  • Fever
  • Headache
  • Myalgia
  • Malaise
  • Tachycardia
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16
Q

Chest infection tx:

A

Mild (bronchitis)- Self limiting usually gets better on its own within 7-10 days

  • Rest
  • Fluids
  • Paracetamol

Severe (pneumonia) based on CRB 65:
- 0 - treatment at home - amoxicillin 500 mg tds for 5 days
(allergic - doxycycline 200 mg)
- 1 - 2 - hospital assessment - amoxicillin 500 mg tds for 5 days AND clarithromycin 500 mg bds for 5 days
- 3 - urgent hospital admission

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17
Q

Pneumonia abx treatment mile stones

A

1 week — fever should have resolved.
4 weeks — chest pain and sputum production should have substantially reduced.
6 weeks — cough and breathlessness should have substantially reduced.
3 months — most symptoms should have resolved but fatigue might still be present.
6 months — symptoms should have fully resolved.

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18
Q

Thrush summary

A

Causative organism: Candida albicans

RF:

  • pregnant
  • diabetes.
  • abx
  • immunocompromised

Presentation:
Vaginal - white discharge, dysuria and pruritis, superficial dyspareunia
Oral - white plaques in mouth

Ix:

  • Urine pH
  • Swab
  • Urine dipstick

Tx:
- miconazole cream - 7 days
- 60+ - fluconazole tablets
12 - 15 yo girls - clotrimazole 1% cream

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19
Q

Bacterial vaginosis summary

A

Causative organism: Gardnerella vaginalis

RF:

  • abx use
  • extreme washing
  • copper IUD

Presentation:
- Fishy smelling discharge

Tx:
- Metronidazole 5-7 days

20
Q

Osmotic diarrhoea

A

Soluble compound that cannot be absorbed therefore water in diffused into lumen by osmosis

21
Q

Secretory diarrhoea

A

Increased secretion of fluid and electrolytes due to toxins released by e.g. E. coli or C. difficile

22
Q

Common causes of diarrhoea

A

Viruses:

  • Norovirus (winter virus) - causing gastroenteritis
  • Rotavirus - young children
  • Cytomegalovirus
Bacterial: 
- C. difficile
Blood diarrhoea:
-  E. coli 
- Shigella 
- Campylobacter -  poultry
- Salmonella 
Parasitic 
- cryptosporidium 
- giardia duodenalis
- schistosomiasis 
- entamoeba histolytica 
Others: 
- Food allergy 
- Coeliacs 
- IBD
- Acute appendicitis
23
Q

Red flags for diarrhoea

A

Blood in stool
Weight loss
Dehydration

24
Q

Diarrhoea hx

A 
Anyone else symptomatic? 
THx 
What have they eaten recently?
Fever 
Vomiting 
Frequency 
Job
25
Q

RF for entamoeba histolytica

A

young, pregnant, corticosteroids, malnutrition and alcoholism

26
Q

RF for Giardia duodenalis

A

Children, travellers, immunocompromised

27
Q

Abscess summary

A

Causative organisms: Staphylococcus aureus or Streptococcus pyogenes

Presentation:

  • swollen pus filled, smooth lumo under skin
  • systemic symptoms such as fever
  • localised pain and tenderness

Mx:

  • large abscesses are surgically drained
  • Small abscesses may drain naturally
  • abx - flucloxacillin
28
Q

Bartholin’s cyst

A

Accumulation of pus inside bartholin’s gland on each side of the vaginal opening

29
Q

Quinsy

A

Peritonsillar abscess
- complication of tonsilitis

Causative organism: Streptococcus pyogenes

Presentation:

  • Severe throat pain which may become unilateral
  • Fever
  • Drooling of saliva
  • Foul-smelling breath
  • Dysphagia
  • Trismus (difficulty opening the mouth)
  • Hot potato voice due to pharyngeal oedema and trismus.
  • Earache on the affected side.
  • Neck stiffness
  • Headache and general malaise.

Mx:

  • Fluids
  • Analgesia
  • IV Penicillin
  • Needle aspiration, incision and drainage and quinsy tonsillectomy
30
Q

GORD summary

A

Causes:

  • Smoking and alcohol
  • Obesity
  • coffee.
  • Pregnancy
  • Big meals
  • Hiatus hernia.
  • Drugs- tricyclic antidepressants, anticholinergics, nitrates and calcium-channel blockers

Presentation:

  • Heartburn
  • regurgitation
  • acidic taste in mouth
Mx: 
Conservative: 
- Weight loss 
- Smoking and alcohol cessation 
- Don't eat big, spicy meals at night

Pharmacological:
- PPI - omeprazole - 1 month

31
Q

Constipation mx in adults

A
  1. bulk-forming laxative e.g. ispaghula husk
    • osmotic agent e.g. macrogol
  3. Lactulose
  4. If tenesmus - add stimulant laxative e.g docussate sodium
32
Q

opioid-induced constipation

A

Macrogol

33
Q

Anal fissure summary

A

Pathophysiology: Small tear in skin of anus which can be caused by passing large faeces

Presentation:

  • Pain when passing
  • Fresh blood
  • Pain when getting up
  • Anal pruritis
Mx: 
Conservative:
- Warm baths 
- Not holding urge in 
-  Fluid 
- Fibre 
- Activity

Pharmacological:

  • paracetamol
  • laxative - ispaghula
  • topical anaesthetic (lidocaine 5% ointment)
  • consider prescribing rectal glyceryl trinitrate (GTN) 0.4% ointment - more than 1 week of symptoms
34
Q

Haemorrhoids summary

A

Pathophysiology: Swollen blood vessels that are internal or external

Cause: straining due to:

  • pregnancy
  • weight lifting
  • constipation

Presentation:

  • rectal bleeding
  • pain when passing
  • Grade 2 - 4 - feel lump
  • Mucous in stool
  • anal pruritus
  • tenesmus
  • pain when getting up
Tx: 
Conservative: 
- fibre 
- fluids
- activity

Pharmacological:

  • Laxative
  • paracetamol
  • Anusol - corticosteroid cream

Surgical:

  • Banding (non-surgical)
  • Haemorrhoidectomy
  • Stapled haemorrhoidopexy
  • Haemorrhoidal artery ligation
35
Q

Types of headaches

A 
Tension
Cluster
Migraine
Medication overuse 
Sinus 
Giant cell arteritis
36
Q

Primary headache

A

Normally recurrent
Due to headache condition
Non life threatening

37
Q

Secondary headaches

A

Due to another condition
Acute
Severe pain
More likely to be life or sight threatening

38
Q

Tension headache summary

A

Sight: generalised frontal and occipital

Quality: tight band like pain +/- radiating into the neck

Intensity: mild or moderate

Time: worst at the end of the day, lasting for about 1 hour and recurrent

Aggravating factors: stress, poor posture, lack of sleep

Relief: analgesics

Secondary symptoms: slight nausea

39
Q

Migraine summary

A

Sight: unilateral frontal or temporal

Quality: throbbing or pulsating

Intensity: moderate- severe, go to bed or avoid light

Time: prolonged headache

Aggravating factors: stress, certain food, lack of sleep, menstrual cycle, FHx

Relief: analgesics and triptans

Secondary symptoms: nausea and vomiting, aura, sensory deficit, neurological symptoms

40
Q

Medication over use headache

A

Affects females more
Headache occurs for 15 + days per month
Occurs in patients with pre- existing headache disorders due to overuse of regular analgesics e.g. cocodamol for at least 10 days per month
Headache does not respond to medication or another type of headache
occurs
Co-exists with depression and sleep disturbances

41
Q

Advice for medication over use headache

A

Shouldn’t take analgesics for more than 2 days per week
Discontinue medication if headaches become worse - headache will worsen before improves but normally resolved completely by 2 months

42
Q

Cluster headache summary

A

Sight: unilateral around or behind the eye

Quality: sharp, stabbing and penetrative pain

Intensity: severe suicidal

Time: 15 mins - 3 hours, occurs in clusters with periods of remission

Aggregating factors: alcohol, smoking, warm temperature, volatile smells, lack of sleep

Relief: oxygen and triptans

Secondary symptoms: ipsilateral autonomic symptoms e.g. tears, red conjunctiva, ptosis, nasal congestion

Clinical exam: autonomic features

43
Q

Temporal arteritis summary

A

Common in: females 50 +

Pathophysiology: Vasculitis involving small or medium sized arteries of the head most commonly the superficial temporal artery

Presentation:

  • Pain and tendernessnear temples
  • jaw claudication
  • visual disturbances
  • fever
  • sometimes associated with polymyalgia rheumatic

Complication: Blindness due to optic nerve ischemia

Ix:
Bloods - CRP, ESR, biopsy

Tx: Prednisone and aspirin 75mg

44
Q

Trigeminal neuralgia summary

A

Sight: unilateral felt in commonly Va distribution

Quality: sharp, shooting pain like stabbing electric shock

Intensity: severe

Time: 2 secs - 2mins sudden onset

Aggregating factors: light touch to face/ scalp, eating, cold wind, combing hair

Relief: difficult to treat

Secondary symptoms: preceding symptoms = numbness or tingling

45
Q

Sinusitis time frame

A

acute - 4-30 days
subacute - 4-12 weeks
Chronic - 12 + weeks

46
Q

Sinusitis summary

A

Pathophysiology: acute sinusitis develops after a cold, causing inflammation of the sinuses

Risks:

  • allergic rhinitis
  • polyps
  • asthma
  • smoking

Presentation:

  • Pain and tenderness over the infected sinus
  • Throbbing, worse when bending forwards
  • Chewing may be painful.
  • Blocked nose
  • Yellow or green nose discharge
  • Fever

Tx:

  • Self limiting 2 - 3 weeks
  • inhale steam
  • nasal decongestants
  • paracetamol
  • avoid triggers

If 10 + days - high-dose nasal corticosteroid for 14 days for adults- mometasone/ fluticasone

Year 3 GP (20 decks)

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