GP stuff Flashcards
(29 cards)
what is chronic fatigue syndrome
diagnosis of exclusion for persistent fatigue at least 3 month duration after a “tiredness screen” comes back negative
what does a tiredness screen include
FBC, ESR/CRP; U&E, Cr, and eGFR; LFTs and Ca2+, TFTs;
random blood glucose;
coeliac screen
CK and ferritin.
other possible symptoms with chronic fatigue syndorme
sleep problems, such as insomnia, hypersomnia, unrefreshing sleep, a disturbed sleep-wake cycle
muscle and/or joint pains
headaches
painful lymph nodes without enlargement
sore throat
cognitive dysfunction, such as difficulty thinking, inability to concentrate, impairment of short-term memory, and difficulties with word-finding
physical or mental exertion makes symptoms worse
general malaise or ‘flu-like’ symptoms
dizziness
nausea
palpitations
management for chronic fatigue syndorme
referral to CFS specialist clinic and they do bunch of stuff to manage energy levels in day and schedule and exercise moderation and monitoring - cnT DO IF OUTSIDE A PROGRAMME AND cbt ect
what is (the cause of) infectious mononucleosis
Infectious mononucleosis (also referred to as glandular fever) is the most prevalent manifestation of Epstein-Barr virus (EBV) infection.
epidemiology of infectious mononucleosis
Most commonly observed among young adults in developed countries.
Exhibits no seasonal variation.
Does not show sex-based differences.
HIgher socioeconomic groups (as lower usually have been exposed in younger ages- subclinical presentation)
symptoms and signs of infectious mononucleosis
- Fever and general malaise.
- Sore throat.
- Transient macular rash!!!!
- Lymphadenopathy, particularly in the neck region.
- Mild hepatosplenomegaly.!!!!
differentials of infectious mononucleosis
streptococcal pharyngitis, influenza, HIV seroconversion
investigations important in infectious mononucleosis
Full Blood Count (FBC): Typically shows elevated lymphocytes.
Monospot test (heterophile antibodies):
EBV viral serology: Can be utilized if the patient is under 12, immunocompromised, or when the Monospot test continues to yield negative results despite high clinical suspicion.
Abdominal ultrasound: Required if assessment of splenomegaly is necessary.
glandular fever-like presentation occurs in acute HIV, so an HIV test should be performed
infectious mononucleosis management
Management is primarily conservative as the illness typically resolves within 2-4 weeks without intervention.
Analgesia: To manage pain.
avoid Alcohol as it can worsen symptoms.
AVOID Ampicillin and amoxicillin as they can trigger an itchy maculopapular rash.
Contact sports should be avoided for at least 3 weeks due to the risk of SPLENIC TRAUMA
what is tonsilitis
inflammation of the tonsils, which are the masses of lymphoid tissue located at the back of the throat. This inflammation is primarily due to an infection.
causes of tonsilitis
The aetiology of tonsillitis is usually due to a viral or bacterial infection.
Common viruses include the Epstein-Barr virus, influenza virus, adenovirus, and rhinovirus.
Bacterial tonsillitis can be caused by Group A streptococcus, which is also responsible for strep throat. (streptococcal pharyngitis)
signs and symptoms of tonsilitis
Sore throat
Headache
Fever (pyrexia)
Enlarged and tender lymph nodes (lymphadenopathy)
Enlarged & erythematous tonsils
Tonsillar exudate
Some people may also experience abdominal pain, and nausea & vomiting
There may be signs of dehydration
how to differentiate pharyngitis from tonsilitis
pharyngitis (simple) usually no lymphadenopathy
infectious mononucleosis how to differentiate from tonsilitis
severe fatigue and splenomegaly in infectious mono
investigations for tonsilitis
Investigations for tonsillitis typically involve clinical examination and patient history.
Additional tests such as throat swabs are only used when an alternative bacterial cause is suspected.
Blood tests are primarily reserved for those with suspected immunodeficiency.
what are the scoring systems FeverPAIN and centor criteria used for
TO IDENTIFY PATIENTS with group A streptococcal pharyngitis and thus need antibiotics
centror criteria and points needed for ab
fever
tonsillar exudates
absence of cough
tender anterior cervical lymphadenopathy
> 3 criteria
feverPAIN criteria
fever
purulence (exudate)
attended within 3 days of symptom onset
inflamed tonsils
no cough or coryza
> 4 criteria to indicate high strep infection
management of tonsilitis
Symptomatic treatment with paracetamol and ibuprofen
other than the scores indicating antibiotic use what are other indications for antibiotics in tonsilitis
Marked systemic upset
Underlying immunodeficiency
Increased risk of complications
when do patients need to be referred to ent
Patients may be referred to ENT for tonsillitis if they have recurrent episodes of tonsillitis. The criteria for this is:
7+ episodes in one year
5+ episodes per year for two years
3+ episodes per year for three years
presentation of surgical site infection
Post-operative wound infections may present with:
For mild infections: Erythema, tenderness, and no systemic symptoms such as fever.
For severe infections: Purulent discharge, fever, evidence of abscess formation, and systemic signs of infection may be present.
(not abdo distention- peritonism ect thats more anastmotic leak)
features of peritonism
abdo pain or tenderness, can be localised or generalised
guarding
rebound tenderness
rigidity
other: nausea, vomiting,
