Minor Illness

Question 1

State some symptoms of common cold

Answer 1

• Rhinitis
• Sore throat
• Headache
• Muscle aches
• Fever
• Loss of taste or smell
• Sinusitis
• Ear pain

Question 2

Discuss how you can distinguish between common cold and flu

Answer 2

Question 3

Influenza is usually a self-limiting illness, however in those who are at risk of increased complications you can offer treatment.

• State some examples of who is at increased risk
• What medicaiton would you give

Answer 3

• At risk groups: immunocompromised, chronic respiratory disease, chronic heart disease, diabetes, over 65yrs, under 6 months, prenant, CKD, morbid obesity
• Medication:
  
  • First line= Oral oseltamivir
  • Second line= Inhaled zanamivir

Question 4

For conjunctivitis, state:

• What it is
• Causes
• Symptoms
• Treatment

Answer 4

• Inflammation of conjunctiva (can be due to infection but not always e.g. may be allergic)
• Causes:
  
  • Viral
  • Bacterial (e.g. can be due to STI)
  • Allergic
  • Foreign body
• Symptoms:
  
  • Redness
  • Swelling
  • Discharge, crusting of lids, stuck together upon wakening
• Management:
  
  • First line= self management
  • If bacterial & severe offer topical antibiotics e.g. chloramphenicol (NOTE: even bacterial is self-limiting so may offer delayed course of topical antibiotics)

Question 5

For a stye, state:

• What it is
• Symptoms
• Management

Answer 5

• Small abscess (painful collection of pus) on the eyelid and is an infection at the root of an eyelash; infection usually due to Staphylococcus aureus
• Symptoms:
  
  • Small red spot on edge of eyelid
  • Visible puss in spot
• Management:
  
  • Warm compress held against eye
  • Do not pop
  • Avoid makeup & contact lenses
  • Advise if not getting better or eyelid becomes red or swollen to contact GP

Question 7

What is an alternative name for a meibommian cyst?

Answer 7

Chalazion

Question 8

For a meibommian cyst/chalazion, state:

• What it is
• Symptoms
• Management

Answer 8

• Inflammatory granuloma caused by obstruction of meibommian gland in eyelid
• Symptoms:
  
  • Loclaised eyelid swelling
  • Tender or non tender swelling
  • +/- mild conjunctivitis
• Management:
  
  • Warm compress
  • Information leaflet- how to massage after warm compress application
  • Might give some topical chloramphenicol if moderate/severe conjuncitivis also suspected

Question 9

For blepharitis, state:

• What it is
• Symptoms
• Management

Answer 9

• Blepharitis is an inflammatory eyelid condition caused by chronic staphylococcal infection and malfunction of the meibomian (lipid) glands. It can cause secondary conjunctivitis and dry eye and occasionally small corneal ulcers.
• Symptoms:
  
  • Red eyes
  • Gritty/sore eye
  • Crusting on lashes
• Management:
  
  • Eyelid hygiene
  • Warm compress
  • Topical chloramphenicol if moderate/severe conjunctivitis

Question 10

• What is orbital cellulitis?
• Remind yourself of difference between pre and post orbital cellulitis
• Discuss management of pre and post orbital cellulitis

Answer 10

• Infection of soft tissue of orbit
• Pre= infection of soft tissues anterior to orbital septum. Post= infection of soft tissues posterior to orbital septum
• Managment:
  
  • Pre: oral co-amoxiclav and review in eye clinic in 48hr
  • Post: admit to hospital for IV antibiotics

Question 11

Compare symptoms and signs of pre- and post- orbital cellulitis

Answer 11

Question 12

What is an aphthous ulcer?

Describe the 3 types of aphthous ulcer

Answer 12

Aphthous ulcers are oral ulcers. Three types:

• Minor: <1cm
• Major: >1cm- often leave scar
• Herpetiform: pinhead sized uclers that are grouped together- very painful

Question 13

State some potential causes of aphthous ulcers

Answer 13

• Trauma
• Smoking cessation
• Anxiety
• Fe, folate, B12 deficiency
• Crohn’s
• Cancer

Question 14

Discuss the management of aphthous ulcers

Answer 14

Mostly self limiting therefore management is:

• Advice: avoid spicy foods, acidic fruit drinks, wash mouth with salt water
• OTC analgesics e.g. bonjela
• Topical cortiosteroids if causing lot of pain, not resolving
• If infected, topical abx

Question 15

For scabies, discuss:

• What it is
• Symptoms
• Whether it is contagious
• Management

Answer 15

• Scabies is an intensely itchy skin infestation caused by the human parasite Sarcoptes scabiei
• Symptoms:
  
  • Pruritis
  • Linear burrows (grey irregular tracks)
  • Erythematous papules often found in interdigital webspaces
  • Nodules (violet in colour and very itchy)- common on penis and scrotum in men
• Highly contagious
• Management:
  
  • Permethrin 5% cream
  • Advice such as all close contacts should be treated (even if asymptomatic) wash clothes at high temperatures

Question 16

Discuss how permethrin cream should be applied to treat scabies

Answer 16

• Product should usually be applied to the whole body from the chin and ears downwards paying special attention to the areas between the fingers and toes and under the nails, However, in people who are immunosuppressed, the very young, and elderly people, the insecticide should be applied to the whole body including the face and scalp.
• Apply to cool, dry skin
• Wash off after 8 hrs​
• Apply second dose after 1 week

Question 17

Discuss the presentation of nappy rash

State some possible causes

Answer 17

Localised skin irritation in nappy region (form of contact dermatitis):

• Erythema
• Sparing of folds & gluteal cleft
• Spots/pimples/blisters
• Baby distressed if sore

Potential causes:

• Infrequent nappy changes
• Insufficienty cleaning
• Wipes, soaps, detergents
• Antibiotics

Question 18

Discuss the management of nappy rash

Answer 18

• Advice:
  
  • Regular changing
  • Leave nappy free as long as possible
  • Water & cotton wool to clean or fragrance/alcohol free wipes
  • Dry gently
  • Barrier cream
  • Avoid talcum powder
• NICE says if rash appears inflammed or is causing discomfort prescribe 1% hydrocortisone cream for application once daily

Question 19

SEE YR3 MEDICINE- INFECTIONS for UTI info

Question 20

What is impetigo?

Answer 20

Impetigo is a common superficial bacterial infection of the skin. The two main clinical forms are:

• Non-bullous impetigo — accounts for the majority of cases (about 70%). Caused by S.Aureus or S.Pyogenes or both
• Bullous impetigo — bullae are fluid filled lesions which are usually more than 5mm in diameter. Caused by S.Aureus

Impetigo can develop as a primary infection in otherwise healthy skin or as a secondary complication of pre-existing skin conditions such as eczema, scabies, or chickenpox.

Question 21

Describe the appearance of non-bullous and bullous impetigo

Answer 21

Non-bullous: start as thin walled vesicles but burst very quickly that child often presents with yellow crusting- commonly on peri-oral or peri-nasal area.

Bullous: fluid filled vesicles which rupture after few days and leave yellow crust

Question 22

Discuss the management of an insect bite in primary care

Answer 22

​Advice & self-management:

• Apply cold compress
• Avoid itching
• Paracetamol
• Crotamiton cream (anti-pruritic)
• Seek medical attention if: appears infected, symptoms worsen, systemic symptoms develop, persisting after a week

Question 23

Discuss the management of oral candidiasis; consider:

• Pharmacological managemetn of mild and severe
• Conservative

Answer 23

Pharmacological

• Infection mild & localised: topical miconazole for 7 days (or nyastatin 2nd line)
• Infection severe or widespread: oral fluconazole for 7 days

Conservative/advice:

• Good oral hygiene
• Smoking cessation
• Rinsing mouth after ICS

Question 24

Dicuss the management of tension headaches in primary care

Answer 24

• Simple analgesia
• Advice:
  
  • Enough sleep
  • Hydration
  • Regular vision checks
  • Screen time

Question 25

Discuss the management of medication overuse headaches in primary care

Answer 25

* Explain the diagnosis of MOH and that use of drugs is main cause * Advise to stop taking all overused pain medication for at least one month * Warn that symptoms may initially worsen * You can discuss with/refer to neurology if overuse involves opiods or tranquilisers or there has been repeated failed withdrawal attempts

Question 26

Discuss the management of migraines in primary care; inlcude conservative and pharmacological management

Answer 26

_Conservative_ * Signpost to information e.g. NHS website * Advise to keep migraine diary to identify triggers so can avoid * Educate regarding known triggers e.g. stress, lack of sleep, dehydration, lack of exercise etc... and promote healthy habits/changes _Pharmacological_ 1. Simple analgesia e.g. paracetamol, ibruprofen 2. Consider adding a triptan (or use triptan alone) e.g. sumatriptan. *\*NOTE: can be given intranasally if vomitting stops oral intake* 3. Antiemetic e.g. metoclopramide *\*NOTE: triptans should be taken when pain starts NOT when aura starts (if they have one)*

Question 27

Discuss the management of cluster headaches in primary care

Answer 27

* SC or nasal triptan e.g.sumatriptan * Short burst oxygen therapy *(100% oxygen at 12-15L over 15 mins)* * Avoid paracetamol, NSAIDs, oral triptans * Advice on avoidance of triggers * Identify and manage comorbidities

Question 28

Discuss the management of trigeminal neuralgia in primary care

Answer 28

* **Carbamezapine** *(start at 100mg BD, then titrate up 100-200mg every 2 weeks until pain is controlled. Once in remission, gradually reduce dose to either lowest dose possible to maintain remission or to nothing and then restart when flare again)*

Question 29

Dicuss the management of consipation in primary care

Answer 29

_Conservative_ * Increase fibre intake (30g daily) * Increase fluid intake * Increase physical activity _Pharmacological_ 1. Bulk forming laxative e.g. ispaghula husk 2. Osmotic laxative e.g. macrogol 3. Add stimulant e.g. senna *\*NOTE: do not prescribe bulk forming laxative if opioid constipation*

Question 30

Discuss the management of haemorrhoids in primary care

Answer 30

* Consider if need referral e.g. extremely painful (suggesting thrombosed haemorrhoid) or too large for conservative * Advice: * Make sure stools soft and easy to pass (plenty water, fibre, exercise etc..) * Anal hygience * Advise against stool withholding * Analgesia e.g. paracetamol * Refer to secondary care if conservative not working

Question 31

Describe the ottawa rules to determine if x-ray of ankle is needed

Answer 31

Question 32

Compare symptoms of sprain and strain

Answer 32

Question 33

State some signs & symptoms of shingles

Answer 33

* Prodromal phase: * Tingling, pain in affected dermatome * Headache * Malaise * Photophobia * Fever * Within few days maculopapular rash appears which then develops into clusters of vesicles; rash is usually painful, itchy and only on one side of body * Vesicles burst and crust over within 7 days

Question 34

Discuss the pathophysiology of shingles

Answer 34

* Varicella zoster virus lies dormant in dorsal root ganglia * Reactivated later in life- thought due to immunocompromise * When reactivated and causing shingles= herpes zoster

Question 35

Discuss the management of shingles

Answer 35

Firstly, assess pt for severity; for example, are there any signs of occular involvement or further infection, are they severely immunocompromised, are they a child and immunocompromsied... If any of the above, consider admission to hosptial. For others: * Information & advice * Pain management * Consider prescribing oral antiviral e.g. aciclivor, famciclivor

Question 36

Which pts, with shingles, would you consider prescribing an antiviral to?

Answer 36

Provide antibiotics to pt with rash onset within last 72 hrs and any of following: * Immuncompromised * Non-truncal involvement * Moderate or severe pain * Moderate or severe rash * _Consider_ in all those over 50 to reduce risk of post-herpetic neuralgia