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Year 3 GP > Minor Illnesses > Flashcards

Minor Illnesses Flashcards

(46 cards)

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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

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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

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A

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

21
Q

Secretory diarrhoea

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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

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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

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A

Blood in stool
Weight loss
Dehydration

24
Q

Diarrhoea hx

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A 
Anyone else symptomatic? 
THx 
What have they eaten recently?
Fever 
Vomiting 
Frequency 
Job
25
RF for entamoeba histolytica
young, pregnant, corticosteroids, malnutrition and alcoholism
26
RF for Giardia duodenalis
Children, travellers, immunocompromised
27
Abscess summary
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
Bartholin's cyst
Accumulation of pus inside bartholin's gland on each side of the vaginal opening
29
Quinsy
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
GORD summary
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
Constipation mx in adults
1. bulk-forming laxative e.g. ispaghula husk 2. + osmotic agent e.g. macrogol 3. Lactulose 4. If tenesmus - add stimulant laxative e.g docussate sodium
32
opioid-induced constipation
Macrogol
33
Anal fissure summary
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
Haemorrhoids summary
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
Types of headaches
``` Tension Cluster Migraine Medication overuse Sinus Giant cell arteritis ```
36
Primary headache
Normally recurrent Due to headache condition Non life threatening
37
Secondary headaches
Due to another condition Acute Severe pain More likely to be life or sight threatening
38
Tension headache summary
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
Migraine summary
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
Medication over use headache
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
Advice for medication over use headache
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
Cluster headache summary
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
Temporal arteritis summary
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
Trigeminal neuralgia summary
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
Sinusitis time frame
acute - 4-30 days subacute - 4-12 weeks Chronic - 12 + weeks
46
Sinusitis summary
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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