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Yr3 - GP > Minor Illnesses + Acute Presentations > Flashcards

Minor Illnesses + Acute Presentations Flashcards

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1
Q

Define cough

A

Reflex response due to airway irritation
Acute = less than 3 weeks
Sub-acute = 3-8 weeks
Chronic = more than 8 weeks

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2
Q

Causes of acute cough

A

URTI
Acute bronchitis
Pneumonia
Acute exacerbations of asthma or COPD

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3
Q

Causes of sub-acute cough

A

Airway hyper-responsiveness following specific infections - Mycoplasma pneumoniae
Post-infectious cough - pertussis
Ongoing infections

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4
Q

Causes of chronic cough

A 
Cigarette smoke exposure
ACE-i
Post-nasal drip syndrome
Asthma
GORD
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5
Q

Define common cold

A

Mild, self-limiting URTI characterized by nasal stuffiness and discharge, sneezing, sore throat and cough

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6
Q

Complications of URTI

A

Sinusitis
LRTI
Acute otitis media

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7
Q

Risk factors for complications of URTI

A 
Comorbidities
- asthma
- COPD
- DM
- cystic fibrosis
Older age and young children
Immunocompromised
Smoking
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8
Q

Clinical features of URTI

A 
Sore/irritated throat
Nasal irritation, congestion, discharge and sneezing
Cough
Hoarse voice
General malaise
Rapid onset over 1-2 days
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9
Q

Differential diagnosis of URTI

A 
Meningitis
Upper airway obstruction
Nasal foreign body
Influenza
Streptococcal pharyngitis
Allergic rhinitis
Glandular fever
Whooping cough (pertussis)
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10
Q

Management of URTI

A

Reassure self-limiting and complications are rare
Antibiotics and antihistamines are ineffective and may cause adverse effects
Adequate fluid
Healthy food
Adequate rest

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11
Q

Define urinary tract infection

A

Infection of any part of urinary tract usually by bacteria

- also fungi, viruses or parasites

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12
Q

Define lower UTI

A

Infection of bladder

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13
Q

Define cystitis

A

Inflammation of the bladder

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14
Q

Define upper UTI

A

Pyelitis, pyelonephritis

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15
Q

Define uncomplicated UTI

A

Infection by a usual pathogen in a person with normal urinary tract and normal kidney function

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16
Q

Define complicated UTI

A

One or more risk factors are present that predispose to persistent infection, recurrent infection or treatment failure

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17
Q

Define recurrent UTI

A

Repeated UTI which may be due to relapse or reinfection

3 or more UTIs in last 12 months

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18
Q

Causative organisms of UTIs

A

Escherichia coli - 80%
Staphylococcus saphrophyticus
Klebsiella pneumoniae
Proteus mirabilis

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19
Q

Routes of entry by bacteria into urinary tract

A

Direct - insertion of catheter into bladder, instrumentation or surgery
Via blood stream - immunocompromised
Retrograde - ascending through urethra into bladder

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20
Q

Risk factors for UTI in males

A 
Over 50 
BPH
Catheterisation
Previous urinary tract instrumentation or surgery
Previous UTI

Anal sex
Immunosuppression
DM
Recent hospitalisation
Uncircumcised men
Vaginal sex
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21
Q

Complications of UTI in males

A 
Renal function impairment
Prostatitis
Pyelonephritis
Sepsis
Urinary stones
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22
Q

Clinical features of UTI in men

A 
Temperature 1.5 degrees higher than normal
New frequency or urgency
New incontinence
New or worsening delirium/debility
New suprapubic pain
Visible haematuria
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23
Q

Urine sample collection methods

A

Mid-stream (MSU) - routine recommended method
- first part of voided urine discarded and without interrupting flow 10ml collected
Clean-catch (CCU)
- whole specimen collected
Catheter urine sample (CSU)

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24
Q

Features of urine dipstick that suggests UTI

A

Positive for nitrite and leukocyte esterase

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25
Management of UTI in men
Start empirical antibiotic | - trimethoprim or nitrofurantoin - 7 days
26
Risk factors for UTI in children
``` Age below 1 year Female sex White Previous UTI Voiding dysfunction Vesicoureteral reflux Sexual activity No history of breastfeeding Immunosuppression ```
27
Complications of UTI in children
Renal scarring/damage Hypertension Bacteriuria and hypertension during pregnancy Renal insufficiency and failure
28
Complications of UTI in women
Ascending infection - pyelonephritis, renal and peri-renal abscess Pre-term delivery and low birth weight if pregnant
29
Risk factors of complications of UTI in women
``` Pregnancy Older age Healthcare associated Presence of symptoms for more than a week before presentation Urologic instrumentation Pre-existing urological conditions Comorbidities ```
30
Management of UTI in women
``` Not recurrent - advise on self-care methods - simple analgesia - avoid dehydration - assess need for antibiotic - nitrofurantoin for 3 days - trimethoprim for 3 days Recurrent - personal hygiene - avoid douching and occlusive underwear - wipe front to back - adequate hydration - avoid delay of habitual and post-coital urination - antibiotic prophylaxis - trimethoprim or nitrofurantoin - amoxicillin ```
31
Define acute bronchitis
Lower respiratory tract infection which causes inflammation of the bronchial airways - cough resulting from acute inflammation of trachea and large airways without evidence of pneumonia
32
Define pneumonia
Infection of lung tissue in which the air sacs in the lungs become filled with microorganisms, fluid, inflammatory cells - affects function of lungs
33
Organisms causing acute bronchitis
Viral infection - rhinovirus - enterovirus - influenza A and B - parainfluenza - coronavirus - adenovirus
34
Causative organisms of community-acquired pneumonia
Bacterial infection - streptococcus pneumoniae - haemophilus influenzae - staphylococcus aureus - group A streptococci - moraxella catarrhalis
35
Complications of acute bornchitis
Usually mild and self-limiting Cough lasts 2-3 weeks Pneumonia may occur as a complications
36
Complications of pneumonia
``` Pleural effusion Empyema Lung abscess Acute respiratory distress syndrome Septic shock Disseminated infection ```
37
Parts of the CURB-65 scoring
1 point for each feature - confusion - new disortietnation - raised RR - 30 bpm or more - low BP - 60 diastolic or 90 systolic - over 65
38
Management of acute bronchitis
``` Conservative - adequate fluid intake - paracetamol or ibuprofen - stop smoking Offer antibiotics if systemically unwell or back up for those at higher risk - doxycycline - not for pregnant women - amoxicillin ```
39
Risk factors for complications of acute bronchitis
``` Pre-existing comorbid condition Older than 65 with 2 or older than 80 with one of the following - hospital admission in previous year - DM - history of congestive heart failure - current oral corticosteroids ```
40
Management of CAP
``` Conservative - rest - adequate fluid intake - simple analgesia Antibiotics - amoxicillin ```
41
Define blepharitis
Common chronic inflammatory condition affecting the margin of the eye Usually bilateral
42
Categorises fo blepharitis
Anterior - inflammation of the base of the eyelashes - bacterial - staphylococci - seborrhoeic dermatitis Posterior - inflammation of the meibomian glands - meibomian glands run along posterior eye margin - produce lipid secretion which provides the lipid layer of the tear film
43
Complications of blepharitis
``` Meibomian cyst External stye Changes to eyelashes - loss, misdirection and depigmentation Eyelid thickening, ulceration and scarring Contact lens intolerance Dry eye syndrome Conjunctivitis Corneal inflammation ```
44
Clinical features of blepharitis
``` Burning, itching and crusting of eyelids Symptoms worse in morning Both eyes affected Recurrent hordeolum Contact lens intolerance ```
45
Management of blepharitis
Symptoms controlled with self-care - eyelid hygiene - cleaned twice daily - warm compress
46
Define a hordeola
Stye Acute localised infection or inflammation of the eyelid margin - bacterial infection of cilium and adjacent gland with local abscess formation - usually staphylococcal`
47
Types of hordeola
External stye - appears on eyelid margin - caused by infection of eyelash follicle and associated sebaceous or apocrine gland Internal stye - occurs on the conjunctival surface of the eyelid - caused by infection of Meibomian gland
48
Complications of hordeola
Infective conjunctivitis Periorbital or orbital cellulitis Meibomian cyst
49
Clinical features of hordeola
Acute-onset painful localised swelling near eyelid margin that develops over several days Usually unilateral External - located at eyelid margin around eyelash follicle - points anteriorly through the skin - small, yellow, pus-filled spot may be visible Internal - swelling tender and localised on internal eyelid
50
Management of stye
Self-care advice - self limiting and rarely causes serious complications - warm compress to closed eyelid for 5-10 mins 2-4 times daily - do not attempt to puncture stye - avoid contact lenses or eye makeup until area has healed
51
Define uveitis
Inflammation of uveal tract - iris, ciliary body and choroid
52
Causes of uveitis
``` Systemic autoimmune disorders - sarcoidosis - psoriatic arthropathy - MS Infection - herpes simplex - herpes zoster virus - CMV Trauma Neoplasia ```
53
Complications of uveitis
Vision loss Visual impairment Paediatric uveitis
54
Clinical features of uveitis
``` Pain or dull ache Red eye Diminished or blurred vision Watering of eye Photophobia Flashes and floaters Unreactive of distorted pupil ```
55
Management of uveitis
``` Refer to ophthalmologist Non-infectious - corticosteriods - cycloplegic-mydriatic drug Infectious - antimicrobial drug - corticosteriods - cycloplegics ```
56
Define conjunctivitis
Inflammation of conjunctiva | - conjunctiva is thin, transparent mucous membrane lining anterior part of sclera
57
Causes of conjuctivitis
``` Viral - adenovirus - herpes simplex - varicella zoster Bacteria - streptococcus pneumonia - staphylococcus aureus - haemophilus influenzae ```
58
Clinical features of conjuctivitis
``` Acute onset conjunctival erythema Discomfort - grittiness, burning Watering and discharge Bacterial - purulent or mucopurulent discharge Viral - mild to moderate erythema of conjunctiva and pruritis ```
59
Differential diagnosis of conjuctivitis
``` Acute glaucoma Scleritis Episcleritis Keratitis Uveitis Iritis Corneal ulcer Atopic of allergic conjunctivitis Nasolacrimal duct obstruction Subconjunctival haematoma Dry eye Blepharitis Thyroid eye disease ```
60
Features for referral for conjunctivitis
Suspected gonococcal or chlamydia conjunctivitis Possible herpes infection Suspected periorbital or orbital cellulitis Recent intraocular surgery Corneal involvement
61
Management of viral conjunctivitis
Reassure most cases self-limiting and do not require antimicrobials Advise self-care - bathing eyelids with cotton wool soaked in sterile saline to remove discharge - cool compress - lubricating drops or artificial tears Avoid antibiotics Inform infective so should prevent spread - wash hands with soap and water - separate towels and flannels
62
Management of bacterial conjunctivitis
Advise most cases resolve within 5-7 days Treat with topical antibiotics if severe - chloramphenicol 0.5% drops - fusidic acid
63
Causes of lumbar back pain
``` Non-specific low back pain Sciatica Vertebral fracture Intra-abdominal pathologies Ankylosing spondylitis Cancer Infection ```
64
Risk factors for lumbar back pain
Obesity Physical inactivity Occupational factors - heavy lifting Depression and other psychological factors
65
Red flags symptoms for cauda equina syndrome with back pain
Severe or progressive bilateral neurological deficit of the legs - major motor weakness with knee extension , ankle eversion or foot dorsiflexion Recent-onset urinary retention or urinary incontinence Recent-onset faecal incontinence Perianal or perineal sensory loss Unexpected laxity of anal sphincter
66
Red flags symptoms for spinal fracture with back pain
Sudden onset of severe central spinal pain which is relieved by lying down History of major trauma Structural deformity Point tenderness over vertebral body
67
Red flag symptoms of cancer with back pain
Over 50 Gradual onset of symptoms Severe unremitting pain that remains when person is supine, aching night pain that prevents of disturbs sleep Localised spinal tenderness No symptomatic improvement after 4-6 weeks conservative therapy Unexplained weight loss Past history of cancer
68
Red flag symptoms of infection with back pain
``` Fever Tuberculosis or recent UTI Diabetes History of IV drug use HIV infection Immunosuppressants ```
69
Management of non-specific back pain
``` Reassure Analgesia to manage pain - NSAID - do not offer paracetamol - benzodiazepine if has muscle spasms Physiotherapy for manual therapy Encourage to stay active, resume normal activities and return to work asap ```
70
Define dyspepsia
Complex of upper gastrointestinal tract symptoms which are typically present for four or more weeks including - upper abdominal pain - heartburn - acid reflux - N+V
71
Define GORD
Gastro-Oesophageal Reflux Disease Reflux of gastric contents back into oesophagus - causing predominantly heartburn and acid regurgitation
72
Risk factors for GORD
``` Stress and anxiety Smoking and alcohol Trigger foods - coffee, chocolate OBesity Drugs that increase LOS pressure - alpha-blockers, anticholinergics, benzodiazepines, beta-blockers Pregnancy Hiatus hernia FH ```
73
Risk factors for Barrett's oesophagus
Male gender Long duration or increased frequency of GORD Previous oesophagitis or hiatus hernia Previous oesophageal stricture or ulcers
74
Complications of GORD
``` Oesophageal ulcers Oesophageal haemorrhage Anaemia - chronic blood loss Oesophageal stricture Aspiration pneumonia Barrett's oesphagus ```
75
Management of GORD
``` Lifestyle measures - weight loss - avoid trigger foods - eat smaller meals - stop smoking - reduce alcohol consumption Sleep with head of bed raised Assess for stress and anxiety Review medication Ask about over the counter medication - antacids, alginates PPI for 4 weeks ```
76
Classification of headaches
``` Primary - migraine - tension - cluster Secondary - trauma - intracerebral haemorrhage - giant cell arteritis - malignancy - meningitis Cranial neuropathies - trigeminal neuralgia - optic neuritis ```
77
Features that indicate serious cause of headache
New severe - intracranial haemorrhage - venous sinus thrombosis Progressive/persistent - mass lesion - subdural haematoma Fever, impaired consciousness, neck pain or photophobia - meningitis or encephalitis Papilloedema - SOL Dizziness - ischaemia or haemorrhagic stroke Visual disturbance - migraine, acute closure glaucoma, temporal arteritis Vomiting - migraine, mass lesion, brain abscess or CO poisoning
78
Diagnostic criteria for migraine without aura
``` At least 5 attacks with following criteria - headache attacks lasting 4-72hrs Headache has at least 2 criteria - unilateral location - pulsating quality - moderate or severe pain intensity - aggravation by or causing avoidance of routine physical activity During headache at least 1 - nausea - vomiting - photophobia - phonophobial ```
79
Diagnostic criteria for migraine with aura
At least 2 attacks One or more following reversible aura symptoms - visual - zigzag lines or scotoma - sensory - pins and needles - speech and language - aphasia - motor weakness - brainstem - vertigo, diplopia - retinal - monocular scintillations or scotoma At least 2 of the following - aura symptom spreads gradually over at least 5 mins - each individual symptom lasts 5-60 mins - unilateral - aura accompanied or followed within 60mins by headache
80
Diagnostic criteria for tension-type headache
Recurrent episodes of headache lasting from 30mins to 7 days - not associated with N/V Headache consists of - bilateral location - pressing or tightening quality - mild or moderate intensity - not aggrevated by routine physical activity
81
Diagnostic criteria of cluster headache
5 severe or very severe attacks of unilateral orbital, supraorbital or temporal pain lasting 15-180mins Associated with at least one - ipsilateral conjunctival injection or lacrimation - nasal congestion / rhinorrhoea - eyelid oedema - forehead and facial sweating - forehead and facial flushing - sensation of fullness in ear - sense of restlessness or agitation Attacks occur between every other day and 8 per day for more than half the time
82
Diagnostic criteria for medication overuse headache
Occurs on at least 15 days per month and pre-existing headache disorder Regularly overused drugs for more than 3 months - ergotamines - triptans - simple analgesics` - opioids
83
Management of cluster headache
Refer to neurologist or GP with special interest Subcut or nasal triptan Do not offer paracetamol, NSAIDs, opioids, ergots or oral triptans Short burst oxygen therapy Advise on avoidance of triggers Advise on risk of medication overuse headache
84
Management of medication overuse headache
Explain diagnosis Withdrawal of overused drug is mainstay of treatment - drugs such as triptans and simple analgesics can be stopped abruptly - headache may continue for 1 month
85
Management of tension type headache
Simple analgesics - do not offer opioids If chronic offer - up to 10 sessions of acupuncture over 5-8 weeks - pharmacological prophylaxis with low dose amitriptyline
86
Complications of migraine
``` Reduced functional ability and QoL Medication overuse headache Progression to chronic migraine Status migrainosus Migraine aura-triggered seizure Increased risk of stroke ```
87
Management of migraine
Explain diagnosis and provide information Advise - keep headache diary can help identify triggers - avoid known triggers and lifestyle management - stress management - good sleep hygiene - adequate hydration - regular meals - exercise - maintenance of healthy weight Advise on medication overuse headache For women who have migraine with aura hormonal contraception is contraindicated Simple analgesics Triptan Anti-emetics - metoclopramide
88
Define sprain
Stretch and/or tear of ligament
89
Classification of sprains
Grade 1 - mild stretching without joint instability Grade 2 - partial rupture of ligament without joint instability Grade 3 - complete rupture of ligament complex with joint instability
90
Define strain
Stretch and/or tear of muscle fibres and/or tendon
91
Classification of strain
1st degree - few muscle fibres, normal strength 2nd degree - several injured fibres, mild swelling, loss of strength, visible bruise 3rd degree - muscle tears all way through, pop sensation, total loss of muscle function, severe pain and swelling, difficulty bearing weight
92
Causes of sprain
Abnormal or excessive forces applied to a joint
93
Causes of a strain
Muscle stretched beyond its limits | Forced to contract too strongly
94
Risk factors of sprains and strains
``` Frequent participation in sports - contact sports and those that feature quick starts - reduced strength and flexibility - poor exercise technique - wearing inappropriate footwear - inadequate warm up and cool down - muscle fatigue Sudden trauma Anatomical variations Overweight/obese Previous sprain/strain ```
95
Complications of severe sprains
Chronic instability Loss of function Pain Secondary degenerative changes
96
Complications of severe strains
Muscle atrophy Muscle fibrosis Heterotrophic ossification Compartment syndrome
97
Clinical features of sprain
``` Pain around affected joint Tenderness Swelling Bruising Functional loss Mechanical instability ```
98
Clinical features of strain
``` Muscle pain Spasm Weakness Inflammation Cramping Large haematomas Swelling ```
99
Management of sprains and strains
``` Analgesia for pain relief - paracetamol - topical NSAID gel - codeine added onto paracetamol PRICE measures - protection - support - rest - 48-72 hrs - ice - compression - elevation Avoid HARM in 72hrs - heat - alcohol - running - massage ```
100
Cardiac causes of chest pain
``` Acute coronary syndrome - unstable angina and myocardial infarction Stable angina Dissecting thoracic aneurysm Pericarditis/cardiac tamponade Acute congestive cardiac failure Arrhythmias ```
101
Clinical features of dissecting thoracic aneurysm
``` Sudden tearing chest pain radiating to back and inter-scapular region Signs - high BP - blood pressure differentials - inequality in pulses - new diastolic murmur ```
102
Clinical features of pericarditis/cardiac tamponade
Symptoms - sharp constant chest pain relieved by sitting forward - may radiate down left shoulder - worse on inspiration, swallowing and coughing - fever, cough and arthralgia - breathlessness, dysphagia, cough and hoarseness Signs - pericardial friction rub - hypotension - muffled heart rate - juglar venous distention
103
Clinical features of acute congestive heart failure
``` Symptoms - ankle swelling - tiredness - severe breathlessness - orthopnea - coughing Signs - elevated jugular venous pressure - gallop rhythm - inspiratory crackles at lung bases - wheeze ```
104
Diagnosis of acute coronary syndrome
``` 12-lead ECG - pathological Q waves - LBBB - ST segment and T-wave abnormalities - normal ECG does not exclude High-sensitivity blood test for serum troponin - detectable level ```
105
Pulmonary causes of chest pain
``` PE Pneumothorax/tension pneumothorax CAP Asthma Lung/lobar collapse Lung cancer Pleural effusion ```
106
Clinical features of PE
``` Symptoms - acute-onset breathlessness - pleuritic chest pain - worse on inspiration - cough - haemoptysis - syncope Signs - tachypnoea - 20bpm - tachycardia - mild pyrexia - signs of DVT ```
107
Clinical features of pneumothorax
``` Symptoms - sudden-onset pleuritic pain and breathlessness - with or without pallor and tachycardia Signs - reduced chest wall movements - reduced breath sounds - reduced vocal fremitus - increased resonance of percussion on affected side ```
108
Clinical features of CAP
``` Symptoms - cough - sputum - wheeze - dyspnoea - pleuritic chest pain Signs - dull percussion note - bronchial breathing - coarse crackles - increased vocal resonance - fever, sweating and malaise ```
109
Clinical features of asthma
``` Symptoms - wheeze - breathlessness - cough - often worse at night, first thing in the morning and upon exercise/exposure to allergens Signs - increased RR and wheeze during acute exacerbations - none when feeling well ```
110
Clinical features of lung/lobar collapse
``` Symptoms - localised chest pain - breathlessness - cough Signs - reduced chest wall movement on affected side - dull percussion note with bronchial breathing - reduced or diminished breath sounds ```
111
Clinical features of lung cancer
``` Symptoms - chest or shoulder pain - haemoptysis - dyspnoea - weight loss - appetite loss - hoarseness - cough Signs - finger clubbing - cervical or supraclavicular lymphadenopathy ```
112
Clinical features of pleural effusion
``` Symptoms - localised chest pain - progressive breathlessness Signs - reduced chest wall movements on affected side - stony dull percussion note - diminished or absent breath sounds - signs of fluid overload - heart or renal failure ```
113
Other causes of chest pain
``` GI - acute pancreatitis - oesophageal rupture - peptic ulcer disease/GORD -acute cholecystitis MSK - rib fracture - costochondritis - spinal disorders - disc prolapse, cervical spondylosis Psychogenic Herpes zoster ```
114
Emergency treatment of ACS
``` Glyceryl trinitrate O2 if sats less than 94% Aspirin Resting 12-lead ECG Ambulance admitt ```
115
Emergency treatment of acute pulmonary oedema
IV diuretic - furosemide IV opioid - diamorphine IV anti-emetic - metoclopramide Nitrate - GTN spray
116
Define angina
Pain/constricting discomfort in chest, neck, shoulders, jaw or arms caused by insufficient blood supply to the myocardium - stable = occurs predictably with physical exertion or emotional stress - unstable = occurs at rest - requires urgent admission to hospital
117
Complications of angina
``` Coronary Artery Disease - stroke - MI - unstable angina - sudden cardiac death Other - anxiety and depression - reduced QoL ```
118
Features of stable angina
``` Precipitated by physical exertion Constricting discomfort in front of chest, neck, shoulders, jaw or arms Relieved by rest or GTN in about 5 mins Atypically - GI discomfort - breathlessness - nausea ```
119
Risk factors for angina
``` Smoking High blood pressure Overweight High cholesterol Inactivity Poor diet High alcohol intake ```
120
Management of stable angina
``` Sublingual glyceryl trinitrate (GTN) Beta-blocker or calcium channel blocker Secondary prevention - low-dose aspirin - ACE-i ```
121
Define dyspnoea
Breathlessness | Subjective distressing sensation or awareness of difficulty with breathing
122
Cardiac causes of breathlessness
``` Silent MI Cardiac arrhythmia Acute pulmonary oedema Cardiac tamponade Chronic heart failiure ```
123
Pulmonary causes of breathlessness
``` Asthma Chronic obstructive pulmonary disease Pneumonia PE Pneumothorax Pleural effusion Lung/lobar collapse Bronchiectasis Interstitial lung disease Lung or pleural cancer ```
124
Other causes of breathlessness
Anaemia Diaphragmatic splinting - ascites, obesity or pregnancy Anxiety-related
125
Managment of angio-oedema without anaphylaxis
Slow IV or IM chlophenamine and hydrocortisone Arrange emergency admission Review after discharge
126
Causes of acute red eye
``` Conjunctivitis Subconjunctival haemorrhage Subtarsal or conjuctival foreign body Corenal abrasion Episcleritis Dry eye Blepharitis Ectropion - outward rotation of eyelid margin Entropion - inward rotation of eyelid margin Childmaltreatment Acute glaucoma Anterior uveitis Scleritis Trauma ```
127
Presentation of episcleritis
Redness and pain in one or both eyes Segmental redness Normal vision, pupil reactions and no corneal staining
128
Define acute glaucoma
Blockage of usual drainage of aqueous humour into anterior chamber
129
Presentation of acute glaucoma
Pain in eye - unilateral Headache Blurring of vision with lights surronded by halos N+V Tender hard eye Fixed and mid-dilated pupil which is unresponsive to bright light
130
Presentations of corneal ulcer/contact lens related red eye
``` Foreign body sensation Photophobia Blurred vision Discharge Pain ```
131
Red eye causes that need same-day ophthalmologist assessment
``` Acute glaucoma Corneal ulcer Anterior uveitis Scleritis Trauma Chemical injuries Neonatal conjunctivitis ```
132
Define acute abdomen
Sudden onset severe abdominal pain
133
Differentials of an RUQ pain
``` Cholecystitis Pyelonephritis Ureteric colic Hepatitis Pneumonia ```
134
Differentials of LUQ pain
Gastric ulcer Pyelonephritis Ureteric colic Pneumonia
135
Differentials of pain of LLQ
``` Diverticulitis Ureteric colic Inguinal hernia IBD UTI Gynecological Testicular torsion ```
136
Differentials of pain in RLQ
``` Appendicitis Ureteric colic Inguinal hernia IBD UTI Gynecological Testicular torsion ```
137
Differentials of pain in epigastric region
Peptic ulcer disease Cholecystitis Pancreatitis MI
138
Differentials of pain in umbilical region
Small/large bowel obstruction Appendicitis AAA
139
Causes of acutely unwell child
Meningitis/sepsis Pneumonia Choking DKA
140
Causes of tiredness
``` Chronic heart failure Diabetes mellitus Hypothyroidism Hyperthyroidism Iron-deficiency anaemia Insomnia Anxiety Depression ```
141
History for diabetes mellitus
``` Polyuria Polydipsia Weight loss Polyphagia N+V Reduced vision Altered consciousness ```
142
Examination findings for diabetes mellitus
Volume depletion - dry mucus membranes, decreased skin tugor Confusion Retinopathy Neuropathy
143
Investigations for diabetes mellitus
``` Fasting blood glucose level - > 6.9 mmol/L HbA1c - > 4.8 mmol/mol Oral glucose tolerance test - > 11 mmol/L ```
144
History of chronic heart failure
``` Decreased exercise tolerance Dyspnoea on exertion Orthopnea PND Previous MI ```
145
Examination findings of chronic heart failure
Oedema Displaced apex beat JV disstension
146
Investigations for chronic heart failure
BNP - increased CXR - cardiomegaly, pulmonary oedema, pleural effusion ECG - anterior Q waves, BBB, left axis deviation
147
History of iron deficieny anaemia
``` Asthenia Hair loss Dyspnoea Menorrhagia Dysphagia ```
148
Examination findings of iron deficiency anaemia
Pallor Tachycardia Systolic ejection murmur Blue sclera
149
Investigations for iron deficiey anaemia
FBC - reduced Hb and Hct, reduced MCV and MCH | Ferritin - reduced
150
History of insommnia
Difficulty initiating sleep Waking frequently Poor concentration Depressed mood
151
Examination findings for insomnia
Reduced alertness Red and puffy eyes Abscence of sings suggesting orgainc illnees
152
History for depression
Reduced mood Loss of interest Feeling hopless Suicidal ideation
153
Clinical examination findings for depression
Psychomotor slowing | Agitiation
154
Investigations for depression
PHQ2 or PHQ9 screening tool
155
History of hyperthyroidism
Weight loss Increased appetitie Oligomenorrhoea Heat intolerance
156
Clinical examination findings for hyperthyroidism
``` Weight loss Hyper-reflexia Tachycardia AF Fine tremor ```
157
Investigations for hyperthyroidism
TSH - decreased T4/3 - increased Increased uptake on radioiodine scan
158
History for hypothyroidism
``` Weakness Cold Hair/eyebrow loss Weight gain Constipation Peri-orbital swelling ```
159
Clinical examination findings for hypothyroidism
``` Bradycardia Hypothermia Slow movement Delayed reflexes Goitre Enlargement of tongue ```
160
Investigations for hypothryoidism
T4 - reduced | TSH - increased
161
History of menstural headache
Episodic headache - associated cyclical occurance
162
History of tension headache
Emotional stressors Depression Insomnia Tight band like or vice-like bilateral steady aching non-pulsatile constricting pain
163
Hisotry of migraine headache
POUNDing - Pulsatile - 4-72 hOurs - Unilateral - Nausea/vomiting - Disabling intensity
164
Causes of headache
``` Migraine Acute sinusitis Otitis media Temporomandibular joint syndrome Medication overuse Medication withdrawal Menstrual headache ```
165
Hisstory of acute sinusitis
``` Frontal headache Nasal congestion Mucopurulent nasal discharge Fever Coughing Sneezing ```
166
Clnical findings of acute sinusitus
Sinus tenderness | Reproducible pain on percussion of frontal/maxillary sinuses = bacterial
167
History of otitis media
``` Common in children Otalgia Irritability Anorexia Vomiting Fever ```
168
Clinical examination of otitis media
Bulging opacified tympanic membrane with reduced mobility | White, pink, red or yellow membrane
169
Investigations for otitis media
Otoscopy | - bulging, opacified tympanic membrane
170
History of TMJ syndrome
TMJ pain on mastication Noise in the joint Limited mandibular movement with jaw locking
171
History of medication overuse headache
``` Headache occuring more than 15 days per month Pre-existing headache disorder Regular medication - paracetamol - NSAIDs - triptans - opiods ```
172
History of medication withdrawal headache
Recent medication changes - hypertension - antihistamines - caffeine - pseudoephedrine - opiates - corticosteriods
173
Causes of dyspepsia
``` Cholecystitis Functional dyspepsia Helicobacter pylori infection GORD/oesophagitis Peptic ulcer disease Lactose intolerance ```
174
Hisotry o fcholecysititis
Epigastric or RUQ pain radiating to the right scapula | Nausea and pain lasting 3-6 hours
175
Clincial examination findings for cholecystitis
Positive murphys sign Tender RUQ/epigastrium Jaundice Fever
176
Investigations for cholecystitis
Abdominal USS
177
History of functional dyspepsia
Heartburn Nausea Upper abdominal pain
178
Investigations for functional dyspepsia
Haemoglobin - normal | Urea breath test - negative
179
History of H.pylori infection
History or FH of previous peptic ulcer disease | Early years spent outside North America/Western Europe
180
Investigations for H.pylori infection
Urea breath test - positive | Stool antigen test - positive
181
History of GORD
``` FH of GORD Hiatal hernia Heartburn Acid regurgitation Dysphagia ```
182
Clinical findings of GORD
Bloating Laryngitis Enamal erosion Halitosis
183
Investigations for GORD
PPI trial - symptoms should improve | Oesophagogastroduodenoscopy
184
History of peptic ulcer disease
History of NSAID use Past ulcers Smoking Ingestion of food improves pain
185
Investigations for peptic ulcer disease
H.pylori breath test/stool antigen | Upper gastrointestinal endoscopy
186
History of lactose intolerance
Bloating Abdominal distress Loose stool after ingestion of lactose
187
Investigations for lactose intolerance
Dietary change | Lactose breath test - positive
188
Causative organism of thrush
Candida albicans
189
Clinical features of thrush
``` Thick, white vaginal discharge - usually non-malodorous Vulva itching Vulval soreness/irritation Superfical dysparenunia Dysuria ```
190
Management of thrush
``` Conservative - wear loose, cotton underwear - controlled diabetes - change of contraceptive Medical - intravaginal antifungal cream of pessary - clotrimazole - oral antifungal - fluconazole ```
191
Complicated candida infection
Recurrent infections - 4 or more in 1 year Severe infection Infection with other yeasts Infection during pregnancy Infection in women with uncontrolled diabetes or are immunocompromised
192
Risk factors for vulvovaginal candidiasis
``` Oestrogen exposure Immunocompromised state Poorly controlled diabetes mellitus Treatment with broad spectrum antibiotics Local irritants Sexual behaviours Contraception - spermacide gels - COCP HRT ```
193
Define bacterial vaginosis
Overgrowth of predominately anaerobic organisms | Vagina loses normal acidity and pH increases to greater than 4.5
194
Clinical features of bacterial vaginosis
50% asymptomatic | Fishy-smelling, thin, grey/white homogeneous discharge - not associated with itching or soreness
195
Management of bacterial vaginosis
Aysymptomic - no treatment usually required Symptomatic - reduce vaginal douching, antiseptics, bubble bath - oral metronidazole
196
Define diarrhoea
Passage of three or more loose/liquid stools per day | Acute - less than 14 days
197
Causes of acute diarrhoea
``` Viral infection - norovirus Bacterial cause - salmonella species - campylobacter jejuni - shigella species - escherichia coli Parasitic causes - cryptosporidium - giardia Drugs - laxatives - ARBs - antibiotics - chemotherapy - metformin - NSAIDs - PPIs - SSRIs Anxiety Food allergy Acute appendicitis Intestinal ischamia ```
198
Causes of blood diarrhoea
``` Bacterial - campylobacter jejuni - salmonella - escherichia coli - shigella - clostridium difficile Viral - cytomegalovirus Parasites - entamoeba histolytica - schistosomiasis ```
199
Causes of chronic diarrhoea
``` IBS Diet - FODMAP malabsorption - artificial sweeteners - caffeine - excess alcohol IBD Microscopic colitis Coeliac disease Malabsorption - lactose intolerance - pancreatic insufficiency Colorectal cancer Bile acid diarrhoea Constipation and faecal impaction ```
200
Red flag symptoms with diarrhoea
``` Blood in stool Recent hospital or antibiotic treatment Weight loss Evidence of dehydration Nocturnal symptoms ```
201
Causative organism of glandular fever
Epstein-Barr virus
202
Clinical features of glandular fever
``` Fever Pharyngitis Cervical or generalised lymphadenopathy Malaise Splenomegaly ```
203
Risk factors for EBV
Kissing | Sexual contact
204
Differentials for glandular fever
``` Group A Strep pharyngitis Hep A Acute HIV infection Adenovirus Human herpes virus 6 Cytomegalovirus infectoin Herpes simplex virus 1 Influenza infection ```
205
Management of glandular fever
``` Supportive care - paracetamol/ibuprofen - good hydration - avoid stenuous physical activity and contact sports for 3-4 weeks - risk of splenic rupture Corticosteriod - prednisolone - reduce upper airway obstruction and haemolytic anaemia IV immunoglobulin - thrombocytopenia ```
206
Complications of glandular fever
``` Severe upper airway obstruction Splenic rupture Fulminant hepatitis Encephalitis Severe thrombocytopenia Haemolytic anaemia ```
207
Investigations for glandular fever
``` FBC - lymphocytosis Heterophile antibodies - monospot - positive EBV-specific antibodies - positive LFTs elevated ```

Yr3 - GP (8 decks)

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