Week 2: Minor illness 1/3

Question 1

influenza

Answer 1

Contagious respiratory illness caused by influenza virus that infect the nose, throat and sometimes the lungs. Can cause mild to severe illness and can lead to death

Question 2

causes of influenza

Answer 2

• Spread mainly by tiny droplets made when people with flu cough, sneeze or talk

Question 3

presentation of influenza

Answer 3

• fever* or feeling feverish/chills
• cough
• sore throat
• runny or stuffy nose
• muscle or body aches
• headaches
• fatigue (tiredness)
• some people may have vomiting and diarrhoea, though this is more common in children than adults.

Question 4

complications of flu

Answer 4

• bacterial pneumonia
• ear infections
• sinus infections
• worsening of chronic medical conditions e.g. CHF, asthma or diabetes

Question 5

prophylaxis of influenza

Answer 5

flu vaccine

Question 6

diagnosis of influenza

Answer 6

• presentation
• rapid influenzas diagnostic test

Question 7

management of influenza

Answer 7

• antipyretic
• anti-viral – oseltamivir (Tamiflu)

Question 8

common cold

Answer 8

A mild self-limiting upper respiratory tract infection characterised by nasal stuffiness and discharge, sneezing, sore throat and cough.

Question 9

causes of cold

Answer 9

• Wide range of virus’ inc rhinovirus, coronavirus, influenza
• Can be transmitted in a variety of ways including
  
  • Direct contact
  • Small-particle aerosols
  • Large-particle aerosols

Question 10

presentation of common cold

Answer 10

The onset of symptoms is usually rapid, over 1–2 days.

• Sore or irritated throat — often the first symptom, typically has a sudden onset and resolves rapidly.
• Nasal irritation, congestion, nasal discharge (rhinorrhoea), and sneezing — nasal discharge is often profuse and clear, but may become thicker and darker as the infection progresses (although this does not usually indicate that bacterial infection is present).
• Cough develops in about 30% of people, typically after nasal symptoms have cleared.
• Hoarse voice caused by associated laryngitis.
• General malaise.
• Other symptoms are less common and may include:
  
  • Fever — this is unusual in adults and is typically low grade.
  • Headache and myalgia — more often associated with influenza rather than the common cold.
  • Loss of taste and smell, eye irritability, and a feeling of pressure in the ears or sinuses (due to obstruction or mucosal swelling).

Question 11

diagnosis of common cold

Answer 11

history

Question 12

management of common cold

Answer 12

• No know treatment improves the time course of infection
• Symptom relief and rest
  
  • Adequate fluid
  • Healthy food
  • Adequate rest
  • Paracetamol or ibuprofen
  • Steam inhalation

Question 13

management of common cold

Answer 13

• No know treatment improves the time course of infection
• Symptom relief and rest
  
  • Adequate fluid
  • Healthy food
  • Adequate rest
  • Paracetamol or ibuprofen
  • Steam inhalation

Question 14

sore throat can be caused by

Answer 14

• Acute pharyngitis- inflammation of the pharynx
• Tonsilitis- inflammation of the tonsils
• Common cold
• Glandular fever
• Flu

Question 15

non-infectious causes of sore throat

Answer 15

• GORD
• Drug induced e.g. Carbimazole
• Smoking
• Hayfever

Question 16

infectious causes of sore throat

Answer 16

• Rhinovirus
• Coronavirus
• Influenza type A and B
• Streptococcal infection e.g. strep pyogenes
• Adenovirus
• Haemophilus influenza

Question 17

How to different between pharyngitis and tonsilitis?

Answer 17

• Pharyngitis  exudate and erythema on pharyx
• Tonsilitis- exudate and erythema on tonsils
  
  • Higher temp

Question 18

in a person with a sore throat when should 999 be called

Answer 18

• epiglottitis
  
  • high pitched stridor
  • haemophilus type B
  • high fever
  • sore throat
  • sitting up and leaning forward
  • drooling due to difficulty swallowing
  • dont examine childs throat- dont want to distress

Question 19

in which patients should specialist advice be soert if they present with a sore throat

Answer 19

If person is on chemo, or has known suspected leukaemia (can be caused by carbimazole), asplenia, aplastic anaemia or HIV/AIDs or taking immunosuppressive therapy seek immediate specialist advice.

Question 20

which tool is used to decide whether sore throat is viral or bacterial in origin

Answer 20

• Viral if more systemic symptoms e.g. fever and cough
• Bacterial if localised to tonsils

Question 21

antibiotic of choice for tonsillitis

Answer 21

penicillin (5-10 days, QDS)or erythromycin

Question 22

common ear infections

Answer 22

• Otitis externa
• Otitis media
• Otitis media with effusion

Question 23

Signs and symptoms of ear disease (can be varied!)

Answer 23

• Otalgia (ear pain)
• Discharge
• Hearing loss (conductive vs sensorineural)
  
  • Tuning forks
• Tinnitus
• Vertigo
• Facial nerve palsy
  
  • Through the petrous bone (middle ear)
  • Disease involving the ear may manifest as facial palsy

Question 24

otitis externa

Answer 24

• Inflammation of the external ear esp EAM
• Known as swimmer ear
• Rare complication of otitis externa= malignant otitis externa
  
  • Rare and very serious potential life threatening esp in immunocompromised e.g. diabetics

Question 25

presentation of otitis externa

Answer 25

* Presents with ear pain and itchiness * Discharge

Question 26

management of otitis externa

Answer 26

* Advice on self-care measures e.g. avoid swimming for 7 days, use hairdryer to dry ear out after swim, over counter ear drops * Topic antibiotics e.g. amoxicillin with or without steroids e.g. hydrocortisone * Oral if immunosuppressive

Question 27

otitis media

Answer 27

* Middle ear infection * More common in infants/ children than in adults

Question 28

causes of otitis media

Answer 28

* Mostly viral aetiology * Occasionally bacterial * S. pneumonia * H. influenza

Question 29

presentation of otitis media

Answer 29

* Otalgia  infants may pull or tug at ear * Other non-specific symptoms e.g. temp * Red +/- bulging TM and loss of normal landmarks middle ear cavity full of puss

Question 30

why are children more susceptible to otitis media

Answer 30

**Why are children more susceptible?** * Pharyngotympanic tube is shorter and more horizontal in infants

Question 31

management of otitis media

Answer 31

amoxicillin paracetamol and ibuprofen

Question 32

presentation of **Otitis media with effusion “glue ear”**

Answer 32

* Looks retracted and TM looks straw coloured * May see evidence of fluid

Question 33

**MOA of otitis media**

Answer 33

* Not an actual infection- can predispose to infection * Due to **eustachian tube dysfunction** * Fluid and negative pressure in middle ear * Decreases mobility of TM and ossicles  affecting hearing * Also draws fluid from across the mucous membrane in the middle ear * Most resolve spontaneously without Abx in 2/3 months * If persists or impede speech and language development/ school performance * Require grommets (tympanostomy tube) * Act to maintain equilibration of pressure

Question 34

sinusitis is

Answer 34

Symptomatic inflammation of the paranasal sinuses.

Question 35

sinusitis causes

Answer 35

* Viral upper resp tract infection, followed by bacterial infection * Sinus mucosa oedema, obstruction of the sinus ostia, and reduction in mucociliary action allow secretions to stagnate and give bacteria a suitable environment in which to grow * Allergic rhinitis * Smoking * Impaired ciliary motility

Question 36

presentation of sinusitis

Answer 36

* Usually follows a common cold * Nasal blockage/ discharge * Facial pain/ pressure * Reduction in smell * Tenderness, swelling or redness over cheekbone * Cough * Bacterial sinusitis when symptoms * \>10 days * Discoloured or purulent nsala discharge

Question 37

**Management of sinusitis**

Answer 37

* If less than \<10 days – do not offer antibiotics * \>10 day * High-dose nasal corticosteroid * Antibiotics- penicillin