Week 2: Minor illness 2/3

Question 1

UTI

Answer 1

A lower urinary tract infection (UTI) is an infection of the bladder (also known as cystitis) usually caused by bacteria from the gastrointestinal tract.

Question 2

uncomplicated UTI

Answer 2

UTI caused by typical pathogens in people with a normal urinary tract and kidney function, and no predisposing co-morbidities.

Question 3

complicated UTI

Answer 3

UTI with an increased likelihood of complications such as persistent infection, treatment failure and recurrent infection.

Risk factors for complicated UTI include

• structural or neurological abnormalities of the urinary tract,
• urinary catheters,
• virulent or atypical infecting organisms and co-morbidities such as poorly controlled diabetes mellitus or immunosuppression.

Question 4

Pyelonephritis should be suspected in people with

Answer 4

fever, loin pain or rigors

Question 5

causes of UTI

Answer 5

Most common pathogen is E.coli less commonly Staphylococcus saprophyticus and klebsiella species

Question 6

RF for UTI

Answer 6

• Sexual intercourse
• PMH of UTI in childhood
• Family history
• Urinary incontinence
• Catheterisation

Question 7

Presentation UTI

Answer 7

• Dysuria
• Frequency
• Urgency
• Cloudy/ haematuria
• Nocturia
• Suprapubic tenderness
• May be less typical symptoms in older people

Question 8

diagnosis of UTI

Answer 8

• Urine dipstick: nitrite or leukocyte and RBC positive
• Urine culture should be taken in women who are: pregnant, >65yo, symptoms which don’t resolve with antibiotics

Question 9

management of UTI

Answer 9

• Self care measures e.g. fluids, pain killers
• First line: Nitrofurantoin or trimethoprim for 3 days
• Second line: penicillin or fosfomycin

Question 10

thrust

Answer 10

Vulvovaginal candidiasis (genital thrush) is a symptomatic inflammation of the vagina and/or vulva caused by a superficial fungal infection (usually yeasts that belong to the genus Candida)

• Candida yeasts are part of the normal flora of the mucous membranes of the female genital tract, but overgrowth can cause infection

Question 11

Risk factors for thrush

Answer 11

• Recent antibiotic use
• Local irritants such as soaps/ douching
• Uncontrolled DM
• Immunosuppression e.g. HIV

Question 12

presentation of thrush

Answer 12

• Vulval or vaginal itching
• Vaginal discharge ‘cheese-like’
• Superficial dyspareunia
• Dysuria

Question 13

diagnosis of thrush

Answer 13

• Self-collected low vulvovaginal swab if exam of the eternal genitals is not possible or needed
• Consider STI screening

Question 14

Bacterial vaginosis

Answer 14

Is characterized by an overgrowth of predominantly anaerobic organisms (such as Gardnerella vaginalis) and a loss of lactobacilli.

• BV is not generally regarded as a sexually transmitted infection; however, the prevalence is higher amongst sexually active women (than non-sexually active women), and it is considered by some experts to be ‘sexually associated’.

Question 15

pH in women with BV

Answer 15

The vagina loses its normal acidity, and vaginal pH increases to greater than 4.5.

Question 16

RF for BV

Answer 16

• Being sexually active
• Recent change in sexual partners
• Douching and vaginal washes
• Menstruation
• Semen in vagina

Question 17

diagnosis fo BV

Answer 17

• Speculum exam- white/grey coating on vaginal walls and vulva with fishy odour
• Test pH of vaginal discharge
• High vaginal swab for gram staining

Question 18

management of BV

Answer 18

oral metronidazole

Question 19

history of discharge in women (questions to ask)

Answer 19

need to determine if physiological discharge or more likely to be infective

• Characteristics of the discharge (onset, duration, colour, odour, consistency, and associated symptoms)
• Exacerbating factors - such as sexual intercourse
• Relieving factors - prescription or over the counter
• The use of vaginal products such as douches, deodorants and vaginal washes.
• Cyclical symptoms, PMH, DH incl contraceptive use.
• Assess the woman’s risk of STI (sexual partner history, younger than 25 years or age, previous STI)

Question 20

physiological discharge character

Answer 20

• white or clear
• non offensive discharge
• that can vary over time.

For example, it is thick and sticky for most of the menstrual cycle but becomes clearer, wetter and stretchy for a short period of time around ovulation. It is heavier and more noticeable during pregnancy, with contraceptive use, and with sexual stimulation.

Question 21

vaginal candidiasis discharge

Answer 21

White, odourless, curdy discharge that may be associated with vulval itching and superficial soreness.

PH would be lower than 4.5

Question 22

BV discharge

Answer 22

Fishy smelling, thin, grey/white homogenous discharge that is not associated with itching or soreness.

Ph would be higher than 4.5

Question 23

trichomoniasis discharge

Answer 23

This is an STI caused by parasites. Fishy smelling, yellow/green frothy discharge that may be associated with itching, soreness, dysuria. Men who have this typically have no symptoms.

PH would be higher than 4.5

Question 24

PID discharge

Answer 24

Characterised by vaginal discharge associated with post coital or intermenstrual bleeding, dysuria, deep dyspareunia or lower abdominal pain.

Question 25

**Examination and investigations for abnormal vaginal discharge**

Answer 25

1. Consider referring women at high risk of STI, or with characteristic features of trichomoniasis, cervicitis or PID to a GUM clinic or other local specialist sexual health service to facilitate screening for infections and partner notification. 2. Palpate the abdomen to assess for tenderness or a mass. 3. Inspect the vulva - for lesions, discharge, vulvitis, ulcers and any other changes. 4. Test the pH of the vaginal discharge to help distinguish between BV, vaginal candidiasis and trichomoniasis. 5. Take a vaginal swab for gram staining

Question 26

most common chest infections

Answer 26

bronchitis and pneumonia

Question 27

**Pneumonia**

Answer 27

is an infection of the lung tissue in which the air sacs in the lungs become filled with microorganisms, fluid and inflammatory cells, affecting the function of the lungs

Question 28

causes of pneumonia: community acquired

Answer 28

* streptococcus pneumonia; * haemophilus influenza, * moraxella catarrhalis

Question 29

causes of pneumonia: atypical organisms

Answer 29

* legionella pneumphila * chlamydia pneumoniae * mycoplasma pneumoniae

Question 30

causes of pneumonia: hospital acquired

Answer 30

E.coli

Question 31

RF for pneumonia

Answer 31

* Smoking, age\>65, immuno-suppression, exposure to chemicals, and underlying lung disease

Question 32

presentation of pneumonia

Answer 32

* Cough * SoB * Green sputum * Sweating * Fever * Shivers * Aches * Pain * Moderately to severely ill * Decreased breath sounds * Dullness to percussion * Vocal fremitus * Tachypnoea, tachycardia, dyspnoea * Temp above 38 * Hypoxia * Confusion * Abnormal chest x-ray

Question 33

what is used to classify pneumonia

Answer 33

CURB-65

Question 34

**Pneumonia investigations**

Answer 34

* **Key** is prompt assessment and CXR on admission * Consolidation on CXR (cant determine infection but can give clues) * CURB 65 score useful to guide management and stratify risk * Use local antibiotic prescriving guidelines * ABCDE approach – do not ignore signs of sepsis * No delay * ITU referral if high CURB -65 score * Blood tests: FBC, U&E and CRP * Sputum sample * ABG if sats low

Question 35

management of pneumonia

Answer 35

**amoxicillin (see other notes for 2^nd/3^rd line therapy)**

Question 36

**Bronchitis**

Answer 36

Is defined as a lower respiratory tract infection which causes inflammation in the bronchial airways * It is a clinical diagnosis characterized by cough resulting from acute inflammation of the trachea and large airways but with no evidence of pneumonia

Question 37

causes of bronchitis

Answer 37

* Viral infections e.g. rhinovirus, enterovirus, influenza A and B, coronavirus

Question 38

RF for bronchitis

Answer 38

* smoking; females who smoke may be at more risk than males who smoke. * childhood respiratory disease. * family history of lung disease. * exposure to pollutants. * asthma. * allergies. * gastroesophageal reflux disease (GERD) those who are older

Question 39

presentation of bronchitis

Answer 39

* cough * sputum, wheeze, breathlessness * substernal/ chest pain * normal CXR

Question 40

investigations for bronchitis

Answer 40

* CXR * Sputum sample

Question 41

management of bronchitis

Answer 41

first choice- doxycycline, second choice amoxicillin

Question 42

**Abscesses** An abscess is a painful collection of pus, usually caused by a bacterial infection. Abscesses can develop anywhere in the body.

Answer 42

* Skin abscesses- develop under the skin * Internal abscesses- develop inside the body, in an organ or in spaces between organs

Question 43

causes of abscesses

Answer 43

* Immune response to bacterial infection- WBC attack bacteria, some nearby tissue dies, creating hole which fills with pus to form abscess. Pus contains a mixture of dead tissue, WBC and bacteria * Internal abscesses usually develop as a complication of an existing condition e.g. infection elsewhere in the body e.g. burst appendix

Question 44

presentation of skin abscess

Answer 44

* Swollen * Pus filled lump under the surface of the skin * Could have a high temp and chills

Question 45

presentation of internal abscess

Answer 45

* Pain in affected area * High temp * Generally feeling unwell

Question 46

treatmetn of small skin abscess

Answer 46

* Small skin abscess may drain naturally or simply, dry up and disappear without any treatment

Question 47

treatment of larger skin abscesses

Answer 47

larger abscesses may need to be treated with antibiotics to clear infection and may need to be drained e.g. clindamycin

Question 48

treatment of internal abscesses

Answer 48

surgery