General Practice YR3 > Minor Illness Presentation > Flashcards

Minor Illness Presentation Flashcards

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1
Q

Background chicken pox

A
  • Varicella zoster causes
  • Incubation is 10 days-3 weeks –> then become symptomatic
  • Treatment conservative
  • Aciclovir considered in immunosupressed
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2
Q

How is itchiness controlled in CP?

A
  • Cut childs nails
  • Calamine lotion
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3
Q

What is shingles?

A
  • VZ virus lies dormant in sensory dorsal root ganglion cells
  • Gets reactivated = shingles
  • YOU CANNOT get shingles from someone with chicken pox
  • But you can get chicken pox from someone with shingles if you haven’t had it before
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4
Q

Chicken pox in pregnancy

A
  • Dangerous if before 28 weeks gestation –> development defects

-
* If around time of delivery -> can lead to life threatening neonatal infection
* Treat this with varicella zoster immunoglobilins and aciclovir

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5
Q

What to do if pregnant women <28 weeks gestation presents with CP exposure?

A
  • Establish immunity - have they had it before?
  • If they have -do not need to worry, immunity will protect
  • If they are unsure test for IgG and IgM levels
  • If no IgG detected - not had before and needs immunoglobulins and aciclovir
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6
Q

How does shingles present?

A
  • Neuropathic pain in dermatome before rash occurs usually
  • Can be mistaken for MI pain if on L of chest
  • Electric shock description of pain
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7
Q

What is Ramsay Hunt syndrome?

A

VZ affecting the facial nerve, can cause facial paralysis

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8
Q

What is fifth disease?

A
  • Viral illness caused by human parvovirus B19
  • Causes red rash on cheeks - aka slapped cheek/erythema infectiousum
  • Spreads respiratory droplets and vertically
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9
Q

Diagnosing fifth disease - presentation

A
  • Children 5-14
  • High fever
  • Runny nose and sore throat
  • Headache
  • Red rash on cheeks
  • Few days later get spotty rash on trunk
  • CLINICAL diagnosis - if atypical can test for Abs
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10
Q

Treatment for fifth disease

A
  • Encourage rest and fluid intake
  • Get better within 3 weeks
  • Can attend school - not infectious once rash emerges
  • If under 16 children should not haev aspirin - risk Reyes syndrome
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11
Q

Safety netting for fifth disease

A
  • Severe cases can get aplastic crisis - need hospital
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12
Q

What are childhood exanthems with examples?

A
  • Skin rashes commonly associated with viral infections in children
  • Eg Measles, chickenpox, roseola infantum, hand foot and mouth disease
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13
Q

What is first second and third disease?

A
  • 1st - Scarlet fever
  • 2nd - Measles
  • 3rd - Rubella
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14
Q

Scarlet fever

A
  • Bacterial infection
  • Group A streptococcus
  • Red rash, fever sore throat strawberry tongue
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15
Q

Measles

A
  • Very contagious 1:15
  • Red blotchy rash on face –> other parts of body
  • Fever, cough, runny nose
  • Can become disabled after infection
  • Vaccination MMR is important
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16
Q

Rubella

A
  • Mild infection
  • AKA german measles
  • Fever and swollen lymph nodes with spotty rash
  • Concerning during pregnancy –> can cause rubella syndrome in foetus
  • Those in fertility clinics get tested for immunity
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17
Q

What is conjuctivits?

A
  • Inflammationof conjuctival membrane - cornea clear and spared
  • Causes discomfort and gritty feeling
  • Usually viral but can be bacterial (get pus and dishcarge)
  • No visual changes on exam and eye is bloodshot and watery
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18
Q

Treatment for conjuctivitis

A
  • Conservative - do not need treatment
  • Sometimes give chloramphenicol eye drops if nursery needs for attendance (risk of aplastic anaemia with eye drops)
  • Usually improves within 5 days
  • Bathe with cooled boiled water
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19
Q

Advice for conjuctivitis

A
  • Very contagious
  • Can spread between eyes and people easily
  • Can go to community pharmacist for treatmetn
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20
Q

Stye - what is it?

A
  • Eyelash follicle infection - or oil gland of lids
  • Swelling at edge of eyelid
  • Caused by staphylococcus aureus bacteria
  • Painful red lump with white punctum
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21
Q

Treatment stye

A
  • Self limiting
  • Resolve within 3 months - a lot longer than conjuctvitis
  • Warm compress
  • Oral abx for severe cases
  • Consider marsupialisation if does not go within 3 months (incision and drainage)
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22
Q

Orbital cellulitis presentation

A
  • Post septal is most severe - sight and intracranial structures threatened
  • Deep to orbital septum
  • Periorbital is confined to superficial
  • Large orbital swelling, proptosis, reduced vision, painful eye movements
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23
Q

Treatment orbital cellulitis

A
  • Antibiotics
  • Sometimes given in primary care
  • Post septal will always need secondary care –> eye casualty in Leic
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24
Q

Management of sprain - what should you do

A

PRICE
* Protect - from further injury eg using support
* Rest
* Ice - for 15/20 mins every 2-3hrs
* Compression - elastic bandage, snug but not tight and removed for sleep (controls swelling and supports)
* Elevation - on pillows until swelling is controlled, for severe may need to immobilise

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25
What to avoid doing in sprain?
HARM * Heat - worsens bruising and inflammation by encouraging blood flow * Alcohol - increases bleeding and swelling and decreases healing * Running - or any other exercise which will further damage * Massage - increases bleeding and swelling
26
When to return to activity after sprain?
* As soon as you can tolerate without excessive pain * Athletes may return when full ROM without pain
27
Management of sprain - medical
* Paracetamol/topical NSAIDs * Oral NSAIDs * Short term use of codeine if needed * Can medically review after 5-7 days if lack of expected improvement or worsening * Consider physio referal if ongoing * Consider ortho referral if slower recovery, worsening or new symptoms, out of proportion symptoms
28
Safety netting for sprains
* Septic arthiritis/haemoarthrosis - fever, maialise, heat from ankle and tenderness * Compartment syndrome - pallor, paralysis, pulselessness, parasthesia
29
What is aphthous ulcer?
* Small erythematous ulcerations usually found in mouth but can be genitals (rarer) * NOT linked to systemic disease * Genetic predisposition, smoking cessation, iron/folate/B12 def, autoimmune conditions, anxiety and trauma can cause
30
3 types of aphthous ulcer
* Minor - 2-4mm diameter * Major - 1cm diameter * Herpetiform - multiple mini ulcers that can be very painful
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Minor ulcers
* Mildly painful, annoying * Heal in 7-10 days --> no scarring * Recurr 3/4x per year
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Major ulcers
* More painful * Recurr freq * 10-30 days to heal * Can scar
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Herpetiform ulcers
* Typically affects females * tiny discrete ulcers that coalesce into ulcerated patches * Heal in 10 days * recur freq
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Management of aphthous ulcer
* Mild - OTC like bonjela and reassure * Severe pain - topical corticosteroid (hydrocortisone oromucosal tablets) * Ask patient to return if not resolved within 2 weeks (up to 6 for major)
35
What to consider if non-resolving ulcer?
* FBC - rule out anaemia * Iron and B12 levels * ESR/CRP * IgA-ttG for coeliac * Malignancy suspicion - non resolving in 3 weeks, growing outwards, cervical lymphadenopathy or oral cancer RF
36
Oral cancer RF
* Betel nut chewing * Smoking * Alcohol * Chewing tobacco
37
Headlice
* Parasitic infection - hairs on head and feeds on scalp blood * Transmitted via head to head contact or sharing combs/towels * Itchy scalp with visible nits (eggs) and lice
38
When can diagnose active infestation headlice?
* Not just if nits * Need to haev live lice to diagnose active * Treat if live louse found
39
Treatment headlice
* Wet combing with fine tooth head louse comb first line - eg **Bug Buster kit** * Physical insecticide - eg **Dimeticone 4%**coats lice and suffocates them * Traditional insecticide - eg **malathion 0.5% liquid** * Detection combing should be done after treatment to confirm success (no live lice) * Unsuccessful - check close conacts, repeat
40
Advice headlice
* Can still attend school * No evidence of clean vs dirty hair lice prefers * No need to treat clothing/bedding - lifespan 1-2 days off human head * Children primary school age examined regularly as it not possible to prevent
41
Scabies - what is it
* Caused by mites burrowing into skin and lay eggs * These hatch and cause inflammatory response = itching * Spread is prolonged skin to skin contact or towels/clothing/bedding
42
Treatment scabies
* All members household treated * Close contacts/sexual contacts within last month treated too - may need GUM for contact tracing * **Permethrin 5% cream** - but cannot have this if broken/secondary infected skin * Can use sedating antihistamine eg piriton if sleep affected (chlorphenamine)
43
How does permethrin cream work?
* kills mites which cause scabies * Apply to whole body - esp between fingers, under nails, armpits - not to broken skin/eyes though * Cream is **flammable** - careful if smokers * Wash cream off after 8-12hrs * Side effect of tingling/stinging when apply but transient
44
Advice scabies
* Bedding, clothing and towels hot wash at 60 degrees * Then dry in hot dryer, dry cleaning or seal in bag for 72hrs * Itching can continue for up to 4 weeks after successful treatment * Avoid scratching if possible - prevent secondary bacterial infections
45
What is nappy rash?
* Inflammation of babys skin caused by prolonged contact with damp nappy * Scaly, dry skin, itchy/painful bottom, red/raw patches, skin that is sore/hot to touch and baby distressed * Caused by nappy rubbing against babys skin, allergic reactions, irritations from wipes, urine/faeces contact with skin for prolonged time
46
Do's for nappy rash
* Change wet nappies ASAP * Keep skin clean and dry - pat and rub gently * Leave nappies off when possible * Use extra absorbant nappies * Make sure they fit properly * Clean baby's skin with water/fragrance free/alcohol free wipes * Bath baby daily but not more than twice a day --> dries skin out
47
Don'ts for nappy rash
* Dont use soaps, lotion or bubble bath --> irritants * Do not use talc/antiseptics * Do not put nappies on too tight --> irritates skin
48
Management nappy rash
* Advice as above * Mild - OTC barrier cream eg Sudocrem * Inflamed - topical 1% hydrocortisone for 7 days max * Candida - topical clotrimazole and miconazole * Bacterial infection - flucloxacillin
49
Saftey netting nappy rash
* No improvement within 7 days - book f/u * Itching/burning discontinue medication * Seek emergency help if allergic reaction to medication
50
What is plantar fasciitis?
* Pain associated with degeneration of plantar fascia because of repetitive microtears * Common for 40-60yrs and females * RF inc prolonged standing occupations, obesity, diabetes and athletes
51
Typical description plantar fasciitis
* Initial gradual onset of heel pain * Intense pain during first few steps after waking/period of inactivity * Pain that reduces with moderate activity but worsens later during day or after long periods standing/walking
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Signs of plantar fasciitis
* Tenderness on plantar heel region * Limited dorsiflexion * Tight achilles tendon * Antalgic gait - limping
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Management plantar fasciitis
* Rest foot * Wear shoes with good arch support and heel cushioning +/- insoles * Avoid walking barefoot * Lose weight if overweight/obese * OTC analgesia - paracetamol/NSAIDs * Ice packs for 15-20 mins * Self exercises to stretch fascia * Referral to physio/podiatry if needed * Consider steroid injections as last resort * Can refer to orto surgery or extracorporeal shockwave therapy
54
What is impetigo?
* Superficial bacterial skin infection caused by either staphylococcus aureus or streptococcus pyogenes usually * Can be primary or complication of existing condition eg eczema/scabies/insect bites * Common in children esp during warm weather
55
Two types of impetigo
* Bullous * Non-bullous
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Spread of impetigo cause
* Skin injuries * Poor hygiene * Close contact * Crowded/close living conditons * Compromised immune system
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Treatment impetigo
* 1% hydrogen peroxide cream or fusidic acid cream often used * Topical mupirocin if fusidic acid allergic * If extensive disease oral flucloxacillin/erythromycin can be used * Children should not attend school until lesions are crusted and healed for until 48hrs after commencing abx
58
Practical advice impetigo
* Good hand hygiene * Avoid scratching * Keep nails short * Isolate contaminated items * Clean and disinfect items
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Advice for outdoors for insect bites
* Wear long sleeved tops and trousers * Don't lie on grass - use blankets * Avoid bright clothes - can attract * Insec repellent
60
Sympotms of insect bite
* Red swollen lump - can be painful +/- itchy * Usually imrpove within few hours/days * Some people have mild allergic reaction - larger red area, resolves within 1 week
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Treatment insect bite
* Wash skin with soap and water to decrease chance of infection + cold compress * Paracetamol/ibuprofen if painful * Antihistamine for itching * Hydrocortisone cream to decrease itching and swelling * Avoid itching - increase risk of infection
62
How to know if bite is infected
* Redness/tenderness * Pus * Feeling unwell * Flucloxacillin used, Clarithromyin in allergy to penicillin * Consider abx lower threshold if diabetic/immunocompromised
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Safety netting advice insect bites
* Infected bites can lead to cellulitis/sepsis * Advice patients to look out for red flags eg systemically unwell * Call 999 if symptoms of anaphylaxis - ABC affected/widespread urticaria
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General Practice YR3
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