Give 5 features of acute bronchitis infection which indicate need for abx
- co morbidity eg asthma, copd, bronchiectasis, immunosurpression
- extremes of age
- crackles on auscultation
- deranged obs (high temp. RR, HR etc)
- purulent sputum
How are viral upper resp tract infections managed?
- no abx needed
- advise may take 2-3 weeks to resolve
- advise good hygiene
- steam inhalation
- vaporub
- lozengers
- cough medicines (no evidence for or against use)
What most commonly causes an upper resp tract infection?
rhinovirus and coronavirus mostly, can also be influenza, adneovirus etc
Describe the symptoms of a lower UTI
- frequency
- urgency
- polyurea
- pain on urination
- haematuria
- suprapubic tenderness
If have 3 -empirical abx without need for dipstick
Give 3 risk factors for a UTI
- female
- catheters
- abnormal anatomy (duplex ureters etc)
- antibiotic use
- sexually active
- diabetes
- immunocompromised
What results on a urine dip indicate a uti is present (3)
- cloudy urine
- nitrites
- leukocyte esterase
- blood
When should a urine sample from a suspected UTI not be sent for MSU?
Non pregnant woman of child bearing age, who hasnt already been tried with empirical antibiotics
When should you refer someone for cystoscopy or imaging due to a UTI?
- persistantly not responded to treatment
- visible haematuria
- women with recurrent infections who are not responding to preventative measures
- men with two or more episodes in three months
- infant<3 months
What is management for uncomplicated UTI
pain relief
nitrofurantion (trimethoprim has lots of resistance) 3 days in females 7 in males
What is first line therapy for mild pyelonephritis
7-10 days ciprofloxacin
What is treatment option for recurrent UTIs with no structural abnormalities
if associated w/ sexual intercourse- low dose trimethoprim within 2 hrs
if not, low dose trimethoprim or nitro daily
What signs are concerning in UTI?
- delirium
- high fever
- loin pain
- N+V
- sepsis red flags
State the factors which score a point on the fever pain score and when are abx indicated?
- fever
- pus on tonsils
- attend within 3 days of symptom onset
- Inflammed tonsils
- No cough or coryza
Score> 2-3= delayed abx, score > 4 = immediate abx
What is major complication of tonsilitis
Peristonsilar abscess (cannot open mouth, drooling, foul breath, hot potato voice, uvula deviation. high risk of necrotising fascitiis, airway compromise, aspiration)
What abx is reccommended in bacterial tonsilitis
phenoxymethylpenicillin (penicillin v)
Which abx is used in acute bronchitis, if abx are indicated?
amoxicillin
How is community aquired pneumonia assesed? which abx is first line?
CURB 65
amox/ doxy
What abx are indicated for treating UTIs in pregnancy
1st tri= nitro
2nd= nitro or trimeth
3rd= trimeth
How does conjunctivitis present?
red eye
bilateral
gritty feeling
discharge- watery, purulent, sticky
What are red flags for red eye? (6)
- marked pain, photophobia, PMH autoimmune conditions (uveitis)
- marked redness in one eye
- reduced acuity (retinal involvement, uveitis. glaucoma)
- hazy cornea, extreme pain, N+V w/ pain (glaucoma)
- Rashes (herpes zoster ophthalmicus)
- trauma (mechanical or chemical)
- possible foreign body (invert eyelid)
What viruses commonly cause conjunctivitis?
- adenovirus
- herpes simplex virus
- herpres zoster ophthalmicus
- chlamydia (in neonates)
What bacteria commonly cause conjunctivitis? What symptoms point towards bacteria over virus
Staph species, strep pneumonia, haemophilus influenzae
Thick purulent discharge, mild photophobia (more severe= more likely viral), bilateral,
How is bacterial conjunctivitis managed?
Self limiting
Seek medical attention if not resolve in 2 weeks, eye pain, photophobia, loss of acuity
Lubricant OTC eyedrops
Avoid others
Remove contacts until 24 hrs after resolved
Topical abx (chloramphenicol) if not resolved or severe
What are the red flag symptoms of dyspepsia/ indigestion? (4)
- unintentional weightloss
- recurrant vomiting
- dysphagia
- evidence of GI bleeding (anaemia, coffee ground vomit, malaena)
