Tutorial 3 - Minor illnesses

Question 1

Briefly describe:
a) the types of antibiotics out there
b) how they each respectively work
c) which antibiotic is best for what

Answer 1

1. Beta lactams ( penicillins - penicillin v, flucloxacillin, amoxicillin, co - amoxiclav and cephalosporins - ceftriaxone) - these antibiotics work by inhibiting the peptidoglycan wall synthesis, these can help with meningitis / pneumonia / UTI’s and penicillins are especially good for skin and middle ear infections.
2. Tetracyclines ( i.e tetracycline or doxycycline), these antibiotics inhibit key protein synthesis. Good for RTI’s and acne.
3. Macroides (i.e. clarithromycin), these antibiotics also inhibit key protein synthesis. Good for most things that penicillin is and respiratory tract infections ( prescribe if allergic to penicillins class).
4. Nitrofurans ( i.e. nitrofurantoin), these antibiotics also inhibit key protein synthesis. Good for UTI’s
5. Quinolones (i.e. ciprofloxacin )

Question 2

Name 5 common upper respiratory tract infections ?

Answer 2

• Common cold
• Epiglotittis
• Laryngitis
• Pharyngitis
• Sinusitis

Question 3

1. What is the common cold ?
2. How does it present ?
3. What are its risk factors ?
4. What tests / exams / investigations can be done ?
5. How is it managed ?

Answer 3

1. Viral infection of the nose and throat.
2. Cough, sneeze, blocked nose, headache, temperature.
3. Infants, smokers, winter months, immunocompromised,
4. Based on signs and symptoms alone, although other tests can be done to rule out other conditions.
5. Plenty of rest, plenty of fluids, gargle salt water for sore throat, various OTC solutions to ease symptoms of cold, other than this self limiting 7 - 10 days.

Question 4

1. What is epiglottis ?
2. How does it present ?
3. What are its risk factors ?
4. What tests / exams / investigations can be done ?
5. How is it managed ?

Answer 4

1. Epiglotittis is inflammation and swelling of the epiglottis.
2. Difficulty swallowing, difficulty breathing , drooling, muffled voice.
3. Affects males more. Often caused due to infection from haemophilia influenzas or staph aureus, so lack of immunisation against HIB and being immunocompromised can increase risk.
4. Neck x-ray - thumb print sign, throat culture ( HIB ), FBC.
5. Urgent treatment. Tube inserted past epiglottis with high flow oxygen, if not possible then emergency tracheostomy - this secures airway. Broad spectrum antibiotic i.e. IV ceftriaxone and once causative organism is discovered more targeted antibiotic treatment can be given.

Question 5

1. What is the pharyngitis ?
2. How does it present ?
3. What are its risk factors ?
4. What tests / exams / investigations can be done ?
5. How is it managed ?

Answer 5

1. Inflammation of the pharynx
2. Sneezing, runny nose, headache, sore throat, fever
3. Smoker, immunocompromised.
4. Throat culture
5. Viral infection - goes away on its own, bacterial infection - treated with antibiotics

Question 6

1. What is the laryngitis ?
2. How does it present ?
3. What are its risk factors ?
4. What tests / exams / investigations can be done ?
5. How is it managed ?

Answer 6

1. Inflammation of voice box / voice cords.
2. Hoarse voice, losing voice, cough, sore throat.
3. Overusing voice i.e. shouting / singing, smoking.
4. Laryngoscopy, throat culture
5. Often goes away in its own, try speak as little as possible, gargle warm salt water, if bacterial infection - antibiotics can be prescribed.

Question 7

1. What is the sinusitis ?
2. How does it present ?
3. What are its risk factors ?
4. What tests / exams / investigations can be done ?
5. How is it managed ?

Answer 7

1. Sinusitis is inflammation of the sinuses ( ethmoidal, maxillary etc ). The sinuses are small gaps behind your cheek bones / forehead which connect to the nose.
2. Yellow / green discharge from nose, blocked nose, pain in cheek / eye/ forehead region.
3. Smoker, recent cold, nasal polyps, allergies ( allergic rhinitis )
4. Allergy testing, nasal endoscopy.
5. Depends on the cause of the sinusitis - infection - antibiotics, cold - rest / fluids / nasal decongesting sprays, allergic rhinitis - antihistamines, avoid allergic trigger. Refer to ENT if not responding to treatment within a week or 2, get recurrent sinusitis.

Question 8

1. What is the tonsillitis ?
2. How does it present ?
3. What are its risk factors ?
4. What tests / exams / investigations can be done ?
5. How is it managed ?

Answer 8

1. Tonsilitis is the inflammation of the tonsils.
2. Sore throat, difficulity swallowing, bad breath, earache
3. Young age, populated places such as nurseries where children frequently come into contact with viruses / bacteria which cause it.
4. Swab, check palatine tonsils - inflamed / white / pus ( quinsy - abcess).
5. Often caused by a viral infection, so should clear up on its own. If bacterial infection than course of antibiotics can be given.

Question 9

1. What is the glandular fever ?
2. How does it present ?
3. What are its risk factors ?
4. What tests / exams / investigations can be done ?
5. How is it managed ?

Question 10

Name 3 common lower respiratory tract infections.

Answer 10

• Acute bronchitis
• Community acquired Pneumonia
• Tuberculosis

Question 11

1. What is community acquired pneumonia ?
2. How does it present ?
3. What are its risk factors ?
4. What tests / exams / investigations can be done ?
5. How is it managed ?

Answer 11

1. Pneumonia is the inflammation of lung parenchyma due to a bacterial / viral lung infection. Most commonly due to streptococcus pneumoniase.
2. Pleuertic chest pain, difficulty breathing, cough ( productive - yellow / green / bloody mucus ), tachycardia, tachypnea.
3. Babies, elderly, immunocompromised, smokers, pre - existing lung conditions i.e. asthma, COPD.
4. Resp exam - crackles ( due to fluid in small air sacs ), decreased breath sounds, bronchial breathing, dull percussion, vocal fremitus . Xray - consolidation ( fluid build up ). Blood test (FBC). Sputum / blood culture. CURB - 65 to access risk.
5. Antibiotic course - commonly a penicillin such as amoxicillin, if allergic can give macrolide such as clarithromycin or tetracycline such as doxycycline. The latter is bacteriostatic not bactericidal, so make take longer to clear the infection.

Question 12

1. What is acute bronchitis ?
2. How does it present ?
3. What are its risk factors ?
4. What tests / exams / investigations can be done ?
5. How is it managed ?

Answer 12

1. Acute bronchitis is inflammation of the bronchi.
2. Cough ( dry or productive ), body aches, fatigue, headache, soreness of chest, sore throat.
3. Smoking, gastric reflux, occupation i.e in contact of textiles known to inflame airway.
4. Wheeze, rhonci, CXR ( rule out a pneumonia).
5. Often a viral cause so rest, plenty of fluids and analgesia such as NSAIDS are recommended. Rarely can be bacterial case in which case course of antibiotics given.

Question 13

1. What is tuberculosis?
2. How does it present ?
3. What are its risk factors ?
4. What tests / exams / investigations can be done ?
5. How is it managed ?

Answer 13

1. TB is a lower respiratory tract infection caused by mycobacterium tuberculosis. It is spread by inhalation of droplets from someone who has active infectious TB. TB can also be described a latent - if the person is no longer infectious - due to granuloma production by patient to surround the bacteria.
2. Persistent cough ( productive / bloody ), weight loss, night sweats, fatigue, appetite loss.
3. Recent travel i.e. Pakistan, India, Romania. Younger children ( < 5 yrs ). Close contact with someone with diagnosed active infectious TB. Immunocompromised (i.e. HIV).
4. Active - CXR, sputum culture
   Latent - tuberculin skin test
   Be careful of younger children / immunocompromised patients who might falsely flag as negative.
5. If treated in time often completely curable. 6 month course of antibiotic / antibiotics ( resistance ). Will still be infectious till around 2 -3 weeks of treatment - so be careful.

Question 14

Name 2 common urinary tract infections.

Answer 14

• Pyelonephritis ( UUTI )
• Cystitis ( LUTI )

Question 15

1. What is pyelonephritis?
2. Which micro - organism causes it ?
3. How does it present ?
4. What are its risk factors ?
5. What tests / exams / investigations can be done ?
6. How is it managed ?

Answer 15

1. Pyelonephritis is infection of one or both kidneys, often bacterial infection tracking up from bladder.
2. E - coli ( gram negative bacilli )
3. Loin to groin pain, fever , painful / burning urination, cloudy urine, blood In urine.
4. kidney stones, BPH, vesicouretral reflux ( secondary to inadequate bladder emptying - blockage / nervous system ), catheter.
5. Mid stream urine sample for testing of bacteria, urine dipstick (if positive for nitrates and leukocytes - likely bacterial infection). Dipsticks not done for those over 65, or cathertised patients.
6. Admit to hospital if any sins of sepsis ( tachcardyia, hypotension, confusion , impaired consciousness etc). Otherwise treat with appropriate antibiotic course i.e. a quinolone such as ciprofloxacin or trimethoprim or a penicillin agent such as co - amoxiclav.

Question 16

1. What is cystitis, what is meant by a complicated UTI and a recurrent UTI?
2. Which micro - organism causes it ?
3. How does it present ?
4. What are its risk factors ?
5. What tests / exams / investigations can be done ?
6. How is it managed ?

Answer 16

1. • Cystitis is a lower urinary tract infection of the bladder.
   • Complicated - anatomical variation, male, atypical pathogen, immunocompromised.
     
     • Recurrent - 2 X UTI’s in space of 6 months or 3x in space of 12 months.
2. E - Coli
3. Frequency, urgency, dysuria ( FUD) low abdominal pain, cloudy, temperature.
4. Female, wiping from back to front, catheter, immunocompromised, diabetic, kidney stone, BPH, menopause.
5. Urine culture / dipstick test.
6. Antibiotics , oestrogen vaginal cream ( for menopause related UTI ).

Question 17

What pathogens cause the flu and what is complicated influenza ?

Answer 17

• Influenzas virus A ,B,C (mildest form)
• Complicated influenzas is often caused by either initial infection from strain B/C, and it is where the flu has either caused hospital admission , exacerbation of pre - existing condition, encephalitis ( brain infection), lower respiratory tract infection ( pneumonia ).

Question 18

Compare and contrast antigenic shift vs drift in relation to influenza A.

Answer 18

• Influenza A has 2 surface antigens H and N.
• Shift - Influenzas A H and/or N antigens have minor mutations, causing seasonal epidemics due to only partial immunity.
• Drift - Influenza A H and/or N antigens has major and sudden changes meaning that no one is immune anymore leading to seasonal epidemics.

Question 19

1. What is influenza ?
2. Which micro - organism causes it ?
3. How does it present ?
4. What are its risk factors ?
5. How is it managed ?

Answer 19

1. Influenza is a viral infection that normally presents seasonally due to the regular mutations of the strains.
2. Influenza A,B,C.
3. uncomplicated - fever, headache, fatigue, myalgia, GI upset, athalgia, sore throat, runny nose.
4. Very young ( 5 months - 5 years), elderly ( > 65 yrs), immunocompromised patients, obese people.
5. Uncomplicated - supportive measures ( rest, fluids, analgesia), complicated - prompt antiviral therapy +/- hospital admission.

Question 20

1. What is candidiasis?
2. Which micro - organism causes it ?
3. How does it present ?
4. What are its risk factors ?
5. What tests / exams / investigations can be done ?
6. How is it managed ?

Answer 20

1. Candidiasis is infection of the vagina and/or vulva due to a yeast infection by Candida albicans ( 90 % of the time ).
2. Candida albicans
3. Vaginal discharge ( white, non offensive), dysparaneuia, dysuria, itchiness / discomfort, erythema.
4. Pregnancy, diabetes, recent antibiotic treatment.
5. High vaginal swab
6. Emollient to moisturise, wear lose fitting underwear, good hygiene ( but avoid any harsh cleaning soaps / vaginal douching), anti fungal pessary , oral tablet, topical treatment.

Question 21

1. What is gastro oesophageal reflux disease (GORD) ?
2. How does it present ?
3. What are its risk factors ?
4. What tests / exams / investigations can be done ?
5. How is it managed ?

Answer 21

1. GORD is a chronic condition which results in the reflux of bile, acids and pepsin up the oesophagus.
2. Heartburn , acid reflux ( bad taste), bad breath, oesphagitis - causing pain when swallowing, hoarse voice / sore throat, persistent cough.
3. Obesity, delayed gastric emptying, hiatus hernia, pregnancy.
4. Endoscopy , barium swallow
5. Offer lifestyle advice i.e. lose weight, eat small regular meals, avoid trigger foods, stop smoking, reduce alcohol intake, offer PPI i.e.omeprazole for 4 - 8 weeks.

Question 22

1. What is peptic ulcer disease (PUD) ?
2. How does it present ?
3. What are its risk factors ?
4. What tests / exams / investigations can be done ?
5. How is it managed ?

Answer 22

1. PUD is ulceration beyond the muscalris mucosae, in the stomach or duodenal region.
2. Abdominal pain in epigastric region, Haematemesis, malaena, nausea / vomitting.
3. Smoking, alcohol, NSAID use, infection with H - Pylori.
4. Endoscopy, urea breath test for H pylori.
5. Advice such as losing weight, eat small regular meals, smoking cessation, alcohol abstinence, PPI, H2 blocker
   ( reduce stomach acid to allow ulcers to heal), antibiotics to treat h - pylori infection.

Question 23

Name some conditions which cause a change in bowel movement ?

Answer 23

• IBS
• IBD
• Colorectal cancer
• Coeliacs
• Gastro - enteritis
• Hypo / hyper thyroid

Question 24

1. What is Crohns ?
2. How does it present ?
3. What are its risk factors ?
4. What tests / exams / investigations can be done ?
5. How is it managed ?

Answer 24

1. Crohns disease is a chronic relapsing - remitting condition resulting in the inflammation of the GI tract. It presents with skip lesions - meaning it can affect any part of the GI tract from mouth to anus and leave “healthy” tissue in-between, it is trans - mural meaning it affects the full thickness of the GI wall and it often affects the terminal ileum.
2. Diarrhoea, abdominal pain, blood in stool, fistulae, reduced appetite / weight loss, skin rashes, arthiritis, iron deficient anaemia.
3. Age ( < 30 yrs), family history, smoking , ethnicity (whites at greatest risk ).
4. Colonoscopy, CT scan ( fistula), FBC (anaemia), U&Es, stool culture (gastroenteritis), coeliacs test, faecal calprotectin, CRP, serum ferritin / bB12/ folate / vitamin D.
5. Not creative - aim is always long term remission. Medication such as corticosteroids, immunosuppressive drugs, biologic therapy, aminosalicylates can be used. Surgery should be avoided - only do if necessary i.e. severe fistula.

Question 25

1. What is Ulcerative colitis (UC) ? 2. How does it present ? 3. What are its risk factors ? 4. What tests / exams / investigations can be done ? 5. How is it managed ?

Answer 25

1. UC is a chronic relapsing - remitting inflammatory bowel condition. It only affects the large colon and only the gastric mucosa. Classed by level of inflammation , i.e. just rectum, up to splenic flexure, past splenic flexure. 2. Abdominal pain, blood in stool, diarrhoea, arthiritis, erythema nodosum. 3. Age, family history, ethnicity ( whites ). 4. FBC, CRP, coeliacs tests, imaging (i.e. xray / CT ), stool culture, faecal calprotectin test, colonoscopy. 5. Medication such as corticosteroids, immunosuppressive drugs, biologic therapy, aminosalicylates can be used. Potentially curative with surgical removal of colon and anus.

Question 26

1. What is colorectal cancer ? 2. How does it present ? 3. What are its risk factors ? 4. What tests / exams / investigations can be done ? 5. How is it managed ?

Answer 26

1. Cancer of the large bowel 2. Persistent blood in stool , change in bowel movement, persistent lower abdominal pain, weight loss, abdominal lump. 3. Age > 60 yrs, diet high in red and processed meats, obesity, alcohol. smoking, family history, pre existing IBD. 4. DRE / abdo exam, colonoscopy, CT scan. 5. Surgery, radiotherapy, chemotherapy.

Question 27

1. What is primary vs secondary hyperthyroidism ? 2. What are its risk factors ? 3. What tests / exams / investigations can be done ? 4. How is it managed ?

Answer 27

1. Primary - High T4, low TSH ( hypothalamus / pituitary system working fine ). Secondary - High TSH and T4 ( problem in hypothalamus / pituitary system). 2. Family history, age (> 60 yrs), pre - existing autoimmune condition i.e. diabetes, iodine rich diet. 3. Thyroid function blood test ( measures circulating T4 and TSH) 4.. Medications which blocks thyroid from producing hormones, removal of thyroid, radio iodine therapy - destroys some hormone producing cells in thyroid.

Question 28

1. What is primary vs secondary hypothyroidism ? 2. What are its risk factors ? 3. What tests / exams / investigations can be done ? 4. How is it managed ?

Answer 28

1. Primary - low T4, high TSH Secondary - Low TSH, low T4 2. Thyroid surgery, radiotherapy, medicines i.e. lithium. 3. Thyroid function blood test ( measures circulating T4 and TSH) 4. Levothyroxine.

Question 29

Compare and contrast how hypo / hyper thyroidism would present.

Answer 29

- CHAMPS - Changes in bowel habits - hypo = constipation, hyper = diarrhoea. - Hair loss - Both can cause hair loss. - Apetite + weight - hypo - gain weight / lose appetite ,,,, hyper - lose weight / increased appetite - M - Hyper - lighter menstruation, hypo - heavier mestruation - Preference to temperature - hyper = feeling more warm, hypo = feel cold when others feel warm - Skin - hypo - dry,, hyper - sweaty.

Question 30

1. What is coeliacs ? 2. How does it present ? 3. What are its risk factors ? 4. What tests / exams / investigations can be done ? 5. How is it managed ?

Answer 30

1. Coeliacs is a chronic immune related inflammatory disorder of the small bowel triggered by exposure to gluten / gliadin antigen ( wheat, rye, barley). 2. Diarrhoea, nausea / vomitting, abdominal pain / cramps, bloating, vitamin B12 / iron deficiency. 3. Family history 4. Blood test- antibodies against gluten / gliadin. 5. Gluten free diet life long.

Question 31

1. What is gastroenteritis ? 2. How does it present ? 3. What tests / exams / investigations can be done ? 4. How is it managed ?

Answer 31

1. Transient disorder due to infection of the enteric system with bacteria, viruses or fungi. 2. Diarrhoea, vomitting, fever, stomach pain, stomach cramps, dehydration. 3. Clinical symptoms 4. Depending on cause antibiotics/antifungals. Most are caused due to viral infection which are self limiting - supportive measures are given i.e., fluids, rest, analgesia - maybe OTC medication to help with diarrhoea such as loperamide.

Question 32

1. What are haemorrhoids? 2. How does it present? 3. What are its risk factors? 4. What tests can be done? 5. What is the management?

Answer 32

1. Abnormally swollen vascular mucosal cushions. They are further divided into internal and external haemorrhoids depending if they pass the dentate line. Below the denote line (external haemorrhoids) are lined with epithelia which are lined with pain nerve fibres, above the dentate line pain is not felt as there are no pain nerve fibres. 2. Bright red blood, perianal pain, mucous discharge, lumps, itchiness. 3. Things that increase intra abdominal pressure I.e., constipation, straining, pregnancy, heavy lifting, chronic cough. 4. Clinical history and examination of perianal area. 5. High fibre diet/laxatives, anal hygiene, simple analgesia i.e. paracetamol , rubber band ligation, haemoriectomy.

Question 33

1. What are anal fissures? 2. How does it present? 3. What are its risk factors? 4. What tests can be done? 5. What is the management?

Answer 33

1. An anal fissure is a tear/ulcer in the lining of the anal canal. They can be acute (< 6 weeks), chronic (> 6 weeks), primary and secondary depending if cause is known or not. 2. Sharp pain of defecation, bright red blood. 3. Constipation, other conditions i.e., Crohns, colon cancer. 4. Diagnosis often based on clinical history and examination on perianal area. 5. Supportive measures i.e., hydration/ plenty of fibre. Warm bath (relaxed anal sphincter - allowing blood flow to help healing process), GTN spray to relax anal spinster - allowing blood flow.

Question 34

1. What is a migraine? 2. How does it present? 3. What are its risk factors? 4. What is the management?

Answer 34

1. Type of primary headache. 2. Moderate - severe unilateral throbbing/pulsating pain (up to 72 hours), photophobia, phonophobia, nausea/vomiting, aura. 3. Lack of sleep, missed meals, menstruation, excessive caffeine consumption. 4. Avoid triggers i.e., lack of sleep. Analgesia i.e., paracetamol, triptans - sumatriptan. Anti - emetic - metoclopramide for vomitting. Amitriptyline for migraine prevention.

Question 35

1. What is a tension type headache? 2. How does it present? 3. What are its risk factors? 4. What is the management?

Answer 35

1. Type of primary headache. 2. Dull bilateral pain (30 mins - several hours), face tenderness, feeling of pressure behind the eye, photophobia, photophonia. 3. Lack of sleep, skipped meals, eye strain. 4. Avoid triggers I.e., lack of sleep. Analgesia i.e., paracetamol. Triptan i.e., sumatriptan. Amitriptyline can be given in an effort to prevent headache.

Question 36

1. What is a cluster headache? 2. How does it present? 3. What are its risk factors? 4. What is the management?

Answer 36

1. Primary headache disorder. Headaches occur at regular time each day for 15 mins - 3 hours for 3 month period then remission for a year/years then its back. 2. Severe headache behind one eye. Can also present with eye watering, swollen eyelids, photophobia, phonophobia, 3. Smoking, alcohol 4. Triptans - sumatriptan. Oxygen therapy. CCB i.e., verapamil.

Question 37

1. What is medication overuse headache? 2. How does it present? 3. What are its risk factors? 4. What is the management?

Answer 37

1. Secondary headache disorder. 2. Pain occurs everyday - often on waking. Improves wit h simple analgesia - but often reoccurs later on. 3. Taking pain relief i.e. NSAIDS or triptans for over 15 days a month. 4. Stop taking pain relief, prescribe antiemetics for withdrawal symptom (vomiting), explain headaches will be worse for 2-10 days but will subside. Once resolved MOH, work out plan for use of analgesia for headaches.