General recap

Consultation session on 27-Sep-2022

Patient 1

Complaint: sore throat

OTC medication: paracetamol and ibuprofen

No sign of tonsil bacterial infection (no white spot)

No antibiotic offer

 

What I learnt:

A sore throat (Virus cause) can make it painful to swallow. A sore throat can also feel dry and scratchy. A sore throat can be a symptom of strep throat, the common cold, allergies, or other upper respiratory tract illnesses. Symptoms: cough, runny nose, etc.

A strep throat (bacteria cause), red and swollen tonsils, sometimes with white patches or streaks of pus. Antibiotics are needed to treat the infection and prevent rheumatic fever and other complications. Symptoms: Pain when swallowing, fever, red and swollen tonsils, sometimes with white patches or streaks of pus, tiny red spots on the roof of the mouth, and swollen lymph nodes in the front of the neck. May has a rash known as scarlet fever (also called scarlatina).

Patient 2

Compliant: abdominal pain

Complication: especially for children, must examine the testicle, abnormal like redness, discharge and swelling.

Diagnose: no physical unwell, suspect mental stress

Patient 3

Compliant: Rashes on and off (skin)

Diagnosis: hives

Medical term: dermatographia

Medication: menthol cream, antihistamines or steroid tablets.

The rash is usually itchy, sometimes feels like it’s stinging or burning, caused/triggered by allergy, high levels of histamine, and contact with chemicals.

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Recap Learning session on 27-Oct-2022

Raynaud’s disease

Raynaud’s affects blood circulation. When encountering cold, anxiety or stressed, fingers and toes may change colour.

Symptoms include: pain, numbness, pins and needles and difficulty moving the affected area. It can be treated by keeping warm.

Medication: nifedipine, help improve circulation, also used to treat high blood pressure.

Some people need to take this medicine every day. It could also be a sign of a more serious condition, such as rheumatoid arthritis or lupus.

Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints. The condition usually affects the hands, feet and wrists.

Lupus is a long-term condition that causes joint pain, skin rashes and tiredness. There’s no cure, but symptoms can improve if treatment starts early. Symptoms: joint and muscle pain, extreme tiredness that will not go away no matter how much you rest, rashes – often over the nose and cheeks, inflammation of different parts of the body including the lungs, heart, liver, joints and kidneys. Usually, it needs blood tests regularly for anaemia and urine test to check for kidney problems.

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Orthostatic hypotension

It is also called postural hypotension — which is a form of low blood pressure that happens when standing after sitting or lying down. Orthostatic hypotension can cause dizziness or lightheadedness and possibly fainting.

Symptoms usually last less than a few minutes. Lightheadedness or dizziness upon standing, blurry vision, weakness, fainting (syncope), confusion.

Causes: when standing from a sitting or lying position, gravity causes blood to collect in the legs and belly. Blood pressure drops because there’s less blood flowing back to the heart (b.p. different 20Hmmg). Special cells (baroreceptors) near the heart and neck arteries sense this lower blood pressure. The baroreceptors send signals to the brain. This tells the heart to beat faster and pump more blood, which evens out blood pressure. These cells also narrow the blood vessels and increase blood pressure.

 Other causes: dehydration, heart problems (e.g., extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure). Endocrine problems (e.g., thyroid conditions, adrenal insufficiency (Addison’s disease) and low blood sugar (hypoglycemia). Diabetes, which damage the nerves that help send signals that control blood pressure. Nervous system disorders (e.g., Parkinson’s disease, multiple system atrophy, Lewy body dementia, pure autonomic failure and amyloidosis). Eating meals,  have low blood pressure after eating meals (postprandial hypotension). This condition is more common in older adults.

Risk factors: Age, medication (e.g., diuretics, alpha blockers, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors and nitrates, certain antidepressants, certain antipsychotics, muscle relaxants, medications to treat erectile dysfunction and narcotics) and certain diseases (e.g., nervous system disorders, such as Parkinson’s disease, nerve damage (neuropathy), such as diabetes. Heat exposure, bed rest for too long, and alcohol.

Complications: high risk of fall, stroke due reduced blood supply to the brain, cardiovascular diseases (e.g., chest pain, heart failure or heart rhythm problems).

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Difference between acute and chronic conditions

 Definition:

• Acute illnesses generally develop suddenly and last a short time, often only a few days or weeks.
• Chronic conditions develop slowly and may worsen over an extended period of time—months to years.

Causes:

• Acute conditions are often caused by a virus or an infection but can also be caused by an injury resulting from a fall or an automobile accident or by the misuse of drugs or medications.
• Chronic conditions are often caused by unhealthy behaviours that increase the risk of disease—poor nutrition, inadequate physical activity, overuse of alcohol, or smoking. Social, emotional, environmental, and genetic factors also play a role. As people age, they are more likely to develop one or more chronic conditions.

 Symptoms:

• Acute diseases come on rapidly and are accompanied by distinct symptoms that require urgent or short-term care and get better once they are treated.
• Chronic conditions are slower to develop, may progress over time, and may have any number of warning signs or no signs at all. Common chronic conditions are arthritis, Alzheimer’s disease, diabetes, heart disease, high blood pressure, and chronic kidney disease. Unlike acute conditions, chronic health conditions cannot be cured—only controlled.

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Sickle cell disease

Sickle cell disease is the name for a group of inherited health conditions that affect the red blood cells. The most serious type is called sickle cell anaemia. It is a serious and lifelong health condition, treatment can help manage many of the symptoms.

Causes:

• unusually shaped red blood cells, they do not live as long as healthy blood cells and can block blood vessels.
• The gene that affects how red blood cells develop, both parents have the gene
• The child’s parents often will not have sickle cell disease themselves and they’re only carriers of the sickle cell trait

Symptoms:

• People born with sickle cell disease tend to have problems from early childhood, although some children have few symptoms and lead normal lives most of the time.
• painful episodes called sickle cell crises, which can be very severe and last up to a week
• an increased risk of serious infections
• anaemia (where red blood cells cannot carry enough oxygen around the body), which can cause tiredness and shortness of breath (SOB)
• delayed growth, strokes and lung problems.

Sickle cell disease is often detected during pregnancy or soon after birth. It is offered to all pregnant women in England to check if there’s a risk of a child being born with the condition, and all babies are offered screening as part of the neweborn blood spot test (heel prick test). Blood tests can also be carried out at any age to check for sickle cell disease or see if you’re a carrier of the gene that causes it.

Treatments:

People with sickle cell disease need treatment throughout their lives. This is usually delivered by different health professionals in a specialist sickle cell centre.

• self-care measures, such as by avoiding triggers and managing pain.
• drinking plenty of fluids and staying warm to prevent painful episodes

painkillers, such as paracetamol or ibuprofen (sometimes treatment with stronger painkillers in the hospital may be necessary)

• daily antibiotics and having regular vaccinations to reduce your chances of getting an infection
• hydroxycarbamide (hydroxyurea) to reduce symptoms
• regular blood transfusions if symptoms continue or get worse, or there are signs of damage caused by sickle cell disease
• an emergency blood transfusion if severe anaemia develops
• The only cure for sickle cell disease is a stem cell or bone marrow transplant, but they’re not done very often because of the risks involved.

Life expectancy:

• tends to be shorter than normal, but this can vary depending on the exact type of sickle cell disease.
• Carriers of sickle cell (sickle cell trait)
  • someone who carries the gene that causes sickle cell disease but does not have sickle cell disease It’s also known as having the sickle cell trait.
  • at risk of having a child with it if their partner is also a carrier.

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HPV

Human papillomavirus (HPV) is the name of a very common group of viruses. They do not cause any problems in most people, but some types can cause genital warts or cancer.

HPV affects the skin. There are more than 100 different types.

Symptoms

• It does not usually case any symptoms
• do not realise and do not have any problems.
• Sometimes the virus can cause painless growths or lumps around your vagina, penis or anus (genital warts).

Spread:

• HPV affect the mouth, throat or genital area. They’re easy to catch.
• Do not need to have penetrative sex.
• any skin-to-skin contact of the genital area
• vaginal, anal or oral sex
• sharing sex toys

Condition link to HPV:

• abnormal changes in the cells that can sometimes turn into cancer
• genital warts
• cervical cancer
• anal cancer
• penile cancer
• vulval cancer
• vaginal cancer
• head and neck cancer

Testing for human papillomavirus (HPV):

• HPV testing is part of cervical screening. A small sample of cells is taken from the cervix and tested for HPV.
• There’s no blood test for HPV.
• Screening is offered to all women and people with a cervix aged 25 to 64. It helps protect them against cervical cancer.
• Some sexual health clinics may offer anal screening to men with a higher risk of developing anal cancer, such as men who have sex with men.

How to protect yourself against human papillomavirus (HPV): 

• Condoms can help protect you against HPV, but they do not cover all the skin around your genitals, so you’re not fully protected.
• HPV vaccine protects against the types of HPV that cause most cases of genital warts and cervical cancer, as well as some other cancers. It does not protect against all types of HPV.

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Abbreviations

LMP – Last menstrual period

SOB – Shortness of breath

PC – Presenting complaint

UPSI – Unprotected sexual Intercourse

HxPC – History of present complaint

RIF – Right iliac fossa pain (causes include appendicitis, gastrointestinal pathologies)

Abx – antibiotics

 

Fetal Position – a position in which you lie on your side with both legs and both arms bent and pulled up to your chest and with your head bowed forward.

Different position