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Minor Illness


Title: Minor Illness Author: FBs Last modified by: currysdigital Created Date: 5/3/2009 11:33:44 AM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: Minor Illness

Minor Illness
  • Amy Tatham Freeda Bhatti

  • Any condition which is self limiting and does
    not prevent the patient from carrying out their
    normal functions for more than a short period of

Why is it important?
  • Around half of consultations in AE and 20 40
    of GP consultations are for minor illnesses
  • 57 million GP consultations/yr OR accounts for
    over an hour a day for every GP
  • In 90 of cases a prescription will be issued
    costing est 370 million/year

Most common
  • Backache
  • Eczema
  • Sore throat/Ear pain
  • Heartburn
  • Rhinitis
  • Constipation
  • Migraine
  • Cough
  • UTI
  • Acne

Quiz TIme
  • Are you ready?

Question 1
  • What is this?
  • It is normal for the foreskin to be attached to
    the head of the penis until what age?
  • 1year
  • 3years
  • 5years
  • Circumcision can be done on the NHS for religious
    and cultural reasons (true/false)

  • Foreskin is very tight and cannot be pulled back
    over the head of the penis
  • Normally attached to the head of the penis until
    5yrs and is still attached in 60 of 6-9yr olds
  • Consider referral if recurrent infections,
    ballooning, painful, poor stream
  • Consider referral after 6 yrs
  • Incidence of circumcision in the UK is 1/15 in
    boys under 15 yrs
  • Not funded by NHS for religious/cultural reasons

Question 2
  1. What is this?
  2. They are not present at birth (true/false)
  3. They usually leave a small scar (true/false)

Strawberry Naevi/Capillary Haemangioma
  • Collection of raised capillaries
  • Not present at birth
  • 1/20 babies develop them at few days/weeks of age
  • Increased in females
  • Usually stop growing at around 6/12 and begin to
    shrink and fade
  • Usually gone by 7yrs
  • If causing feeding/breathing/speech difficulties
    can be treated with laser/steroids

Question 3
  • What is this?
  • What percentage are caused by viruses?
  • 96
  • 72
  • 50
  • Chloramphenicol is available OTC (true/false)

Acute Infective Conjunctivitis
  • Inflammation of the conjunctiva
  • Usually lasts lt2weeks
  • Symptoms itch, swelling of the eyelid, purulent
  • Exclude red flags
  • 50 viral aetiology
  • Difficult to clinically distinguish viral and
    bacterial cases
  • Viral often occur with an URTI and may last
    couple of weeks
  • Bacterial usually last 2-5days
  • No evidence of benefit in treatment
  • Consider treatment if prolonged (gt2weeks) or
    severe symptoms
  • Advise on cleaning eyes/avoiding transmission
  • Chloramphenicol is available OTC for people aged
    over 2yrs

Question 4
  • What is this rash?
  • Is it contagious?
  • How long does the rash typically last
  • Upto 2 weeks
  • Upto 2 months
  • Upto 18 months

Molluscum Contagiosum
  • Pink or pearly white papules with central
    umbilication, upto 5mm diameter
  • Caused by DNA virus of pox family
  • Lesions can occur anywhere except palms of hands
    and soles of feet.
  • Children trunk, flexures, anogenital
  • Adults sexual contact may cause lesions in
    thighs, pubis, genitals, lower abdo
  • Immunocompromised (HIV, steroids) atypical
  • Self limiting, usually resolves by 18months
  • Infectious, avoid sharing towels/baths
  • Can suggest trauma (by squeezing after bathing)
    or cryotherapy if appropriate
  • If unsightly or persistent other treatments
    include topical 0.5 podophllyotoxin or imiquimod
    5 cream

Question 5
  • At what age should children be referred for
  • 6mths
  • 1year
  • 18mths of age
  • There is still an increased risk of cancer and
    subfertility after surgery (true/false)
  • Retractile testicles should fully descend by 3yrs
    of age (true/false)

  • Failure of testicular descent
  • Usually unilateral 80 (right 50, left 30),
    bilateral 20
  • Increased in premature babies (20 incidence),
    compared to full term babies (2 incidence)
  • Increased risk of cancer and subfertility
  • Retractile testicles exaggerated cremasteric
    reflex, can be manipulated down
  • Become less retractile with age, full descent may
    not occur until after puberty. No treatment

Question 6
  1. What do you notice about this mans head?
  2. Finasteride results in hair re-growth in a third
    of men (true/false)
  3. Finasteride is not available on the NHS

Male Pattern Baldness
  • Hereditary
  • Usually occurs in late 20s-30s
  • Set pattern of hair loss
  • Receding frontal hairline
  • Thinning of hair at temples and crown
  • Hair follicles become over sensitive to
    dihydrotestosterone (DHT), it makes hair
    follicles shrink
  • Rx options
  • Reassurance
  • Finasteride
  • Stops conversion of testosterone to DHT, takes
    4/12 for effect
  • Some regrowth in 2/3rds of men
  • Not available on NHS
  • Minoxidil lotion
  • ?how it works
  • Slows balding in 50, 15 experience hair regrowth

Question 7
  • Sore throats are self limiting and improve within
    a week without treatment in
  • 75
  • 85
  • 95
  • Consultation rates for sore throats are
  • 1/10 patients per year
  • 1/20 patients per year
  • 1/40 patients per year

Sore throat
  • Independent of causative organism, self limiting
    and resolves in 7 days in 85 of patients
  • Centor guidelines can help you decide who needs
  • Patients unwell with tonsillitis who have ¾ of
    following are more at risk of infection with GpA
    ß-haemolytic strep and complications
  • Tonsillar exudate
  • Tender ant cervical LNs
  • Absence of cough
  • History of fever
  • If unwell with ¾ of above risk of quinsy is
    160, compared to 1400 without
  • Pen V antibiotic of choice. Consider delayed
  • People who receive antibiotics are more likely to
    present in future with minor illnesses

Question 8
  • In acute sinusitis there is evidence that
    decongestants help (true/false)
  • In acute sinusitis antibiotics are of no benefit

Acute Sinusitis
  • Usually occurs as secondary bacterial infection
    after a viral URTI
  • Other causes
  • allergic rhinitits, swimming, diving, high
    altitudes, dental infection, trauma
  • Symptoms usually occurring a week after URTI
  • pain on bending, maxillary pain, purulent
    rhinorrhoea, tooth pain
  • Red flags
  • Unilateral signs, bleeding, diplopia/proptosis,
    maxillary paraesthesia, orbital swelling,
  • First line treatment
  • Paracetamol, brufen /- codeine
  • No evidence decongestants help
  • If persistent symptoms gt2/52
  • Nasal steroid may be of small benefit (73 vs
  • Antibiotics may be of small benefit 80 get
    better within 2/52 without treatment compared to
    90 with antibiotics
  • If symptoms persist gt12/52, red flags or frequent
    recurrent episodes refer to ENT

Question 9
  • What is the diagnosis?
  • The herpes virus is thought to be the cause in
    the majority of cases (true/false)
  • Name some differential diagnoses

Bells Palsy
  • Sudden onset facial paralysis, usually unilateral
  • Increase incidence in 15-45yr olds
  • 1/60 lifetime risk, GPs can expect to see 1 case
    every 2-3 yrs
  • Cause used to be largely unknown, now thought
    predominantly due to herpes virus
  • Usually LMN affects muscles of one side of face
  • UMN affects lower half of face, eye spared
  • Loss of taste anterior 2/3rds of tongue
  • If patient presents within first 72hrs of
    symptoms can give prednisolone 25mg bd for 10/7,
    otherwise no treatment
  • 85 recover fully within 9months

Bells Palsy Differential Diagnoses
  • Lyme disease bilateral, tick exposure, rash,
  • Otitis media examine ears, otalgia, hearing
  • Ramsey Hunt rash, prodrome of pain
  • Sarcoidosis if affecting parotid gland may be
    recurrent, usually bilateral
  • Guillain-Barre Syndrome usually bilateral
  • HIV bilateral lymphadenopathy
  • Tumours cholesteatoma, parotid gland tumour,
    primary/secondary brain tumours
  • MS consider in a young patient if unilateral,
    painless and resolves in a few weeks
  • Stroke

How do patients consulting with minor illnesses
make you feel?
Bad Ok
  • Frustration as they take Can be used
    as A break btwn more
  • up valuable time a pretext to a more
  • serious problem consultations
  • Patient takes no
  • responsibility for Rather see
    than Opportunity to alter
  • illness miss an important health
  • illness

Why do patients with minor illness consult rather
than self care?
Health seeking behaviour
Patient Factors
  • Demographics e.g age (elderly),socioeconomic
  • Illness itself i.e perceived threat
  • Health beliefs, poor education
  • Previous experience
  • Other events in patients life e.g
    bereavement,work stress (therefore not coping)
  • Secondary gain prescription eg sick note

Society Factors
  • Media e.g health stories like the Swine Flu,
    medicalisation of normal, Jade Goody effect
    (P.S. Were not saying theyre not justified
  • Jade Goody effect resulted in a dramatic uptake
    for smears good)
  • Government
  • - confusing on one hand keen to promote self
    care e.g by increasing availability OTC
    medicines but also promote policies so patients
    have easier access to GPs
  • Society
  • Different cultures eg Asian Eastern European
    may present more
  • Certain groups eg Refugees ( often because of the
    hell theyve endured)
  • The its free on the NHS society

Doctor Factors
  • Access greater the access, the more likely
    patients are likely to use/abuse
  • Doctor Behaviour in the Consultation doctor may
    be too approachable encouraging people to drop in
    any time (that dr wont mind)
  • Secondary gain some doctors subconciously
    encourage minor illnesses (easy consultations,
    adds relaxing time to their surgeries)
  • Ineffective opportunistic health education/self
    care counselling
  • Not defining boundaries
  • Previous doctor behaviour eg someone who gave a
    patient abx for sore throat and thus they expect
    the same in the future

How can we as GPs encourage patients to self
manage minor illness?
  • Access
  • Consultation Behaviour
  • - Chanign Our Attitude not encouraging
    simple consults
  • - Giving information, educating pitching at
    the right level
  • - Prescribing (or not)
  • - Safety netting
  • - Doctors acting in a similar way eg no abx for
    sore throats
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