“I know what she needs”

1. “I know what she needs” Sore throat case study

2. By looking at Katie and Amanda’s visit to the GP, we have learned a lot about infection, specifically concerning the throat. We have also considered how we as doctors would deal with patients who are hypochondriacs or want a quick fix.

3. Question 1: What is a sore throat commonly caused by? Sore throat: pain at the back of the mouth, commonly due to bacterial or viral infection of the tonsils (tonsillitis) or the pharynx (pharyngitis). – Oxford Concise Medical Dictionary. NB: Pain itself caused by inflammation *Acute pharyngitis accounts for 1% of all ambulatory office visits.* *The incidence of viral and bacterial pharyngitis peaks in children aged 4-7 years.*

4. Question 2:Label this diagram of the throat • http://www.summitmedicalgroup.com/library/adult_health/viral_sore_throat/

5. Question 3: Fill in the ‘VINDICATE’ diagnosis tool with the correct headings.

6. Question 4: What is bacteria? Fill in the blanks. Bacteria: a group of micro-organisms all of which lack a distinct nuclear membrane and most of which have a cell wall. Most bacteria are unicellular; the cells may be spherical (coccus), rod-shaped (bacillus), spiral (spirillum), comma-shaped (vibrio) or corkscrew-shaped (spirochaete). Generally they range in size between 0.5 and 5 µm. Motile species bear flagella on their surface. Many possess a slimy capsule and some can produce an encysted or resting form (endospore). Bacteria reproduce asexually by simple division of cells. Transfer of DNA from one bacterium to another takes place in the process of conjugation. NB: µm = micrometre Reference: Oxford Concise Medical Dictionary

7. Question 5: Label this diagram of a bacterium.

8. *Group A streptococcal bacteria cause approximately 5-15% of all pharyngitis infections, accounting for several million cases of streptococcal pharyngitis each year.* • Other common bacteria that cause pharyngitis: • Diptheria (rare) • Gonococcalpharyngitis • Haemophilusinfluenzae • Quinsy • Staphylococcus aureus(rare) • Syphilis (rare) • Vincent’s angina • -Murtagh’sGeneral Practice 4th ed.

9. Question 6: What is a virus? Fill in the blanks Viri are not living cells. They consist of nucleic acid surrounded by a protein shell. They cannot reproduce or carry out metabolic functions without hijacking the ‘machinery’ of a host cell. (obligate intracellular parasites) They are too small to be visible with a light microscope and too small to be trapped by filters. Examples of viruses are: the common cold, influenza, measles, mumps, chickenpox, herpes, AIDS, polio, rabies. Antiviral drugs are effective against some of them, and many viral diseases are controlled by means of vaccines. *At least 50% of sore throats, mainly pharyngitis, are caused by viruses.* -Murtagh’s General Practice 4th ed. References: ‘Bacterial structure and the action of anti-biotics’ Lecture presented by Dr Catherine McDermott Oxford Concise Dictionary

10. Viral vs. bacterial infection symptoms Venn diagram Viral Sinus symptoms Secretions: thick/yellow Fatigue, malaise Nasal congestion/ rhinorrhea (runny nose) Rash Slight fever Sore throat Abdominal pain Severe myalgia (pain in the muscles) Headache Nausea, vomiting, diarrhoea Cough Foul breath Conjunctivitis, photophobia Bacterial Reference: http://emedicine.medscape.com/article/302460-overview

11. Question 7: What are antibiotics and how do they work? Antibiotic: a compound produced by a micro-organism that in small amounts can kill (bactericidal e.g. penicillin) or inhibit (bacteriostatic e.g. tetracycline) another organism. Antibiotics are natural products of various microorganisms, including some fungi, actinomycetes and bacteria, although many of them have been chemically modified- so they are called ‘semi-synthetic’. They are designed through the principle of selective toxicity. Reference: ‘Microbiology and infection control for health professionals’, Lee & Bishop

12. Question 8: What are adverse effects of excessive use of antibiotics? • Antibiotics can kill ‘good’ bacteria as well as the one that is being targeted (causing diarrhoea, thrush, malnutrition syndromes). • It is expensive. • It creates an environment for bacteria to become antibiotic resistant. • If the patient is misdiagnosed and is actually suffering from a viral infection, the antibiotics will not help their condition.

13. Question 9: What is the tympanic membrane and why do doctors check it if suspecting an infection? The TM is easily traumatised, and an infection will cause inflammation (myringitis) and redness, possibly pressure build-up and even perforation. ‘The tympanic membrane is also called the eardrum. It separates the outer ear from the middle ear.’ http://www.nlm.nih.gov/medlineplus/ency/imagepages/8993.htm http://emedicine.medscape.com/article/858558-overview

14. Complete the find-a-word. Pharyngitis Tonsillitis Bacteria Viri Infection Prokaryotic Eukaryotic Antibiotic Tympanic Capsule Endospore Culture Rhinovirus Streptococcus

15. I hope this little memory-jogger has helped!