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Most acute cases caused by respiratory virus.

  • Rest at home including voice rest (best treatment)

  • Avoid talking, use voice sparingly (hoarseness lasts 3–14 d)

  • Use warm sialogogues (e.g. hot lemon drinks)

  • Avoid whispering

  • Drink ample fluids, especially water

  • Avoid smoking and passive smoke

  • Use steam inhalations (5 mins tds)

  • Humidity helps, esp. hot steamy showers

  • Consider use of cough suppressants, esp. mucolytic agents

  • Use simple analgesics, e.g. paracetamol or aspirin


All Australians should have a blood level <10 mcg/dL. Levels above this are associated with adverse neurocognitive defects.

Children at risk of elevated blood lead:

  • aged 9–48 mths living in or visiting older houses with peeling paint

  • those with pica

  • those living in lead-contaminated areas (e.g. heavy traffic, lead mining, battery breaking yards)

Symptoms, which are now rare, include:

  • bad taste in mouth

  • lethargy/fatigue

  • musculoskeletal aches and pains

  • abdominal discomfort

  • irritability/abnormal behaviour/cognitive defects

  • bowel disturbances

Consider lead toxicity in children presenting with developmental delay or behaviour problems and in those with unexplained iron-deficiency anaemia. Active management needed if blood level is >40 mcg/dL. Treatment involves chelation with sodium calcium edetate, succimer or dimercaprol in hospital. Penicillamine or succimer are oral preparations which can be used.


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Table L1 Pa in in the leg: diagnostic strategy model

Probability diagnosis


Nerve root ‘sciatica’

Muscular injury (e.g. hamstring)

Osteoarthritis (hip, knee)

Overuse injury (e.g. Achilles tendinopathy, hamstring strain)

Serious disorders not to be missed


  • peripheral vascular disease

  • arterial occlusion (embolism/thrombosis)

  • thrombosis popliteal aneurysm

  • deep venous thrombosis


  • osteoid osteoma

  • primary (e.g. myeloma)

  • metastases (e.g. breast to femur)


  • osteomyelitis

  • septic arthritis

  • erysipelas

  • lymphangitis

  • gas gangrene

Pitfalls (often missed)

Osteoarthritis hip

Osgood–Schlatter disorder

Spinal canal stenosis

Herpes zoster (early)

Nerve entrapment

‘Hip pocket nerve’ Meralgia paraesthetica

Peripheral neuropathy

Trochanteric bursalgia

Ruptured baker cyst

Spinal canal stenosis—neurogenic claudication

Spinal causes of leg pain

Problems originating from the spine are an important, yet at times complex, cause of pain in the leg. Important causes are:

  • nerve root (radicular) pain from direct pressure, esp. sciatica (L4–S3) (image 57–8)

  • referred pain from:

    • – disc pressure on tissues in front of the spinal cord

    • – apophyseal joints

    • – sacroiliac joints

  • spinal canal stenosis causing claudication

Vascular causes of leg pain

Occlusive arterial disease

Acute lower limb ischaemia

Sudden occlusion whether by embolism or thrombosis is a dramatic event which requires immediate diagnosis and management to save the limb.

Signs and symptoms—the 6 Ps

  • Pain

  • Pulselessness

  • Pallor

  • Paralysis

  • Paraesthesia or numbness

  • ‘Perishing’ cold

Management ...

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