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BMJ 10-Minute Consultation: Primary Care

BMJ 10-Minute Consultation: Primary Care

Professor Adrian Hunnisett | Helen

(2016)

Additional Information

Book Details

Abstract

Suspected premature menopause • New patient asking for a benzodiazepine prescription • Management of recurrent gout • Asthma unresponsive to simple treatment in a child • Haemochromatosis • Smoking cessation • Otalgia • Fungal nail infection • Chronic diarrhoea in a teenager • Atrial fibrillation • Sleep disorder (insomnia) • Memory problems in an older person • Genital warts • Request for slimming tablets • Raised blood glucose concentration • Haematuria • Reduced sexual desire in women • Herpes zoster ophthalmicus • Exacerbation of atopic eczema in children • Acute anterior uveitis • Hirsutism • Thyroid swellings • Non-alcoholic fatty liver disease • Aphthous ulcers • Acne vulgaris • Transient ischaemic attack • Tennis elbow • Malignant melanoma • Hoarse voice • My baby keeps bringing up his feeds! • Chalazion • Female stress urinary incontinence • Pollen food syndrome in a teenage student • Acute cough in adults • Vitamin B-12 deficiency • Sexual health consultation for men who have sex with men • Stridor in children • Gout • Macromastia (large breasts): request for breast reduction • Hallux valgus • Frequent exacerbations in chronic obstructive pulmonary disease • Epididymo-orchitis • Gilbert's syndrome • Osgood-Schlatter disease • Measles, mumps, and rubella vaccination in a child with suspected egg allergy • Funny turn • Hypoglycaemia • Otitis media with effusion ("glue ear") • The Watery Eye • Sexual dysfunction in cardiovascular disease • Chronic chilblains • Malaria • Otorrhoea • The Hajj • Dyspepsia • Varicose veins • Epistaxis • Reviewing a patient with coeliac disease • A scaly rash on the hands • A child with neck swelling • Tick bite and early Lyme borreliosis • Blepharitis • Blood stained nappy • Otitis externa • Dry eye • Adult trigger finger • Minor incised traumatic laceration • Vasectomy • Hearing loss in adults • Abnormal vaginal discharge • Young people who self harm by cutting • Tremor • Assessment and management of renal colic • A pain in the bottom • Umbilical hernia • Thrombocytopenia in an adult • Atrial fibrillation • Phimosis in childhood

Table of Contents

Section Title Page Action Price
Book Cover C
Title i
Copyright ii
About the publisher iii
About The BMJ iii
Contents iv
About the editors ix
Introduction to 10 Minute Consultations x
Assessing the risk of diabetes 1
What you should cover 1
What should you do next? 1
Bariatric surgery 3
What you should cover 3
What you should do 3
Breast lumps 5
What you should cover 5
Examination 5
What you should do 6
Red flags 6
Diagnosing chronic obstructive pulmonary disease 7
What you should cover 7
Elicit risk factors— See box 1 7
What you should do 7
Examination 7
Investigations 7
Spirometry 7
Other investigations 7
Predict disability 7
Management 7
Referrals 8
Double vision 9
What you should cover 9
Assessment 9
Examination 9
What you should do 10
Urgent, same day referral 10
Foot drop 11
Medical history 11
What you should do 11
Physical examination 11
Advice and treatment 12
Gastro-oesophageal reflux disease in children: NICE guidance 13
Recommendations 13
Initial management of gastro-oesophageal reflux and GORD 15
Pharmacological treatment of GORD 15
Surgery for GORD 17
Overcoming barriers 17
Gradual loss of vision in adults 19
What you should cover 19
History 19
Examination 19
What you should do 19
High INR on warfarin 21
What you should cover 21
What you should do 21
Advice and follow-up 21
Nipple discharge 23
What you should cover 23
History 23
Examination 23
Inspection 23
Palpation 23
Red flags based on NICE guidelines for suspected cancer 4 23
What you should do 23
Pain at the base of the thumb 25
What you should cover 25
Alternative or concomitant diagnoses to consider 25
What you should do 25
Examination 25
Investigations 25
Treatment options 25
Pelvic pain 27
What you should cover 27
History 27
Examination 27
What you should do 27
Reducing the risk of diabetes 29
What you should cover 29
What you should do 29
Teenagers with back pain 31
What you should cover 31
History 31
Examination 31
What you should do 31
When to refer 32
The drooling child 33
What issues you should cover 33
Ear, nose, and throat examination 33
What you should do 33
Atrial fibrillation 35
What you should cover 35
What you should do 35
Initial assessment 35
Stroke risk assessment 35
Investigations 35
Management 35
When to refer to cardiologist (or cardiac rhythm management specialist if available) 35
Rate control 35
Stroke risk reduction 35
Diagnosis and management of chronic heart failure 37
What you should cover 37
Ask about 37
Clinical examination 37
What you should do 37
Talk to the patient 37
Establish the diagnosis 37
Blood tests 37
Other tests 37
Make a management plan 37
Drug treatment 37
Treatment of comorbidities 38
Long term health promotion and rehabilitation 38
Tick bite and early Lyme borreliosis 39
What you should cover 39
What you should do 39
Dyspepsia 41
What you should cover 41
What you should do 41
When to refer 41
Thrombocytopenia in an adult 43
What issues you should cover? 43
Pointers to diagnosis 43
What you should do? 43
Outcome 44
Osgood-Schlatter disease 45
What you should cover 45
History 45
What you should do 45
Examination and treatment 45
Funny turn 47
What you should cover 47
Assessing symptoms 47
Associated symptoms 47
Timing and onset 47
What you should do 47
Examination 47
ABCD 2 score 47
Investigations 47
Referral 47
Driving 48
Vitamin B-12 deficiency 49
What you should cover 49
Assess clinical evidence of B-12 deficiency 49
What you should do 49
Consider the cause 49
Consider referral 49
Treatment 49
Monitoring 49
A pain in the bottom 51
What you should cover 51
History 51
Examination 51
What you should do 51
Anal fissures 51
Haemorrhoids 51
Functional anorectal pain 51
Adult acute rhinosinusitis 53
What you should cover 53
Ask about 53
Examination 53
What you should do 53
When to refer immediately 54
Flashes, floaters, and a field defect 55
What you should cover 55
Ask about 55
What you should do 55
Hypoglycaemia 57
What you should cover 57
What you should do 57
Examination and investigations 57
Treatment and advice 57
Follow-up 58
Varicose veins 59
What you should cover 59
What you should do 59
An adult with a neck lump 61
What you should cover 61
History 61
Examination 61
What you should do 61
Dental pain 63
What you should cover 63
Nature and severity of the pain 63
History 63
What you should do 63
Examination 63
Extra-orally 63
Intra-orally 63
Consider referral 64
Medication 64
New patient asking for a benzodiazepine prescription 65
What issues you should cover 65
Is it appropriate to prescribe diazepam to this patient? 65
Is it safe to prescribe? 65
What should you prescribe? 65
What you should do 65
Measles, mumps, and rubella vaccination in a child with suspected egg allergy 67
What you should cover 67
What you should do 67
Otitis media with effusion (“glue ear”) 69
What you should cover 69
What you should do 69
Reviewing a patient with coeliac disease 71
What you should cover 71
What you should do 71
Clinical examination 71
Blood tests 71
Management 71
Longer term aspects of management 72
Phimosis in childhood 73
What is phimosis? 73
What you should cover 73
History 73
Examination 73
What you should do 73
Chronic chilblains 75
What you should cover 75
What you should do 75
Hearing loss in adults 76
What you should cover 76
Hearing difficulties 76
Associated ear, nose, and throat (ENT) symptoms 76
Risk factors for otological disease 76
Red flags 76
What you should do 76
Examination 76
Referrals 76
Pointers to diagnosis of hearing loss 76
Conductive loss (unilateral) 76
Conductive loss (bilateral) 76
Sensorineural loss (bilateral and gradual) 77
Sensorineural loss (unilateral) 77
Tremor 78
What you should cover 78
History 78
Medical history 78
Drug history 78
Social history and lifestyle 78
Family history 78
Examination 78
What you should do 78
Management of recurrent gout 80
What issues you should cover 80
What you should do 80
During the consultation 80
Reducing the risk of further attacks 80
Drug treatment 80
Ongoing care 80
Gout 82
What you should cover 82
What you should do 82
Otorrhoea 84
What you should cover 84
What is the link between otorrhoea and otalgia? 84
Risk factors 84
Prevalence and incidence 84
Examination 84
What you should do 84
Referral to an ear, nose, and throat specialist 85
Adult trigger finger 86
What you should cover 86
History 86
What you should do 86
Examination 86
Treatment options 86
Management 86
Young people who self harm by cutting 88
What you should cover 88
History and her feelings 88
Examination 88
What you should do 88
What not to miss 89
Hallux valgus 90
What you should cover 90
What you should do 90
Frequent exacerbations in chronic obstructive pulmonary disease 92
What you should cover 92
What you should do 92
Consider alternative diagnoses 92
Optimise therapy 92
Support and palliative care 92
Gilbert’s syndrome 94
What you should cover 94
What you should do 94
History and examination 94
Investigations 94
Diagnosis 94
Patient advice and education 94
Epistaxis 96
What you should cover 96
What you should do 96
First aid 96
Treatment 96
Follow-up 96
The Watery Eye 98
What you should cover 98
History 98
What you should do 98
Examination 98
Management 98
A feeling of a lump in the throat 100
What you should cover 100
Examination 100
What you should do 101
Abnormal vaginal discharge 102
What you should cover 102
What you should do 102
Examination 102
Management 102
When to consider referral to genitourinary medicine 102
Infective (non-sexually transmitted infection) 102
Infective (sexually transmitted infection) 102
Personal hygiene and advice 103
Eustachian tube dysfunction in adults 104
What is eustachian tube dysfunction? 104
What you should cover 104
History 104
Preceding symptoms and precipitating factors 104
Examination 104
Primary care 104
Consider if available in primary care 104
Treatment in primary care 104
Auto-inflation devices (Otovent, Ear Popper) 104
Intranasal preparations 104
Referral to ENT services 104
Secondary care 105
Further investigations 105
Treatment 105
A scaly rash on the hands 106
What issues you should cover 106
Pointers to diagnosis 106
What you should do 106
Follow-up 107
Transient ischaemic attack 108
What issues you should cover 108
General points 108
Assessing symptoms 108
What you should do 108
Eyelid lumps and lesions 110
What you should cover 110
History 110
Examination 110
Red flags 110
What you should do 110
Conservative management 110
Routine referral 110
Urgent referral 111
Baby with an abnormal head 112
What you should cover 112
What you should do 112
Management of positional plagiocephaly 113
Acute cough in adults 114
What you should cover 114
What you should do 114
Advice and treatment 114
Sexual dysfunction in cardiovascular disease 116
What you should cover 116
What you should do 116
Management options 116
Consider referral 117
Acne vulgaris 118
What issues you should cover 118
What you should do 118
First line treatments 118
Second line treatments 118
Assessment and management of renal colic 120
What you should cover 120
Important features of the examination include 120
What you should do 120
Pain management 120
Reasons to refer a patient immediately to hospital 120
Initial investigations if patient is not admitted 121
Dry eye 122
What you should cover 122
History 122
Examination 122
What you should do 122
Macromastia (large breasts): request for breast reduction 124
What issues you should cover 124
Medical or social history 124
Physical examination 124
Physical issues 124
Psychological issues 124
What you should do 124
Give advice on conservative treatment 124
Refer to a plastic surgeon 125
Umbilical hernia 126
What you should consider during the consultation 126
Asymptomatic umbilical hernias 126
Symptomatic umbilical hernias 126
What you should do 126
Surgery 127
Follow-up 127
Fungal nail infection 128
What issues you should cover 128
What you should do 128
Examination and diagnosis 128
Explanation and reassurance 128
Treatments 128
Preventing further infections 129
A child with neck swelling 130
What you should cover 130
Important features in the history 130
Important features of the examination 130
General examination 130
Neck examination: lymphadenomatous swellings 130
Neck examination: findings suggestive of non-lymphadenomatous swellings 130
Causes of massive neck swelling (refer urgently to hospital) 131
What you should do 131
Aphthous ulcers 132
What issues you should cover 132
What you should do 132
The Hajj 134
What you should cover 134
Explore his understanding of the Hajj 134
Does he experience angina? 134
Does he appreciate the possible effects of heat, physical exertion, crowds, and altered routine on his health? 134
Has he been vaccinated? 134
Will he be travelling elsewhere after the Hajj? 134
What you should do 134
Malaria 136
What you should cover 136
What you should do 136
Epididymo-orchitis 138
What you should cover 138
Taking history 138
What you should do 138
Treatment 138
Tennis elbow 140
What issues you should cover 140
What you should do 140
History 140
Examination and treatment 140
Hoarse voice 141
What you should cover 141
History taking 141
Examination 141
What you should do 141
Memory problems in an older person 143
What issues you should cover 143
What you should do 143
Hirsutism 144
What issues you should cover 144
What you should do 144
Otitis externa 146
What you should cover 146
What you should do 146
Treatment 146
Malignant melanoma 148
What issues you should cover 148
What you should do 148
Blepharitis 149
What you should cover 149
History 149
Examination 149
What you should do 149
Chalazion 151
What you should cover 151
What you should do 151
Genital warts 152
What issues you should cover 152
What you should do 152
Blood stained nappy 154
What you should cover 154
Was it blood? 154
Bleeding and blood 154
Stools 154
Explore the feeds 154
What you should do 154
Haemochromatosis 155
What you should cover 155
What is haemochromatosis? 155
Who gets it? 155
What are the signs, symptoms, and sequelae? 155
How do you diagnose hereditary haemochromatosis? 155
What you should do 155
Vasectomy 156
What you should cover 156
How it works 156
Aftercare 156
Thyroid swellings 158
What issues you should cover 158
What you should do 158
Examination 158
Management 158
Otalgia 159
Case history 159
What you should cover 159
History 159
Examination 159
What you should do 159
Herpes zoster ophthalmicus 161
What issues you should cover 161
What is it and why has she got it? 161
Have I got the right diagnosis? 161
Can I predict who will get eye problems? 161
What are the possible ocular complications? 161
What you should do 161
Eye examination 161
Treatment and management 161
Referral 162
Suspected premature menopause 163
What issues you should cover 163
What you should do 163
Sexual health consultation for men who have sex with men 164
What you should cover 164
What you should do 164
Female stress urinary incontinence 165
What issues you should cover 165
What you should do 165
Examination 165
Investigations 165
Management 165
Stridor in children 167
What issues you should cover 167
How long has the stridor been present? 167
Associated features 167
History 167
What you should do 167
Physical examination 167
Management 167
Exacerbation of atopic eczema in children 169
What issues you should cover 169
What you should do 169
Asthma unresponsive to simple treatment in a child 171
What issues you should cover 171
What you should do now 171
Chronic diarrhoea in a teenager 172
What issues you should cover 172
What is the risk of underlying disease? 172
History 172
Examination 172
What you should do 172
Minor incised traumatic laceration 174
What you should cover 174
Medical history 174
What you should do 174
Physical examination and wound cleansing 174
Wound closure 174
Sutures 174
Adhesive glue 174
Wound dressing, patient advice, and follow-up 175
Pollen food syndrome in a teenage student 176
What issues you should cover 176
Detailed history is the cornerstone of diagnosis 176
How does the problem affect her? 176
Ask about related co-morbidities, particularly hay fever and asthma 176
What treatments, if any, has she tried and with what effect? 176
What you should do 176
Examination 176
Confirmatory testing 176
Food avoidance 176
Advice on botanical relations 176
Treatments 176
Information and support 176
Acute anterior uveitis 178
What issues you should cover 178
What you should do 178
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