General Practice Cases at a Glance E-Book

Carol Cooper

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: At a Glance
• Sprache: Englisch

Seitenzahl: 337

Veröffentlichungsjahr: 2016

Beschreibung

General Practice Cases at a Glance is a workbook of clinical scenarios, ideal for those working in general practice, on their GP rotations, or looking to improve their history-taking, diagnostic and management planning skills. Written by practising teaching GPs, it provides an accessible overview of the richness and complexity of general practice.

With 50 engaging consultations, covering all age ranges and a broad spread of clinical areas, each symptom-based chapter begins with the clinical presentation of a patient, before going on to uncover the full history and examination. As you work through each true-to-life case, there are red flag symptoms, useful charts and tables, and further resources to deepen your knowledge.

General Practice Cases at a Glance:

• Is suitable for clinical students, Foundation doctors, and those preparing for the MRCGP's CSA
• Includes 50 case scenarios from across the medical spectrum, from mental health and paediatrics to musculoskeletal and ENT medicine
• Is comprehensively illustrated
• Features current clinical guidelines, and charts and tables to accompany each case
• Is the companion volume to General Practice at a Glance, ISBN 978-0-470-65551-1, (Awarded First Prize in the Primary health care category at the 2013 BMA Medical Book Awards) but is also a stand-alone resource

Leseprobe

General Practice Casesat a Glance

Carol Cooper

Honorary Teaching Fellow Department of Primary Care and Public Health Imperial College London General Practitioner London, UK

Martin Block

Programme Director Imperial GP Specialty Training Department of Primary Care and Public Health Imperial College London GP Partner, Clapham Park Group Practice London, UK

This edition first published 2017 © 2017 by Carol Cooper and Martin Block

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Library of Congress Cataloging-in-Publication DataNames: Cooper, Carol, 1951-, author. | Block, Martin (General practitioner), author.       Title: General practice cases at a glance / Carol Cooper, Martin Block.    Other titles: At a glance series (Oxford, England)    Description: Chichester, West Sussex ; Malden, MA : John Wiley & Sons Inc., 2016. | Series: At a glance | Includes bibliographical references and index.    Identifiers: LCCN 2015045693 | ISBN 9781119043782 (pbk.)    Subjects: | MESH: General Practice—methods—Case Reports. | General Practice—methods—Problems and Exercises.    Classification: LCC RC46 | NLM WB 18.2 | DDC 616—dc23    LC record available at http://lccn.loc.gov/2015045693

A catalogue record for this book is available from the British Library.

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Cover image: © Hero Images/Getty

CONTENTS

Preface

Part 1 Introduction

1 The consultation

2 Clinical reasoning to reach a diagnosis

Part 2 Cases

1 My baby is burning up

2 I need something for hay fever

3 I can’t seem to shift this cough

4 My knee is very bad

5 I have migraine

6 I’ve come for my flu jab

7 He’s a little terror

8 I’ve got a problem with my shoulder

9 I can’t believe how much weight I’ve put on

10 It’s my back passage

11 I am pregnant again

12 My baby has an upset tummy

13 My ear really hurts

14 I’m worried about my drinking

15 She cries all the time

16 I need something to help me sleep

17 My eye hurts

18 I think I should get this prostate test, doctor

19 I can’t live with this pain much longer

20 I’ve got a red eye

21 I’m fed up with my spots

22 I’ve come for the results of my blood tests

23 I’d like to talk to you about HRT

24 I’ve got a bit of a discharge

25 I’m feeling tired and woozy

26 I think I need to get my blood pressure checked

27 Well, I’m pregnant

28 I’ve been feeling short of breath

29 She’s coughing non-stop

30 I’m worried about my memory

31 I’ve got this pain in my chest, doctor

32 I’ve been having terrible stomach cramps

33 I’m concerned this mole has been growing

34 I seem to have lost weight

35 I’m worried about my erection

36 I think the cancer has got me

37 I’m all over the place these days

38 She’s had tummy ache for two days

39 I don’t want to have my period when I am on holiday

40 It’s my leg

41 I’m having terrible diarrhoea

42 The nurse did my diabetes check last week. I’m here for the results

43 My skin is really itchy

44 Doctor, I’m just feeling really down

45 I’ve got a really bad burning in my stomach

46 I want to talk about my risk of breast cancer

47 I’ve got a terrible back ache

48 I’d like antibiotics please

49 I’m tired all the time

50 I’m worried about this lump, doctor

List of abbreviations

Index of cases by speciality

Index

EULA

List of Tables

Chapter 1

Table 1.1

Chapter 6

Table 6.1

Chapter 9

Table 9.1

Chapter 11

Table 11.1

Chapter 13

Table 13.1

Chapter 18

Table 18.1

Table 18.2

Chapter 21

Table 21.1

Chapter 22

Table 22.1

Table 22.2

Chapter 26

Table 26.1

Chapter 27

Table 27.1

Chapter 42

Table 42.1

Chapter 43

Table 43.1

Chapter 46

Table 46.1

List of Illustrations

Chapter 1

Figure 1.1

Causes of fever.

Figure 1.2

Usual prodromal phases of some infections, during which there may be fever and malaise.

Chapter 2

Figure 2.1

Complications of anorexia nervosa.

Chapter 3

Figure 3.1

The course of the recurrent laryngeal nerves.

Chapter 4

Figure 4.1

Heberden’s nodes. Source: Drahreg01 https://commons.m.wikimedia.org/wiki/File:Heberden-Arthrose.JPG. Used under CCA 3.0.

Chapter 5

Figure 5.1

Location of berry aneurysms.

Chapter 6

Figure 6.1

Mrs Brown’s ECG. Source: CardioNetworks https://commons.wikimedia.org/wiki/File:Afib_ecg_(CardioNetworks_ECGpedia).jpg. Used under CCA 3.0.

Chapter 9

Figure 9.1

Waist size and health: what is known.

Chapter 10

Figure 10.1

Section through the anus.

Figure 10.2

Describing the position of anal lesions.

Chapter 11

Figure 11.1

Types of FGM (from WHO classification).

Chapter 14

Figure 14.1

Cycle of change. Adapted from Prochaska J and DiClemente C. J Consulting & Clinical Psychology 1983; 5: 390–339.

Chapter 17

Figure 17.1

Pupillary reactions in the swinging light test.

Figure 17.2

Papilloedema. Source: Olver J et al. (2014) Ophthalmology at a Glance, 2nd edn. Reproduced with permission of Jane Olver.

Chapter 19

Figure 19.1

The persistent pain cycle. Source: Reproduced with permission of www.paintoolkit.org.

Figure 19.2

Boom and bust cycle.Source: Reproduced with permission of www.paintoolkit.org.

Chapter 20

Figure 20.1

Causes of acute red eye. Source: (a) Tanalai. https://commons.wikimedia.org/wiki/File:Swollen_eye_with_conjunctivitis.jpg. Used under CCA 3.0; (b) James Heilman, MD. https://commons.wikimedia.org/wiki/File:Allergicconjunctivitis.jpg. Used under CCA-SA 4.0; (c) clubtable. https://commons.wikimedia.org/wiki/File:Blepharitis.JPG. Public domain; (d) Jonathan Trobe, M.D. https://commons.wikimedia.org/wiki/File:Acute_Angle_Closure-glaucoma.jpg. Used under CCA 3.0; (e) EyeMD. https://commons.wikimedia.org/wiki/File:Hypopyon.jpg. Used under CCA SA 2.5; (f) Kribz. https://commons.wikimedia.org/wiki/File:Scleritis.png. Used under CCA-SA 3.0; (g) Olver J et al. (2014) Ophthalmology at a Glance, 2nd edn. Reproduced with permission of Jane Olver.

Chapter 29

Figure 29.1

Some inhaler devices.

Figure 29.2

Stepwise management of asthma in children under five years. Adapted from BTS/SIGN guidelines, 2014.

Figure 29.3

Stepwise management of asthma in children aged 5–12 years. Adapted from BTS/SIGN guidelines, 2014.

Chapter 33

Figure 33.1

Malignant melanoma.Source: National Cancer Institute. https://commons.wikimedia.org/wiki/File:Melanoma_with_diameter_change.jpg. Public domain.

Figure 33.2

Seborrhoeic keratosis.Source: Lmbuga https://commons.wikimedia.org/wiki/File:Queratose_seborreica_1.jpg. Public domain.

Chapter 36

Figure 36.1

Death certificate.

Chapter 38

Figure 38.1

Causes of abdominal pain in children.

Chapter 40

Figure 40.1

Arterial supply to the lower limb.

Figure 40.2

Femoro-popliteal bypass grafting.

Chapter 46

Figure 46.1

Family tree for Desta Gebru.

Chapter 48

Figure 48.1

Tonsillitis with exudate.

Figure 48.2

Quinsy.

Chapter p01_c01

Figure 1.1

Using SOCRATES as a guide to taking a history.

Figure 1.2

Ideas, concerns and expectations.

Chapter p01_c02

Figure 2.1

Clinical reasoning stages.

Guide

Cover

Table of Contents

Preface

Pages

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Preface

General practice has seen huge changes in the last few years and is on course for many more. Areas once considered the exclusive province of secondary care have shifted to primary care.

The consultation is at the heart of general practice: a one-to-one exchange (unless there are relatives in tow) where the GP can assess the problem, make a working diagnosis, and plan management with the patient. It’s a lot to do in just 10 or 15 minutes

This makes the GP attachment the ideal place for a medical student to learn essential skills, like focused history-taking, examination, clinical decision-making and good communication. Even if you ultimately choose to work in a speciality very unlike general practice, you will find these skills useful.

The book is by two practising GPs who are linked with the academic department of primary care at London’s Imperial College Medical School. It is a companion volume to General Practice at a Glance, but can be used on its own.

These 50 consultations cover all age ranges and a broad spread of clinical areas. Some you could consider ‘bread-and-butter general practice’, while others contain less common conditions that shouldn’t be missed. The book follows the ‘at a Glance’ style: clear and concise, with charts and tables to accompany each case, and clinical guidelines to make sure students are up to speed with current thinking.

Every scenario is symptom-based, because that’s how patients present. The cases reflect the diversity of today’s patient population as well as the spread of common symptoms. Each begins with a short opening quote such as, ‘I am tired all the time‘.

With each one, you’ll have to tease out the relevant history, decide what to examine and which investigations are needed, reach a working diagnosis and formulate a management plan. You will be put on the spot, just as in your exams, and just as you will be in real-life clinical practice.

While the patients are fictionalized, they are complex and realistic, and, as in everyday medicine, some provide lighter moments too.

Each case takes one or two pages and includes:

the history, including a brief PMH and current medication

questions for you to answer as you go along

red flag symptoms and signs which mustn’t be missed (marked )

useful info, charts and graphics

further resources, mostly online, to deepen your knowledge.

We suggest you ask yourself at the end of every case, ‘What have I learnt here?’

You can work your way through the book, or dip in wherever you want. The consultations are arranged randomly, to reflect clinical general practice. However the index can guide you to consultations system by system for revision purposes if you like.

We wrote this title to:

reflect the richness of general practice

challenge students to think on their feet

make them commit their thoughts

enable them get the most from their general practice attachment

give them tools to become good doctors.

We hope you enjoy this book and wish you success and fulfillment in your career.

Carol Cooper Martin Block

Disclaimer

Patients in this book are designed to reflect real life, with their own reports of symptoms and concerns. Please note that all names used are entirely fictitious and any similarity to individuals, alive or dead, is coincidental.

Acknowledgements

Martin: I would like to offer thanks to my trainees past and present and to Anna Strhan for her support and constant inspiration.

Carol: I would like to thank my colleagues Paul Booton, Graham Easton, Rob Hicks and Sally Mason, and my students at Imperial College.

Part 1Introduction

1 The consultation

2 Clinical reasoning to reach a diagnosis

1The consultation

The vast majority of medical care takes place in general practice, with well over 300 million consultations a year in the UK. That makes general practice the first port of call for every symptom you can imagine, and then some. For many patients, it is the only port of call. So it’s imperative to get the consultation right.

In general practice, you’ll find a microcosm of all the clinical specialities, and there’s no way of knowing what will come in next. All the consultations in this book take place in general practice, either in practice premises or at home, but good consultation skills lie at the heart of good medicine in every field, whether you are a GP or a neurosurgeon. Use your time in general practice wisely and make sure you learn these eminently transferrable skills.

While textbooks are usually disease based, consultations are patient based, most often around a presenting symptom. Teasing out what is wrong requires and . In time these will become second nature to you, and you will also get faster as you become more experienced.