GP Notes

Patient presents with an itchy rash Worse with warmth and at night Sites of Rash: Contacts with rash: Examination: Erythematous papular rash in the following sites: Reason for visit: Scabies Management: 1. Permethrin 5% cream- leave on overnight then wash off in the morning.  Avoid hot baths or scrubbing prior to application. Treat the whole family 2. Wash clothing, any soft toys and bedclothes as usual in hot water and hang in the sun 3. Repeat treatment in a week if it doesn't settle Keywords:  +scabies

Patient presents with pain in the heel Side: Worse when steps out of bed Relieved after walking Increases toward the end of the day Worse after sitting Examination: Tenderness to palpation over the heel Location: No gait abnormality Reason for visit: Plantar fasciitis Management: 1. Rest from long walks and running 2. Regular anti-inflammatories 3. Plantar fascia stretching exercises 4. Good footwear with prefabricated insoles Advised that if symptoms do not settle we can refer for a steroid injection in the plantar fascia Keywords: +plantarfasciitis

Patient presents with a headache Has a history of migraines Site:  Temproofrontal region Side: Radiation:  retro-orbital and occipital Quality:  Intense and throbbing Previous attack:  Regularly up to 2 per month No precipitating factors identified Associated nausea and vomiting Headache preceded by an aura No features of this headache markedly different from previous migraines Denises any weakness or numbness in the limbs or facial muscles No loss of consciousness Examination: Neurological Exam normal: - GCS 15 - Oriented to Time Person and Place - No obvious facial droop - Normal speech - Moving 4 limbs freely Reason for visit: Migraine Management: 1. Aspirin 900mg 2. 1L IV normal saline stat 3. 10mg metoclopramide Patient will be reviewed after treatment Keywords:  acute migraine, +acutemigraine

Patient presents with a suspected foreign body Mechanism: Location: Examination: Over the area of interest is a puncture wound No obvious FB visible protruding from the wound Advised to the patient we can explore the wound in an attempt to remove the FB Patient provided verbal consent to this procedure Management: Wound cleaned with chlorhexadine 2ml of 1% Xylocaine infiltrated into the wound Small incision with a scalpel to open the wound Using fine tooth forceps the foreign body was located and removed Wound closed with pressure Dressing applied and patient advised to watch for wound infection: redness, pain, pus Return if deterioration or concerns Keywords:  Skin Foreign body, Superficial FB, +skinfb

Patient presents for the repeat of their medications used to treat chronic pain The patient states they continue to require the prescribed medication due to their pain. They are not requesting increased doses or increased frequency On Examination: The patient does not appear intoxicated with alcohol or opiate medication. GCS 15 Management: 1. Script as printed 2. Patient encouraged to consider a reduction in the dose of their medication should the level of their pain decrease 3. Patient advised to return to this clinic should they have any issues with the medication or pain needs Keywords:  Opiates, Opiate prescription, S8, Chronic Pain,   +opiates

Discussed with the patient raised cholesterol. Suggest eating less of the following foods: Butter Ghee Hard margarines Lard, dripping and goose fat Fatty meat and meat products such as sausages Full fat cheese, milk, cream and yogurt Coconut and palm oils and coconut cream and to try to eat more of: Porridge Oatbran Oat breakfast cereals Bread made with 50% oat flour or oat bran Oatcakes Pearl barley Baked beans Adzuki beans, black beans, black-eyed peas, butter beans, cannellini beans, chickpeas, edamame beans, kidney beans, lima beans, mung beans, navy beans, pinto beans, split peas, white beans Red lentils, green lentils Vegetables rich in soluble fibre such as okra, aubergine, citrus fruits, turnip, sweet potato and mango Unsalted soya nuts (also called roasted edamame beans) Soya alternative to milk Soya alternative to yoghurt Soya mince/chunks Tofu Almonds, pistachios, walnuts, pecans, cashews, peanuts (always unsalted) The additional advice was gi

Patient presents with : - sore eye and eyelid - Lid swelling and redness - Crusts and scales around the base of the eyelids - Eye discharge - Inflammation and crusting of the lid margins Reason for visit: Blepharitis Management: 1. Eyelid hygeine - Gently clean the eyelid of debris with a cotton woold bud 2. Ocular lubricants such as artificial tears 3. Oral antibiotics as prescribed 4. Chloramphenicol drops on the lid margin Keywords:  +blepharitis

Patient presents for removal of sutures following recent skins surgery  review of pathology report undertaken and the diagnosis of the lesions removed was explained to the patient On examination: Site of the lesions are: The sutures appear clean and the wound is healed and opposed Mangement: 1. suture removal undertaken Patient advised to return should there be any wound dehiscing Also advised to return should be any signs of cellulitis such as redness, heat, pain, purulent discharge Keywords:  removal of sutures, +ROS

Patient presents following bites by a nonvenomous insect Patient complains of small maculopapular raised lesions over the body which are itchy On examination: Macular papular lesions over the body The lesions do not look infected The patient does not look systemically unwell No evidence of lymphadenopathy Normal capillary refill Management: 1.advised the patient other carer that these lesions do not usually need any treatment  2.can put moisturiser cream on it such as Sorbelene 3.antihistamine such as promethazine can be used for excessive itchiness 4. Ice on the bites  may also provide relief 5. Simple analgesics such as paracetamol or ibuprofens can also be used if required The patient has been advised to return should there be any signs of infection or any other ongoing concerns which they would like to have addressed Keywords:  Insect Bite, +insectbite

Patient presents with the sensation of a foreign body in the cornea Affected Eye: Cause: Assessment: VA Left:  6/  Right 6/ The patient was consented for an eye examation General examination of both eyes was normal Local Anaesthetic (tetracaine Hydrochloride 0.5%) drops were placed in the affected eye An opthalmoscope was used to systematically scan the cornea A FB was located as per the picture below: The FB was removed with The patient was discharged and advised to return if : - Loss of vision - Discharge from the eye - Increasing pain in the affected eye Keywords:  Cornea, foreign body, corneal foreignbody,  +cornealforeignbody

Patient presents for the treatment of acute pain Cause Patient states that simple analgesia such paracetamol or Ibuprofen are not providing adequate pain relief On Examination: The patient does not appear intoxicated with alcohol or opiate medication. GCS 15 Management: 1. Script as printed 2. Patient encouraged to consider a reduction in the dose of their medication should the level of their pain decrease 3. Patient advised to return to this clinic should they have any issues with the medication or pain needs 4. Patient Advised of the addictive nature of the medication have been prescribed and that they should seek to reduce the dose as quickly as possible and return to using simple analgesics such as Keywords:  +acutepain

Patient presents with in the elbow The pain refers down the back on the forearm Occurs at rest The pain occurs during gripping hand movements, particularly on rotation / turning, picking up objects with a grasping action, carrying buckets etc Side: Examination: No visible swelling Localised tenderness over the lateral epicondyle, anteriorly Pain on passive stretching wrist Pain on resisted extension of the wrist and third finger Normal elbow movement Reason for visit: Tennis elbow Management: 1. Rest from offending activity 2. Rest, ice, compression, elevation and oral NSAIDs 3. stretching and strengthening exercises Exercises The dumbbell exercise Use a dumbbell or similar type of weight such as a bucket of water. Start with 0.5 kg (1 lb) and build up gradually to 5 kg. 1. Sit in a chair beside a table. 2. Rest your arm on the table so that the wrist is over the edge. 3. With your palm facing downwards, grasp the weight. 4. Slowly raise and lower the wei

Patient presents following a postive faecal occult blood test Denies any active bleeding or heamorrhoids States no family history of colorectal cancer Denies night sweats, weight loss or angina Examination: Abdominal exam: soft No tenderness, guarding or rebound PR exam performed with consent:  No evidence of rectal masses No active bleeding No haemorrhoids Reason for visit: Faecal occult blood test positive Management: Discussed result with the patient Advised patient of the requirement to proceed to colonoscopy to assess for possible sourse of bleeding - colorectal cancer - haemorrhoids - anal fissues - diverticulitis Referral arrranged Patient encouraged to return following procedure or if they have any concerns Keywords:  Positive Faecal Occult Blood, Positive FOB, +fobpositive

Discussed with patient preventative health activities: Smoking: Non smoker Nutrition:  Good diet Alcohol: Nil concerns Physical activity :  Adequate physical activity Skin checks: Has regular skin checks and no issues Blood Pressure:  Normotensive Cholesterol: ordered today PSA : Ordered today Bowel Cancer screening:  Has completed the govt screening Sexual health:  No problems with erections or sex Keywords:  +prevhealthm

Child presents with symptoms consistent with hand, foot and mouth disease - fevers - runny nose - reduced oral intake - raised lesions on hands, feet and mouth Examination: temp: Ear Nose and Throat exam: - Ear:  No redness or discharge - Clear rhinorrhoea - No pharyngitis.  tonsils are not enlarged, not inflamed and have no pus Cervical lymphadenopathy present Respiratory exam was normal - No respiratory distress - Bilateral air entry - No crepitations or wheeze heard on auscutation Nil signs of meningitis: - Nil photophobia - nil purpuric rash - Nil neck stiffness Red maculules on the hands and feet Shallow ulcers in the mouth Reason for visit: Hand, foot and mouth disease Management: Parents reassured and the diagnosis explained Regular paracetamol +/- Ibuprofen Careful hygeine Advised to exclude child from daycare / school until blisters have dried up Return here or to ED if not improving or concerns they are getting worse Actions: Letter

Patient presents requesting assistance with smoking cessation They state they would like to try Champix Discussed smoking, psychological, physical and social aspects of addiction. Discussed how Champix works to block nicotine receptors. Patient needs to look at other aspects of smoking, and how will address these. Tips given, such as picking quit date; throwing out all cigarettes, lighters etc; dealing with stress; telling friends/family about quitting, 4Ds No Hx of depression or suicide attempts - Discussed this risk. Advised patient to self-monitor, and ask family to monitor for neuropsychiatric sx such as change in behaviour, aggression, agitation, depressed mood, suicidal ideation and behaviour. Advised to cease Champix immediately should these sx occur, and present for R/V. Discussed common SEs including nausea, insomnia, headaches. Discussed cost of Champix to medicare/PBS, and authority rules - desire to quit, GP counselling program, one script per 12 month per

Patient reports a irritation in the eye Side: Location: Cause: No significant change in vision No other eye disorders Examination: VA Left: Right: Both sides: Normal visual fields Eye examined:  Topical anaesthetic dropped inserted in the eye some watery discharge No evidence of foreign body during magnified examination Eye flurosein stained Evidence of uptake over the following area: Reason for visit: Corneal abrasion Management: Advised the patient these will usually settle within a couple of days Regular simple analgesia in that time Chlorsig ointment prescribed for lubricate the eye Optometrist review in 2-3/7 if not settling Review here or ED immediately should patient notice a decrease in visual acuity Keywords: Cornea, Coneal abrasion, +cornealabrasion

Patient presents with swelling and pain localised over the olecranon process Side: The patient is systemically well Examination: Swelling without any marked tenderness over affected elbow Normal ROM in the joint No evidence of overlying cellulitis Reason for visit: Olecranon bursitis Management: Advised the patient of the diagnosis and explained treatment options 1. Observe 2. NSAIDS 3. Needle aspiration Patient elected for needle aspiration Consented Verbally for the procedure Area cleaned and performed under sterile conditions Swelling localied and 1% Xylocaine infiltrated into the skin overlying the bursa 18g Sharp needle inserted into the bursa Aspiration of about 20ml of clear fluid consistant with synovial fluid wound dressed and patient advised to return if : - swelling - redness - fevers - Pain - any concern the patient has Simple analgesia advised to be used Keywords:  Olecranon bursitis, +olecranonbursitis

Patient presents following multiple episodes of diarrhoea Number of diarrhoea: Commenced: Last loose bowel motion: Examination: The patient appears well Abdominal exam: Abdomen is soft with mild tenderness No guarding No rebound Reason for visit: Enteritis Management: Advised to obtain some Gastrostop from the chemist and take 2 immediately and then 1 after each loose bowel motion Keep hydrated with water / gastrolyte If symptoms do not settle then return here or ED for review Keywords: Enteritis, Diarrhoea, diarrhea, +enteritis

Patient presents with pain in the ear Side: Examination: Pain on retraction of the pina Discharge from the ear canal Reason for visit: Otitis externa Management: 1. Sofradex drops as prescribed 2. Gentle toileting of the ear prior to drops being put in 3. Regular simple analgesia Return if deterioration or concerns Keywords:  Otitis externa, Swimmer's ear, +otitisexterna

Side Examined:  Look: Knee appears normal with no obvious swelling, redness or trauma Feel: Palpation of the medial collateral ligament  - normal Palpation of the lateral collateral ligament  - Normal Palpation over the medical meniscus - Normal Palpation of the lateral meniscus - Normal No hypermobility of patella No tenderness of the popliteal fossa Move Anterior draw:  Normal Posterior draw: Normal Testing of collateral ligaments: Normal McMurrays test: Normal Keywords:  Knee Examination, Knee exam, +kneeexam

Patient presents with pain in the shoulder Side: History: No stiffness or restriction No excessive movement / instability No weakness Rough / smooth No history of significant injury The pain does not keep the patient awake at night There is no stiffness in the neck No pain on touching the shoulder blades No pain on brushing hair Pain is not worse in the morning No aching in both shoulders or hips No pain associated With sporting activity, including weight training and house work, dressing or other activities Believes able to thorw a ball underhand for 10-20 metres and overhead 20-25m Feels can lift a 2L container level with shoulder Believes can carry a 20-30kg weight by their side Examination: Cervical spine exam is normal Inspection:  The shape and contour or the shoulder joints appears normal Normal posture and position of the scapula No evidence of deformity,swelling or muscle wasting Palpation:  The following joints were palpated: AC Joint The subac

Patient presents with a red itchy rash History of atopy Site: On Examination: Dry Red rash as per the picture Management: 1 .avoid soap and perfume products. Use a bland bath oil in the bath and cleansing bar as a soap substitute. 2.  apply emollients soon after bathing 3.  have short, tepid showers 4.avoid rubbing and scratching 5.   keep finger now short and claim 5. avoid overheating, particularly at night 6. Avoid sudden changes in temperature, especially those that cause sweating 7.  Wear light, soft, loose close, preferably made of cotton., Clothing should be worn next to the skin 8. avoid will next to the skin 9. avoid dusty conditions concerned, especially send printed 10. avoid contact with people with sores, especially herpes 11. keep skin moisturised 12.  try and ensure there were no dust mites in the house 13. Corticosteroid treatment as prescribed Keywords:  Eczema, Dermatitis, +eczema

Patient presents with sore throat and fevers Examination: temp: Ear Nose and Throat exam: - Ear:  No redness or discharge - Clear rhinorrhoea - The throat is red and there is pus visible on enlarged tonsils Cervical lymphadenopathy present Respiratory exam : good air entry bilaterally No respiratory distress No crepitations or wheeze Nil signs of meningitis: - Nil photophobia - nil purpuric rash - Nil neck stiffness Reason for visit: Tonsillitis Management: 1. Regular paracetamol +/- Ibuprofen 2. Oral Antibioitcs as charted 3. Rest 4. Keep well hydrated with regular water 5. Sore throat can be treated with regular aspirin gargles:  Dissolvable aspirin in a small amount of water and gargled (Do not swallow) Return here or to ED if not improving or concerns they are getting worse Keywords:  Tonsillitis, +tonsillitis

Discharge from the eye Side: Patient is systemically well Examination: Eye:  Discharge Type: Nil other features of a systemic illness Reason for visit: Conjunctivitis Management: 1. Keep eye clean by cleaning regularly 2. Topical Antibiotics as prescribed 3. Return here if infection getting worse Keywords:  Conjunctivitis, +conjunctivitis

Patient presents for repeat prescription of the antidepressant Patient remained stable on the medication as prescribed Patient stated that mood is well controlled and they have no desire to try and wean down or cease the medication Brief mental state examination The patient is dressed normally and display no obvious psychiatric disorder The patient has a normal affect GCS 15 Management 1. Medication to continue as prescribed 2. Patient to return immediately should they feel their mood is worsening and they need medical help 3. Advised to call QAS if acutely suicidal or they feel they may harm someone else Keywords:  Antidepressants,  +antidepressants

Patient presents with a small patch of hair loss Site: Examination: Patch of hair loss on a clean scalp  approximate size (diameter): Reason for visit: Alopecia areata Management:  topical steroid cream as prescribed Advised that if this does not work the following treatments could be considered: - Topical irritants - intralesional steroids - topical minoxidil - topical immunotherapy with DNCB antigen Keywords: alopecia areata, +alopeciaareata

Patient  presents requesting screening testing for sexually-transmitted diseases Patient states they have no symptoms which concern for a STD Counselled patient on the testing that we perform HIV counselling provided and the patient informed that the negative result does not mean that they are clear if they can send I will need to have further testing if they had an exposure which they feel would be high risk for this disease  tests to be performed:  - Gonorrhoea  and chlamydia with first catch urine  -  had HIV, hepatitis C, hepatitis B, syphilis with blood testing serology   herpes simplex testing  was not included as the patient does not have any lesions which were consistent with this disease  advised patient that the best form of protection for STDs is condom is but this would not provide protection against  contracting herpes from her partner who has an active infection  advised patient that if the neither partner has herpes and I can see lesions they should avoid c

Patient presents following multiple episodes of vomiting and diarrhoea Colicky Abdo pain Number of vomits: Number of diarrhoea: Last vomit: Last loose bowel motion: Examination: The patient appears well Abdominal exam: Abdomen is soft with mild tenderness No guarding No rebound Reason for visit: Gastroenteritis Management: Advised to obtain some Gastrostop from the chemist and take 2 immediately and then 1 after each loose bowel motion When symptoms settle then rehydrate with water If symptoms do not settle then return here or ED for review Anti-emetics as per script written Keywords:  Gastro, Gastroenteritis, Viral gastroenteritis, +gastro

Patient presents for a drivers license medical Private standards Driving History: No Accidents/fines in the past 12 months No significant illness No new Significant diagnoses in the past 12 months Family members have not commented on patient's driving Partner / Family has not commented about patient's snoring or stopping breathing in sleep No plans to drive longer distances Drives occasionally at night Does not require glasses to drive BP noted and normotensive Pulse regular Visual fields as documented ROM neck- Normal ROM hips- Normal ROM knees- Normal ROM ankles- Normal Rhombergs- negative No requirement for MMSE identified Medical certificate completed. Restrictions-  Nil Next DL due in 1 year

Patient requests to commence Duromine Discussion about indications: a) BMI >35 b) Health affected by weight: i. diabetes/ impaired glucose tolerance ii. raised fasting insulin iii. high cholesterol iv. sleep apnoea v. high cardiovascular risk as a consequence of obesity FHx of heart disease/ thyroid/ diabetes Y/N Discussed SEs and rare risks of duromine: Cardiac: pulmonary hypertension, hypertension, shortness of breath, valvular disorders, chest pain, palpitations, fast heart rate, angina, stroke, heart attack, heart failure, cardiac arrest CNS disorders: overstimulation, restlessness, nervousness, insomnia, tremor, dizziness, headache. Euphoria, fatigue, depression, psychosis and hallucinations. GI system: Nausea, vomiting, dry mouth, abdominal cramps, unpleasant taste, diarrhoea and constipation. Renal system: Urination problems, retention. Skin: Rash, swelling Results Fasting lipids = NAD Fasting glucose level =  NAD TSH = Normal EUCS/LFTs Nor

Patient presents with  hearing loss Side Affected: Examination: The affected ear is inpacted with wax There is no trauma to the canal Reason for visit: Ear wax Management: Patient advised of treatment options: Treatment with Waxsol for a few days and return for syringing or Ear syringing now Patient elected to have ear syringed Advised of the following risks: - Perforation of the ear drum - otitis externa, damage to the external canal - pain, deafness, vertigo - tinnitus Patient provided verbal consent and referred to the nurse to carry out the treatment Keywords:  Ear Syringe , Ear Wax, Blocked Ears, +earsyringe

Wedge resection for a ingrown toenail: - verbal consent obtained from patient - advised a piece of nail and nail bed will be removed and diathermied - advised that toenail may grow back - explained risk of bleeding and nerve damage - Allergies to Local anaesthetic excluded - Digital nerve block infiltrated into toe to achieve numbness 0.1% Xylocaine 10ml - Regional Anaesthesia:  5ml infiltrated into the deep and superficial peroneal nerve and anaestheisa achieved - Wedge of toeanail cut and removed - gutter cleaned and fragments of toenail removed - Diathermy for bleeding - wound cleaned and dressed and patient advised to return if any uncontrollable bleeding Keywords:  Wedge Resection toenial, ingrown toenail, +wedgerx

Shoulder exam: Look -  No obvious deformity, scars or wasting Feel - No obvious tenderness to palpation over SC joint, clavicle, AC joint, shoulder joint, rotator cuff tendons Move:  Abde to abduct forward shoulder to 180 degrees Abde to abduct shoulder laterally to 180 degrees Gerbers test negative Impingement test negative reassured Keywords:  Shoulder Exam, Normal shoulder exam, Shoulder examination

Patient presents with red lesions On Examination: Vesicopustular lesions with honey-coloured crusts Management of Impetigo advised to patient: 1. Soak a clean cloth in a mixture of half a cup of vinegar and 1 Litre of tepid water.  Apply the compress to moist areas for 10 minutes several times a day then wipe off crusts 2. Bactroban 3 times a day for 10 days 3. Other general measures: - Cover the sores - Avoid close contact with others - Regular hand washing - Use separate towels and cloths - change and launder clothes and linen daily Oral antibiotics as prescribed (Fluclox 12.5mg/kg qid for 10 days or Cephalexin 25mg/kg bd for 10 days) Exclude from childcare until antibiotics have commenced and any sores on exposed skin should be covered with a watertight dressing Keywords:  Impetigo , School sore, +impetigo

The patient presented for review of the recent investigations ordered There were no abnormalities in any of the investigations The patient was reassured and encouraged to represent should they have any further symptoms or concerns Keywords:  Review results, Normal results, Normal investigations, +normalresults

Patient describes symptoms of dysuria and frequency No abdominal pain No flank pain No chills / rigors Examination: Abdominal exam: soft No tenderness, guarding or rebound Diagnosis: Urinary Tract Infection (UTI) Cystitis Management: Oral antibiotics as prescribed Urine requested and sent for MCS The following advice was also provided to the patient to avoid recurrent attacks: - Patient advised to keep rested - Drink a lot of water - Always try to completely empty bladder - Gently wash or wipe your bottom from front to back with soft, moist tissues after opening bowels - Paracetamol  / Ibuprofen for pain - Make urine alkaline with Ural sachets Return if deterioration or concerns Keywords:  UTI, Urinary tract infection, cystitis

Child presents with a cough Worse at night Described as "barking" Also has runny nose and fevers Examination: Respiratory exam : Good air entry bilaterally No respiratory distress No crepitations or wheeze Mild inspriatory stridor Cervical lymphadenopathy present Clear Rhinorrhoea Nil signs of meningitis: - Nil photophobia - nil purpuric rash - Nil neck stiffness Diagnosis: Croup - Mild Management: Regular paracetamol +/- Ibuprofen Encourage fluids and Rest Oral steroids as prescribed (prednisone 1mg /kg daily) Return here or to ED if not improving or concerns they are getting worse Keywords:  Croup

Patient presents with symptoms suggestive of a viral upper respiratory tract infection: - sore throat - cough - fevers - malaise Examination: Respiratory exam : good air entry bilaterally No respiratory distress No crepitations or wheeze Throat exam: some redness on the tonsils and pharynx but not pus visible Cervical lymphadenopathy present Nil signs of meningitis: - Nil photophobia - nil purpuric rash - Nil neck stiffness Examination: General: Reason for visit: URTI Management: Patient advised to: - Rest - Regular paracetamol +/- Ibuprofen - Drink plenty of fluids They have been advised to return here or present to ED should their symptoms worsen or if they have any concerns Keywords:  Viral URTI, Adult URTI, Pharyngitis, Viral infection, Upper Respiratory Tract Infection

Patient presents with stress Assessment of patient's stress Causative Factor: Suggest the following to help with stress: 1. Education - ensure the patient has as much information as they need about their illness 2. Diet - ensure the patient receives information on an appropriate diet 3. Exercise - ensure the patient receives information on an appropriate exercise program - even the dying will receive some benefit from activity 4. Stress management - internal and external External: pharmacotherapy massage aromatherapy music therapy acupuncture Internal: relaxation exercises and procedures positive imaging and techniques include breathing, muscle contraction and muscle relaxation exercises spiritual: reconciliation and forgiveness for those who have wronged them relationship counselling meditation prayer sexual counselling - work on increasing intimacy with partner Keywords: stress, work stress

On examination of the breasts was performed and the patient was offered a chaperone but declined Systematic examination included observation of the breasts  while sitting on the side of the bed which did not appear to be abnormal The patient was then asked to lie supine on palpation in a circular manner was performed from the nipple out There were no lumps or tenderness on palpation The axilla was also palpated and did not feel any lumps or tenderness Keywords: Breast exam, Breast examination, Examination of the breasts

Patient presents with sore ankle after rolling it Describes pain and swelling around the ankle Patient presents with sore ankle after rolling it Describes pain and swelling around the ankle Able to weight bear On exam: Ankle exam: Swelling and pain over the ATFL No tenderness to palpation of the distal fibula, distal tibia or proximal 5th metatarsal Impression: Sprained ankle Plan: Advised patient of diagnosis Encouraged to mobilise Use simple analgesic such as Paracetamol and Ibuprofen Ice regularly for the first 48 hours Compression bandage as required Return here if pain worsening or any other concerns Keywords: Ankle sprain, sprained ankle, ATFL tear