Sprained Ankle

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Chest infection

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Patient presents with a productive cough Generalised Malaise Sputum green in colour Occasional fevers Examination: Respiratory exam: Good Air entry bilaterally No Resp distress CREPITATIONS HEARD Reason for visit: Chest infection Management: Oral Antibioitics as prescribed 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:  +chestinfection, Penumonia
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Gout

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Patient complains of severe joint pain Joint/s affected: Patient states they have a history of gout and this feels like that On Examination: The patient is afebrile Joint affected feel hot and very sensitive to movement Clinical Impression :  Gout Plan: 1. Anti-inflammatory medication prescribed (indomethicin, Colchicine or Prednisone) 2. Apply hot compresses or ice to the joint involved 3. Bed Rest Discussed the usefulness of Allopurinol.  Not prescribed at this time but if continued attacks the patient will represent for treatment Discussed the "Rules of Moderation" and these notes have been printed and provided to the patient Rules of moderation Do: • restrict intake of food high in purines, especially organ meats (liver, brain, kidneys, sweetbread), shellfish and tinned fish (sardines, anchovies, herrings), game, pork • reduce your intake of alcohol, especially beer and red wine • reduce or cease intake of sugary, fizzy soft drinks and frui...
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Sciatica With no other focal neurology

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Patient presents with lower back pain Associated burning pain going down the back of leg Side: Denies numbness of the leg Denies any weakness No trouble toileting and no numbness around the perianal region On Examination: Palpation of the lower back in the midline does not elicit any tenderness Straight Leg Raise: Pain on lifting the affected leg Unaffected leg did not cause any pain Slump Test - Positive Brief neurological examination of the lower limbs: - Normal power both sides - Normal gross sensation - Normal knee and ankle reflex Imp:   Sciatica ? Lumbar Disc prolapse Management: Explained the diagnosis to the patient and that usually improves in 6-12 weeks Discussed possible investigations: - Xray not advised - MRI-  Will usually determine the cause of pain but private fee involved Suggested seeing a physio for further assessment and exercise program Exercise and stretching particularly swimming Weight control Return immediately ...
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