GP Notes

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...

Complains of white lesions on the tongue some mild pain while swallowing Dry mouth and bad breath Examination: White lesions on the tongue Reason for contact: Oral Thrush Management: 1. Anti-fungal lozenges prescribed Prevention advised: 1. Rinse Mouth 2. Brush teeth regularly 3. Regular Dental visits

Preventative Health Screen Height: Weight: BMI: BP PSA Testing: Recently completed and no issues Exericse: Exercises regularly Diet: Eating a good balanced diet Bowel Cancer Screening: completed and nil abnormalities Mood: Happy and no concerns about mood Bloods: Completed in the last 2 years and no issues Smoking: Non smoker Alcohol: Social drinker with no concerns regarding alcohol consumption Actions

Preventative Health Screen Height: Weight: BMI: BP Pap Smears: UTD Exericse: Exercises regularly Diet: Eating a good balanced diet Bowel Cancer Screening: completed and nil abnormalities Mood: Happy and no concerns about mood Mammograms: UTD and no issues Bloods: Completed in the last 2 years and no issues Smoking: Non smoker Alcohol: Social drinker with no concerns regarding alcohol consumption Actions:

Patient advises they have recently given up alcohol Heavy Drinker Usual daily consumption: Experiencing the following symptoms: - headaches - nausea - tremors - anxiety - hallucinations  - seizures. - Insomnia On Examination Appears agitated / in a withdrawal State Vital signs noted  Impression: Alcohol Withdrawal Management: 1. Valium 5mg qid 2. Maxolon 10mg tds prn 3. Thiamine 4. Given details to contact nearest detox centre for phone assessment and admission as soon as possible 5. Continue to try to maintain abstinence 6. Mental Health Plan prepared and referral psychologist arranged Present to ED or call ambulance if any seizures

A prescription for Temazepam has been provided to be used as a short term treatment for insomnia. The patient was advised of the risk associated with this treatment: 1. Possible dependence 2. Tolerance ie.  Continued use may cause the drug to lose its effectiveness 3. Morning sedation Encouraged to only use for a short term and try not to use more than 2 nights in a row I have also suggested other methods to assist with insomnia : - Guided meditation with apps / youtube - Don't drink coffee after 3pm - Reduce blue light exposure before bed or use apps to remove blue light on iphone/ipad - Increase physical output during the day but not immediately before bed Advised patient I would not prescribe this medication on an ongoing basis

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 ...

Patient presents with: - Redness of the skin - Itchiness - Dry scaly flaky skin Commenced: Recent exposure: Areas Affected: On examination: Red, dry and flaky skin in the following areas: Impression: Contact Dermatitis Suspected Allergen:  Plan: Advised the patient to remove exposure to the allergen If hands involved use gloves next time in contact with it Hydrocortisone Cream Prednisone 50mg daily for 3 days Return if symptoms worsen If develops shortness of breath or chest tightness call an ambulance

Presents for a refill of her oral contraceptive pill script Has been on this medication for some time without any ill effect No history of - Hypertension - DVT / PE - Migraine with aura Preventiative health screen: Cervical smears up to date Good Diet Exercises regularly Non smoker No concerns about mood Examination: BP:  Reason for contact: Oral contraceptive pill script Management: Script as requested

MENTAL HEALTH ASSESSMENT AND PLAN Patient Details: Name: _____________________________________________ DOB: ___________________ Gender:   Female  / Male Medical History:    Medications: Social History: Occupation: Marital status:   Single   / Married   / Defacto / Divorced  / Widowed / Other ____________ Sexual Orientation:       Heterosexual  / Homosexual / _________________ Lives with:   Is a Carer:     No Has a Carer: Self Alcohol:  Non Drinker / Social Light Drinker /  _______________________ Smoking:   Non Smoker  / Ex smoker /  _______________ PART 1- MENTAL HEALTH ASSESSMENT Reasons for Preparation of Mental Health Plan: Outcome Measurement Tool: Tool :  K10 Result: Other issues: Previous Mental Health or other behavioural Diagnosis: Substance Abuse History:  ...

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 Ear Syringing performed - Large clumps of wax removed Relief of patient symptoms achieved Return if increasing ear pain

Patient presents with a painful tooth Tooth involved: Describes pain in the tooth when touched Jaw Pain Also reports subjective fevers On Examination: Patient appears well Palpation of the affected tooth elicits pain Some swelling around the tooth Impression:   Infected tooth Plan: 1. Oral antibiotics as prescribed 2. Regular panadol and nurofen for the pain 3. Arrange urgent dental review

Patient presents with a painless cyst in the eyelid Location: Duration: Describes a irritation in the eyelid with no changes to visual acuity On examination: Lump consistant with a chalazion Treatment: Advised the patient of the diagnosis and reassured them this is not serious Discussed the following options: 1. Leave alone and allow to resolve on its own over a few months 2.Steaming the eyelid with  hot water (left for about 5 to 10 minutes after boiling) in a thermos onto the closed eye for 10 to 15 minutes combined with massage. 3. Soak a hand towel or similar cloth in hot water and press it firmly but gently against the closed eye for several minutes. 4. Surgical referral to opthalmologist for excision Advised to return if the lump becomes infected Patient has elected to trial conservative measures and return if these fail keywords:  chalazion, meibomian cyst , tarsal cyst

Abdominal exam: Soft No tenderness No rebound guarding No masses Keywords:  GIT exam, GITN

Throat exam: Normal pharynx and tonsils with no signs of inflammation or pus Keywords: throatn, throat examination

Respiratory exam: No respiratory distress Normal air entry both sides No crepitations No wheeze Keywords:  Respiratory examination, respiratory exam, RSN, Chest examination, chest exam

Ear Nose and Throat exam: Ears:  Normal TM both sides Nose: No discharge Throat: Normal pharynx and tonsils with no signs of inflammation or pus Keywords:  ENT examination, ENT exam, ENTN

Neurological Examination of the Upper Limbs was normal: Left side: Tone - Normal Power - 5/5 for all movements. Normal grip power Sensation - Gross sensory examination of the upper limb dermatomes was normal Reflexes - Bicep tendon reflex normal; Wrist reflex normal; Proprioception - Not examined Right side: Tone - Normal Power - 5/5 for all movements. Normal grip power Sensation - Gross sensory examination of the upper limb dermatomes was normal Reflexes - Bicep tendon reflex normal; Wrist reflex normal; Proprioception - Not examined Keywords:  Upper Limb Neuro exam, +ULNNAD

Counselled to take daily, check BP and weight at 1/52 and 4/52. At 3/12 must have lost 5% body to weight to continue. Take for shortest time as needed. If 5% loss to continue losing 5% per weeks. To be taken in conjunction with seeing an exercise physiologist and dietician. Not to be taken during pregnancy or lactation. Counselled that Duromine can cause lightheadedness and not to drive if symptomatic while on duromine.

(a) patient history; Red lumps over body over abdomen and trunk Recent cold and flu symptoms - fevers, sore throat (b) clinical examination; Rash as desribed Vescicular rash Respiratory exam : good air entry bilaterally No respiratory distress No crepitations or wheeze Cervical lymphadenopathy present Throat exam was normal: - Pharynx showed no redness or pus - Tonsils normal and not inflamed or redness (c)  necessary investigation; Swab of lesion sent for pathology Differential diagnosis: Chickenpox (d) management plan; Advised to rest in bed or move around quietly until feeling well. Paracetamol for the fever. Daub calamine or a similar soothing lotion to relieve itching, although the itch is usually not severe. Solugel is an effective preparation. Avoid scratching Keep the diet simple. Drink ample fluids, including orange juice and lemonade. Give regular sips of water and consider icy poles. Daily bathing is advisable, with sodium bicarbo...