GP Notes

Patient presents with pain along the Achilles tendon Also complains of the following symptoms: -Swelling of the skin over the tendon with warmth, redness and tenderness -Pain when rising up on the toes and pain with pushing off on the toes -Painful heel for the first few minutes of walking and waking up in the morning -Stiffness of the ankle which improves with mild activity On Examination: Patient has tenderness to palpation over the Achilles tendon Clinical impression: Achilles tendinitis Management: 1. gentle calf stretching 2. strengthening of the Achilles tendon 3. Eccentric calf raises 4. May need to consider heel raise or orthotics if pain does not settle 5. as symptoms resolve, resumed normal weight-bearing activities gradually 6. avoid running until the tenderness is gone. Swimming or cycling in low gear a good replacement activities Prevention of Achillies Tendonitis: - do strengthening and stretching exercises to keep calf muscle strong and flexible - Keep yo...

Painful red rash Site: Duration: Examination: Vescicular rash in the distribuation of: Reason for visit: Shingles Management: 1. Antiviral medication as prescribed 2. Rest 3. Paracetamol and Ibuprofen prn 4. Moisturisers for rash prn Return if deterioration or concerns Keywords: +shingles

Patient presents with discomfort and pain in the jaw in front of the ear, especially when eating Examination: tendernesss to palpation over the TMJ on the left side Management: Advised to: - When eating, avoid opening your mouth wider than the thickness of your thumb and cut all food into smallpieces - Do not bite any food with your front teeth—use small bite-size pieces - Avoid eating food requiring prolonged chewing such as hard crusts of bread, tough meat, raw vegetables - Avoid chewing gum - Always try to open your jaw in a hinge or arc motion - Do not protrude your jaw - Avoid clenching your teeth together—keep your lips together and your teeth apart. - Try to breathe through your nose at all times. - Do not sleep on your jaw—try to sleep on your back. - Practice a relaxed lifestyle so that your jaws and face muscles feel relaxed. For a nagging problem Once the acute phase has settled, it is best to strengthen the muscles and joints by performing a set of exer...

Patient presents with pain in the hand Side: Pins and needles shooting down from the wrist joint into the hand Reduced strength Worse after manual labour Examination: Hand examination: Loss of muscle mass over the thenar eminance Tinels test positive Phalens test positive Diagnosis: Carpal Tunnel Syndrome Management: Disucssed treatment options 1. Steroid injection into the wrist joint for temporary relief 2. Referral to orthopaedic surgeon for Carpal Tunnel release Keywords:  +CTS

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

Patient presents with a painless lump Site: Describes as slow growing Examination: Lump:  Soft subcutaneous lump Approx diameter: Impression:  Lipoma Management: Advised patient this is a benign lump An USS has been requested to confirm diagnosis Lumps can be removed if there is a cosmetic requirement or they become big enough to be symptomatic Keywords: Lipoma, +lipoma

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

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 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 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...

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...

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

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