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

Discussed the procedure with the patient Advised how the lesion would be removed Advised of the following potential complications: - Infection - Wound dehiscence - Post operative pain - Insufficient removal of the lesion requiring further excision Patient was given the opportunity to ask any questions They have provided verbal consent to proceed Keywords:  +skinsconsent

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 bruising for the last Does not recall any trauma to account for the bruises Has not had any significant bruising in the past Denies abdominal pain, haemoptytis, PR bleeding, malaena or nose bleeds Feels otherwise well No chest pain, abdominal pain or SOB No fatigue No personal or family history of blood clotting disorders, haemophilia, thalassaemia Examination: The patient appears well.  There is clinically no evidence of anaemia Vitals as noted Bruises noted in the following areas: Respiratory exam : good air entry bilaterally No respiratory distress No crepitations or wheeze Abdominal exam: soft No tenderness, guarding or rebound No hepatomegaly or splenomegaly Brief examination of the Cardiovascular system was normal: - Heart sound were dual with no obvious murmurs - JVP was not elevated - No peripheral oedema - No fine creps throughout the lung fields Throat exam was normal: - Pharynx showed no redness or pus - Tonsils ...