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Common general practice consultations – Notes for OSCEs

Common general practice consultations – Notes for OSCEs

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Published by haydenfarquhar
My notes for our Primary Care rotation
My notes for our Primary Care rotation

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Published by: haydenfarquhar on Nov 08, 2009
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Common general practice consultations – Notes forOSCEs
Check up – general, cardiac and female genital
Cardiac – see CHF summary 
Assessment of Card iovascular Risk Factors
Previous IHD
Family history of CAD
History of Diabetes
Renal failureFemale Genital PAP smear sShould be done every 2 years for women 18-70 for those without pathology s/s andfor those who have had sex
From sexual activity 
Begin at 18-20 or two years after sex, whichever is laterCease at 70 if have had normal smears for five yearsThere are reminder registers
PAP required if cervix not fully excisedVaginal vault smears needed if Hx of dysplasia
Grading of squamous abnormalities
HPV = atypiaCIN 1
3 = mild
severe dysplasiaCIS = carcinoma in situInvasive carcinomaASCUS = atypical SC of undetermined significanceLSIL = low grade squamous intraepithelial lesionHSIL = high grade SILCIN = cervical intraepithelial neoplasia
When to refer 
If normal repeat at 2 yearsIf possible or definite LSIL repeat at 12 months, if over 30 with no negativesmears in last 3 years refer to colposcopy or repeat in six monthsHigh grade lesions refer to colposcopy or gynaecologistNOTE: if the patient has HPV smoking is a significant RF for developing a dysplasia
advise to quit
s/s of cc or other disorders…
Vaginal bleeding especially postcoitalDischargeWeakness
Prevention of cancer 
Intercourse with one partnerCondoms if unsure of sexual HxPAP smearsCounseling for those at riskUse of beta carotene has protective effect
eat lots of green leaf andorange vegesNO smoking
Females 18-26 at practiceSchool program
Test results
BGL 4-6 mmol/L (fasting)
HbA1c < or equal to 7%Cholesterol
LDL-C < 2.5 mmol/L
 Total Cholesterol < 4.0 mmol/L
 Triglycerides < 1.5 mmol/LLFTs
Plasma bilirubin
Albumin – indicates chronic liver disease if low
ALT – specific to liver indicates hepatocyte damage
AST – indicates hepatocytes damage
ALP – indicates cholestasis
GGT - raised with cholestasis and
drug and alcohol
 Thyroid function testsFirst look for TSHThen look for T3, T4Hyperthryroidism = Increased HR, Sweating, tremor, anxiety, Increasedappetite, Weight loss, Intollerance to heatHypothyroidism = Cretinism (if present at birth), Mental and physicalslowness, Sensitivity to cold, Decreased pulse, Weight gain, Thickening of skin
Immunisation/vaccination (all ages)
See immunisation schedule
Throat complaint
With a sore throat you need to determine whether it is not deep neck pain, getthem to point to the area that is sore, enquire about other s/s e.g. fever, metallictasteUsually viral treat symptomatically
 Soothing fluids including icy polesAnalgesia
2 paracetamol or soluble aspirin for adults, paracetamol elixir forkids
Rest with adequate fluidsSoothing gargles e.g. soluble aspirinAdvice against overuse of OTC lozenges and topical sprays
1.Viral pharyngitis2.Strep tonsillitis3.Chronic sinusitis with postnasal dripWhat not to missCV angina, MINeoplasia – of oropharynx, tongue\Severe infections – acute epiglottitis, peritonsillar abscess, pharyngealabscess, diphtheria, HIVPitfalls often missedForeign bodyEBVCandida (infants and steroid inhalers)STIs (gonococcal, herpes, syphilis)Reflux oesophagitis
pharyngitisIrritants e.g. cigaretteChronic mouth breathingApthous ulcerationThyroiditisStrep tonsillopharyngitis1.Fever >382.Tender cervical lymph3.Tonsillar exudates4.NO coughDx with throat swab
Tx with penicillin
Upper respiratory infection
Most common cause of a cough
How would you describe it, how long present for?Do you cough up sputum, describe?Any blood in sputum and how much?Is there burning in your throat or chest?Any other s/s?Smoker?Chest pain or fever, shivers or sweats?Wheeze?Previous attacks of wheezing or hay fever?Hx of asthma?Lost weight?Anyone in family with TB or persistent cough?Smoker? Exposure to smoke?Work? Work history? Exposure to asbestos?Do you keep birds?

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