DGP Core Topics and Presentations

Principles of Clinical Practice 3 - General Practice
Core presentations
This guide contains core presentations, tasks and resources that you should become familiar with during your general
practice rotation. As generalists, General Practitioners require a good working knowledge of typical presentations,
prevention and management across specialties and across the lifespan. Examples are presented in the following
tables, with alignment with other rotations in the MD program indicated; it should be noted that these lists are not
exhaustive. They should also assist your revision and learning for your future clinical terms. The tables of women’s
health, paediatrics, aged care and mental health presentations within general practice are designed to direct your
learning whether or not you have completed these MD year 3 terms.
Ambulatory Care, Medicine and Surgery
Table 1: Core presentations for Ambulatory Care, Medicine and Surgery
Typical Tasks to perform or

Core topic Resources
Presentations learning objectives
Health promotion ‘I’ve come for a »» Practice doing 45-49 year old RACGP Red Book: Guidelines
checkup.’ assessments and develop for preventive activities in general
Preventive health
some recommendations practice
activities and ‘I need a medical
in consultation with your http://www.racgp.org.au/your-
screening activities for work.’
supervisor. practice/guidelines/redbook/
Immunisations ‘I’ve come for my
»» Explain common screening RACGP smoking, nutrition,
flu shot’
programs to patients relevant alcohol and physical activity guide
to each age and sex. http://www.racgp.org.au/your-
»» Practice the 5As as per the practice/guidelines/snap/
SNAP guide.
Immunise Australia Program
»» Ensure immunisations are up- (includes Australian Immunisation
to-date for all patients and learn Handbook)
how to enter them correctly in http://www.immunise.health.gov.
medical software au/
6 © University of Melbourne - Melbourne Medical School - 2017

Preparation and overview for the GP term

Cardiovascular ‘My Dad had a heart »» Calculate total cardiovascular Heart Foundation. Information for
disease attack at age 50 risk and explain the results to health professionals
and I am worried the the patient. http://heartfoundation.org.au/for-
Hypertension
same will happen to »» Educate patients on professionals
Lipid disorders me’ lifestyle changes in optimal Australian absolute cardiovascular
Atrial fibrillation ‘I had a blood management of hypertension risk calculator
pressure check at and list the classes of anti- www.cvdcheck.org.au and
CVD check-up
work and the nurse hypertensive medications and https://www.heartfoundation.
Valvular heart common side effects.
said it was very high org.au/for-professionals/clinical-
disease/prescribing
and I should see the »» Review lipid results (under information/absolute-risk
anticoagulants
doctor.’ supervision) and counsel a
https://heartfoundation.org.au/for-
Chest pain, patient about elevated lipids
‘I am not due to professionals/clinical-information/
interpretation of (non -pharmacological and
see my cardiologist absolute-risk
ECGs pharmacological management).
for 6 months, but I
NPS MedicineWise
Stroke think I should see »» Assess a patient with
www.nps.org.au
him earlier, as I am known heart failure who
getting very short of is experiencing increasing Stroke Foundation
breath’ symptoms, review their Clinical guidelines:
medications and consider https://strokefoundation.com.au/
‘I have been getting
medication side effects and what-we-do/treatment-programs/
a tight feeling in my
interactions. clinical-guidelines
chest when I walk’
»» Take a history from a patient
‘I woke up in the presenting with palpitations.
night with my heart
»» Calculate CHADS2 or
pounding’
CHA2DS2-VASc risk and
counsel a patient who is
starting warfarin.
»» Perform and interpret ECGs in
the clinic.
»» Take a history of how a CVA
or TIA has impacted on the
patient’s life and review tertiary
prevention in consultation
with the hospital discharge
summary.
© University of Melbourne - Melbourne Medical School - 2017 7


Respiratory ‘I need to go back »» Observe the practice nurse National Asthma Council Australia
disease on my orange puffer’ performing spirometry and www.nationalasthma.org.au
interpret the results.
Asthma ‘I am here for some Australian asthma handbook
antibiotics as my »» Explain use of inhalers, spacers www.asthmahandbook.org.au/
COPD
breathing is worse’ and check patient’s technique.
RACGP Clinical guidelines:
Lung Cancer / »» Perform PEFR.
‘Help..I am having Supporting smoking cessation
smoking
trouble breathing’... »» Employ motivational www.racgp.org.au/your-practice/
interviewing techniques for guidelines/smoking-cessation/
a patient who smokes and
Lung Foundation Australia
discuss non-pharmacological
http://lungfoundation.com.au/
and pharmacological methods
health-professionals/general-
of quitting.
practice/
»» Outline emergency
management of an acute Motivational interviewing
asthma attack. techniques
http://www.racgp.org.au/
»» Complete a GP management
afp/2012/september/motivational-
plan with a patient with asthma
interviewing-techniques/
»» Complete/review Asthma Cycle
of Care and asthma action
plans
»» Outline management of acute
exacerbation of COPD.
»» Review COPD medications
Prepare a GP management
plan.
ENT ‘I have got a really »» Discuss the indications for The Royal Victorian Eye and Ear
sore ear / throat / antibiotic treatment in acute Hospital. Clinical resources
Acute sinusitis
pain behind my eyes’ sinusitis and viral URTI with http://www.eyeandear.org.au/
URTI patients page/Health_Professionals/
‘I can’t speak up
Tonsillitis »» Demonstrate correct nasal Clinical_Resources/
in the classroom
because I am having spray technique eTherapeutic Guidelines, available
Hoarsenes
a real problem with in MD Connect™
this scratchy throat’
The Royal Children’s Hospital-
‘I really need How to use a nasal spray
antibiotics’ http://www.rch.org.au/genmed/
clinical_resources/Asthma-_
using_a_nasal_spray/


Chronic kidney ‘My Dad has to go »» Identify risk factors and Kidney Health Australia. Chronic
disease onto dialysis for his screen patients for CKD. kidney disease management
kidneys. Should I »» Write chronic disease handbook in General Practice.
Screening
have a check-up for management plans for Available from: www.kidney.org.au
recommendations
this?’ patients with CKD and add
Diagnostic criteria
recalls to the practice software
and classification
for medium and long term
system for CKD
management.
Diagnosis
Management
Complications
Diabetes mellitus ‘My brother has »» Practise calculating RACGP. General practice
recently been AUSDRISK management of type 2 diabetes
Screening
diagnosed with »» Counsel a patient with newly http://www.racgp.org.au/your-
Diagnosis diabetes and I am practice/guidelines/diabetes/
diagnosed type 2 diabetes.
Treatment wondering if I should
»» Refer a patient to an allied Diabetes Australia
be checked too?’
Prevention of health professional as part https://www.diabetesaustralia.
complications ‘I can’t clear up this of a care plan and team care com.au/for-health-professionals
skin infection despite arrangement
Emergencies
having two courses »» Complete a diabetes annual
of antibiotics’ cycle of care.
‘I am due for a new »» Measure blood glucose levels
care plan so I can »» Test urine for glucose and
go back to see the ketones
podiatrist for my
diabetes check’
Gastroenterology ‘Can I have another »» Give lifestyle advice to a GESA. Irritable bowel syndrome
script?’ patient diagnosed with irritable http://www.gesa.org.au/
GORD
bowel syndrome. resources/clinical-guidelines-
‘My tummy
Irritable bowel and-updates/irritable-bowel-
symptoms are »» Give lifestyle advice to a
syndrome syndrome/
playing up again, patient with GORD. Know
Coeliac disease and it is really red flags and indications for AFP. Coeliac disease: where are
worrying me.’ gastroscopy. we in 2014?
Fatty liver/ abnormal
LFTs »» Interpret and explain coeliac http://www.racgp.org.au/
‘The naturopath
screening tests to a patient. afp/2014/october/coeliac-
told me to cut out
»» Review and interpret LFTs. disease-where-are-we-in-2014/
gluten and I am
feeling heaps better. »» Give lifestyle advice to a Coeliac Australia. Resources
Do I need a test for patient who has a liver US http://www.coeliac.org.au/
coeliac disease?’ confirming fatty liver. resources/
AFP. Fatty liver disease
afp/2013/july/fatty-liver-disease/


Thyroid Disease ‘I am feeling really »» Examine patients presenting Australian Prescriber.

tired’ with a neck lump. Thyroid function tests
Hypothyroidism
»» Interpret thyroid function tests. https://www.nps.org.au/
‘I have been losing
Hyperthyroidism australian-prescriber/articles/
weight lately’ »» Counsel a patient who is going
thyroid-function-tests
on thyroxine/ carbimazole.
Dermatology ‘I have this new red »» Practice describing skin DermNet NZ

spot next to my rashes and lesions, develop http://www.dermnetnz.org/
Malignant neoplasms
nose’ a differential diagnosis and
of skin MD Connect™. MD2 Foundation
consider management
‘I can’t go to work, term lecture: ‘Introduction to
Skin manifestations approaches.
as my hands are Dermatology’, and performing
of systemic disease
terrible since I »» Perform dermoscopy. a skin examination ( clinical
Contact dermatitis started this job at the examinations guide)
Acne florist.’ https://mdconnect.medicine.
unimelb.edu.au/
Eczema ‘I’m fed up of my
spotty cheeks and eTherapeutic Guidelines, available
Psoriasis
back’ in MD Connect™
Men’s health ‘Can I have a script »» Take a history from a patient Andrology Australia. Health
for Viagra?’ who is presenting with erectile professionals pages
Erectile dysfunction
dysfunction taking into account https://www.andrologyaustralia.
‘I am up all night
Benign prostatic total cardiovascular risk, and org/health-professionals/
needing to pee’
hyperplasia counsel a patient starting on
RACGP. Prostate cancer
‘My wife has been phosphodiesterase inhibitors.
Prostate cancer screening: Patient information
hassling me to get a
screening »» Counsel a patient seeking a sheet.
prostate test.’
PSA test according to recent http://www.racgp.org.au/your-
RACGP guidelines. practice/guidelines/prostate-
»» Complete an international cancer/
prostate symptom score
RACGP. Red book Guidelines
assessment
for preventive activities in general
practice 9th edition.
http://www.racgp.org.au/your-
practice/guidelines/redbook/9-
early-detection-of-cancers/91-
prostate-cancer/
Calculator: International
Prostatism Symptom Score (IPSS)
http://www.uptodate.com/
contents/calculator-international-
prostatism-symptom-score-ipss


Headache 'I am getting »» Practise taking headache NPS Medicinewise. Headache

headaches every day history including asking about http://www.nps.org.au/conditions/
Tension headache
now.’ red flags. nervous-system-problems/pain/
Migraine for-individuals/pain-conditions/
»» Ask a patient to prepare and
Red flags for then review a headache diary. headache
headaches »» Assess differential diagnosis
Bacterial and viral for headache including
meningitis migraine, cluster headache
and tension headache
Head injury
and perform a focused
neurological examination for
headache.
Bones and Joints ‘My back has »» Interview and examine RACGP. Clinical guidelines for
been terrible after patients with back pain musculoskeletal diseases.
Back pain
I did a big day of enquiring about red flags. http://www.racgp.org.au/
Osteoarthritis gardening.’ For each patient presenting your-practice/guidelines/
Rheumatoid arthritis with back pain, determine musculoskeletal/
‘My hands have
likely underlying cause and
Polymyalgia really stiffened up Arthritis Australia
determine whether imaging is
rheumatica and I am worried I www.arthritisaustralia.com.au
indicated or not.
am getting the same
Osteoporosis »» For patients with back pain, Osteoporosis Australia. Healthcare
arthritis my mother
prepare a team care plan professionals
had.’
including team members http://www.osteoporosis.org.au/
‘I had a terrible fall details - who, why, how to healthcare-professionals
and broke my hip. access, cost. RACGP. Clinical guideline for
The surgery went
»» Enquire about level of the prevention and treatment of
well but the doctor
functioning in rheumatoid osteoporosis in postmenopausal
said I should get my
arthritis and about extra- women and older men
bones checked.’
articular manifestations of the http://www.racgp.org.au/
disease. your-practice/guidelines/
»» Enquire about functioning and musculoskeletal/osteoporosis/
pain management; refer to Diagnostic Imaging Pathways
support organisations. http://www.imagingpathways.
»» Osteoarthritis – inquire about health.wa.gov.au/
day-to-day functioning,
management strategies and
the role of physiotherapy and
other physical therapies.
»» Determine need for DEXA
scan according to a person’s
fracture risk; interpret DEXA
results (under supervision) and
discuss lifestyle advice and
pharmacological treatments to
reduce fracture risk.


Ophthalmology ‘I woke up today »» Practise examination of the The Royal Victorian Eye and Ear
with this red, painful eye Hospital. Clinical resources
Approach to the red
eye’ »» Create a differential diagnosis http://www.eyeandear.org.au/
eye
and suggested management page/Health_Professionals/
‘I was hammering in
Foreign body in the Clinical_Resources/
the workshop and for each diagnosis listed.
eye (read the Golden Eye Rules)
think I got something
Chalazion and other in my eye’
eyelid problems
‘I have this painful
bump on my eyelid’
Travel medicine ‘I am going on a »» Counsel a patient who is going Centers for Disease Control and
round-the-world overseas providing general Prevention. Traveller’s Health
General travel advice
trip. Do I need any travel advice and specific www.cdc.gov/travel
Immunisations shots?’ advice on recommended
Australian Government. Smart
Fever in a returned vaccines
traveller website
traveller »» Identify malaria prophylaxis www.smarttraveller.gov.au
according to up to date
Malaria prophylaxis
recommendations and explain
how it must be taken.
»» Take a history from returned
traveller who is unwell.
Other medical ‘Help me quickly; my »» Outline initial management Australian Prescriber. The doctor’s
emergencies/ child has collapsed of a patient with suspected bag. App available.
injuries in the café across anaphylaxis. https://www.nps.org.au/
the road’ »» Practice interpreting X-rays australian-prescriber/articles/the-
Anaphylaxis
and compare with official doctors-bag
‘My daughter has
Epistaxis
fallen off the monkey radiology result MD Connect™. MD2 PCP2
Acute limb injury with bars at school.’ »» Apply a plaster to a closed Ambulatory Care /ED student
possible fracture non deformed fracture guide
Acute wound »» Provide plaster care advice MD Connect™ Library software.
»» Apply a broad arm sling and a Medical Imaging.
collar and cuff sling https://mdconnect.medicine.
»» Counsel a patient about unimelb.edu.au/
wound management (including Therapeutic guidelines. Ulcer and
tetanus and antibiotic) and Wound Management.
apply a dressing https://mdconnect.medicine.
unimelb.edu.au/


Multi-system ‘I’m tired all the time’ »» List differential diagnosis for Fatigue – a rational approach to
presentations each presentation investigation
‘I’m losing weight’
»» Consider which ‘red flag’ http://www.racgp.org.au/
‘I’m having difficulty afp/2014/july/fatigue/
conditions should be excluded
sleeping’
»» Justify which investigations
‘My (relative) is acting may be ordered
out of sorts’
»» Consider appropriate
management strategies for
each diagnosis
Surgery ‘I found a breast »» Practise breast examination Cancer Council National GP Portal
lump when I was in under direct supervision. http://gp.cancer.org.au/
Breast disease
the shower’ »» Describe lumps; identify Breast Screen Victoria.
Symptomatic breast
‘My mum’s sister has characteristics of benign and www.breastscreen.org.au
disease
just died of breast malignant lumps
Breast Cancer Network Australia
Breast cancer cancer. Should I »» Give advice to patients about
Health professional information
screening have any tests?’ breast self-examination
(scroll past position statements)
https://www.bcna.org.au/about-
us/advocacy/position-statements/
RACGP. Red book Guidelines
for preventive activities in general
practice.
breast-cancer/
Lumps and bumps ‘I have this lump »» Describe lumps using MD Connect™.Clinical
on my back that is descriptive terminology and examinations guide
Sebaceous cyst/
getting bigger and create a differential diagnosis
abscesses MD Connect™ Library. Skin atlas.
really hurting’ »» Practice suturing
Lipoma https://mdconnect.medicine.
‘I have these funny »» Outline different treatment
unimelb.edu.au/
Haemorrhoids lumps on my arm’ options for haemorrhoids
‘I think I have piles’


Upper abdominal ‘I am getting really »» Take an alcohol history MD Connect™. MD2 PCP2
pain bad heartburn »» Employ motivational Surgery student guide
/ tummy pain / interviewing techniques in https://mdconnect.medicine.
GORD
nausea’ patients presenting with unimelb.edu.au/
Hiatus hernia
alcohol related health issues AFP. Motivational interviewing
Peptic ulcer disease »» Explain gallstone diagnosis techniques.
Gastritis and treatment to a patient; http://www.racgp.org.au/
write a referral to a surgeon for afp/2012/september/motivational-
Pancreatitis
a patient for consideration of interviewing-techniques/
Gallbladder disease elective cholecystectomy
Gastroenterology Society of
Obstructive jaundice »» Take a history from a patient Australia clinical guidelines h
presenting with obstructive ttps://www.gesa.org.au/
jaundice and formulate a
AFP. Biliary pain
differential diagnosis
afp/2013/july/biliary-pain/
MJA. Acute pancreatitis –
update on management
https://www. mja.com.au/
journal/2015/202/8/ acute-
pancreatitis-update-management
Lower abdominal ‘I couldn’t sleep last »» Practise taking histories from Department of Health. Cancer
pain night due to such and performing physical screening
bad tummy pain’ examinations in patients www.cancerscreening.gov.au
Acute abdomen
presenting with acute and
differential diagnosis ‘My Dad has been BMJ Best Practice. Assessment
chronic abdominal pain
diagnosed with of the acute abdomen
Appendicitis
bowel cancer. »» Write a referral letter to an http://bestpractice.bmj.com/best-
Ureteric colic Should I be having emergency department for a practice/monograph/503.html
any tests?’ patient presenting with acute
Diverticular disease Gynaecological presentations:
abdominal pain
and diverticulitis refer to the Women’s Health term
»» Practise taking family histories
Inflammatory bowel guide.
to determine appropriate
disease https://mdconnect.medicine.
investigations
unimelb.edu.au/
Gynaecological »» Explain the national bowel
presentations for RACGP. Red book guidelines for
cancer screening program to
abdominal pain preventive activities in general
a patient who presents with
including ectopic practice. Colorectal cancer.
queries about an FOBT in the
pregnancy and http://www.racgp.org.au/your-
mail
ovarian pathology practice/guidelines/redbook/9-
Colorectal carcinoma
colorectal-cancer/
and the national
bowel cancer
screening program

Aged Care
General resources
• PCP3 Aged Care term guide 2016 - available on MD Connect
• RACGP. Guidelines for preventive activities in general practice (Red book);
http://www.racgp.org.au/your-practice/guidelines/redbook/5-preventive-activities-in-older-age/
• RACGP. Medical care of older persons in residential aged care facilities (Silver book),
http://www.racgp.org.au/your-practice/guidelines/silverbook/
• Australian Medicines Handbook. Guides: Prescribing for the elderly (Available via MD Connect)
• Alzheimer’s Australia. (Information and support for patients and carers, as well as tools for dementia assessment
including people from a non-English speaking background.) www.fightdementia.org.au
• Advance Care Planning. Australia. Links to training resources and courses provided by the Respecting Patient
Choices Program at Austin Health, http://advancecareplanning.org.au
Table 2: Core presentations for Aged Care
Aged Care

Prescribing in ‘Doctor, I don’t »» Attend Home Medication AFP. Prescribing in the elderly
the elderly and understand why I Reviews with local pharmacists http://www.racgp.org.au/
polypharmacy have to take all these »» Interview patients about how afp/2010/october/prescribing-in-
pills!’ they manage medication the-elderly/
including the use of Webster
packs
»» Explain to patients why the
medication is necessary

Aged Care

Comprehensive ‘The nurse rang me »» Conduct several over-75-year- Austroads. For health
geriatric and said I was due old Health Assessments, and professionals
assessment for a checkup.’ make recommendations based http://www.austroads.com.au/
on your findings to discuss with drivers-vehicles/assessing-fitness-
‘I’ve come for my flu
your supervisor to-drive/for-health-professionals
jab’
»» Review a referral to a Team Department of Social Services.
Care Arrangement and My aged care
consider accompanying a http://www.myagedcare.gov.au/
patient to an allied health
Aged Care Assessment Team
appointment
(ACAT) assessments
»» Discuss driving safety with
http://www.myagedcare.gov.au/
an older person taking into
eligibility-and-assessment/acat-
account their medical history
assessments
»» Discuss level of community
The Australian Immunisation
support and home safety
Handbook 10th edition June 2015
»» Discuss the completion of
http://www.health.gov.au/internet/
Advance Care Plans with
immunise/publishing.nsf/content/
patients
handbook10-home
»» Counsel a person considering
residential care including
referral for an ACAT
assessment
»» Accompany a GP to local aged
care facilities; contribute to the
rounds there
Dementia care in ‘I’m worried about »» Practise doing MMSE World Health Organization.
the community my mother’s »» Interview carers to understand Dementia
memory’ the issues and refer them to http://www.who.int/topics/
Delirium in the
local support services including dementia/en/
elderly ‘I’m exhausted
caring for my father respite care Dementia Collaborative Research
who has dementia’ Centres. Talks and publications
http://www.dementiaresearch.org.
au/presentations.html
Depression in the ‘I feel like a burden’ »» Practise interviewing elderly PCP3 Aged Care term guide.
elderly patients about their mental Available on MD Connect https://
health mdconnect.medicine.unimelb.
edu.au/

Aged Care

Falls ‘I fell again last night’ »» Assess patient for acute injury AFP. Falls prevention in older
»» Attend home visits to elderly adults
patients with the GP or http://www.racgp.org.au/
practice nurse to assess afp/2012/december/falls-
sensory impairments, falls risk, prevention/
emotional wellbeing and other
safety issues
Palliative care ‘My pain is bad’ »» Attend one home visit with the Palliative Care Victoria
local palliative care team/GP http://www.pallcarevic.asn.au/
(if possible)
Osteoporosis ‘I went to the »» See MD2 core presentations See MD2 core presentations
chemist for a bone
scan and they told
me I had to see my
GP’

Child and Adolescent Health

General resources
Children aged less than 15 years account for 11% of general practice encounters.1 The following resources are
designed to assist with student learning about paediatrics and to provide an approach to history taking and physical
examination in children presenting to general practice.
• Child and Adolescent Health guide - available on MD Connect
• Royal Children’s Hospital clinical practice guidelines and kids health information. This website (apps also available)
provides detailed clinical practice guidelines for paediatric presentations. The Kids health information fact sheets
provide useful parent and patient information. www.rch.org.au
• University of British Columbia. Learn paediatrics by students for students. Includes approaches to common
problems (e.g. approach to the child with a fever and a rash) and a series of videos including abdominal,
respiratory, cardio and neurologic examinations, inspections, and auscultations on children and newborns.
http://learn.pediatrics.ubc.ca/
• The videos are also available through Vimeo: https://vimeo.com/learnpediatrics/videos/page:2/sort:date
Hutson JM, Beasley SW. The surgical examination of children. 2nd ed. Springer; 2013. Ebook available through
the University library at: https://my.unimelb.edu.au/login/pages/login.jsp Raising Children Network. The
Australian parenting website: comprehensive, practical, expert child health and parenting information and activities
covering children aged 0-15 years. www.raisingchildren.net.au
Allied health and other community resources

Your GP supervisor and the practice are part of the wider community; you should understand the role the GP and
practice play in community services. e.g.:
• Your local maternal and child health centre (MCHC) – the nurse may allow you to visit during a session.
• If your GP practice or related allied health provider conducts education sessions at any local MCHC, crèches,
kindergartens or schools you may be able to accompany them and contribute.
• Consider volunteering at the Royal Children’s Hospital Teddy Bear Hospital, especially if it visits your local
community.
• Understand the impact of a sick child on the family and the role of parental education and support in acute and
chronic diseases.
1 Britt HC, Millar GC, Henderson J, Bayram C, Harrison CM, Valenti L, et al. General practice activity in Australia 2013-14. Sydney: Sydney University Press, 2014.

Table 3: Core presentations for Child and Adolescent Health

First 6 weeks ‘I am here for my »» Examine a baby who presents Newborn exam
baby’s 6 week for a 6 week check including https://www.thewomens.org.
New baby check
check’ doing a hip examination au/health-professionals/clinical-
Well child check education-training/the-womens-
»» Plot centiles
Growth and maternity-services-education-
»» Interview parents regarding
development program-msep/
feeding and settling
Developmental »» Counsel a parent who has The 6 week check: An opportunity
dysplasia of the hip immunisation queries for continuity of care. AFP May
2012 http://www.racgp.org.au/
Breastfeeding and
afp/2012/may/the-6-week-check/
feeding
Royal Children’s Hospital.
Immunisation
Developmental dysplasia of the hip
Approach to http://www.ddheducation.com/
undescended
Royal Children’s Hospital. Child
testis
growth learning resource
http://www.rch.org.au/childgrowth/
Child_growth_e-learning/
Immunise Australia Program
http://www.immunise.health.gov.au/
Fever in a child ‘My baby aged 8 »» Interview parents of children Interactive sessions CAH student
weeks has a fever’ presenting with fevers guide session 4
Consider how
»» Perform a systematic exam to https://mdconnect.medicine.
investigation and ‘My child aged 4
find the source of the fever unimelb.edu.au/
management years has a fever on
of fever differs and off for the last »» Apply the traffic light system/ RCH clinical practice guidelines
according to age 48 hours’ screening tool for young febrile child
children presenting with acute http://www.rch.org.au/clinicalguide/
Application of
febrile illness guideline_index/Febrile_Child/
traffic light system
and management »» Provide fever advice to the Royal Children’s Hospital. Febrile
approach parent (stable child) child. Includes a link to the
according to age Screening tool for young children
of child presenting with acute febrile illness.
http://www.rch.org.au/clinicalguide/
guideline_index/Febrile_Child/


Bowel and ‘My child is »» Advise a parent about RCH clinical practice guidelines on
bladder constipated’ conservative and medical constipation and parent information
management for constipation sheet:
Constipation ‘I think my child has
a bladder infection’ »» Develop a plan for enuresis with http://www.rch.org.au/clinicalguide/
Urinary tract guideline_index/Constipation/
a parent
infections ‘My child is wetting
»» Manage a UTI in the community Royal Children’s Hospital.
the bed at night’
Enuresis Bedwetting
http://www.rch.org.au/kidsinfo/
fact_sheets/Bedwetting/
Royal Children’s Hospital. Urinary
Tract Infection
guideline_index/Urinary_Tract_
Infection/
Respiratory ‘My child has a sore »» Perform ENT exam; know CAH student guide. ENT exam- Ear,
infections ear‘ the different appearances of nose and throat (ENT) examination
tympanic membranes in children
Acute otitis media ‘My child has funny
»» Advise a patient regarding https://mdconnect.medicine.
breathing’
Pharyngitis unimelb.edu.au/
natural history of an URTI and
Bronchiolitis when to return to the GP/ Royal Children’s Hospital. Viral
hospital illnesses
Croup
»» Counsel a parent whose child http://www.rch.org.au/kidsinfo/
Pneumonia
is going on a short course of fact_sheets/Viral_illnesses/
oral steroids


Asthma ‘My child has a »» Practise taking asthma National Asthma Council Australia.
wheeze’ histories and classify type and Australian Asthma Handbook,
Classification
severity of asthma Version 1.2. National Asthma
‘My child has a
Diagnosis Council Australia, Melbourne, 2016.
cough at night and »» Give feedback on and
Treatment demonstrate correct inhaler Website. Available from:
after exercise’
and spacer technique to a http://www.asthmahandbook.org.
Acute asthma
patient au
management
»» Interpret and explain spirometry Definitions of asthma patterns in
results to a parent children aged 0–5 years not taking
»» Write an asthma management regular preventer
plan using the medical software http://www.asthmahandbook.org.
au/table/show/14
»» Complete an asthma action
plan for childcare/school Royal Children’s Hospital. Inhaled
medications for asthma and rhinitis
http://www.rch.org.au/genmed/
clinical_resources/Inhaled_
medications_for_asthma_and_
rhinitis/
National Asthma Council Australia.
Spirometry handbook
https://www.nationalasthma.org.
au/health-professionals/spirometry-
training-and-tools
Common skin ‘My child has an »» Describe a rash using MD2 Foundation term-‘Introduction
problems itchy rash on her appropriate terminology to Dermatology’ lecture on MD
arms and legs’ »» Develop a management plan Connect
Eczema
and give eczema advice to a https://mdconnect.medicine.
‘My child has a sore
Nappy rash unimelb.edu.au/
rash on his bottom parent
Vulvovaginitis and I’m not sure Royal Children’s Hospital. Eczema
what to do next’ management
http://www.rch.org.au/rchcpg/
‘My little girl is
hospital_clinical_guideline_index/
complaining of an
Eczema_management/
itch down below and
it looks a bit red’ Royal Children’s Hospital.
Nappy rash
guideline_index/Nappy_Rash/
Prepubescent Gynaecology
(Includes vulvovaginitis)
guideline_index/Prepubescent_
Gynaecology/


Common ‘My child has blisters »» Describe and diagnose Royal Children’s Hospital clinical
infections on his tummy that common childhood rashes practice guideline chicken pox
are spreading’ »» Advise a parent on natural http://www.rch.org.au/clinicalguide/
Chicken pox/
history of these conditions and guideline_index/Chickenpox_
varicella ‘My child has a
give school/childcare exclusion varicella/
weepy rash on his
Hand foot and
face’ advice Royal Children’s Hospital.
mouth disease
Cellulitis and Skin Infections
Impetigo
guideline_index/Cellulitis_and_Skin_
Infections/
Royal Children’s Hospital. Impetigo
school sores.
http://www.rch.org.au/kidsinfo/fact_
sheets/Impetigo_school_sores/
Department of Health. Infectious
diseases.
https://www2.health.vic.gov.au/
public-health/infectious-diseases
Department of Health. Disease
information and advice. (A-Z
list of blue book diseases
with descriptions, notification
requirements, school exclusions
and management guidelines.)
https://www2.health.vic.gov.au/
public-health/infectious-diseases/
disease-information-advice
Common ‘Help, my child is »» Assess and manage an acute Royal Children’s Hospital.
emergency struggling to breathe’ asthma attack presenting to GP Asthma Acute
presentations: »» Instruct a patient/ parent on http://www.rch.org.au/clinicalguide/
‘Help, my child has
Acute asthma collapsed’ how to administer an adrenaline guideline_index/Asthma_Acute/
attack auto injector ASCIA. Anaphylaxis resources.
‘My child fell off the
»» Understand which fractures http://www.allergy.org.au/health-
Head injury monkey bars in the
are referred and which are professionals/anaphylaxis-resources
playground’
Foreign body managed in the general
(nasal/inhaled/ practice
ingested)
Anaphylaxis
Fractures


Common ‘My little boy is Abdominal and inguino-scrotal

surgical complaining of examination in children refer to
presentations stinging from the tip Child and Adolescent Health guide
of his penis when he available on MD Connect™
Balanitis
pees’ https://mdconnect.medicine.
Inguinal hernias unimelb.edu.au/
‘My 12 yr-old has a
Testicular torsion pain in his tummy Royal Children’s Hospital.
Congenital and a sore testicle’ The Penis and Foreskin
haemangiomas http://www.rch.org.au/clinicalguide/
‘My baby has a red
guideline_index/The_Penis_and_
lump on his eye that
Foreskin/
looks sore’
Acute scrotal pain or swelling
guideline_index/Acute_Scrotal_
Pain_or_Swelling/
Haemangiomas of infancy
http://www.rch.org.au/kidsinfo/fact_
sheets/haemangiomas_of_infancy/

Mental Health
Mental health issues are common in patients presenting to general practice. For example, in 2013-2014, 13% of GP
encounters were shown to be related to mental health and one third of these were for depression2. If students have
not completed the MD year 3 Mental Health term, they will need some basic knowledge about how mental health
conditions present in general practice, in particular:
• Awareness of some simple strategies to detect patients with possible mental illness. Some familiarity with the
diagnostic criteria for common psychiatric conditions managed in general practice, in particular anxiety and
depression is required
• How to take a history from a patient experiencing psychological distress, including how to conduct a Mental State
Examination
• Knowledge of psychotropic medications commonly prescribed in the GP setting for mental illness and their side
effects
• Awareness of effective non-pharmacological strategies for common mental illnesses encountered in the GP setting
2 Britt H, Miller GC, Henderson J, Bayram C, Harrison C, Valenti L, Wong C, Gordon J, Pollack AJ, Pan Y, Charles J. 2014. General practice activity in Australia 2013–14.
General practice series no.36. Sydney: Sydney University Press.

Table 4: Core presentations for Mental Health
Mental Health

Detection of ‘I have had a heart »» Ask some questions to RACGP. Clinical guidelines
mental illness in attack recently determine the patient’s mental (‘Psychosocial’ chapter).
general practice and need to get health. http://www.racgp.org.au/your-
my scripts and a »» Consider the mental health practice/guidelines/redbook
Assessing a person
referral back to the challenges for people with
with psychological Heart Foundation. Psychosocial
cardiologist’ acute or chronic medical
distress health.
‘I am a new Mum problems http://heartfoundation.org.au/for-
and I am having a lot »» Practise interviewing patients professionals/clinical-information/
of trouble getting to about their use of alcohol and psychosocial-health
sleep, even when the other drugs
Beyondblue - Perinatal mental
baby is sleeping fine’ »» Administer the Edinburgh health
‘I’ve just dropped Postnatal Depression Scale https://www.beyondblue.org.au/
out of uni and my as part of your assessment of resources/health-professionals/
parents are nagging sleep issues in the postnatal perinatal-mental-health
me to do something period
Turning point. New screening and
about my heavy »» Perform a HEADSS
assessment tools.
drinking’ assessment on a young person
http://www.turningpoint.org.au/
‘I have really lost my »» Interview a patient to explore Treatment/For-Health-Professionals/
motivation at work, whether they have symptoms New-screening-and-assessment-
I’m tired and moody of anxiety and/or depressive tools1.aspx
and think I need disorder
Royal Children’s Hospital. Engaging
something to help
with and assessing the adolescent
me sleep’
patient.
‘I want you to see http://www.rch.org.au/clinicalguide/
my 15 year old son, guideline_index/Engaging_with_
who is acting really and_assessing_the_adolescent_
weird lately’ patient/
‘I’m just not feeling Headspace
well’ (Somatisation) http://headspace.org.au/
Reachout
http://au.professionals.reachout.
com

Mental Health

Diagnosed ‘I’ve come in for a »» Conduct mental state In general practice, the ICD-10
conditions repeat script’ examinations including risk codes for mental disorders are
assessments. commonly recommended instead
Key diagnostic ‘My anxiety is getting
»» Practise applying K10 or on the DSM-V diagnostic criteria.
criteria for mood worse’
and anxiety another psychometric measure. They can be easily accessed
‘My daughter is
disorders »» Perform a mental state exam on line at
losing lots of weight’.
on a young person, who is http://apps.who.int/classifications/
Anxiety
exhibiting unusual behavior icd10/browse/2015/en#/V
Depression
»» Provide patients with Within Chapter V, it is
Post natal information about their specific recommended as a minimum that
depression conditions you read sections F30-39 (mood
Psychosis »» Describe common and disorders) and F40-48 (neurotic,
effective approaches to the stress-related and somatoform
Eating disorders
management of anxiety disorders)
Substance misuse disorders and understand the http://www.rch.org.au/clinicalguide/
/ Dual diagnosis evidence for CBT guideline_index/Mental_State_
Bipolar disorder »» Compile a list of local resources Examination/

and services for people with Headspace
dual diagnosis and substance http://headspace.org.au/
misuse
‘Help us, she’s fading away’ How
»» If possible, sit in with a patient
to manage the patient with anorexia
during a session with their
nervosa
clinical psychologist
http://www.racgp.org.au/afp/2014/
»» Practise writing mental health august/help-us-shes-fading-away/
plans with your supervisor.
http://www.mindhealthconnect.org.
»» Interview patients with a history
au/
of mental illness regarding the
impact it has on their life. https://beacon.anu.edu.au/
»» Provide information about the Beyond Blue
local crisis service. http://www.beyondblue.org.au/
»» Find resources on the internet
that you could use to provide
psycho-education to patients.
»» Find online therapy options for
patients with common mental
health concerns

Mental Health

Psycho ‘I need a repeat »» Counsel patients who are RACGP. Prescribing drugs of
pharmacology script for my starting an SSRI including side dependence in general practice,
serepax, which I take effects. Part B Benzodiazepines.
SSRIs
to help me sleep’ »» Know the guidelines for http://www.racgp.org.au/your-
Benzodiazepines practice/guidelines/drugs-of-
‘I stopped taking prescribing benzodiazepines in
Atypical general practice dependence-b/
the medication the
antipsychotics doctor prescribed »» Interview a patient about their Therapeutic Guidelines - available
for depression, as it history of sleep problems and on MD Connect
made me feel really medication usage. Incorporate https://mdconnect.medicine.
numb. But I am still sleep hygiene advice as part of unimelb.edu.au/
struggling’ your management strategy for
NPS MedicineWise
patients with sleep issues.
‘I’m putting on loads http://www.nps.org.au/
of weight from those »» Read about common
meds’. medication options for the
treatment of Depressive
Disorder, with attention to
recommended dose range,
common side effects and how
to switch from one medication
to another.

Women’s Health
General resources
• PCP3 Women’s Health student guide - (available on MD ConnectTM)
https://MD Connect.medicine.unimelb.edu.au
• Royal Women’s Hospital website -This website provides clinical practice guidelines to health professionals and
patient information for pregnancy and gynaecological care - www.thewomens.org.au
• Melbourne Sexual Health Centre - This website provides detailed guidelines on the management and treatment
of sexually transmitted infections and has useful resources for patients. www.mshc.org.au
• Family Planning Victoria - This website has links for both patients and health care practitioners. It covers a range
of sexual and reproductive health topics including contraception and has useful patient resources. www.fpv.org.au
• Jean Hailes website for Women’s health -This website has useful resources for GPs and for patients.
www.jeanhailes.org.au.
Table 5: Core presentations for Women’s Health
Women’s Health

Well woman ‘I would like a check »» Give lifestyle advice e.g. on RACGP. SNAP guide
check- non –up’ smoking, nutrition, alcohol, http://www.racgp.org.au/your-
pregnant physical activity practice/guidelines/snap/
‘I would like an STI
Lifestyle and check’ »» Practise motivational Australian absolute cardiovascular
nutritional advice interviewing disease risk calculator
»» Calculate total cardiovascular www.cvdcheck.org.au and
Mental health
risk using the CVD risk https://www.heartfoundation.
assessment
calculator org.au/for-professionals/clinical-
Contraceptive information/absolute-risk
»» Discuss cervical cancer
advice
screening with at risk women. Family planning Victoria
STI screening Perform cervical cancer smears www.fpv.org.au
(direct supervision required)
PapScreen Victoria
»» Take a sexual history and
www.papscreen.org.au
discuss STI screening
Melbourne sexual health centre
»» Perform breast examinations
http://www.mshc.org.au/
(direct supervision required)
Australian STI management
guidelines for use in primary care
www.sti.guidelines.org.au
For mental health assessment
please refer to resources listed
under the Mental Health term.

Women’s Health

Pelvic pain ‘I have pain when »» Consider ectopic pregnancy in RANZCOG guidelines.
having sex/ I bleed any woman of child- bearing http://www.ranzcog.edu.au/college-
Ectopic pregnancy
after sex’ age who presents with statements-guidelines.html
Treatment of acute abdominal pain or bleeding
RANZCOG. Useful Clinical
established PID,
»» Practise taking endocervical Guidance: Chronic pelvic pain,
and complications
swabs (under direct initial management of.
Endometriosis supervision); interpret results http://www.ranzcog.edu.au/college-
and explain the results to a statements-guidelines.html
patient (under supervision)
for example giving a positive
chlamydia PCR result
Contraception ‘I would like to go on »» Counsel a patient experiencing Family Planning Victoria

and period the pill’ dysmenorrhoea and provide www.fpv.org.au
problems advice about non hormonal
‘I have painful NPS Medicinewise. Contraceptive
management
COCP periods/ I have methods
irregular periods- »» Counsel a patient before they http://www.nps.org.au/medicines/
POP
help!’ go on the COCP and use a contraceptive-methods
Implanon pill pack to demonstrate how
‘I have heavy John Guillebaud and Anne
to take it effectively, including
IUS (Mirena)-IUD periods’ McGregor. Contraception: your
what to do about missed pills
Depot provera questions answered (textbook)
»» Counsel a patient for implanon
Dysmenorrhoea insertion RANZCOG. Heavy menstrual
bleeding
Heavy menstrual »» Counsel a patient pre-Mirena
bleeding (HMB) insertion
»» Take histories from women
Ethical issues-
suffering from HMB and
prescribing for
discuss investigations and
adolescents- Gillick
management strategies
competence
Polycystic ovary ‘I feel like I have »» Order baseline investigation in Jean Hailes For Women’s Health.
syndrome (PCOS) more facial hair suspected PCOS www.jeanhailes.org.au
than normal and my »» Give management and lifestyle
Hirsutism Polycystic ovary syndrome GP tool
periods are irregular’ advice to a patient with PCOS available from
Acne
https://jeanhailes.org.au/contents/
Subfertility documents/Resources/Tools/
PCOS_tool.pdf

Women’s Health

Emergency ‘I had unprotected »» Counsel a patient about oral RANZCOG - www.ranzcog.org.au

contraception- sex last night and emergency contraception Search for ‘emergency
Hormonal versus do not wish to get contraception’.
non hormonal pregnant’
Family Planning Victoria. Emergency
contraception
http://www.fpv.org.au/sexual-
health-info/contraception/
emergency-contraception
Pre- conception ‘I would like to get »» Counsel a woman who is RACGP red book 9th edition-
care pregnant…’ considering getting pregnant preventive activities prior to
pregnancy:
Pre conception
counselling-
medical issues,
preventive-activities-prior-to-
lifestyle issues,
pregnancy/
preventive
interventions
Infertility ‘I would like to get »» Order pre-IVF investigations/ Australian Doctor 2015 How to
pregnant, and have write a letter referring a patient Treat Series. Subfertility and IVF
Lifestyle factors
been trying for over to a fertility specialist http://www.australiandoctor.com.
Male and female a year now’ au/login
factors
(Site requires registration, available
Menstrual cycle to APHRA registered medical
factors students)

Women’s Health

Standard ‘I am pregnant, what » Provide lifestyle advice to a Royal Women’s Hospital

antenatal care do I do now?’…. woman who has just found out www.thewomens.org.au
she is pregnant
Lifestyle advice in I am pregnant AFP Noninvasive prenatal testing.
pregnancy and bleeding… » Assess and refer a patient with 2014. 43(7): 432-434
am I having a abnormal vaginal bleeding for http://www.racgp.org.au/afp/2014/
Immunisation
miscarriage? appropriate investigations july/noninvasive-prenatal-testing/
advice in
» Discuss antenatal care options
pregnancy Immunise Australia Program.
available and the usual
http://www.immunise.health.gov.au/
Referral pathways schedule of care
unplanned Royal Women’s Hospital. Abortion.
» Counsel a patient about
pregnancy https://www.thewomens.org.
combined maternal serum
au/patients-visitors/clinics-and-
screening and Non-invasive pre
services/unplanned-pregnancy-
natal testing (NIPT)
services/abortion-service/
» Give immunisation advice to a
pregnant patient
» Identify referral pathways for
unplanned pregnancy, and
options for termination of
pregnancy
Post natal care ‘My baby is now 6 » Perform Mood assessment/ Australian Family Physician. The six
weeks’ screen for PND week check. 2012. 47(5): 288-290
Standard post
» Give breastfeeding advice http://www.racgp.org.au/afp/2012/
natal check
may/the-6-week-check/
» Give contraception advice
Breastfeeding
» Do a 6 week baby check and
give immunisation advice
Menopause ‘I have hot flushes » Counsel patients who request Jean Hailes For Women’s Health.
and no interest in sex to go on HRT www.jeanhailes.org.au
Lifestyle advice
- am I experiencing » Provide general lifestyle Menopause Management GP Tool
When to prescribe the change?’ advice to a woman who is available from
HRT
‘I feel like I leak urine perimenopasual https://jeanhailes.org.au/health-
Osteoporosis when I cough or do » Practise taking histories from professionals/tools
screening exercise’ women presenting with urinary
UroGynaecology Association of
Breast cancer incontinence.
‘I have a sensation Australasia. Patient information
screening of something coming » Outline pharmacological http://www.ugsa.org.au/pages/
down’ and non-pharmacological patient-information.html
Metabolic
management of menopause to
syndrome/ CVD
the patient.
risk
» Refer a patient for urodynamics
Incontinence
» Outline treatment options
Uterovaginal for patients who present with
prolapse uterovaginal prolapse

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Principles of Clinical Practice 3 - General Practice

Ambulatory Care, Medicine and Surgery

Table 1: Core presentations for Ambulatory Care, Medicine and Surgery

Ambulatory Care, Medicine and Surgery

Typical Tasks to perform or

6 © University of Melbourne - Melbourne Medical School - 2017

Ambulatory Care, Medicine and Surgery

Typical Tasks to perform or

© University of Melbourne - Melbourne Medical School - 2017 7

Ambulatory Care, Medicine and Surgery

Typical Tasks to perform or

8 © University of Melbourne - Melbourne Medical School - 2017

Ambulatory Care, Medicine and Surgery

Typical Tasks to perform or

© University of Melbourne - Melbourne Medical School - 2017 9

Ambulatory Care, Medicine and Surgery

Typical Tasks to perform or

Thyroid Disease ‘I am feeling really »» Examine patients presenting Australian Prescriber.

Dermatology ‘I have this new red »» Practice describing skin DermNet NZ

10 © University of Melbourne - Melbourne Medical School - 2017

Ambulatory Care, Medicine and Surgery

Typical Tasks to perform or

Headache 'I am getting »» Practise taking headache NPS Medicinewise. Headache

© University of Melbourne - Melbourne Medical School - 2017 11

Ambulatory Care, Medicine and Surgery

Typical Tasks to perform or

12 © University of Melbourne - Melbourne Medical School - 2017

Ambulatory Care, Medicine and Surgery

Typical Tasks to perform or

© University of Melbourne - Melbourne Medical School - 2017 13

Ambulatory Care, Medicine and Surgery

Typical Tasks to perform or

14 © University of Melbourne - Melbourne Medical School - 2017

Table 2: Core presentations for Aged Care

Typical Tasks to perform or

© University of Melbourne - Melbourne Medical School - 2017 15

Typical Tasks to perform or

16 © University of Melbourne - Melbourne Medical School - 2017

Typical Tasks to perform or

© University of Melbourne - Melbourne Medical School - 2017 17

Child and Adolescent Health

Allied health and other community resources

18 © University of Melbourne - Melbourne Medical School - 2017

Table 3: Core presentations for Child and Adolescent Health

Child and Adolescent Health

Typical Tasks to perform or

© University of Melbourne - Melbourne Medical School - 2017 19

Child and Adolescent Health

Typical Tasks to perform or

20 © University of Melbourne - Melbourne Medical School - 2017

Child and Adolescent Health

Typical Tasks to perform or

© University of Melbourne - Melbourne Medical School - 2017 21

Child and Adolescent Health

Typical Tasks to perform or

22 © University of Melbourne - Melbourne Medical School - 2017

Child and Adolescent Health

Typical Tasks to perform or

Common ‘My little boy is Abdominal and inguino-scrotal

© University of Melbourne - Melbourne Medical School - 2017 23

24 © University of Melbourne - Melbourne Medical School - 2017

Table 4: Core presentations for Mental Health

Typical Tasks to perform or