Station Red Flags/Safety net DD

1 Chest Pain

MI, Angina, Pulmonary

Embolism, Pericarditis,
2 Pericarditis
Pneumonia, Pneumothorax ,
MSK pain, GORD
sudden severe chest pain
radiating to lt.
CVS

arm/shoulder/neck/jaw,
Musculoskeletal chest pain breathlessness, heart racing,
dizziness/fainting

chest pain, SOB, chest

4 Post MI HF
tightness, heart racing

Arrhythmia, ACS, Angina,

5 Arrythmia Pheochromocytoma,
Hyperthyroidism

Hepatitis A, B/C, Alcohol,

6 Hepatitis Results
Gallstones, HCC

Current, ex- or passive

Dry cough DDs smoker, Weight loss, Change
7
(mesothelioma and all +) in voice, Bone pain, Working
with asbestos

8 PCP
Cough productive of rusty or
green sputum with small
9 Cough & SOB (Pneumonia) amounts of blood mixed in,
Fever, Recent upper
respiratory tract infection
Respiratory

TB, Lung cancer, Asthma,

Weight loss, Night sweats, Pneumonia, PCP
10 Cough & SOB (TB) Travel to areas with high
prevalence, contacts with TB

severe breathlessness,
11 Cough & haemoptysis haemoptysis, facial swelling,
weakness in arms

12 Asthma wheeze diagnosis Reliever inhaler-not

controlling symptoms, too
breathless to talk, lips-turn-
blue, (what to do in asthma
attack)
 Reliever inhaler-not
controlling symptoms, too
breathless to talk, lips-turn-
13 Asthma discharge blue, (what to do in asthma
attack)

nervousness, anxiety and

irritability, mood swings,
Weight Loss - Cancer, GI
difficulty sleeping, persistent
infections, Hyperthyroidism, DM,
tiredness and weakness,
HIV, TB, IBD, IBS, Anorexia,
sensitivity to heat, swelling in
Hyperthyroidism (Weight loss bullimia. Tremor/Sweating -
14 your neck from an enlarged
OR Tremor & sweating) Hyperthyroid, Hypoglycemia,
thyroid gland (goitre), an
Arrythmia, Anxiety/panic attack,
irregular and/or unusually
pheochromocytoma,
fast heart rate (palpitations),
medications (salbutamol)
twitching or trembling, weight
loss

Hypothyroid, Cancer, CKD, DM,

15 Hypothyroidism Depression, Medication,
Hyponatraemia

Extremely Tired, sleep

problems, muscle or joint
pain, headaches, a sore
throat or sore glands that
aren't swollen, problems
16 CFS thinking, remembering or
concentrating, flu-like
symptoms, feeling dizzy or
sick, fast or irregular
Tired

heartbeats, severity of
symptoms vary day to day

Pain, joint stiffness - morning

Lupus (rashes), Cancer, Thyroid,
stiffness - Shoulders, Neck,
GCA, subacute lupus
17 Pain & aches (PMR) Hips, daily activity - able to
erythematosus (weeks or years
move around, fever/flu-like,
after taking omeprazole)
Mood, Pain affecting sleep

18 AACG (acute red eye) Trauma, foreign body, AACG,

Subconjunctival Exclude - Pain, Photophobia, cluster headache, Reiter's
Eye

19 syndrome, IBD
haemorrhage Altered vision

20 Constipation talk to patient duration, passing wind, pain,

cramps, bloating, N, V,
Diet, decreased mobility,
bleeding PR, Wt loss, Pain in
medication (opiod), faecal
back passage while opening
impaction, intestinal obstruction,
the bowel (anal fissure), any
Ca - colon/rectum,
lump in back passage
GI

(haemorrhoids)
 duration, passing wind, pain,
cramps, bloating, N, V,
Diet, decreased mobility,
bleeding PR, Wt loss, Pain in
medication (opiod), faecal
back passage while opening
impaction, intestinal obstruction,
the bowel (anal fissure), any
21 Constipation talk to nurse Ca - colon/rectum,
lump in back passage
GI
(haemorrhoids)

ALARMS (Anaemia, Loss of

weight, Anorexia, Recent
22 Indigestion (GORD) change in bowel habit,
Melaena, Swallowing
difficulty)

23 TIA

24 Encephalitis Before/During/After Fits

Decreased GCS, vomiting,

25 Head injury seizures, basal skull fracture,
amnesia

a sudden agonising
headache, a stiff neck,
feeling and being sick,
sensitivity to light, blurred or
double vision, slurred speech Meningitis, SAH, GCA, SOL,
26 SAH
and weakness on one side of Migraine, cluster headache,
the body, loss of tension headache, Trauma
consciousness or
convulsions (uncontrollable
shaking)
Neuro

frequent, severe headaches,

pain and tenderness over the
temples, jaw pain while
27 GCA eating or talking, vision
problems, such as double
vision or a loss of vision in
one or both eyes

Labyrinthitis, Meniere's disease,

Meningitis, Migraine, Acoustic
dizziness, vertigo, nausea,
neuroma SOL, TIA, Ototoxicity,
28 Vestibular neuronitis sore throat/cold/flu, OM,
Gentamicin/anticonvulsants,
hearing problems
Anaemia, Postural hypotension,
Hypoglycaemia
 speed of onset, chest
pain/cough/sputum,
Elderly confusion (Telephone dysuria/frequency/incontinen
29
conversation) ce, head injury, headache,
photophobia, vomiting,
dizziness

lightheadedness or
dizziness, feeling sick,
blurred vision, generally
30 Postural hypotension
feeling weak, confusion,
fainting, trigger - change in
position TIA, arrythmias, confusion
(UTI/Pneumonia/Constipation),
Elderly

medication, postural
hypotension, anaemia, DM,
HTN, vision problems
balance problems and
muscle weakness, poor
vision, a long-term health
condition, such as heart
disease, dementia or low
31 Fall & hip # cause blood pressure
(hypotension), which can
lead to dizziness and a brief
loss of consciousness.
Osteoporosis. Home
environment.
ICE/Psychosocial Management plan

INV- routine blood tests, cardiac enzymes, ECG. Confirm

with senior. cholesterol, LFT, U+E. Aspirin. GTN.
Mx? go home?
Observation unit - Troponin at 6 hr and 12 hr. Statin. Refer
to specialist. Lifestyle advice. Safety netting.

INV - blood tests, ECG, chest X-ray, Echocardiogram, Pain

killers - Ibuprofen or Aspirin, Colchicine, PPI, consider
steroids if not improved, Observation in hospital till all
investigations are normal
routine blood tests, Chest X-ray, ECG, cardiac enzymes,
echo. NSAIDs. Rest. Ice. After 2 weeks, most sprains and
heart attack? strains will feel better. Avoid strenuous exercise such as
running for up to 8 weeks, as there's a risk of further
damage.

Cardiac rehabilitation. Smoking, Diet, Physical activity - light

activites and gradual increase, Stress, Alcohol, Medications
- ACE inhibitors, Aspirin, beta blockers, statins

Blood tests - FBC, heart enzymes, U+E, TFT. ECG, Chest

X-ray, ECG monitoring - 24 hours, exercise ECG, Meds - to
control rate or rhythm, cardioversion, catheter ablation,
pacemaker. Safety netting.

Explain results and causes. Symptomatic treatment.

General advice. Safety netting.

INV (CXR, Sputum, FBC, U&E, ESR, CT, Bronchoscopy),

Referral

O2, IV antibiotics

INV (blds, bld cultures, sputum cultures, ABG, CXR), Tx -

Admit (CURB65), O2, IV Antibiotics, IV fluids,

INV - chest X-ray, Sputum for AFB, Urgent referral to

specialist TB service, Antibiotics - 2 antibiotics (isoniazid,
rifampicin) for 6 months, 2 additional antibiotics
(pyrazinamide, ethambutol) for 1st 2 months,
precautions/prevention for spread of infection, Regular,
Complete the course. (BCG?)

Referral. Confirmation of diagnosis.

Medication and Inhaler, Peak flow meter and reading,

Asthma diary, Triggers. General advice for exercise.
 Medication and Inhaler, Peak flow meter and reading,
Asthma diary, Triggers, Asthma action plan, Safety netting

Medication - Carbimazole - 1 or 2 months before you notice

any benefit. Beta blocker to quickly relieve the symptoms in
the mean time. SE of carbimazole - feeling sick, upset
stomach, aching joints, rash, *agranulocytosis (fever, sore
throat, persistent cough). [Radioiodine, Surgery], Safety
netting

Levothyroxine - explain dose and duration, side effects.

Follow up blood tests.Exercise/CBT for depression. Safety
netting.

Treatment - cognitive behavioural therapy (CBT), a

structured exercise programme called graded exercise
therapy (GET), medication to control pain, nausea and
sleeping problems.

MSK, Blood tests, ESR, CRP, U+E, TFT, RA factor, antibody

test, X-ray, Ultrasound, Pain killer, Steroid (prednisolone) -
High dose to gradual reduction every 1 to 2 months. A few
days to about 2 years. Relapse, Dont' stop suddenly. SE -
HT, high blood sugar, thinning of bones, mood changes,
weight gain, indigestion and heart burn. Diet - calcium rich.
Physical activity. Avoid smoking. Mod alcohol. supplments -
calcium and minerals. Follow up regularly - Wt, Ht, blood
sugar, BP, bone density. Steroid card (steroid >3wks).
Methotrexate - SE: N, V, diarrhoea, skin rashes

Blind? Eye drops, Prevention (triggers)

Reassurance - explain causes. Safety netting.

Change co-codamol to paracetamol, Lactulse (osmotic

laxative), senna, bisacodyl, and sodium picosulphate
(stimulant), suppository, manual removal
 Change co-codamol to paracetamol, Lactulse (osmotic
laxative), senna, bisacodyl, and sodium picosulphate
(stimulant), suppository, manual removal

Lifestyle advice, PPI, Endoscopy

Observation at hospital. CT scan within 24 hours. Blood

stroke? tests, ECG. Referral to specialist. Aspirin and meds
according to blood test results. Safety netting.
ICU, Acyclovir, Steroid, IV fluids, Pain killers, Meds for fits,
Monitor, Complications - MDT
CT scan, Observation, Involve senior, if normal - discharge -
continue observe - 24 hours at home, Rest, No contact
sports, Warning signs

Investigations urgent CT head; since this may miss small

bleeds (20%), if CT normal, then LP (>12h after onset) for
xanthochromia. Treatment 15l/min O2, analgesia (codeine
30mg PO or 5mg morphine IV) and anti-emetic, eg
metoclopramide 10mg IV/IM. Refer urgently to
neurosurgeon for endovascular coiling or neurosurgical
clipping and consider transfer to ICU if decreased GCS. Lie
the patient fl at and advise not to get up or eat. Reassess
often and request neuro obs. Nimodipine (60mg/4h PO)
prevents vasospasm and improves outcome.1 Keep systolic
<130mmHg, using IV B-blockers, unless lethargic (suggests
vasospasm; may require permissive hypertension). Focal
neurology or decreased GCS carry a worse prognosis.
Complications cerebral ischaemia, rebleeding,
hydrocephalus, death.

SE of steroids: high
blood pressure,
INVs (ESR, CRP, ultrasound of temples, biopsy), Meds -
high blood sugar,
Prednisolone high dose - gradual reduce - 2 to 4 weeks,
osteoporosis,
Aspirin, PPI, Methotrexate, Steroid card, Follow up
mood changes,
regularly, Safety net - vision problem/loss of vision, chest
weight gain,
pain, weakness, slurred speech
indigestion and
heart burn

Can pass within a few weeks. Self-help measures - bed rest

and medications and gradual return to activity. Drink water
little and often. If severe - avoid falling and injury. Avoid
when can I go
driving, using tools and machinery, or working at heights if
home? Do I need
you're feeling dizzy. avoid alcohol, avoid bright lights, try to
any further tests or
cut out noise and anything that causes stress from your
treatment?
surroundings. avoid visually distracting environments such
as: supermarkets, shopping centres, busy roads. Meds -
Benzodiazepine, Antiemetics, Antibiotics
Sepsis 6: Give IV Antibiotics, Fluids, O2. Take Blood culture,
Lactate, Urine output.

Changing medication or altering your dose, if medication is

the cause, wearing support stockings – this can improve
circulation and increase blood pressure. Prevention - Do:
get up slowly from sitting to standing, take care when getting
out of bed – move slowly from lying to sitting to standing,
raise the head of your bed by about 15cm (6 inches) with
bricks or heavy books, eat small, frequent meals – lying
down or sitting still for a while after eating may also help.
Don't: Don't: sit or stand for long periods, bend down or
change posture suddenly, drink caffeinated drinks at night,
drink too much alcohol

Avoiding falls at home, Home hazard assessment. Strength

and balance training with physiotherapist. Medication
review. Sight tests. Alcohol.
 NHS/NICE/GMC/Patient info/external links OHFP Page

https://www.nhs.uk/conditions/heart-attack/

https://www.nhs.uk/conditions/pericarditis/

https://www.nhs.uk/conditions/sprains-and-strains/

https://www.nhs.uk/conditions/coronary-heart-disease/recovery/

https://cks.nice.org.uk/atrial-fibrillation#!scenario

https://www.nhs.uk/conditions/hepatitis/
https://cks.nice.org.uk/hepatitis-a#!scenario:1
https://cks.nice.org.uk/hepatitis-b#!scenario:1

https://cks.nice.org.uk/lung-and-pleural-cancers-recognition-and-referral#!scenario

https://www.nhs.uk/conditions/pneumonia/

https://www.nhs.uk/conditions/pneumonia/ Pg. 276

https://cks.nice.org.uk/asthma#!scenario
https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/
Pg. 334
https://cks.nice.org.uk/hyperthyroidism#!scenario

https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/
https://cks.nice.org.uk/hypothyroidism#!scenario

https://www.nhs.uk/conditions/chronic-fatigue-syndrome-cfs/
https://cks.nice.org.uk/tirednessfatigue-in-adults#!scenario

https://www.nhs.uk/conditions/polymyalgia-rheumatica/
https://cks.nice.org.uk/polymyalgia-rheumatica#!scenario

https://www.nhs.uk/conditions/red-eye/ Pg. 427

https://cks.nice.org.uk/glaucoma#!scenario
https://cks.nice.org.uk/red-eye#!scenario Pg. 428
https://www.nhs.uk/conditions/heartburn-and-acid-reflux/

https://cks.nice.org.uk/stroke-and-tia#!scenario:1

https://geekymedics.com/collapse-headache/
https://cks.nice.org.uk/headache-assessment#!
scenariorecommendation:1

Pg. 360

https://geekymedics.com/headache-history-taking/
https://cks.nice.org.uk/giant-cell-arteritis#!scenario

https://www.nhs.uk/conditions/vestibular-neuronitis/
https://cks.nice.org.uk/vestibular-neuronitis#!scenario
https://www.nhs.uk/conditions/low-blood-pressure-hypotension/

https://www.nhs.uk/conditions/falls/
https://www.nhs.uk/conditions/falls/prevention/
 Video links

https://www.youtube.com/watch?v=W57bLUIca_w&list=PLtcH7MaCwE7dlT_n_f3sS7PnCcxq-9Eu4&index=7
https://www.youtube.com/watch?v=szLwxa_VTa0

https://www.youtube.com/watch?v=CCD1_Axdkg8&t=11s
 Station Red Flags DD

UTI symptoms, Nocturia,

urgency, hesistancy, UTI, BPH, Prostate cancer,
UTI & BPH incontinence, poor/weak stream, Stones, Pyelonephritis,
poor emptying, dribbling, LOW, Epididymo-orchitis
LOA, anaemia (prostate cancer)

UTI, Pyelonephritis, Ectopic

Pain, UTI symptoms, loin pain,
UTI female pregnancy, Appendicitis, PID,
fever, Medications, Allergy
Calculi
URO

speed of onset, ,
dysuria/frequency/incontinence/
haematuria/pyuria, chest
UTI confusion
pain/cough/sputum. head injury,
headache, photophobia,
vomiting, dizziness
3

Weight loss, frank blood or clots,

UTI, Tumour, Stones, Blood
Haematuria Exam: - Increased BP,
disorders
Proteinuria
4

Lower back pain & groin,

Episodic intense pain - back,
Urinary stone, UTI,
sides of abdomen, groin, feeling
Loin Pain Pyelonephritis, Renal cell
restless and unable to lie still,
carcinoma, Basal pneumonia
nausea, frequency, dysuria,
haematuria
Back Pain

Back pain

Back sprain
7
 difficulty swallowing, persistent
indigestion or heartburn,
Oesophageal cancer, Gastric
bringing up food soon after
cancer, Oesophageal stricture,
Dysphagia eating, loss of appetite and
Oesophageal spasm, GORD,
weight loss, pain or discomfort
Myasthenia gravis, Stroke
in your upper tummy, chest or
back
GI

Haematemesis

9
ICE/Psychosocial/Issues Management plan

Exam - Abd, DRE, Bloods, Urine dipstick, Urine C&S,

PSA, Antibiotics for UTI - Nitrofurantoin (100mgBDx3d),
explain BPH, TRUS, Tamsulosin - relax the muscle of
cancer the prostate and neck of bladder, Finasteride - reduce
the size of prostate, surgery, bladder training, general
advice - less fluids in evenings, cut down
tea/coffee/alcohol. healthy diet to avoid constipation.

Urine test, Antibiotics, FP10, General advice, Warning

Dx, Mx, Meds - SEs, sex
signs

Sepsis 6: Give IV Antibiotics, Fluids, O2. Take Blood

culture, Lactate, Urine output.

INVESTIGATIONS and referral within 2 weeks

Causes: build-up of calcium,

Inv - Urine test, stone in urine, Blood tests - kidney
ammonia, uric acid, cysteine,
function, calcium, CT KUB, X-ray, ultrasound, (IVU),
high protein low fibre diet, PMH
<4mm - pass in urine, Meds - pain killer, antiemetics,
- stones, UTI, FH, inactive -
collect stone, Drink enough water, 6-7mm - ESWL,
bed bound, surgery (intestine -
ureteroscopy, percutaneous nephrolithotomy, open
bypass), Crohn's, antacids,
surgery, Safety netting - high T, shivering/shaking,
aspirin, diuretics, certain
worsen pain - sudden severe pain
antibiotics
Food - swallowing problem.
Urgent referral (2 weeks). Endoscopy - biopsy. Barium
Types of food - soft or fluid.
swallow/meal. Stent. Speech and language therapist -
Stent. Cancer - a possibility,
to help with swallowing difficulty. Dietician.
have to confirm
 NHS/NICE/GMC/Patient info/external
OHFP Page
links

https://www.nhs.uk/conditions/prostate-
enlargement/
https://cks.nice.org.uk/urinary-tract-
infection-lower-men#!scenario

https://www.nhs.uk/conditions/urinary-
tract-infections-utis/
https://cks.nice.org.uk/urinary-tract-
infection-lower-women#!scenario

https://www.nhs.uk/conditions/sepsis/treatment/
Pg. 341, 484

https://www.nhs.uk/conditions/blood-in-
urine/ https://cks.nice.org.uk/urological-
cancers-recognition-and-referral#!
scenario
Pg. 374

https://www.nhs.uk/conditions/kidney-
stones/ https://cks.nice.org.uk/renal-or-
ureteric-colic-acute#!scenario

https://cks.nice.org.uk/back-pain-low-
without-radiculopathy#!scenario
https://cks.nice.org.uk/urological-
cancers-recognition-and-referral#!
scenario

https://geekymedics.com/gentleman-back-pain/
https://www.nhs.uk/conditions/oesophageal-cancer/

https://geekymedics.com/a-lady-with-haematemesis/
Offer urgent direct accessupper gastrointestinal endoscopy (to
be performed within 2weeks) to assess for oesophageal
cancer in people: with dysphagia or aged 55 and over with
weight lossand andany of the following: upper abdominal pain,
reflux, dyspepsia
 Station Red Flags DD/risk factors

PMH - HT, DM. Previous pre-eclampsia,

Headache, visual changes,
first pregnancy, FH, >10 yrs since last
1 Pre-eclampsia fit, swelling of
pregnancy, >40 yrs of age, obese at start
feet/ankles/face
of pregnancy, multiple pregnancy (twins)

Periods - regular, painful. Stroke, heart

2 Contraception DVT disease, liver disease. Ovarian cyst.
Smoking

3 PID (RIF) fever, bleeding,

redness/hotness/swelling in
contraception, sexual history
private parts or groin area,
4 PID UTI symptoms

fever, bleeding, discharge,

pain and/or swelling in
private parts, rash, UTI,
5 STI gonorrhoea
Sexual history,
contraception - IUCD, PMH
- STI

missed period - LMP,

irregular bleeding,
painful/heavy periods,
6 Ectopic pregnancy abdominal pain, shoulder past history of PID
tip pain, bleeding,
discharge, contraception -
IUCD,

pain, bleeding, discharge,

previous pregnancies -
PMH - DM, HTN, kidney, thyroid, PCOS,
outcome, management,
7 Miscarriage fibroids, STI, Meds - Folic acid,
smoking, alcohol,
contraception,
recreational drugs, diet -
coffee/tea, psychosocial
ICE/Psychosocial Management plan

Admit, Monitor - BP, urine protein, LFT, U+E,

Hospitalisation- want to go home, Pool
Ultrasound, Cardiotocography, Labetalol, MgSO4,
delivery
Induce labour/Caesarean section

Short-term/Long-term, Pills/Device, Advantages &

COCP
Disadvantages, condoms to protect against STIs

Swabs, blood tests, urine tests, Ultrasound, Pain

killers, Antibiotics for 2 weeks, Partner treatment,
management plan, partner cheating Avoid sex until symptoms improved, Follow up after
3 days and 2 weeks, Offer HIV testing, Safety
netting

Antibiotics 1 inj & 1 tab, pain killer, avoid having

sex until infection is cleared, safe sex, partner
cause, partner cheating, serious
treatment, offer HIV, complications of STI, safety
netting

very important to stay in hospital, investigations,

monitoring, severe complications - severe bleeding,
wants to go home, doesn't want parents to shock and collapse, potentially life-threatening if
know ruptured. options depends on INV - terminate by
itself, methotrexate, surgery, meanwhile - inform us
if - SOB, dizziness, severe pain or bleeding

vitals, ht, wt, gpe, abd ex, Inv - blood group, sugar,
infection, ultrasound, Miscarriage: 1st trimester -
chromosome (baby), placenta, 2nd trimester(14-26
wks) - maternal health - medical ds, infection,
meds, womb structure, weakened cervix.
Cause of miscarriages, Lifestyle, Possibility Monitoring. Lifestyle advice - Avoid smoking,
of another miscarriage, Management plan alcohol, recreational drugs, healthy diet, caution -
rubella infection. Reassure - one-off, chance of
successful pregnancy even after recurrent
miscarriages. Ultrasound. Follow up regularly.
Karyotyping (10-12 wks) - genetic abnormality,
Blood tests - antiphospholipid. Safety netting
NHS/NICE/GMC/Patient info/external links OHFP Page

https://www.nhs.uk/conditions/pre-eclampsia/

https://www.nhs.uk/conditions/contraception/which-method-suits-me/

https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/

https://cks.nice.org.uk/pelvic-inflammatory-disease#!scenario

https://www.nhs.uk/conditions/sexually-
transmitted-infections-stis/
https://www.nhs.uk/live-well/sexual-
health/visiting-an-sti-clinic/
https://cks.nice.org.uk/gonorrhoea#!scenario

https://www.nhs.uk/conditions/ectopic-
pregnancy/ https://cks.nice.org.uk/ectopic-
pregnancy#!scenario
 Station Red Flags DD/issues/risks

Meningitis, OM, Pneumonia, UTI,

1 Febrile convulsion Fever, Fit (before/during/after)
Gastroenteritis

Review patient's present condition, Lack of sleep, flashing lights, loud music,
2 Epilepsy
PMH, BIDD skipping meals, dehydration, stress

before/during/after, loss of
consciousness, drowsiness,
3 Head injury
nausea/vomiting, weakness, any
injury, fits

pain inside the ear, a high

temperature of 38C or above, being
sick, a lack of energy, difficulty
hearing, discharge running out of
the ear, feeling of pressure or
fullness inside the ear, itching and
4 OM child irritation in and around the ear, scaly
skin in and around the ear. Young
children and babies with an ear
infection may also: rub or pull their
ear, not react to some sounds, be
irritable or restless, be off their food,
keep losing their balance

Who's taking care of the child?

5 NAI Skeletal survey,
Partner - Biological?

Tummy pain, Stool - elaborate,

6 Intussusception Vomiting, Drowsy, Floppy, Tolerate
drinks, Fever.

7 Pyloric stenosis Projectile vomiting, dehydration,

flu vs common cold, each year, nasal

8 Flu jab stuffy/runny nose, egg allergy
spray, beginning of Oct - end of Nov
 9 MMR

First 10 kg - 100, Next 10 kg - 50,

10 IV fluid prescription
>20.1 kg - 20

drowsiness, poor feeding, stool and

11 Neonatal jaundice urine colour, birth history, blood
groups
ICE/Psychosocial Management plan
Symptomatic: Antipyretics, Fluids. Observation. DOC -
chances - up to 5 year old,
Amoxicllin x 5d (if allergic erythromycin/clarithromycin x
siblings
5d), Safety netting

Explain medication. Triggers. General advice. Safety

swimming, dancing
netting.

Observation for a few hours, Senior review. Might need to

do a CT scan. Safety netting.

Most ear infections clear up within 3 days, although

sometimes symptoms can last up to a week. Antibiotics
might be prescribed if: an ear infection doesn't start to get
better after 3 days, you or your child has any fluid coming
out of their ear, (you or your child has an illness that
means there's a risk of complications, such as cystic
fibrosis).

Explain GP's letter, examination and vitals. INV-blood

tests, electrolytes, urine and stool test. X ray.
Intussusception - common in age 3 months and 2 years.
Pain killers. IV fluids. NG tube. Ultrasound scan to
confirm. Referral for air enema - relieve the telescoping
part. May need operation.

INV - routine blds, ABG, Ultrasound. Rehydration. Test

feed. Surgery (pylorotomy)

seizures
Explain the necessity of fluid. Explain the type of fluid.

vitals, GPE, eye, gum, tummy. LFT (indirect and direct),

Treatment/Phototherapy depends on the level of bilirubin.
Reassurance and safety netting.
 NHS/NICE/GMC/Patient info/external links OHFP Page

https://www.nhs.uk/conditions/febrile-seizures/

https://www.nhs.uk/conditions/epilepsy/

https://www.nhs.uk/conditions/ear-infections/
https://cks.nice.org.uk/otitis-media-acute#!
scenario

https://geekymedics.com/a-drowsy-baby/
https://cks.nice.org.uk/child-maltreatment-
recognition-and-management#!scenario

https://www.gosh.nhs.uk/medical-information-0/procedures-and-treatments/treatment-intussusception-using-air-enema

https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/pyloric-stenosis

https://cks.nice.org.uk/immunizations-seasonal-influenza#!scenario
https://cks.nice.org.uk/immunizations-childhood#!scenario:1

https://www.nhs.uk/conditions/jaundice-newborn/
https://cks.nice.org.uk/jaundice-in-the-newborn#!
scenarioclarification
 Station Red Flags DD/Q for management/Risks

Orientation - Time and Place,

Registration,
Attention/Calculation, Recall,
1 MMSE Language - name 2 objects, 5, 5, 3, 5, 3, 1, 2, 3, 1, 1, 1
repeat words, 3 stage
command, reading, writing.
Copying a picture

Mood, Cognitive function,

Suicide, Hallucination, Insight,
Thought.
2 Psychotic patient
Family/Friends/Forensics/Finan
ce. Addiction. Medical
condition/Medication

CAGE DWT. Cut down,

Annoyed at criticism, Guilty
3 Alcohol dependency feelings, Eye-opener,
Dependency, Withdrawal,
Tolerance

4 Drug dependency

5 Suicide Assess suicide risk

6 PCM homosexual patient

7 Alcohol colleague

SPIES. Seek info. Patient

safety. Initiative. Escalate.
8 Cocaine colleague Support

9 Colleague coming late

 complications - osteoporosis,
Weight loss - how much,
heart problems - arrhythmia,
duration, why. Diet - meals,
nerves - fits, difficulty in
10 Anorexia nervosa portions, Exercise,
concentration and memory,
lightheadedness, dizziness,
kidney and bowel problems,
Mood, depression/suicide risks
irregular menstruation
ICE/Psychosocial Management plan

Reassure safety!!!

Non-med: Alcohol Anonymous, One-to-one counselling,

CBT, Family therapy, Alcohol diary. Med: Acamprosate,
Naltrexone, Disulfiram, Chlordiazepoxide

Support, Helpline

Psychosocial, Stress,
SPIES
Family
Why - weight loss, role CBT, MANTRA, SSCM, focal psychodynamic, Admit or not.
model, school/social life self-help group (BEAT)
 NHS/NICE/GMC/Patient info/external links OHFP Page

https://cks.nice.org.uk/alcohol-problem-drinking#!scenariorecommendation:3

https://www.nhs.uk/live-well/healthy-body/cocaine-get-
help/ https://www.nhs.uk/live-well/healthy-
body/heroin-get-help/

https://cks.nice.org.uk/self-harm#!scenario

https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/raising-and-acting-on-concerns/part-1-raising-a-concern
Pg. 33

https://www.gmc-uk.org/ethical-guidance/learning-materials/a-colleagues-fitness-to-practise

https://www.nhs.uk/conditions/stress-anxiety-depression/understanding-stress/
https://www.nhs.uk/conditions/anorexia/
https://cks.nice.org.uk/eating-disorders#!scenario
 DD/Q for management
Station Red Flags/Risk factors
plan

headache, dizziness, visual

1 BP management (Q risk) BP, Meds - SE, DM - contro
problem

2 Epilepsy Compliance (SE), Triggers

3 CDAD

4 MRSA

5 Post MI lifestyle
gement
 slowness of thought, difficulty
with planning, trouble with
understanding, problems with
6 Vascular dementia (psoriasis)
concentration, mood or
Lifestyle management

behavioural changes, problems

with memory and language

7 Stroke assessment

8 Obesity counselling

9 Statin

menopause, long-term steroids,

hysterectomy, family history,
10 Osteoporosis
anorexia, not exercising
regularly, smoking, alcohol

11 Diabetic retinopathy

12 Diabetic review

13 Hypoglycaemia
Compliance + LStyle

14 Hypoglycaemia fits

Diabetes control, urine

frequency, feeling very thirsty,
being sick, tummy pain, breath
15 DKA
that smells fruity, deep or fast
breathing, feeling very tired or
sleepy, confusion, passing out

16 Warfarin

17 NSI nurse
18 NSI child Clean, Needle, Wound, Jabs

19 COPD smoking cessation

20 Smoking cessation

21 URTI

22 Skin lesion Mole

7 point check list: Major

features of the lesions (scoring
2 points each):
Change in size
23 Melanoma Irregular shape
Irregular colour.
Skin

Minor features of the lesions

(scoring 1 point each):
Largest diameter 7 mm or more
Inflammation
Oozing
Change in sensation risk factors - sun
24 BCC/SCC
exposure, occupation

25 Coeliac disease (endoscopy)

26 Post-op hemi-arthroplasty

27 Ankle pin removal pre op

28 Herniography

29 Dermoid cyst

Pain management breast

30
cancer

http://gp-training.net/training/communication_skills/index.htm
 NHS/NICE/GMC/Patient
ICE/Psychosocial Management plan
info/external links

https://www.nhs.uk/conditions/hig
Change meds, Explain about new med, SE, h-blood-pressure-hypertension/
SE - cough
lifestyle advice https://www.nhs.uk/medicines/los
artan/

General advice, DVLA https://www.nhs.uk/conditions/epilepsy/

PCR or immunoassay of C. difficile. Urgent AXR

to exclude toxic megacolon. Stopping the
antibiotics. Metronidazole 400mg/8h PO or
vancomycin 125mg/6h PO initially - 10 to 14
days course. (IV for who fail to respond after
The use of antibiotics initial treatment.) Rehydration. General advice to
alters the balance of prevent spread of infection - make sure you
the gut flora, and can finish the entire course of any antibiotics you're
allow the overgrowth of prescribed, even if you're feeling better. drink
https://www.nhs.uk/conditions/c-difficile/
C. difficile. Food plenty of fluids to avoid dehydration and eat plain
poisoning ward to foods such as soup, rice, pasta and bread if you
prevent spread of feel hungry. take paracetamol for tummy pain or
infection. a fever. don't take anti-diarrhoeal medication, as
this can stop the infection being cleared from
your body. regularly wash your hands and
contaminated surfaces, objects or sheets. stay at
home until at least 48 hours after your last
episode of diarrhoea

If screening finds MRSA on your skin, you may

need treatment to remove it. This is known as
decolonisation. This usually involves: applying
antibacterial cream inside your nose three times
a day for five days, washing with an antibacterial
shampoo every day for five days, changing your
https://www.nhs.uk/conditions/mrsa/
towel, clothes and bedding every day during
treatment – the resulting laundry should be
washed separately from other people's and at a
high temperature. (Treatment is normally done at
home, but may be started after going into
hospital if you need to be admitted quickly.)

return to work - 2 Cardiac rehabilitation. Exercise - light activities

weeks (for light and gradual increase. Work - if light, 2 weeks,
https://www.nhs.uk/conditions/he
activity), months for Sex - 4-6weeks, DVLA - 4-6 weeks,
art-attack/recovery/
manual work. sex - 4-6 Stress/Depression, Diet, Smoking, Alcohol,
https://cks.nice.org.uk/mi-
weeks. DVLA - Exercise and weight management. Medications -
secondary-prevention#!scenario
recommended 4 weeks, ACE inhibitors, Anti-platelets, Beta blockers,
bus drivers - 6 weeks. Statins
 https://www.nhs.uk/conditions/vascular-dementia/

https://www.nhs.uk/conditions/stroke/prevention/

You may need to exercise for longer each day to

prevent obesity or to avoid regaining weight if
https://www.nhs.uk/conditions/ob
you've been obese. To prevent obesity, 45-60
esity/
minutes of moderate-intensity activity a day is
https://cks.nice.org.uk/obesity#!
recommended. To avoid regaining weight after
scenario
being obese, you may need to do 60-90 minutes
of activity each day.

https://www.nhs.uk/conditions/high-cholesterol/preve

https://www.nhs.uk/conditions/ost
Prevention of falls, Diet, Weight-bearing
eoporosis/
exercise, Muscle-strengthening exercise,
https://cks.nice.org.uk/osteoporo
Calcium, Vitamin D, Bisphosphonates, quit
sis-prevention-of-fragility-
smoking, no binge drinking
fractures#!scenario:1

Blind - irreversible, but

Refer to eye specialist. Diabetes check up.
can stop the https://www.nhs.uk/conditions/diabetic-retinopathy/
Advice about life style.
progression

https://www.nhs.uk/conditions/type-2-diabetes/food-a

https://www.nhs.uk/conditions/low-blood-sugar-hypog

https://www.diabetes.co.uk/driving-and-hypoglycaem

Want to go home -
Convince her that it's Monitoring - glucose, ABG, K+, urine ketones,
https://www.nhs.uk/conditions/diabetic-ketoacidosis/
serious and potentially ECG, Treatment - IV fluids, Insulin, K+
life threatening

https://www.nhs.uk/conditions/wa
rfarin/
https://cks.nice.org.uk/anticoagul
ation-oral#!
scenariorecommendation:42

https://www.nhs.uk/common-health-questions/accide
 https://www.nhs.uk/common-health-questions/accide
Worried - Reassure! Wound infection, Tetanus, Hepatitis, HIV

Smoking cessation. Inhaler review. Pulmonary

https://www.nhs.uk/live-well/quit-smoking/nhs-stop-sm
rehabilitation programme.

https://www.nhs.uk/conditions/stop-smoking-treatmen

Antibiotics https://www.nhs.uk/conditions/respiratory-tract-infect

https://www.nhs.uk/conditions/moles/

https://www.nhs.uk/conditions/me
lanoma-skin-cancer/
https://cks.nice.org.uk/melanoma
-and-pigmented-lesions#!
Referral - 2 weeks, CT, Biopsy, Excision,
scenario
https://cks.nice.org.uk/melanoma
-and-pigmented-lesions#!
diagnosissub

https://www.nhs.uk/conditions/no
n-melanoma-skin-cancer/
treatment, recurrence Referral - 2 weeks, CT, Biopsy, Excision https://cks.nice.org.uk/skin-
cancers-recognition-and-
referral#!scenario

Convince & ensure https://www.nhs.uk/conditions/coeliac-disease/

Occu+Physio,
https://www.nhs.uk/conditions/hip-fracture/recovery/
Adaptations at home
https://www.nhs.uk/conditions/enhanced-recovery/

https://www.nhs.uk/conditions/having-surgery/

https://www.nhs.uk/conditions/ovarian-cyst/causes/

Pain ladder, Address concerns, Safety net
https://www.nhs.uk/conditions/en
d-of-life-care/controlling-pain-
and-other-symptoms/
https://cks.nice.org.uk/palliative-
cancer-care-pain#!scenario:2
 OHFP
Page

Pg. 348

Pg. 180
Pg. 323
Pg. 116
 Station
1 BBN Cerebral bleeding
2 BBN Stroke
BBN
3 EDH Joshua
4 Pelvic #
5 Post Mortem
6 Domestic violence
7 Insomnia domestic violence
8 Cancer withhold
9 End of life DNR
10 Treatment refusal (SCLC)
Red Flags/Important points DD/Q for management
SPIKES (Setting, Perception,
Invitation, Knowledge,
Emotions and Empathy,
Strategy and Summary)
ICE and empathy, reasons,
Psychosocial, ICE
explain procedure, consent
brief BPV and pregnancy Hx,
Comment on non-verbal cues, Offer
Rapport, Confidentiality, HARK
confidentiality, Relationship -
(humiliation, afraid, rape, kick),
partner, child, how - abused,
children
support - family, friends - finance,
accommodation
Find the reason why, Maintain
your position, Answer with
different explanation: It is her
right to know, we need to treat
her according to her wishes,
Disclosure in layers, Trust,
Can't change the word -
cancer (will not be lying to the
patient)
Find out reason - why, The key points from Treatment and
Understand, Retention, care towards the end of life: good
Implication, Social history practice in decision making are: 
Start with the presumption that a
patient has mental capacity. 
Support your patient to understand
their options and make a decision .
 Do not assume a patient lacks
capacity based on age.  Make use
of carers and loved ones who know
your patient well.  Take
reasonable steps to plan for a
foreseeable change in a patient’s
capacity.
 Patient safety, Find out the
reason (why), Understand,
Retention, Implication,
11 Infective endocarditis
Convince the patient to view
their decision from another
angle. (Don't you think)

Patient safety, Find out the

reason (why), Understand,
Retention, Implication,
12 Warfarin (rat poison)
Convince the patient to view
their decision from another
angle. (Don't you think)

13 Angiogram (walking - conflict of opinion)

Assess the child's condition,

Ask about the herbal
14 Herbal medication
medication to the mother, Tell
her the implication

It's terminal stage of dementia.

Explain all the investigations.
No NG tube (Risk for
15 Dementia Social history
aspiration). Patients wish
regarding her care. Alternative
ways of feeding

Elaborate incident, Medical

16 Elderly abuse
causes, Social history

Causes of fall, Medical cause,

17 Elderly wrist #
Environmental cause, Age

Confidentiality, Gillick
competence, Abuse
18 Concerned mother OCP
relationship - too immature,
difference in age, maturity
Ask about boyfriend.
Relationship with the
boyfriend. LMP. Check the
19 Emergency contraception competency of the patient,
Implications of unprotected
sex, Past medical history,
Personal history

Acknowledge his anger.

Assess his present condition.
20 Cerebral palsy Ask past medical history,
Social history. Explain the
reason for no X-ray
 Sleeping pattern. Medical
causes. Tea, coffee. Smoking,
Alcohol, recreational drug.
21 Insomnia
Stress. PTSD. Watching TV.
Noisy environment. Physical
exercise

Assess the patient's condition.

22 Ankle sprain
Explain the X-ray.

23 Angry patient - change cannula

24 IV cannula - Dr Wilson
25 Colleague delaying patient discharge

26 Medical error MI
Medical error

27 Misdiagnosed Pneumonia
28 Hairline #
29 Amoxicllin rash
30 Foreign body
31 PSGN biopsy
32 Sample not labelled

33 Post-op wound infection

34 New post-op wound infection
35 Vascular surgery complication
ICE/Psychosocial Management plan

Warning shot, Chunk, PAUSE &

WAIT. Do not launch into explain
everything. Acknowledge and
Reflect.

cause of death, procedure, duration, ICE, give time for reflection, consent,
funeral, body disfiguration arrange follow-up

MARAC, Social services - ensure safety,

Confidentiality, Social services - taking
(?escape plan), evidence of abuse
the child away, finance/accomodation
(photograph)

Give alternatives - Age UK, Occupational

therapist, Convince the patient to view
their decision from another angle (Don't
you think).
Smoking, Colleague behaviour, Drugs

Hospice: Hospice at home, Hospice

daycare, Hospice care, Care home

Medical management, Social services

Keep in hospital, Care home

Confidentiality. Involving parents.

Assess Capacity. Morning after pill. If
vomiting after 3 hours, come back. (IUCD
- emergency contraception option)
 Keep regular sleep hours. Create a
restful sleeping environment. Make sure
your bed is comfortable. Exercise
regularly. Cut down on caffeine. Don't
over-indulge - food, alcohol. Don't
smoke. Try to relax before going to bed.
Write away your worries. If you can't
sleep, get up.

Change the note : We cannot change Do PRICE. Avoid HARM. Pain killer,
the note. Offer medical certificate. Protection. Rest. Ice. Compression.
Zero contract - can get sick pay. Elevation. Avoid Heat, Alcohol, Running,
Citizen Advice Bureau. Massage

Patient safety. Documentation. Being

open. Reporting. Learning. Complaint.
NHS/NICE/GMC/Patient info/external links OHFP Page

Pg. 22

Pg. 91
https://cks.nice.org.uk/dementia#!scenario:2
https://cks.nice.org.uk/insomnia#!scenariorecommendation:1

https://www.nhs.uk/conditions/sprains-and-strains/
https://cks.nice.org.uk/sprains-and-strains#!scenario
 Station
1 Diabetic foot
2 Alcoholic foot
3 Cerebellar ataxia
4 Whiplash injury
5 Brachial plexus injury
6 Peripheral field of vision
7 Acoustic neuroma (CN 8)
8 OM Otoscopy
9 GCA fundoscopy
10 Chronic diarrhoea
11 Diverticulitis
12 ARLD
13 Knee examination
14 Reactive arthritis
Red Flags
balance, walking, speaking, swallowing, tasks
that require a high degree of control, such as
writing and eating,
vision
decreased GCS, large forces, multiple
injuries, focal neurology
frequent, severe headaches, pain and
tenderness over the temples, jaw pain while
eating or talking, vision problems, such as
double vision or a loss of vision in one or both
eyes, CI -glaucoma (PMH, pain at the back of
eyes, colour halos around light)
Rectal bleeding,Unintentional and
unexplained weight loss.
Diarrhoea persisting for more than 6 weeks, in
a person over 60 years of age.
Family history of bowel or ovarian cancer.
Abdominal mass.
Rectal mass.
Anaemia.
Raised inflammatory markers
pain, stiffness and swelling in the joints and
tendons, most commonly the knees, feet,
toes, hips and ankles.genital tract – causing
pain when peeing, or discharge from the
penis or vagina ,eyes – causing eye pain,
redness, sticky discharge, conjunctivitis and,
rarely, inflammation of the eye (iritis).
15 Meningitis
16 Primary survey conscious
17 Primary survey unconscious

18 Spacer

19 PCM venepuncture
20 IV cannulation
Urinary retention
21
(catheterisation)

22 Testicular examination

23 Breast examination (lump)

Breast examination
24
(teaching)
25 BLS
26 Speculum (teaching)

27 Antenatal examination

28 Thyroid examination
Changes in weight and appetite, mood 
and energy level, bowel habit, menses (in 
females), Heat/cold intolerance, Palpitations,
Previous history of thyroid disease, Past 
medical history of other autoimmune 
disease, Drug history (e.g. amiodarone),
Family history of thyroid disease, Smoking

29 Simman Asthma
30 Simman Dizzy spells
31 Simman Anaphylaxis
32 Simman UTI
DD/Examination
Inspection, Palpation (T, Tenderness, ICE/Psychosocial
Pulses, Capillary refill), Neurological
examination - Fine touch, Pain touch,

C-spine injury

Blind - high dose steroids

are attempted to
eye drops to dilate, Red reflex, Optic
decrease swelling and
disc, Retinal vessels, Macula and
improve the blood supply
peripheral retina
to bring sight back. Stop
GCA in other eye.

Rapport

Look - anatomical position: symmetry of

joints, swelling, redness, muscle
wasting, deformity. Feel: Temperature
(ankles, knees), Tenderness (knees, cause - STI, food
heels, Achilles tendons), Ankle poisoning
oedema/swelling, Patella tap. Move:
Active - knees: flexion, extension.
ankles: plantar flexion, dorsiflexion
Management plan

Blood and urine test, CT or MRI scan. Nerve

conduction studies. Vitamin levels. Multidisciplinary
team.

advise that symptoms are likely to worsen before

improving, give paracetamol and regular NSAIDs,
heat/ice may help, soft collars are not used, initial rest
(≤48h) then gradual return to normal activity

CRP, ESR, doppler, biopsy, IV steroids, PK,

antiemetics, High dose to low dose steroid,

Inv: Colonoscopy with biopsy, FBC and ferritin studies,

Imaging: Barium studies, CT abdomen & colon

blood and urine tests, genital swabs, ultrasound scans

and X-rays may be used to check for infection and rule
out other causes of your symptoms. (ESR,CRP, FBC,
HLA-B27). Ibuprofen. DMARDS. Eye drops. Most
people start returning to normal activities after 3 to 6
months. Symptoms don't usually last longer than 12
months.
 NHS/NICE/GMC/Patient info/external links OHFP Page
https://www.nhs.uk/live-well/healthy-body/foot-care-diabetics/

https://www.nhs.uk/conditions/Ataxia/

https://cks.nice.org.uk/neck-pain-whiplash-injury#!scenario

https://www.nhs.uk/conditions/acoustic-neuroma/
https://www.nhs.uk/conditions/ear-infections/

Pg. 429

https://www.nhs.uk/conditions/reactive-arthritis/
https://www.nhs.uk/conditions/testicular-cancer/diagnosis/
https://www.nhs.uk/common-health-questions/mens-
health/what-should-my-testicles-look-and-feel-like/
https://cks.nice.org.uk/scrotal-swellings#!topicsummary

https://www.nhs.uk/conditions/breast-cancer/ Pg. 423

https://cks.nice.org.uk/asthma#!scenario:2
https://cks.nice.org.uk/atrial-fibrillation#!scenario
https://cks.nice.org.uk/angio-oedema-and-anaphylaxis#!scenario:1
 Station Red Flags DD/Issues

1 Premature child birth

2 Talk to son (confidential)

3 Angry son (morning round)

4 Two people policy

acknowledge, depression,
5 Changing the counsellor psychosocial, coping, reassure,
professional ethics

History - previous renal or other

medical problems, urine output, fl
uid intake, medications (?
nephrotoxic), rashes, bleeding,
lethargy, anorexia. Examination-
6 Uraemia and hyponatraemia
volume status, BP (compare to
what is normal for patient from eg
old obs charts), HR, JVP, basal
creps, gallop rhythm, oedema,
palpable bladder.

Period, Pills, Pregnancy (CI for

7 Acne
retinoids)

Tingling & numbness in the feet,

Weakness of the lower limb,
8 Back pain (Disc prolapse) cauda equina - bowel problem,
urinary retention, Numbness in the
saddle area

Hyponatremia - feeling sick,

headache, muscle pain, reduced
appetite, confusion, severe
9 Tiredness (Citalopram)
hyponatraemia (feeling listless and
tired, disorientation, agitation,
psychosis, seizures (fits))
 extreme tiredness, a lack of
energy, pins and needles
(paraesthesia), a sore and red
tongue, mouth ulcers, muscle
10 Vitamin B12 deficiency weakness, disturbed vision,
psychological problems, which
may include depression and
confusion, problems with memory,
understanding and judgement

11 Drug prescription

warm humid climate, contact Fungal infection, Lyme disease,

12 Fungal infection sports, diabetes, Meningitis, Eczema, Psoriasis,
immunosuppressants IBD, Cancer

13 Simman DNAR

14 Teaching ECG

15 Bronchiolitis

Food poisoning - feeling sick

(nausea), diarrhoea, being sick
(vomiting), stomach cramps, a
16 Acute gastroenteritis high temperature of 38C or above
feeling generally unwell – such as
feeling tired or having aches and
chills

17 Gender selection

PIP, MCP and MTP joints, wrist,

elbow, knee, ankle, morning stiff
18 Rheumatoid arthritis
ness, malaise, fatigue, mild fever,
weight loss, family history
19 Colorectal polyp

Cranial nerve (TIA) (slurring of

20
speech and blurry vision)

21 CP child (cannula)

BP management (Q risk - 18%)

22
normal lipids but high BP

23 Bloody diarrhoea

24 High INR + clarithromycin

Speculum (Hx, Pap smear,

25
address concern)

Gonorrhoea (don't want to tell

26
wife)

Iron deficiency anaemia

27
(Wellman check)
 recurrent/unusual infection, easy
bruising, bleeding, joint pain, bone
28 Tiredness and Bruises
pain, malaise, weakness, abdo
pain, weight loss, night sweats

Breast counselling (lump

0.2x0.8, mobile & no skin
changes, Family Hx of breast
29
Ca, wants urgent referral but
lesion is benign shown on
paper)

Breast examination (cyclical

30
mastalgia)

Ramipril (low GFR) in a known

31
hypertensive

Warfarin (INR 2) urine 1+ blood

32
(painless haematuria)

Metastatic cancer - discuss

33
management

34 Confusion with COPD

35 First ANC visit

36 Palpitations ?Cause
37 COPD - chest infection

SOCRATES, sleep, N, V, vision,

38 Tension headache bright lights, weakness/numbness
in legs, LOW, LOA, Meds, FH

39 DCIS

40 End-stage MS DNAR

41 Chest pain (stable angina)

Aortic aneurysm (mid back

42
pain)

fever, sore throat, body rash,

tiredness, joint pain, muscle pain,
swollen glands - symptoms last for
1-2 weeks or more. Immune
43 HIV
system - weight loss
chronic diarrhoea, night sweats,
skin problems, recurrent
infections.

44 Obstructive sleep apnoea

Thrombosis, Claudication Hx, 6Ps

- Pain, Pulseless, Pale,
45 Acute limb ischaemia
Perishingly cold, Paraesthesia,
Paralysis
46 Upper GI bleeding (Sim man)

recent surgery/ immobility/

fracture/ travel, oestrogen
COPD/ asthma, pneumonia,
(pregnancy, HRT, the pill),
47 Pulmonary embolism pulmonary oedema (LVF), PE,
malignancy, previous PE/DVT,
numbness, pins and needles, MI;
thrombophilia, varicose veins,
muscle weakness,
obesity, central lines. pain, problems
with balance and co-ordination,
difficulty walking without
assistance, an inability to move
the legs, arms and/or face
48 Guillain-Barre syndrome
(paralysis), difficulty breathing,
pale skin,
blurred or tiredness,
double vision, difficulty
breathlessness,
speaking, problems a high
swallowing or
temperature (fever), excessive
chewing, difficulty peeing, and
sweating,
constipation,weight loss, frequent
persistent and/or
infections,
severe painunusual and frequent
bleeding, such as bleeding gums
49 Tiredness with gum bleeding
or nosebleeds, easily bruised skin,
flat red or purple spots on the skin
(petechiae), bone and joint pain, a
feeling of fullness or discomfort in
your tummy (abdomen), caused
by swelling of the liver or spleen
50 Thalassaemia

Otitis Externa, Impacted ear wax

can cause pain and deafness,
51 Otitis externa
Barotrauma, Foreign bodies,
Otitis media, Cholesteatoma

Ectopic pregnancy (combined

52
exam:)

51 Postpartum haemorrhage
 a tingling or painful feeling in an
area of skin, a headache or feeling
generally unwell, A rash will
52 Shingles appear a few days later. Usually
you get shingles on your chest
and tummy, but it can appear on
your face, eyes and genitals.

Ischaemic stroke following SOL

53
removal surgery

Heart burn, Feeling sick

(nauseated).
An acid taste in the mouth.
54 Barrett's oesophagus Bloating.
Belching.
A burning pain when you swallow
hot drinks.

Patient on Ramipril planning to

55
get pregnant
 NHS/NICE/GMC/Patient
ICE/Psychosocial Management plan
info/external links

female counsellor, don't

report

Investigations- urine colour, hourly volume, dipstick,

M,C+S, osmolality and Na+; blds FBC, U+E, LFT, CK,
CRP, osmolality, ESR, clotting; ABG beware acidosis
or iK+; urgent ECG iK+ causes fl at P waves, wide
QRS and tall, peaked T waves; CXR, urinary tract
USS. Treatment - insert catheter to monitor output;
assess for and treat causes and serious
https://www.nhs.uk/conditions/k
complications: • Obstructed - catheter will relieve
idney-disease/
urethral obstruction; ureteric obstruction may require
https://cks.nice.org.uk/acute-
nephrostomy or stenting • Shocked - increased HR,
kidney-injury#!
decreased BP, absent JVP; fluid resuscitate
scenariorecommendation:1
±inotropes • Overloaded - oedema, basal creps,
increased JVP: O2, furosemide, CXR •
Hyperkalaemia insulin/glucose, Ca2+ gluconate,
salbutamol. Continue IV fl uids unless overloaded (no
KCl if iK+), stop nephrotoxic drugs – this includes
ACEi/metformin even if CCF/DM; monitor urine
output; consider HDU referral for CVP monitoring.

https://www.nhs.uk/conditions/a
cne/
https://cks.nice.org.uk/rosacea-
acne#!scenario

Symptomatic, Physiotherapy, Epidural injection, MRI

(if it doesn't resolve in 6 weeks). Cauda equina - MRI,
https://www.nhs.uk/conditions/slipped-disc/
Neurosurgical referral for decompression. Safety
netting (cauda equina symptoms)

https://www.nhs.uk/conditions/s
Referral to psychiatrist (and endocrinologist). Stop sri-antidepressants/side-
the drug. Review the drug. Check hydration status. effects/
Urine osmolality. IV saline. https://cks.nice.org.uk/hyponatr
aemia#!scenario

Inj hydroxycobolamine every other day for 2 weeks.
Diet-related - vitamin B12 tablets every day/Inj twice
a year. Non diet related - Inj every 3 months. Follow
up blood tests - 10-14 days and 8 weeks.
https://www.nhs.uk/conditions/v
itamin-b12-or-folate-deficiency-
anaemia/
https://cks.nice.org.uk/anaemia
-b12-and-folate-deficiency#!
scenario

https://www.nhs.uk/conditions/ri
Antifungal (cream, gel, spray), Oral anti fungals,
ngworm/
General advice - keep clothes, towels & bed sheets
https://cks.nice.org.uk/fungal-
separate, keep your skin clean, avoid contact with
skin-infection-body-and-groin#!
people/pets with the same problem
scenario

https://geekymedics.com/document-death-confir

https://www.nhs.uk/conditions/b
Gets better within 2-3 weeks, Keep your child upright,
ronchiolitis/
Oxygen, Drink plenty of fluids, Keep the air moist, https://www.nice.org.uk/guidanc
Smoke-free environment, Relieve fever, saline nasal e/ng9/chapter/1-
drops, Recommendations#manageme
nt-of-bronchiolitis
https://www.nhs.uk/conditions/f
ood-poisoning/
https://patient.info/doctor/notifia
ble-diseases
Treat if dehydration/Symptomatic treatment. General
https://www.nhs.uk/conditions/d
advice. Notifiable disease - statutory duty.
iarrhoea-and-vomiting/
https://cks.nice.org.uk/gastroen
teritis#!
scenariorecommendation:24

https://www.nhs.uk/conditions/r
heumatoid-arthritis/
https://cks.nice.org.uk/rheumat
oid-arthritis#!scenario
 https://www.nhs.uk/conditions/bowel-cancer/diag

https://www.nhs.uk/conditions/n
hs-health-check/your-nhs-
health-check-results-and-
action-plan/
https://cks.nice.org.uk/cvd-risk-
assessment-and-
management#!scenario:2

CKS - If the INR is high, and is:

Greater than 8.0 with no bleeding or minor bleeding
— stop warfarin and give 0.5–1 mg phytomenadione
by slow intravenous injection, or 5 mg by mouth. The
dose of phytomenadione may be repeated after 24 https://www.nhs.uk/conditions/
hours, if the INR is still too high. warfarin/
Restart warfarin when the INR is less than 5.0. https://cks.nice.org.uk/anticoag
6.0–8.0 with no bleeding or minor bleeding — stop ulation-oral#!
warfarin. scenariorecommendation:48
Restart warfarin when the INR is less than 5.0.
Less than 6.0, but more than 0.5 units above the
target value — reduce dose, or stop warfarin. https://www.nhs.uk/conditions/c
Restart warfarin when the INR less than 5.0. ervical-screening/
https://www.nhs.uk/conditions/v
accinations/hpv-human-
papillomavirus-vaccine/

https://www.nhs.uk/conditions/n
hs-health-check/what-is-an-
nhs-health-check-new/
https://www.nhs.uk/conditions/ir
on-deficiency-anaemia/
Find out the cause - INVs (endoscopy). Referral https://cks.nice.org.uk/anaemia
within 2 weeks. Iron tablets. Follow up blood tests. -iron-deficiency#!
scenariorecommendation:3
https://cks.nice.org.uk/gastroint
estinal-tract-lower-cancers-
recognition-and-referral#!
scenario
 https://geekymedics.com/a-
tired-hairdresser/
https://www.nhs.uk/conditions/a
FBC, blood film, U+E, LFT, LDH, urate, clotting; bone
cute-myeloid-leukaemia/
marrow biopsy. Urgent referral.
https://cks.nice.org.uk/haematol
ogical-cancers-recognition-and-
referral#!scenario
https://www.nhs.uk/conditions/b
reast-cancer/
urgent referral (Family
https://cks.nice.org.uk/breast-
history +)
cancer-recognition-and-
referral#!scenario

https://www.nhs.uk/conditions/b
reast-pain/
https://cks.nice.org.uk/breast-
pain-cyclical#!scenario

https://www.nhs.uk/conditions/k
idney-disease/treatment/
https://www.nice.org.uk/guidanc
e/cg182/chapter/1-
recommendations#pharmacoth
erapy

Find out the cause of haematuria (UTI, stones, blood

disorder, beetroot). INR - 2 (within normal range).
Urine sample - UTI. U+E, X-ray, Scans. May refer to
specialist - Cystoscopy

https://cks.nice.org.uk/hyponatraemia#!scenario
https://www.nhs.uk/conditions/p
regnancy-and-baby/antenatal-
appointment-schedule/
https://www.nhs.uk/conditions/p
regnancy-and-baby/healthy-
pregnancy-diet/
https://www.nhs.uk/conditions/p
regnancy-and-baby/health-
things-you-should-know-
pregnant/
https://cks.nice.org.uk/antenata
l-care-uncomplicated-
pregnancy#!scenario
 Exam - BP, back of eyes, nerves. Reassure. Cause - https://www.nhs.uk/conditions/t
brain tumour, CT scan, Work stress. Relaxation techniques, Medication - ension-headaches/
work - stress, Mood ibuprofen. Time-off from work. Offer info. Follow up - https://geekymedics.com/a-
2 weeks. Safety netting. lady-with-a-headache/

https://www.nhs.uk/conditions/breast-cancer/

https://www.nhs.uk/conditions/a
ngina/
https://cks.nice.org.uk/angina#!
scenario

https://www.nhs.uk/conditions/abdominal-aortic-a

Regular monitoring - HIV viral load test, CD4

lymphcyte cell counts. Combination of antiretroviral https://www.nhs.uk/conditions/h
drugs. HIV viral load to see how well the treatment is iv-and-aids/
working. Diet, exercise regularly, stop smoking. https://cks.nice.org.uk/hiv-
Getting support.
lifestyle changesTell youras
– such partner/former
losing excesspartners.
weight, infection-and-aids#!scenario
Opportunistic
cutting infections.
down on Safety
alcohol and netting.
sleeping on your side.
using a continuous positive airway pressure (CPAP)
device – these devices prevent your airway closing https://www.nhs.uk/conditions/o
while you sleep by delivering a continuous supply of bstructive-sleep-apnoea/
compressed air through a mask. wearing a https://cks.nice.org.uk/obstructi
mandibular advancement device (MAD) – this gum ve-sleep-apnoea-syndrome#!
shield-like device fits around your teeth, holding your scenario
jaw and tongue forward to increase the space at the
back of your throat while you sleep. surgery - last https://www.nhs.uk/conditions/p
resort. Complications. DVLA. eripheral-arterial-disease-pad/
Emergency - Vascular Admit. Arterial Dopplers. https://www.rcemlearning.co.uk
15l/min O2, analgesia, heparin, IV hydration, /references/acute-limb-
(vascular) surgeons urgent referral, ischaemia/
https://cks.nice.org.uk/peripher
al-arterial-disease#!scenario
ABC, 15 l O2, 0.9% saline, FBC,U+E, LFT, Clotting,
urgent 4 unit X-match, take history, ABG, Senior, https://www.nhs.uk/conditions/stomach-ulcer/com
Urgent endoscopy (NBM until OGD)

https://geekymedics.com/a-
lady-with-shortness-of-breath/
https://cks.nice.org.uk/pulmona
ry-embolism#!scenario
Admission to AMU, Supportive treatment ( Pain
management , Antipyretics , Catheterisation , NPO ,
DVT prophylaxis , Parenteral nutrition , Keep https://www.nhs.uk/conditions/g
monitoring Vitals (Resp Rate), Referral to neurologist, uillain-barre-syndrome/
Plan for LP , Nerve conduction studies , CBC , https://www.rcemlearning.co.uk
ESR,CRP, Then plan for IVIG and plasmapheresis. /references/guillain-barre-
Reassure. Support and rehabilitation - syndrome/
physiotherapist, occupational therapist. Safety netting
( Dyspnoea immediately inform )
https://www.nhs.uk/conditions/a
cute-myeloid-leukaemia/
https://cks.nice.org.uk/haematol
ogical-cancers-recognition-and-
referral#!scenario

Most ear infections clear up within 3 days, although

sometimes symptoms can last up to a week.
Antibiotics might be prescribed if: an ear infection
doesn't start to get better after 3 days, you or your
child has any fluid coming out of their ear. Ear drops
[antibiotic ear drops – to treat a bacterial infection,
https://www.nhs.uk/conditions/e
steroid ear drops – to bring down swelling, antifungal
ar-infections/
ear drops – to treat a fungal infection], antibiotic
https://cks.nice.org.uk/otitis-
tablets – if your bacterial infection is severe. Safety
externa#!scenario
net - a very high temperature or feel hot and shivery,
earache that doesn't start to get better after 3 days,
swelling around the ear
fluid coming from the ear, hearing loss or a change in
hearing, other symptoms, like being sick, a severe
sore throat or dizziness

Severe bleeding call senior help; lay flat and elevate

legs; O2 (15l/min); secure 2 large-bore IV cannulae
(take blood for FBC, clotting, G+S), 1l 0.9% saline
STAT; urgent blood (O-negative, type specific, or full
X-match); compress the uterus bimanually, give
https://patient.info/doctor/postpartum-haemorrha
Syntocinon® 10 units/h in 500ml 0.9% saline,
deliver/check placenta, remove any retained
placental tissue and repair tears; may need
evacuation under anaesthetic or emergency
hysterectomy.
Antiviral therapy limits post-herpetic neuralgia if
started within 72h (aciclovir 800mg/5h PO). Treat
pain with simple analgesia (paracetamol, NSAIDs)
and amitriptyline 25mg/24h PO. Do: take
paracetamol to ease pain, keep the rash clean and
https://www.nhs.uk/conditions/s
dry to reduce the risk of infection, wear loose-fitting
hingles/
clothing, use a cool compress (a bag of frozen
https://cks.nice.org.uk/shingles
vegetables wrapped in a towel or a wet cloth) a few
#!diagnosissub
times a day, Don't: do not let dressings or plasters
stick to the rash, do not use antibiotic cream – this
slows healing. It can take up to 4 weeks for the rash
to heal. Your skin can be painful for weeks after the
rash has gone, but it usually settles over time.
https://www.nhs.uk/conditions/s
troke/
https://www.nhs.uk/conditions/o
https://cks.nice.org.uk/stroke-
esophageal-cancer/causes/
and-tia#!scenario
https://www.bupa.co.uk/health-
information/digestive-gut-
health/barretts-oesophagus
Treatment of acid reflux - PPI. Life style advice. https://patient.info/health/acid-
Surveillance - It may be every 2-3 years if there are reflux-and-
no dysplasia cells detected. Once dysplasia cells are oesophagitis/barretts-
found, the check may be advised every 3-6 months oesophagus
or so. https://www.macmillan.org.uk/in
formation-and-
support/diagnosing/causes-
and-risk-factors/pre-cancerous-
conditions/barretts-
Labetalol https://www.nice.org.uk/guidance/cg107/chapter
oesophagus.html#20441
 OHFP Page Video/External link

Pg. 372

https://www.youtube.com/watch?v=FY3UtmTaK5Y

Pg. 386
Pg. 211 (223) of
OSCE book

Pg. 416

Pg. 226 https://www.youtube.com/watch?v=KNqoXboSVUI

Pg. 454
https://www.youtube.com/watch?v=sJBpai74tlU
https://www.youtube.com/watch?v=sJBpai74tlU
Pg. 396

Pg. 688 (OHGP)

 https://www.youtube.com/watch?v=BEnMQm40dQI

Pg. 490

Pg. 444-446
Pg. 298-299

How to use ear drops: Remove

any visible discharge or earwax
using cotton wool. Hold the bottle
in your hand to warm it – cold ear
drops can make you feel dizzy.
Lie on your side with the affected
ear facing up to put the drops in.
Gently pull and push your ear to
work the drops in. Stay lying down
for 5 minutes so the drops don't
come out.

Pg. 507
BNF Pg. 141
Medicine History 31
Surgery 9
Obs & Gyn 7
Paediatrics 10
Psychiatry 10
Counselling 30
Ethicals 35
Examination 32
New stations 57

221