StethascopePrimary Care

COPD - what's the next treatment option?

You are reviewing a 67-year-old man who has COPD. He is an ex-smoker; his FEV1 is 45% predicted. He is taking salbutamol when necessary and has become progressively more short of breath on exertion over the last few months. What should you do next in terms of his pharmacotherapy?

Check your answer in our highly rated module on Long-term management of COPD. You’ll update your knowledge on the role of drug and non-drug therapies in controlling symptoms and improving outcomes as you work through interactive patient scenarios. The module has been getting great reviews from other GP users:

“Especially liked all the case studies to check we could apply the theory/guidelines to patient care.”

You might also want to try our GP modules on other aspects of COPD:
Managing acute exacerbations of COPD in primary care
COPD: Diagnosis and assessment of severity

Practical tips on incidental raised liver enzymes

An incidental finding of abnormal LFTs is a common event in primary care and it can be difficult to know which patients need further investigation. Our two Ask an expert modules on Alcohol-related liver disease and Non-alcoholic fatty liver disease (NAFLD) offer a practical evidence-based approach to the problem. Consultant hepatologist Dr Stuart McPherson gives answers to common clinical challenges submitted by GPs and the modules are very popular with other users:

“Gives me more confidence in dealing with a very difficult and challenging area.”

“An extremely helpful module on how to approach abnormal LFTs. Will change my practice.”

Should you prescribe the contraceptive pill for this teenager?

Sarah is 14 years old and has come to see you alone. She says she would like to start taking the contraceptive pill as she is planning to have sex with her 19-year-old boyfriend, whom she met online. He is very keen for them to have sex; she is less sure but is worried they may split up if they don't. How do you balance your concerns about this situation while recognising that Sarah has made a responsible decision to come to you for contraception? What should you explain to Sarah about confidentiality?

Check your answers in our new module Contraception in young people under the age of 18. It offers advice on how to approach your consultations with this age group, as well as special considerations such as safeguarding and confidentiality. It also covers clinical aspects including emergency contraception and quick starting contraception. Other GPs are finding it really useful:

“An excellent case scenario-based guide, very relevant to general practice."”

Good dilemmas likely to occur in regular general practice.”

You might also like to try some of our other modules on contraception, all focused on challenging clinical topics for GPs:
Ask an expert: Contraception in primary care
Contraception in the perimenopause
Quick tips: Safety of different contraception methods (UKMEC 2016)

How would you manage this patient with sciatica?

A 35 year old man presents with acute sciatica. He is otherwise healthy and you have no concerns about serious pathology. He has already tried ibuprofen and paracetamol but is still troubled by his leg pain. What is the most appropriate next step in management?

Check your answer in our Guideline Focus module on Low back pain and sciatica. The module highlights the key practice-changing points for GPs from the NICE guideline on this common presentation. It also advises on risk stratification to identify patients at high risk of chronic pain, investigations to request and those to avoid, the latest evidence on safety and efficacy of different analgesics, and who to refer for radiofrequency denervation and other specialist interventions. The module is proving very popular with other GPs:

“Clear points which are easy to follow and use in a busy surgery.”

“Great review of recent guidance, especially use of the STarT back tool and appropriate referral for MRI.”

Our related new video module on Back examination is full of practical tips on how to use the history and exam findings to reach the right diagnosis. And if you're concerned about missing an inflammatory cause of back pain, you might also want to check our Step by step module on Diagnosis and management of axial spondyloarthritis in primary care.

Heart failure: practical tips for GPs

Mr Smith is an 82-year-old with mild exertional dyspnoea which is not significantly limiting his daily activities. There is no history of orthopnoea or paroxysmal nocturnal dyspnoea. His past history includes hypertension, diabetes mellitus and prostatism. His current drugs are bendroflumethiazide, felodipine, tamsulosin, metformin and aspirin. At his annual diabetes review, he is noted to have an irregular pulse and an ECG confirms atrial fibrillation. His blood pressure is 128/64, heart rate is 84bpm, JVP is not elevated, chest is clear, and he has no peripheral oedema. An echocardiogram shows mild LVSD, moderate biatrial dilatation and no important valvular lesions. What is the best approach to managing this patient? Check your answer in our new Step by step module on Managing heart failure in primary care. The module covers which drugs to prescribe and which to avoid, how to monitor symptoms, treatment options for refractory symptoms and when to refer. Other GP users are finding it very helpful:

“Easy to follow with helpful scenarios.”

“Excellent - up-to-date and very practical and relevant.”

You may also be interested in our other heart failure modules for GPs:
Step by step: a guide to diagnosing heart failure
Ask an expert: chronic heart failure
What's new in chronic heart failure

How would you manage this asthma patient?

Rachael, who is 43 years old, is taking high-dose inhaled corticosteroids, a long-acting beta agonist and montelukast for her asthma. She uses a short-acting beta agonist (SABA) as required. Despite her medication, her asthma control is very poor; she typically wakes up coughing three nights a week and uses her SABA inhaler twice a day. What is the most appropriate next step in management? Check your answer in our new module on Managing chronic asthma in adults in primary care, which highlights the practice-changing points from the latest update of the BTS/SIGN asthma guidelines. It also includes practical tips - with a video demonstration - to help you advise patients on good inhaler technique. The module has already been getting great reviews from other GP users:

“Highly recommended, Will definitely help me to manage and diagnose asthma much better.”

“Real world case-based scenarios. Very useful.”

You might also want to look at our latest modules covering other aspects of asthma care, all of which are fully up to date with the latest BTS/SIGN guidance:

Guideline Focus: Asthma diagnosis in children and adults

Acute asthma in adults: assessment and management

Management of acute asthma in children

Childhood fever: are you confident to spot the red flags?

Assessing a feverish child under the age of five years can be challenging. Most will have a self-limiting infection but it’s vital not to miss the cases caused by more serious infections such as meningitis or pneumonia. Our newly updated module on Fever in under fives will ensure you feel confident to use the NICE traffic light system to identify children who need emergency referral or urgent specialist input. We’ve also added a summary of the 2016 NICE sepsis recommendations for under-fives so that it’s clear what to do if your assessment of a feverish child leads you to suspect sepsis. Other GPs are finding the module very helpful:

“A must for all GPs, from registrars to old hands!”

“Excellent module for daily practice.”