StethascopePrimary Care

How would you manage this 8-week-old baby?

Rob brings his 8-week-old son, Joshua, to your baby clinic. Joshua is partly formula fed as his mother has just gone back to work. She breastfeeds first thing in the morning and at night. Rob is concerned because Joshua seems unsettled during the day, and cries a lot during and after feeds. He is feeding every three hours and sometimes vomits quite large amounts when Rob puts him down for his sleep after a feed, and he always takes a long time to wind. His stools are normal.

How should you approach this scenario? What factors in the assessment would help distinguish between possible diagnoses?

Check your answers in our new Ask an expert module on Common problems in new babies in primary care. It will help you feel confident that you won’t miss anything serious, as well as providing much-needed reassurance on topics including: common rashes; feeding problems; constipation; jaundice; eye problems; sepsis; and heart murmur. Other GPs are already giving the module great reviews:

“I really liked this module. Concise and well presented information with extra links (super useful). A well needed refresher.”

“Very useful and covered most of the common neonatal issues a GP would see.”

Hay fever and perennial allergic rhinitis: your questions answered

Does nasal saline irrigation have a role in managing hay fever? Which OTC antihistamine should you advise patients to try first? And how old does a child need to be before you should consider hay fever as a possible diagnosis?

With the grass pollen season now underway in the UK, find the answers to these and other questions in our newly updated Ask an expert module on Hay fever and perennial allergic rhinitis, in which consultant allergists Dr Sophie Farooque and Dr Guy Scadding answer clinical queries submitted by GPs. Among the other topics covered are safe treatment options during pregnancy and indications for allergy testing and immunotherapy.

Other GPs have found the module really worthwhile:

“Excellent and very practical - just what I needed.”

“Highly recommended, I see patients like this all the time in the GP setting. It has definitely changed my approach.”

Acute, itchy facial rash: what's the diagnosis?

Rosalind is a 45 year old who works as a horse riding tutor. She presents at your practice as a temporary patient while visiting her family. She has had an intensely itchy one-sided facial rash for several months. This has been treated by her usual doctor with various approaches, including topical corticosteroids, antibiotics, a short course of oral corticosteroids, and twice with aciclovir for suspected shingles. The rash has been getting worse: it is spreading and is very itchy. What is the most likely diagnosis and what’s the best next step in treating Rosalind?

Check your answers in our new Quick quiz module on acute itchy rashes. You’ll learn as you work through six patient presentations, choosing the most likely differential as you go. The module also includes treatment tips. Other GPs are giving it great reviews:

“Excellent module. Love the case-based approach with pictures - which is practical and memorable.”

“What a fantastic module - like being given a private tutorial in dermatology. I learnt so much.”

How would you manage this patient with raised LFTs?

Jill is a 75 year old with a BMI of 28 and a history of hypertension, for which she takes amlodipine. She does not drink alcohol and has no other significant past medical history. Three months ago, LFTs requested by the practice nurse during a routine health check came back showing a raised ALT level of 70 IU/L. Jill was advised to lose weight and increase her physical activity and to have repeat LFTs after three months. Those results have come back and her ALT remains elevated at 75 IU/L. You request a liver screen and the ultrasound shows fatty infiltration of the liver. The rest of the liver screen is negative. Her FIB-4 score is 1.52. What is the most appropriate next step?

Check your answer in our new Step by Step module on Investigating asymptomatic patients with abnormal liver function tests. It offers practical tips on interpreting LFTs and liver screen results as well as advice on which patients can be managed in primary care and who should be referred. The module is getting great reviews from other GPs:

“Excellent. Clear, practical, pragmatic - just what general practice wants.”

“Great module, really loved the flow charts!”

A quick neurological screen for a 10-minute consultation

examIt’s not feasible to carry out a full neurological examination in a 10-minute consultation - so it’s helpful to know which aspects of the exam are most important to check in which patients. Our new video module on a Quick neurological exam for primary care is full of practical tips. Consultant neurologist Dr Giles Elrington starts by demonstrating a 15-point neurological screen that can be completed in a few minutes. He then explains how to use the results of that screen, together with the presenting symptoms, to target specific diagnoses with more focused examinations - including for multiple sclerosis, Parkinson’s disease, sciatica, carpal tunnel syndrome, cervical radiculopathy, radial nerve dysfunction and foot drop. Other GPs are loving the module:

“Brilliant module. Simplicity is its hallmark. Will review it again and again as these are all common presentations in general practice.”

“This is just fantastic. I’ve watched it all twice now. Great tips for a GP eg. a quick screen to exclude peripheral neuropathy.”

What can you do for patients with unexplained chronic cough?

coughing womanYou see a 47 year old non-smoker who is suffering from a dry chronic cough that has been bothering her for several months - there are no red flags, her chest x-ray and spirometry results were normal and she is not taking any regular medication. She says the constant coughing is driving her mad and irritating her work colleagues and she is desperate for you to do something to help control it. What is the best next step?

Find the answer in our highly rated new module on dealing with patients who present with a Chronic cough in primary care. The module covers red flags to look out for and common causes that can be easily addressed. It also outlines a pragmatic “trials of treatment” approach for managing the significant number of patients in whom no obvious cause can be identified. Other GPs are finding it really helpful:

“One of the best overviews about a very common, often challenging, problem in our daily surgery.”

“Good pragmatic approach to a troublesome problem.”

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

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.”