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
It’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?
You 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.”
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.”
Does this 51-year-old need ongoing contraception?
You see Jane, who is 51 years old and who had a levonorgestrel intrauterine system fitted three years ago for contraception and to help control her menorrhagia. She has been amenorrhoeic for the past two years and wants to know when it would be safe to assume she has gone through the menopause and can have the IUS removed without any ongoing risk of pregnancy. She asks if there are any hormone tests you could do to check this. What is the most appropriate next step?
Check your answer in our recently updated Clinical pointers module on Managing the menopause. It includes all the latest practice-changing tips from the Faculty of Sexual and Reproductive Healthcare’s (FSRH) guidance on contraception in women aged over 40, which was updated in late 2017. As well as diagnosis of the menopause and advice on contraception, the module also covers evidence-based approaches to managing menopausal symptoms and the risks versus benefits of HRT for different groups. It gets great reviews from other GP users:
“Excellent. Finally a summary that simplifies the key points.”
“Fab module, genuinely really useful.”