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Medical knowledgeAppendix 1Within the general context of primary care, the following areas should be considered for each problem or disease
The problems and diseases listed below are tabulated in groups of presenting conditions classified on the basis of contemporary coding systems reflecting the current range of general practice workload in the United Kingdom. Seriously ill patients· Cardiovascular problems including cardiac arrest, acute coronary syndrome, acute myocardial infarct, acute left ventricular failure, dissecting aneurysms, severe hypertension and life-threatening arrhythmias · Respiratory problems including acute severe asthma, pulmonary embolus, pneumothorax, pneumonia, epiglottitis, bronchiolitis and respiratory failure · Central nervous system problems including cerebrovascular problems such as strokes, seizures including febrile convulsions, infections such as meningitis or encephalitis, and signs of other significant intracranial pathology such as tumours · Gastrointestinal problems including gastroenteritis especially in childhood, haemorrhage, acute abdominal pain and liver failure · Infectious diseases not covered elsewhere e.g. malaria · Shocked patients including septicaemia, cardiogenic and anaphylactic shock, and haemorrhage · Unconscious patients including those with diabetic problems such as hypoglycaemia, hyperglycaemic ketoacidosis and hyperosmolar non-ketotic coma · Psychiatric problems including acute psychoses, acute organic reactions, the suicidal patient, psychological crises and the application of the Mental Health Act · Urological problems including torsion of the testis, priapism, paraphimosis, gross haematuria, ureteric colic and acute retention of urine · Women’s problems including severe vaginal bleeding and/or pelvic pain e.g. ectopic pregnancy and emergencies associated with pregnancy e.g. placental abruption or eclampsia · Terminally ill patients, including symptomatic and palliative care, and general issues surrounding management including the patient’s and family’s wishes, in order to facilitate a good death · Sudden unexpected death including sudden infant death syndrome, confirmation of death, dealing with relatives, certification and referral to the Coroner / Procurator Fiscal Complex and undifferentiated conditions- including symptoms and ill-defined conditions for which no diagnosis classifiable elsewhere is recorded. · ‘Tiredness all the time’ / malaise / fatigue / weakness / lassitude · ‘Funny turns’ / dizziness / giddiness / faints / blackouts / ataxia /’gone off legs’ · Anorexia and/or weight loss · Weight gain and/or obesity and conditions, which may be associated with obesity · ‘Swelling’: localised, mass, lump including single lymph nodes · Non-specific rashes · Fever, including pyrexia of unknown origin and ‘burning up’ · Allergic problems · Pallor including patients who may be anaemic for any cause · Confusion, memory loss, poor concentration and forgetfulness · Frequency of micturition, including metabolic causes Trauma/Injuries/Toxic effects.· Abuse: sexual adult, child; non-accidental child, elder · Wounds (including surgical) and lacerations: management and principles of care · Fractures, sprains, strains and other significant soft-tissue trauma: recognition and principles of management · Head injuries including minor, with or without loss of consciousness, concussion and more serious cranial or intracranial injuries · Internal injuries of the chest, abdomen or pelvis: recognition and principles of management · Poisoning including by drugs (prescribed, over the counter or non-medicinal), foods, and other chemicals whether deliberately or unintentionally and including adverse effects of prescribed drugs · Postoperative complications including those related to the procedure, infections and other systems for example, respiratory or circulatory · Miscellaneous including epistaxis, foreign bodies, burns Respiratory tract diseases· Sore throats and colds, upper respiratory tract infections including nasopharyngitis, pharyngitis, tonsillitis, peri-tonsillar abscess, epiglottitis, laryngitis and tracheitis · Shortness of breath including lower respiratory tract infections, e.g. bronchiolitis, bronchitis and pneumonia (of any cause), bronchiectasis, emphysema, pneumothorax and pulmonary embolus · Wheezing including asthma, chronic obstructive pulmonary disease · Cough including haemoptysis · Stridor · Hoarseness, change in character of voice Ear, nose and throat problems· Nasal problems including catarrh, hay fever, ‘rhinitis’, polyps, epistaxis · Otalgia including otitis externa and media · Mouth problems including pain such as ulceration, infections such as gingivitis, malignancies, disorders of the salivary glands, and medical problems associated with the dentition · Sinus problems · Hearing problems including deafness, tinnitus and associated speech or language disorders Eye problems· Red eye including conjunctivitis of various causes, iritis, episcleritis, corneal or dendritic ulcers · Loss of vision including visual impairment such as cataracts and retinal problems such as detachment, vascular lesions, atrophy or tumours · Eye pain such as glaucoma or retrobulbar neuritis · Eyelid problems such as blepharitis, ectropion and disorders of tears Dermatological problems· Pruritus either generalised or localised · Rashes including dermatoses, eczema, acne and those associated with internal disease · Skin tumours including benign lesions such as naevi and various moles and malignant lesions such as malignant melanoma, squamous cell carcinoma, basal cell carcinoma · Nail and/or hair disorders including alopecia Gastrointestinal problems· Abdominal masses including ascites, intra-abdominal masses or enlarged organs and localised swellings for example, hernias · Abdominal pain · Change in bowel habit · Constipation · Diarrhoea including infective, malabsorption, inflammatory bowel disease · Gastrointestinal haemorrhage · ‘Indigestion’/ ‘heartburn’/dyspepsia including oesophageal reflux and peptic ulcer disease · Rectal problems including bleeding, pain and masses · Nausea and/or vomiting and/or diarrhoea · Jaundice including hepato-biliary conditions such as infection, malignancy, gall bladder disease and haemolysis for any cause Musculo-skeletal problems· Back pain including mechanical, disc lesions or tumours · Neck pain including cervical spondylosis, torticollis and ‘whiplash’ injuries · Joint pain, swelling or stiffness including individual joints such as hip, knee or shoulder or generalised · Soft tissue problems including pain in a limb, connective tissue disorders such as polymyalgia rheumatica · Rheumatic problems including osteoarthrosis, systemic conditions such as rheumatoid arthritis and osteoporosis · Sports medicine Neurological problems· Headaches including tension, vascular such as migraine and raised intracranial pressure · Vertigo including vertebro-basilar, labyrinthine or cerebellar problems · Seizures · Strokes and transient ischaemic attacks · Speech disorders · Degenerative disorders including multiple sclerosis, Parkinson’s disease, motor neurone disease and encephalopathies · Sensory and/or motor disturbances including neuropathies and neuralgias such as face pain Cardiovascular problems· Risk factors for coronary heart disease and other thromboembolic diseases such as lipid disorders · Chest pain including ischaemic heart disease and pericarditis · Cardiac failure including left ventricular dysfunction · Hypertension · Palpitations including conduction defects such as atrial fibrillation · Murmurs including congenital heart disease and acquired valvular problems · Circulation disorders including arterial problems such as peripheral vascular disease and aneurysms and venous problems such as thromboembolism Psychiatric disorders· Communication problems including autistic spectrum disorder · Behaviour problems such as attention deficit hyperactivity disorder, encopresis, school problems · Problems of particular life stages e.g. childhood, adolescence, old age · Family, social and cultural context of psychiatric illness · Depression, including features of a major illness such as biological symptoms, assessment of suicidal risk, detection of masked depression · Major mental illness including psychotic disorders such as schizophrenia · Somatisation disorder · Personality disorder · Anxiety including generalised anxiety disorder, situational anxiety and adjustment reactions · Substance misuse including alcohol · Sleep disorders · Dementias · Learning difficulties and mental disability). · Co-morbidity: the association of psychiatric disorders with other medical conditions Children’s problems· Prenatal diagnosis · Neonatal problems including jaundice and feeding problems · Delayed development including knowledge of normal developmental milestones · Failure to thrive · Childhood infections including exanthemata · Common diseases of childhood · Coping with childhood physical or learning disability · Child health surveillance and immunisation · Non-accidental injury Urogenital problems· Urinary tract infections · Haematuria · Loin pain · Dysuria · Vaginal discharge · Incontinence Sexual health· Issues of sexual identity and sexual orientation · Contraception male and female · Infertility, primary or secondary · Assisted conception · Sexually transmitted diseases including safe sex and contact tracing. · Sexual problems including loss of libido, anorgasmia and impotence. Men’s health· Testicular problems including pain e.g. orchitis and swelling e.g. tumours. · Urinary problems including benign prostatic hypertrophy or malignancy Women’s health· Breast problems including pain or lumps; malignancy · Pregnancy including pre-conceptual and normal antenatal care, antenatal problems such as bleeding or hyperemesis; postnatal problems · Abnormal vaginal bleeding including intermenstrual bleeding, post-coital or post-menopausal · Hormonal problems including the menopause and premenstrual syndrome · Menstrual problems including pain such as endometriosis or bleeding such as menorrhagia · Pelvic mass including cysts, fibroids and malignancy · Pelvic pain including pelvic inflammatory disease · Urinary problems including stress and/or urge incontinence · Vaginal discharge and/or pruritus including infections such as bacterial vaginosis, atrophic changes and malignancy Miscellaneous problems· Bleeding and bruising problems and other haematological disorders · Endocrine disorders · Genetic disorders · Lymphatic disorders including functional asplenia · Occupational medicine · Preventive medicine including screening, opportunistic health promotion especially with regard to smoking, immunisation, harm minimisation and promotion of a healthy lifestyle · Travel medicine including preventive aspects and treatment of infections contracted abroad. Serious communicable diseases· Particularly, but not limited to, infections such as Human Immunodeficiency Virus (HIV), tuberculosis and hepatitis B and C · Means and control of transmission, awareness of diagnosis, investigation, management, consent for testing, issues of confidentiality and the implications to the patient of a positive result · Role of Public Health Services Pharmaco-therapeutics· Application of the concept of rational prescribing, especially with regard to patient safety · Awareness of drug contraindications, adverse effects, iatrogenic disorders and potential interactions · Awareness of the factors affecting dose, drug requirements, compliance and monitoring · Evaluating independent evidence regarding the appropriateness of treatment |
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