The 10-Minute Clinical Assessment

Foreword xi Preface to 1st Edition xii Preface to 2nd edition xiv About the author xv Acknowledgements xvi Selected useful resources xvii The focused consultation 1 Focused clinical assessment 3 Useful consultation tools 8 Red flags in general practice 12 Undifferentiated and miscellaneous presentations 15 Suspected cancer 17 Weight loss 24 Tiredness 29 Dizziness 35 Chronic pain 41 Sudden collapse and syncope 45 Frequent attenders 50 Medication review and polypharmacy 54 Medically unexplained symptoms 58 Insomnia 63 Irritability and ‘stress’ 67 Domestic violence 71 Homelessness 75 Paediatrics and adolescent health 81 The sick and/or feverish child 83 Suspected meningococcal meningitis and septicaemia 90 Neonatal jaundice 95 Faltering growth 99 Headache and migraine in children 104 Head injury in children 108 Suspected cancer in children and adolescents 113 Abdominal pain in children 118 Hearing loss in children 124 Childhood cough 128 Childhood wheeze 133 Constipation in children 138 Childhood obesity 142 Suspected child abuse and neglect 148 Nocturnal enuresis 153 Knee problems in children 158 Hip problems in children 163 Adolescent health problems 167 Self-harm in teenagers 171 Eating disorders 175 Autism-spectrum disorder 180 Cardiovascular 183 Chest pain 185 Palpitations 191 Cardiovascular risk assessment 195 Hypertension 200 Atrial fibrillation 205 Heart failure 209 Peripheral vascular disease 215 Respiratory 221 Shortness of breath 223 Haemoptysis 228 Suspected lung cancer 233 Asthma 237 Chronic obstructive pulmonary disease 242 Suspected pneumonia 248 Pleural effusion 252 Pulmonary embolism 256 Endocrine and metabolic 261 Diabetes review 263 Obesity 268 Hirsutism in women 273 Hypothyroidism 277 Hyperthyroidism 281 Hyponatraemia 285 Hypernatraemia 289 Hypokalaemia 292 Hyperkalaemia 296 Hypocalcaemia 299 Hypercalcaemia 302 Gastrointestinal 307 Nausea and vomiting 309 Dysphagia 313 Dyspepsia and reflux 317 Upper gastrointestinal bleeding and melaena 321 Abdominal pain 326 Constipation 332 Diarrhoea 336 Rectal bleeding and suspected bowel cancer 341 Abnormal liver function tests 346 Irritable bowel syndrome 351 Inflammatory bowel disease 356 Coeliac disease 361 Infectious diseases 365 Fever of unknown origin 367 Fever and illness in the returning traveller 372 HIV infection and AIDS 377 Tuberculosis 383 Rheumatic fever 388 Haematology 393 Iron-deficiency anaemia 395 Macrocytic anaemia (B12 and folate deficiency) 400 Bleeding disorders 405 Myeloma 409 Musculoskeletal 413 Soft-tissue injury 415 Acute hot and swollen joint 420 Chronic musculoskeletal pain 424 Polyarthralgia 429 Neck pain 435 Back pain 440 Shoulder and arm problems 446 Elbow problems 452 Hand problems 456 Hip pain 461 Groin problems 466 Leg pain and/or swelling 470 Knee pain 476 Foot and ankle problems 483 Gout 489 Osteoporosis 493 Neurology 499 Headache 501 Transient ischaemic attack and stroke 508 Head injury in adults 514 Suspected or confirmed brain tumour 519 Tremor 524 Motor neurone disease 528 Peripheral neuropathy 533 Multiple sclerosis 538 Gynaecology 543 Combined oral contraception 545 Menorrhagia 549 Amenorrhoea 553 Breast lumps 557 Loss of libido 561 Polycystic ovary syndrome 565 Suspected ovarian cancer 570 Obstetrics 575 Routine antenatal care 577 Bleeding in early pregnancy 582 Abdominal pain in pregnancy 586 Pre-eclampsia 591 Urology and renal medicine 595 Suspected urinary tract infection in women 597 Lower urinary tract symptoms in men 601 Urinary incontinence 606 Urethral discharge in men 612 Scrotal and testicular problems 616 Erectile dysfunction 621 Renal or ureteric colic (kidney stones) 626 Haematuria 631 Chronic kidney disease 635 Mental health 641 Depression 643 Self-harm and harm to others 648 Anxiety phobias and panic disorder 653 Alcohol screening 657 Alcohol dependence 662 Illicit drug misuse 667 Obsessive–compulsive disorder 672 Mania 675 Schizophrenia 679 Skin 685 Moles and malignant melanoma 687 Pressure ulcers 690 Ophthalmology 695 Eye injuries 697 The acute red eye 701 Gradual painless visual disturbance 706 Sudden painless visual disturbance 710 Eye problems in older people 715 Ear nose and throat 719 Neck swelling 721 Sore throat 725 Ear pain 730 Hearing loss in adults 734 Tinnitus 738 Sinusitis and facial pain 742 Problems in older people 747 General health assessment in older people 749 Cognitive problems and dementia 755 Falls in older people 760 Delirium and acute confusional state 766 Depression in older people 772 Palliative and end-of-life care 777 Parkinson’s disease 781 Index 785