Clinical Knowledge Summaries

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• Clinical Knowledge Summaries
• Training scenarios

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Scenario 1

• A well woman is found to have a TSH above
  normal and less than 10 uM/L. T3 and T4 are in
  the normal range.
• How are you going to manage her initially?
• Her antibodies are negative what are you going
  to advise her?
• On follow-up three years later her TSH is greater
  than 10 uM/l. What are you going to advise her?

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Scenario 2

• You are asked by a colleague what ferritin level
  is suggestive of iron deficiency anaemia.
• What do you say?
• The patient has a history of RA, the colleague
  asks if ferritin is still a reliable measure for
  iron deficiency anaemia?

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Scenario 3

• You see an otherwise well woman with an anal
  fissure.
• How are you going to manage her initially?
• How are you going to prescribe GTN?
• She tells you her friend had a similar problem
  and that she was told that GTN is useless and
  the only thing that works is an operation. What
  are you going to advise her?

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Scenario 4

• A 29 year old lady is due to have her third
  baby. She does not have the Internet at home and
  she asks you for some information about
  contraception she can read at home.
• Find a suitable patient information leaflet

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Scenario 5

• A 30 year old man presents with a sore eye after
  getting something in it when out jogging this
  morning.
• Having excluded a serious cause of red eye, you
  find a small peripheral corneal abrasion. Are you
  going to refer him?
• How are you going to manage him?
• Your practice nurse suggests you prescribe
  diclofenac eye drops. What do you think?
• Are you going to patch his eye?

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Scenario 6

• A pregnant lady comes to your surgery worried
  that she has been in contact with a child who has
  been diagnosed with chicken pox.
• How do you assess this problem and what questions
  do you need to ask?
• What do you advise this lady if she has not had a
  history of chickenpox?

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Scenario 7

• You make a diagnosis of glue ear in a 5 year old
  boy.
• Under what circumstances would you refer him?

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Scenario 8

• You are asked by a nurse in the practice whether
  corticosteroids can be used in people with acute
  gout?
• What do you tell him?
• He would like to read the trial evidence. How can
  you find the articles for him?

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Scenario 9

• One of your patients has seen the local
  psychiatrist and he has asked you to switch her
  from a TCA to a SSRI of your choice?
• How are you going to do this?

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Scenario 10

• A pregnant women has been suffering from
  indigestion and tried OTC medicine and lifestyle
  strategies to no effect. She asked for some
  medicine that is safe for her baby?
• What do you advise?
• Would you use a PPI or ranitidine?
• What is the evidence for PPI and ranitidine use
  in pregnancy?

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Scenario 11

• A 70 year old lady presents with a venous leg
  ulcer.
• How do you assess this lady?
• Do you organize doppler studies in all patients
  with venous leg ulcers?