GP APEX

Dyspnoea

Respiratory:

• PE

• Malignancy

  • Ix: first = XR/CT, refer to specialist for MRI/Bronchoscopy/Biopsy

• Asthma/Asthma Attack

  • 4 breaths x 4 puffs → if not recovered by 2 attempts = call 00

• COPD/Exacerbation

• Sarcoidosis

• ILD

• Pleural Effusion

• Pneumothorax

Cardio:

• HF/HFrEF

  • Mx: LMNOP + 4 Pillars (ACE/ARB, BB, Spironolactone, SGLT2i)

  • HFrEF = <40%, 4 pillars

  • HFpEF = 41-50%, SGLT2i

  • Safety net for weight gain (fluid overload)

• Acute Coronary Syndrome

  • Mx: MONA ABASH C

• Cardiac Tamonade (Becs Triad)

Infective:

• Pneumonia (Typical, Atypical)

• Bronchitis

Traumatic:

• Pneumothorax

• MSK Pain (Ribs)

• Upper Airway Obstruction (Foreign Body, Anaphylaxis)

• Costocondritis

Other:

• Anxiety/Panic Attacks

• Anaemia

• Metabolic Acidosis (DKA)

• Neuromuscular

lung cancer screening if 50-70yo + 30 pack year

Itch

Derm:

• Atopic Dermatitis/Eczema

  • Atopic Triad: eczema, asthma, hayfever + FHx

• Psoriasis

• Contact Dermatitis

• Lichen Planus

• Urticaria

• BCC/SCC

Infective:

• Candida/Tinea (Fungal)

• Bacterial ()

  • 
    

• Scabies

• Shingles (VZV)

• Impetigo

Systemic: fever, fatigue, night sweats/chills, LOW

• Hepatic

  • Jaundice, urine/stool change

• Renal

  • Jaundice, urine/stool change, Uremic Frost

• Haem ()

  • Bleeding/bruising, worse w hot water or alcohol, red broken blood vessels?

• Anaphylaxis

  • Swelling, trouble breathing, throat closing, acuity

• Dermatitis Herpetiformis (Coeliac Disease)

Other:

• Drug Induced

• Psychiatric

• Coeliac Disease

• Gallstones

• Renal Failure

• Conjunctivitis

• Liver Cirrhosis

Visual Disturbance

Black Spots = occlusion/detachment; Blurred = optic disk swelling/papilloedma; Wavy Lines = migraine

Emergency vs Semi-Urgent vs Non-Urgent

Acute:

Painful: inflammation, pressure, trauma

• Acute Angle Glaucoma

  • Sudden pain/headache, halo

• Optic Neuritis

  • Painful eye movements, Diplopia, colour vision loss

  • MS is a RF

• Anterior Uveitis/Iritis

  • Sudden dull ache, photophobia, lacrimation, irregul pupil

  • RF = HSV, Autoimmune (ank spond, JIA, RA)

• Conjunctivitis

  • Viral, Bacterial or Allergic

• Corneal Abrasion

  • Pain/red eye without vision change

• Corneal Ulcer/Keratitis

  • Erosion over days, red eye, photophob, progressive pain

  • RF = contact lenses

• Orbital Cellulitis

  • Swelling + pain on eye movement

• Periorbital Cellulitis

  • Swelling without eye pain

• Herpes Simplex Keratitis

  • Dendrites on fluroscein (cornea involvement)

• Herpes Zoster Opthalmicus

  • Headache.fever, eye/scalp pain, rash over V1

• GCA

  • Pain on chewing (jaw claudication) or brushing hair

• Migrain w Aura

  • N/V, Headache, Wavy Lines

• Refractive Error

Painless:

• Retinal Detachment

  • Curtain + floaters/flashes + RAPD

• Retinal Artery Occlusion

  • Cherry red spot, hemi/whole field LOV

• Retinal Vein Occlusion

  • Stormy sunset, single quad/whole field LOV

• Amaurosis Fugax/TIA of the Eyeball

  • R A/V Occl → Retinal Vessel Ischaemia

  • Transient LOV (secs-min)

  • Ix: carotid artery doppler, Ix clot causes/source (AF etc)

  • Mx: anticoags (DOACs) if CVS source, antiplatelets otherwise (aspirin, clopidogrel)

• Space Occupying Lesion

• Stroke

  • Changes in bodily sensation, slurred speech, arm/leg weakness

Chronic:

Painful:

• 
  

Painless:

• Macular Degeneration (Age Related)

  • Slow, irrevers Central LOV, drusen deposits

  • Dry = bilat, Wet = unilat

• Cataract

  • Lens opacification, gradual LOV, Blur/smudge, daylight glare, night light halo, monocular diplopia

• Open Angle Glaucoma

  • Slow, peripheral LOV

• Diabetic Retinopathy

  • Microaneurysms, cotton wool, angiogenesis

• Hypertensive Retinopathy

  • Prolonged HTN → gradual LOV

Dizziness

Cardio: CP, SOB, palps, lightheadedness, positional changes, pacemaker

• Arrythmia

• Postural HTN

• AMI

• Vasovagal

• HF

Neuro: headache, sensation/speech changes, visual disturbances, muscle weakness, gait change, delirium sx, fatigue, para/anaesthesia, trauma

• Migraine

• Stroke

  • 5 D’s of stroke = Diplopia, Dizziness, Dysarthria, Dysphagia, Dystaxia

• MS

• Space Occupying Lesion

• Seizure

• Delirium

Vestibular: recent URTI, hearing change, fullness sensation (ears/sinuses), N/V, tinnitus/ringing, ear pain/discharge

• BPPV

• Vestibular Neuritis

• Meniere’s Disease

  • Mx = low salt diet, betahistine, diuretics, antiemetics 

• Acoustic Neuroma

• Vestibular Neuritis

Other: fatigue, LOW, fever, night sweats

• Anaemia

  • Bleeding, diet

• Hypoglycaemia

• Electrolyte Disturbance

• Medications (Antihypertensives, Polypharmacy, Sedatives, some ADHD meds, Antypsychotics)

Limb Pain

Vascular:

• PVD

• DVT

• Vasculitis

• Acute Limb Ischemia

• Chronic Venous Insufficiency

• Buerger’s Disease

MSK:

• Osteoarthritis

• Rheumatoid Arthritis

• Gout

• Trauma/Fracture

• Soft Tissue Injury/Tendinopathy

• Osteoporosis

• Reactive Arthritis

• Synovitis

• Plantar Fasciitis

• Adhesive Capsulitis (pain on active and passive movement)

Infective:

• Septic Arthritis

• Cellulitis

• Osteomyelitis

  • Ix w XR (1st) + MRI (diagnostic)

Neuro:

• Peripheral Neuropathy

• Lumbar Spinal Stenosis

• Sciatica

• Peripheral Nerve Entrapment (Carpal Tunnel)

Other:

• Diabetic Foot/Charcot Joint

• Lung Cancer (Wrist Pain)

• Leukaemia

Tiredness

Systemic:

• IDA/Anaemia

• Malignancy

CVS:

• HF

• Arrythmia

• Valvular Disease

Resp:

• COPD

• ILD

• OSA

Endocrine:

• Hyper/Hypothyroid

• Diabetes

• Obesity

GU:

• UTI

• Pyelonephritis

• AKI/CKD

Other:

• Infective (mono, viral, HIV, TB, chronic infections)

• Depression

• GIT (except IBS)

Erectile Dysfunction

Psych:

• Depression

Vascular:

• Atherosclerosis

Neurogenic:

• Diabetic neuropathy

• Stroke

• MS

• Parkinsons

Endocrine:

• Thyroid disorders

• Diabetes

Anatomical:

• Peyronie disease

Confusion

CNS:

• Alzheimers

• Parkinsons

• Space Occupying Lesion

• Seizure (post-ictal)

• Subdural Haematoma

• Stroke

• Meningitis

• Epilepsy

• Dementia

Metabolic:

• Hypoglycaemia

• Hypoxia

• Electrolyte Disturbance

• Hypothyroidism

• Hepatic/Uremic Encephalopathy

Infective:

• Sepsis (UTI, Pneumonia)

• Meningitis

• Encephalitis

• Delirium (poo, pee, pain, pills, puss, electrolytes, environment)

Psych:

• Psychosis

• Mania

• Drug/Alcohol induced encephalopathies

• Depression

Other:

• Stroke

• Polypharmacy

• Overdose

• Arrythmias

• Anaphylaxis

• Malignancy

Palpitations

Cardiac:

• Arrhythmia (AF, VF, SVT)

• MI

• HF

• Valvular Disease

• Structural - HOCM

Respiratory:

• PE

• Asthma/COPD

Endocrine:

• Hyperthyroidism

• Hypoglycaemia

• Pheochromocytoma

Psych:

• Anxiety/Panic Attacks

Other:

• Infection

• Anaemia

• Caffeine/Alc/Drugs

• Dehydration

• Pregnancy

Urinary Difficulties

Infective:

• UTI

• STI

• Prostatitis

• Urethritis

• Pyelonephritis

Obstructive:

• BPH

• Prostate Cancer

• Bladder Malignancy

• Kidney Stone

• Urethral Stricture

Endocrine:

• Diabetes

Neurological:

• Neurogenic Bladder

• Cauda Equina Syndrome

• Stroke

• Parkinsons

Anatomical:

• Pelvic Floor Prolapse

Weight Loss

Systemic:

• Malignancy

Endocrine:

• Addison’s/Adrenal Insufficiency

• Hyperthyoid 

• T1DM/Diabetes

GIT:

• Coeliac

• IBD

Psych:

• Anorexia

• Depression

• ADHD Medications

Infective:

• TB

• EBV

Nausea

GIT - Acute:

• Appendicitis

• Pancreatitis

• Cholecystitis

• Bowel Obstruction

• Gastroenteritis

GIT - Other:

• Gastroenteritis/C. diff infection

• GORD/PUD

• Coeliac Disease

• IBD/IBS

• Bowel Cancer

Systemic:

• Infection

Neuro:

• Meningitis

• Migraine

• Space Occupying Lesion/Brain Tumour

• Head Trauma

• BPPV/Meniere’s

Gynae:

• Pregnancy

• Ovarian Torsion

• Ectopic Pregnancy

Metabolic:

• DKA

Other:

• Kidney Stones

• Medications

• Anxiety/Eating Disorders

• AMI

• Acute Angle Closure Glaucoma

Fever

Inflammation:

• Rheumatoid/Autoimmune:

  • Rheumatoid arthritis

  • SLE

  • Vasculitis

  • IBD

  • Temporal arteritis 

Infection:

• Any system (resp, urinary, GIT, CNS, skin, ENT, systemic, STI, MSK)

  • EBV/pharyngitis/tonsillitis, Cellulitis, pneumonia, gastro, septic arthritis, osteomyelitis

• Bacterial, fungal, viral (CMV, HIV)

• Sepsis 

Malignancy: 

• 
  

Drug Related:

• Allergic response/ anaphylaxis

• Drug fever

• Serotonin syndrome (SSRIs)

• Neuroleptic malignant syndrome (antipsychotics) 

Other:

• DVT/ PE

• Heat stroke

• Thyroid storm  

Back Pain

MSK:

• Fracture

• Muscular Strain

• Degenerative Stenosis/Arthritic Changes

• Ankylosing Spondylitis

• Mechanical Back Pain

Neuro:

• Disc Bulge

• Disc Prolapse

• Sciatica

Infective:

• Spinal Abscess

• TB (potts disease)

• Osteomyelitis

Referred Pain:

• Renal (pyelonephritis)

• Gynae (PID, Endometriosis)

• GIT (pancreatitis)

Red Flags:

• Cauda Equina

• AAA

• Aortic Dissection

• Prostate Cancer

Malignancy:

• Primary

• Metastatic (prostate, leukaemia)

Screening Programs

Bowel

• 45-74, every 2 years

CST

• 25-74, every 5 years

Mammogram

• 50-74, every 2 years

• Can request from 40

Lung

• 50-70 + 30 Pack Year History + Asymptomatic + Currently Smoking or Quit in the last 10 years