Download Lanarkshire Checklist

REGISTRARS’ NEEDS ASSESSMENT CHECKLIST AND SCENARIOS
FOR KNOWLEDGE OF CLINICAL AREAS & PRACTICE
ORGANISATION.
It is not claimed that this checklist is comprehensive, but is hoped that it in general indicates
fields in which by the end of their Registrar Year a GP should have general competence and
understanding.
The GP Registrar should indicate his degree of confidence under the various headings in the
early stage of training on a scale of A to D. This should be performed in the early stages of
training to identify knowledge gaps and possible tutorial topics, and to inform the reading
needs of the registrar and possible clinical attachment needs. This can be repeated at
intervals through the year, usually around Month 4 and Month 8 to assess progress.
Confident
Not confident


A
B
C
D
1. INFECTIOUS DISEASES
Immunisation (Indications & Contraindications)
Childhood Immunisation
Influenza
Pneumococcal
Occupational Health/High Risk Groups
Travel Immunisation
Infectious Diseases
Glandular Fever
Chickenpox/Herpes – Simplex and Zoster
Hepatitis
Tuberculosis
Gastroenteritis (D & V)
Sexually Transmitted Diseases & HIV
Meningitis
Foreign Travel
Case Scenario
1. A mother makes an appointment to discuss childhood vaccinations as she is reluctant to
have her son vaccinated. How would you deal with this?
2. You are called to see a child at home with a two day history of diarrhoea and vomiting.
Describe your assessment and management plan for this situation.
3. A 25 year old woman presents to you with dysuria and frequency for several weeks.
MSSU is negative, and it fails to respond to antibiotic treatment. Describe your further
investigation and possible differential diagnosis.
A
2. ENT
Childhood Earache
Deafness – Adult
Deafness – Child
Dizzy Spells
Hoarseness
Sore Throat
Rhinitis/Sinusitis
B
C
D
Case Scenario
1. A mother brings her five year old child with earache, stating “it only ever resolves with
antibiotics”. How do you proceed?
2. You see a 12 year old boy who has had recurrent absences from school with acute
tonsillitis, pyrexia and lymphadenopathy. Describe your immediate management and
your criteria for referral for surgical intervention.
3. A 19 year old boy presents to you with symptoms of all year round sneezing, nasal
congestion and alternating blockage and rhinorrhoea. Discuss the likely diagnosis,
possible complications and management plan.
A
B
C
D
3. EYES
The Eye Examination
The Red Eye
The Painful Eye
Cataracts (the role of GPs/Opticians/Specialists)
Squint
Glaucoma
The Visually Impaired
The Eye in Systemic Disease
Case Scenario
1. A patient presents with a red, sticky and uncomfortable eye.
diagnosis and management.
Discuss the potential
2. At routine 10 month assessment mother reports a history of possible squint in her child.
Discuss your assessment and management options.
A
B
C
D
4. RESPIRATORY DISEASE
Asthma – Diagnosis – BTS Guidelines – child
Contract Requirements
Asthma – Diagnosis – BTS Guidelines – adult
Contract Requirements
COPD – Diagnosis – BTS Guidelines –
Contract Requirements & Spirometry
Lung Cancer
Pneumonia/Chest Infections
Pulmonary Fibrosis
Case Scenario
1. A 55 year old woman smoker (20 per day) for 25 years presents with dyspnoea and
cough. How would you manage this patient?
2. A 45 year old man with no previous history of respiratory illness has developed a recent
onset intermittent wheeze every time he visits his neighbour’s house where there is a
parrot.
a. How would you manage him?
b. What are the possible diagnoses?
3. Discuss the potential uses of Spirometry in General Practice and how this may affect
your management plans for patients with COPD.
A
B
C
D
5. CARDIOVASCULAR DISEASE
Hypertension
Congestive Cardiac Failure
Ischaemic Heart Disease
Acute Coronary Syndromes – Investigation &
Management
Risk Factor Assessment and Management
In Cardiovascular Disease
Arteriovenous Disease
Cerebrovascular Disease and Transient
Ischaemic Episodes
The Contract Guidelines for Cardiovascular
Disease (Hypertension, Ischaemic Disease,
Cerebrovascular Disease)
Case Scenario
1. A worried patient attends you in the surgery after his best friend has recently died of a
heart attack. He wishes to discuss his potential risk. How would you and your practice
deal with this?
2. A 34 year old lady presents with recent onset shortness of breath on exertion and lightheadedness when playing tennis. The only finding on examination is a loud systolic
murmur over her precordium.
How would you proceed?
3. A 45 year old man presents with high BP on three separate occasions (readings 150/100
– 160/105 – 160/100). Discuss your assessment and investigation and management
plan for this patient.
A
6. OBSTETRICS & GYNAECOLOGY
Obstetrics
Miscarriage
TOP
Pre-conception Advice
Shared Antenatal Care and Antenatal Screening
Postnatal Care
Ectopic Pregnancy
Breast Feeding and Mother and Infant Bonding
Gynaecology
Menstrual Disorders
Menopause/HRT (Indications & Risks)
Puberty Changes
Gynaecological Cancer and Screening
Breast Cancer and Screening
Infertility
B
C
D
Male Infertility
Female Infertility (Clinical Investigation and
Treatment and Ethical Issues)
Family Planning
Natural / Barrier Methods
Hormonal Methods
IUDs
Sterilisation
Teenagers
Relationship and Psychosexual Problems
Case Scenario
1. A 41 year old woman wants to know if she can be sent abroad for infertility treatment if it
is not available on the NHS. How would you react to this?
2. A 16 year old girl presents with persistent vaginal discharge. Discuss the management
issues.
3. A 39 year old single woman who has had flushings and is on no contraception wishes to
be referred for infertility treatment. How would you investigate?
A
7. PAEDIATRICS
Common Childhood Problems
Infant Feeding
Worried Mums
The Child as a Symptom?
Common Childhood Infectious Diseases with
Fever
Minor Symptoms of a Normal Child
Enuresis/Encopresis
UTIs
Sleep Disturbance
Child Health Screening
Developmental Milestones and Assessment
Congenital Defects
Child and Family Guidance
Behavioural and Social Problems
Common Abnormalities Detected at Screening
(the clicking hip, cardiac murmur, undescended
testes etc.)
Child and Family Clinic – It’s Role
School Problems
Paediatrics (Significant Problems)
The Brain Damaged Child
Meningitis
Abdominal Pain
Non Accidental Injury
Sudden Infant Death Syndrome
Malignant Disease and the Dying Child
Neonatal Problems
B
C
D
Case Scenario
1. A three year old child won’t sleep on her own in her bedroom and doesn’t sleep until the
early hours of the morning presents to you. How would you approach this problem?
2. Mother consults with her nine year old girl who has persistent nocturnal bedwetting but is
dry by day. Describe your assessment and management plan.
3. One of your patients has cerebral palsy (mild) with partial weakness of the left leg and
mild learning disability. Describe how this patient’s needs might be assessed and dealt
with in the community.
A
B
C
D
8. CANCER
Palliative Care and the Respective Roles of the
Multi-Disciplinary Team (the GP, the District
Nurse, the McMillan Nurse etc.)
Palliative Care
Care of Relatives
Symptom Relief
Radiotherapy
Chemotherapy
What to tell the patient?
Case Scenario
1. A patient is discharged following an exploratory laparotomy and found to have inoperable
bowel cancer with multiple metastases. What are the issues you would discuss at the
initial home visit?
2. Describe the role of the GP, McMillan Nurse and District Nurse in the care of terminally ill
patients.
A
B
C
D
9. GASTROINTESTINAL DISEASE
Oesophageal Lesions
Dyspepsia
GORD
Gallbladder Disease and Jaundice
Abdominal Pain (Chronic and Acute)
Altered Bowel Habit
Weight Loss
Peri-anal Conditions
Hernia
Post-Operative Care in the Community
Case Scenario
1. A 55 year old man with a six week history of altered bowel habit presents to you. What
factors would you take into account when deciding whether to refer?
2. A 38 year old man presents with a three month history of recurrent dyspepsia and waterbrash, eased with antacids and meals, worse at night. He is a smoker with a family
history of peptic ulcer disease. Describe how you would assess and manage this
problem. What might be indications for referral for further investigation?
A
B
C
D
10. CENTRAL NERVOUS DISEASE
Epilepsy (and New Contract Guidelines)
Headaches
Parkinson’s Disease
CVA and its Rehabilitation
Brain Tumour
Multiple Sclerosis
Case Scenario
1. A 37 year old lady presents to you with a one month history of worsening unilateral
headaches associated with photophobia. How would you assess and investigate?
2. A patient returns home from abroad, having suffered a mild cerebrovascular accident with
mild residual weakness of left arm and leg. A CT scan while abroad has confirmed the
presence of a cerebral infarct. What would your management plan be for this patient on
their return to your practice?
3. As part of the New Contract your practice plan to establish an Epilepsy Clinic for review
of patients with active epilepsy. Describe how you may identify these patients and what
might be your protocol for the clinic assessments.
A
B
C
D
11. ORTHOPAEDICS & RHEUMATOLOGY
Orthopaedics
Orthopaedic examination
Osteoarthritis
Gout
Osteoporosis
Back Pain
Shoulder and Neck Pain
Injury Management (principles)
Orthopaedic referrals
Foot Problems
Common conditions such as Tenosynovitis,
Carpal Tunnel Syndrome, Frozen Shoulder,
Bursitis
Appropriate use of PAMS and alternative
therapies.
Case Scenarios
1. A 35 year old man seeks a six week medical certificate for back pain. He is newly
registered with the practice. How would you approach this and what are the
management issues?
2. A 55 year old woman presents with a history of paraesthesia of the right first, second,
third and inner aspect of the fourth digits, suggestive of a possible carpal tunnel
syndrome. Describe the possible aetiology and how you would investigate and manage
this problem.
3. One of your patients attends you after discharge from hospital for an insurance line after
suffering a fractured femur after a fall. She is a 70 year old lady who smokes. What
might you wish to discuss with her at this consultation?
A
B
C
D
12. ORTHOPAEDICS & RHEUMATOLOGY
Rheumatology
The diagnosis and recognition of connective
tissue diseases.
The therapeutic indication for various
Treatments.
The principles and practice of shared care
Monitoring the condition and effects of therapy
The role of PAMS and alternative therapies
Benefits, Aids and Supports
Case Scenario
1. A young mother of a two year old presents with a flitting polyarthropathy. How would you
proceed to assess? What are the implications for her?
2. What may be the implications to a practice of undertaking shared antenatal care for a
patient with Rheumatoid Arthritis?
3. A patient severely disabled with sero negative polyarthropathy is having problems with
mobility around the house and getting in and out of the bath. How could you help in this
situation?
A
13. PSYCHOLOGICAL MEDICINE
Schizophrenia
Dementia
Depression
Suicide Risk
Phobias
Anxiety
Mental Health Acts
Adults with Incapacity Act
The emergency psychiatric admission
Stress Management
Bereavement Services
Learning Disorders
Child and Family Psychiatry
Eating Disorders
Drug Addiction
B
C
D
Case Scenario
1. A 23 year old single mother with four children presents with a history of being unable to
sleep, crying all the time, can’t cope with life and expressing some suicidal ideation.
What would be your approach to this consultation?
2. What are the implications for monitoring patients on Lithium therapy as a mood stabiliser
in General Practice?
3. A 20 year old girl presents with a history suggestive of Anorexia Nervosa. Describe how
you would assess and what your management plan for this problem may be.
A
B
C
D
14. ENDOCRINE DISEASE
Diabetes – Type I – Type II
Thyroid Disease
Polycystic Ovarian Disease
Paget’s Disease of the Bone
Obesity
Case Scenario
1. A 45 year old Type II diabetic attends for annual review of their diabetes. What should be
covered?
2. A 27 year old lady presents with galactorrhoea. She has a negative pregnancy test.
How do you proceed?
3. A 60 year old frequent attender complains of tiredness and lethargy. Discuss.
A
B
C
D
15. SKIN DISEASE
Psoriasis
Eczema and Dermatitis
(contact and seborrhoeic)
Skin Cancers
Urticaria
Pruritis
Acne Vulgaris
Acne Rosacea
Leg Ulcers (venous or arterial)
Skin Infections (bacterial, viral, fungal and
radiculosis)
Manifestations of Systemic Disease
Benign Skin Lesions
Nail Lesions
Bullous Disorders
Case Scenario
1. A 16 year old presents with psoriasis of limbs and scalp.
management.
Discuss appropriate
2. Mrs. Smith, 27 years old, consults following successful excision of a malignant melanoma
from her leg. What issues would you discuss with her?
A
B
C
D
16. Urological Diseases (CHILD & ADULT)
Prostatic Disorders
Nephritis
Genito-Urinary Cancer
Renal Colic
Urinary Retention
Haematuria
Investigation and Management – Male and
Female Incontinence
Testicular Disorders
Investigation and Management of
Proteinuria
Erectile Dysfunction
Congenital Anomalies
Case Scenario
1. A 45 year old man complains of urinary frequency. Discuss appropriate investigation and
management.
2. A man attends for a new patient medical. You test his urine and find ++ of blood. How
would you manage this?
3. A 25 year old man presents with erectile dysfunction. What issues does this raise and
how would you manage this?
A
B
C
D
17. MINOR SURGERY
Infective Lesions
Warts
Excision of Skin Lesions
Joint Injection/Aspiration
Guidelines for Minor Surgery and Consent
Drugs Used
Minor Surgery Register
Case Scenario
1. What minimum surgical equipment should our practice have to equip it to
satisfactorily undertake minor surgery procedures?
A
18. INVESTIGATIONS
Laboratory Services (Haematology,
Bacteriology, Biochemistry)
B
C
D
Radiology
X-ray
Ultrasound
CT/MRI Scanning
Specialty Investigations
Cardiology (Exercise Tolerance Testing,
Echocardiography, 24 Hour ECG and
24 Hour BP Monitoring)
Respiratory (Pulmonary Function Testing/
Spirometry)
Case Scenario
1. A 55 year old patient presents with recent onset dizziness and is found to have an
irregular pulse but is otherwise stable. How would you manage this case?
2. A 56 year old lady presents to you with BP readings taken by the GP of 160/100 –
170/105 – 180/110. On each occasion she appears very anxious, and you are worried
regarding a possible “white coat” effect. How might you further investigate this situation
to clarify whether she has genuine hypertension?
3. A 45 year old man presents with abnormal LFTs and a raised Serum Ferritin of 800. How
may you wish to further assess and investigate this?
A
B
C
D
19. THERAPEUTICS
Evidence Based Prescribing
Repeat Prescribing and review of medication
in General Practice
Practical Prescribing (a normal prescription,
controlled drug prescribing).
Controlled drug register
“SLS” prescribing
Interaction with Prescribing Adviser
(prescribing targets)
Area Formulary
Use of SPA Data
BNF
Case Scenario
1. A patient presents saying his Methadone prescription was not issued. What systems are
available in Primary Care to monitor prescribing and provide an audit trail?
2. Your SPA data from the Prescribing Bureau indicates that you have 3% above the
national average prescribing costs. On closer inspection, it appears that your average
prescription cost is below average but your number of items prescribed is above average.
Discuss the possible reasons for this in the practice.
A
20. THE ROLE OF THE PRACTICE IN HEALTH PROMOTION
The Practice Team and their roles
Ethical Dilemmas
Insurance and Pre-Employment Medicals
Certification and the Law (relations with the
Police, Procurator Fiscal, Employers, Death
Certification, Private Certification and
Notifiable Diseases)
The Primary Care/Secondary Care Interface
Medical Certification and Benefits
GP Politics
LMC, GMC, BMA (GMSC), PCT, LHCC
Practice Management
Complaints Procedure
Health and Safety
Appraisal
Confidentiality
B
C
D
Case Scenario
1. A Police Officer asks you to make a Death Certificate out for a sudden death. How do
you deal with this?
2. A patient complains to you about their management by one of your partners. How would
you deal with this complaint? What ethical issues does this raise?
3. A patient asks for advice about stopping smoking. What evidence is there for the various
interventions and what can you and your practice do to help him?
4. A patient approaching middle age asks what she can do to “improve health and fitness”.
What topics would you wish to discuss and what support might be available in achieving
her aims?
A
B
C
D
21. STATUTORY AND VOLUNTARY SERVICES
Community Care
Voluntary Services
Benefits Agency
Charities/Red Cross etc
Local Authority (Community Care/Elderly/
Handicapped/Mentally Ill)
Child Protection/Counselling Services/Disease
Orientated Self Help Groups and Help Lines
In General Practice you are part of a wider team and will enable your patients to be aware of
access a variety of non medical services, both statutory and voluntary. You will require to
have a knowledge of and understanding of the work of these agencies and how to involve
them.
Case Scenarios
Community Care
1. A relative phones you to say that an elderly patient is struggling to cope on their own.
Outline your approach to assessing their needs, making use of the primary care team
and/or other agencies.
2. How would you attempt to improve lines of communication with your local social work
department?
Benefits Agency
1. Outline the criteria applied when the Benefits Agency assess patients applying for
Disability Living Allowance or Attendance Allowance. What is the GPs role in this
process?
2. Explain the use of a DS1500 form.
Voluntary Services
1. What is the role of “self-help” groups and what are their potential benefits/problems?
2. How could you advise a patient about accessing local voluntary services, either to
provide the patient with support or if they wished to do voluntary work?
Miscellaneous
1. You are phoned late afternoon by the daughter of a 76 year old man with a history of
alcohol abuse, signs of self-neglect and a physically handicapped wife. He refuses to go
into care. When sober he is thought not to be at risk to himself or others, although he is
moderately demented. What would you do?
2. A pregnant woman attends your Antenatal Clinic. She indicates that she has a history
of Heroin abuse and is currently on a Methadone maintenance programme under the
care of the Community Addiction Team. What are your responsibilities with respect
to the unborn child in this situation?
3. A patient with learning difficulties attends with her carer. She has recently been
discharged into the community and is residing in local authority housing. The carer states
that the patient is bored since her discharge and just sits watching television all day. She
would like to get her more involved in activities to stimulate her. How would you arrange
this?
4. An elderly patient attends to discuss the difficulties she has coping with her husband who
has dementia. She can rarely manage to leave him alone for any more than 10 minutes.
She has little family support and cannot even manage to go to the shops now. Can you
help?
5. A mother attends with her 5 year old daughter who has a cough and cold symptoms.
Whilst examining the chest you notice numerous bruises of various ages. How would you
proceed with this consultation?
6. A patient suffering from ME attends stating that she would like to get in touch with other
patients who suffer from the same condition. How would you advise her?
7. A depressed lady attends 18 months following the death of her husband She states that
her family feel she has not come to terms with the loss of her husband. Can you help?
8. A 67 year old man attends following the diagnosis of inoperable bronchial ca. He has
been told that his disease is too far advanced for any treatment to be of help. What
charitable organisations can be incorporated onto the provision of his palliative care?
A
B
C
D
22. PROCEDURES
Cardio-Pulmonary Resuscitation
Use and Interpretation of ECG
Nebuliser Use
Use of Peak Flow Meter
Suturing
Catheterisation
Joint Injection
Case Scenario
1. Describe how you would treat by local injection a patient with tennis elbow.
2. Describe a possible protocol for nebuliser use in General Practice for an acute asthma
presentation.
A
C
D
23. EMERGENCIES
The Unconscious Patient
The Convulsing Patient
The Confused Patient
The Acute Abdomen
Anaphylaxis
Case Scenario
1. You are called from surgery to see a 45 year old man who has been found unconscious
outside the Bank of Scotland. You are in a rural location and know it will take 30 minutes
for the ambulance to arrive. What do you do?
2. A mother brings an 8 year old boy to the surgery without an appointment. She has
collected him from school and brought him directly. He has become acutely breathless,
wheezy and distressed. Discuss how you would manage this case.
A
24. PRACTICE ORGANISATION
Practice Finances
PAYE Schedule D (Practice Accounts)
The New Contract
Premises Issues
The infrastructure of General Practice
Appointment Systems (advanced access/open
Surgeries/IT
B
C
D
Paperless/Paperlight Practices
Personal Management Issues
(Stress/communication skills/CPD and
appraisal)
Practice Meetings (Practice Team/Educational/
Partner)
Case Scenario
1. One of the quality markers of the New Contract is an annual review of your patient’s
repeat prescribing. Describe a practical way of implementing this in General Practice.
What are the implications to the practice?
2. Your practice waiting time for routine appointments is now routinely two weeks for one
partner and three days for the other partners. What might be the reasons for this
discrepancy between partners?
The New GP Contract has been one of the main recent catalysts for change in General
Practice organisation. It is important that GP Registrars have a solid knowledge of the main
components of the Contract
A
B
C
D
25. THE NEW GP CONTRACT
Financial Terms (Global Sum, GSE, correction
Factor & MPIG)
Core Services
Enhanced Services - National
- Local
Additional Services
Quality Indicators/Payments
IT Templates/Requirements
Opportunities
Problems
Case Scenario
1. What are the clinical domains in the Quality and Outcomes Framework of the new
GMS Contract?
2. How would you set up a register for hypertension?
3. What are the implications of “closing the practice list” under the New Contract?
A
26. Information Technology
Systems(GPASS,VAMP,EXETER,EMIS,MEDIEL
etc)
Word Processing
Databases
Spreadsheets
e-mail
B
C
D
Hardware
“Paperlight/Paperless” Practice
Computing & Audit
Case Scenario
1. In using your clinical computer system (e.g. GPASS), Do you understand the importance
of storing information using the correct audit codes (Read Codes)?
2. A patient asks you for information about a condition you know little about.
a. How could you use the practice IT system to help the patient and your own
professional
development?
b. Are you aware of what internet resources are available for Registrars?
c. Do you have any concerns about your basic internet skills?
3. You become concerned that there may be patients at the practice on long term oral
Steroids who are not getting osteoporosis prevention treatment.
a. How would you use the practice IT system to analyse and act upon your concerns?
(e.g. research and audit).
b. Which members of the practice team can help you with the IT aspects of audit?
c. Do you have any concerns about your ability to run searches of the clinical database
using the clinical software at the practice?
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