Appendix 1 - Medical knowledge
Within the general context of primary care, the following
areas should be considered for each problem or disease.
- The natural history of the untreated condition including
whether acute or chronic
- An accurate idea of the prevalence and incidence across the
ages and any changes over time
- Typical and atypical presentations
- Risk factors
- Diagnostic features
- Recognition of ‘alarm’ or ‘red flag’ features
- Treatment including initial, emergency and continuing care
- Prognosis
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