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An average score is calculated at the bottom of each section.Metabolic Problems Statement:Average score:DATE:Tick or score (1-5)Basic statistics4Absolute risk (AR) and absolute risk reduction (ARR)Hazard ratio (HR)Incidence and prevalence<Number needed to harm (NNH) and number needed to treat (NNT)Odds and odds ratio (OR)Pre- and post-test probabilityCPositive predictive value (PPV) and negative predictive value (NPV)4Relative risk (RR) and relative risk reduction (RRR)Specificity and sensitivityCritical appraisal8Appropriateness of prospective and retrospective studiesHBias, inclusion and exclusion criteria and representativeness of samplesCommon tests used to analyse parametric data (e.g. awareness of t-tests, analysis of variance, multiple regression) and non-parametric data (e.g. awareness of chi squared, Mann-Whitney U tests)>Confidence intervals, probability and correlation coefficientsNMethods used to validate qualitative research (e.g. triangulation, saturation)6Reliability, validity and generalisability of findingsnResearch methodologies and their appropriate use (see condensed statement 3.6: Research and Academic Activity)Research methodologiesCase-control studiesCohort studies+Interviews, focus groups and questionnaires Meta-analysisNarrative-based research Pilot studiesQualitative researchQuantitative researchRandomised controlled trialsSystematic reviewsSymptomsaSymptoms and signs of genetic conditions vary widely, particularly in autosomal dominant conditions where symptoms may vary in number and severity between affected patients within the same family (e.g. variability of expression in neurofibromatosis). Anxiety about a family history of a disease, for example breast cancer, is also a common presentation. Conditions(Examples of common chromosome anomalies: Down SyndromeTurner syndromeKlinefelter syndromeTranslocations)Autosomal dominant single gene disorders:Adult polycystic kidney diseaseNeurofibromatosisHuntington diseaseHypercholesterolemia Recessive single gene disorders:Cystic fibrosis8Haemoglobinopathies (Sickle cell disease, Thalassaemias)HaemochromatosisX-linked single gene disorders:(Duchenne and Becker Muscular Dystrophies Haemophilia A Fragile XDisorders with a genetic component (e.g. bipolar disorder, cerebrovascular disease, cardiovascular disease, Alzheimers, asthma),Common familial cancers (e.g. breast, colon)lConditions exhibiting variable inheritance patterns (e.g. inherited forms of deafness, muscular dystrophies) Investigation TreatmentuVaries depending on the individual disease but includes, for example, regular surveillance or family planning optionsBasic knowledgeRDNA as genetic material and how mutations and variants contribute to human diseaseEPatterns of inheritance: single gene, chromosomal and multifactorial YHow to access genetic information, for example from regional genetics centres and on-line/Cardiovascular  chest pain, haemorrhage, shock6Respiratory  wheeze, breathlessness, stridor, chokingYCentral nervous system  convulsions, reduced conscious level, confusion, unconsciousnessIMental health  threatened self-harm, delusional states, violent patients Severe painAcute coronary syndromes Anaphylaxis Appendicitis ArrhythmiasAsthma!Bowel obstruction and perforationCommon problems that may be expected with certain practice activities: anaphylaxis after immunisation, local anaesthetic toxicity and vaso-vagal attacks (e.g. during minor surgery or IUD insertion)Dissecting aneurysms+Ectopic pregnancy and antenatal emergencies#Haemorrhage (revealed or concealed) IschaemiaMalignant hypertensionMeningitis and septicaemia Parasuicide and suicide attemptsPulmonary embolusPulmonary oedema (severe)#Shock (including no cardiac output)Status epilepticus9Understand the principles of managing dangerous diagnoses Blood glucoseOther investigations are rare in primary care because acutely ill patients needing investigation are usually referred to secondary care.9Pre-hospital management of convulsions and acute dyspnoea Emergencies*The  ABC principles in initial managementdThe response time required in order to optimise the outcome for the patient (e.g.  the golden hour )3The organisational aspects of NHS out of hours carewUnderstand the importance of maintaining personal security and awareness and management of the security risks to others ResourceshAppropriate use of emergency services; including logistics of how to obtain an ambulance/paramedic crew cFamiliarity with available equipment in own bag/car/practice and that carried by emergency servicesiSelection and maintenance of the appropriate equipment and un-expired drugs that should be carried by GPsBeing able to organise and lead a response when required, which may include participation by staff, members of the public or qualified responders ~Knowledge of training required for practice staff and others (as a team) in the appropriate responses to an acutely ill person PreventionAdvice to patients on prevention; e.g. with a patient with known heart disease, this includes advice on how to manage ischaemic pain including use of GTN, aspirin and appropriate first-line use of paramedic ambulance"Abdominal pain (acute and chronic)Behavioural problemsDevelopmental delay&Failure to thrive and growth disordersVomiting, fever, drowsiness BronchiolitisChild abuse and deprivationMChronic disease in children: asthma, diabetes, arthritis, learning disability Constipation9Cough/dyspnoea, wheezing including respiratory infectionsEpilepsy6Foreign bodies (e.g. nose, ears, swallowing, inhaling)Gastroenteritis Infant colic MeningitisMental health problems such as attention deficit hyperactivity disorder, depression, eating disorders, substance misuse and self-harm, autistic spectrum disorder and related conditionsNeonatal problems: BirthmarksEarly feeding problems Heart murmurJaundicePoor weight gain Sticky eyeJNormal development and developmental problems (physical and psychological) Otitis medianPsychological problems: enuresis, encopresis, bullying, school refusal, behaviour disorders including tantrumsPyrexia and febrile convulsions%Sensory deficit (especially deafness)ASudden Infant Death Syndrome (SIDS) and strategies to reduce riskUrinary tract infectionYAvoiding smoking, using volatile substances and other drugs and minimising alcohol intake Breastfeeding7Healthy diet and exercise for children and young people ImmunisationMKeeping children and young people safe; child protection, accident preventionPre-natal diagnosis]Reducing the risk of teenagers getting pregnant or acquiring sexually transmitted infections.Social and emotional well-being+Breast pain, breast lumps, nipple discharge&Dysparunia, pelvic pain, endometriosisAEmotional problems, including low mood and symptoms of depressionFaecal incontinence#Infertility - primary and secondary!Menopause and menopausal problems< Period-related problemsPost menopausal bleeding"Pruritis vulvae, vaginal discharge5Urinary malfunction: dysuria, frequency, incontinenceAbnormal cervical cytologyFibroids8Gynaecological infections, including Bartholin s abscessGynaecological malignanciesIntrauterine infectionMenstrual disorders: Amenorrhoea DysmenorrhoeaInter-menstrual bleedingIrregular bleeding patterns MenorrhagiaPre-menstrual syndromeMental health issues specific to women including anxiety, depression, parasuicide, eating disorders self-harming and the relationship between these, pregnancy and the menopause.:Pregnancy (including normal antenatal and postnatal care):"Abnormal lies and placenta praeviaAnaemia%Ante-partum haemorrhage and abruptionCommon problems including hyperemesis, acid reflux, back pain, symphysis pubis dysfunction, leg ache and varicose veins and haemorrhoidsJDeep vein thrombosis and pulmonary embolism, post dates, reduced movementsEctopic pregnancyGestational diabetesGrowth retardation)Intrauterine death and foetal abnormalityMiscarriage & abortionMultiple pregnancyPoly- and oligohydramnios+Pre-eclampsia and hypertension in pregnancyPremature labour Rhesus status and role of anti-DTrophoblastic disease4Sexual dysfunction including psychosexual conditionsVaginal and uterine prolapsePregnancy testing"Urinalysis, MSU and urine dipstick9Blood tests including renal function tests, hormone tests"Bacteriological and virology tests`Knowledge of secondary care investigations including colposcopy and sub-fertility investigations6Primary care management of the conditions listed aboveUMenopause management including the pros and cons of Hormone Replacement Therapy (HRT)Knowledge of specialist treatments and surgical procedures including: laparoscopy, D&C, hysterectomy, oopherectomy, ovarian cystectomy, pelvic floor repair, medical and surgical termination of pregnancy, sterilisation.4Understand the risks of prescribing during pregnancyBleeding in pregnancySuspected ectopic pregnancyDomestic violenceAHealth education regarding lifestyle and sexual and mental healthkPre-pregnancy issues discontinuing contraception, folic acid, family & genetic history and lifestyle advicePregnancy care including health promotion, social and cultural factors, smoking and alcohol, diet, age factors and previous obstetric history Rubella testing and immunisation9Risk assessment, screening and management of osteoporosisAbdominal and loin painsErectile dysfunction HaematuriaRetention of urine,Sore/painful penis, ulceration, skin changesTesticular lumpsTesticular pain (orchalgia)GUrinary symptoms; dysuria, frequency, nocturia, poor stream, prostatism2Benign Prostatic Hypertrophy (BPH) and prostatitis*Circumcision (religious and non-religious)Male contraception: vasectomyMale infertility5Male-specific cancers: Testicular and prostate cancerAMental health issues including depression, suicide and andropauseUrinalysis, MSU and dipstickSBlood tests including renal function tests and Prostate specific antigen (PSA) testSemen analysis^Knowledge of secondary care investigations including prostate biopsy and testicular ultrasoundUnderstand principles of treatment for common conditions managed largely in primary care  benign prostatic hypertrophy, prostatitis, sexual dysfunction, infertility etc1Injection of anti-androgens for testicular cancer&Acute management of testicular torsion-Acute management of paraphimosis and priapismAcute urinary retention"Acute management of ureteric colicXHealth education regarding lifestyle and risk taking behaviour, sexual and mental healthAbnormal genital smellAno-genital lumpsEGenital skin conditions including rashes, ulcers and lichen sclerosisIntermenstrual bleedingLower abdominal pain in womenPain on intercourse&Pain on passing urine in men and womenTesticular pain and swellingCUnusual or different vaginal discharge or penile urethral dischargeVaginal bleeding after sexYAno-genital ulcers  herpes simplex, syphilis, tropical infections, primary HIV infectionAno-genital wartsBacterial vaginosis CandidiasisChlamydial infectionsConditions suggestive of immunosuppression (e.g. Pneumocystis, pneumonia, Tuberculosis, Lymphoma, Seborrhoeic Dermatitis, or Oral Thrush) or of primary HIV infection#Conjunctivitis (neonatal and adult) Gonorrhoea Group B Haemolytic StreptococcusHIV and AIDS and the presentations/complications including Pneumocystis pneumonia, candidiasis, cryptococcus, Kaposi s sarcoma, toxoplasmosis, lymphoma, hepatitis, tuberculosisReiter s syndromeSexual dysfunction0Sexual identity disorders and gender realignmentSyphilisTrichomonas Vaginalis/Diagnosis and management of bacterial vaginosis/Blood tests for HIV and appropriate counselling1Blood tests for syphilis and their interpretation4Blood tests for Hepatitis B and their interpretationyMicrobiology and virology swabs  which to use, which samples to take, limitations of tests and interpretation of results-Secondary care investigations e.g. colposcopyContraception - effectiveness rates, risks, benefits and appropriate selection of patients for all methods, including methods of emergency contraception.Contraception  the safe provision of all methods of oral contraception (including emergency hormonal contraception) and also contraceptive patches and DMPA injections.Contraception  knowledge and availability of intrauterine methods of contraception (including as a method of emergency contraception), subdermal implants, sterilisation and natural family planning.MAbortion  methods and the legal procedures relating to referral for abortionbPrinciples of treatment for common conditions diagnosed and/or managed in primary care (see above)Principles of antiretroviral combination therapy for HIV/AIDS, potential side effects and the role of the GP in their management in primary care Emergency hormonal contraception Anxiety/panicHypercalcaemiaMajor haemorrhage PancytopeniaPathological bone fracturesSpinal cord compressionSuperior Vena Caval obstruction!Knowledge about a syringe driver:Suitable drugsRConversion of drugs from oral dosage to syringe drive, either, IV or subcutaneous.)Use of emergency drugs in palliative care2Abdominal pain and bowel upset (i.e. somatisation)Anxiety Depression)Dizziness, palpitations and paraesthesiae)Early signs of possible psychotic illnessInsomniaMultiple somatic complaints2Tired all the time (when physical causes excluded)ADHD6Alcohol and drug misuse (see condensed statement 15.3)Anxiety disordersEating disordersPersonality disorderPost-traumatic stress disorder#Schizophrenia and psychotic illnessSomatisation disorder`Use of depression rating scales, and other aids to evaluation of possible diagnosis and severity Pharmacology%CBT and simple behavioural techniquesProblem-solving therapy< 0Basis of systemic and strength focused therapiesSelf-administered therapy EmergencyThreatened or attempted suicideDelirium PsychosisPanicAggressive or violent patients$Drug overdose and alcohol withdrawalThe family of the patientMMembers of the primary health care team, receptionist, counsellor, CAB workeriSpecialist mental health services and non-medical agencies (non professional, lay or voluntary resources)FMental health promotion, especially children, families and adolescents5Screening of all language-delayed children for autismEarly intervention in psychosis AgitationChallenging behaviour TearfulnessWeight loss and gain Withdrawal ;Cerebral palsy  especially with severe learning disabilityDermatological problemsgEpilepsy  increased incidence and complexity associated with increased severity of learning disabilitycGI  swallowing problems, reflux oesophagitis, helicobacter pylori, constipation, gastric carcinoma6Obesity  predisposes to other health problems, stigma7Orthopaedic problems  joint contractures, osteoporosisPsychiatric problems  emotional and behavioural disorders, schizophrenia, bipolar affective disorder, Alzheimer's disease in Down's syndrome.=Respiratory problems  chest infections, aspiration pneumonia:Sensory impairments  hearing and vision disorders, earwaxSexual and physical abusebHurdles in the delivery of treatment due to difficulties reading instructions and treatment labelsThe risks of  over the counter prescriptions in some patients who may not fully understand how or why to take treatments but live with a degree of independenceIssues around implementation of interventions  dependency on carers, the difficulties with drug delivery in residential care homes.1Difficulties around identifying drug side-effectsIn urgent life-threatening cases treatment needs to proceed in the best interests of a person with insufficient capacity to consent=Specialist learning disability teams and non medical agencies=Health reviews proposed for people with learning disabilitiesAnkle swellingBreathlessness Chest painCollapse"Palpitations and silent arrythmias#Relating to cerebrovascular disease'Relating to peripheral vascular diseaseAneurysms (e.g. AAA, femoral)hArrhythmias (ectopic beats, atrial fibrillation and flutter, ventricular tachycardias, bradyarrhythmias)(Cerebrovascular disease (TIA and stroke)9Coronary heart disease (angina, acute MI, cardiac arrest) Heart failure&Hypertension (essential and malignant)POther cardiac disease (cardiomyopathy, valve problems, congenital heart disease)1Peripheral vascular disease (arterial and venous)Thromboembolism!ECG (interpreting and performing)24 hr ambulatory BPSphygmomanometer8Venous dopplers and ankle-brachial pressure index (ABPI)4Common secondary care investigations and treatments.^Management of patients at cardiovascular risk, especially blood pressure and lipid management.=Chronic disease management of those with established disease.DEmergency care of MI, cardiac arrest, stroke and critical ischaemia.9The role of health promotion and lifestyle interventions.Management of cardiovascular risk factors both modifiable (BP, lipids, smoking, alcohol, exercise, obesity, diet) and fixed (ethnicity, sex, family history).PManagement of relevant co-morbidities (e.g. diabetes mellitus, hyperlipidaemia).Abdominal painAnorexia and weight lossChange in bowel habitDiarrhoea and constipationDyspeptic symptoms DysphagiaHaematemesis and melaenaNausea and vomitingRectal bleeding,Tenesmus+Abdominal masses, organomegally and ascitesAcute abdominal conditions1Coeliac disease and other causes of malabsorptionDiverticulosis"Gallstones and gallbladder disease:Gastro-oesophageal reflux disease (GORD) and hiatus hernia&GI cancers (including their red flags)hHernias (e.g. inguinal, umbilical and periumbilical, femoral, surgical), incarceration and strangulation?Inflammatory bowel disease (e.g. Crohns and ulcerative colitis)@Irritable bowel syndrome (including making a positive diagnosis)1Non-ulcer dyspepsia, gastritis, peptic ulceration9Chronic liver disease, malignancy and acute liver failure PoisoningPerianal diseaseBlood tests (LFTs, amylase)H.Pylori testingCoeliac antibody screening,Stool testing including faecal occult bloodsAbdominal ultrasoundhCommon secondary care investigations (endoscopy, barium studies, CT, liver biopsy, ERCP, jejunal biopsy)OPrimary care management of the conditions listed in  symptoms and  conditions [Awareness of secondary care management of digestive problems (medical and surgical options) Acute abdomen Incarcerated/strangulated herniaDietary advice$Smoking cessation and alcohol adviceFOpiate misuse (needle tracks, pinpoint pupils, runny nose, drowsiness)Physical manifestations of alcohol problems (accidents, violence, obesity, dyspepsia, erectile dysfunction, fits, foetal alcohol syndrome, liver damage, anaemia, neurological damage)SPsychological manifestations of alcohol problems (anxiety, depression, parasuicide)-Stimulant misuse (agitation, skin ulceration)FSuggestive of cannabis use (red eyes, irritability, anxiety and panic)yComplications of drug use and misuse relating to the drugs themselves, routes of use, and the associated lifestyle issuesChronic liver diseaseHepatitis B and CHIV*Urine (and other) tests for drug treatment7Screening tools for alcohol abuse (e.g. CAGE and AUDIT)Care of drug abusing patients*Safe prescribing for drug abusing patients*Brief interventions for excess alcohol useManagement of physical)Life threatening drug related emergencies:Alcohol related emergencies (fits, delirium and psychosis)%Harm reduction approach (see Table 1)CatarrhDischarging ear Dizziness EpistaxisQFacial pain (e.g. Bell s palsy, tempero-mandibular pain and trigeminal neuralgia)Facial weaknessHearing loss and tinnitus Hoarseness9Neck swellings (e.g. goitre, lymph nodes and other lumps)Otalgia Sore throat Speech delayCroupEar wax%Gingivitis and common dental problems Nasal polypsOtitis externa$Otitis media (suppurative/secretory).Perforated tympanic membrane and cholesteatomafPharyngitis and tonsillitis; laryngitis; glandular fever; oral candida, herpes; salivary stones; GORD !Rhinitis (infective and allergic)"Sinusitis (infective and allergic)Snoring and sleep apnoeaSuspected head and neck cancer.Trauma (e.g. nasal fracture, haematoma auris) Ulcers (e.g. mouth, pharynx)iUnilateral hearing loss in the absence of external ear pathology or obvious cause (e.g. acoustic neuroma)Vertigo and Mnire s diseaseRole of otoscopyRole of tuning fork testsAwareness of key specialist investigations (pure tone threshold audiogram; speech audiometry, impedance tympanometry, auditory brainstem responses and otoacoustic emissions).RAwareness that investigations may delay< referral in suspected head and neck cancer1Watchful waiting and use of delayed prescriptions Nasal cauteryUFracture nose (need manipulation under anaesthetic within 2 weeks for optimum result)Septal haematomaTonsillitis with quinsy;Otitis externa if extremely blocked or painful; mastoiditis$Foreign bodies (e.g. in ear or nose)%Auricular haematoma or perichondritis7Screening for hearing impairment in adults and children-Awareness of iatrogenic causes of ototoxicity;Altered vision (e.g. flashes, floaters, distortions, halos)Sticky or itchy eyesSudden loss of visionThe painful eye The red eye7Disorders of the lids and lacrimal drainage apparatus: BlepharitisStye and chalazion Entropion and ectropion Basal cell carcinoma ,Naso-lacrimal obstruction and dacryocystitis7External eye disease: sclera, cornea and anterior uvea:'Conjunctivitis (infective and allergic)Dry eye syndromeEpiscleritis and scleritisCorneal ulcers and keratitisIritis and uveitisOrbital cellulitisDisorders of refraction:Cataract"Myopia, hypermetropia, astigmatism Principles of refractive surgery'Problems associated with contact lensesDisorders of aqueous drainage:Acute angle closure glaucomaPrimary open angle glaucomaSecondary glaucomasVitreo-retinal disorders:Flashes and floatersMacular degenerationRetinal detachmentRetinoblastomaVitreous detachmentVitreous haemorrhage0Disorders of the optic disc and visual pathways::Swollen optic disc: recognition and differential diagnosis;Atrophic optic disc: recognition and differential diagnosis&Pathological cupping of the optic discMigraine Transient ischaemic attack (TIA)4Eye movement disorders and problems of binocularity:Amblyopic diplopia&Non-paralytic and paralytic strabismusUnderstanding of appropriate investigations to exclude systemic disease (e.g. ESR for temporal arteritis, CXR for sarcoid, etc.)iKnowledge of secondary care investigations and treatment including slit lamp and eye pressure measurementeMedications including mydriatics, topical anaesthetics, corticosteroids, antibiotics, glaucoma agents2Removal of superficial foreign bodies from the eyefSuperficial ocular trauma, including assessment of foreign bodies, abrasions and minor lid lacerationsArc eye'Severe blunt injury, including hyphaema2Severe orbital injury, including blow-out fracture-Penetrating ocular injury and tissue prolapse"Retained intra-ocular foreign body8Sudden painless loss of vision (e.g. retinal detachment)Severe intra-ocular infectionGenetics  family history3Co-morbidities especially diabetes and hypertensionPatients with metabolic problems are frequently asymptomatic or have non-specific symptoms, such as tiredness, malaise, weight loss or gainLDiabetes mellitus  tiredness, polydipsia, polyuria, weight loss, infectionsHyperlipidaemia  xanthelasmaHyperuricaemia  goutdHypothyroidism  tiredness, weight gain, constipation, hoarse voice, dry skin and hair, menorrhagia _Hyperthyroidism  weight loss, tremor, palpitations, hyperactivity, exopthalmos, double vision IIndividual endocrine disorders have typical symptom complexes (e.g. PCOS)dAdrenal disease (e.g. Cushing s syndrome, hyperaldosteronism, Addison s disease, phaeochromocytoma) !Diabetes mellitus  type 1 and 2 Hyperlipidaemia Hyperuricaemia 3Impaired Glucose Tolerance (and metabolic syndrome)ObesityParathyroid diseaseDPituitary disease (e.g. prolactinoma, acromegaly, diabetes inspidus)MThyroid disorders  hypothyroidism, hyperthyroidism, goitre, thyroid nodules Body mass index calculation-WHO diagnostic criteria for diabetes mellitusNNear patient capillary glucose measurement (including patient self-monitoring)2HbA1c and fructosamine to assess glycaemic control:Albumin: creatinine ratio or dipstick for microalbuminuria-Interpret serum electrolyte and urate resultslInterpret thyroid function tests and understanding their limitations  TSH, T4, free T4, T3, auto antibodiesJInterpret lipid profile tests  total cholesterol, HDL, LDL, triglycerides%Visual acuity and retinal photographyKnowledge of secondary care investigations including the glucose tolerance test, thyroid ultrasound and fine needle aspiration, specialised endocrine testsUnderstand principles of treatment for common conditions managed largely in primary care  obesity, diabetes mellitus, hypothyroidism, hyperlipidaemia, hyperuricaemiaChronic disease management including specific disease management, systems of care, and multidisciplinary team work for people with established metabolic problemsCommunication with patients and their families and inter-professional communication both within the PHCT and between primary and secondary careAcute management of diabetic emergencies  hypoglycaemia, hyperglycaemic ketoacidosis and hyperglycaemic hyperosmolar non-ketotic coma.PAcute management of thyroid emergencies  myxoedema coma and hyperthyroid crisis<Recognition and primary care management of Addisonian crisisLHealth promotion activities include dietary modification and exercise advicesUnderstand when prevention of hyperuricaemia is appropriate e.g. patients treated for myelo/proliferative disordersjObesity and diabetes mellitus are risk factors for other conditions, so optimal management is preventativeAbnormal movements and chorea Drowsiness and delirium Headache Loss of consciousness and coma$Memory loss and cognitive impairment Neuropathies Seizures Tremor ZVertigo and dizziness (neurological, otological, psychological and cardiovascular causes) Common causes of headache:Tension headache,Migraine and cluster headache, 0Cervical neuralgia, sinusitis, and dental pain, Drug rebound headache.Serious causes of headache:%Raised intracranial pressure, tumoursTThunderclap headache (e.g. subarachnoid haemorrhage, enlarging aneurysm or migraine)Temporal arteritisTrigeminal neuralgia Herpes zosterAmyotrophic lateral sclerosis Brain infections:Meningitis and encephalitis Brain abscessTuberculosis and HIV9Congenital conditions (e.g. cerebral palsy, spina bifida) Epilepsy Essential tremor .Genetic conditions (e.g. Huntingdon s disease)Mononeuropathies including trigeminal neuralgia, Bell s palsy, carpal tunnel syndrome and other nerve entrapments (e.g. ulnar, sciatic and femoral nerves) Multiple sclerosis vNeurological causes of vertigo (e.g. stroke, multiple sclerosis, trauma & concussion, acoustic neuroma, brain tumours)Parkinson s diseasePolyneuropathies including metabolic causes (diabetes, alcohol, B12 and folate, porphyria, uraemia), infectious causes (e.g. Gullain-Barre, post-viral, HIV) and drug-induced neuropathy< Speech disorders#Stroke (haemorrhage and infarction)[TIP: Stroke is also covered in statements 9: Older adults and 15.1: Cardiovascular problemsKnowledge of secondary care investigations and treatment including electroencephalography (EEG), Computerised Tomography (CT) and Magnetic Resonance Imaging (MRI), nerve conduction studiesUnderstand principles of treatment for common conditions managed largely in primary care  epilepsy, headaches, vertigo, neuropathic pain, mononeuropathies, essential tremor and Parkinson s diseaseeAcute management of meningitis and meningococcal septicaemia, collapse, loss of consciousness or coma3OVERALL AVERAGE SCORE (when all sections complete):=Understand indications for emergency referral of people with:StrokeIntra-cranial haemorrhageRaised intracranial pressureHHealth education and accident prevention advice for people with epilepsy%Vaccination for meningococcal disease=Understand avoidance of triggers and prophylaxis for migraineaInvestigation of people with family history of genetic neurological disease (e.g. berry aneurysm)Cough HaemoptysisWheezeSputum productionAllergy and anaphylaxisAspiration of a foreign body Bronchitis Chronic cough"Chronic interstitial lung diseases,Chronic obstructive pulmonary disease (COPD)'Epiglottitis, laryngitis and tracheitisHypersensitivity pneumonitis Influenza Lung cancerPneumonia (of any cause) PneumothoraxSore throats and colds&Tonsillitis and peri-tonsillar abscess Tuberculosis7Serial peak flow measurement, including patient diaries+Reversibility testing using peak flow meter SpirometryKnowledge of secondary care investigations and treatment including lung function tests, Computerised Tomography (CT) and Magnetic Resonance Imaging (MRI) imagingUnderstand principles of treatment for common conditions managed largely in primary care  upper and lower respiratory tract infections, asthma, COPD, allergic reactions and anaphylaxis1Inhaler technique for using commonly used devices>Acute management of people presenting with shortness of breathAcute management of anaphylaxis.Management of exacerbations of asthma and COPDYUnderstand indications for emergency referral of people with asthma, COPD and anaphylaxis3Smoking cessation assessment, advice and managementjVaccination against influenza, Streptococcus pneumoniae, Haemophilus influenza B, diphtheria and pertussisYHealth education advice and patient self-management plans for people with asthma and COPDHUnderstand avoidance of triggers and prophylaxis for allergic conditions_Investigation of people with family history of genetic respiratory disease e.g. cystic fibrosis.Inflammation  pain, swelling, redness, warmth;Injuries  cuts, bruises, burns, wounds, sprains, fracturesJLoss of function  weakness, restricted movement, deformity and disabilityCSystemic manifestations  rashes, tiredness, nerve compression etc.Acute arthropathies Back/neck pain  acuteBack/neck pain  chronicChronic disability #Chronic inflammatory arthropathies Common injuries and sprains"Fibromyalgia and allied syndromes Fractures Head injury2Internal injuries of the chest, abdomen and pelvisAKnee pain (e.g. ligamentous injuries, cartilage tears, arthritis)Osteoarthritis Osteoporosis Pain management -Polymyalgia rheumatica and allied conditions EShoulder disorders (e.g. rotator cuff tears, capsulitis, impingement)<Soft tissue disorders (e.g. bursitis, synovitis, tendonitis)?Awareness of rarer musculoskeletal and rheumatological diseasessIndications for plain radiography, ultrasound, CT and MR scan including the use of tools such as the  Ottawa Rules %General rules of X-ray Interpretation4Implications of  misses on X-rays and common errorsBIndications for additional investigations for example blood tests.Understand the principles of treatment for common conditions managed largely in primary care including the use and monitoring of NSAIDs and disease modifying drugsKnowledge of when joint injections and aspirations are appropriate in general practice and the ability to perform when appropriate e.g. Shoulder and knee joints and injections forTennis and Golfer s ElbowUnderstand the roles of allied health professionals (nursing, physiotherapy, chiropody, podiatry, occupational therapy, counselling and psychological services)nChronic disease management including systems of care, multidisciplinary team work and shared care arrangements8The initial management of the patient who has been burntUTo be aware of the safety of the patient, the scene of the incident and medical staff1To be aware of how to summon help in an emergencyBe competent in basic life support (adult and paediatric), the use of simple airway adjuncts (for example oropharyngeal airway and pocket mask) and the safe use of a defibrillator$Be competent in stopping haemorrhageGBe competent in reducing pain by the use of analgesia or other methods.7Be aware of the principles of major incident managementWReferrals requiring emergency action to save life or prevent serious long term sequelae/Advise regarding appropriate levels of exercise-Heath promotion regarding accident preventionBruising or purpura Hair loss Itch (also known as pruritus) Lumps in and under the skin Nail problems#Photosensitivity and  the red face Pigmented skin lesions Rashes Signs of infections of the skin Acne and rosacea Drug eruptions Eczema Generalised pruritus Hair and nail disorders 5Infections of the skin (bacterial, viral and fungal) -Infestations including scabies and head lice Ingrowing toenailsLeg ulcers and lymphoedema Psoriasis $Skin tumours (benign and malignant) Urticaria VasculitisAwareness of other less common skin conditions such as the bullous disorders, lichen planus, vitiligo, photosensitivity, pemphigus, pemphigoid, discoid lupus, granuloma annulare and lichen sclerosus?Ability to take specimens for mycology from skin, hair and nail)Basic interpretation of histology reports Skin biopsy}Those commonly used in primary care (including an awareness of appropriate quantities to be prescribed and how to apply them)KPrinciples of protective care (sun care, occupational health and hand care)eAn awareness of specialised treatments, such as retinoids, ciclosporin, phototherapy and methotrexatePThe indications for and the skills to perform curettage, cautery and cryosurgeryAngioedema and AnaphylaxisMeningococcal sepsisDisseminated herpes simplex ErythrodermaPustular psoriasisSevere nodulo-cystic acneToxic epidermal necrolysisStevens-Johnson syndromeNecrotising fasciitis Sun exposureFixed factors: family history and genetics (how genetic factors influence the inheritance of common diseases such as psoriasis and atopic eczema). Occupation and care of the hands HaematologyBleeding disordersClotting disorders and VTE/DVTVHaematological investigations (e.g. FBC, film, ESR, D-dimers, B12/folate, haematinics)LymphadenopathyLymphoproliferative disorders/Myelodysplasia and myeloproliferative disordersParaproteinaemias and myeloma<pPost-splenectomy prophylaxis!Red cell disorders and haemolysis$Warfarin (initiation and monitoring)Renal problems Haematuria (and microhaematuria)GlomerulonephritisNephrotic syndromePyelonephritis and UTIRenal function test interpretation and monitoring (e.g. U+E, Creatinine, eGFR, 24-hour urinary collection tests, microalbuminaemia, proteinuria)*Renal impairment and chronic renal failureRenal and bladder stones"Renal tract imaging (e.g. CT, USS)0Urinary tract malignancies (e.g. renal, bladder)Infectious diseasesBacterial infections (e.g. brucellosis, endocarditis, erysipelas staphylococcus, streptococcus, legionella, listeria, Lyme disease, psittacosis, tetanus, treponema)LFood poisoning (e.g. botulism, campylobacter, salmonella, E.coli, rotavirus)8Hospital-acquired infections (e.g. MRSA and clostridium)YInfluenza vaccination campaigns and management of high risk groups, flu pandemic planning_Notifiable diseases and role of public health in infectious disease control and contact tracingXParasitic and protozoal infections (e.g. head lice, threadworms, toxoplasmosis, scabies)Post-viral fatigue syndromePyrexia of unknown originWRoutine immunisation schedules and issues around vaccination (e.g. MMR, BCG, pneumovax)MSystemic fungal infections (e.g. aspergillosis, oral candidiasis, pityriasis)Travel advice and vaccinationsViral infections (e.g. hepatitis A, herpes simplex, herpes zoster, HIV, influenza, infectious mononucleosis, hand, foot and mouth, measles, mumps, parvovirus, rubella)Surgery*Evaluating a patient s fitness for surgery*Optimising a patient s fitness for surgery;Managing common post-surgical complications after dischargeRoutine wound care and healing9Recovery, rehabilitation and return to work after surgery MiscellaneousMedically unexplained symptomsChronic fatigue syndromeOff legs!Common occupational health issuesEvidence-based PracticeResearch and Academic ActivityyHow to draw and interpret a family tree and recognise basic patterns of inheritance, and knowledge of basic genetic testsGenetics in Primary CareCare of Acutely Ill People!Care of Children and Young People<Viral exanthems (childhood illnesses associated with rashes) 15.XThe Rest of General PracticeWomen's Health Men's Health"Epididymo-orchitis and epidydmitisSOther testicular conditions e.g. cryptorchidism, varicocele, haematocele, hydrocele Sexual Health,Care of People with Cancer & Palliative Care*Care of People with Mental Health Problems)Care of People with Learning DisabilitiesCardiovascular ProblemsDigestive ProblemsDrug and Alcohol ProblemsENT and Facial Problems Eye ProblemsMetabolic ProblemsNeurological ProblemsRespiratory Problems&Rheumatology, Musculoskeletal & Trauma Skin Problemsf Tropical diseases (malaria, amoebic dysentery, giardiasis), traveller s diarrhoea, malaria prophylaxis :Average for this section:Riley, Haynes & FieldThe condensed knowledgeScoreB1  I am not at all confident in this area of knowledge or abilityH2  I have some knowledge or ability here, but don t feel I am competent@3  I am probably competent at this but would like to learn moreA4  I feel confident my current knowledge or ability is competent 5  I am simply awesome at this!sThe final page of this spreadsheet contains a summary which displays the average score for each of the statements. @The Condensed Curriculum Guide: Condensed Knowledge Rating ScaleYou can use this extract from The Essential Knowledge chapter of The Condensed Curriculum Guide as a self-assessment tool by giving each item of knowledge a score from 1-5, based on your level of confidence: 6@ _) by Ben Riley, Jayne Haynes & Steve Field}Extracted from the official guide to the new RCGP Curriculum and the nMRCGP for GPs in training, their trainers and educators;This pages of this spreadsheet list the core items of knowledge derived from the knowledge base of the RCGP curriculum supporting statements. The knowledge base contains only part of the knowledge, skills and attitudes described in the curriculum and tested in the nMRCGP assessments. For details of the other key educational outcomes, including the applied knowledge and important attitudes and skills, see The Condensed Curriculum Guide. Please note that some statements do not have a condensed knowledge section in the book, and so do not appear in this spreadsheet.sIt is advisable to ask your educational supervisor, trainer, or a mentor who has observed your performance, to review your scores in order to check that your subjective assessment is a true reflection of your abilities. If there is more than 1 point of disagreement between you and your trainer over a particular item of knowledge or skill, reflect on why this might be. ? RCGP, 2008. The material listed in this spreadsheet may be reproduced by individuals without formal permission for the purposes of private use or educational activities. 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