A 16-year-old girl comes to the surgery with her friend seeking an abortion. She has missed her last three periods and took a pregnancy test which came out positive. Her boyfriend is also 16 years old. It is probable that she will need a surgical termination of pregnancy due to her gestation. However, she doesn’t wish to inform her parents. What is the best course of action?
Whilst speaking to one of the junior partners at your GP surgery you notice the smell of alcohol on her breath. What is the most appropriate course of action?
Which medication is not suitable for subcutaneous administration and should not be used in a syringe driver?
Which prescription contains the highest opioid dosage?
How should strong opioids be used for cancer pain management in primary care?
A 75-year-old patient of yours has terminal lung cancer and is taking morphine. One day you visit him at home to review his medication and check on symptoms. He and his wife are both confused with dosing and think he may have taken too much.
Which of the following symptoms and signs suggests opioid toxicity?
A 16-year-old girl presents with chronic leg pain and is diagnosed with an osteosarcoma.
Which of the following is true of osteosarcoma?
A patient in their late 60s with end stage chronic obstructive pulmonary disease on home oxygen is presenting with intractable cough and breathlessness.
They use regular nebulised salbutamol and ipratropium as well as saline nebulised PRN. They also have a regular inhaled corticosteroid and long acting beta agonist combination inhaler and once daily tiotropium inhaled. They take regular oral theophylline. They keep an emergency pack of prednisolone and amoxicillin at home in case they develop any infective symptoms.
On examination, they are apyrexial and chest auscultation reveals globally reduced air entry, with no focal acute signs. There is no evidence of cardiac failure or peripheral oedema.
What is the most appropriate additional treatment for their cough and breathlessness?
A 68-year-old man with known Hodgkin’s lymphoma presents with concerns of facial swelling. Upon examination, his face appears red and puffy, with engorged neck veins and a non-rising jugular venous pulse upon liver palpation. What is the likely diagnosis?
A 58-year-old gentleman with known lung cancer is seen as an emergency. He has developed a significant deterioration in his breathlessness over the last few days. He also complains of headache and dizziness.
On examination he has a soft stridor and you notice some dilated veins on his chest wall.
What is the most appropriate management plan?