Diagnosis:

Think of how you could explain the diagnosis & pathology to the patient.

Management:

Include management options, safety-netting and write down phases you would use.

'A pulmonary embolism (PE) is a blood clot that develops in a blood vessel in the body (often in the leg). It then travels to a lung artery where it suddenly blocks blood flow. A blood clot that forms in a blood vessel in one area of the body, breaks off, and travels to another area of the body in the blood is called an embolus. An embolus can lodge itself in a blood vessel. This can block the blood supply to a particular organ. This blockage of a blood vessel by an embolus is called an embolism.'

Management:

Lifestyle

'Lifestyle factors significantly impact depression management. Engaging in regular exercise can naturally boost mood by releasing feel-good chemicals in the brain. Eating a nutritious diet provides the body with essential nutrients that support brain function and mood regulation. Quality sleep is crucial for emotional and mental health, as it helps the brain process emotions and recover from stress. Reducing alcohol consumption and avoiding recreational drugs are also key, as they can exacerbate depression symptoms. Furthermore, staying connected with others and participating in enjoyable activities can combat feelings of isolation and help build a supportive network. Together, these lifestyle adjustments can complement medical treatments and contribute to overall mental health improvement.'

'Firstly, I want to reassure you that experiencing bleeding while on HRT is something that can happen, especially as your body is adjusting to the hormones. However, after six months, we would expect these symptoms to have settled down to some extent. Let's talk through what might be happening, and what steps we can take next. Hormone Replacement Therapy is designed to help manage the symptoms of menopause by replacing the hormones that your body is no longer making in sufficient quantities. It's a balance, and sometimes getting that balance right takes a bit of time and adjustment. There are different types of HRT, and bleeding can be a side effect of some of these treatments, especially in the initial stages. Continuous HRT, where both estrogen and progestogen are taken daily without a break, might lead to irregular bleeding or spotting in the first few months. This is usually because your body is adjusting to the hormones. However, by six months, we would expect this to have settled. If it hasn't, we need to consider a few possibilities.'

Management:

'Firstly, it's important to check that the bleeding isn't due to any other underlying conditions. This might involve some tests, like an ultrasound or even an endometrial biopsy, to check the health of your uterine lining. Secondly, we might need to adjust your HRT. This could mean changing the dose, the type of hormones, or how you take them (for example, switching from a pill to a patch or gel). Each method and type of hormone has its own profile of side effects and benefits, and it might be that we just haven't found the perfect match for you yet.'

'A pulmonary embolism (PE) is a blood clot that develops in a blood vessel in the body (often in the leg). It then travels to a lung artery where it suddenly blocks blood flow. A blood clot that forms in a blood vessel in one area of the body, breaks off, and travels to another area of the body in the blood is called an embolus. An embolus can lodge itself in a blood vessel. This can block the blood supply to a particular organ. This blockage of a blood vessel by an embolus is called an embolism.'

Management:

The most important treatment is to stop smoking. However, there are other treatment options to ease the symptoms and treat the flares, such as; inhalers, steroid tablets, antibiotics etc.

What happens in PCOS is, because there is a hormonal imbalance, it can make it difficult for the body to release eggs which is known as ovulation. If eggs are not released, this can give the appearance of cysts in the body.

The hormonal imbalance would cause symptoms such as:

• irregular periods

• increased hair growth, and

• skin problems such as acne

Also, because it's more difficult to ovulate, people with PCOS may find it more difficult to get pregnant naturally.

We also found that there are links with diabetes and being overweight.

Unfortunately, there is no cure for PCOS but there is a lot we can do to improve the symptoms.

Some people may not experience any symptoms at all. If they do, they usually have painful periods, heavy periods or some tummy pains. Sometimes, they may cause problems with pregnancy as well.

There are different types of fibroids. They can grow within the muscles of the womb, or outside the womb.

There are quite a few risk factors for fibroids. This includes family history, being overweight, increasing age, and being of Afro-Caribbean origin.

There are lots of things we can do to manage fibroids. It depends on how much the fibroids are impacting on the patient. Some people may not need any treatment at all. Some people may need medications to help improve the symptoms or even try to shrink the fibroid size. Some people may require surgery to remove large fibroids.

It affects the memory , behaviours and also the way they look after themselves. Dementia can not be reversed but there are lots of support and medications we can offer to make them live a comfortable life.

The people who have this syndrome usually present with joints pain as the hyper flexibility of there joints put strain on the joints and tendons and this make the prone also for recurrent joints dislocation. They also have stretchy skin which could get bruised easily.

The management of this condition is mainly practicing suitable Low-impact exercises like swimming and cycling as high-impact exercises like running and weight lifting, while beneficial for general health, can cause more damage to the joints. In some conditions, we prefer to be guided by physiotherapist to put a suitable exercise program.

The other part of management includes pain management with some pin killers if needed.

Doing this test has the advantage of detecting cancer that needs treatment which can be initiated early but at the same time it can lead to invasive test like biopsy (Taking a sample from the prostate) which was not required.

In mild cases, NAFLD might not cause any symptoms. But as it progresses, it can lead to inflammation and damage in the liver. If left untreated, NAFLD can even lead to liver failure or liver cancer.

It's important to remember that NAFLD can be managed through healthy lifestyle changes like eating a balanced diet, exercising regularly, and maintaining a healthy weight.

The machine itself looks like a long, narrow tube. The tube is open at both ends, and the space inside is quite wide. It might feel a bit like being in a tunnel, but it's not enclosed and it is not tight.

During the scan, you'll hear a series of loud knocking noises. These are caused by the magnet and radio waves working together.

To help you feel more comfortable, you can wear loose-fitting clothing and bring your own headphones to listen to music. You may also be given earplugs to help with the noise. The technician will be able to see and hear you throughout the scan and can provide comfort or assistance if needed.

It's important to stay as still as possible during the scan, but if you need to move or adjust your position, or if you have any concerns, you can signal to the technician who will be there to guide you through the process.

Remember that the MRI is a safe and painless procedure that can provide valuable information about your health.

It is important to know that gliclazide can sometimes make your blood sugar level too low. This is known as hypoglycaemia. This can affect your concentration.

It is required by law that you must:

1. inform DVLA that you are currently taking gliclazide.

2. check your blood sugar within 2 hours before driving and repeat every 2 hours.

3. be able to supply 6 weeks of uninterrupted evidence of your blood sugar readings on your blood glucose meter.

4. stop driving immediately and inform DVLA if you have one severe hypo.

Focused History:

·         Pain (analyse pain as usual, explore pain in specific sites e.g. pelvic, spine, thigh and shin)

·         Headache, change in skull shape

·         Most of the cases asymptomatic

·         Ask about dental problems if considering treatment with bisphosphonates.

Key Red Flags:

·         Sciatica (tingling/electric shock down any leg)

·         Cauda equina (numbness around the ring, urine/stool incontinence ….

·         Hearing loss and tinnitus

·         Ask about falls and possible fractures.

·         Rapid change in pain nature (e.g. new night pain), change of bone shape, or weight loss (suggestive of possible osteosarcoma)

·         Heart failure (rare complication to Paget’s disease)

Psychosocial/ICE/Impact:

·         Pain management

·         Can I still work / exercise?

·         Would it change to cancer in the future? There is a rare and uncommon bone cancer called osteosarcoma that was reported in less than 1:10.000 cases of Paget’s disease.

·         Are my children at risk of having Paget’s disease? Yes, the children of the people who have Paget’s disease are about seven times more likely to develop this disease.

Key differentials

·         Osteoarthritis

·         Liver disease (if presented only with raised ALP)

·         Menopause symptoms

·         Osteoporosis

As we do not know exactly what triggers Paget’s disease, we do not know how individuals who are predisposed to it, can avoid it. General advice for everyone is to try to lead a healthy lifestyle. This includes a healthy diet, regular exercise and maintaining a healthy weight.

If you develop worsening pain, fever or immobility of the joint please seek urgent care.

You will be placed a medication cause Apixaban  ,it is a blood thinners that helps prevent clot formation .  The medication can cause risk of bleeding so , we usually recommend avoidance of high contact sport  and contact us if you notice unusual bleeding . We will monitor your kidney and liver blood test regularly while on the medication to ensure you do not develop side effect . How dose that sounds .

Management involves special talking therapy known as trauma focused cognitive behavioural therapy (CBT) has been found to be extremely helpful. Medications such as sertraline is helpful also. There are support groups available where you will meet others going through what you are going through. Here is CRISIS team number if you are extremely low in mood and have thoughts of suicide. We will follow you up in 1-2 weeks time to know how you are getting on

Vasectomy is a simple outpatient procedure to prevent pregnancy. It is also called male sterilization or snip and is done under local anesthesia and lasts most of the time around 30 minutes The procedure blocks the supply of sperm to the semen. It is a common form of male birth control that is done by cutting and sealing the tubes that carry sperm. The sperm, which can no longer reach the semen, are absorbed by the body. Vasectomy is available on the NHS. There is usually a waiting list. It may be possible to reverse a vasectomy, but this does not always work. Reversal is not usually available on the NHS.

Management: Usually, we offer a blood thinner which prevents further blood clots forming while your lungs deals with the blood clot present- as this happens, your breathing will improve and the shortness of breath will settle

Management: Treatment via specialised therapy is directed at empowering individuals with distraction techniques (rapid eye movement) or coping strategies (CBT) to help interrupt/take control of this panic episodes.

The condition is not curable but we have lot's of treatment to improve symptoms.

Some of the treatment we off is pain relief, physiotherapy, occupational therapy, bone protection.

Is they any of these treatments you would want me to explain more or you are interested in.

The good thing is that it's unlikely to turn into cancer.

Please if any of symptoms change please do see like worsening of the pain, swelling , fractures

we may need to do an abdominal and internal examination, TVUS scan to look for fibroids, cysts and other causes of symptoms

Management

1. Managing the pain and heavy bleeding using pain killers, anti-inflammatory

2. hormonal treatment if not trying to conceive

3. refer if severe symptoms or Deep endometriosis involving the bowel, bladder, or ureter.

Depending on your symptoms and your medical history and other risks, there are other non-hormonal medications that we can consider using to help manage symptoms of menopause, such as antidepressants. It doesn't mean that you have depression, but it can help manage symptoms like mood swings and sleep disturbance.

HRT is not a contraceptive. We would therefore still advise patients to use contraception if they still have some bleeding. The guidance suggests that women are potentially fertile for 2 years after he last menstrual period if she is younger than 50 and for 1 year if she is over 50. Generally, women can stop contraception after the age of 55.

We can review how you are with the HRT in 3 months after you have decided to start.

cancer that develops in the bone marrow. The bone marrow is a spongy tissue that

helps to produce blood cells

For example Mr. X, while chronic back pain can be responsible for your back pain, I have to share with

you that your symptoms are pointing to something that could be more serious.

The combination of your back pain waking you up at night, the fatigue, the weight loss, and

your raised inflammatory markers on your blood test are concerning. Based on these signs,

I’m worried that there may be a possibility of multiple myeloma, a type of cancer that

affects the bone marrow. I understand this news is very upsetting, and I want to emphasize

that we don’t have a definitive diagnosis yet. We will need to run additional tests, such as

blood tests, urine test and refer you to a specialist very urgently to get a clearer picture of

what’s going on.

Management:

Offer urgent urinary Bence jones protein, blood test for serum electrophoresis

Advice if this is positive, then you will refer on an urgent pathway to blood specialist

(Haematologist). The blood specialist will do further test to confirm the diagnosis. If

confirmed, they will discuss in MDT consisting of cancer doctor (Oncologist) and

other experts in this field who may also offer

X-rays of lower back urgently to rule out pathological fracture.

Offer PPI if offering NSAIDs to patient

Follow up in 2 days with results

Safety net re cauda equina symptoms and also hypercalcaemia symptoms

(Polyuria, constipation, thirst)

Cancer safety netting just in case he does not hear from anyone in the surgery in 2

days, then to recontact.

Mohammed Eltahir

PKD is inherited from an affected parent or a carrier parent, any siblings have a 50% chance of inheriting the condition.

In this condition ,Kidneys develop many fluid filled cysts, with time these cysts may increase in size affecting the kidney function.

There is no cure for the condition but there is a lot that can be done to manage the symptoms.

Gul Rukh Saquib

It causes pain over multiple regions and can also be associated with fatigue that can improve with exercise. other features also include brain fog, headaches, IBS like symptoms, mood changes.

Aerobic exercises - anything that makes your heart beat faster and slightly out of breath -> including swimming, brisk walking and cycling. Also strengthening exercises and stretching are some that can be helpful. Important to note that initially they might make pain worse - but with daily consistency this can settle. (versus arthritis leaflet can be very useful.

This method, which is used under the advice and guidance of the pharmacist is a last resort and is only used after discussing with the next of kin/family and obtaining consent.

ADHD or attention deficit hyperactivity disorder is a behavioural condition that primarily affects children. Key symptoms are problems with concentration and focus, being restless and finding it hard to control emotions. The exact cause is not fully understood and diagnosis involves detailed assessment from a specialist.

Treatment:

Treatment involves behavioural therapy for children and support for families. Sometimes this can be combined with medication.

The main treatments are:

• moisturising creams, lotions, ointments and gels you apply to your skin and wash with (emollients)

• steroid creams, lotions or gels you apply to your skin (topical corticosteroids)

A person with a personality disorder thinks, feels, behaves or relates to others very differently from the average person.

There are several different types of personality disorder.

It's called multiple myeloma as the cancer often affects several areas of the body, such as the spine, skull, pelvis and ribs.

Symptoms might include breathlessness, wheezing , cough and a tight chest. These symptoms might get triggered by exercise , cold weather or allergens.

At the moment there is no cure for asthma but symptoms can be controlled with inhalers.

Management:

Managing your asthma includes

1) Inhalers

Inhaler is a small devise that lets you breathe in the medicine , there are two main types

Reliever inhalers- Salbutamol

are used to quickly relieve the symptoms for a short time

Preventer inhalers - steroid inhalers

are used every day to prevent the asthma symptoms .

2) Identifying and avoiding your asthma triggers can help you to keep your symptoms under control

3) Vaccinations

4) stopping smoking

5) Having Regular asthma reviews

6) Discussing your asthma action plan

Asthma action plan tells you what to do if your symptoms suddenly worsen

Management:

check for constipation, UTI, DM.

if less than 5, reassurance.

if more than 5, bewetting once or twice a week, offer wait and watch strategy.

address fluid intake, especially in the evenings. advise not to take caffeine based drinks like fizzy drinks in the evenings.

Adress toiletting patterns. encourage passing urine through out the day and before bedtime.

combine fluid intake and toilet pattern advice with positive reward system for agreed behaviours like passing urine before bedtime.

if the above fails, combine reward system with enuresis alarm.

if parents unwilling for alarm or child not able to use the alram system, or trial(usually 3 month, initial review at 2 weeks) with alarm system fails, consider trial of desmopressin.

desmopressin can also be used for short term treatment,for example if the child is planning to go for a school trip. start desmopressin 1 week before the trip to establish response to treatment.

Head lice are tiny insects that live in hair. Nits are the empty egg cases attached to hair that head lice hatch from.

Head lice are a common problem, particularly in school children aged 4 to 11.

They’re largely harmless, but can live in the hair for a long time if not treated and can be irritating and frustrating to deal with.

No need for school exclusion, is spread by contact, has nothing to do with hygiene.

Treatment

If a live head louse is found, treat with one of the following:

• Wet combing — this is the systematic combing of wet hair with a louse detection comb to remove head lice. 

Pharmacist can help or you can buy over the counter dimeticon 4/

If a live louse is found after treatment by wet combing (that is, a live louse is found on day 17):

• Check that the following were used: the correct combing technique, sufficient duration of combing, and sufficient combing sessions.

• Advise that household members, close family, and close friends (both adults and children) should be assessed to identify possible sources of reinfestation.

• Advise the person to repeat wet combing or consider using an appropriate insecticide