Case 1: Patient Presenting With Dizziness

1. How do the GPs questions help to define the differential diagnoses?
   1. Asked the patient to actually define what dizziness is… for some people, they may be saying they’re dizzy because they feel nausea, whereas others might be actually feeling like the world is spinning around them etc…
      1. Important to ask the patient what they mean by these sorts of terms… really helps narrow down the differential diagnosis.
      2. Even with allergy - must understand what the patient means…
2. What is the differential diagnosis of dizziness in this case? Are there any other questions you might ask? 1.
3. What examination does the GP do? Why do they examine what they do and and would you do anything different?
   1. Dix-Hallpike Manueover…
4. How did the GP come to a management plan and share this with the patient? Would you have done anything different?
   1. Used a leaflet to inform the patient of her options, and how she can exercise etc. to improve her condition.

• GP resources

Post-Operative Care

1. Watch the opening first two minutes of the consultation. Summarise what you have learned about the patient's problem and why she has presented today. What to do you notice about who is talking most at this point? Is this important and if so why?

2. The patient is due to return to the hand surgery team; but has come to see their GP with a problem arising from her recent surgery. Discuss why this might be. How much knowledge of post-operative problems does a GP need to have? How does communication between primary and secondary care operate and are there potential problems with this system? How could problems be overcome?

3. What are the features of infection vs inflammation? How certain can the GP be that there is an infection in the wound? How would you manage the uncertainty and possible risk of an untreated wound infection? Are there other questions or simple tests you might do? How does the GP reach the decision to prescribe antibiotics?

4. What do you understand by the term antimicrobial stewardship? What are GPs expected to do regarding this when considering prescribing antibiotics?

5. What patient safety aspects do you notice about this case? (consider prescribing safety in terms of drug allergies and interactions as well as any safety netting you observe). What support do GPs have to prescribe more safely? (consider use of IT)

6. At 4.00m the GP asks the patient "what happens when you take penicillin?" What do people mean when they say are allergic to something? Are all drug reactions an allergy? What are the features that would suggest an allergic reaction versus intolerance? How should drug reactions be recorded and communicated in healthcare systems?