MAFP/icFRACGP Part 1 cheat sheet

Consultation models: Calgary-Cambridge (initiating, gathering, physical exam, explanation/planning, closing) and Pendleton's seven tasks both structure the same content differently; either can anchor an OSCE station.

Open-to-closed funnel: begin with open questions ("What would you like to discuss today?"), move to closed questions for precision, then return to open for the patient's perspective.

BATHE screen: Background, Affect, Trouble, Handling, Empathy - a five-item psychosocial probe usable inside a standard consultation.

ICE (Ideas, Concerns, Expectations) should be elicited before explanation; unaddressed ICE is a common cause of non-adherence.

Chunk-and-check: give information in 2-3 sentence blocks, then confirm understanding with a teach-back question rather than "Do you understand?".

Breaking bad news: SPIKES (Setting, Perception, Invitation, Knowledge, Empathy, Strategy/summary) - the Invitation step asks how much the patient wants to know.

Motivational interviewing core: open questions, affirmations, reflections, summaries (OARS); change talk is elicited, not argued for, and the righting reflex is suppressed.

Interpreter use: a trained interpreter is preferred over a family member; a family interpreter risks altered information and confidentiality breaches.

Non-verbal communication (eye contact, posture, silence, seating at 45 degrees) carries weight in shared decision-making and in detecting distress.

Absolute risk reduction = control event rate − intervention event rate; number needed to treat = 1/ARR (round up to a whole patient).

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); a highly sensitive test is best for ruling out (SnNout), a highly specific test for ruling in (SpPin).

Positive likelihood ratio = sensitivity/(1−specificity); LR >10 gives strong evidence to rule in, LR <0.1 strong evidence to rule out.

Positive predictive value depends on prevalence; sensitivity and specificity do not change with prevalence.

Cardiovascular risk tools (e.g. Framingham, SCORE, QRISK) estimate 5- or 10-year risk and drive statin and antihypertensive thresholds; risk is not the same as a single abnormal lipid value.

Antibiotic stewardship: most acute upper respiratory infections, acute bronchitis and uncomplicated otitis media in adults are viral or self-limiting; delayed prescriptions reduce antibiotic use without worsening outcomes.

Spirometry: FEV1/FVC <0.70 post-bronchodilator supports airflow obstruction; severity is graded by FEV1 percent predicted.

Depression screening tools (PHQ-9, EPDS for perinatal) are screening aids, not diagnostic; diagnosis still requires symptom duration and functional impact.

Renal dosing: eGFR (CKD-EPI) is used for most drugs; Cockcroft-Gault creatinine clearance is still preferred for many drug labels.

HbA1c reflects approximately 3 months of glycaemia; it is unreliable in haemoglobinopathies, recent transfusion and pregnancy.

Screening criteria (Wilson-Jungner): important condition, accepted treatment, adequate test, detectable latent stage, agreed policy, cost-effective, continuous case-finding.

Lead-time bias makes screened patients appear to live longer without the test changing the disease course; length-time bias favours detection of slow-growing disease.

Primary, secondary and tertiary prevention: immunisation is primary, cancer screening is secondary, cardiac rehabilitation is tertiary.

Herd immunity threshold = 1 − 1/R0; for measles (R0 roughly 12-18) the threshold is above 90%, which is why vaccine coverage targets are high.

Incidence counts new cases per population at risk per time; prevalence counts all existing cases and rises with longer survival.

Social determinants (income, housing, education, employment, early life) drive much of the morbidity seen in general practice; the inverse care law states that need is greatest where provision is lowest.

Audit cycle: define standard, measure practice, compare, implement change, re-audit - distinct from research, which generates new knowledge.

Equity vs equality: equality gives the same to all, equity allocates according to need; outreach clinics for underserved groups are an equity measure.

Notifiable diseases (e.g. measles, meningococcal disease, tuberculosis, pertussis) must be reported to public health authorities; timeframes and lists vary by jurisdiction.

Four ethical principles: autonomy, beneficence, non-maleficence, justice; autonomy generally prevails when a competent adult refuses treatment.

Valid consent requires capacity, adequate information and voluntariness; capacity is decision-specific and time-specific, not global.

Adults are presumed to have capacity; a refusal of treatment by a capacitous adult must be respected even if the outcome is fatal.

Confidentiality exceptions: patient consent, statutory reporting, serious risk to identifiable others, and court order; disclose the minimum necessary.

Duty of candour: after a harmful incident, the patient should receive an honest explanation and apology; an apology is not an admission of legal liability in most jurisdictions.

Boundary crossing vs boundary violation: a minor, contextual flexibility is a crossing; exploitation of the doctor-patient power imbalance is a violation.

Professionalism includes managing conflicts of interest, declaring gifts and industry relationships, and not treating oneself or close family where objectivity is compromised.

Impaired colleagues: the first duty is patient safety; concerns are raised through the appropriate channel (clinical lead, regulator) rather than informally managed.

Gillick competence assesses a minor's capacity to consent to a specific treatment; it is not a blanket age threshold.

Medical records are the patient's information and the practitioner's or practice's legal record; retention periods vary by jurisdiction and by patient age at last contact.

Mandatory reporting duties typically cover child abuse, certain communicable diseases, impaired driving where legislation requires, and gunshot wounds in some jurisdictions.

Fitness to drive: an unconditional licence is not the same as a conditional one; doctors advise the patient and, where required, notify the licensing authority.

Work capacity certification: fit for work, fit with restrictions, or unfit; a certificate should state functional capacity rather than a diagnosis where possible.

Privacy principles generally require collection for a lawful purpose, use limited to that purpose, and disclosure with consent unless an exception applies.

Electronic health records: audit trails record access; access without a clinical relationship is a breach even if the record is not altered.

Adverse event reporting systems are usually non-punitive and separate from disciplinary processes; reporting is a systems-improvement function.

Prescribing law: controlled drugs have restricted quantities, validity periods and repeat rules that differ from ordinary prescriptions.

Delegation and supervision: a doctor remains accountable for tasks delegated to trainees and nurses within their competence and scope.

Cervical screening: HPV primary testing is the standard in many programmes; a positive HPV test triggers cytology or colposcopy depending on genotype and age.

Combined oral contraceptive pill is contraindicated in migraine with aura (WHO category 4) because of stroke risk; progestogen-only methods are usually preferred.

Emergency contraception: levonorgestrel is effective up to 72 hours but less so near ovulation; ulipristal acetate up to 120 hours; a copper IUD is the most effective and can be inserted up to 5 days.

Menopause is diagnosed clinically after 12 months of amenorrhoea in a woman over 45; FSH testing is not required in that age group.

Hormone therapy: systemic HT is the most effective treatment for vasomotor symptoms; vaginal oestrogen is preferred for genitourinary syndrome of menopause.

Preeclampsia: hypertension after 20 weeks plus proteinuria or end-organ dysfunction; aspirin prophylaxis is considered in women at high risk.

Gestational diabetes screening typically uses a 75 g oral glucose tolerance test at 24-28 weeks; thresholds differ by guideline body.

Postpartum haemorrhage: primary PPH is blood loss of 500 mL or more within 24 hours of birth; uterine atony is the commonest cause.

Bacterial vaginosis: clue cells, pH >4.5, fishy odour with potassium hydroxide, and thin grey discharge; metronidazole or clindamycin are first-line.

Paediatric weight estimation in emergencies: APLS uses (age + 4) × 2 kg for children aged 1-10 years.

Normal developmental milestones: sits unsupported around 6-8 months, walks 12-18 months, two-word phrases by 2 years; regression of skills warrants investigation.

Fever in a child under 3 months is a red flag requiring urgent assessment; the younger the infant, the lower the threshold for investigation and admission.

Bronchiolitis: supportive care; bronchodilators, corticosteroids and antibiotics are not routinely indicated.

Croup: single-dose dexamethasone; nebulised adrenaline for moderate to severe stridor, with observation afterwards for rebound.

Acute otitis media: many cases resolve spontaneously; immediate antibiotics are indicated in young infants, severe symptoms or bilateral infection in young children.

Kawasaki disease: fever ≥5 days plus 4 of 5 criteria (rash, conjunctivitis, mucosal changes, extremity changes, cervical lymphadenopathy); IVIG and aspirin reduce coronary risk.

Immunisation schedules are jurisdiction-specific; live vaccines are generally avoided in significant immunosuppression and during pregnancy.

Adolescent confidentiality: capacity to consent to confidential care increases with maturity; a parent's right to information is not absolute where the young person is competent.

Major depressive episode: at least 2 weeks of depressed mood or anhedonia plus ≥4 other symptoms causing functional impairment.

Suicide risk assessment covers ideation, intent, plan, means, previous attempts and protective factors; asking about suicide does not increase risk.

SSRIs: onset of benefit takes 2-4 weeks; review at 1-2 weeks for adverse effects and suicidality, especially in young people.

Serotonin syndrome: agitation, clonus, hyperreflexia, hyperthermia - a toxidrome from serotonergic combinations.

Benzodiazepines are for short-term use; dependence develops with prolonged use, and withdrawal can be life-threatening.

Alcohol withdrawal: risk of seizures and delirium tremens; benzodiazepines are first-line and thiamine is given to prevent Wernicke encephalopathy.

Bipolar disorder: an antidepressant alone can precipitate mania; a mood stabiliser is the foundation of treatment.

Eating disorders: anorexia nervosa has the highest mortality of psychiatric disorders; medical monitoring covers electrolytes, ECG (QTc) and weight trends.

Perinatal mental health: the Edinburgh Postnatal Depression Scale is a screening tool, not a diagnosis; scores above the threshold trigger a fuller assessment.

Comprehensive geriatric assessment covers medical, functional, cognitive, psychological and social domains and reduces hospitalisation when targeted at at-risk older adults.

Frailty screening tools (e.g. Clinical Frailty Scale) predict outcomes; frailty is not the same as age.

Polypharmacy: use explicit criteria (e.g. Beers, STOPP/START) to identify potentially inappropriate medications; deprescribing follows a stepwise taper plan.

Anticholinergic burden contributes to confusion, falls and urinary retention; review in older adults with cognitive decline.

Falls: multifactorial assessment covers vision, gait and balance, medication, home hazards, postural blood pressure and continence.

Delirium vs dementia: delirium has acute onset, fluctuating course and altered attention; dementia is chronic and progressive.

Pain in palliative care: the WHO analgesic ladder moves from non-opioid to weak opioid to strong opioid; constipation prophylaxis accompanies regular opioids.

Advance care planning records goals and preferences; an advance directive may be legally binding for refusing treatment but usually cannot demand specific treatment.

Palliative care is appropriate from diagnosis of a life-limiting illness, not only in the final days; it is delivered alongside disease-directed treatment.

Shared decision-making requires presenting options, benefits, harms and uncertainties, eliciting the patient's values, and agreeing a plan.

Anger or complaint handling: acknowledge the emotion first, explore the concern, then address facts; premature explanation escalates conflict.

Cultural safety: ask about the patient's explanatory model (what they call the problem, what they fear, what they expect) before offering the biomedical model.

Written information and teach-back improve recall; recall of verbal information alone is commonly poor within minutes of a consultation.

Telehealth communication: confirm identity and location, state that the consultation is being documented, and have a plan for examination or escalation.

Difficult conversations about prognosis: ask before giving detail, use the patient's own words, and allow silence; summarising reduces misunderstanding.

Patient-centred care measures include continuity, coordination, accessibility and whole-person care; continuity of care is associated with lower mortality in some cohort studies.

Consent for examination: explain, seek permission, use a chaperone where intimate examination is involved, and record what was discussed.

ECG basics: rate = 300/number of large squares between R waves; PR 120-200 ms, QRS <120 ms, QTc roughly <440 ms in men and <460 ms in women.

Anion gap = Na − (Cl + HCO3); normal is roughly 8-12 mmol/L; a raised gap suggests ketoacidosis, lactate, urate or toxin.

Corrected calcium (mg/dL) = measured Ca + 0.8 × (4.0 − albumin g/dL); ionised calcium is unaffected by albumin.

Sodium correction in hyperglycaemia: add 2.4 mmol/L to measured sodium for every 5.5 mmol/L glucose above 5.5.

Wells score and D-dimer: D-dimer is useful for excluding venous thromboembolism in low-probability patients; it is not a rule-in test.

CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30, low blood pressure, age ≥65) stratifies pneumonia severity and site of care.

CHA2DS2-VASc estimates stroke risk in atrial fibrillation; HAS-BLED estimates bleeding risk and does not by itself preclude anticoagulation.

Therapeutic index and half-life: drugs with narrow therapeutic index (digoxin, lithium, warfarin) need monitoring; steady state is reached after roughly 4-5 half-lives.

Evidence hierarchy: systematic reviews of RCTs sit above individual RCTs, cohort studies, case-control studies and expert opinion.

Crude vs age-standardised rates: standardisation removes the effect of differing age structures when comparing populations.

Attributable risk = incidence in exposed − incidence in unexposed; population attributable fraction estimates the share of disease preventable by removing exposure.

Immunisation coverage targets are typically 90-95% for herd protection against measles; coverage gaps cluster geographically rather than randomly.

Antimicrobial resistance is driven by prescribing volume and duration; shorter courses are preferred where evidence supports them.

Health promotion frameworks (e.g. Ottawa Charter) include building healthy public policy, creating supportive environments and reorienting health services.

Screening harms include false positives, overdiagnosis, anxiety and procedure complications; the balance of benefit and harm should be discussed.

Practice data: recall registers, audit and quality improvement cycles use routinely collected data; data quality limits interpretation.

Outbreak investigation: case definition, case finding, descriptive epidemiology (person, place, time), hypothesis generation, control measures, communication.

Vaccine hesitancy is addressed with a presumptive recommendation, listening to concerns and addressing specific safety questions rather than repeating facts.

Consent for a procedure without capacity: treat in the patient's best interests under the relevant legal framework, involving family and, where required, a substitute decision-maker.

Minors and confidentiality: a competent minor's confidentiality should be respected, with the limits explained at the outset.

Research ethics: informed consent, equipoise, ethics committee approval, and the right to withdraw without penalty.

Withdrawal of life-sustaining treatment is legally and ethically distinct from euthanasia; the intention and the cause of death differ.

Conscientious objection: a clinician may decline to participate in a specific procedure but must not obstruct access and should refer promptly.

Financial conflicts of interest: relationships with pharmaceutical or device companies should be declared and should not influence prescribing.

Social media: patient information must never be posted; even de-identified cases can be re-identifiable.

Whistleblowing: concerns about unsafe care should first go through internal channels where safe, then to the regulator if internal routes fail.

Professional boundaries online: personal and professional identities should be separated, and friend requests from patients are generally declined.

Access to records: patients generally have a right of access to their own record, subject to a harm exception; third-party information may be redacted.

Correction of records: patients may request correction of factual inaccuracies; clinical opinion is generally not altered but a note of disagreement may be added.

Prescription validity: most schedules specify a maximum validity period (commonly 6 months for many medicines and shorter for controlled drugs) - confirm local rules.

Sick leave certification and return-to-work planning: graded return, modified duties and early referral to occupational health improve outcomes.

Complaints process: acknowledge, investigate, respond in writing, and identify system changes; complaints are distinct from negligence claims.

Insurance and indemnity: practitioners should hold cover for the scope of their practice, including telehealth and procedures.

Record retention for minors: records are generally kept for a defined period after the patient reaches adulthood, not from the date of the last visit.

Referral documentation: include the reason for referral, relevant history, medications, allergies and the question being asked.

Legal reporting of impaired drivers: the duty varies; where a patient continues to drive despite advice, the doctor may have a duty to notify the authority.

Preconception care: folic acid 400 micrograms daily from at least 1 month before conception reduces neural tube defects; higher doses for previous affected pregnancy.

Antenatal screening windows: first-trimester combined screening (nuchal translucency plus biochemistry) is typically 11-14 weeks; anatomy scan around 18-22 weeks.

Ectopic pregnancy: consider in any woman of reproductive age with abdominal pain and amenorrhoea; transvaginal ultrasound plus serial hCG guides management.

Miscarriage: expectant, medical and surgical management are all options; anti-D prophylaxis is considered in Rh-negative women.

PCOS (Rotterdam criteria): two of oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound.

Endometriosis: diagnosis is clinical or laparoscopic; first-line treatment is combined hormonal contraception or progestogens for symptom control.

Urinary incontinence: pelvic floor muscle training is first-line for stress incontinence; urge incontinence responds to bladder training and antimuscarinics or mirabegron.

Breast screening: mammography intervals and starting ages vary by programme; a palpable lump is investigated regardless of screening history.

Contraceptive efficacy: typical-use failure rates are much higher than perfect-use rates; long-acting reversible contraception is the most effective reversible option.

Paediatric vital sign ranges change with age; a normal adult respiratory rate is abnormal in an infant, and tachypnoea is an early sign of respiratory distress.

Dehydration assessment: prolonged capillary refill, reduced skin turgor, sunken eyes and reduced urine output; oral rehydration is first-line in mild-moderate cases.

Febrile convulsion: typically 6 months to 5 years, generalised, under 15 minutes, no recurrence within 24 hours; most children need no investigation.

Meningococcal disease: non-blanching rash with fever is a red flag; do not delay parenteral antibiotics for investigation.

Failure to thrive: plot weight, length and head circumference on the correct chart; crossing centile lines downward warrants assessment.

Autism assessment: concerns about social communication, joint attention and repetitive behaviour prompt referral for multidisciplinary assessment, not watchful waiting.

Asthma in children: spacer with mask is preferred to a nebuliser for delivering beta-agonists in acute exacerbations.

Adolescent health: HEADSS (Home, Education, Activities, Drugs, Sexuality, Suicidality) structures the psychosocial interview.

Child safety: injuries inconsistent with the developmental stage or the reported mechanism should prompt consideration of safeguarding processes.

First-episode psychosis: urgent referral to early intervention services; antipsychotics are started at low dose with metabolic monitoring.

Anxiety disorders: cognitive behavioural therapy and SSRIs are first-line; benzodiazepines are not recommended for long-term management.

Post-traumatic stress disorder: trauma-focused psychological therapy is first-line; routine debriefing after trauma is not recommended.

Opioid substitution: methadone and buprenorphine reduce mortality; buprenorphine has a ceiling effect and lower respiratory depression risk.

Mental Health Act-type legislation: detention requires a mental disorder of a nature or degree warranting detention plus risk to self or others; it is not a substitute for capacity law.

Insomnia: cognitive behavioural therapy for insomnia is first-line; hypnotics are for short-term use only.

ADHD: diagnosis requires symptoms before age 12, in multiple settings, with functional impairment; stimulants require cardiovascular and growth monitoring.

Somatic symptom disorder: manage with scheduled visits, a single named clinician and avoidance of unnecessary investigation, not reassurance-seeking tests.

Substance use screening: AUDIT-C and single-item screens identify hazardous drinking; brief intervention reduces consumption.

Falls risk: a fall in the past year, gait or balance problems and fear of falling identify those needing multifactorial assessment.

Osteoporosis: FRAX or Garvan estimates fracture risk; DEXA is used to confirm density and monitor treatment.

Urinary tract infection in older adults: asymptomatic bacteriuria is common and should not be treated; confusion alone without urinary symptoms is not diagnostic.

Constipation in older adults: exclude impaction and drug causes (opioids, anticholinergics, iron); osmotic laxatives are preferred to stimulants for chronic use.

Pressure injury prevention: risk assessment, repositioning, skin inspection and adequate nutrition; staging describes tissue depth, not severity of pain.

Last days of life: anticipatory prescribing for pain, breathlessness, agitation and secretions; stop non-essential medications and review hydration goals.

Bereavement: grief is usually not pathological; prolonged grief disorder requires persistent, disabling symptoms beyond expected grieving.

Advance directive validity: made voluntarily by a competent adult, informed, and applicable to the current situation; an outdated directive may not apply.

Carers: assess carer strain and provide respite; carer burnout is a common precipitant of avoidable admission.

Empathic responses name the emotion ("That sounds frightening") rather than reassure prematurely; reassurance before acknowledgement blocks disclosure.

The 'golden minute': allowing the patient to speak uninterrupted at the start is associated with fewer late-arising concerns.

Consultation length and continuity correlate with fewer emergency admissions in some primary care cohorts; continuity is a measurable outcome.

Consent discussion for screening includes the possibility of overdiagnosis; presenting only the benefit is not informed choice.

Complaint letters should be answered factually, without defensiveness, with an explanation of what will change and an apology where appropriate.

Group and family consultations: establish who the patient is, agree confidentiality limits, and ensure each person's view is heard.

Breaking news to a child: use developmentally appropriate language, check understanding, and involve parents in the plan.

Interpreters and consent: consent for a procedure must be obtained through a competent interpreter, not summarised by a relative.

Acute coronary syndrome: serial troponin, ECG within 10 minutes of presentation; aspirin is given unless contraindicated.

Stroke: thrombolysis window is commonly up to 4.5 hours and thrombectomy up to 24 hours in selected patients; time of onset is critical.

Sepsis: use a screening tool (qSOFA or NEWS) to trigger escalation; antibiotics within 1 hour in septic shock.

Diabetic ketoacidosis: fluids, insulin infusion, potassium replacement and treatment of precipitant; potassium is checked before insulin if low.

Thyroid function: TSH is the first-line test; a normal TSH makes primary thyroid disease unlikely.

Anaemia: mean corpuscular volume guides the workup; iron deficiency shows low ferritin, and ferritin rises in inflammation so interpret with CRP.

Anticoagulation reversal: vitamin K and prothrombin complex for warfarin-related major bleeding; idarucizumab for dabigatran; andexanet for factor Xa inhibitors where available.

Drug interactions: CYP3A4 inhibitors (e.g. macrolides, azoles) raise levels of statins, calcium channel blockers and many others.

Vaccination in immunosuppression: inactivated vaccines are generally safe; live vaccines are usually contraindicated.

Primary care gatekeeping is associated with lower costs and, in some systems, better equity; access barriers shift care to emergency departments.

Deprivation indices (e.g. area-based) are used to adjust funding and target services; individual socioeconomic status may differ from area measures.

Screening programme quality metrics include coverage, recall rate, interval cancer rate and positive predictive value of referral.

Outbreak of vaccine-preventable disease: identify unvaccinated contacts, offer post-exposure prophylaxis where available, and exclude according to public health advice.

Antimicrobial stewardship metrics: proportion of prescriptions for viral illness, guideline concordance and use of delayed prescriptions.

Health literacy: low health literacy is associated with poorer self-management; plain-language materials and teach-back mitigate this.

Health needs assessment: combine epidemiological data with community consultation and service mapping to set priorities.

Smoking cessation: combination nicotine replacement or varenicline plus behavioural support is more effective than either alone.

Truth-telling: disclose what the patient wants to know, at the pace they choose; therapeutic privilege is rarely justified.

Confidentiality after death: information may be disclosed to family only with consent or where the law permits, and the deceased's wishes should be considered.

Referral and scope: a doctor should practise within competence and refer when a problem exceeds it; declining to refer without reason is a professional failure.

Fitness to practise: health, conduct and performance are the three domains; a health problem alone is not misconduct.

Gifts from patients: small gifts of gratitude are usually acceptable; gifts that create obligation or are of substantial value should be declined or declared.

Documentation of consent: record what was discussed, the risks mentioned, the patient's questions and the decision.

Advocacy: doctors have a role in advocating for individual patients and for population health, including resource allocation issues.

Social media and professional identity: posting identifiable patient images or details is a serious breach even in closed groups.

Capacity assessment: can the patient understand, retain, weigh and communicate the decision? A decision may be unwise without being incapacitous.

Substitute decision-making: the legal hierarchy of decision-makers (spouse, carer, guardian) varies by jurisdiction and should be confirmed locally.

Prescribing errors: look-alike/sound-alike drug names, decimal point errors and omitted units are common causes; write doses with leading zeros.

Recall systems: registers for chronic disease and immunisation require accurate coding and regular data cleaning.

Practice accreditation: standards typically cover safety, governance, infection control, patient feedback and continuous quality improvement.

Medical defence: notify the insurer early about adverse events and complaints that may become claims.

Employment law: practice staff are covered by workplace relations law; performance and conduct processes must follow procedural fairness.

Telehealth prescribing: verify identity and location, document the modality, and follow jurisdiction rules for controlled medicines.

Records as evidence: contemporaneous, dated, signed entries carry more weight than retrospective additions; late entries should be marked as such.

Menorrhagia: check ferritin and consider structural causes (fibroids, polyps) with ultrasound; the levonorgestrel intrauterine system is first-line for heavy menstrual bleeding without structural cause.

Postmenopausal bleeding: any bleeding after 12 months of amenorrhoea requires investigation for endometrial cancer, usually transvaginal ultrasound and biopsy.

Ovarian cancer: symptoms are nonspecific (bloating, early satiety, pelvic pain); CA-125 is not a population screening test.

Cervical screening in pregnancy: screening can be performed; abnormal results are managed with colposcopy and deferred treatment where possible.

Breastfeeding: most medicines are compatible; check a reliable lactation resource rather than stopping breastfeeding by default.

Contraception after childbirth: progestogen-only methods can start immediately postpartum; combined methods are delayed because of thrombosis risk.

Menstrual migraine: perimenstrual prophylaxis with a NSAID or triptan is an option; combined hormonal contraception is avoided with aura.

Pelvic inflammatory disease: treat empirically with broad-spectrum antibiotics covering chlamydia and gonorrhoea; remove an IUD only if no improvement.

Fertility: age is the strongest predictor of natural conception; referral thresholds depend on age and duration of trying.

Growth charts: use the correct chart for age, sex and, for preterm infants, corrected gestational age until about 2 years.

Newborn jaundice: bilirubin thresholds for phototherapy depend on age in hours and gestational age; prolonged jaundice beyond 14 days needs investigation.

Heart murmurs: innocent murmurs are soft, systolic, asymptomatic and vary with posture; any diastolic murmur or failure to thrive warrants referral.

Febrile child with petechiae: immediate parenteral antibiotics and urgent transfer; do not wait for lumbar puncture.

Type 1 diabetes: children may present with polyuria, polydipsia and weight loss; DKA can be the first presentation.

Adolescent contraception: long-acting reversible methods are safe and effective; confidentiality and capacity should be assessed.

Screen time and development: excessive screen time is associated with poorer language and sleep outcomes; discuss routines rather than impose bans.

Vaccine catch-up: schedules exist for children who missed doses; the number of doses needed depends on age at catch-up.

Depression in older adults may present with somatic complaints or cognitive change rather than low mood; screen when there is functional decline.

Lithium monitoring: check levels 12 hours post-dose, plus renal and thyroid function; toxicity presents with tremor, ataxia and confusion.

Clozapine: requires regular full blood count monitoring for neutropenia; fever or sore throat requires urgent testing.

Suicide postvention: bereaved family and friends are at increased risk and may benefit from support and follow-up.

Panic disorder: rule out cardiac, respiratory and endocrine causes where presentation is atypical; CBT is first-line.

Alcohol dependence: abrupt withdrawal can be dangerous; assess for risk of seizures and consider assisted withdrawal.

Perinatal psychosis: a psychiatric emergency with high risk to mother and infant; requires urgent specialist involvement.

Mental capacity and psychiatric illness: a psychotic belief may still be a capacitous decision if the person can weigh information; capacity is decision-specific.

Postnatal depression treatment: psychological therapy and SSRIs (sertraline is commonly preferred in breastfeeding) are options; untreated illness carries risk.

Falls and anticoagulation: anticoagulation should not be stopped solely because of falls risk; the stroke risk often outweighs bleeding risk.

Cognitive impairment and driving: assess fitness to drive and advise the licensing authority where required.

Incontinence in older adults: exclude reversible causes (constipation, infection, medications, mobility) before diagnosing chronic incontinence.

Nutrition and hydration at end of life: reduced intake is part of the dying process; artificial hydration may worsen secretions and breathlessness.

Opioid conversion: use an equianalgesic table and reduce the calculated dose for incomplete cross-tolerance when switching.

Terminal agitation: exclude pain, urinary retention, constipation and hypoxia before treating with medication.

Advance care planning documentation: record the discussion, the substitute decision-maker and the goals of care in a place accessible to out-of-hours services.

Palliative care emergencies: spinal cord compression, superior vena cava obstruction, hypercalcaemia and haemorrhage each need urgent specific management.

Grief and depression: grief usually does not require antidepressant treatment; persistent functional impairment warrants assessment.

Health coaching and behaviour change: use the 'ask-tell-ask' sequence rather than advice-giving; elicit the patient's own reasons for change.

Dealing with uncertainty: explicit acknowledgement of uncertainty and a safety-net plan is safer than false reassurance.

Safety netting: state which symptoms should prompt review, the timeframe, and how to access care.

Consent to share information: explain what will be shared, with whom, and why; check the patient's preference.

Consultation with an angry patient: allow uninterrupted venting, summarise the grievance, then negotiate the next step.

Communication with people with cognitive impairment: address the person directly, use short sentences, and involve carers as partners.

Interpreters for sensitive topics: confidentiality must be explained to the interpreter; family interpreters are avoided for intimate or safeguarding matters.

Feedback on communication: use video review or observed consultations; self-assessment correlates poorly with observed performance.

Antibiotic choice: take a microbiological sample before antibiotics where safe, and review the choice at 48-72 hours.

Analgesic ladder: paracetamol and NSAIDs for mild pain; weak opioids for moderate; strong opioids for severe, with laxatives and antiemetics as needed.

Asthma: diagnosis needs variable airflow obstruction; peak flow variability and reversibility testing support it.

COPD: stop smoking, vaccination and pulmonary rehabilitation are core; long-acting bronchodilators are first-line maintenance.

Heart failure: BNP or NT-proBNP is used to rule out heart failure in breathless patients in primary care.

Hypertension: confirm with ambulatory or home monitoring; treatment thresholds depend on age, comorbidity and risk.

Thyroid disease in pregnancy: use trimester-specific reference ranges; untreated hypothyroidism affects fetal development.

Skin cancer: use the ABCDE criteria and dermoscopy; urgent referral for suspicious pigmented lesions.

UTI: dipstick is useful in women with typical symptoms; culture is preferred in men, pregnancy, recurrent infection and treatment failure.

Number needed to screen = number needed to treat divided by prevalence of detectable disease; it conveys screening effort per life saved.

Overdiagnosis is detection of disease that would never have caused harm; it is a harm of screening even when the test is accurate.

Immunisation registers and reminders increase coverage; recall and outreach are more effective than general publicity alone.

Health inequality: life expectancy gaps between the most and least deprived groups are substantial and widened in some countries in recent decades.

Practice population denominator: registered lists may overestimate the population because of list inflation; this affects coverage calculations.

Chronic disease management: registers, recall and review cycles improve process measures, but outcome benefit depends on treatment intensity.

Communicable disease control: isolation periods and post-exposure prophylaxis are set by public health authorities, not by the treating clinician alone.

Screening for familial hypercholesterolaemia: use family cascade screening after an index case is identified.

Consent and capacity in emergencies: treat immediately in a life-threatening situation where consent cannot be obtained, documenting the reasoning.

Competence and training: trainees must be supervised in proportion to their experience; the supervising doctor retains responsibility.

Advertising and claims: doctors must not make unsubstantiated claims about treatments or cures.

Patient choice and referral: patients may request referral to a specific practitioner; the doctor should consider appropriateness and resource implications.

Confidentiality in families: information about one family member should not be shared with another without consent, even in the same household.

Cultural and religious beliefs: explore and accommodate where safe; refusal of blood products requires an advance plan.

Fitness to practise and self-reporting: a doctor with a health condition affecting practice should seek help and may have a duty to inform the regulator.

Professional isolation: solo practitioners should build peer review and second-opinion pathways.

Medical certificates and fraud: issuing a false certificate is a professional and legal offence.

Data breaches: contain, assess, notify where required and document; most jurisdictions have mandatory breach notification for serious breaches.

Consent for children: parental consent is usually required, but a competent minor may consent to their own treatment in many jurisdictions.

Restraint and detention: physical restraint in general practice is exceptional; legal authority and documentation are required.

Workplace safety: needlestick injuries require immediate washing, reporting and assessment for post-exposure prophylaxis.

Practice policies: complaints, infection control, cold chain and medicines management should have written policies reviewed regularly.

Referral pathways: urgent suspected cancer pathways have defined timeframes; use them for red-flag presentations.

Legal capacity and wills: a doctor may be asked to assess testamentary capacity; use a structured assessment and document findings.

Osteoporosis in women: assess fracture risk around menopause; calcium and vitamin D plus weight-bearing exercise are preventive measures.

Menopause and contraception: contraception is needed until 12 months of amenorrhoea after age 50, and 24 months after age 50 if the uterus is present.

Pregnancy hypertension: labetalol, nifedipine and methyldopa are commonly used; ACE inhibitors and ARBs are contraindicated.

Gestational diabetes: lifestyle and metformin are first-line; insulin is added if targets are not met.

Antenatal mental health: ask about mood at booking and postnatally; the EPDS is a screening tool.

Vaginal discharge: distinguish physiological, candidiasis, bacterial vaginosis and trichomoniasis by pH, microscopy and symptoms.

Female genital mutilation: mandatory reporting duties apply in many jurisdictions, including for adults who disclose as children.

Domestic violence: ask directly and safely, provide resources, and document; do not disclose to the partner.

Acute asthma in children: oxygen to target saturation, inhaled beta-agonist via spacer, systemic corticosteroids; reassess after each treatment.

Gastroenteritis: oral rehydration solution is preferred to soft drinks; antiemetics may help with persistent vomiting but are not routine.

Intussusception: colicky pain, drawing up legs, redcurrant stool; ultrasound is diagnostic and air enema is therapeutic.

Pyloric stenosis: projectile non-bilious vomiting at 3-6 weeks, visible peristalsis and a palpable olive; correct electrolytes before surgery.

Undescended testis: refer if not descended by 6 months; orchidopexy is usually performed before 18 months.

Hearing and vision screening: newborn hearing screening and preschool vision screening detect treatable problems early.

Adolescent sleep: delayed sleep phase is common; sleep hygiene and light exposure advice are first-line.

Safeguarding: bruising in a non-mobile infant, injuries in a pattern, and delayed presentation are red flags for abuse.

Depression treatment: mild illness may respond to guided self-help and exercise; moderate-severe illness warrants antidepressant and/or psychological therapy.

Antidepressant discontinuation: taper gradually; abrupt cessation causes discontinuation symptoms such as dizziness and flu-like symptoms.

Bipolar mania: needs urgent specialist assessment; antipsychotics or mood stabilisers are used, and antidepressants are usually stopped.

Psychosis and substance use: dual diagnosis is common; integrated treatment improves outcomes.

Personality disorder: dialectical behaviour therapy is effective for emotionally unstable personality disorder; crisis plans reduce self-harm presentations.

Self-harm: assessment focuses on intent, method, precipitants and protective factors; admission is not automatic.

Dementia and depression: depression can mimic dementia (pseudodementia); cognitive testing before and after treatment helps.

Mental health legislation and physical treatment: treatment for physical illness can proceed under general consent law even when the patient is detained under mental health law.

Delirium prevention: address orientation, hydration, sleep, pain, mobility and sensory aids; multicomponent interventions reduce incidence.

Dementia and pain: pain may present as agitation; use observational tools such as Abbey or PAINAD when self-report is unreliable.

Polypharmacy in palliative care: stop preventive medicines (statins, bisphosphonates) when life expectancy is short, and focus on symptom control.

Opioid side effects: constipation does not resolve with continued use, so prescribe laxatives prophylactically; nausea often settles within a week.

Syringe drivers: used when the oral route is unavailable; compatibility of medicines in the same syringe must be checked.

Spiritual and cultural care: ask about beliefs and rituals and involve chaplaincy or cultural support where wanted.

Bereavement risk: sudden death, young dependants and poor social support increase risk; offer structured follow-up.

Palliative care in non-malignant disease: heart failure, COPD and dementia have unpredictable trajectories; anticipatory planning is still appropriate.

Open disclosure after an error: explain what happened, the consequences, what will be done, and express regret; do not speculate on blame.

Consent and risk communication: use absolute risks and natural frequencies (e.g. 1 in 100) rather than relative risk alone.

Cultural interpreters: professional interpreters are required for consent, safeguarding and complex discussions.

Patient complaints about communication: respond to the emotional content first; a factual response without acknowledgement is perceived as defensive.

Breaking bad news to families: establish who the patient is and what they know, and allow time for questions.

Communication with adolescents: offer confidentiality and explain its limits at the start of the consultation.

Written action plans: asthma and anaphylaxis plans improve outcomes when written and reviewed with the patient.

Consultation closure: summarise, confirm the plan, and state the safety-net and follow-up explicitly.

Anticoagulation in atrial fibrillation: DOACs are preferred to warfarin in most non-valvular AF; mechanical valves require warfarin.

Hypothyroidism: levothyroxine is titrated by TSH, checked 6-8 weeks after dose change.

Hyperthyroidism: carbimazole or propylthiouracil; PTU is preferred in the first trimester of pregnancy.

Gout: NSAIDs, colchicine or corticosteroids for acute attacks; urate-lowering therapy is not started during an acute attack unless already established.

Chronic kidney disease: stage by eGFR and albuminuria; ACE inhibitors or ARBs are used in albuminuric CKD.

Osteoarthritis: exercise and weight loss are core; intra-articular corticosteroid provides short-term relief.

Low back pain: most is non-specific; imaging is not indicated without red flags.

Red flags in headache: sudden onset, fever, neurological deficit, new onset after 50, or change in pattern.

Diabetes: metformin remains first-line; SGLT2 inhibitors and GLP-1 agonists have cardiovascular and renal benefits in selected patients.

Screening test performance in low-prevalence populations: even a highly specific test yields many false positives when prevalence is low.

Vaccine effectiveness is measured in observational studies; no vaccine is 100% effective, so vaccinated cases still occur.

Outbreak thresholds: a single case of a disease targeted for elimination (e.g. measles, polio) triggers public health action.

Health system funding models (fee-for-service, capitation, pay-for-performance) shape clinician behaviour and access.

Rural and remote health: workforce shortages and travel distance reduce access; telehealth and outreach mitigate but do not eliminate inequity.

Environmental health: air quality, housing damp and heat waves have measurable effects on respiratory and cardiovascular admissions.

Antimicrobial resistance surveillance uses local antibiograms to guide empirical therapy.

Screening participation is lower in disadvantaged groups, which can widen rather than narrow inequalities.

Consent for research: participants must be competent, informed and free from coercion; payment must not be unduly influential.

Professional boundaries with vulnerable patients: extra care is needed where there is dependency, such as in mental illness or palliative care.

Confidentiality and adolescents: explain the limits (risk of serious harm) at the start, and encourage parental involvement where safe.

Ethical allocation of scarce resources: transparency, consistency and clinical need are the defensible criteria.

Duty to report impaired colleagues: patient safety takes precedence over loyalty; report to the appropriate authority.

Social media and patient contact: do not provide clinical advice through personal social media accounts.

Conscientious provision of care: declining to provide a service must not leave the patient without timely alternatives.

Professional development: reflective practice and audit are professional obligations, not optional extras.

Medical records and legal requests: respond to subpoenas and court orders through the practice's legal process, disclosing only what is required.

Consent and photography: clinical images require consent, and use for teaching or publication requires specific consent.

Prescribing off-label: document the rationale and the evidence, and discuss with the patient where relevant.

Dispensing and cold chain: vaccines must be stored within the recommended temperature range and monitored with data loggers.

Infection control: hand hygiene, sharps disposal and spill management follow standard precautions.

Practice complaints and the regulator: a complaint may be made directly to the regulator; the practice should cooperate fully.

Locum and contracting arrangements: indemnity, registration and scope of practice must be confirmed before starting.

Legal minors and parental responsibility: not all parents have parental responsibility; check before obtaining consent for a procedure.

Endometrial cancer risk: unopposed oestrogen, obesity, tamoxifen and PCOS increase risk; postmenopausal bleeding is the key symptom.

Ovarian torsion: sudden severe unilateral pain with nausea; urgent surgical assessment is needed.

Mastitis: continue breastfeeding, empty the breast, and use antibiotics if symptoms are severe or persist beyond 24 hours.

Contraceptive pill and blood pressure: check blood pressure before starting and annually; hypertension may contraindicate combined methods.

Menopause and osteoporosis: fracture risk assessment guides treatment; bisphosphonates are used where risk is high.

Pregnancy and travel: live vaccines are avoided; inactivated vaccines may be given where indicated.

Postpartum contraception and breastfeeding: progestogen-only methods do not reduce milk supply and are suitable.

Cervical screening after hysterectomy: screening may be discontinued if the hysterectomy was for benign disease and no cervical tissue remains.

Neonatal sepsis: risk factors include maternal fever, prolonged rupture of membranes and group B streptococcus colonisation; thresholds for investigation vary.

Cyanotic heart disease: duct-dependent lesions present with cyanosis; prostaglandin infusion maintains the ductus arteriosus.

Kawasaki and vaccination: live vaccines are deferred after IVIG because of passive antibodies.

Childhood obesity: use BMI centile for age and sex; lifestyle intervention for the family is the mainstay.

Adolescent mental health: depression and anxiety are common; screen and refer early, and involve school where appropriate.

Febrile illness and antipyretics: antipyretics relieve discomfort but do not prevent febrile convulsions.

Childhood eczema: emollients and topical corticosteroids; avoid soap and use fragrance-free products.

Vaccine hesitancy in parents: acknowledge concerns, provide specific information and maintain the relationship even if declined.

Postpartum psychosis: onset is usually within 2 weeks of birth; urgent referral and admission are often required.

Medication in pregnancy: SSRIs are generally continued where the risk of relapse is high; untreated illness also carries risk.

Anxiety in older adults: may present as physical symptoms; screen and treat rather than attribute to age.

Benzodiazepine dependence: taper slowly, with psychological support, to avoid withdrawal seizures.

Opioid dependence: naloxone take-home kits reduce overdose deaths; prescribe where risk is high.

Psychiatric emergencies: risk of harm to self or others, severe self-neglect and psychosis with risk require urgent specialist assessment.

Mental health and physical comorbidity: depression worsens outcomes in diabetes and cardiovascular disease; integrated care improves outcomes.

Cultural formulation: consider cultural explanations of illness and idioms of distress in assessment.

Frailty and surgery: frailty predicts postoperative complications; preoperative assessment should include function and cognition.

Dementia and decision-making: a diagnosis of dementia does not remove capacity; assess the specific decision.

Falls and vitamin D: supplementation is considered in older adults with deficiency or limited sun exposure.

Pressure ulcers and nutrition: nutritional support and repositioning reduce risk; document staging and review.

Palliative sedation: used for refractory symptoms in the last days; the intention is symptom relief, and consent or best-interests discussion should be documented.

Opioid toxicity: pinpoint pupils, drowsiness and reduced respiratory rate; naloxone is used cautiously in opioid-tolerant patients.

Advance care planning and out-of-hours care: ensure the plan is accessible to ambulance and after-hours services.

Carer support: carers have a legal right to assessment in many jurisdictions; offer information and respite.

Teach-back: ask the patient to explain the plan in their own words; this detects misunderstanding better than asking if they understood.

Breaking bad news: allow silence and tears, and respond to emotion before moving to information.

Shared decision-making tools: decision aids improve knowledge and reduce decisional conflict.

Consultation with an interpreter: speak to the patient, not the interpreter, and use short segments.

Complaints and apology: an apology is expected and does not usually constitute an admission of liability.

Cultural safety: ask about the patient's preferences for family involvement in decision-making.

Communication in dementia: use the person's name, short sentences and non-verbal cues; avoid arguing with delusions.

Patient feedback: use structured feedback to improve communication, not as a measure of popularity.

Antibiotic allergy: clarify the reaction; a history of rash is not always true allergy, and delabelling improves outcomes.

Anaphylaxis: intramuscular adrenaline into the anterolateral thigh; repeat after 5 minutes if needed.

Acute asthma in adults: oxygen, inhaled beta-agonist, ipratropium for severe cases, systemic corticosteroids and magnesium for severe or life-threatening attacks.

Opioid conversion: use equianalgesic tables and reduce for cross-tolerance; review after switching.

Thyroid storm: urgent supportive care, beta-blocker, thionamide and iodine after the thionamide.

Hyperkalaemia: ECG changes, calcium gluconate for cardiac protection, insulin-dextrose and salbutamol; dialysis in refractory cases.

Hyponatraemia: correct slowly to avoid osmotic demyelination; the rate depends on chronicity and symptoms.

Anticoagulation and procedures: plan interruption and bridging according to bleeding and thrombotic risk.

Vaccination in pregnancy: inactivated influenza and pertussis vaccines are recommended in many programmes.

Screening programme evaluation: measure mortality reduction, stage shift and interval cancers; survival alone is biased by lead time.

Vaccination coverage measurement: use the registered population as the denominator, with data quality checks.

Health promotion: brief advice on smoking, alcohol and physical activity is effective when repeated and linked to support.

Antimicrobial stewardship: delayed prescriptions and patient education reduce antibiotic use.

Outbreak communication: consistent, timely messaging reduces anxiety and improves adherence.

Chronic disease registers: coding accuracy affects recall and funding; audit data quality regularly.

Population ageing: increases demand for chronic disease and palliative care; workforce planning should reflect this.

Screening for hepatitis B and C in at-risk groups: targeted testing is more cost-effective than universal screening in low-prevalence populations.

Consent and capacity: a patient may refuse treatment that the doctor considers best; document the discussion.

Confidentiality and public interest: disclose only the minimum necessary and record the reasoning.

Professional boundaries: avoid treating relatives or friends where possible; if unavoidable, document and consider referral.

Conflicts of interest: declare and manage; do not let financial interests influence clinical decisions.

Whistleblowing: follow the organisation's policy and escalate to the regulator if needed.

Social media: maintain professional boundaries and never post identifiable patient information.

Research integrity: report results honestly, including negative findings, and declare funding.

Cultural competence: recognise your own biases and how they affect communication and decision-making.

Records and access: patients can request access; respond within the legal timeframe and redact third-party information.

Prescribing: check dose, route, frequency and duration; avoid abbreviations that can be misread.

Controlled drugs: follow jurisdiction rules for quantity, validity and repeat prescriptions.

Sick leave: state functional capacity and expected duration; review if prolonged.

Complaints: acknowledge, investigate and respond in writing; identify system changes.

Indemnity: ensure cover for the full scope of practice, including telehealth and minor procedures.

Retention: keep records for the required period, including after a patient moves away or dies.

Reporting: know the mandatory reporting duties in your jurisdiction and follow them promptly.

Cervical screening: HPV testing is primary; abnormal results are triaged by genotype and cytology.

Contraception: combined methods are contraindicated in migraine with aura; progestogen-only methods are preferred.

Emergency contraception: copper IUD is the most effective; ulipristal is more effective than levonorgestrel near ovulation.

Menopause: diagnose clinically after 12 months of amenorrhoea over age 45; FSH is not required.

Hormone therapy: systemic therapy for vasomotor symptoms; vaginal oestrogen for genitourinary syndrome.

Preeclampsia: hypertension after 20 weeks plus proteinuria or end-organ dysfunction; aspirin for high-risk women.

Gestational diabetes: 75 g OGTT at 24-28 weeks; thresholds vary by guideline.

Postpartum haemorrhage: uterine atony is the commonest cause; treat with uterotonics and resuscitation.

Bacterial vaginosis: clue cells, pH >4.5, fishy odour; metronidazole or clindamycin.

Paediatric weight: (age + 4) × 2 kg for ages 1-10 in emergencies.

Development: sits at 6-8 months, walks at 12-18 months, two-word phrases by 2 years; regression needs investigation.

Fever under 3 months: urgent assessment and low threshold for investigation.

Bronchiolitis: supportive care; bronchodilators and steroids are not routine.

Croup: dexamethasone; nebulised adrenaline for moderate-severe stridor with observation.

Otitis media: immediate antibiotics for young infants, severe symptoms or bilateral infection in young children.

Kawasaki: fever ≥5 days plus 4 of 5 criteria; IVIG and aspirin reduce coronary risk.

Immunisation: live vaccines are avoided in significant immunosuppression and pregnancy.

Adolescent confidentiality: capacity increases with maturity; explain limits at the start.

Depression: ≥2 weeks of low mood or anhedonia plus ≥4 other symptoms with functional impairment.

Suicide risk: ask directly about ideation, plan, means, previous attempts and protective factors.

SSRIs: benefit takes 2-4 weeks; review early for adverse effects and suicidality, especially in young people.

Serotonin syndrome: agitation, clonus, hyperreflexia, hyperthermia from serotonergic combinations.

Benzodiazepines: short-term use only; dependence and withdrawal seizures are risks.

Alcohol withdrawal: benzodiazepines first-line; thiamine to prevent Wernicke encephalopathy.

Bipolar disorder: antidepressant monotherapy can precipitate mania; mood stabiliser is the foundation.

Eating disorders: anorexia has the highest mortality; monitor electrolytes, QTc and weight.

Perinatal depression: EPDS is a screening tool, not a diagnosis; above threshold triggers fuller assessment.

Comprehensive geriatric assessment: medical, functional, cognitive, psychological and social domains; reduces hospitalisation in at-risk older adults.

Frailty: Clinical Frailty Scale predicts outcomes; frailty is not the same as age.

Polypharmacy: use Beers or STOPP/START criteria; deprescribe with a taper plan.

Anticholinergic burden: contributes to confusion, falls and urinary retention; review in cognitive decline.

Falls: multifactorial assessment of vision, gait, medication, home hazards, postural blood pressure and continence.

Delirium vs dementia: delirium is acute, fluctuating and attentional; dementia is chronic and progressive.

Palliative pain: WHO ladder; prescribe laxatives with regular opioids.

Advance care planning: records goals and preferences; an advance directive may be legally binding for refusal.

Palliative care: appropriate from diagnosis of a life-limiting illness, alongside disease-directed treatment.

Open disclosure: explain what happened, the consequences, what will be done and express regret; avoid speculation on blame.

Risk communication: use absolute risks and natural frequencies rather than relative risk alone.

Interpreters: professional interpreters are required for consent, safeguarding and complex discussions.

Complaints: acknowledge the emotional content first; a factual response without acknowledgement feels defensive.

Breaking bad news to families: establish who the patient is and what they know; allow time for questions.

Adolescents: offer confidentiality and explain its limits at the start.

Written action plans: asthma and anaphylaxis plans improve outcomes when written and reviewed.

Consultation closure: summarise, confirm the plan and state the safety-net and follow-up explicitly.

Atrial fibrillation: DOACs preferred to warfarin in non-valvular AF; mechanical valves require warfarin.

Hypothyroidism: levothyroxine titrated by TSH, checked 6-8 weeks after dose change.

Hyperthyroidism: carbimazole or PTU; PTU preferred in the first trimester.

Gout: NSAIDs, colchicine or corticosteroids for acute attacks; urate-lowering therapy not started during an acute attack unless already established.

CKD: stage by eGFR and albuminuria; ACE inhibitors or ARBs for albuminuric CKD.

Osteoarthritis: exercise and weight loss are core; intra-articular corticosteroid gives short-term relief.

Low back pain: most is non-specific; imaging not indicated without red flags.

Headache red flags: sudden onset, fever, neurological deficit, new onset after 50, or change in pattern.

Diabetes: metformin first-line; SGLT2 inhibitors and GLP-1 agonists have cardiovascular and renal benefits in selected patients.

Screening in low-prevalence populations: even a highly specific test yields many false positives when prevalence is low.

Vaccine effectiveness: measured in observational studies; no vaccine is 100% effective.

Elimination targets: a single case of measles or polio triggers public health action.

Funding models: fee-for-service, capitation and pay-for-performance shape clinician behaviour and access.

Rural and remote health: workforce shortages and travel distance reduce access; telehealth mitigates but does not eliminate inequity.

Environmental health: air quality, damp housing and heat waves affect respiratory and cardiovascular admissions.

Antimicrobial resistance: local antibiograms guide empirical therapy.

Screening participation: lower in disadvantaged groups, which can widen inequalities.

Research consent: participants must be competent, informed and free from coercion; payment must not be unduly influential.

Vulnerable patients: extra care with boundaries where there is dependency, such as mental illness or palliative care.

Adolescent confidentiality: explain limits (risk of serious harm) at the start and encourage parental involvement where safe.

Scarce resources: transparency, consistency and clinical need are the defensible criteria.

Impaired colleagues: patient safety takes precedence over loyalty; report to the appropriate authority.

Social media: do not provide clinical advice through personal accounts.

Conscientious objection: declining a service must not leave the patient without timely alternatives.

Professional development: reflective practice and audit are professional obligations.

Legal requests: respond to subpoenas and court orders through the practice's legal process, disclosing only what is required.

Clinical images: consent required; use for teaching or publication needs specific consent.

Off-label prescribing: document the rationale and evidence, and discuss with the patient where relevant.

Cold chain: vaccines stored within the recommended range and monitored with data loggers.

Infection control: hand hygiene, sharps disposal and spill management follow standard precautions.

Complaints to the regulator: the practice should cooperate fully.

Locum arrangements: confirm indemnity, registration and scope before starting.

Parental responsibility: not all parents have it; check before obtaining consent.

Endometrial cancer: unopposed oestrogen, obesity, tamoxifen and PCOS increase risk; postmenopausal bleeding is the key symptom.

Ovarian torsion: sudden severe unilateral pain with nausea; urgent surgical assessment.

Mastitis: continue breastfeeding, empty the breast, and use antibiotics if severe or persisting beyond 24 hours.

Contraceptive pill: check blood pressure before starting and annually; hypertension may contraindicate combined methods.

Menopause and osteoporosis: fracture risk assessment guides treatment; bisphosphonates where risk is high.

Pregnancy and travel: live vaccines avoided; inactivated vaccines may be given where indicated.

Postpartum contraception: progestogen-only methods do not reduce milk supply and are suitable.

Cervical screening after hysterectomy: may be discontinued if for benign disease and no cervical tissue remains.

Neonatal sepsis: risk factors include maternal fever, prolonged rupture of membranes and group B streptococcus colonisation.

Cyanotic heart disease: duct-dependent lesions present with cyanosis; prostaglandin maintains the ductus arteriosus.

Kawasaki and vaccination: live vaccines are deferred after IVIG because of passive antibodies.

Childhood obesity: use BMI centile for age and sex; family-based lifestyle intervention is the mainstay.

Adolescent mental health: depression and anxiety are common; screen and refer early, involving school where appropriate.

Antipyretics: relieve discomfort but do not prevent febrile convulsions.

Childhood eczema: emollients and topical corticosteroids; avoid soap and fragrance.

Vaccine hesitancy: acknowledge concerns, give specific information and maintain the relationship if declined.

Postpartum psychosis: onset usually within 2 weeks of birth; urgent referral and often admission.

Medication in pregnancy: SSRIs are generally continued where relapse risk is high; untreated illness also carries risk.

Anxiety in older adults: may present as physical symptoms; screen and treat rather than attribute to age.

Benzodiazepine dependence: taper slowly with psychological support to avoid withdrawal seizures.

Opioid dependence: take-home naloxone reduces overdose deaths; prescribe where risk is high.

Psychiatric emergencies: risk to self or others, severe self-neglect and psychosis with risk need urgent specialist assessment.

Physical comorbidity: depression worsens outcomes in diabetes and cardiovascular disease; integrated care improves outcomes.

Cultural formulation: consider cultural explanations of illness and idioms of distress.

Frailty and surgery: frailty predicts postoperative complications; preoperative assessment includes function and cognition.

Dementia and decision-making: a diagnosis does not remove capacity; assess the specific decision.

Falls and vitamin D: supplementation considered in older adults with deficiency or limited sun exposure.

Pressure ulcers: nutritional support and repositioning reduce risk; document staging and review.

Palliative sedation: used for refractory symptoms in the last days; intention is symptom relief, with consent or best-interests discussion documented.

Opioid toxicity: pinpoint pupils, drowsiness and reduced respiratory rate; naloxone used cautiously in opioid-tolerant patients.

Out-of-hours care: ensure the advance care plan is accessible to ambulance and after-hours services.

Carer support: carers have a legal right to assessment in many jurisdictions; offer information and respite.