Produces fluid which protects and enriches sperm. A tube like structure called the urethra carries urine from the bladder to penis and this runs through the middle of the prostate. Urethra can be narrowed if the prostate enlarges and this is what causes the urinary symptoms
Treatments for BPH
Conservative watch and wait
Reduce alcohol and caffeine
Drugs for BPH
Alpha blockers- tamsulosin-relaxes smooth muscle of the prostate
5alpha reductase inhibitors- finasteride- blocks the conversion of an enzyme in the prostate that is responsible for the enlargement
Surgery-TURP- transurethral resection of prostate or prostatectomy
Safety NET- IF NOT IMPROVING RETURN TO GP
Ix PSA biopsy of prostate (urologist)
‘Cells in the prostate become abnormal and multiply out of control, most common over 65, cmnest uk cancer’
Narrowing of one or more arteries. Mainly affects the arteries supplying blood to legs. It is due to fatty plaques developing on inside lining of the blood vessels.
Smoking cessation, exercise, WL, reduce alcohol
tx identifiable causes- HTN/ DM
safety return if symptoms worsen or not improving
vascular urgently if rest pain, absent foot pulses, pallor/evidence of gangrene.
symptoms/signs of Delerium tremens
Tremor, confusion, fits, visual hallucinations.
ASK under 16s when coming for contraception
How OLD is your partner?
Was the sex consensual or did you feel coerced/forced?
Are your parents/ carer aware of your sexual activity?
Are your parents/carer aware that you are here to see me today?
Do you feel able to tell your parents/carer?
Have you ever been drunk or under the influence of drugs whilst having sexual intercourse?
Any hx depression/ mental health problems?
UNDER 13- CHILD PROTECTION REFER URGENT, +- SS/police
Mental state exam brief
3.Address 42 west street(recall for later)
5. name current location
6. identification 2 ppl
8. Year world war 1
9. 20 to 1 count down
10 recall address from earlier
Recessive gene e.g. cf
For a person to suffer with this condition must get two copies of the defective gene. For a child to suffer with this both parents must be carriers of the affected gene.The child could get just one copy of the defective gene which would make them a carrier.If 2 ppl with the recessive gene- 25% chance their children will suffer 25% that they will not have the condition or carry the gene and a 50% that they will be carriers.
Test is done on blood/saliva not 100% accurate.
Assymptomatic NVH- 2 of 3 dipstick positive—Check BP, creatinine and eGFR and send urine for ACR and PCR.
Refer if any one of : eGFR<60ml/min, ACR>30 PCR> 50 BP>140/90- nephrology referral
Scenario: I want slimming pills!!
Man BMI 17.5, wants to slim.
Start open Q- why do you think these would be useful for you?
Whats been going on in your life?
What are you doing to try to lose the weight?
Exploring concerns and Ideas, important because of....
Can you tell me what you eat going through a normal day please....
Who do you live with? Have you spoken to them about how youre feeling, job, depression
‘your BMI is a measure of what is a normal and healthy weight in relation to height- yours is below what is considered normal and healthy. This could be harmful as your body will not be getting the nutrients it needs.’
Alcohol/smoking/Do you take anything else- laxatives etc??
Empathy- Im sorry that you view yourself in this negative way.
I want to help you as I think you have a negative body image and I think you need some help from a specialist in this condition. Also I could refer you to a dietitian for further dietary advice.What do you think about this?
Giles 62years heavy alcohol intake-Sent by my wife who is concerned.
HPC/ PMH/FH/ SH/ DH
Can you tell me what you drink and how much on a typical day from when you get up until when you go to bed...
How much per week- work out units...
JOB/ DRIVING>>SHOULDN T drive dangerous+++
Challenge his beliefs- Giles I feel you are drinking above the recommended safe level, this could cause lots of problems with your health
Clarify why you cant give him a note. Use what he likes to help him- I know your wife is v concerned perhaps if you cut down your alcohol this may help your marriage.
Thanks for telling me that.
Alcohol dependant – needs to be referred specialist team how does he feel about this?
Dyspepsia red flags
Examine abdomen- epigastric mass
Richard Williams – ED BMI 25, 42yrs no pmh
How can I help? clarify why he is here
How long has it been going on?
Is it difficult getting/ maintaining?
Sexual partner/more than one??
Make him feel at ease- This is a very common problem.
Causes smoke, alcohol, psychological, pvd. Assess mood how affecting relationship?
Invite wife- marriage counselling
Did you have anything in mind to help this ?? How do you feel about that ? Pick up cues!!
Sarah 41yrs pmh nad
Why stressed? Vomiting and stress in work
Concentration/sleep/libido/ appetite/ social support/ relationships/ how is it affecting her body?
Explore vomiting – when ? pattern/blood/ food/ LMP? PREGNANT
Folic acid/smoking ask/ cant give you tablets as youre pregnant