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The term goitre refers to an abnormal enlargement of the thyroid gland, typically caused by iodine deficiency or autoimmune diseases such as Graves' disease or Hashimoto's thyroiditis, as well as hormonal changes, thyroid nodules or thyroid cancer. Symptoms include a visible neck swelling, throat tightness, coughing, hoarseness and difficulty swallowing or breathing. Untreated goitre can lead to c...

Global travel offers many opportunities for adventure – but some come with medical considerations. An infrequent but important consultation is altitude medicine for people planning to travel to areas high above sea level. In episode 80, Dr James Waldron and Dr Rashbal Ghattaora talked about how to approach a travel consultation, with notes on relevant medications and counselling. In this episode,...

Undiagnosed type 2 diabetes is an increasing and concerning trend in the UK, particularly among Black and Asian ethnic groups and in areas of high deprivation. Early diagnosis and management are crucial, particularly in younger adults and underserved populations. Therefore, education, screening, and tailored treatment pathways are needed, but reaching these groups can be challenging. In this episo...

Transient loss of consciousness (TLoC) affects nearly half the population of the UK at some point in their lives and is not an uncommon presentation in primary care. In this episode, Dr Kate Chesterman discusses the initial assessment of these patients and the factors that will help to differentiate between vasovagal syncope, cardiac syncope and epilepsy. She gives guidance on referral criteria an...

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age, as well as being a major cause of infertility and pregnancy complications. It includes symptoms of hyperandrogenism, the presence of hyperandrogenaemia, oligo-ovulation or anovulation and polycystic ovarian morphology on ultrasound. It is strongly associated with complications that may arise from it, i...

In this episode, Dr Hannah Rosa discusses erectile dysfunction. Using the latest guidelines, this episode takes you through everything to consider when first reviewing a patient with erectile dysfunction, including key points to cover in the history and examination and which investigations to order. A four-step approach to management is discussed, along with guidance on referral and follow up. Acc...

Quitting smoking is the single most important thing a smoker can do to improve their health, and with the right combination of support, medication and determination, individuals can successfully overcome their nicotine addiction and enjoy a smoke-free life. For many, quitting smoking completely can be a challenge due to the addictive nature of nicotine, but various strategies and treatments are av...

In this episode, Dr Hannah Rosa discusses a condition that affects 95% of people aged 11–30 to some extent: acne. The 2021 NICE guideline on acne vulgaris is explored in detail, and broken down into four steps: Getting the diagnosis of acne right, including how to grade its severity What constitutes good general skin-care advice Management options The new MHRA guideline on isotretinoin. Access epi...

Testicular torsion is a urological emergency that usually affects young men, and a high index of suspicion is vital to ensure prompt diagnosis and management. A history and physical examination consistent with testicular torsion requires immediate surgical assessment for scrotal exploration – and if the initial examination suggests testicular torsion, the surgical approach should take precedence o...

Disclosing sexual violence is a difficult and emotional prospect for a patient and the way a GP responds can set the course of that person’s journey. It is important we get it right, but it is a complex topic. In this second part of our series on sexual violence, Dr James Waldron is joined again by Hayley Wilson (Consent and Sexual Violence Development Officer at Nottingham Trent University) to ex...

Hypothyroidism, or an underactive thyroid gland, is increasingly common as people get older, but it may often be undiagnosed or diagnosed late due to the insidious nature of some of its symptoms. These include fatigue, weight gain, sensitivity to cold, constipation, dry skin, hair loss and depression. Common causes of hypothyroidism include autoimmune diseases, thyroid surgery, radiation therapy,...

Restless leg syndrome (RLS) is prevalent in around 5–10% of the population and can result in an impact on quality of life that is comparable to conditions such as type 2 diabetes and osteoarthritis. It can result in significant impairments in sleep, energy, daily activities and behaviour and is associated with anxiety and depression in those who experience it. In this episode, Dr Kate Chesterman d...

Benign prostatic hyperplasia (BPH) is an extremely common condition seen in clinical practice, and one which can cause considerable difficulties in older men. Common symptoms include frequent urination, difficulty starting urination, weak urine stream or the need to urinate during the night – all of which significantly impact on quality of life. Treatment options vary depending on symptom severity...

Understanding sexual violence is vitally important in primary care. A GP may be the first (or only) individual spoken to by a person who has experienced sexual violence. But how often does the experience disclosed represent the full scope of the issue? How much sexual violence goes unreported? What has changed about our understanding of sexual violence and its context? In this episode, the first o...

In this episode, Dr Hannah Rosa discusses a topic which is at the heart of good clinical care: empathy. Research has shown that empathy decreases as medical students progress through medical school and that in society empathy levels have fallen over recent decades. But what does this mean for us working in primary care? What are the benefits that increasing empathy in our clinical practice can bri...

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder that primarily affects the joints. Causing joint pain, stiffness, swelling and reduced joint motion, its exact cause is still unknown, but is believed to involve a combination of factors. In this episode, Dr Roger Henderson looks at the aetiology of RA, diagnostic testing and the management pathway for patients with the condit...

In this episode, which has been recorded for Chronic Conditions Month 2024, Dr Yassir Javaid (GP with a Specialist Interest in Cardiology) examines the role of the QRISK3 calculator in the primary prevention of cardiovascular disease. He considers the development of the tool, the differences between QRISK2 and QRISK3 (including the additional risk factors now included in the updated calculator) an...

Diverticular disease is a condition characterised by the presence of small pouches, called diverticula, in the wall of the colon (large intestine). These pouches can develop when weak spots in the colon's muscular wall give way under pressure. Diverticular disease encompasses two main conditions: diverticulosis and diverticulitis. In this episode, Dr Roger Henderson takes an overview look at the s...

Coeliac disease (CD) is a chronic autoimmune disorder that primarily affects the small intestine and is triggered by the consumption of gluten, a protein found in wheat, barley, rye and sometimes oats. When individuals with CD ingest gluten, their immune system responds by damaging the lining of the small intestine. This damage impairs the absorption of nutrients from food, leading to various symp...

In this episode, Dr Hannah Rosa takes a look around the world at some of the different strategies that are being used to try to reduce the health complications caused by alcohol. She then looks at the latest research which links alcohol as a primary cause of a variety of cancers, before finishing with a consideration of the economic cost. Access episode show notes containing key references and tak...

Obesity is a medical condition characterised by excessive accumulation of body fat, to the point where it may have adverse effects on health. Its incidence is steadily rising in both young people and adults. It is typically measured using BMI, but this has limitations and may not always accurately represent the level of obesity. While genetics and hormonal factors have a role in obesity, lifestyle...

Recurrent vulvovaginal candidiasis is reported in 6% of women of reproductive age. It has a significant impact on an individual’s quality of life that is comparable to conditions such as asthma and migraine. Appropriate management of the acute infection and subsequent maintenance treatment can help to reduce the burden of this condition. In this episode, Dr Kate Chesterman discusses the risk facto...

The most common cause of peptic ulcers (gastric and duodenal) is infection with Helicobacter pylori (H. pylori) or the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Other factors such as excessive alcohol consumption, smoking, stress and certain medical conditions may also contribute to the development of peptic ulcers. Symptoms of peptic ulcer disease can vary but may include bu...

Dysphagia refers to difficulty swallowing. It can occur at any age and may be caused by various conditions, including neurological disorders, muscular disorders, structural abnormalities, or even psychological factors. Dysphagia can range from mild to severe, and it can lead to complications such as malnutrition, dehydration and aspiration pneumonia if not properly managed. The treatment for dysph...

Trigeminal neuralgia (TN) is a condition characterised by severe, shooting pain in the face, along the trigeminal nerve. The pain can be triggered by even mild stimulation of the face, such as brushing teeth, touching the face or eating. It is often described as one of the most excruciating pains known to medicine and it can significantly impact a person's quality of life. The exact cause of trige...