Knowledge guides

LG15: General medicine presentations and conditions

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

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Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.

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Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.

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Presentations
  • Abdominal distension
  • Abdominal mass
  • Abnormal speech and communication
  • Adverse drug reaction
  • Agitation, acute
  • Altered bowel habit
  • Altered conscious state
  • Altered gait / Difficulty walking
  • Altered sensation
  • Anorexia / Loss of appetite
  • Anuria / Oliguria
  • Bleeding:
    • abdominal
    • rectal
    • vaginal
  • Cardiac murmur
  • Changes to vision / Visual loss
  • Confusion
  • Constipation
  • Cough
  • Diarrhoea
  • Discharge:
    • nipple
    • urethral
    • vaginal
  • Dizziness
  • Dysmenorrhoea
  • Dyspareunia
  • Dysphagia
  • Dyspnoea
  • Dysuria
  • Erectile dysfunction
  • Facial droop
  • Falls
  • Fatigue / Lethargy / Malaise / Tiredness
  • Fever
  • Haematemesis
  • Haematuria
  • Haemoptysis
  • Headache
  • Hearing loss
  • Hyperglycaemia
  • Hypertension
  • Hypoglycaemia
  • Hypotension
  • Insomnia
  • Intoxication, acute
  • Itch / Pruritus
  • Jaundice
  • Lesions:
    • breast
    • skin
  • Loss of consciousness
  • Lymphadenopathy:
    • in the neck
  • Malnutrition
  • Medication optimisation / rationalisation
  • Melaena
  • Menorrhagia
  • Muscle weakness:
    • generalised
    • specific
  • Nocturia
  • Oedema / Swelling:
    • generalised
    • joint
    • lower limb
    • peripheral
  • Pain:
    • abdominal
    • acute
    • chest
    • chronic
    • facial
    • joint
    • musculoskeletal
  • Pallor
  • Palpitations
  • Polydipsia
  • Psychological distress
  • Psychosis
  • Pyrexia of unknown origin
  • Rash
  • Seizure
  • Sensory disturbance
  • Somnolence
  • Stridor
  • Substance misuse
  • Suicidal ideation
  • Syncope
  • Tinnitus
  • Trauma:
    • head injuries
    • joint injuries
    • lacerations
    • soft tissue injuries
  • Tremor
  • Urinary retention
  • Vertigo
  • Vomiting
  • Weakness
  • Weight change:
    • gain
    • loss
  • Wheeze

For each presentation and condition, Advanced Trainees will know how to:

Synthesise
  • recognise the clinical presentation
  • identify relevant epidemiology, pathophysiology, and clinical science
  • take a relevant clinical history
  • conduct an appropriate examination
  • establish a differential diagnosis
  • plan and arrange appropriate investigation
  • consider the impact of illness and disease on patients and families, and their quality of life
Manage
  • provide evidence-based management
  • for less common or more complex presentations and conditions the trainee must also seek expert opinions
  • prescribe therapies tailored to patients’ needs and conditions
  • recognise potential complications of disease and its management, and initiate preventative strategies
  • involve multidisciplinary teams
Consider other factors
  • identify individual and social factors and the impact of these on diagnosis and management

For each presentation and condition, Advanced Trainees will know how to:

Synthesise
  • recognise the clinical presentation
  • identify relevant epidemiology, pathophysiology, and clinical science
  • take a relevant clinical history
  • conduct an appropriate examination
  • establish a differential diagnosis
  • plan and arrange appropriate investigation
  • consider the impact of illness and disease on patients and families, and their quality of life
Manage
  • provide evidence-based management
  • for less common or more complex presentations and conditions the trainee must also seek expert opinions
  • prescribe therapies tailored to patients’ needs and conditions
  • recognise potential complications of disease and its management, and initiate preventative strategies
  • involve multidisciplinary teams
Consider other factors
  • identify individual and social factors and the impact of these on diagnosis and management
  • Aetiology, epidemiology, and natural history for general medical conditions listed in this knowledge guide
  • An understanding of how the social determinants of health impact on the conditions listed in this knowledge guide
  • Diagnosis, natural history, and treatment options for people with complex, multisystem, and chronic disorders
  • Epidemiology and determinants of diseases in the local community
  • Long-term effects of chronic substance use
  • Pain management, treatment options, and referral to appropriate healthcare specialists
  • Pharmacology, such as:
    • medication considerations for elderly patients
    • medication rationalisation
    • monitoring and toxicity of immunosuppressive drugs
    • pain management
    • polypharmacy and drug interactions
    • side effects of psychiatric medications in normal doses and in over-dosage
  • Population and global health considerations, such as:
    • burden of disease in population groups, nationally and globally
    • disease prevention
    • environmental influences on health
    • global emergencies and the broad impact on populations
    • health indicators and priorities locally, nationally, and globally
    • immunisation health
    • impact of climate change on health
    • outbreak and disease control
  • Primary preventative care, such as:
    • antibiotic prophylaxis and stewardship
    • cancer screening recommendations
    • preventing hospital-acquired complications
    • promoting healthy lifestyles
    • sexual health screening
    • vaccination
  • Specific needs for an ageing population
Procedures (required)
  • Airway stabilisation procedures
  • Blood product transfusion
  • Indwelling urinary catheter insertion
  • Intravenous cannulation
  • Puncture:*
    • arterial (arterial blood gas sampling)
    • lumbar
  • Ventilation:
    • high-flow oxygen therapy
    • manual
    • non-invasive ventilation:
      • bilevel positive airway pressure (BiPAP)
      • continuous positive pressure ventilation (CPAP)
Procedures (optional)
  • Arterial catheter insertion*
  • Ascitic aspirate / paracentesis
  • Aspiration:*
    • bone marrow
    • joint
    • pleurocentesis
  • Bedside ultrasound
  • Biopsy:*
    • liver
    • skin
  • Bronchoscopy
  • Central venous catheter insertion
  • Endoscopy
  • Endotracheal intubation
  • Intercostal catheter insertion
  • Mechanical ventilation
  • Nasogastric tube insertion
  • Percutaneous long line (PICC)
  • Point-of-care ultrasound (POCUS)
  • Procedural sedation

* Highly recommended for trainees in rural, regional, and remote settings.

General management considerations

  • Chronic pain management and awareness of the psychosocial consequences of chronic pain, such as depression and work loss
  • Complexity theory and its application in the provision of holistic health care
  • Consideration of appropriate secondary prevention, such as secondary stroke prevention
  • Consideration of clinical indications to determine patients’ needs, including comorbidities, and the most appropriate approach to investigations and care
  • Consideration of the patient holistically, including cultural background, ethnicity, family and psychosocial support, geographic location, and socioeconomic status, and the considerations when managing and following up these patients, such as community-based decision making and travel between rural and metropolitan areas
  • Cost, implications, and scope of healthcare-related adverse outcomes
  • Family violence awareness and screening
  • Goals of therapy
  • Informed consent
  • Medication review and polypharmacy management
  • Principles of trauma-informed, patient-centred care
  • Role of allied health professionals in holistic care of patients and families affected by illness
  • Tailoring treatment and management to the setting in which care is being provided, such as clinical resources and workforce planning
  • The timing of decisions and risks for the individual patient

Management considerations specific to ageing patients

  • Correlation between frailty and vulnerability
  • Impacts of changing familial dynamics / roles, such as children caring for ageing or frail parents
  • Role of aged care services and aged care assessment teams
  • Transitions to supported accommodation

Management considerations specific to end-of-life care

  • Awareness of voluntary assisted dying (VAD) legislation and implications for discussion and management of VAD as an end-of-life option
  • Common problems associated with end-of-life care, such as dyspnoea, end organ failure, and pain
  • Medical and social factors associated with medical futility
  • Medicolegal aspects of decisions regarding advance health directives, capacity to consent, and resuscitation
  • Suitability and timing of discussions regarding ceiling of care, organ donation, and resuscitation

Management considerations specific to patients with chronic illness

  • Awareness and access to appropriate disability services and aids
  • Difference between curative, palliative, and rehabilitative approaches to disease management
  • Factors in rehabilitation and lifestyle management
  • Impact of chronic disease and medication on fertility
  • Impact of illness and disability on patients’ ability to care for family members
  • Interplay of psychosocial factors in the morbidity of chronic disease
  • Long-term implications of chronic disease on work
  • Navigation of sub-specialty advice and guidelines
  • Stanford model of chronic disease management

Management considerations specific to young adults

  • Educational and vocational resources available to adolescents with special needs, and interaction of the physician with these services
  • Issues of consent
  • Transfer of responsibility from parents to patient