Referral Points Flashcards
Cold
Q: Under what circumstances should a cold be referred to a GP?
A: Severe earache, vulnerable patients (e.g., very young, elderly, heart or lung disease, asthma), persistent fever and cough, chest pain, or unexplained shortness of breath.
Cough
Q: What are key reasons to refer a patient with a cough to a GP?
- Symptoms lasting longer than 2 weeks and not improving
- Chest pain
- Shortness of breath
- Wheezing
- Recurring cough at night
- Suspected drug-induced cough (e.g., ACE inhibitors, beta-blockers)
- Whooping cough/croup
- Foul-smelling sputum
- Yellow, green, brown or blood stained phlegm/sputum
Sore Throat
Q: When should a patient with a sore throat be referred to a GP?
A: Dysphagia (difficulty swallowing), symptoms lasting longer than 7-10 days, hoarseness persisting over 3 weeks, sore throat with skin rash, pus/exudate on tonsils with fever and swollen glands, recurrent infections, suspected adverse drug reaction (e.g., carbimazole), breathing difficulties, or failed treatment.
Ear Wax
Q: When should a patient with ear wax be referred?
A: If there is a foreign body in the ear, pain, dizziness, tinnitus, or failure of OTC treatment.
Headache
Q: When should a headache be referred?
A: If associated with recent head trauma, in children under 12, accompanied by stiff neck, fever, or rash, sudden/severe onset and/or severe pain, suspected adverse drug reaction (e.g., oral contraceptives), drowsiness, blackouts, visual disturbances, vomiting, or recurring headaches.
Constipation
Q: When should a patient with constipation be referred to a GP?
A: Blood in the stools, pain on defecation, suspected drug-induced constipation (e.g., opiates, antidepressants), presence of abdominal pain, vomiting, bloating, weight loss, failed treatment, or change in bowel habit lasting over 2 weeks.
Diarrhoea
Q: What are key referral criteria for diarrhoea?
A: Persistent change in bowel habits, recent foreign travel, blood or mucus in stools, severe vomiting with fever, dehydration signs (e.g., dry mouth, drowsiness, passing little urine, confusion, sunken fontanelle/eyes), lasting more than 3 days in adults, 2 days in young children, or 1 day in babies under 1 year.
Dyspepsia (Indigestion)
Q: When should a patient with dyspepsia be referred?
A: Unexplained weight loss, suspected drug-induced dyspepsia (e.g., NSAIDs, ferrous sulphate), persistent vomiting, symptoms lasting longer than 5 days or recurring, black/tarry stools, severe pain, pain radiating to other parts of the body eg arm, symmptoms developing for the first time in a patient over 45 years old, dysphagia (difficulty swallowing), or failed treatment.
Haemorrhoids (Piles)
Q: When should a patient with haemorrhoids be referred?
A: Blood in stools, abdominal pain or vomiting, weight loss, persistent bowel habit change, or symptoms lasting longer than 3 weeks.
Mouth Ulcers
Q: What are referral criteria for mouth ulcers?
A: Symptoms lasting longer than 3 weeks, suspected drug-induced ulcers (e.g., NSAIDs), clusters of 5-10 ulcers, rash, diarrhoea, weight loss, or involvement of other mucous membranes.
Cystitis
Q: When should a patient with cystitis be referred?
A: If the patient is diabetic, immunocompromised, pregnant, male, elderly (women?), or a child, if there is vaginal discharge, blood in urine (haematuria), if there is fever, nausea and or vomiting, pain and tenderness in loin pain, recurrent cystitis, failed treatment, or symptoms lasting more than 2 days.
Primary Dysmenorrhoea (Menstrual Pain)
Q: When should a patient with primary dysmenorrhoea be referred?
A: If there is abnormal vaginal discharge, heavy or unexplained bleeding, systematic symptoms suggesting infections (eg fever), or symptoms suggestive of secondary dysmenorrhoea.
Vaginal Thrush
Q: What are key referral criteria for vaginal thrush?
A: If the patient is diabetic, has had more than two episodes in 6 months, failed OTC treatment, is pregnant, has vaginal/ vulval sores, ulcers or blisters, green/yellow or blood-stained vaginal discharge, foul-smelling discharge, is under 16 or over 60, has no improvement after 7 days, has a history of STDs or exposure to partner with STDs, abnormal vaginal bleeding, or associated lower abdominal pain or dysuria.
Athlete’s Foot
Q: When should a patient with athlete’s foot be referred?
A: If the condition does not respond to treatment, affects the nails, spreads beyond the foot/ other parts of the foot, affects a diabetic patient, or shows signs of bacterial infection (e.g., pus, weeping, yellow crusts).
Cold Sores
Q: What are referral criteria for cold sores?
A: Symptoms lasting more than 2 weeks, lesions inside the mouth, eye involvement, immunocompromised patients, signs of secondary bacterial infection (e.g., pus, weeping, yellow crust), occurrence in babies or children, severe/widespread/worsening lesions, or painless lesions.
Warts and Verrucas
Q: When should a wart or verruca be referred?
A: If anogenital warts are present, facial warts, if the patient is diabetic or immunocompromised, if the wart is bleeding, itching, or has changed in size or color, or if OTC treatment has been unsuccessful after 3 months.
