GP Multi-Issue Consultation Template

Consult Summary

58M w/ R knee pain x 3/52, suboptimal T2DM/HTN control, & scripts request. Plan: XR R knee, ↑ metformin, add amlodipine, repeat HbA1c/U&E in 3/12, physio ref.

Issues

Issue 1: Right knee pain

• Gradual onset R medial knee pain over 3 weeks.
• Aggravated by stairs and prolonged walking; relieved by rest.
• Morning stiffness lasting less than 20 minutes.
• Denies locking, giving way, or acute trauma.
• No systemic features, fevers, or weight loss.
• Nil other joint involvement.
• Keen gardener, kneeling frequently over recent weekends.
• Taking paracetamol (Panadol®) PRN with minimal relief.
• O/E: Mild medial joint line tenderness, crepitus, small effusion.
• DDx: Osteoarthritis, degenerative medial meniscal tear, pes anserine bursitis.

Issue 2: T2DM and Hypertension Review

• Routine review of bloods and home BP monitor readings.
• Asymptomatic; no polyuria, polydipsia, blurred vision, or chest pain.
• No postural dizziness or peripheral oedema.
• Home BP averaging 152/92 mmHg over past fortnight.
• Compliant with perindopril and metformin; diet suboptimal recently.
• Recent path (12/05/2024): HbA1c 7.8 %, eGFR > 90 mL/min.
• Fasting lipids: TC 4.2 mmol/L, LDL 2.1 mmol/L.
• Urine ACR normal at 1.2 mg/mmol.
• Reviewed by podiatrist 14/03/2024: normal neurovascular foot assessment.

Medications

• perindopril erbumine (Coversyl®) 5 mg PO daily
• metformin hydrochloride (Diabex®) 500 mg PO BD
• atorvastatin (Lipitor®) 20 mg PO nocte
• paracetamol (Panadol®) 1,000 mg PO QID PRN

Past Medical History

• Type 2 diabetes mellitus (diagnosed 2019)
• Essential hypertension (diagnosed 2018)
• Hyperlipidaemia
• GORD

Social History

• Lives at home with wife; works as an accountant.
• Ex-smoker (ceased 2010, 15 pack-year history).
• Alcohol: 1–2 standard drinks on weekends.
• Sedentary job; walks dog 20 mins daily.

Preventative History

• National Bowel Cancer Screening (FOBT) negative 10/11/2023.
• PSA normal (1.1 ng/mL) on 12/05/2024.
• Influenza vaccine administered 15/04/2024.
• Optometry Diabetic Eye Check normal 02/02/2024; skin check NAD 2023.

Physical Examination

• BP: 156/94 mmHg (sitting, repeat 152/90 mmHg)
• HR: 74 bpm, regular
• Weight: 92 kg
• BMI: 29.4 kg/m²
• Temp: 36.6 °C
• R knee: antalgic gait, trace effusion, no erythema/warmth.
• R knee: medial joint line tenderness, ROM 0–115 degrees.
• R knee: McMurray's equivocal medially, ligaments stable.
• CVS: HS dual + nil, chest clear, no pedal oedema.

Impression

• Issue 1: R knee osteoarthritis, DDx degenerative medial meniscal tear.
• Issue 2: Suboptimally controlled T2DM and essential HTN.

Plan

• Discussed weight loss, low-impact exercise, and knee offloading strategies.
• Advised low-GI diet and reduced salt intake.
• Avoid NSAIDs given cardiovascular/renal risk profile.
• Safety-netted for red flags (hot swollen joint, chest pain).
• XR R knee (weight-bearing) to assess joint space/OA severity.
• Refer to local physiotherapist for quadriceps strengthening programme.
• Increase metformin hydrochloride (Diabex®) to 1,000 mg PO BD.
• Commence amlodipine (Norvasc®) 5 mg PO daily for BP.
• Repeat U&E in 2/52; HbA1c, FBG, lipids in 3/12.
• Review in 2 weeks for XR results and BP check.