Practice scenario

Women's health,

Practice scenario: breast soreness in a breastfeeding mother

Mrs Alexander is a new mum. She has been struggling with breastfeeding, has experienced pain when the baby latches on, and has woken this morning with a painful left breast.

08 Apr 2026

Skin and nail,

Practice scenario: swollen ankles

A 61-year-old man presents with a 36 to 48-hour history of unilateral ankle swelling and pain that appears to be getting worse. His medical history reveals he is hypertensive (amlodopine 5mg od), has type 2 diabetes (metformin 500mg tds) and receives statin therapy (atorvastatin 40mg od). None of his medications have been changed over the last 12 months. What do you advise?

20 Feb 2026

Skin and nail,

Practice scenario: Generalised, widespread rash

A man in his 40s asks to speak with you. He tells you he has been bothered by an itchy rash on his legs for the last week or so but now it is also on his arms. He has not tried any medication to get rid of the rash but has been taking an antihistamine to help with the itching. Otherwise, he is fit and healthy and takes no prescribed medicines. What do you advise?

20 Oct 2025

Older people's health,

Practice scenario: Confusion in the elderly

Mr T is a 77-year-old man with a number of medical problems including angina, type 2 diabetes and COPD. At his last review three months ago, he was stable with no alterations to his medication regimen. Today, when his carer picks up his medication, she says he hasn’t quite seemed himself for the last few days and is a little confused. She didn’t think to mention it to the doctor given that he is prone to being distracted at times. What is your advice?

13 Oct 2025

Child health,

Practice scenario: Childhood diarrhoea

A father seeks advice for his four-year-old daughter, who is at home. She has had diarrhoea for the last 36 hours, with frequent trips to the toilet, where she passes very loose and watery stools. She has also been sick a couple of times during the last 24 hours. Both he and his wife have been trying to make their daughter eat and drink but have restricted her to soup. What would you advise him to do? By Professor Paul Rutter, University of Portsmouth

02 Sep 2025

Endocrine and metabolism,

Practice scenario: excessive thirst and urination

A 58-year-old male presents complaining of frequent urination and excessive thirst for the last two months. He tells you he has been going to the toilet a lot – and not just during the day. He has had to get out of bed at least twice every night. He does not describe having urgency and reports no pain or other symptoms. His medical history reveals that he has high blood pressure, for which he takes ramipril 10mg daily. He also suffers from intermittent dyspepsia-like symptoms that are controlled with omeprazole 20mg daily. What do you advise?

28 Jul 2025

child-rash-chicken-pox-scarlet-fever-summary

Child health,

Practice scenario: maculopapular rash in young boy

The parents of a six-year-old boy come to see you. They tell you that Jake has been poorly for the past two days. He complained originally of a sore throat but, while that is getting better, Jake now has a temperature and they have also noticed a distinctive rash spreading up his trunk. He is normally fit and healthy with no other medical problems. What do you advise?

07 Jul 2025

Gastrointestinal,

Practice scenario: Presence of dark or tarry stools

Paul, 55, presents at the pharmacy on a Saturday morning. He tells you that over the last two or three days, he has noticed that his stools are darker than normal. When he flushes the toilet, the pan does not become clean. He hasn’t had a change in the number of bowel movements and doesn’t have any other symptoms, apart from a little stomach discomfort. He is otherwise fit and healthy and takes no medication on a regular basis. What would you advise him to do?

20 Jun 2025

Allergies,

Practice scenario: Nasal congestion

Debbie, 26, presents one afternoon in the pharmacy. She thinks she might be getting hay fever. She has never had it before but over the last week, her nose has been blocked and she is coughing as her throat is irritated. She also says that her eyes have been watering. Her medical history is unremarkable. She has mild asthma, for which she occasionally uses a blue ‘reliever’ inhaler, but only rarely. What would you advise?

12 May 2025

Musculoskeletal,

Practice scenario: non-trauma related bruising

A 46-year-old woman presents in the pharmacy asking for advice about how she can stop getting bruised. She tells you that most of the time she cannot even remember banging an arm or leg, but bruises just seem to appear. She says this has been going on for ages. Although she doesn’t mind too much when this happens, they can look unsightly. Her history reveals no medical conditions and only one trip to hospital when she was a teenager for a broken left arm. What should you do next?

06 May 2025

Pregnancy & baby care,

Practice scenario: a crying baby

Rob and Louise Davies have been struggling for the last couple of weeks with their baby May, who has been crying much more than usual. They understand that babies cry a lot, but are concerned that May is not happy or ill. They tell you that in between the crying, she seems generally to be fine. They have been giving her colic mixture, but this does not seem to have helped. What do you advise?

16 Jan 2025

Healthy living,

Practice scenario: Unintentional weight loss

A patient, Grace Foden, is struggling with her energy levels and feels so tired by the end of the day that she just wants to sit around watching TV. She says she has dropped a dress size over the past four months but hasn’t been on any specific diet. Grace is not on any medicines apart from the contraceptive pill. What do you advise?

30 Oct 2024

Pain relief,

Everyday scenario: Dealing with elbow pain

Andrew Cotton, a man in his mid-40s, asks for a “good painkiller” to ease the pain he has been experiencing in his elbow for a number of weeks. He says it seems to be getting worse. He has been taking paracetamol on a regular basis and has no other conditions. What do you advise?

13 May 2024

Clinical,

Everyday scenario: Sudden chest pain

Larry Cooper calls the pharmacy wanting advice. He has tried to contact his GP surgery but could not get through. He has been getting chest pain and feels nauseous. He says his symptoms have been present for about 20 to 30 minutes and have eased a little but are still bothersome. What should you do next?

23 Apr 2024

Problem Skin,

Generalised pruritus

Jane Morris, a 71-year-old regular patient, has been bothered with generalised itchy skin for the past two to three months, which is causing sleeping difficulties. The itching started on her return from an extended break in Spain. She takes atorvastatin for hyperlipidaemia and seems to have a residual tan from her holiday. What do you advise?

13 Sep 2023

Child health,

Croup-like symptoms

A young mum is anxious about her 18-month-old boy, who has been coughing violently and had some difficulty breathing the previous night. While things seem easier this morning, he is still coughing a lot and breathless as well. What do you advise?

16 Aug 2023

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Practice scenario: breast soreness in a breastfeeding mother