The universal GP Training website for everyone, not just Bradford.   Created in 2002 by Dr Ramesh Mehay

Bradford VTS Online Resources:

Clinical Knowledge


Important features in the history

  • If you would like to have a go at adding some “top tips” to this page for this specialty (and have your name displayed proudly with bradfordvts),  please email me –

Important features in the Examination

Vertigo: The HINTS examination

The HINTS exam- this exam helps to differentiate between peripheral and central cause of vertigo, such as vestibular neuritis vs stroke.   It should be done on patients who present within hours or days of on going vertigo and nystagmus.

  • Reassuring HINTS exam is – Unidirectional nystagmus, No vertical skew, and abnormal head impulse test. likely vestibular neuritis.
  • Worrying HINTS test is – Bidirectional or vertical nystagmus, vertical skew or normal head impulse test. Need imaging to rule out posterior or cerebellar stroke.

Red Flags

Other Top Tips

      • 1st seizure in young people: medication is often only started after a 2nd seizure.  In contrast, new-onset epilepsy in older people (>65y) is often treated after just a single seizure. Why? More likely to be an underlying cause – for example, scarring from a stroke. Risk of harm from seizures may be greater – for example, seizure causes fall >> fracture.   Also, more likely to live alone – increased risk of sudden unexpected death in epilepsy (SUDEP).
      • All older people with a seizure need to be seen urgently at the hospital for a full workup.  Immediately if you think there may have been a stroke that triggered this.  2ww if you are concerned there may be an underlying tumour.  Neurology outpatients within 2 weeks for all with new onset of seizures.
      • Decision to treat is made by the hospital but GPs asked to up-titrate medication. Bear in mind that as a general rule of thumb: the initial dose and rate of titration of antiepileptic medication in older people should be about half of that in younger patients – helps with tolerability.

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Bradford VTS was created by Dr. Ramesh Mehay, a Programme Director for Bradford GP Training Scheme back in 2001. Over the years, it has seen many permutations.  At the time, there were very few resources for GP trainees and their trainers so Bradford decided to create one FOR EVERYONE. 

So, we see Bradford VTS as  the INDEPENDENT vocational training scheme website providing a wealth of free medical resources for GP trainees, their trainers and TPDs everywhere and anywhere.  We also welcome other health professionals – as we know the site is used by both those qualified and in training – such as Associate Physicians, ANPs, Medical & Nursing Students. 

Our fundamental belief is to openly and freely share knowledge to help learn and develop with each other.  Feel free to use the information – as long as it is not for a commercial purpose.   

We have a wealth of downloadable resources and we also welcome copyright-free educational material from all our users to help build our rich resource (send to

Our sections on (medical) COMMUNICATION SKILLS and (medical) TEACHING & LEARNING are perhaps the best and most comprehensive on the world wide web (see white-on-black menu header section on the homepage).