Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE PrEP vs PEP PrEP Indications Recommended for: MSM, heterosexuals, transgender/gender diverse individuals, IV drug users at risk of HIV Those with high HIV anxiety Risk assessment: Past 3 months’ risk (e.g. condomless anal/vaginal sex, STIs, chemsex, injecting drugs) Foreseeable risk (e.g. travel, leaving a monogamous relationship) Investigations Prior HIV testing: Exclude acute HIV infection STI screen: Hep A/B/C, chlamydia, gonorrhoea, syphilis Renal function: eGFR >60 Hepa B status: Immunise if non-immune Discuss adherence, potential side effects (headache, nausea) Monitoring Every 3 months: HIV, STI testing Kidney function: Check at 3 months, then every 6 months PrEP takes 7 days to become effective Common side effects: headache, nausea Check for medication interactions (e.g., high-dose NSAIDs, antivirals) PEP (2-1-1 method for MSM) Start within 72 hrs post-exposure Dosage: 2 pills 2 hrs before intercourse (up to 24 hrs prior) 1 pill 24 hrs and 48 hrs after the first dose Medication: Tenofovir/emtricitabine PrEP vs PEP PrEP (Pre-Exposure Prophylaxis) Indications High-Risk Groups: MSM, heterosexuals, transgender/gender-diverse persons at elevated risk IV drug users with sharing equipment Individuals with high HIV-related anxiety or foresee risk Risk Assessment Past 3-month behaviour: Condomless anal/vaginal sex, recent STIs, chemsex, needle sharing Future/foreseeable risk: Travel to high-prevalence areas, leaving monogamous relationship, new partnerships Investigations Prior to Initiation HIV Testing: Must exclude existing HIV infection (acute HIV) STI Screen: Hepatitis A/B/C, chlamydia, gonorrhoea, syphilis Renal Function: eGFR >60 mL/min for safe use Hepatitis B Status: Immunise if non-immune (tenofovir also active against HBV) Discuss adherence and potential side effects (headache, nausea) Monitoring Every 3 Months: HIV test, STI testing Kidney Function: At 3 months, then every 6 months if stable Onset: Takes ~7 days for full rectal mucosal protection, possibly longer (21 days) for vaginal mucosa (some guidelines differ) Side Effects: Headache, nausea (usually mild, self-limiting) Check drug interactions (e.g., high-dose NSAIDs, other antivirals) PEP (Post-Exposure Prophylaxis) Post-exposure prophylaxis, must be started within 72 hours of possible exposure (sexual or needle-stick). Typically 28-day course of combination antiretrovirals (e.g., tenofovir/emtricitabine + a third agent). (Note: The “2-1-1 method” refers to on-demand (event-based) PrEP for MSM, not PEP. It is sometimes mistaken for PEP but is actually a type of PrEP used before and after intermittent exposures.) On-Demand (Event-Based) PrEP (2-1-1) for MSM Start: 2 tablets of tenofovir/emtricitabine 2–24 hours before sexual intercourse Then: 1 tablet 24 hours after first dose, and 1 tablet 48 hours after first dose Suited for infrequent sexual exposures (MSM). Must ensure no existing HIV infection and normal renal function prior. Summary of Differences Aspect PrEP (Pre-Exposure) PEP (Post-Exposure) Purpose Prevent HIV in high-risk individuals beforeexposure Prevent HIV infection after a potential exposure Timing Daily or Event-Based (2-1-1) usage prior to risk Within 72 hours of exposure, ideally ASAP Duration Ongoing (daily) for continuous risk, or short course around events (2-1-1 method) 28-day regimen of antiretrovirals Drugs Tenofovir/emtricitabine ± others if indicated (e.g. descovy or truvada) Typically 2–3 drug combination: e.g. Tenofovir/emtricitabine + raltegravir or dolutegravir Monitoring HIV, STI screen, renal function every 3 months; more frequent if issues Baseline HIV/renal function, repeat HIV testing at 4–6 weeks & 3 months post-exposure; LFTs, etc. Notes PrEP reduces HIV acquisition risk by >90% when taken correctly. PEP is emergency prophylaxis; start within 72 hours or efficacy drastically reduces. On-demand PrEP (“2-1-1”) is not the same as PEP; it’s still a pre-exposure measure for those with intermittent exposures (commonly MSM). Encourage safe sex, regular STI screening, and counselling for risk reduction. Bookmark Failed! Bookmark Saved! Add Bookmark Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Dizziness / Syncope Common causes: Anxiety (hyperventilation), intoxication (alcohol/drugs), orthostatic hypotension, vasovagal Neurological: Vertebrobasilar insufficiency, TIA/stroke, hypoglycaemia, cataplexy, pseudoseizures, substance-induced Cardiac: Arrhythmias (heart block, SVT, VT), outflow obstruction (aortic stenosis, HOCM, PE) Vasovagal: Triggered by heat, stress, cough, strain Orthostatic: Dehydration, vomiting, bleeding, medications (diuretics, CCBs, nitrates) Key assessment: Prodromal symptoms, differentiate syncope vs presyncope, orthostatic BP measurements History Alcohol intake (can induce hypoglycaemia) Illicit drugs Neurological signs (weakness, sensory/speech changes → central cause) Hyperventilation episodes Palpitations, chest pain, SOB (cardiac) Sudden onset, rapid recovery (suggests cardiac cause) Prolonged standing, stress event (vasovagal) Poor oral intake, recent bleeding Recent medication changes (hypotension risk) Key assessment: Frequency, duration, triggers, witnessed LOC or incontinence Investigations Bloods: FBC, BSL, UEC (rule out metabolic causes) ECG ± Holter (detect arrhythmias) CT brain (if central cause suspected) Orthostatic BP: Supine, immediate standing, 3 mins post-standing Echocardiogram (if cardiac suspicion or abnormal ECG) Medication review (deliriogenic/hypotensive agents) Management Hydration, electrolyte balance Cardiology referral + echocardiogram (if cardiac cause suspected) Treat underlying cause based on findings Vasovagal syncope: Educate on trigger avoidance, counter-pressure maneuvers Medication review: Adjust diuretics, CCBs, nitrates if contributing Lifestyle modifications: Gradual positional changes, small frequent meals, increased salt (if indicated) Dizziness / Syncope Differentials Common Causes: Anxiety (hyperventilation), intoxication (alcohol/drugs), orthostatic hypotension, vasovagal Neurological: Vertebrobasilar insufficiency, TIA/stroke, hypoglycaemia, cataplexy, pseudoseizures, substance-induced Cardiac: Arrhythmias (heart block, SVT, VT), outflow obstruction (aortic stenosis, HOCM, pulmonary embolism) Vasovagal: Triggered by heat, stress, cough, strain Orthostatic: Dehydration, vomiting, bleeding, medications (diuretics, CCBs, nitrates) Key Assessment: Prodromal symptoms, differentiate syncope vs presyncope, orthostatic BP measurements History Alcohol intake (risk of hypoglycaemia) Illicit drug use Neurological signs (weakness, sensory or speech changes suggest central cause) Hyperventilation episodes Palpitations, chest pain, SOB (possible cardiac cause) Sudden onset, rapid recovery (suggests arrhythmic/cardiac cause) Prolonged standing, stress event (vasovagal) Poor oral intake, recent bleeding Recent medication changes (risk of hypotension) Frequency, duration, triggers, witnessed LOC or incontinence Investigations Bloods: FBC, BSL, UEC to exclude metabolic derangements ECG ± Holter monitor to detect arrhythmias CT brain if central neurological cause suspected Orthostatic BP: Check supine, immediately standing, then at 3 minutes Echocardiogram if cardiac abnormality suspected or ECG changes Medication review (deliriogenic or hypotensive agents) Management Ensure adequate hydration, correct electrolyte imbalances Cardiology referral + echocardiogram if cardiac cause is likely Treat underlying cause based on investigations Vasovagal syncope: Educate on avoiding triggers, use counter-pressure maneuvers Medication review: Adjust diuretics, CCBs, nitrates if contributing to hypotension Lifestyle modifications: Slow positional changes, small frequent meals, increased salt intake if indicated Bookmark Failed! Bookmark Saved! Refresh Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Diplopia Types & Causes Monocular Diplopia (persists when one eye covered): Refractive errors (corrected with lenses) Cataract, keratoconus Retinal pathology (e.g., macular degeneration) Binocular Diplopia (resolves with either eye covered): Neurological: CN III, IV, VI palsies (urgent) Thyroid eye disease: Restricted movement (esp. inferior rectus) Myasthenia gravis: Fatiguable weakness Intracranial pathology: Tumours, aneurysms, ↑ ICP Microvascular ischaemia: Diabetes, hypertension Trauma: Orbital fractures Red Flags (Urgent Referral) Binocular diplopia + pain, anisocoria, or ptosis Suspected GCA: Headache, jaw claudication, scalp tenderness, ↑ ESR/CRP Aneurysm or intracranial tumour suspicion Cranial Nerve Palsies CN III: Features: Eye "down and out," ptosis, ± mydriasis (pupil-involving) Pupil-involving: Compressive lesion (e.g., aneurysm) → urgent imaging Pupil-sparing: Likely microvascular → monitor for resolution in 3 months CN IV: Features: Eye "up and out," worsens on downgaze, head tilt compensates Causes: Trauma, idiopathic, microvascular, compressive CN VI: Features: Eye fails to abduct Causes: ↑ ICP, microvascular, trauma Urgent referral: If headache or papilloedema present Common Causes Microvascular ischaemia (older adults with diabetes, hypertension) Post-viral mononeuropathy (e.g., herpes zoster) Intracranial pathology (tumours, aneurysms, MS) Idiopathic Notes Myasthenia gravis: Fatiguable diplopia, test with ice pack or edrophonium GCA: Start high-dose steroids, urgent biopsy to prevent vision loss Diplopia Types & Causes Monocular Diplopia (persists when one eye is covered): Refractive errors (often correctable with lenses) Cataract, keratoconus Retinal pathology (e.g. macular degeneration) Binocular Diplopia (resolves with either eye covered): Neurological causes affecting CN III, IV, VI (urgent consideration) Thyroid eye disease (restricted movement, especially inferior rectus) Myasthenia gravis (fatiguable weakness) Intracranial pathology (tumours, aneurysms, raised intracranial pressure) Microvascular ischaemia (common in diabetes, hypertension) Trauma (orbital fractures) Red Flags (Urgent Referral) Binocular diplopia with pain, anisocoria, or ptosis Suspected giant cell arteritis (GCA): Headache, jaw claudication, scalp tenderness, elevated ESR/CRP Suspicion of aneurysm or intracranial tumour Cranial Nerve Palsies Nerve Key Features Causes Comments CN III - Eye “down and out” - Ptosis ± pupil involvement - Pupil-involving → compressive lesion (e.g. aneurysm) → urgent imaging - Pupil-sparing → likely microvascular; monitor for resolution in 3 months Microvascular (diabetes, hypertension) Aneurysm, mass, trauma Pupil involvement is a red flag for compressive etiology CN IV - Eye “up and out” - Worsens on downgaze (e.g. reading, going downstairs) - Patients often tilt head away from lesion Trauma, idiopathic, microvascular, compressive The most commonly injured CN in head trauma CN VI - Failure to abduct the affected eye - Horizontal diplopia, especially on lateral gaze - Raised intracranial pressure can compress CN VI ↑ ICP, microvascular disease, trauma Urgent referral if headache or papilloedema present Common Causes Microvascular ischaemia (often in older adults with diabetes, hypertension) Post-viral mononeuropathy (e.g. herpes zoster) Intracranial pathology (tumours, aneurysms, multiple sclerosis) Idiopathic Notes Myasthenia gravis: Diplopia often improves with rest, or with an ice pack test; edrophonium test can confirm. GCA: Start high-dose corticosteroids urgently to prevent irreversible vision loss. Bookmark Failed! Bookmark Saved! Refresh Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Diabetes Causes of Poor Blood Sugar Level (BSL) Control Incorrect insulin dose Poor medication compliance Incorrect storage of insulin (should not exceed 30 days at room temperature) Incorrect injecting technique SEs of meds (e.g., antipsychotics, steroids) Underlying infection Smoking and alcohol use Poor diet Sedentary lifestyle or lack of exercise Obesity Pharmacological Treatment (Stepwise Progression) Before initiating pharmacotherapy: Trial 3 months of lifestyle changes if HbA1c < 8.5%. First-line: Metformin (unless contraindicated) Second-line: Add a DPP-4 inhibitor, SGLT-2 inhibitor, or sulfonylurea Third-line: Any second-line agent not yet used + GLP-1 receptor agonist or insulin Fourth-line: Intensify by switching or adding GLP-1 receptor agonist or insulin Notes: If already on a GLP-1 receptor agonist, proceed to insulin or add insulin as a fourth hypoglycaemic agent. Assess renal function regularly; avoid SGLT-2 inhibitors and metformin if eGFR < 30 mL/min. If glycaemic target is not achieved after 3 months of each step, progress to the next step. Criteria for IFG and IGT Impaired Fasting Glucose (IFG): Fasting plasma glucose: 6.1 to 6.9 mmol/L (adults) Fasting plasma glucose: 5.6 to 6.9 mmol/L (children and adolescents) Impaired Glucose Tolerance (IGT): 2-hour plasma glucose during an OGTT: 7.8 to 11.0 mmol/L When to Repeat Testing If asymptomatic with a positive result: Confirm diagnosis by repeating the same test on a different day. For prediabetes (IFG/IGT), monitor every 6–12 months to assess progression to diabetes. Frequency of Testing Based on HbA1c or Glucose Levels HbA1c ≥6.5% (48 mmol/mol): Diagnostic of diabetes; repeat testing unnecessary if symptomatic. HbA1c 6.0–6.4% (42–46 mmol/mol): Indicative of prediabetes; testing should be repeated in 6–12 months for progression monitoring. Venous Glucose Levels: Retest annually (or sooner if clinically indicated) for glucose in prediabetes range (IFG or IGT). ____________________________________ Preventative Screening Recommendations (Red book) Individuals at normal risk should undergo screening for diabetes risk using AUSDRISK every 3 years from the age of 40. Criteria for 'High Risk' Diabetes (AUSDRISK >12) 1st-degree relative with diabetes CVD history Belonging to high-risk ethnic groups: Indian subcontinent, Pacific Islanders, ATS), South Asian PCOS Use of antipsychotic meds GDM history Age >40 and BMI >25 kg/m² Hx of IFG or IGT ATSI-Specific Screening Recommendations ATSI people should have annual diabetes screening using FBG or HbA1c from the age of 18, bypassing AUSDRISK. How Often to Screen with Which Test High-risk diabetes: Monitor every 3 years with FBG or HbA1c. Impaired glucose tolerance or fasting glucose: Monitor annually using FBG or HbA1c. Notes: All individuals <25 years with diabetes should be referred to an endocrinologist. In cases of previous GDM, an OGTT is recommended annually if planning another pregnancy. Insulin Initiation Counselling Injection technique: Ensure correct insulin injection technique and educate on site rotation Avoid repeated use of the same injection site to prevent lipohypertrophy Monitoring blood glucose: Teach pre- and post-prandial self-monitoring of blood glucose (BSL) Targets: Pre-prandial: 4–6 mmol/L (individualised) Post-prandial: <10 mmol/L Timing of insulin: Short-acting: Inject 15–30 minutes before meals Long-acting: Typically at bedtime; post-meal Adjusting doses: Adding or adjusting bolus insulin: Start with 4 units SC or increase by 1–2 units based on the highest post-meal BSL. Managing hypoglycaemia: Recognise sx (e.g., sweating, tremor, dizziness) Treat with quick-acting carbohydrates (e.g., glucose tablets, juice) Recheck blood glucose after 15 minutes Lifestyle considerations: Explain the effect of exercise on lowering blood glucose and need for adjustment Mitigation of weight gain associated with insulin therapy through diet and exercise Access to equipment: Enrol the patient in the NDSS for subsidised insulin and equipment Driving considerations: Notify local driving authorities (if required by law) Advise monitoring BSLs before driving Individualised plan: Customise counselling based on patient factors, including literacy, age, and comorbidities. Drugs for Diabetes Biguanides Metformin (modified release) Start 500mg up to 2g daily (egfr >60) Start 500mg up to 1g daily (egfr 30-60) Note: 1g max in immediate release total also SGLT2 Dapagliflozin 10mg od (only dose) (avoid egfr <45) Empagliflozin Ertugliflozin SU Gliclazide modified release 30mg up to 120mg daily (egfr >30) Glipizide Glibenclamide Glimepiride DPP-4 Linagliptin 5mg od (can use all stages of ckd inc egfr <15) Saxagliptin Sitagliptin GLP-1 Liraglutide 0.6mg SC od, incr weekly up to max 1.8mg od (contraindicated egfr <30) Dulaglutide Exenatide SGLT2 Incr glucose release prox tubule of the kidneys → mild diuresis → mild lowering of BP → benefit in cardio patients (esp HF) Good for patient w CVD, diabetes, HF, or is fat (red risk of cardiovasc events and red HF hospitalisations) Not effective for glycaemic control in pts with poor renal function Caution w loop diuretics due to effects of diuresis Counselling Good for weight loss Incr risk of UTI Pre-op stop 3 days prior Avoid VLED or fasting due to DKA risk GLP-1 Incr gastric emptying → decr satiety → nausea incretin mimetic → incr insulin from pancreas → pancreatitis Good for patient w obesity or CVD (cardio benefits → likely from not being fat) Avoid if prev pancreatitis Weight loss drug (Saxenda - liraglutide) DPP-4 Inhibits GLP-1, hence no point adding to GLP-1 Can also cause pancreatitis No weight loss thus less nausea/vomiting No cardio benefits, avoid in heart failure When to Commence Double Therapy Initiate double therapy if HbA1c >8.5% HbA1c target for most adults with diabetes is <7% (individualised based on patient factors such as age and comorbidities) Monitoring Targets Pre-prandial (fasting) blood glucose: 6–8 mmol/L Post-prandial blood glucose: <10 mmol/L Weekly blood glucose reviews to assess control Insulin Initiation and Titration Starting dose of basal insulin: 0.2 units/kg subcutaneously at bedtime Titration: Adjust dose by 10–20% weekly, depending on blood glucose control and risk of hypoglycaemia Sick-day Management General principles: Do not stop basal insulin (risk of DKA if omitted) Increase blood glucose and ketone monitoring to every 1–4 hours Maintain adequate fluid and carbohydrate intake Stop SGLT2 inhibitors to avoid euglycaemic DKA For persistent hyperglycaemia (>15 mmol/L): Add supplemental rapid-acting insulin every 2–4 hours Increase fluid intake Assess for ketosis if blood glucose remains elevated or sx worsen Indications for hospital referral: Persistent vomiting >4 hours Severe or worsening hyperglycaemia Blood ketones >1.5 mmol/L Sx of DKA (e.g., abdominal pain, drowsiness, acetone breath) Notes: Restart meds (e.g., metformin, SGLT2 inhibitors) once the patient is well, eating, and drinking normally. Cycle of Care Examinations (6-monthly): Foot exam Weight, height, and BMI BP Investigations (annually): HbA1c Lipid profile Urine ACR eGFR Education (annually): Reinforce self-care, including smoking cessation Emphasise healthy diet and regular physical activity Medication review Eye exam: Optometry review every 1–2 years, depending on risk factors _ Non-pharmacological Management Lifestyle: Smoking cessation Limit alcohol intake to ≤2 std drinks per day Aim for 5–10% weight loss in overweight or obese patients Exercise: At least 150 mins/week of moderate-to-vigorous aerobic exercise, spread over at least 3 days (no more than 2 consecutive days without activity) Resistance training 2–3 times per week (targeting all major muscle groups) Dietary advice: Increase intake of wholegrains, vegetables, and low-calorie foods Decrease intake of processed and high-fat foods Follow evidence-based guidelines or refer to a dietitian for individualised dietary plans BP Management: Aim for BP <140/90 mmHg If albuminuria is present, target <130/80 mmHg Vaccinations: Annual influenza vaccine Pneumococcal vaccine dTpa booster (if due) Others Involve diabetic nurse educator Organise annual podiatry review Refer for biannual eye review by optometrist Diabetes Causes of Poor Glycaemic Control Incorrect insulin dosing or poor injection technique (lipohypertrophy from repeated use of the same site) Insulin storage issues (avoid extremes of temperature, discard vials/pens after ~30 days at room temperature) Medication non-adherence or side effects (e.g. steroids, antipsychotics) Lifestyle factors (smoking, alcohol, sedentary lifestyle, high-calorie diet, obesity) Underlying infections, acute stressors, or comorbid conditions (e.g. uncontrolled thyroid disease) Pharmacological Treatment (Stepwise) Lifestyle Trial (3 months) If HbA1c <8.5%, intensify diet, exercise, and weight management first First Line Metformin (unless contraindicated by renal or GI issues) 500 mg up to 2 g daily if eGFR >60; up to 1 g if eGFR 30–60 Titrate slowly to reduce GI side effects Second Line Add one of: DPP-4 inhibitor (e.g. linagliptin; safe even in advanced CKD) SGLT2 inhibitor (e.g. dapagliflozin; beneficial in heart failure but avoid if eGFR <30) Sulfonylurea (e.g. gliclazide; risk of hypoglycaemia, weight gain) Choice guided by comorbidities (SGLT2/GLP-1 for ASCVD or HF) Third Line Add an additional second-line agent not yet used Or add a GLP-1 receptor agonist (e.g. liraglutide) if appropriate If HbA1c remains above target, consider basal insulin Fourth Line Intensify insulin regimen or combine insulin with a GLP-1 receptor agonist if not already added Monitoring & Targets Individualise HbA1c target, generally <7% for most adults Reassess every 3 months Renal Considerations Avoid SGLT2 inhibitors and metformin if eGFR <30 Linagliptin is suitable across all stages of CKD Other Oral Agents Acarbose (alpha-glucosidase inhibitor) can reduce postprandial spikes but less commonly used due to GI side effects Meglitinides (repaglinide) sometimes used for postprandial hyperglycaemia Selected Drug Classes SGLT2 Inhibitors (e.g. empagliflozin, dapagliflozin) Promote glucosuria, mild diuresis, reduce HF hospitalisations Stop 3 days preoperatively to avoid euglycaemic DKA Watch for UTIs, dehydration GLP-1 Receptor Agonists (e.g. liraglutide, dulaglutide) Slows gastric emptying, promotes satiety, assists weight reduction Potential CVD benefit, caution if history of pancreatitis Sulfonylureas (e.g. gliclazide) Effective, inexpensive, but risk of hypoglycaemia and weight gain Use lower doses in older adults to avoid severe hypos DPP-4 Inhibitors (e.g. linagliptin, sitagliptin) Minimal hypoglycaemia, neutral weight impact Possible pancreatitis risk Avoid combining with GLP-1 receptor agonists due to overlapping mechanism Insulin Basal (long-acting) vs bolus (rapid-acting) Start low, e.g. 0.2 units/kg basal at bedtime, titrate carefully Consider pre-/post-meal glucose checks to guide bolus insulin Cycle of Care Every 6 Months Foot examination (including pulses, monofilament testing), weight/BMI, blood pressure Annually HbA1c, lipid profile, eGFR, urine albumin-creatinine ratio Eye examination at least every 1–2 years (retinal screening) Screening & Prevention AUSDRISK every 3 years from age 40, or younger if high-risk ethnicity or obesity Aboriginal and Torres Strait Islander people: annual screening from age 18 with fasting glucose or HbA1c Vaccinations (influenza yearly, pneumococcal, ensure dTpa up to date) Assess blood pressure (<140/90, or <130/80 if albuminuria) and lipids regularly Non-Pharmacological Management Lifestyle Smoking cessation, limit alcohol to ≤2 standard drinks/day Aim for 5–10% weight loss if overweight or obese Dietary advice: balanced meals rich in vegetables, wholegrains, lean protein, minimal refined sugars/fats Exercise ≥150 mins/week moderate aerobic activity, with resistance training 2–3 days/week Avoid more than 2 consecutive days without activity Foot Care Encourage daily foot inspection, well-fitting footwear, regular podiatry in neuropathy or PVD Sick Day Management Continue basal insulin Increase glucose and ketone monitoring (every 1–4 hours) Stop SGLT2 inhibitors if unwell to prevent euglycaemic DKA Maintain adequate hydration and carbohydrate intake Consider hospital referral if persistent vomiting or blood ketones >1.5 mmol/L Insulin Initiation Technique & Monitoring Correct injection sites, rotation to avoid lipohypertrophy Check pre- and post-meal BGL (individual targets often 4–6 mmol/L fasting, <10 mmol/L postprandial) Adjusting Doses Increase basal insulin by 2–4 units weekly or 10–20% based on fasting glucose trends Add or adjust bolus insulin for postprandial hyperglycaemia Hypoglycaemia Management Recognise early signs (tremor, sweating, confusion) Treat with 15 g fast-acting carbohydrate, recheck glucose after 15 minutes Educate about driving safety and the need for regular monitoring Notes: Explore medication adherence, injection technique, and lifestyle barriers before escalating treatment Choose therapies considering comorbidities (CKD, HF, ASCVD) for added benefits (SGLT2, GLP-1) Emphasise comprehensive care: foot checks, retinopathy screening, blood pressure/lipid control, vaccination Adjust management promptly if HbA1c remains above target at 3-month reviews Address psychosocial factors and ensure patient education around self-management and hypoglycaemia prevention Bookmark Failed! Bookmark Saved! Refresh Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Pitted Keratolysis Definition Superficial bacterial infection of the soles, causing whitish, malodorous skin with "punched-out" pits Aetiology Bacteria: Corynebacteria, Dermatophilus, Kytococcus sedentarius Moist environments promote bacterial growth → stratum corneum breakdown → sulfur compounds cause malodour Risk Factors Occupations with prolonged moisture exposure (farmers, athletes, sailors) Hot, humid climates, hyperhidrosis, occlusive footwear More common in males Symptoms Whitish, pitted skin on soles Foul odour (most prominent feature) Pits may merge into larger lesions Can be asymptomatic or cause discomfort Management Topical clindamycin 1% lotion BD x 10 days Manage hyperhidrosis (antiperspirants, foot hygiene) Pitted Keratolysis Definition A superficial bacterial infection of the soles, characterised by whitish, malodorous skin with small “punched-out” pits. The condition involves bacterial degradation of the superficial stratum corneum. Aetiology Caused by Corynebacterium, Dermatophilus congolensis, or Kytococcus sedentarius Moist environments foster bacterial growth, leading to stratum corneum breakdown. Sulfur compounds released by these bacteria cause foul odour. Risk Factors Occupations with prolonged moisture exposure (farmers, athletes, sailors) Hot, humid climates, hyperhidrosis, or occlusive footwear More common in males Symptoms Whitish, pitted skin on soles, sometimes merging into larger erosions Foul odour (often the most prominent clinical feature) Can be asymptomatic or mildly uncomfortable Management Topical Antibiotics Clindamycin 1% lotion applied BD (twice daily) for ~10 days Manage Hyperhidrosis Foot hygiene measures: Frequent sock changes, airing footwear, antiperspirants or foot powders Avoid occlusive shoes or use moisture-wicking socks General Measures Keep feet dry, use antibacterial soaps if needed Consider an antifungal if concurrent tinea pedis is suspected Bookmark Failed! Bookmark Saved! Add Bookmark Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Dementia Risk Factors Vascular risk factors (diabetes, hypertension, hypercholesterolaemia, smoking, previous stroke) Family history Depression Traumatic brain injury Excess alcohol Sedentary lifestyle Social isolation Hearing impairment (emerging modifiable risk factor) Types (Most to Least Common) Alzheimer’s: Progressive memory loss, language deficits, normal gait early Vascular: Acute onset, vascular risk factors, neurological symptoms Lewy Body: Parkinsonism, visual hallucinations, fluctuating cognition, avoid Parkinson’s meds if possible, cholinesterase inhibitors may help Frontotemporal: Personality changes, disinhibition, inappropriate behaviour Diagnosis Cognitive tests: GPCOG, RUDAS Exclude reversible causes: Depression, medications (psychotropics, TCAs, benzodiazepines, beta-blockers), metabolic/infectious causes Assess functional impairment (must impact daily life) Avoid MMSE in Lewy Body Dementia/Parkinson’s MMSE scoring: 20–24 = Mild 13–20 = Moderate <12 = Severe Symptoms Impaired memory, concentration, perception, judgement, language Differentials Dementia subtypes (Alzheimer’s, Lewy Body, Frontotemporal, Vascular) Delirium (acute onset) Depression/anxiety Elder abuse Hearing impairment Drug/alcohol abuse Intracranial causes: Space-occupying lesion, chronic subdural haematoma, NPH, stroke Metabolic: B12/folate/iron deficiency, hypercalcaemia, hyponatraemia, hypothyroidism Infective: HIV, syphilis Mild cognitive impairment (MCI): Between age-related memory loss and dementia History Differentiate dementia vs delirium vs depression Acute vs gradual onset Family history Hallucinations Personality/behaviour changes Fluctuating symptoms: Delirium/depression worse at night (sundowning) Depression worse in the morning Sleep disturbances: Depression → early morning waking Assess for reversible causes: Alcohol, falls, headaches, diet, abdominal pain, cold intolerance, infection Investigations Delirium Workup FBC, UEC, LFTs, BGL ECG (AF, ACS, bradycardia – contraindication for cholinesterase inhibitors) Urine MCS If indicated: CT, CXR, troponin, blood cultures Dementia Reversible Causes B12, folate, TFTs CMP, iron studies HIV/syphilis Notes: Normal pressure hydrocephalus: "Wacky, wobbly, wet" (dementia, wide-based gait, urinary incontinence) Chronic subdural haematoma: Trauma absent in 50%, check anticoagulation status AHD terminology: Enduring power of attorney, enduring guardian Management Non-Pharmacological Home aged care assessment Advance care planning (AHD, will creation) Dementia Australia referral Assess driving ability (OT driver assessment) Carer support options Encourage social engagement Education on progressive nature of disease Blister packs, medication review Cognitive training (e.g. crosswords, limited evidence but commonly recommended) Regular aerobic exercise (may improve physical function, cognitive benefit uncertain) Delirium: Review in 48 hours to assess improvement MCI: Regular cognitive monitoring Hearing assessment (hearing aids if needed) Dementia Risk Factors Vascular risk factors (diabetes, hypertension, hypercholesterolaemia, smoking, previous stroke) Family history of dementia Depression Traumatic brain injury Excess alcohol Sedentary lifestyle Social isolation Hearing impairment (recently recognised as a modifiable risk factor) Types (Most to Least Common) Type Key Features Alzheimer’s Progressive memory loss, language deficits, normal gait in early stages Vascular Stepwise decline, associated with vascular risk factors, focal neurological signs Lewy Body Parkinsonism, visual hallucinations, fluctuating cognition; caution with Parkinson’s meds; cholinesterase inhibitors may help Frontotemporal Early personality changes, disinhibition, inappropriate behaviour, younger onset common Diagnosis Cognitive Testing: GPCOG, RUDAS Exclude Reversible Causes: Depression, psychotropic medications (e.g. TCAs, benzodiazepines, beta-blockers), metabolic or infectious causes Functional Assessment: Must show impact on daily life Avoid MMSE in Lewy Body Dementia/Parkinson’s disease (less reliable) MMSE Scoring (for broad reference): 20–24 = Mild impairment 13–20 = Moderate impairment <12 = Severe impairment Symptoms Impaired memory, concentration, perception, judgement, language Differentials Dementia subtypes (Alzheimer’s, Lewy Body, Frontotemporal, Vascular) Delirium (acute onset) Depression or anxiety Elder abuse or neglect Hearing impairment Drug/alcohol misuse Intracranial causes: Tumour, chronic subdural haematoma, normal pressure hydrocephalus (NPH), stroke Metabolic: B12/folate/iron deficiency, hypercalcaemia, hyponatraemia, hypothyroidism Infections: HIV, syphilis Mild cognitive impairment (MCI) History Differentiate dementia vs delirium vs depression Check onset (acute, fluctuating, or gradual) Ask about family history, hallucinations, personality/behaviour changes Look for fluctuating symptoms (e.g. sundowning in delirium/dementia) Sleep disturbances: Depression often worse in the morning, insomnia or early waking Review for reversible factors: Alcohol use, falls, headaches, diet, possible infection Investigations Delirium Workup: FBC, UEC, LFTs, BGL, ECG (check for arrhythmias/contraindications to cholinesterase inhibitors), urine MCS. If indicated, CT brain, CXR, troponin, blood cultures. Dementia Reversible Causes: B12, folate, TFTs, CMP, iron studies, HIV/syphilis serology. Note : Normal pressure hydrocephalus (NPH): “Wacky, wobbly, wet” (dementia, wide-based gait, urinary incontinence). Chronic subdural haematoma: ~50% without clear trauma history, check anticoagulation status. Advanced care planning (AHD) terminology: enduring power of attorney/guardian. Management Non-Pharmacological Home aged care assessment for support services Advance care planning (AHD), will creation Dementia Australia referral for patient/carer support Assess driving safety (occupational therapist driver assessment if needed) Carer support, encourage social engagement Education on the progressive nature of dementia Use blister packs/medication review to ensure adherence Cognitive training (e.g. crosswords, though evidence is limited) Regular aerobic exercise for general health (cognitive benefit uncertain) If delirium risk or MCI, follow up closely to monitor cognitive changes Hearing assessment and aids if indicated Notes Delirium superimposed on dementia can worsen outcomes; early identification is crucial. If suspected post-stroke or vascular dementia, optimise vascular risk factor management (BP, lipids, glucose). Anticholinergics and sedatives can exacerbate confusion; review medications carefully. Hearing impairment can significantly impact cognitive function; correct if possible. Bookmark Failed! Bookmark Saved! Refresh Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Shingles & Postherpetic Neuralgia (PHN) Shingles Treatment Prodrome: Burning pain, headache, fever, lymphadenopathy Antivirals (if within 72 hrs of rash onset): Valaciclovir 1 g TDS x 7 days Start anytime if immunocompromised or ophthalmic involvement Consider Prednisolone 50 mg OD x 7 days (severe cases) Symptomatic relief: Ice packs, paracetamol Early antiviral therapy ↓ PHN risk Postherpetic Neuralgia (PHN) Persistent pain >3 months post-infection (rare if <50 yrs) Zostavax reduces risk in older adults Management First-line: Lignocaine 5% patch (localised pain) Systemic first-line: Amitriptyline 10 mg nocte, titrate as needed Second-line: Pregabalin 75 mg OD or Gabapentin 100 mg BD (adjust per response) Adjuvants: Paracetamol, ice massage, Duloxetine if needed Refractory cases: TENS (2 weeks), Tramadol 100 mg daily, opioids CBT for chronic pain & mood disturbances Vaccination Against Shingles & PHN Recommended ≥60 yrs (funded 70–79 yrs) Household contacts ≥50 yrs (if living with immunocompromised patients) Give before an outbreak, NOT during active shingles Contraindications Pregnancy or ≤4 weeks postpartum Shingles within past year (temporary immunity) Immunocompromised (live vaccine risk) Notes Antiepileptics & topical steroids ineffective for shingles/PHN Same management principles apply to Ramsay Hunt syndrome Shingles (Herpes Zoster) & Postherpetic Neuralgia (PHN) Shingles (Herpes Zoster) Clinical Features Prodrome: Burning pain, headache, fever, lymphadenopathy. Rash: Clustered vesicles on an erythematous base, typically unilateral and dermatomal. Treatment Antivirals (within 72 hrs of rash onset): Valaciclovir 1 g TDS for 7 days If immunocompromised or ophthalmic involvement, start antivirals anytime. Consider Prednisolone 50 mg OD x 7 days for severe cases. Symptomatic Relief: Ice packs, paracetamol/NSAIDs, adequate analgesia. Early antiviral therapy reduces PHN risk. Postherpetic Neuralgia (PHN) Definition Persistent pain >3 months post-shingles rash resolution. Higher risk with older age (>50 yrs). Vaccination with Zostavax can reduce PHN incidence. Management First-Line Local: Lignocaine 5% Patch for well-localised pain areas. Systemic First-Line: Amitriptyline 10 mg nocte, titrate gradually. Second-Line: Pregabalin (start 75 mg OD) or Gabapentin (start 100 mg BD), adjust per response. Adjuvants: Paracetamol, ice massage, duloxetine if partial response. Refractory Cases: TENS for 2 weeks’ trial. Consider Tramadol 100 mg daily or stronger opioids. CBT for chronic pain and mood disturbances. Vaccination Against Shingles & PHN Recommended ≥60 years (funded for 70–79 years in Australia). Household contacts ≥50 yrs if living with immunocompromised patients. Live Vaccine: Give before an outbreak, not during active infection. Contraindications Pregnancy or ≤4 weeks postpartum. Shingles within the past year (temporary immunity). Immunocompromised (risk from live vaccine). Notes Antiepileptics & topical steroids are not effective for acute shingles or PHN relief (except gabapentinoids specifically indicated for neuropathic pain in PHN). Same management principles apply to Ramsay Hunt syndrome (VZV reactivation in CN VII with ear involvement). Bookmark Failed! Bookmark Saved! Refresh Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Carpal Tunnel Syndrome (CTS) & De Quervain's Tenosynovitis Risk Factors Both: Overuse (repetitive wrist/thumb movements, lifting infants), pregnancy CTS: Diabetes, obesity, hypothyroidism Management General: Avoid aggravating activities Splinting: CTS: Night wrist splint (neutral position) De Quervain's: Thumb spica splint Physiotherapy: Rehab exercises for flexibility, strain reduction Medical: Steroid injections: Rapid relief; more effective in early De Quervain's Surgical Referral: CTS: Transverse carpal ligament release De Quervain's: Release first dorsal compartment Note: Splinting/rest: First-line for undiagnosed joint pain while awaiting evaluation Carpal Tunnel Syndrome and De Quervain's Tendosynovitis Definition Carpal Tunnel Syndrome is a median nerve entrapment at the wrist, leading to sensory and motor symptoms in the thumb, index, middle, and radial half of the ring finger. De Quervain’s Tenosynovitis is inflammation of the first dorsal compartment (abductor pollicis longus and extensor pollicis brevis tendons), causing pain and swelling along the radial aspect of the wrist, especially with thumb movements Risk Factors Both Repetitive wrist or thumb activities (e.g. lifting infants, typing, certain sports) Pregnancy (often due to fluid retention) Carpal Tunnel Syndrome Diabetes, hypothyroidism, obesity, rheumatoid arthritis Female sex, particularly peri-menopausal or pregnant/postpartum Workplace factors involving prolonged wrist flexion or vibration De Quervain’s Tenosynovitis Overuse in new parents frequently lifting the baby under the arms Inflammatory arthropathies (e.g. rheumatoid arthritis) Clinical Presentation Carpal Tunnel Syndrome Numbness, tingling, and pain in median nerve distribution (thumb, index, middle, and half of the ring finger), sparing the palm Nocturnal symptoms are common, often causing patients to shake their hand to relieve tingling Weakness or atrophy of the thenar eminence may occur in advanced cases De Quervain’s Tenosynovitis Pain localised to the radial side of the wrist, exacerbated by thumb abduction or extension Swelling at the base of the thumb Positive Finkelstein’s test (increased pain with ulnar deviation of the wrist while grasping the thumb) Examination and Investigations For Carpal Tunnel Syndrome, provocative tests such as Phalen’s and Tinel’s sign can support the diagnosis Ultrasound may show thickening of the flexor tendons or median nerve swelling in CTS, and tenosynovitis in De Quervain’s Nerve conduction studies are helpful for confirming CTS severity and guiding management Imaging is not routinely required for De Quervain’s unless diagnosis is uncertain or there is suspicion of other pathologies Management Conservative Measures Activity modification to avoid repetitive or aggravating motions Use of a neutral-position wrist splint at night for CTS Use of a thumb spica splint for De Quervain’s, particularly in acute flares Non-steroidal anti-inflammatory drugs (NSAIDs) or simple analgesics to alleviate pain Specific hand therapy or physiotherapy exercises to improve tendon gliding, enhance wrist/thumb ergonomics, and reduce strain Address contributing factors such as poorly controlled diabetes or hypothyroidism in CTS Steroid Injections Local corticosteroid injections can provide significant relief, especially in the early stages of both conditions Ultrasound guidance may improve accuracy of injection for De Quervain’s, targeting the first dorsal compartment In pregnancy, injections can be used with caution when splinting and simple measures are insufficient Surgery Consider referral for carpal tunnel release if there is persistent or worsening median nerve dysfunction, or failure of conservative therapy De Quervain’s surgical decompression may be indicated if marked pain or tendon entrapment persists despite splinting and injections Postoperative rehabilitation helps restore grip strength and range of motion Key Points Night splinting is often the first-line conservative management for CTS, especially if nocturnal symptoms predominate Finkelstein’s test is a hallmark clinical test for De Quervain’s Pregnancy-related CTS often improves spontaneously postpartum, though symptom recurrence may happen in subsequent pregnancies or menopause Splinting and rest are beneficial while awaiting specialist evaluation in uncertain cases of wrist or thumb pain Optimising comorbidities (e.g. diabetes, thyroid disease) can reduce severity or recurrence of CTS Early physiotherapy referral and ergonomic assessment can prevent chronicity and promote functional recovery Bookmark Failed! Bookmark Saved! Add Bookmark Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Onycholysis Definition Nail detachment from the nail bed, starting distally Usually painless but increases risk of infection & discolouration Aetiology Trauma (repetitive impact, aggressive manicures) Prolonged water exposure (dishwashing, frequent handwashing) Skin conditions (psoriasis, eczema) Fungal infections (Candida, dermatophytes) Diagnosis Nail clippings/scrapings for fungal testing Consider systemic causes (psoriasis, thyroid disease) if other symptoms present Management Patient Advice Keep nails short to reduce trauma Avoid inserting objects under nails Keep nails dry, limit water exposure Use mild soaps/shampoos to prevent irritation Treatment If fungal infection: Antifungal therapy If non-infectious: Reduce trauma & water exposure If Candida: Topical antifungal creams Onycholysis Definition Onycholysis is the separation or detachment of the nail from the nail bed, typically beginning distally and moving proximally. It is usually painless but may predispose to secondary infection, discolouration, and cosmetic concerns. Aetiology Trauma: Repetitive impact, aggressive manicures, or nail picking Prolonged Water Exposure: Frequent handwashing, dishwashing, resulting in softening and irritation Skin Conditions: Psoriasis, eczema can weaken the nail–nail bed interface Fungal Infections: Candida or dermatophytes causing onychomycosis Diagnosis Nail Clippings/Scrapings: To check for fungal involvement (microscopy, culture, or PCR) Systemic Causes: Consider psoriasis, thyroid disease, or other relevant conditions if there are additional clinical features Management Patient Advice Keep Nails Short: Reduces leverage and trauma on the nail bed Avoid Inserting Objects under nails to prevent further detachment Limit Water Exposure: Wear gloves for dishwashing or cleaning Mild Soaps/Shampoos: Minimises irritation Gentle nail care; avoid harsh manicures/pedicures Specific Treatment Fungal Infection: Topical or oral antifungal therapy if confirmed onychomycosis (e.g. terbinafine for dermatophytes, topical azole for candida) Non-Infectious (Trauma, Psoriasis): Reduce repeated trauma, improve dryness, consider topical therapies (e.g. mild steroid for psoriatic changes if indicated) Candida Onycholysis: Topical antifungal creams (e.g. clotrimazole), keep area dry, limit water immersion Bookmark Failed! Bookmark Saved! Refresh Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Allergic Rhinitis Risk Factors Family history of atopy Exposure to dust mites Lack of exposure to animals in early life Lack of older siblings Non-attendance of childcare Heavy maternal smoking in the first year of life Early introduction of solid foods/formula Note: Urban living and environmental pollutants can exacerbate allergic rhinitis. Strong association with comorbid asthma, eczema, and conjunctivitis (part of the atopic triad). Pharm Treatment Ladder 1st Line: Oral/intranasal antihistamines: Loratadine 10 mg PO OD Azelastine 125 mcg nasal spray, 1 spray BD ADD intranasal steroids OR montelukast: Mometasone 50 mcg, 2 sprays daily 2nd Line: Montelukast 10 mg daily (5 mg for <14 yrs, 4 mg for <6 yrs) ADD both intranasal steroid AND montelukast For Rhinorrhoea: Ipratropium 22 mcg/spray, 4 sprays TDS If above fails: Consider referral for immunotherapy Review diagnosis and adherence Note: Intranasal saline irrigation can improve symptom control and reduce reliance on medications. Sublingual immunotherapy (SLIT) may be a better option for patients unable to access allergen-specific immunotherapy. Additonal Notes: If allergic rhinitis + asthma, intranasal steroids are 1st line. Be cautious with montelukast: potential for nightmares, aggression, and depression, which is reversible post-cessation. Regular re-evaluation of treatment efficacy and compliance is essential for long-term management. Allergic Rhinitis Risk Factors Family history of atopy Exposure to dust mites Lack of exposure to animals in early life Lack of older siblings Non-attendance of childcare Heavy maternal smoking in the first year of life Early introduction of solid foods/formula Urban living and environmental pollutants exacerbate allergic rhinitis Strong association with comorbid asthma, eczema, and conjunctivitis Pharmacological Treatment Ladder 1st Line Oral or intranasal antihistamines Loratadine 10 mg daily Azelastine nasal spray 125 mcg, 1 spray each nostril BD Add intranasal steroids or montelukast if symptoms persist Mometasone 50 mcg, 2 sprays daily 2nd Line Montelukast 10 mg daily (5 mg for children under 14, 4 mg for under 6) Use both intranasal steroid and montelukast if single-agent therapy inadequate For Rhinorrhoea Ipratropium bromide nasal spray 22 mcg/spray, 4 sprays TDS If Above Fails Consider referral for immunotherapy (subcutaneous or sublingual) Review diagnosis and adherence to treatment Additional Considerations Intranasal saline irrigation helps symptom control and may reduce medication reliance Sublingual immunotherapy (SLIT) can be suitable for patients who cannot attend specialist allergen immunotherapy Intranasal steroids are first line when allergic rhinitis coexists with asthma Monitor for montelukast-related adverse effects such as nightmares, aggression, or depression, which usually resolve after stopping Re-evaluate treatment efficacy and compliance regularly, checking inhaler and nasal spray technique if relevant Environmental measures such as dust mite reduction, pollen avoidance, and pet dander minimisation can reduce allergen exposure and symptom severity Identify symptom pattern (intermittent vs persistent) to tailor treatment duration and intensity Skin prick testing or specific IgE tests may clarify triggers for targeted avoidance or immunotherapy Untreated or poorly controlled allergic rhinitis can contribute to sinusitis, otitis media, and reduced quality of life, so ensuring optimal control is essential Bookmark Failed! Bookmark Saved! Add Bookmark Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Erythema Multiforme Definition Self-limiting, immune-mediated condition affecting mucocutaneous surfaces. Presents with target-like lesions and can be isolated, recurrent, or persistent. Primarily affects young adults (~1%). Aetiology & Causes Idiopathic (common) Infections: Herpes simplex virus (HSV) (most common) Mycoplasma pneumoniae (next most common), COVID-19, CMV, EBV Drugs: Sulphonamides (e.g. co-trimoxazole), penicillins, anticonvulsants Systemic disease: SLE, Hodgkin’s lymphoma Vaccinations Clinical Features Skin Lesions Symmetrical rash, mainly on extensor surfaces Target lesions (hallmark sign) with three zones: Dusky centre (epidermal necrosis) Pale oedematous ring Peripheral erythematous rim May be painful, itchy, or swollen Mucosal Involvement Blisters → shallow ulcers covered by a white membrane Affects oral mucosa, causing pain with eating/swallowing Diagnosis Clinical diagnosis based on history and examination If doubt: Consider keratitis, conjunctival screening, uveitis (risk of visual impairment) Differential Diagnosis SJS/TEN (key distinction): More severe mucosal damage, skin peeling, systemic illness Others: Urticaria, viral exanthem, fixed drug eruption Bullous pemphigoid, paraneoplastic pemphigus Polymorphous light eruption, Rowell syndrome (SLE-related) Management Usually self-limiting, no specific treatment needed Symptomatic care: Itching: Antihistamines, topical steroids, cool compresses Pain: Local anaesthetic gels, mouth rinses Eye involvement: Urgent ophthalmology referral Recurrent/severe cases: Oral antivirals (e.g. aciclovir) if HSV-related Antibiotics if bacterial trigger (e.g. Mycoplasma pneumoniae) Prognosis Minor cases resolve in 2–3 weeks without scarring Erythema multiforme major may take up to 6 weeks Rare progression to SJS/TEN, but eye involvement may cause long-term complications (e.g. vision loss) Erythema Multiforme Definition Erythema multiforme is a self-limiting, immune-mediated condition affecting mucocutaneous surfaces. It often presents with target-like lesions and may be isolated, recurrent, or persistent. Typically seen in young adults, though it can occur at any age. The incidence is relatively low (~1%), but precise figures vary. Lesions are usually symmetrical and predominantly located on extensor surfaces. Aetiology & Causes Idiopathic: No identifiable trigger (relatively common) Infections: Herpes simplex virus (HSV): The most common trigger Mycoplasma pneumoniae: The second most frequent cause, particularly in children and adolescents Other infectious agents: COVID-19, CMV, EBV Drugs: Sulphonamides (e.g. co-trimoxazole) Penicillins (especially amoxicillin) Anticonvulsants (phenytoin, carbamazepine, lamotrigine) Systemic disease: SLE, Hodgkin’s lymphoma (rare association) Vaccinations: Occasionally reported post-immunisation Clinical Features Skin Lesions: Symmetrical rash primarily on the extensor surfaces of arms, legs, and dorsal hands/feet Target lesions: Characteristic with three distinct zones: Dusky or purplish centre (epidermal necrosis) Pale oedematous ring Outer erythematous halo May be painful, pruritic, or swollen Mucosal Involvement: Formation of blisters leading to shallow ulcers with a white membranous covering Commonly affects oral mucosa, causing discomfort with eating or swallowing May also affect lips, ocular mucosa, or genital mucosa Diagnosis Largely clinical, based on the typical target lesions and relevant triggers (e.g. HSV infection, recent medication use). Ophthalmic assessment if concern for keratitis, conjunctival inflammation, or uveitis (especially in cases with eye discomfort or vision changes). Differential Diagnosis Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN): More severe mucosal damage, extensive skin peeling, and systemic involvement. Urticaria: Usually more fleeting lesions, intense pruritus, no target lesions. Viral exanthem: Tends to be more diffuse and not target-shaped. Fixed drug eruption: Typically single or few round, well-demarcated patches that recur at the same site with re-exposure. Bullous pemphigoid or paraneoplastic pemphigus: Usually seen in older patients, with tense bullae or widespread erosions. Polymorphous light eruption (PMLE): Photosensitive rash, different morphological pattern. Rowell syndrome: A rare variant of cutaneous lupus with erythema multiforme-like lesions. Management Usually Self-Limiting: Mild forms require no specific therapy beyond addressing discomfort. Symptomatic Care: Itch: Oral antihistamines, topical corticosteroids, cool compresses Pain relief in mouth lesions: Local anaesthetic mouthwashes or gels (e.g. benzydamine rinse) Eye involvement: Urgent ophthalmology review if red or painful eye, blurred vision, or photosensitivity Recurrent or Severe Cases: Oral antivirals (e.g. aciclovir) if HSV is the confirmed or highly suspected trigger Antibiotics if an active Mycoplasma pneumoniae infection is identified Rarely, short-course systemic corticosteroids in severe inflammatory cases (controversial and typically specialist-led) Prognosis Minor Erythema Multiforme usually resolves spontaneously within 2–3 weeks, leaving no scar. Erythema Multiforme Major (with significant mucosal involvement) may last up to 6 weeks. Progression to SJS/TEN is rare but can occur. Ocular involvement may lead to chronic complications (e.g. dry eyes, vision impairment). Notes Erythema multiforme is typically less severe than SJS/TEN, but watch closely for increasing mucosal involvement or systemic symptoms. Eye involvement: Potential for corneal ulceration or uveitis. Early specialist referral is crucial for preventing long-term damage. Recurrence is common, especially if triggered by HSV. Consider prophylactic antivirals in frequent recurrences. Bookmark Failed! Bookmark Saved! Add Bookmark Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Kidney Stones (Nephrolithiasis) Types of Kidney Stones Calcium oxalate (70–80%) – Most common, linked to hypercalciuria, hyperoxaluria Struvite (10–15%) – Urease-producing bacteria (e.g., Proteus, Klebsiella), risk of infected obstruction Uric acid (5–10%) – Radiolucent, associated with acidic urine, high purine intake Cystine (<2%) – Rare, due to cystinuria, often in childhood When to Refer to Urology Urgent (Immediate Surgical Assessment Required): Sepsis (fever, tachycardia, hypotension) Uncontrollable pain despite maximal analgesia Significant renal failure (rising creatinine, AKI) Single kidney Pre-existing renal disease with high obstruction risk Stone >7 mm (unlikely to pass) Non-Urgent (Long-Term Follow-Up): Failure to pass stone within 3 weeks Persistent haematuria post-stone passage Recurrent/severe pain despite conservative management Investigations Initial Workup: Bloods: UEC, CMP (renal function, calcium, uric acid) FBC, CRP (if infection suspected) Urine Tests: Urinalysis, urine MCS (haematuria, infection) Urine pH (acidic = uric acid stones, alkaline = struvite) Stone analysis (if available) Imaging: CT KUB (non-contrast): Gold standard XR KUB: Tracks radio-opaque stones Renal ultrasound: If pregnant or simple case <50 years Follow-Up: Repeat CT KUB in 4 weeks unless stone retrieved Consider 24-hour urine collection if recurrent stones or metabolic abnormalities Management Short-Term (Acute Pain Relief & Stone Passage) First-line: Ibuprofen 400 mg PO TDS Second-line (if vomiting): Indomethacin 100 mg suppository Severe pain: Morphine 5 mg IV/SC Anti-emetic: Metoclopramide 10 mg IV/IM Alpha-blocker: Tamsulosin 400 mcg PO daily (promotes passage, no immediate effect) Fluids: Encourage oral hydration (IV bolus fluids not routinely recommended) Long-Term (Prevention & Monitoring) Post-Discharge Analgesia: Ibuprofen 400 mg TDS PRN Paracetamol 1 g QID PRN Tamsulosin 400 mcg daily Metoclopramide 10 mg TDS PRN Monitoring: Strain urine for stone analysis Repeat CT KUB in 4 weeks if stone not retrieved Return to ED if fever or worsening pain Lifestyle & Prevention Hydration: Maintain urine output >2.5 L/day (aim for clear urine) Dietary Modifications: Low oxalate: Avoid spinach, nuts, chocolate, beans Low protein: Reduces acidity, prevents uric acid stones Low sodium: Decreases urinary calcium excretion Low uric acid: Limit red meats, alcohol Normal calcium intake: Dietary calcium is protective (avoid supplements) Refer to dietitian for personalised advice Pharmacological Prevention (If Lifestyle Alone Fails) Thiazide diuretics: Reduce urinary calcium excretion (for calcium oxalate stones) Allopurinol: Lowers uric acid (for recurrent uric acid stones) Potassium citrate: Alkalinises urine, prevents uric acid/cystine stones Notes NSAIDs: First-line for pain, reduce ureteric inflammation Tamsulosin: Aids passage for distal ureteric stones >5 mm but no immediate pain relief Struvite stones: Strongly linked to recurrent UTIs, need long-term urology follow-up Most stones ≤5 mm pass spontaneously; those >7 mm usually need intervention IV fluids for forced diuresis are no longer recommended (may worsen renal colic) Kidney Stones (Nephrolithiasis) Types of Kidney Stones Calcium Oxalate (70–80%) Most common, often linked to hypercalciuria, hyperoxaluria Struvite (10–15%) Associated with urease-producing bacteria (e.g. Proteus, Klebsiella); risk of infected obstruction Uric Acid (5–10%) Radiolucent on plain X-ray, linked to acidic urine & high purine intake Cystine (<2%) Rare, due to cystinuria, often starts in childhood When to Refer to Urology Urgent (Immediate Surgical Assessment) Sepsis (fever, tachycardia, hypotension) Uncontrollable pain despite maximal analgesia Significant renal failure (rising creatinine, AKI) Single kidney or pre-existing renal disease with obstructing stone Stone >7 mm (unlikely to pass spontaneously) Non-Urgent (Long-Term Follow-Up) Failure to pass stone within 3 weeks Persistent haematuria after stone passage Recurrent or severe pain despite conservative management Investigations Initial Workup Bloods: UEC, CMP for renal function, electrolytes, calcium, uric acid FBC, CRP if infection suspected Urine Tests: Urinalysis, urine MCS (check haematuria, infection) Urine pH (acidic → uric acid stone, alkaline → struvite) Stone analysis if a stone is passed/retrieved Imaging: CT KUB (non-contrast): Gold standard for diagnosis XR KUB: Follows known radio-opaque stones Renal ultrasound: Option if pregnant or younger patients <50 with mild suspicion Follow-Up: Repeat CT KUB in ~4 weeks unless stone is retrieved 24-hour urine collection for recurrent stones or metabolic abnormalities Management Short-Term (Acute Pain Relief & Stone Passage) NSAIDs first-line: e.g. ibuprofen 400 mg PO TDS If vomiting or severe pain: indomethacin 100 mg suppository or opioids (morphine) if needed Antiemetics: e.g. metoclopramide 10 mg IV/IM Alpha-Blocker: Tamsulosin 400 mcg daily (helps distal ureteric stone passage; no immediate pain relief) Hydration: Encourage oral fluids; IV bolus fluids for forced diuresis are no longer recommended (may worsen renal colic) Long-Term (Prevention & Monitoring) Post-Discharge Analgesia: Ibuprofen 400 mg TDS PRN, paracetamol 1 g QID PRN, tamsulosin 400 mcg daily, metoclopramide 10 mg TDS PRN Monitoring: Strain urine for stone retrieval and analysis; repeat imaging if stone not retrieved; return if fever or worsening pain Lifestyle & Prevention Hydration: Aim for urine output >2.5 L/day (clear/pale urine) Dietary Modifications: Low oxalate (limit spinach, nuts, chocolate, beans) Moderate protein to reduce acidity (limit red meats) Lower sodium to decrease urinary calcium excretion Normal dietary calcium (avoid supplements) is protective Weight Management: Obesity increases risk Dietitian Referral for personalised advice Pharmacological Prevention (If Lifestyle Alone Fails) Thiazide Diuretics: Decrease urinary calcium excretion (for calcium stones) Allopurinol: For recurrent uric acid stones Potassium Citrate: Alkalinises urine, preventing uric acid or cystine stone formation Notes NSAIDs reduce ureteric inflammation and help analgesia; first-line for renal colic. Tamsulosin aids passage of distal ureteric stones (>5 mm), but does not offer immediate pain relief. Struvite Stones: Associated with recurrent UTIs; ensure long-term follow-up. Stone Size: ≤5 mm → ~80% chance of spontaneous passage 7 mm → often needs urological intervention. Forced Diuresis is no longer recommended due to risk of exacerbating renal colic. Bookmark Failed! Bookmark Saved! Add Bookmark Refresh Refresh