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 Postpartum Thyroiditis Cause Autoimmune thyroid destruction Increased risk with: Previous episodes of postpartum thyroiditis Positive thyroid peroxidase (TPO) antibodies T1DM Disease Course Typically 1–6 months postpartum Hyperthyroid phase: Transient (1–2 months) Hypothyroid phase: May last 4–6 months; can be permanent in ~20% of cases Management Hyperthyroid Phase: Symptomatic relief: Propranolol 10 mg BD (no role for thionamides unless >1 year) Hypothyroid Phase: Treat if symptomatic or TSH >10: Levothyroxine 50–100 mcg daily Continue for 6–12 months, then trial cessation and reassess Monitoring: Repeat TSH every 4 weeks in the early stages to monitor recovery After treatment cessation, recheck TSH in 6 weeks Long-term follow-up: Annual TSH checks due to risk of permanent hypothyroidism Postpartum Thyroiditis Cause Autoimmune-mediated thyroid injury that occurs in the postpartum period Higher risk in: Previous postpartum thyroiditis Positive thyroid peroxidase (TPO) antibodies Type 1 diabetes mellitus (autoimmune predisposition) Disease Course Typically begins 1–3 months postpartum, although may occur up to 6 months Phases Hyperthyroid Phase Often mild and short-lived (1–2 months) Can present with palpitations, anxiety, weight loss, heat intolerance Hypothyroid Phase May last 4–6 months, presenting with fatigue, weight gain, cold intolerance Some women only experience one phase (isolated hyperthyroidism or hypothyroidism) Resolution Usually returns to euthyroid state within 12–18 months postpartum ~20% may develop permanent hypothyroidism Clinical Presentation Hyperthyroid Symptoms Anxiety, palpitations, irritability, tremor, sweating, weight loss Hypothyroid Symptoms Fatigue, weight gain, depression, cold intolerance, constipation, dry skin Management Monitoring Check TSH and free T4 at diagnosis, then every 4–6 weeks early on to track progression through phases After resolution or treatment cessation, recheck TSH in ~6 weeks Long-term annual TSH recommended due to risk of permanent hypothyroidism Hyperthyroid Phase Typically mild and self-limiting Symptomatic relief with beta-blockers (e.g. propranolol 10–40 mg BD) if palpitations or significant adrenergic symptoms No routine role for antithyroid drugs (e.g. carbimazole) unless hyperthyroidism persists >1 year or if Graves’ disease is suspected If clinical or biochemical features suggest Graves’ (ophthalmopathy, very high T3/T4, positive TSH receptor antibodies), obtain radionuclide imaging or TSI testing Hypothyroid Phase Treat with levothyroxine if symptomatic or TSH >10 mU/L Typical starting dose: 50–100 mcg daily, adjusted based on TSH/free T4 Continue for 6–12 months, then attempt cessation and recheck TSH after 6 weeks to determine if thyroid function has normalised If TSH remains elevated, long-term levothyroxine may be required Notes & Follow-Up Women who have experienced postpartum thyroiditis have an increased risk of future thyroid dysfunction, both in subsequent pregnancies and later in life Educate on recognising symptoms early in postpartum periods Emphasise the importance of regular follow-up, especially TSH monitoring in future pregnancies or annually if initial postpartum thyroiditis resolves Suspect postpartum thyroiditis in any new mother with thyroid-related symptoms within 12 months of delivery Early phase hyperthyroidism often does not require thionamides, but symptomatic control with beta-blockers is helpful Address hypothyroidism promptly if TSH is significantly elevated or clinical symptoms are problematic Monitor TSH periodically even after apparent resolution to catch the 20% who develop permanent hypothyroidism Bookmark Failed! 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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 Hepatitis B Step 1: HBsAg (Surface Antigen) Is there a current infection? YES → You currently have a Hepatitis B infection ⁠NO → Move to Step 2 to check for any past infection Step 2: Anti-HBc (Core Antibody) Have you ever been infected? YES → You’ve had a Hepatitis B infection at some point (past or current) NO → Move to Step 3 to see if you’re protected through vaccination Step 3: Anti-HBs (Surface Antibody) Do you have immunity? YES → You’re immune (either from vaccination or past infection). NO → You’re not protected - you’re susceptible and need vaccination. Serology Interpretation Susceptible: All serology negative Previous Infection: HBsAg: negative HBcAb+/HBsAb+: positive Previous Vaccination: HBsAg and HBcAb: negative HBsAb+: positive Acute Infection: HBsAg+: positive HBcAb+: IgM high titre HBsAb: negative Chronic Infection: HBsAg+: positive HBcAb+: IgG low titre HBsAb: negative Note: If only anti-HBc is positive with negative HBsAg and HBsAb, consider previous resolved infection, occult HBV infection, or false positivity (requires HBV DNA testing) Non-Responder No current chronic Hep B infection History of age-appropriate Hep B vaccinations HBsAb <10 mIU/mL Management: Booster (4th dose) → Test 4–5 weeks later If still negative, give another 2 doses (1 month apart) and retest at 4 weeks post final dose (3 extra doses total) Persistent non-responders require HBIG within 72 hrs for exposure Testing for Hepatitis B Serological Testing: Determines acute/chronic infection, resolved infection, vaccination immunity, or susceptibility Isolated Anti-HBc Positive: Causes: Previous infection (low-level anti-HBs undetectable) Occult HBV infection (HBV DNA positive, HBsAg negative) False-positive result Resolving acute infection Who to Test: Pregnant women (routine antenatal screening for HBsAg) Household/sexual contacts of infected individuals People at risk (e.g., migrants from intermediate/high-prevalence countries) All patients with elevated liver enzymes without clear explanation Co-infection screening (Hep B, Hep C, Hep D, and HIV is recommended) Follow-Up and Notification: Acute Hepatitis B must be notified to public health authorities Chronic Hepatitis B notification varies by jurisdiction Hepatitis B Serology Interpretation Profile Interpretation Susceptible All markers negative Previous Infection (Resolved) - HBsAg: Negative - HBcAb: Positive - HBsAb: Positive Previous Vaccination - HBsAg: Negative - HBcAb: Negative - HBsAb: Positive Acute Infection - HBsAg: Positive - HBcAb (IgM): High titre - HBsAb: Negative Chronic Infection - HBsAg: Positive - HBcAb (IgG): Typically present (low titre) - HBsAb: Negative Note: If only anti-HBc is positive (with negative HBsAg and HBsAb), consider: Previous resolved infection with low-level anti-HBs not detectable Occult HBV infection (check HBV DNA) False-positive result Resolving acute infection where HBsAg has become negative and HBsAb not yet appeared Non-Responder Definition: No current chronic Hep B infection History of age-appropriate Hep B vaccinations HBsAb <10 mIU/mL indicates lack of protective antibodies Management: Booster (4th dose) → retest HBsAb in ~4–5 weeks If still negative, give an additional 2 doses (1 month apart) → retest 4 weeks after final dose (total 3 extra doses) Persistent non-responders: If exposed to HBV, require HBIG (Hepatitis B Immunoglobulin) within 72 hours for immediate passive protection Testing for Hepatitis B Serological Testing Determines acute/chronic infection, resolved infection, vaccination immunity, or susceptibility Isolated Anti-HBc Positive: Previous resolved infection (low-level anti-HBs undetectable) Occult HBV infection (HBV DNA positive, HBsAg negative) False-positive result Resolving acute infection Who to Test Pregnant women (routine antenatal HBsAg screening) Household/sexual contacts of infected individuals People at risk (e.g. migrants from intermediate/high-prevalence countries) All patients with elevated liver enzymes of unknown cause Co-infection screening (Hep B, Hep C, Hep D, and HIV) recommended in higher-risk or uncertain contexts Follow-Up & Notification Acute Hepatitis B: Must be notified to public health authorities Chronic Hepatitis B: Notification depends on jurisdiction; typically mandatory in Australia Notes HBsAg: Key marker of infection; if positive for >6 months, indicates chronic infection. HBsAb: Confers immunity (either post-infection or post-vaccination). HBcAb IgM: Indicates recent/acute infection. HBcAb IgG: Signifies past or chronic infection. HBV DNA: Determines viral replication level, used for therapy decisions in chronic HBV. Vaccination: Check HBsAb post-completion of vaccine series to confirm response 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 Multiple Sclerosis (MS) History Painful eye movements Blurred/monocular vision loss Lower limb weakness/paraesthesia Multiple neurological symptoms at different times Uhthoff’s phenomenon (worsens with heat/exertion) Examination UMN signs: Weakness, sensory loss, hyperreflexia LMN signs: Rare but possible Lhermitte sign: Electric shock sensation with neck flexion Optic nerve involvement: Swelling, pallor, ↓ visual acuity, visual field deficits Investigations MRI brain ± C-spine: ≥2 distinct lesions CSF: ↑ IgG bands (consider if MRI normal but MS suspected) Visual evoked potentials: Supportive Treatment Education: Relapsing-remitting course Comorbidity management: Depression, anxiety Neurologist referral Relapses: Prednisolone Rehabilitation: Physio (strength), OT (aids), Psych (CBT), Social work (placement assessment) Disease-modifying therapy: Interferon beta, glatiramer (↓ relapse rates) Lifestyle: Smoking cessation, adequate vitamin D Multiple Sclerosis (MS) History Painful eye movements, often with blurred/monocular vision loss (optic neuritis) Lower limb weakness/paraesthesia Multiple neurological symptoms separated in time and space Uhthoff’s phenomenon: Worsening symptoms with heat or exertion Examination UMN signs: Weakness, sensory loss, hyperreflexia LMN signs: Rare, but some lesions might mimic peripheral presentations Lhermitte’s sign: Electric shock sensation down the spine/limbs on neck flexion Optic nerve involvement: Optic disc swelling or pallor, reduced visual acuity, possible visual field deficits Investigations MRI brain ± C-spine: Demonstrates ≥2 distinct lesions disseminated in time and space CSF: Elevated IgG oligoclonal bands (supportive if MRI is inconclusive) Visual Evoked Potentials: May show delayed conduction if optic nerve involvement is suspected Treatment Education: Explain relapsing-remitting nature in many cases Comorbidity Management: Address depression, anxiety, possible spasticity or pain syndromes Relapses: High-dose corticosteroids (e.g. prednisolone or IV methylprednisolone) Neurologist Referral: Key for disease-modifying therapies (e.g. interferon beta, glatiramer acetate), also newer biologics (natalizumab, fingolimod) Rehabilitation: Physiotherapy (strength, balance), OT (daily aids), psychological support (CBT), social work (community resources) Lifestyle: Smoking cessation, ensure adequate vitamin D 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 Kawasaki Disease Differentials Infectious Scarlet fever: Fever, sandpaper rash Staphylococcal scalded skin syndrome (SSSS): Flaccid blisters, exfoliation Measles: Koplik spots, maculopapular rash, conjunctivitis Epstein-Barr virus (EBV): Fever, lymphadenopathy, pharyngitis Toxic shock syndrome: Rapid onset, shock, diffuse rash Autoimmune/Inflammatory Systemic juvenile idiopathic arthritis (JIA): Fever, salmon-pink rash, arthritis Stevens-Johnson syndrome (SJS): Mucosal involvement, skin detachment Other: Drug eruptions, acute rheumatic fever Diagnostic Criteria Definitive Diagnosis Fever for ≥5 days plus four of five CREAM features Conjunctivitis: Bilateral, non-exudative Rash: Polymorphous, non-vesicular Erythema/Oedema: Palms and soles, later desquamation Adenopathy: Unilateral cervical lymph node >1.5 cm Mucosal involvement: Strawberry tongue, cracked lips Incomplete Kawasaki Disease Fever ≥5 days plus two to three CREAM features Supportive findings: Elevated CRP, ESR, echocardiographic abnormalities Treatment IVIG 2 g/kg IV within 10 days of symptom onset Aspirin Acute phase: 30–50 mg/kg/day until fever resolves Antiplatelet phase: 5 mg/kg/day until normal echocardiogram (≥6 weeks) Steroids Prednisolone 2 mg/kg/day if high-risk (e.g., persistent inflammation, IVIG-refractory) Severe/Refractory Cases Consider biologics (e.g., infliximab) if IVIG-resistant Monitoring Complications Coronary artery aneurysms (CAA): 5–25% if untreated Echocardiography At diagnosis, 2 weeks, and 6 weeks to assess coronary arteries Long-Term Follow-Up With CAA: Cardiology follow-up, possible anticoagulation Notes Red flags: Fever >36 hours post-IVIG, persistent high CRP/ESR Infants: Higher risk of incomplete Kawasaki disease and CAA Kawasaki Disease Definition Acute systemic vasculitis primarily affecting children under 5 years Leading cause of acquired heart disease in children Often follows an upper respiratory tract infection with an unknown exact aetiology Diagnostic Criteria Fever for ≥5 days plus four of the following five features Bilateral, non-purulent conjunctivitis Polymorphous rash, typically maculopapular and non-vesicular Mucosal changes such as erythema, cracked lips, strawberry tongue Peripheral changes including erythema and oedema of palms/soles, with desquamation in the subacute phase Unilateral cervical lymphadenopathy >1.5 cm in diameter Incomplete Kawasaki disease: Fever ≥5 days with 2–3 principal features, supported by laboratory findings (elevated CRP/ESR) and echocardiographic evidence of coronary abnormalities Other associated features may include gastrointestinal symptoms, aseptic meningitis, sterile pyuria, uveitis, and gallbladder hydrops Differential Diagnosis Scarlet fever: Characterised by a sandpaper rash and strawberry tongue Staphylococcal scalded skin syndrome: Presents with widespread erythema, flaccid blisters, and skin peeling Measles: Features include Koplik spots, rash, and conjunctivitis Epstein-Barr virus infection: Associated with fever, lymphadenopathy, and pharyngitis Toxic shock syndrome: Rapid onset with shock and diffuse rash Systemic juvenile idiopathic arthritis: Persistent fever, salmon-pink rash, and arthritis Stevens-Johnson syndrome: Notable for mucosal involvement and skin detachment Drug eruptions and acute rheumatic fever Management Intravenous Immunoglobulin (IVIG) Administer 2 g/kg IV as a single infusion over 10–12 hours, ideally within the first 7 days of illness Reduces the risk of coronary artery aneurysms significantly Aspirin High-dose during the acute phase at 30–100 mg/kg/day divided into multiple doses until afebrile for 48 hours Switch to low-dose aspirin (3–5 mg/kg/day) for at least 6 weeks or longer if coronary abnormalities persist Corticosteroids Consider for IVIG-resistant cases or high-risk patients Options include methylprednisolone 30 mg/kg IV (maximum 1000 mg) over 1 hour for 1–3 days or oral prednisolone 2 mg/kg/day Biologic Agents For severe refractory cases, consider agents such as infliximab under specialist guidance Supportive Care Maintain hydration and provide symptomatic management Monitor for signs of cardiac compromise and manage complications accordingly Follow-Up Serial echocardiography at diagnosis, 2 weeks, and 6–8 weeks post-diagnosis to monitor coronary artery status Long-term cardiology follow-up for children with coronary abnormalities, including possible continued aspirin or anticoagulant therapy Regular monitoring of inflammatory markers (CRP, ESR) to assess treatment response Notes Coronary artery aneurysms are the primary complication and early treatment is crucial to mitigate this risk Incomplete Kawasaki disease is more common in infants under 1 year and may require additional laboratory and imaging support for diagnosis Parental education is essential to manage expectations and stress during the acute phase A multidisciplinary approach ensures optimal care and monitoring throughout the disease course Bookmark Failed! 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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 Chronic Rhinosinusitis Definition Chronic rhinosinusitis is defined by inflammation of the nasal and sinus mucosa lasting >12 weeks with two or more of the following symptoms: Nasal obstruction or congestion Mucopurulent nasal discharge (anterior or posterior drip) Facial pain or pressure Reduction or loss of sense of smell Note: Symptoms must persist despite medical therapy to meet the criteria Contributing Factors Bacterial infection Allergy (including allergic rhinitis) Physical obstructions: e.g., nasal polyps, anatomical variation Cystic fibrosis Mucociliary dysfunction Prolonged use of intranasal decongestants (rhinitis medicamentosa) Environmental irritants (e.g., pollution or occupational dust) Common Differentials Chronic bacterial rhinosinusitis Rhinitis medicamentosa Nasal polyps Allergic rhinitis Nasopharyngeal carcinoma Cluster headaches History Rhinorrhoea, nasal congestion, facial pain, nausea, loss of smell/taste, cough Triggers such as allergens or seasonal changes Management Initial Treatment Saline nasal irrigation (isotonic or hypertonic solution) Intranasal steroids (e.g., Mometasone 50 mcg, 2 sprays/day) Oral decongestants or antihistamines for flare-ups Avoid prolonged decongestant use Intranasal ipratropium bromide if rhinorrhoea is prominent Referral Criteria If symptoms persist after 1 month of medical therapy Specialist referral for nasal polyps, sinus abnormalities, or CT findings indicating obstruction Considerations CT scan if there is failure to improve after 1 month, or red flag symptoms (suggestive of nasopharyngeal carcinoma) to assess sinus anatomy Consider serum IgE testing for specific allergens Chronic Rhinosinusitis with Nasal Polyps Management: Oral corticosteroids (e.g., Prednisolone 25 mg daily for 5–10 days) may be used for reducing polyp size Nasal endoscopy to confirm polyps Surgical polypectomy may be required if polyps are refractory or obstructive Long-term intranasal corticosteroids to prevent recurrence Aspirin desensitisation may be required for patients with AERD Chronic Rhinosinusitis without Nasal Polyps Management: Oral corticosteroids: Short course if symptoms are uncontrolled Antibiotics: Not routinely recommended unless bacterial infection is confirmed Refer for further management if symptoms persist Red Flag Symptoms Orbital cellulitis (swelling around eyes, impaired eye movement) Intracranial complications (e.g., severe headache, neurological signs) Unilateral nasal obstruction with facial pain or epistaxis (suspect malignancy) Chronic Rhinosinusitis Definition Inflammation of the nasal and sinus mucosa lasting >12 weeks Requires ≥2 of the following: nasal obstruction/congestion, mucopurulent nasal discharge (anterior/posterior), facial pain/pressure, and reduced/lost sense of smell Symptoms must persist despite medical therapy Contributing Factors Bacterial infection Allergic rhinitis or other atopic conditions Nasal polyps or anatomical variations (e.g. septal deviation) Cystic fibrosis or other mucociliary dysfunction Overuse of topical decongestants (rhinitis medicamentosa) Environmental irritants (occupational dust, pollution) Common Differentials Chronic bacterial rhinosinusitis Rhinitis medicamentosa Nasal polyps Allergic rhinitis Nasopharyngeal carcinoma Cluster headaches History Rhinorrhoea, nasal congestion, facial pain/pressure, anosmia or hyposmia Postnasal drip or cough Triggers such as seasonal allergens, pollutants Check for red flag features (unilateral obstruction, epistaxis, orbital symptoms) Management Initial Treatment Saline nasal irrigation (isotonic or hypertonic) Intranasal corticosteroids (e.g. Mometasone 50 mcg, 2 sprays each nostril daily) Short-term oral decongestants or antihistamines for flare-ups Intranasal ipratropium bromide for prominent rhinorrhoea Avoid prolonged use of topical decongestants to prevent rebound congestion Referral Criteria Symptoms persisting after 1 month of optimal medical therapy Suspicion of nasal polyps, sinus abnormalities, or obstructive anatomy on exam Recurrent or severe cases requiring imaging or endoscopic evaluation Additional Considerations CT sinus if failure to improve after 1 month or concerning features (suspected malignancy, orbital extension) Allergen testing (IgE levels or skin prick tests) if allergic triggers suspected Consider dual therapy (intranasal steroids plus short-course oral steroids) for severe inflammation Specialist referral for possible functional endoscopic sinus surgery (FESS) if medical therapy is inadequate Chronic Rhinosinusitis with Nasal Polyps Management Short course of oral corticosteroids (e.g. Prednisolone 25 mg daily for 5–10 days) to reduce polyp size Long-term intranasal steroids to maintain control and prevent recurrence Nasal endoscopy to confirm polyp location and extent Surgical polypectomy or FESS if polyps are obstructive or refractory Aspirin desensitisation in aspirin-exacerbated respiratory disease (AERD) Biologic therapy (e.g. dupilumab) may be considered for severe, persistent nasal polyps Chronic Rhinosinusitis without Nasal Polyps Management Intranasal steroids and saline irrigation as first-line Short-course oral corticosteroids only if significant mucosal inflammation or acute exacerbations Antibiotics generally reserved for evidence of bacterial superinfection (purulent discharge, fever, marked localised pain) Referral for imaging or ENT opinion if no improvement Red Flag Symptoms Orbital cellulitis (peri-orbital swelling, pain, impaired eye movement) Intracranial complications (severe headache, focal neurological signs) Unilateral nasal obstruction with facial pain or bleeding (consider malignancy) Key Points Chronic rhinosinusitis significantly impacts quality of life, contributing to fatigue and sleep disruption Combined medical therapies (intranasal steroids plus saline irrigation) are more effective than monotherapy Regular review of treatment adherence and technique (e.g. correct nasal spray administration) is essential Early referral to ENT indicated if suspicion of complications, anatomical abnormality, or failure of conservative measures Bookmark Failed! 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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 Osteoarthritis (OA) Features Suggestive of OA Age-related, symmetrical joint pain and stiffness Reduced joint mobility Joint swelling, crepitus Counselling Points OA progresses slowly or stabilises; not a rapidly degenerative disease Symptoms may fluctuate and do not always correlate with imaging findings Goals: Optimise function and quality of life, not cure Emphasise weight loss, exercise, and pacing activities Self-Management Strategies Weight Loss: Target 5–10% reduction in overweight patients Exercise: Regular aerobic (land or water-based) and resistance exercises (e.g., Tai Chi, aqua aerobics) Activity Pacing: Manage symptoms with pain diaries, rest periods, and joint protection Use physical aids or assistive devices as needed OA of the Hand – Management Exercises: Strengthening and stretching Splints: For thumb carpometacarpal joint Heat Therapy: Short-term pain relief Avoid repetitive thumb movements and prolonged gripping Non-Pharmacological Management Exercise: Land- and water-based aerobic and strengthening exercises Weight Loss: Especially in knee/hip OA Physiotherapy: Muscle strengthening and joint mobilisation Psychological Support: CBT or counselling for chronic pain Pharmacological Management Paracetamol: First-line oral analgesic Topical NSAIDs: Preferred for localised joint pain Oral NSAIDs: For patients with low cardiovascular/GI risk; use lowest effective dose Duloxetine: For chronic knee OA pain Intra-articular Steroids: Short-term relief for severe flares When to Refer for Surgery Persistent symptoms despite maximal conservative therapy Significant functional limitations or impaired daily activities Advanced disease on imaging (though surgery decisions should prioritise symptoms over imaging) Additional Notes Assess interventions regularly for efficacy and alignment with patient goals It is recommended that a trial approach is taken to the use of interventions in osteoarthritis. Osteoarthritis (OA) Features Suggestive of OA Commonly age-related, often with symmetrical joint pain and stiffness Reduced joint mobility and function Joint swelling, possible crepitus on movement Counselling points: OA often progresses slowly or may stabilise Symptoms can fluctuate and do not always correlate with imaging findings Aim for optimised function and quality of life rather than cure Emphasise weight loss, exercise, and pacing daily activities Self-Management Strategies Weight Loss (if overweight/obese) Aim for 5–10% reduction to decrease load on weight-bearing joints Exercise Regular aerobic (land- or water-based), e.g. walking, swimming, aqua aerobics Resistance exercises (e.g. light weights, Tai Chi) for muscle strengthening Joint-friendly activities → Minimises further joint stress Activity Pacing Use pain diaries to gauge tolerance Schedule rest periods or lighter tasks between more strenuous activities Joint protection (assistive devices, splints) if needed Physical Aids & Assistive Devices Consider walking sticks, orthoses, or braces to reduce stress on affected joints Splints for hand OA (especially the thumb CMC joint) OA of the Hand – Additional Management Exercises: Strengthening and stretching for the fingers, thumbs, wrists Splints: Particularly helpful for thumb carpometacarpal joint support Heat Therapy: Short-term pain relief Avoid repetitive thumb movements and prolonged gripping Non-Pharmacological Management Exercise: Land-based and aquatic aerobic plus strengthening exercises Weight Loss: Key for knee/hip OA or obese patients to reduce joint load Physiotherapy: Muscle strengthening, joint mobilisation, gait training Psychological Support: CBT or counselling for chronic pain coping strategies Pharmacological Management Paracetamol: First-line oral analgesic (mild–moderate pain) Topical NSAIDs (e.g. diclofenac gel): Useful for localised joint pain in knees/hands Oral NSAIDs: For moderate–severe OA pain, use lowest effective dose. Consider GI/cardiovascular risk. Duloxetine: Can help with chronic knee OA pain Intra-Articular Steroids: Short-term relief for severe flares (limit frequency to avoid cartilage damage) When to Refer for Surgery Persistent symptoms despite maximal conservative (non-surgical) therapy Significant functional limitations or impaired daily activities Advanced disease on imaging (though symptoms and function guide decisions more than imaging alone) Additional Notes Regularly assess interventions for efficacy and patient alignment with goals. Trial approaches in OA management: adapt medication/exercise programs to patient response. Combined strategies (lifestyle + medications) often yield best outcomes. 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 Anaphylaxis Diagnostic Criteria Definitive: Skin/mucosal changes (urticaria, flushing, angioedema) plus one of: Respiratory: Wheeze, cough, stridor, throat tightness Cardiovascular: Hypotension, pallor, tachycardia/bradycardia, collapse Gastrointestinal: Vomiting, diarrhoea, abdominal pain Alternative: Acute onset with hypotension, bronchospasm, or upper airway obstruction, even without skin features Management Immediate Remove trigger if identified Positioning: Lay flat, elevate legs, avoid sudden standing or sitting Pharmacological Management IM Adrenaline: 10 mcg/kg (max 0.5 mL of 1:1000), repeat every 5 minutes if needed Oxygen: High-flow to maintain SpO₂ >94% IV Fluids: Adults: 1 L normal saline bolus, repeat as needed Children: 20 mL/kg saline bolus Antihistamines: Cetirizine for itch/urticaria (not for airway or cardiovascular symptoms) Steroids: Prednisolone 1 mg/kg (max 50 mg) for 2 days (optional, not first-line) Refractory Anaphylaxis Repeat IM adrenaline every 5 minutes as needed IV Adrenaline Infusion: Start at 0.05–0.1 mcg/kg/min if poor response to IM doses Vasopressors (e.g., noradrenaline) if persistent hypotension despite fluids Symptom-Specific Treatment Stridor: Nebulised adrenaline 5 mL (1:1000) Wheeze: MDI salbutamol 12 puffs via spacer OR Nebulised salbutamol 5 mg if severe Post-Event Care Observation: Monitor for at least 4 hours after the last adrenaline dose (risk of biphasic reaction) Discharge: Prescribe adrenaline auto-injector (Epipen) Provide a personalised action plan Educate on early use of adrenaline in future episodes Notes Adjust doses for elderly or those with cardiac comorbidities Avoid steroids as routine first-line treatment Document hypotension if present, as it confirms anaphylactic shock Non-Pharmacological Management Identify Triggers Common allergens: Foods (nuts, shellfish, dairy), medications, insect stings, latex Referral: Skin prick or specific IgE testing for confirmation Avoid Allergen Exposure Food allergies: Educate on cross-contamination, label reading, safe food handling Environmental allergies: Avoid risky activities (e.g., gardening for bee sting allergy) Emergency Preparedness Adrenaline auto-injector: Prescribe and demonstrate correct use MedicAlert bracelet: Clearly lists allergen and emergency management instructions Specialist Referral Allergy specialist: Consider for testing, desensitisation (e.g., venom immunotherapy) Immunologist: If frequent anaphylaxis or uncertain trigger Regular Follow-Up Annual review: Update action plan, check auto-injector expiry, reassess avoidance strategies Additional Notes Education is critical: Patients and caregivers must be trained in recognising symptoms and using adrenaline early Biphasic reaction risk: Emphasise the need for medical review even if symptoms resolve Anaphylaxis Diagnostic Criteria Definitive: Skin or mucosal changes such as urticaria, flushing or angioedema plus one of the following Respiratory compromise: Wheeze, cough, stridor or throat tightness Cardiovascular compromise: Hypotension, pallor, tachycardia or bradycardia, collapse Gastrointestinal symptoms: Vomiting, diarrhoea, or abdominal pain Alternatively, acute onset with hypotension, bronchospasm or upper airway obstruction even without skin changes Management Immediate Measures Remove the trigger if identified Position the patient supine with legs elevated and avoid sudden movements Create a calm environment to minimise stress Pharmacological Management Intramuscular adrenaline at 10 mcg/kg (maximum 0.5 mL of 1:1000 solution) with repeats every 5 minutes as needed Administer high-flow oxygen to maintain SpO₂ above 94% Give intravenous fluids: Adults receive 1 L normal saline bolus (repeat as required); children receive 20 mL/kg saline bolus Use antihistamines such as cetirizine to relieve pruritus and urticaria (not effective for airway or cardiovascular compromise) Consider corticosteroids, e.g. prednisolone 1 mg/kg (maximum 50 mg) for 2 days in severe or protracted cases, though not first-line Refractory Anaphylaxis Repeat intramuscular adrenaline every 5 minutes if inadequate response Initiate intravenous adrenaline infusion at 0.05–0.1 mcg/kg/min if necessary Add vasopressors such as noradrenaline if hypotension persists despite fluid resuscitation Symptom-Specific Treatment For stridor, administer nebulised adrenaline 5 mL of 1:1000 solution For wheezing, use MDI salbutamol (12 puffs via spacer) or nebulised salbutamol 5 mg for severe cases Post-Event Care Observe the patient for at least 4 hours after the last adrenaline dose due to biphasic reaction risk Prescribe an adrenaline auto-injector and provide a demonstration of correct use Provide a personalised anaphylaxis action plan and educate on early administration of adrenaline in future episodes Non-Pharmacological Management Identify common triggers such as foods (nuts, shellfish, dairy), medications, insect stings, and latex Arrange referral for skin prick tests or specific IgE testing for confirmation Advise on allergen avoidance strategies including proper food handling, label reading, and minimising exposure during high-risk activities Ensure emergency preparedness by prescribing an adrenaline auto-injector and recommending a MedicAlert bracelet Specialist Referral and Follow-Up Refer to an allergy specialist for further evaluation and desensitisation (e.g. venom immunotherapy) if indicated Consider immunologist referral if anaphylaxis is frequent or the trigger remains uncertain Schedule annual reviews to update the action plan, check auto-injector expiry and reassess avoidance strategies Additional Notes Adjust medication doses in elderly patients or those with cardiac comorbidities Document any objective findings such as hypotension as they confirm anaphylactic shock Emphasise caregiver education on early recognition of symptoms and the importance of prompt adrenaline administration Remain vigilant for biphasic reactions and advise medical review even if symptoms initially resolve Bookmark Failed! 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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 First Trimester Bleeding & Ectopic Pregnancy Differential Diagnoses Pregnancy-Related: Miscarriage: Threatened, incomplete, or missed Ectopic pregnancy: Embryo implants outside uterus Gestational trophoblastic disease: Abnormal trophoblastic growth Cervical Causes: Cervical polyps (benign growths) Cervical ectropion (eversion of endocervical epithelium) Cervical cancer Infections: Pelvic inflammatory disease (PID) Cervicitis/vaginitis (e.g., chlamydia, gonorrhoea) Other: Implantation bleeding (10–14 days post-conception) ____________________________________ Investigations Transvaginal ultrasound → Assess pregnancy location & viability Serial β-hCG → Normal IUP: Doubles every 48–72 hrs CBC → Assess for anaemia/infection Blood group & antibody screen → Determine Rh status (Anti-D if Rh-negative) Pelvic exam → Assess cervix for dilation, lesions, or bleeding source ____________________________________ Risk Factors for Ectopic Pregnancy Previous ectopic pregnancy Tubal surgery (ligation, reversal) PID (tubal scarring from STI) IVF & assisted reproduction IUD use (↑ risk if conception occurs) Smoking Age >35 Endometriosis Prior tubal sterilization (failed) Note: 1/3–1/2 of ectopic pregnancies occur without known risk factors First Trimester Bleeding & Ectopic Pregnancy Differential Diagnoses Pregnancy-related causes including miscarriage (threatened, incomplete or missed), ectopic pregnancy and gestational trophoblastic disease Cervical causes such as cervical polyps, cervical ectropion and cervical cancer Infections including pelvic inflammatory disease and cervicitis or vaginitis (eg chlamydia, gonorrhoea) Other causes such as implantation bleeding occurring 10–14 days post-conception Assessment Evaluate haemodynamic stability and assess the degree of pain and blood loss Perform a detailed history to determine gestational age, symptom duration and associated features such as syncope, chest pain or shoulder tip pain Ensure a qualitative urinary pregnancy test is undertaken in all women of reproductive age with unexplained abdominal pain Recognise that significant blood loss may occur before overt signs of instability emerge Investigations Transvaginal ultrasound to assess pregnancy location, viability and to identify adnexal masses or free fluid Serial serum β-hCG measurements with an expected doubling every 48–72 hours in a normal intrauterine pregnancy; plateaued or suboptimal rise suggests ectopic or non-viable pregnancy Qualitative urinary hCG testing as a rapid and cost-effective screening tool Complete blood count to evaluate for anaemia or infection Blood group and antibody screen to determine Rh status and the need for anti-D immunoglobulin Pelvic examination including speculum and bimanual exam to assess cervical dilation, lesions or the source of bleeding Risk Factors for Ectopic Pregnancy Previous ectopic pregnancy or tubal surgery (eg ligation, reversal) Prior pelvic inflammatory disease or history of sexually transmissible infections Assisted reproductive techniques (eg IVF) and conception despite an intrauterine device in situ Smoking, age over 35 and endometriosis Note that up to one-third to one-half of ectopic pregnancies occur without recognised risk factors Management Immediate transfer to hospital for haemodynamically unstable patients or those with signs of rupture For ectopic pregnancy in stable patients, consider medical management with methotrexate when criteria are met (eg hCG <5000 IU/L, adnexal mass <3.5 cm without fetal cardiac activity) Surgical management via laparoscopy is indicated for unstable patients, suspected rupture, failed medical management or contraindications to methotrexate, with salpingectomy or salpingostomy as appropriate Management of miscarriage depends on clinical scenario (threatened, inevitable, incomplete or missed) and may involve expectant, medical or surgical approaches with appropriate follow-up to confirm complete resolution Administer Rh D immunoglobulin for Rh-negative patients within 72 hours of a sensitising event Notes Early pregnancy bleeding affects 20–40% of pregnant women, with miscarriage and ectopic pregnancy being the most common causes The discriminatory zone for hCG (typically 1500–2000 IU/L) is useful; absence of an intrauterine gestational sac above this level strongly suggests ectopic pregnancy A pregnancy of unknown location necessitates close follow-up with repeat hCG measurements and ultrasound examinations All women of reproductive age presenting with abdominal pain should be presumed to have an ectopic pregnancy until proven otherwise Early pregnancy assessment units facilitate prompt, accurate diagnosis and management, reducing unnecessary admissions and improving patient outcomes Bookmark Failed! 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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 ENT Special Examinations HINTS Exam Distinguishes central vs. peripheral causes of acute vestibular syndrome (persistent vertigo + nystagmus ≥24h). Head Impulse Test Patient focuses on a target; examiner rapidly turns the head Peripheral lesion (e.g. vestibular neuritis): Positive (abnormal) test → corrective saccade Central lesion (e.g. stroke): Normal (negative) test (no saccade) Bilateral or inconsistent findings suggest central pathology Nystagmus Peripheral: Unidirectional, horizontal, suppressed by fixation Central: Vertical, torsional, or direction-changing (in different gaze positions) Test of Skew Cover-uncover test to check for vertical misalignment Positive (realignment on uncovering): Suggests central cause Negative: More likely peripheral Interpretation Central cause (stroke risk): Negative head impulse, vertical/direction-changing nystagmus, positive test of skew Peripheral cause: Positive head impulse (one direction), unidirectional horizontal nystagmus, negative test of skew Most accurate when all three tests are considered together Rinne’s Test Compares air conduction (AC) vs. bone conduction (BC) Positive (normal) Rinne (AC > BC): Normal or sensorineural hearing loss (SNHL) Negative Rinne (BC > AC): Conductive hearing loss (CHL) Weber’s Test Tuning fork placed on forehead or vertex CHL: Sound lateralises to affected ear SNHL: Sound lateralises to unaffected ear Notes HINTS is for continuous, severe vertigo to rule out stroke Urgent neuroimaging if central signs (e.g. abnormal HINTS, new neuro deficits, severe headache) Rinne + Weber help differentiate CHL vs. SNHL Consider ENT or neurology referral for persistent vertigo, hearing loss, or abnormal HINTS Evaluate stroke risk factors (age, hypertension, diabetes, AF) and ear disease causes (otitis media, TM perforation) ENT Special Examinations HINTS Exam A clinical test battery to distinguish central from peripheral causes of acute vestibular syndrome, generally used when patients have persistent vertigo and nystagmus for ≥24 hours Head Impulse Test Patient focuses on a target, examiner rapidly turns the head to one side while observing the eyes A peripheral lesion (e.g. vestibular neuritis) typically shows a positive (abnormal) head impulse: corrective saccade back to the target A normal head impulse (no saccade) in a patient with acute continuous vertigo raises concern for a central lesion (e.g. cerebellar stroke) If the head impulse test is positive in both directions or inconsistent, consider central pathology Nystagmus Peripheral (vestibular) causes typically produce unidirectional, horizontal nystagmus that may be inhibited by fixation Central causes can have purely vertical, purely torsional, or direction-changing nystagmus; nystagmus that changes direction when looking in different gaze positions is particularly concerning Test of Skew Performed via the cover-uncover test to check for vertical skew deviation A negative test (no vertical misalignment) usually suggests a peripheral cause A positive test (vertical realignment when one eye is uncovered) is more indicative of a central lesion Interpretation High suspicion of central cause (possible stroke) if: Normal (negative) head impulse Direction-changing or purely vertical nystagmus Positive test of skew Peripheral cause more likely if: Positive (abnormal) head impulse in one direction, unidirectional horizontal nystagmus, and no skew deviation HINTS is most accurate when all three components are considered together Rinne’s Test Compares air conduction (AC) to bone conduction (BC) in each ear Positive (normal) Rinne: AC > BC Indicates either normal hearing or sensorineural hearing loss (SNHL) in that ear Negative Rinne: BC > AC Indicates conductive hearing loss (CHL) in that ear Weber’s Test Tuning fork placed on the centre of the forehead or top of the head Patient reports which ear (if any) the sound lateralises to In CHL, sound lateralises to the affected (poorer hearing) ear In SNHL, sound lateralises to the unaffected (better hearing) ear Notes: The HINTS exam is primarily used in continuous, severe vertigo to help exclude a posterior circulation stroke Any suspicion of central lesion (e.g. inconsistent or concerning HINTS findings, new neurological deficits, severe headache) warrants urgent neuroimaging Rinne’s and Weber’s tests are commonly performed together to localise hearing loss as conductive or sensorineural Patients with significant hearing changes, persistent vertigo, or abnormal HINTS findings often benefit from ENT or neurology referral Thorough history and examination are crucial, including evaluation of risk factors for stroke in acute vertigo (older age, hypertension, diabetes, atrial fibrillation) and potential causes of ear disease (otitis media, tympanic membrane perforation) Bookmark Failed! 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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 Angina Aetiology Primary cause: Coronary artery disease (CAD) due to atherosclerosis Other causes: Aortic stenosis, hypertrophic obstructive cardiomyopathy (HOCM), coronary artery spasm Symptoms Retrosternal chest pain radiating to shoulders, neck, jaw, or arms Triggered by exertion/emotional stress, relieved by rest or GTN Pain lasts <10 minutes Management Pharmacological (Stepwise Approach) Line Medications & Notes 1st Line GTN spray 400–800 mcg SL, repeat every 5 min up to 3 doses. Use before exertion 2nd Line Beta-blockers (e.g., Atenolol 25–100 mg OD, Metoprolol 25–100 mg BID). If LVEF <40%, use carvedilol/bisoprolol. OR Non-DHP CCB (if BB not tolerated) 3rd Line Add dihydropyridine CCB (e.g., Amlodipine 2.5–10 mg OD) alongside BB 4th Line Replace CCB if ineffective: Long-acting nitrates (e.g., Isosorbide mononitrate 30–120 mg OD) Last Line Nicorandil 5–20 mg BID for refractory cases Non-Pharmacological Lifestyle: Smoking cessation, regular exercise (150 min/week), weight management (BMI <25), healthy diet Avoid: Dihydropyridine + non-DHP CCBs (risk of bradycardia) Special Considerations Heart failure: Use carvedilol/bisoprolol if EF <40%. Avoid BB + verapamil/diltiazem Nitrate tolerance: Limit patch use to 14 hrs/day Refractory angina: Consider nicorandil or specialist referral Complications Acute coronary syndrome (MI) Chronic heart failure Arrhythmias (e.g., VT) Angina Aetiology/Causes: Primarily caused by coronary artery disease (CAD) due to atherosclerosis, leading to reduced myocardial oxygen supply. Other conditions include aortic stenosis, hypertrophic obstructive cardiomyopathy (HOCM), and coronary artery spasm. Symptoms: Retrosternal chest pain radiating to shoulders, neck, jaw, or arms. Triggered by physical exertion or emotional stress and relieved by rest or nitroglycerin. Pain typically lasts less than 10 minutes. Differential Diagnosis: Myocardial infarction - Pain lasts >20 minutes, not relieved by GTN Gastro-oesophageal reflux disease - Burning sensation, often occurs after meals Musculoskeletal pain - Localised, reproducible on palpation Pulmonary embolism - Sudden onset with breathlessness, pleuritic pain Investigations: Test Purpose ECG Identify ischaemia-related changes (e.g., ST depression) Blood tests (i.e., troponin) Rule out myocardial infarction Stress ECG/Echo For intermediate pre-test probability of ischaemic heart disease (IHD) Exercise stress test Assess for exercise-induced ischaemia Coronary angiography Determine extent of coronary artery blockage Suitable if persistent symptoms with normal stress test Catheter coronary angiogram Indicated in high-risk acute coronary syndrome (ACS) Myocardial Perfusion Scan Not for typical angina; consider if stress test results are inconclusive Management: Pharmacological Management (Stepwise Approach): Line of Therapy Medications and Notes 1st Line GTN spray 400–800 mcg sublingually, repeat every 5 mins up to 3 doses. Use preventively before exertion. If pain persists >10 mins after 2 sprays, give a 3rd spray and call for help Side effects: headache, flushing, orthostatic hypotension 2nd Line Add Beta-blockers: Atenolol 25–100 mg daily, Metoprolol tartrate 25–100 mg BID If LVEF <40%, use beta-blockers recommended for heart failure (carvedilol, bisoprolol, nebivolol) OR non-DHP CCB (if BB not tolerated): Diltiazem 180–360 mg daily, or Verapamil 120–480 mg daily (avoid in LVEF <40%) 3rd Line Add a dihydropyridine CCB (e.g., Amlodipine 2.5–10 mg daily or Nifedipine MR 30–60 mg daily) along with a BB 4th Line Replace CCB if still no improvement: Long-acting GTN patch 5–15 mg transdermal, max 14 hours/day Isosorbide mononitrate MR 30–120 mg daily (ensure a nitrate-free period) Last Line Nicorandil 5–20 mg BID: useful in refractory angina or when combined with other antianginals Non-Pharmacological Management: Smoking cessation Regular aerobic exercise (150 min/week) Healthy diet with reduced saturated fats Weight management (target BMI <25) Avoid using dihydropyridine CCBs alongside non-DHP CCBs due to the risk of bradycardia. Special Considerations: Beta-blockers and Heart Failure: Use heart failure-specific beta-blockers (carvedilol, bisoprolol) if EF <40%. Avoid combining beta-blockers with verapamil/diltiazem due to bradycardia risk. Nitrate Use: Limit patch to 14 hours/day to prevent tolerance. Refractory Angina: If two antianginals do not suffice, consider adding nicorandil or specialist referral. Complications: Progression to acute coronary syndrome (myocardial infarction). Chronic heart failure development. Arrhythmias (e.g., ventricular tachycardia). Prognosis: Proper management with lifestyle changes and medication leads to good outcomes. Revascularisation may be needed for high-risk cases. Notes: Exercise Considerations: Use GTN before exercise to reduce angina episodes. Combination Therapy: If dual therapy (i.e., BB + CCB or long-acting nitrate) does not suffice, specialist consultation is advised. GTN Safety Tips: Instruct patients to sit down before taking GTN spray due to the risk of orthostatic hypotension. Refractory Angina: Consider perhexiline in patients with refractory symptoms despite optimal therapy or if unsuitable for revascularisation. Use of Investigations: Stress tests are optimal for patients with intermediate IHD probability. Myocardial perfusion scans are not indicated in patients with typical angina unless further evaluation is needed. Calcium Scoring: For asymptomatic individuals aged 45–75, calcium scoring may guide management in intermediate risk (10–20%) groups based on the Framingham Risk Equation. High-Risk Indicators: For high-risk patients (e.g., ACS), immediate angiography is preferred over non-invasive tests. Preventing Angina 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 Obstructive Sleep Apnoea (OSA) Key risk factors Obesity (especially central adiposity) Anatomical abnormalities (e.g. high arched palate, retrognathia) Craniofacial syndromes (e.g. Down syndrome—near-universal by adulthood) Family history of OSA Alcohol, smoking, sedatives, muscle relaxants Clinical Presentation Night-time symptoms: Loud, habitual snoring (bed partner may leave room) Witnessed apnoeas, gasping, choking awakenings Frequent nocturnal awakenings, nocturia, night sweats Daytime symptoms: Excessive daytime sleepiness (EDS) → Napping, difficulty staying awake, near-miss MVA Morning headaches, poor concentration, irritability, mood changes Decreased libido, erectile dysfunction Comorbidities Hypertension (especially early-onset) Arrhythmias (e.g. AF) Cardiovascular/cerebrovascular disease Diabetes mellitus, thyroid disease Down syndrome, obesity ↑ Risk of motor vehicle accidents (MVA) due to EDS Screening Tools STOP-Bang (Snoring, Tiredness, Observed apnoeas, BP, BMI, Age, Neck circumference, Gender) Berlin Questionnaire OSA-50 (focuses on obesity, snoring, apnoea, age) Epworth Sleepiness Scale (ESS) ESS ≥8 → Consider further evaluation GP can order sleep study under MBS if ESS ≥8 + high-risk screening tool Diagnosis Gold-standard: Overnight sleep study (polysomnography) Types: Home-based (unattended) → Suitable for most In-laboratory (attended) → Indicated for: Comorbid neuromuscular, cardiac, or significant respiratory disease Suspected respiratory failure or parasomnias Intellectual/physical disability preventing home study Failed home-based study or unsuitable home environment Sleep Study Indices Apnoea–Hypopnoea Index (AHI) = (Apnoeas + Hypopnoeas) / hour AHI >5 → Diagnostic for OSA (if clinically relevant) AHI >30 → Severe OSA Hypoxic Burden: P90 or T90 (SpO₂ <90%) 1–5% → Moderate disease >5% → Severe disease Severity Classification: Mild: AHI 5–15 Moderate: AHI 15–30 Severe: AHI >30 Clinical impairment & comorbidities often outweigh numerical thresholds Management General (Conservative) Measures Weight loss (even modest reduction is beneficial) Smoking cessation, avoid alcohol/sedatives (↓ pharyngeal muscle relaxation) Optimise sleep hygiene (regular schedule, adequate duration) Intranasal corticosteroids (if nasal congestion contributes) Positional therapy (if positional OSA) Avoid supine sleeping (e.g. tennis ball sewn into pyjama back) Elevate head of bed (5–8 cm) Continuous Positive Airway Pressure (CPAP) Gold-standard for moderate-severe OSA or symptomatic mild OSA Indications: AHI >30 or P90 >5% AHI 15–30 or P90 1–5% + symptoms or complications (e.g. uncontrolled HTN) Benefits: Reduces apnoea/hypopnoea episodes Improves alertness, mood, QoL, BP control ↓ Risk of MVAs Challenges & Troubleshooting: Nasal dryness/congestion → Saline spray, humidified CPAP Mouth leak/dry mouth → Chin strap, full-face mask Skin irritation → Adjust mask, alternative interfaces Persistent intolerance → Consider CPAP pressure adjustments, short-term anxiolytics, sleep physician referral Mandibular Advancement Splints (MAS) Indications: Mild–moderate OSA (if CPAP intolerant) Primary snoring (without significant apnoea/hypopnoea) Mechanism: Advances mandible → enlarges retroglossal space Issues: TMJ discomfort, occlusal changes Special Considerations OSA & Respiratory Disease Coexisting COPD/asthma → ↑ risk of nocturnal hypoventilation Consider advanced sleep studies (e.g. CO₂ monitoring) Optimise underlying lung disease (inhalers, smoking cessation) Down Syndrome High prevalence (~100% by adulthood) → Maintain high suspicion Pregnancy Associated with hypertension/pre-eclampsia → Early detection important Complications of Untreated OSA Cardiovascular: Hypertension, arrhythmias (e.g. AF), MI, stroke Neurocognitive: Poor concentration, depression, memory impairment Accidents: ↑ Risk of MVA (due to EDS) Metabolic: Insulin resistance, worsened diabetes control Obstructive Sleep Apnoea (OSA) Epidemiology and Risk Factors Typical demographic: Overweight, middle-aged men with a thick neck circumference (>40 cm). However, OSA also occurs in women, younger adults, and people with normal body habitus . Key risk factors: Obesity (particularly central adiposity) Anatomical abnormalities (e.g. high arched palate, retrognathia) Craniofacial structural changes (e.g. in Down syndrome, where risk can be near-universal by adulthood) Family history of OSA Alcohol use Smoking Sedatives and muscle relaxants Clinical Presentation Night-time symptoms Loud, habitual snoring (often prompting bed partner to leave the bedroom) Witnessed apnoeas (bed partner observes pauses in breathing) Gasping, choking, or snorting awakenings Frequent nocturnal awakenings Nocturia Nocturnal sweating Daytime symptoms Excessive daytime sleepiness (EDS)—patients may present with unintentional napping, difficulty staying awake when reading or watching TV, or near-miss motor vehicle accidents Morning headaches Poor concentration, irritability, mood changes Decreased libido or erectile dysfunction Comorbidities Hypertension (particularly younger-onset hypertension) Arrhythmias (e.g. atrial fibrillation) Cardiovascular disease, cerebrovascular disease Diabetes mellitus Thyroid disease Down syndrome (high prevalence of OSA) Obesity Untreated OSA is also associated with a higher risk of motor vehicle accidents due to excessive daytime sleepiness . Screening Tools Several validated questionnaires help identify high-risk individuals and guide referral for sleep studies: Berlin Questionnaire STOP-Bang (Snoring, Tiredness, Observed apnoeas, high blood Pressure, BMI, Age, Neck circumference, Gender) OSA-50 (focuses on obesity, snoring, apnoea, age) Epworth Sleepiness Scale (ESS): Measures subjective daytime sleepiness. An ESS ≥8 is considered significant, prompting further evaluation. Under Medicare Benefits Schedule (MBS) criteria, a GP can directly order a sleep study for patients with an ESS ≥8 plus a high-risk result on one of the validated screening tools . Diagnosis Formal diagnosis requires an overnight sleep study (polysomnography), which may be: Home-based (unattended): Suitable for most patients with straightforward suspected OSA. In-laboratory (attended): Indicated if there is: Comorbid neuromuscular disease, heart failure, or significant respiratory disease Suspected respiratory failure or parasomnias Intellectual or physical disability preventing at-home testing Unsuitable home environment Prior failed home-based study Strong preference for a supervised study Key Indices in Sleep Studies Apnoea–Hypopnoea Index (AHI): Number of apnoeas + hypopnoeas per hour of sleep. AHI >5 = diagnostic for OSA (provided clinical context) AHI >30 = severe OSA Hypoxic Burden: Measured by the percentage of total sleep time with SpO₂ <90% (P90) or total time below 90% (T90). P90 or T90 ~1–5% suggests moderate disease P90 >5% suggests more severe disease A single AHI threshold does not always capture the full clinical picture; daytime sleepiness, comorbid conditions, and the presence or absence of significant hypoxaemia all guide management decisions. Classification of OSA Severity Mild: AHI 5–15 events/hour Moderate: AHI 15–30 events/hour Severe: AHI >30 events/hour Additional markers include the degree of daytime sleepiness, clinical impairment, and comorbidities—these factors often trump purely numerical thresholds. Management of OSA in Adults General (Conservative) Measures All patients benefit from conservative interventions, which may be sufficient for those with mild disease and minimal daytime symptoms: Weight reduction: Even modest weight loss can significantly reduce apnoeic events. Smoking cessation: Improves nasal mucosal inflammation and reduces upper airway oedema. Avoidance of alcohol and sedatives: These worsen pharyngeal muscle relaxation and increase apnoeic episodes. Optimise sleep hygiene: Adequate and regular sleep minimises daytime fatigue and helps reduce apnoea severity. Intranasal corticosteroids: Especially helpful in reducing nasal congestion and improving airflow. Positional therapy: Avoid supine sleeping if the patient has positional OSA. Simple measures (e.g. tennis ball sewn into the back of the pyjama top) may help. Elevating the head of the bed (5–8 cm) can reduce rostral fluid shift, thus improving airway patency. Continuous Positive Airway Pressure (CPAP) CPAP is the gold-standard, most effective therapy for moderate to severe OSA, or mild OSA with significant daytime symptoms . It delivers pressurised air to keep the airway patent throughout sleep. Indications: Severe OSA (AHI >30 or P90 >5%) Moderate OSA (AHI 15–30 or P90 1–5%) with daytime sleepiness or other clinically significant issues (e.g. poorly controlled hypertension) Benefits: Reduces apnoea/hypopnoea frequency Improves daytime alertness, mood, and quality of life May improve blood pressure control Reduces risk of motor vehicle accidents Challenges: Cost of CPAP machines (some patients may rent on trial first) Mask fit and comfort Adherence (motivation, claustrophobia, dryness, air leak) Troubleshooting common CPAP problems: Nasal dryness/congestion: Use intranasal saline spray or switch to a humidified CPAP device. Mouth leak/dry mouth: Consider a chin strap or a full-face mask. Skin irritation or nasal bridge sores: Adjust mask fit; consider alternative mask interfaces. Persistent discomfort or intolerance: Offer short-term anxiolytic if anxiety is a barrier, reduce initial CPAP pressure, or recheck for machine fault or mask leak. In complex cases or persistent intolerance, a repeat sleep study or referral to a sleep physician is recommended. Mandibular Advancement Splints (MAS) A dentist-fitted mandibular advancement splint may help: Mild to moderate OSA—especially if the patient cannot tolerate CPAP Primary snoring (with minimal apnoea/hypopnoea) They work by holding the mandible slightly forward, enlarging the retroglossal space. Long-term issues include temporomandibular joint discomfort or occlusal changes. Simple “boil-and-bite” mouthguards are generally not recommended. Surgical Interventions Adenotonsillectomy or nasal surgery: May help if significant hypertrophy or obstruction is identified, or to improve CPAP tolerance. Orthognathic surgery (e.g. maxillomandibular advancement): May be considered in patients with severe craniofacial abnormalities. Palatal surgery (uvulopalatopharyngoplasty): Historically used, but has poor long-term success in most patients. Upper airway pacemaker: Largely experimental and of unclear long-term benefit. Special Considerations OSA with Respiratory Disease Coexisting COPD or asthma increases risk of nocturnal hypoventilation. Consider advanced or in-laboratory sleep studies (with CO₂ monitoring) if clinically indicated. Ensure optimal management of the underlying respiratory condition (e.g. inhalers, smoking cessation, pulmonary rehabilitation). Down Syndrome Maintain a high index of suspicion for OSA. Adults with Down syndrome commonly have anatomical risk factors, and the prevalence of OSA approaches 100% by adulthood. Pregnancy OSA in pregnancy may be associated with hypertension or pre-eclampsia. Early detection and appropriate management are important. Complications of Untreated OSA Cardiovascular morbidity: Systemic hypertension, arrhythmias (e.g. atrial fibrillation), higher risk of myocardial infarction and stroke Neurocognitive dysfunction: Poor concentration, depression, memory impairment Increased accident risk: Due to excessive daytime sleepiness Metabolic sequelae: Insulin resistance, worsened glycaemic control in diabetes 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 Foreign Body in Airways Management Suspected Airway Obstruction Main Bronchus or Higher: Signs: Sudden cough, choking, vomiting, distress Steps: Open mouth; retrieve object with Magill forceps if visible If not: 5 back blows → 5 chest compressions (CPR protocol) Lower than Main Bronchus: Signs: Persistent cough, wheeze, dyspnoea (no coryzal symptoms) Steps: Avoid back blows/compressions Sit upright, refer urgently for imaging and rigid bronchoscopy Key Points Complete Obstruction: No air movement/cyanosis → start CPR immediately CXR Findings: Hyperinflation, mediastinal shift, radiopaque object Prevention Foods: <4 years: Avoid peanuts, hard lollies, small toy parts <15 months: Also avoid raw carrots, apples, whole nuts Eating Habits: Sit quietly, small portions Parental Education: Supervise meals/play; ensure toy safety (no button batteries/small parts) Notes Delayed Diagnosis: Persistent wheeze/cough without fever/coryza → suspect foreign body Follow-Up: Post-removal, check for pneumonitis or airway injury Foreign Body in Airways Definition Inhalation of an object leading to partial or complete airway obstruction Common in children under 4 years due to exploration by mouth and immature chewing/swallowing coordination Can be life-threatening if not promptly identified and managed Suspected Airway Obstruction (Main Bronchus or Higher) Signs Sudden onset of coughing, choking, gagging, vomiting, or distress Stridor or wheezing not explained by infection Potential cyanosis if complete obstruction Management Steps Open the mouth and attempt to visualise the object for removal with Magill forceps if clearly seen If not visible Give 5 firm back blows between the scapulae Follow with 5 chest compressions as per paediatric CPR guidelines Continue alternating until resolution or professional help arrives Commence CPR immediately if complete obstruction is present with no air movement or cyanosis Suspected Lower Airway Foreign Body (Distal to Main Bronchus) Signs Persistent cough, wheeze, or dyspnoea without typical coryzal symptoms Potential unilateral wheezing or decreased air entry on auscultation Management Steps Avoid back blows or chest thrusts in partial lower airway obstruction Sit the child upright for comfort Urgent referral for imaging (chest X-ray) and possible rigid bronchoscopy under general anaesthesia Chest X-ray may show hyperinflation or mediastinal shift if there is a ball-valve effect Key Points Complete obstruction with no effective cough or sound requires immediate CPR Radiopaque objects may be visible on X-ray, but organic materials may not show up well Delayed diagnosis can present as persistent cough or unilateral wheeze without fever or runny nose Prevention Foods Avoid small, hard foods in children under 4 years, such as peanuts or hard lollies Under 15 months, also avoid raw carrots, apples, or whole nuts Eating Behaviour Encourage sitting quietly during meals and offering small pieces Teach children to chew thoroughly before swallowing Parental Education Supervise children during eating and play Check toys for small parts or button batteries that can be aspirated Keep plastic bags and small household items out of reach Notes Persistent wheeze or cough without fever or coryzal symptoms should prompt suspicion of a retained foreign body Post-removal follow-up is important to rule out pneumonitis or airway injury Early recognition and referral can prevent complications such as bronchiectasis or chronic pulmonary infection Bookmark Failed! 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