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 Global Developmental Delay Causes Perinatal TORCH infections: Toxoplasmosis, CMV, Rubella, HSV Hypoxic-ischaemic injury: Placental abruption, uterine rupture, prolonged labour Birth trauma: Macrosomia, improper forceps/vacuum use, intracranial haemorrhage Congenital/Genetic Fetal Alcohol Syndrome: Microcephaly, smooth philtrum, small palpebral fissures, developmental delays Inborn Errors of Metabolism: Congenital hypothyroidism (delayed milestones, hypotonia, lethargy) Neuromuscular Disorders: Duchenne Muscular Dystrophy, Spinal Muscular Atrophy Cerebral Palsy: Prenatal (75%): Intrauterine insults, congenital infections, genetic causes Perinatal (15%): Birth asphyxia, stroke Postnatal (10%): Meningitis, trauma, kernicterus Genetic Syndromes: Fragile X (intellectual disability, speech delay, hyperactivity), Down Syndrome, Prader-Willi Syndrome Postnatal Environmental factors: Neglect, malnutrition (iron, iodine deficiencies) CNS infections: Meningitis, encephalitis, severe sepsis Examination Growth Plot weight, height, head circumference (OFC), BMI on growth charts Dysmorphic Features Microcephaly, flat nasal bridge, single palmar crease, hypotonia Vision/Hearing Assess tracking, visual fixation, response to sounds Developmental Assessment Gross motor: Head control, rolling, sitting, walking Fine motor: Pincer grasp, hand use, object transfer Speech/language: Babbling, first words, sentence formation Social interaction: Smiling, eye contact, joint attention Neurological Examination Tone abnormalities: Hypotonia (floppy infant), hypertonia (spasticity) Deep tendon reflexes: Increased in spasticity (e.g., cerebral palsy), reduced in hypotonia (e.g., neuromuscular disorders) Posture and movement patterns Management Referrals Developmental paediatrician for assessment Genetic testing (chromosomal microarray, Fragile X screening) if syndromic features present Neurologist if seizures, regression, or abnormal tone Investigations Brain MRI if structural abnormalities, perinatal insults, or neurological signs Vision and hearing assessment to rule out sensory causes Thyroid function tests (TFTs) for congenital hypothyroidism Metabolic screening if metabolic disorders suspected Early Intervention NDIS funding for therapy and support services Occupational therapy (OT), physiotherapy, speech therapy Specialist educational programs for developmental support Follow-Up Multidisciplinary team reviews with paediatrics, allied health, and education specialists Regular monitoring of developmental progress and intervention effectiveness Additional Notes Hypotonia is a common feature across most causes ("floppy infant") Prognosis depends on the underlying cause and timing of intervention Early diagnosis and therapy significantly improve long-term outcomes Global Developmental Delay Causes Perinatal TORCH infections such as toxoplasmosis, cytomegalovirus, rubella, and herpes simplex Hypoxic-ischaemic encephalopathy from events like placental abruption, uterine rupture, or prolonged labour Birth trauma associated with macrosomia or improper use of forceps/vacuum extraction Congenital/Genetic Fetal alcohol syndrome characterised by microcephaly, smooth philtrum, and small palpebral fissures Inborn errors of metabolism including congenital hypothyroidism leading to delayed milestones and hypotonia Genetic syndromes such as Down syndrome, Fragile X syndrome, and Prader-Willi syndrome Neuromuscular Disorders Conditions like Duchenne muscular dystrophy or spinal muscular atrophy causing motor deficits Cerebral Palsy Often prenatal in origin, though perinatal or postnatal insults may contribute Postnatal Environmental factors including neglect, nutritional deficiencies, and central nervous system infections (e.g. meningitis) Other Contributory Factors Exposure to toxins such as lead and socioeconomic deprivation affecting early development Examination Anthropometric Measurements Record weight, height, and BMI using Down syndrome-specific or standard growth charts as appropriate Dysmorphic Features Identify features such as microcephaly, flat nasal bridge, epicanthal folds, or single palmar crease Sensory Screening Assess vision with cover-uncover tests and hearing by evaluating responses to auditory stimuli Developmental Assessment Evaluate gross and fine motor skills, language abilities, social interactions, and adaptive behaviours using age-appropriate tools Neurological Examination Check muscle tone (noting hypotonia or “floppy infant” presentation), reflexes, posture, and coordination Spine Examination Inspect for structural anomalies such as spina bifida or scoliosis Investigations Genetic Testing Perform chromosomal microarray as first-line when a genetic aetiology is suspected Neuroimaging MRI brain for structural abnormalities if indicated by neurological findings Metabolic Screening Assess thyroid function and perform relevant metabolic panels Sensory Assessments Conduct formal vision and hearing tests to rule out contributory sensory deficits Developmental Screening Use standardised developmental assessments to quantify delays Management Multidisciplinary Approach Refer to a developmental paediatrician for comprehensive evaluation and management Include geneticists, neurologists, and allied health professionals as indicated Early Intervention Initiate speech, occupational, and physical therapies as early as possible Develop individualised educational and behavioural support plans Support Services Facilitate access to funding and community resources (e.g. disability support schemes) Provide caregiver education and psychological support Regular Follow-Up Schedule multidisciplinary reviews to monitor progress and adjust interventions accordingly Complications and Prognosis Prognosis depends on the underlying cause and the timeliness of intervention Early, targeted therapy can significantly improve outcomes Some children may catch up to peers, while others may require lifelong support Potential long-term complications include persistent learning difficulties and social or adaptive challenges Notes Hypotonia is a frequent finding contributing to motor delays Global developmental delay may coexist with other neurodevelopmental disorders necessitating comprehensive evaluation Ongoing monitoring is essential to adjust interventions and support developmental progress 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 Grover’s Disease (Transient Acantholytic Dermatosis) Definition Pruritic, red, crusted or eroded papules/vesicles Sites: Central back, mid-chest, upper arms Common in: Caucasian men >50 with sun-damaged skin Duration: Days to decades, often seasonal Risk Factors Sweating, sun exposure, fever Malignancy, hospitalisation, prolonged bed rest Clinical Features Small, red, crusted/eroded papules Intense itch, worsened by sweating Primarily affects back, chest, upper arms Management Self-limiting, but symptom relief may be needed Key Treatments Cooling measures (avoid heat, reduce sweating) Moisturisers (prevent dryness) Topical steroids (e.g. betamethasone, triamcinolone) for itch/inflammation Oral retinoids, phototherapy (for severe cases) Grover’s Disease (Transient Acantholytic Dermatosis) Definition Grover’s disease is an itchy dermatosis characterised by small, red, crusted or eroded papules/vesicles, primarily affecting the central back, mid-chest, and upper arms. Most common in Caucasian men over 50 years with sun-damaged Can be short-lived or persist for days to decades, often exhibiting a seasonal fluctuation (e.g. worse in winter) Risk Factors Sweating, sun exposure, fever: Heat and perspiration can exacerbate or precipitate lesions Malignancy or Prolonged Bed Rest: Hospitalised, bed-bound, or debilitated patients sometimes develop Grover’s disease Other: Chronic sun-damaged skin, older age, and fair complexion Clinical Features Lesions: Small, red, sometimes crusted or eroded papules, occasionally vesicular Pruritus: Often intense itch, worsened by sweating or heat Distribution: Typically the central back, chest, upper arms, though it can appear on the trunk generally Course: May last days to weeks, spontaneously resolving, but can persist for months or even years in recurrent or chronic forms Management Self-Limiting Many cases resolve spontaneously without specific treatment; focus on symptomatic relief. General Measures Cooling Measures: Keep ambient temperatures comfortable; avoid excessive heat or sweaty environments Moisturisers: Prevent dryness and reduce itching; apply after bathing Avoid Triggers: Minimising sweating (light clothing, air-conditioned environment), gentle sun exposure if triggers are known Topical Treatments Topical Corticosteroids (e.g. betamethasone dipropionate, triamcinolone) to reduce inflammation and pruritus Apply once or twice daily, for short courses (1–2 weeks), with caution around skin thinning Calamine or menthol-based lotions for mild cooling effect More Severe Cases Oral Retinoids (e.g. acitretin) under specialist guidance if refractory Phototherapy (NB-UVB or PUVA) can be beneficial for extensive or resistant disease Oral Antihistamines for significant itch, though efficacy varies Notes Patients often benefit from reducing friction or sweating on affected areas; wearing loose, breathable clothing. Differential diagnoses include eczema, psoriasis, pityriasis rosea, Darier’s disease, or pemphigus foliaceus (in acantholytic conditions). If lesions do not respond to standard topical therapies or have unusual features, consider referral to a dermatologist for biopsy and advanced management. 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 Chronic Fatigue Syndrome (CFS) Diagnostic Criteria Fatigue: Persistent, unexplained fatigue >6 months, not relieved by rest, with significant functional impairment. Associated Symptoms (≥4, lasting >6 months): Impaired memory/concentration Post-exertional malaise Unrefreshing sleep Muscle or multi-joint pain (no swelling/redness) New/severe headaches Sore throat or tender cervical/axillary lymph nodes Symptoms and Key Features Hallmark Symptoms: Post-exertional malaise, unrefreshing sleep, cognitive impairment Common Features: Orthostatic intolerance, acute onset (often post-viral), crimson crescents in the oropharynx Triggers Post-viral fatigue (e.g., Epstein-Barr virus) Psychological or physical stress Immune Dysregulation: Possible role in pathogenesis Vitamin D deficiency Differentials Obstructive sleep apnoea Hypothyroidism, hyperthyroidism Anaemia, iron deficiency Fibromyalgia Depression, generalised anxiety disorder Multiple sclerosis HIV, hepatitis Investigations Initial Screening FBC ESR/CRP UEC, LFT, TFT Vitamin D: Exclude deficiency Further Testing (if indicated): Coeliac serology: Malabsorption Cortisol: Adrenal insufficiency Infectious workup: EBV serology Management Non-Pharmacological Graded Exercise Therapy: Low-level activity with rest periods CBT: For coexisting depression/anxiety Pacing: Avoid over-exertion to manage post-exertional malaise Sleep Hygiene: Address unrefreshing sleep Pharmacological Pain: NSAIDs or paracetamol Sleep Issues: Sedatives or low-dose antidepressants (e.g., amitriptyline) Avoid polypharmacy—limited evidence for specific medications Chronic Fatigue Syndrome (CFS) Diagnostic Criteria Fatigue: Persistent, unexplained fatigue >6 months, not relieved by rest, causing significant functional impairment. Associated Symptoms (≥4, lasting >6 months): Impaired memory or concentration Post-exertional malaise Unrefreshing sleep Muscle or multi-joint pain (without swelling/redness) New or severe headaches Sore throat or tender cervical/axillary lymph nodes Symptoms and Key Features Hallmark Symptoms: Post-exertional malaise, unrefreshing sleep, cognitive impairment Common Features: Orthostatic intolerance, often acute onset (post-viral), crimson crescents in the oropharynx Triggers Post-viral fatigue (e.g. Epstein-Barr virus) Psychological or physical stress Immune dysregulation (potential role) Vitamin D deficiency Differentials Obstructive sleep apnoea Thyroid dysfunction (hypothyroidism/hyperthyroidism) Anaemia or iron deficiency Fibromyalgia Depression or generalised anxiety disorder Multiple sclerosis HIV, hepatitis Investigations Initial Screening: FBC ESR/CRP UEC, LFT, TFT Vitamin D (exclude deficiency) Further Testing (if indicated): Coeliac serology (malabsorption) Cortisol (adrenal insufficiency) Infectious workup (e.g. EBV serology) Management Non-Pharmacological: Graded Exercise Therapy (low-level activity with planned rest periods) CBT for coexisting depression/anxiety Pacing to avoid over-exertion and manage post-exertional malaise Sleep hygiene to address unrefreshing sleep Pharmacological: Pain relief (NSAIDs or paracetamol) Sedatives or low-dose antidepressants (e.g. amitriptyline) for sleep issues Avoid polypharmacy; limited evidence for specific medications 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 Interstitial Lung Disease (ILD) Types Idiopathic Pulmonary Fibrosis (IPF): >50 yrs, linked to smoking, GORD; antifibrotics (pirfenidone, nintedanib) slow progression CTD-ILD: RA, SLE, systemic sclerosis; may respond to immunosuppressants Pneumoconioses: Asbestos, silica, coal dust exposure Hypersensitivity Pneumonitis: Inhaled organic allergens (e.g. bird proteins, mould) Drug-Induced: Amiodarone, methotrexate, nitrofurantoin Smoking-Related: Respiratory bronchiolitis-ILD, Langerhans cell histiocytosis Presentation Dry cough, dyspnoea, velcro crackles, clubbing (IPF), rash/Raynaud’s (CTD-ILD) Specialist referral for HRCT to confirm; DLCO helps distinguish parenchymal from extraparenchymal causes Vaccinate (influenza, pneumococcal) due to infection risk Investigations Initial: Pulse oximetry, spirometry (restrictive: ↓FVC, ↑FEV₁/FVC), CXR Specialist: HRCT (diagnosis, pattern differentiation), ANA, RF, DLCO, lung biopsy if unclear Monitor: ≥10% ↓FVC or ≥15% ↓DLCO = significant decline Management IPF: Antifibrotics (pirfenidone, nintedanib), pulmonary rehab, long-term O₂ if hypoxaemic CTD-ILD: Immunosuppressants (e.g., mycophenolate, cyclophosphamide) Smoking-Related ILD: Smoking cessation; corticosteroids if progressive; consider lung transplant Hypersensitivity Pneumonitis: Allergen avoidance, corticosteroids if severe Pneumoconioses: Manage symptoms, monitor occupational exposures Special Notes HRCT Patterns: UIP: Honeycombing, basal/subpleural (IPF, RA-ILD) NSIP: Bilateral ground-glass opacities (CTD-ILD) Childhood ILD: Rare; refer to paediatric specialist, genetic testing for familial cases Monitoring Regular lung function tests to track progression and comorbidities Pulmonary rehab improves QoL; O₂ for hypoxaemia Interstitial Lung Disease (ILD) Types Idiopathic Pulmonary Fibrosis (IPF) Typically age >50, associated with smoking, gastro-oesophageal reflux disease (GORD) Antifibrotic agents (pirfenidone, nintedanib) may slow disease progression Connective Tissue Disease–Related ILD (CTD-ILD) Common in RA, SLE, systemic sclerosis May respond to immunosuppressive therapy (e.g. mycophenolate mofetil, cyclophosphamide) Pneumoconioses From occupational exposures: Asbestos, silica, coal dust Hypersensitivity Pneumonitis Inhaled organic allergens (e.g. bird proteins, mould) → alveolar inflammation Drug-Induced Amiodarone, methotrexate, nitrofurantoin can all cause ILD Smoking-Related Includes respiratory bronchiolitis–ILD and Langerhans cell histiocytosis (often younger smokers) Presentation Dry cough, progressive dyspnoea Velcro crackles on auscultation, clubbing (particularly in IPF) Signs of underlying CTD if relevant (rash, Raynaud’s, arthralgias) Specialist referral for HRCT (high-resolution CT) to confirm pattern; DLCO helps differentiate parenchymal from extraparenchymal causes Vaccinations (influenza, pneumococcal) recommended due to increased infection risk Investigations Initial Pulse oximetry → check resting SpO₂ and possible desaturation on exertion Spirometry → restrictive pattern: ↓FVC with preserved or increased FEV₁/FVC ratio CXR → reticular or reticulonodular opacities, possible honeycombing Specialist HRCT → critical for diagnosis and pattern differentiation (e.g. UIP, NSIP) Autoimmune markers (ANA, RF) if CTD suspected DLCO (diffusing capacity) → often reduced in ILD Lung biopsy (rarely needed) for unclear cases Monitoring: ≥10% ↓FVC or ≥15% ↓DLCO signals significant decline in disease status Management IPF Antifibrotics: Pirfenidone or nintedanib to slow fibrotic progression Pulmonary rehabilitation: Improves functional capacity and QoL Long-term oxygen if hypoxaemic; consider lung transplant evaluation in advanced disease CTD-ILD Immunosuppressants: Mycophenolate mofetil, cyclophosphamide (especially in scleroderma-related ILD) Treat underlying rheumatologic disease concurrently (e.g. DMARDs for RA, lupus therapy) Smoking-Related ILD Smoking cessation is fundamental Corticosteroids if progressive or inflammatory Consider lung transplant if advanced Hypersensitivity Pneumonitis Allergen avoidance is critical Corticosteroids if severe or progressive disease Pneumoconioses Manage symptoms, avoid ongoing occupational exposures, monitor for progressive fibrotic changes Special Notes HRCT Patterns UIP (usual interstitial pneumonia): Honeycombing, basal/subpleural predominance (classic in IPF, can also appear in RA-ILD) NSIP (nonspecific interstitial pneumonia): More bilateral ground-glass opacities, often linked to CTDs Childhood ILD is rare and may require paediatric respiratory referral, genetic testing for familial ILD Monitoring Regular lung function tests (FVC, DLCO) track progression and comorbidities Pulmonary rehabilitation improves quality of life and exercise tolerance Long-term oxygen therapy if hypoxaemic (PaO₂ <55 mmHg or SpO₂ <88%) Refer to specialist (respiratory physician) if uncertain diagnosis, significant disease progression, or complicated comorbidities 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 Paracetamol Hepatotoxicity Overdose Dose Single Dose: ≥10 g or 200 mg/kg in 24 hours Chronic Use: ≥6 g or 150 mg/kg/day over 48 hours Clinical Features Nausea, vomiting Right upper quadrant pain Elevated liver enzymes (AST/ALT >1000 IU/L) Jaundice Coagulopathy Hypoglycaemia Management Initial Steps Assess ingestion history and time Activated charcoal if within 1 hour of ingestion N-Acetylcysteine (NAC) Start immediately per dosing protocol (based on time post-ingestion) Continue NAC even if delayed presentation Monitoring Liver function tests (AST/ALT, bilirubin) Coagulation profile (INR/PT) Glucose levels Supportive Care Manage liver dysfunction Avoid hepatotoxic drugs Referral Criteria AST/ALT >1000 IU/L Acute liver failure (encephalopathy, coagulopathy) Uncertain ingestion time or beyond treatment window Massive overdose requiring ICU care Failure to respond to initial therapy Paracetamol Hepatotoxicity Overdose Dose Single Dose: ≥10 g or 200 mg/kg in 24 hours (whichever is less) Chronic Use: ≥6 g or 150 mg/kg/day over 48 hours (especially in low-weight or malnourished patients) Clinical Features Nausea, vomiting Right upper quadrant (RUQ) abdominal pain Elevated liver enzymes (AST/ALT often >1000 IU/L in severe cases) Jaundice if significant liver damage Coagulopathy (↑ INR, prolonged PT) Hypoglycaemia (due to impaired gluconeogenesis in severe cases) Management Initial Steps Assess Ingestion History & Timing Confirm dose, time of ingestion, and any co-ingestants Activated Charcoal If presentation <1 hour post-ingestion (reduces paracetamol absorption) N-Acetylcysteine (NAC) Begin as soon as possible according to an approved dosing protocol Continue NAC even if patient presents late (beyond the typical 8-hour window) NAC prevents hepatocellular damage by replenishing glutathione Monitoring Liver Function Tests: AST, ALT, bilirubin Coagulation Profile: INR/PT (detects hepatic synthetic failure) Glucose Levels: Hypoglycaemia risk in severe liver injury Supportive Care Manage potential hypoglycaemia with IV dextrose if needed Monitor fluid balance, renal function Avoid hepatotoxic drugs (e.g. further paracetamol, certain antibiotics) Consider ICU admission if severe toxicity or acute liver failure Referral Criteria AST/ALT >1000 IU/L (suggests severe hepatic injury) Acute Liver Failure: Encephalopathy, coagulopathy (INR >1.5), significant jaundice Uncertain ingestion time or beyond typical treatment window (≥8 hours) Massive Overdose requiring closer monitoring or ICU Failure to respond to initial NAC therapy (persistent or rising transaminases, coagulopathy) 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 Thrombophlebitis Shouldn’t be able to see the actual veins in DVT Same risk factors as DVT Tender on palpation Still do US doppler as can prog to DVT/PE Treatment Ibuprofen 400mg tds (not paracetamol) Elevate leg Compression stockings Warm compresses Continue to mobilise Enoxaparin 40mg SC od for 4/52 (consider esp if high risk prog deeper) Thrombophlebitis Risk Factors Prolonged immobilisation (e.g. long-haul flights, bed rest) Recent surgery (especially orthopaedic procedures of the lower limb) Active cancer or malignancy Pregnancy or postpartum period Use of oral contraceptives or hormone replacement therapy Obesity Varicose veins Inherited thrombophilias (e.g. Factor V Leiden mutation) Many of these risk factors overlap with those for DVT, often summarised by Virchow’s Triad (stasis, endothelial injury, hypercoagulability). Clinical Presentation Superficial thrombophlebitis Localised tenderness, pain, redness, and a palpable cord-like vein The affected vein is often visible or palpable just below the skin surface Swelling is usually localised along the inflamed vein rather than the entire limb Patients might notice local warmth over the area Deep vein thrombosis Typically presents with diffuse swelling of the entire calf or leg Pain, possibly worse on dorsiflexion (Homan’s sign), though this sign is neither sensitive nor specific The overlying veins are often not visible as dilated, cord-like structures More pronounced risk of pulmonary embolism if untreated Because superficial thrombophlebitis can progress to DVT in certain scenarios, careful assessment is required. Investigations A thorough history (including risk factors) and physical examination are essentialLook for signs suggestive of DVT (e.g. diffuse swelling) or superficial thrombophlebitis (a palpable cord, local redness, tenderness) Clinical Assessment Assess for extension beyond superficial veins or suspicion of concomitant DVTCheck for risk factors such as recent immobilisation, active malignancy, or previous venous thromboembolic events Ultrasound (Doppler) Examination Duplex ultrasound is the main investigation to confirm superficial thrombophlebitis and assess for extension into the deep venous systemEven if the clinical suspicion is high for superficial thrombophlebitis, a Doppler ultrasound is recommended to exclude concurrent DVT or extension toward the deep system Management Management aims to reduce inflammation, relieve pain, and prevent extension into deep veins Conservative Measures Leg elevation Warm compresses Compression stockings (graduated compression helps reduce pain and swelling) Mobilisation rather than strict bed rest Analgesia and Anti-Inflammatory Treatment NSAIDs (e.g. ibuprofen 400 mg three times daily) for pain and inflammation Consider contraindications (e.g. peptic ulcer disease, renal impairment, cardiovascular disease) Paracetamol alone is less effective for the inflammatory component Anticoagulation Consider anticoagulation if the thrombus is extensive, close to the deep venous system, or the patient is high risk (e.g. previous VTE, active cancer, thrombophilia) Low molecular weight heparin (e.g. enoxaparin 40 mg subcut once daily) for up to 4 weeks is often used Alternative agents (such as DOACs or fondaparinux) may be considered in specific circumstances Follow current Therapeutic Guidelines for dosing and duration Monitoring and Follow-Up Ensure symptomatic improvement (decreasing pain, erythema, swelling) Consider repeat ultrasound if symptoms worsen or do not improve Advise patients to seek urgent review if signs of DVT or PE develop Complications Propagation of the clot into deeper veins (leading to secondary DVT) Pulmonary embolism if extension reaches the deep system Recurrent superficial thrombophlebitis, especially in patients with varicose veins or thrombophilias Chronic venous insufficiency if repeated episodes damage venous valves Prevention Address modifiable risk factors (weight reduction, smoking cessation, regular mobilisation) Optimise management of varicose veins (consider surgical intervention if recurrent issues) Provide prophylaxis in high-risk situations (e.g. prophylactic LMWH during high-risk periods for patients with previous VTE or known thrombophilias) 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 Bipolar Disorder History Family history of bipolar Previous manic episodes Functional impairment Antidepressant use without mania prophylaxis Exclude drug-induced psychosis (illicit drugs) Rapid mood swings, mixed features Comorbid anxiety/substance use disorders Diagnosis Persistent irritable/elevated/expansive mood + 3 DIGFAST symptoms: Distractibility Indiscretion (risky behaviour) Grandiosity Flight of ideas Agitation/activity ↑ Sleep ↓ Talkativeness Exclude thyroid disorders/other medical conditions Use DSM-5 criteria Management Acute Mania Initial Actions: Inform patient of likely mania Assess insight into condition Collateral history with consent Arrange admission to psychiatric services Crisis assessment team involvement Assess safety and risk to self/others Medications: Oral: Olanzapine 5 mg PO stat or risperidone 0.5 mg nocte IM (if oral not tolerated): Midazolam 5 mg IM Droperidol/Olanzapine 5 mg IM Monitor vitals and side effects Bipolar Depression First-Line: SSRI + mood stabiliser (e.g., lithium or 2nd-gen antipsychotics) Monotherapy Option: Quetiapine (not inferior to dual therapy) Taper off antidepressants within 1–2 months to avoid mania Assess suicidality Long-Term Management Educate family to monitor for mania Refer to bipolar support groups Ongoing CBT Regular aerobic exercise (150 min/week) Psychoeducation: improve adherence, prevent relapse Monitor adherence to prophylaxis meds and metabolic side effects Contraception/STI check Avoid illicit drugs Encourage regular sleep patterns Routine screening for comorbidities Regular follow-ups Subtypes Type 1 ≥7 days of mania requiring hospitalisation or causing significant functional impairment Psychosis = Mania Marked social/occupational dysfunction Type 2 Hypomania (4+ days, 3+ DIGFAST) + major depressive episodes No significant functional impairment or psychosis Notes Avoid haloperidol/metoclopramide in Parkinson’s (EPSE risk) Avoid benzodiazepines (high complication risk) Use antidepressants cautiously (mood switching risk) Regularly review meds to minimise polypharmacy Same meds applicable for acute delirium (e.g., olanzapine 2.5 mg PO/IM) Bipolar Disorder History Family history of bipolar disorder Previous manic episodes or rapid mood swings Functional impairment during mood episodes Antidepressant use without concurrent mania prophylaxis Possible drug-induced psychosis (illicit substances) Comorbid anxiety or substance use disorders Mixed features (coexisting manic and depressive symptoms) Diagnosis Elevated, irritable, or expansive mood plus ≥3 DIGFAST symptoms: Distractibility, Indiscretion (risky behaviour), Grandiosity, Flight of ideas, Activity increase, Sleep decrease, Talkativeness. Exclude medical causes (e.g. thyroid disorders). Use DSM-5 criteria for bipolar spectrum. Bipolar I: ≥7 days of mania (or hospitalisation), severe functional impairment or psychosis. Bipolar II: Hypomania (≥4 days) plus major depression, no severe functional impairment or psychosis. Management Acute Mania Initial actions: Inform patient of likely mania, assess insight. Consider collateral history with consent. Arrange psychiatric admission if necessary. Crisis assessment if risk to self or others. Medications (oral): Olanzapine 5 mg PO stat or risperidone 0.5 mg nocte. If IM needed: Midazolam 5 mg IM or droperidol/olanzapine 5 mg IM. Monitor vitals and side effects. Bipolar Depression First-line: SSRI + mood stabiliser (e.g. lithium) or second-generation antipsychotic. Monotherapy option: Quetiapine. Avoid prolonged antidepressant use: Taper off within 1–2 months to reduce mania risk. Assess suicidality. Long-Term Management Educate family to recognise early mania signs. Offer referrals to bipolar support networks. Ongoing CBT, encourage regular aerobic exercise (150 min/week). Psychoeducation to improve adherence and recognise relapse triggers. Monitor prophylaxis medication adherence and metabolic parameters. Screen for STI, ensure contraception if indicated. Discourage illicit drugs, maintain regular sleep patterns. Routine screening for comorbidities (diabetes, dyslipidaemia). Regular follow-ups for mental state review and therapy adjustments. Subtypes Type 1: Manic episodes ≥7 days or requiring hospitalisation, possibly with psychosis or marked functional impairment. Type 2: Hypomania (≥4 days + ≥3 DIGFAST symptoms) plus major depression, no significant functional impairment or psychosis. Notes Use haloperidol or metoclopramide cautiously in Parkinson’s disease (EPSE risk). Benzodiazepines have high complication risks in certain populations. Antidepressants can induce mania; use cautiously and with mood stabilisers. Regularly review medications to minimise polypharmacy. Low-dose antipsychotics (e.g. olanzapine 2.5 mg PO/IM) can be used off-label for acute delirium. 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 CA-125 Malignancies Endometrial, ovarian, bowel, breast cancers Benign Conditions Liver cirrhosis Ovarian cysts Pelvic inflammatory disease (PID) Uterine fibroids Pregnancy Endometriosis Adenomyosis Peritoneal irritation Key Considerations Limited specificity → Elevated in both malignant & benign conditions Benign causes often due to peritoneal irritation/inflammation CA-125 Definition A glycoprotein tumour marker produced by coelomic epithelium and its derivatives Primarily used to support diagnosis and monitor treatment response in ovarian cancer Causes of Elevated CA-125 Malignancies Ovarian, endometrial, breast and bowel cancers Benign Conditions Liver cirrhosis with ascites Ovarian cysts Pelvic inflammatory disease Uterine fibroids Endometriosis and adenomyosis Pregnancy, particularly in the first trimester Peritoneal irritation from infections or inflammatory processes Normal Variants Mild elevations may occur during menstruation without underlying pathology Clinical Utility and Limitations Limited specificity, as levels are elevated in both malignant and benign conditions Not recommended for screening in asymptomatic women Serial measurements are more useful than a single value in monitoring treatment response or detecting recurrence Variability due to menstrual cycle and pregnancy necessitates clinical correlation Investigations and Interpretation Serum assay with normal levels typically <35 U/mL Should be interpreted alongside clinical history, examination and imaging Elevated levels in the presence of a pelvic mass increase suspicion for ovarian malignancy Serial measurements guide management decisions in known ovarian cancer Monitoring and Follow-Up Regular monitoring is essential in ovarian cancer to assess treatment efficacy and detect relapse In benign conditions, CA-125 levels usually normalise with resolution of inflammation Changes in CA-125 must be correlated with clinical and imaging findings Notes: CA-125 is most valuable in the first 6 weeks of pregnancy for confirming intrauterine pregnancy In liver cirrhosis, elevated CA-125 is typically secondary to peritoneal irritation from ascites Combining CA-125 with other markers and imaging enhances diagnostic accuracy for pelvic masses CA-125 should be used as part of a comprehensive evaluation rather than in isolation Awareness of assay variability and influencing factors, such as hormonal fluctuations, is important in interpretation 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 Erythema Nodosum (EN) Definition Hypersensitivity reaction (50%) Painful, red, tender subcutaneous nodules, usually on shins (less common: thighs, forearms) Type of panniculitis (inflammation of subcutaneous fat) Peak age 20–30, 3–6× more common in women Aetiology & Causes Sarcoidosis (most common) Infections: Streptococcal throat infection, viral infections, tuberculosis, chlamydia Drugs: OCPs, NSAIDs, iodides Inflammatory diseases: Crohn’s, ulcerative colitis Pregnancy (may resolve postpartum) Clinical Features Tender, hot nodules (6–12 in clusters) on shins, thighs, forearms Size: Cherry to grapefruit Duration: ~10 days per lesion, bruising & colour changes in week 2 Resolves in 3–6 weeks, but may persist for months/years Systemic symptoms: Arthralgia (knees most affected), fever, malaise Diagnosis Clinical diagnosis, confirmed by skin biopsy if uncertain Histology: Inflammation of subcutaneous fat without vasculitis Investigations: Throat swab, ASOT (streptococcal infection) CXR (rule out TB, sarcoidosis) Bloods: FBC, U&E, ESR, CRP Mantoux test (if TB suspected) Management Rest, limb elevation if swelling/pain severe Supportive care: Compression stockings, NSAIDs Potassium iodide & oral tetracyclines (reduce inflammation) Severe/persistent cases: Systemic corticosteroids (used cautiously due to side effects) Prognosis Self-limiting, resolves in 3–6 weeks Recurrence possible if underlying cause persists Chronic cases may last months to years Erythema Nodosum (EN) Definition Erythema nodosum (EN) is a hypersensitivity reaction characterised by painful, red, tender subcutaneous nodules, typically on the shins, though the thighs and forearms can also be affected. It is considered a type of panniculitis(inflammation of subcutaneous fat). EN most commonly presents in young adults (peak age 20–30), with a 3–6× higher incidence in females. Aetiology & Causes Sarcoidosis: Most common identifiable cause Infections: Streptococcal throat infection (check for recent sore throat) Viral (e.g. EBV, CMV) Mycobacterium tuberculosis (TB) Chlamydia Drugs: Oral contraceptives (OCPs), NSAIDs, iodides Inflammatory Diseases: Crohn’s disease, ulcerative colitis Pregnancy: EN may appear during pregnancy but often resolves postpartum Idiopathic: Up to 50% of cases have no identifiable cause Clinical Features Lesions: Tender, hot nodules often grouped in clusters (6–12 lesions) Size can range from small “cherry” nodules to larger “grapefruit-sized” lumps Commonly located over shins, can also appear on thighs and forearms Duration of each lesion is around 10 days, then they may undergo colour changes (bluish, bruise-like) in the second week Typically resolve spontaneously in 3–6 weeks, but can persist or recur Systemic Symptoms: Arthralgia, particularly affecting knees and ankles Fever, malaise, and generalised “flu-like” symptoms Diagnosis Primarily clinical based on characteristic nodules on the lower limbs. Skin Biopsy (deep incisional or excisional) if the diagnosis is uncertain, showing a septal panniculitis without true vasculitis. Investigations to identify underlying cause: Throat swab, antistreptolysin O titre (ASOT) if strep infection suspected Chest X-ray (CXR) to rule out sarcoidosis, TB Basic blood tests: FBC, U&E, ESR, CRP Mantoux test (or IGRA) if TB suspected Stool culture, serology for infections based on clinical suspicion (e.g. COVID-19, Mycoplasma) Screening for inflammatory bowel disease if GI symptoms Management Supportive Care Rest, limb elevation to reduce swelling/pain Compression stockings if there is significant oedema NSAIDs (e.g. ibuprofen) for pain and inflammation, provided no contraindications Potassium iodide (specialist consideration) and oral tetracyclines have been used anecdotally to reduce inflammation Address Underlying Cause Streptococcal infection → appropriate antibiotics (e.g. penicillin) Sarcoidosis → consider referral to respiratory specialist and possible corticosteroid therapy IBD → treat flares, refer to gastroenterology if needed Drug-induced → discontinue the offending medication if feasible Pharmacological Therapy Systemic corticosteroids in severe or persistent cases (e.g. prednisolone) Use cautiously given side-effect profile; weigh risks and benefits Lifestyle & Follow-up Light exercise or activity within comfort limits Adequate hydration and rest Monitor nodules for resolution or progression Investigate if recurrent or persistent (re-check for chronic infections, autoimmune conditions) Prognosis Self-limiting: Most lesions resolve within 3–6 weeks without scarring, though bruising and colour changes may persist briefly. Chronic or Recurrent: Can last months or years if the underlying cause is not addressed or if there is ongoing inflammation (e.g. in sarcoidosis or IBD). Monitoring: Follow up to ensure resolution and to manage any systemic cause. Notes If EN is recurring or persistent, always reassess for undiagnosed causes such as sarcoidosis, TB, IBD, or underlying malignancy (rare). Consider pregnancy implications—EN may spontaneously resolve postpartum. Some patients experience significant pain and functional limitations—supportive measures and analgesia are key. 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 Measles Clinical Case Definition Suspected Case Descending maculopapular rash lasting ≥3 days Fever >38°C at rash onset At least one of the 4 Cs: Cough Coryza Conjunctivitis Koplik spots (pathognomonic) Management Infection Control Isolate in a closed room with airborne precautions Staff to wear a surgical mask + N95 respirator Terminal cleaning after patient leaves Notification Immediate report to public health authorities Contact tracing (including those exposed up to 30 minutes post-exposure) Post-Exposure Prophylaxis (PEP) Vaccine: Within 72 hours for unvaccinated or exposed individuals Immunoglobulin (within 6 days) for: Immunocompromised patients Pregnant women Infants <6 months Investigations Diagnostics Nasopharyngeal swab or urine PCR (best within 3 weeks from onset) Measles IgM/IgG if PCR is unavailable Other Tests FBC: Lymphopenia possible CXR: If pneumonia suspected Notes Infectious Period: 5 days before to 5 days after rash onset Differentials: Rubella, scarlet fever, dengue, drug rash, Kawasaki disease COVID-19: Exclude if meets epidemiological and clinical criteria Measles Definition Acute viral illness caused by the measles virus Characterised by fever, cough, coryza, conjunctivitis, and a descending maculopapular rash Highly contagious, with an incubation period of 10–14 days Can lead to severe complications, particularly in young children, pregnant women, and immunocompromised individuals Presentation Prodromal phase includes fever over 38°C, malaise, dry cough, runny nose, and red eyes Koplik spots: Small white lesions on the buccal mucosa appearing 1–2 days before the rash (pathognomonic) Rash: Descending, blotchy red maculopapular rash starting at the hairline and progressing downward, typically non-itchy Other features may include otitis media, pneumonia, and diarrhoea during the illness Differential Diagnosis Rubella: Similar rash but milder, with postauricular lymphadenopathy Scarlet fever: Sandpaper rash with strawberry tongue following streptococcal infection Dengue: Febrile illness with rash and myalgia, usually with relevant travel history Drug eruption: Rash due to medications, lacking respiratory or conjunctival symptoms Kawasaki disease: Prolonged fever with rash, conjunctivitis, and mucosal changes, but with distinct cardiac involvement Investigations Nasopharyngeal swab or urine PCR: Preferred diagnostic tests if performed within 3 weeks from rash onset Serology: Measles IgM and IgG antibody testing if PCR is unavailable Full blood count: May reveal lymphopenia during the acute phase Chest X-ray: To evaluate for complications such as pneumonia when indicated Additional tests: Consider screening for other infections (e.g., COVID-19) if clinically warranted Management Isolation: Place the patient in a closed room and ensure staff use appropriate PPE (surgical mask plus N95) Infection control: Perform terminal cleaning after patient departure and trace contacts who were exposed up to 30 minutes post-exposure Notification: Report immediately to public health authorities Post-exposure prophylaxis: MMR vaccine within 72 hours for unvaccinated or exposed individuals Immunoglobulin within 6 days for high-risk groups including immunocompromised individuals, pregnant women, and infants under 6 months Supportive care: Ensure adequate hydration and administer antipyretics such as paracetamol for fever Monitor for complications like pneumonia, encephalitis, or otitis media Prevention Vaccination: Two doses of MMR vaccine provide over 99% protection; aim for 95% coverage to maintain herd immunity Offer catch-up vaccination for individuals born between 1966 and 1994 who may have received only one dose In outbreak settings, consider MMR vaccination from 6 months of age, with the first dose repeated if administered before 11 months Infection control in practice: Isolate symptomatic patients on arrival and screen for travel history and exposure Maintain current immunisation records for staff and patients Public health measures: Follow guidelines for contact tracing and outbreak management during increased measles activity Notes Infectious period: Patients are contagious from 5 days before to 5 days after rash onset Complications: Approximately 10% of cases may result in pneumonia, otitis media, or acute encephalitis; subacute sclerosing panencephalitis is a rare, fatal long-term complication Detailed documentation of exposures and prompt public health notification are essential in outbreak settings Educate patients and caregivers on the critical importance of vaccination and early isolation measures Consider epidemiological factors and current global measles trends, including decreased immunisation rates and increased travel-related cases 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 Anxiety & Adjustment Disorder Diagnosis Generalised Anxiety Disorder (GAD) Excessive worry/anxiety about multiple topics most days for >6 months BESKIM (≥3 symptoms): B: Blank mind (poor concentration) E: Easily fatigued S: Sleep disturbances K: Keyed up (restlessness) I: Irritability M: Muscle tension Clinically significant impairment Adjustment Disorder Anxiety symptoms within 3 months of a stressor Resolves within 6 months of stressor cessation Does not meet criteria for other mental health conditions Key Steps: Rule out other mental health disorders/medical causes Investigations ECG Bloods: FBC, FBG, TFTs Electrolytes (if clinically indicated) Management Non-Pharmacological Breathing control strategies Cognitive Behaviour Therapy (CBT) (1st line before pharmacotherapy) Avoid stimulants (e.g., caffeine) Refer to e-mental health programs Psychoeducation: Relaxation techniques, stress management Pharmacological SSRIs: 1st line for GAD (not for adjustment disorder) Diazepam: 2–5 mg BD PRN for ≤2 weeks (severe anxiety in adjustment disorder or GAD) Monitoring Regular follow-up for treatment response and side effects Adjust treatment plan as needed Anxiety & Adjustment Disorder Diagnoses Generalised Anxiety Disorder (GAD) Definition Excessive anxiety and worry about multiple events or activities, occurring most days for at least 6 months. Symptoms At least 3 of the following (mnemonic BESKIM): B: Blank mind / poor concentration E: Easily fatigued S: Sleep disturbances K: Keyed up / restlessness I: Irritability M: Muscle tension Symptoms cause clinically significant distress or functional impairment (e.g. social, occupational). Exclusions Rule out medical causes (e.g. hyperthyroidism, anaemia) and other mental health disorders (e.g. social anxiety, panic disorder). Adjustment Disorder Definition The development of emotional or behavioural symptoms (e.g. anxiety, low mood) in response to an identifiable stressor within 3 months of the stressor’s onset. Symptoms do not meet full criteria for another mental disorder (e.g. GAD, major depression). Symptoms resolve within 6 months after the stressor or its consequences end. Exclusions Does not meet criteria for other mental health conditions (e.g. major depressive episode, PTSD). Not merely an exacerbation of a pre-existing disorder. Key Steps in Evaluation Thorough history and mental state examination: Identify triggers, stressors, timeline, functional impairment. Rule out physical causes mimicking anxiety (e.g. thyroid disorders, anaemia, cardiac arrhythmias). Assess for risk factors: family history of anxiety, substance use, co-morbid depression, suicidality. Investigations Depending on clinical judgment: ECG Particularly if considering use of certain medications (e.g. SSRIs in older patients) or if cardiac symptoms are present (palpitations, chest tightness). Blood Tests FBC (Full Blood Count): Exclude anaemia, infection. FBG (Fasting Blood Glucose): Screen for hyperglycaemia or diabetes. TFTs (Thyroid Function Tests): Exclude hyperthyroidism or hypothyroidism. Electrolytes if indicated (e.g. if diuretic use, suspicion of electrolyte imbalance). Management Non-Pharmacological Interventions Consider these interventions first (especially in adjustment disorder and mild-to-moderate GAD): Psychological Therapies Cognitive Behavioural Therapy (CBT): First-line psychotherapy; addresses maladaptive thought patterns. E-mental health programs (e.g. MindSpot, This Way Up, myCompass) for structured online CBT in Australia. Breathing control and relaxation exercises (e.g. progressive muscle relaxation, mindfulness). Psychoeducation Stress management and coping strategies. Identify and reduce triggers (avoid excess caffeine or stimulants). Lifestyle modifications Ensure good sleep hygiene, regular exercise, healthy diet. Social support, problem-solving around stressors. Pharmacological Therapy Generalised Anxiety Disorder (GAD) SSRIs (e.g. escitalopram, sertraline) are first-line. SNRIs (e.g. venlafaxine, duloxetine) may be considered if SSRIs are not tolerated or ineffective. Benzodiazepines (e.g. diazepam) should generally be short-term (e.g. ≤2 weeks) for severe acute anxiety or while waiting for SSRIs to take effect; avoid long-term use due to dependence risk. Adjustment Disorder Pharmacotherapy is not routinely required if symptoms are mild and stressor is time-limited. Short-course benzodiazepines (e.g. diazepam 2–5 mg BD PRN for up to 2 weeks) may be used cautiously if anxiety is severe. SSRIs are not typically first-line for pure adjustment disorder but may be considered if the patient’s symptoms persist or evolve into GAD or major depression. Monitoring & Follow-Up Regular reviews to assess treatment response, adherence, and side effects. Adjust treatment as needed (e.g. switch SSRIs if intolerable side effects, increase psychosocial support if stressors intensify). In GAD, check for long-term improvement in anxiety levels, sleep, functioning (work, relationships). In adjustment disorder, ensure resolution of symptoms typically within 6 months. If not, reassess diagnosis or consider more intensive therapy. Bookmark Failed! Bookmark Saved! Add Bookmark Refresh Refresh