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 Dacrocystitis, Dacryostenosis, Dacryocystocoele Dacrocystitis Cause: Infected nasolacrimal duct obstruction (Staph aureus, Strep pneumoniae) Features: Painful, red swelling at medial canthus Epiphora, purulent punctal discharge ± Fever in severe cases Management: Warm compresses, gentle sac massage Oral antibiotics: Cephalexin 500 mg QID x 7 days (weight-based for children) Abscess: Refer for I&D Urgent referral: Worsening infection, orbital cellulitis (proptosis, diplopia) Dacryostenosis (Congenital Nasolacrimal Duct Obstruction) Cause: Failure of distal duct canalisation in infants Features: Epiphora, crusting, no swelling/erythema Management: Massage lacrimal sac (downward strokes), warm compresses Topical antibiotics for secondary infection only Persistent >12 months: Refer for probing under anaesthesia Most resolve spontaneously by 1 year Dacryocystocoele Cause: Obstruction of both ends of nasolacrimal duct → fluid accumulation, cyst formation Features: Firm, bluish cystic swelling at medial canthus (neonate) ± Nasal obstruction or respiratory distress Management: Urgent referral: High risk of infection or orbital cellulitis Definitive: Surgical decompression/marsupialisation Notes Red Flags: Fever, periorbital erythema, proptosis → orbital cellulitis → immediate referral Adults: Recurrent dacrocystitis may require dacryocystorhinostomy (DCR). Follow-up critical to monitor resolution/prevent complications (e.g., meningitis, sepsis). Dacrocystitis, Dacryostenosis, Dacryocystocoele Dacrocystitis Cause: Infection of a nasolacrimal duct obstruction (commonly Staphylococcus aureus, Streptococcus pneumoniae). Features: Painful, red swelling at the medial canthus Epiphora (tearing), purulent punctal discharge Possible fever in severe cases Management: Warm compresses, gentle lacrimal sac massage Oral antibiotics (e.g. cephalexin 500 mg QID for 7 days; weight-based dosing in children) Abscess formation → Refer for incision and drainage Urgent referral if worsening infection or signs of orbital cellulitis (proptosis, diplopia) Dacryostenosis (Congenital Nasolacrimal Duct Obstruction) Cause: Failure of distal nasolacrimal duct to canalise in infants Features: Epiphora, crusting around eyelids Typically no swelling or erythema Management: Lacrimal sac massage (downward strokes), warm compresses Topical antibiotics only if secondary infection Persistent obstruction beyond 12 months → Refer for probing under anaesthesia Most cases resolve spontaneously by age 1 year Dacryocystocoele Cause: Obstruction at both ends of the nasolacrimal duct leading to fluid accumulation and cyst formation Features: Firm, bluish, cystic swelling at the medial canthus (noted in neonates) Possible nasal obstruction or respiratory distress in infants Management: Urgent referral due to high risk of infection or progression to orbital cellulitis Definitive treatment may involve surgical decompression or marsupialisation Notes Red Flags: Fever, periorbital erythema, proptosis → potential orbital cellulitis → immediate referral Adults: Recurrent dacrocystitis may require dacryocystorhinostomy (DCR) Follow-up is essential to ensure resolution and to prevent complications (e.g. meningitis, sepsis) 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 Bleeding Disorders Causes Haemophilia A/B: Factor VIII/IX deficiency → impaired clotting VWD: Deficient/defective VWF → poor platelet adhesion, low factor VIII ITP: Autoimmune platelet destruction → thrombocytopenia Presentation Bruising (purpura), bleeding gums, epistaxis, menorrhagia Haematomas, haemarthrosis (haemophilia), prolonged post-op bleeding Investigations Haemophilia: ↓ Factor VIII/IX, ↑aPTT, normal PT VWD: ↓VWF antigen/activity, factor VIII levels ITP: ↓ Platelet count; consider platelet function tests if normal count Management of Bleeding Disorders Haemophilia: Factor replacement (prophylaxis for severe cases) Desmopressin for mild Haemophilia A Tranexamic acid for mucosal bleeds VWD: Desmopressin (mild/moderate Type 1, pre-procedure) VWF-containing factor VIII concentrate for major bleeds Avoid NSAIDs ITP: First-line: Corticosteroids, IVIG (acute severe) Refractory: Thrombopoietin agonists (eltrombopag, romiplostim) Platelet transfusions (life-threatening), splenectomy if unresponsive General Measures Correct anaemia with transfusions if needed Maintain oral hygiene to reduce gum bleeding Haematology input for surgery/invasive procedures Bleeding disorders Causes: Haemophilia A and B - Genetic disorders caused by deficiencies in clotting factors VIII (Haemophilia A) and IX (Haemophilia B). Thrombocytopaenia - A reduction in platelet count, with Immune Thrombocytopaenic Purpura (ITP) being the most common form. Von Willebrand Disease (vWD) - A hereditary condition affecting the von Willebrand factor, which is involved in platelet adhesion and binds factor VIII in the clotting cascade. Vitamin Deficiencies - Deficiencies in vitamins A8 and B9 (factors VIII and IX) can also contribute to clotting issues. Pathophysiology: Bleeding disorders often result from either a deficiency in clotting factors (as in haemophilia) or a dysfunction in platelet formation and adhesion (as seen in thrombocytopaenia and vWD). This impairment leads to the inability to form stable blood clots, resulting in prolonged bleeding. Symptoms: Easy bruising (purpura) Bleeding from gums and nosebleeds (epistaxis) Prolonged bleeding from small cuts Blood in urine (haematuria) Heavy menstrual bleeding (menorrhagia) Joint bleeds (haemarthrosis), often seen in haemophilia Postoperative bleeding Differential Diagnosis: Liver disease (affects clotting factor production) Vitamin K deficiency (required for clotting factor synthesis) Disseminated Intravascular Coagulation (DIC) Investigations: Haemophilia Screen - Measures levels of factor VIII and factor IX to diagnose haemophilia A and B. Von Willebrand Screen - Includes tests for von Willebrand factor antigen, factor VIII activity, and ristocetin cofactor activity to diagnose vWD. Platelet Count - Helps assess for thrombocytopaenia. Diagnosis of ITP is usually by exclusion. Management: Replacement Therapy - Infusion of deficient clotting factors (e.g., factor VIII or IX for haemophilia). Desmopressin (DDAVP) - For mild cases of vWD and haemophilia A; it helps to release stored factor VIII and von Willebrand factor. Antifibrinolytics (e.g., Tranexamic Acid) - Used to reduce bleeding during surgery or after injury. Platelet Transfusions - In cases of severe thrombocytopaenia or bleeding episodes. Hormonal Therapy - For managing menorrhagia in patients with bleeding disorders. Complications: Chronic joint damage due to recurrent haemarthrosis in haemophilia Increased risk of bleeding complications during surgical or dental procedures Anaemia due to chronic blood loss Prognosis: With appropriate management and preventive care, individuals with bleeding disorders can maintain a good quality of life. However, they remain at risk for bleeding complications, especially in cases of trauma or surgery. Hereditary thrombophilia Note: Von Willebrand Disease (vWD) Prevalence: vWD is the most common inherited bleeding disorder, affecting around 0.1% (1 in 1,000) of the general population. Types of vWD: Type 1: The most common form (75-85% of cases), characterised by a quantitative reduction in von Willebrand factor (VWF) levels. Type 2: Caused by dysfunctional VWF with defects in specific protein functions. Type 3: The rarest and most severe form, with little to no detectable VWF. Transmission is generally autosomal dominant, except for some cases of Types 2N, 2A, and 2M, which can be autosomal recessive. Common Manifestations: Frequent bruising and mucocutaneous bleeding, which can occur at any age. Women with vWD often experience heavy menstrual and postpartum bleeding. Joint and soft tissue bleeding is uncommon in vWD but may appear in Types 2N and 3. Some individuals have prolonged activated partial thromboplastin time (aPTT) due to low factor VIII levels. Lab Testing: Initial evaluation should include a CBC with platelet count and coagulation studies. Screening tests for vWD, if required, should measure: VWF protein levels (VWF antigen, VWF) VWF functional activity (VWF activity, VWF) Factor VIII activity level A positive family history or a personal history of bleeding may prompt screening for VWD if VWF activity is <30%. Hormonal Influence: VWF levels can increase with age, inflammation, and oestrogen, which may affect the presentation and diagnosis in certain populations. 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 Colorectal Cancer Screening Recommendations Definition:Colorectal cancer (CRC) screening aims to detect early-stage cancers or precancerous polyps in the colon or rectum, improving survival rates through early intervention. Causes/Aetiology: Genetic Factors: Family history, Lynch syndrome, familial adenomatous polyposis (FAP). Lifestyle Factors: High red/processed meat diet, alcohol use, smoking, low physical activity. Other Risk Factors: Inflammatory bowel disease (IBD), prior colorectal polyps or cancer. Pathophysiology:CRC develops from abnormal cellular growth in the colon or rectum lining, often originating from adenomatous polyps. Mutations (e.g., in the APC gene) can transform these polyps into malignant tumors. Symptoms: Early Stage: Often asymptomatic, underscoring the importance of screening. Advanced Stage: Blood in stool, weight loss, fatigue, abdominal pain, bowel habit changes, sensation of incomplete bowel evacuation. Differential Diagnosis: Irritable Bowel Syndrome (IBS): No blood in stool. Hemorrhoids: Can cause rectal bleeding, typically painless. Gastrointestinal Infections: May include diarrhea with blood and mucus. Diverticulosis/Diverticulitis: Abdominal pain, bowel changes. Investigations: Faecal Occult Blood Test (FOBT): Detects blood in stool; recommended every 2 years for ages 50–74. Colonoscopy: Gold standard for detecting polyps and cancers, used for high-risk individuals or positive FOBT. Flexible Sigmoidoscopy: May supplement FOBT for screening. Screening Guidelines: Low Risk (<1% 10-year risk): 1st-degree relative >55 years: FOBT every 2 years from age 50–74. 1st-degree relative + 1 second-degree relative: FOBT every 2 years from age 50–74. Moderate Risk (1–4% 10-year risk): 1st-degree relative <55 years: FOBT every 2 years from age 40–49. 2 first-degree relatives: Consider annual FOBT from age 40. 1st-degree + 2 second-degree relatives: Referral for colonoscopy, regular screening from age 50. High Risk (>4% 10-year risk): 3 first-degree relatives: Screening from ages 35–44, colonoscopy every 5 years. 3 first/second-degree relatives (one <55 years): Referral to familial cancer clinic; follow high-risk screening protocols. Lynch syndrome: Annual screening from age 25 or as directed by genetic counseling. Large adenomas history: FOBT every 2 years from ages 35–44, colonoscopy every 5 years. Risk Reduction: Lifestyle: Reduce alcohol, stop smoking, maintain BMI 20-25, increase dietary fiber, and limit red/processed meats. Aspirin: Low-dose (100 mg daily) from ages 50-70 may reduce CRC risk. Management: Low/Moderate Risk: Regular FOBT or colonoscopy per guidelines; positive results followed by diagnostic colonoscopy. High Risk: Genetic testing and personalized screening via familial cancer clinic; frequent colonoscopy for early detection. Complications:Advanced CRC can metastasize, especially to the liver, lungs, and other organs. Untreated polyps and adenomas can become cancerous. Prognosis: Early Detection: High survival rates with early treatment. Advanced CRC: Prognosis is poorer, focused on symptom management. Notes: Lynch Syndrome: Associated with increased risks of colorectal, endometrial, gastric, and ovarian cancers. Screening Frequency: Adjust intervals based on individual risk factors and family history. Colorectal Cancer Screening Recommendations Definition: Colorectal cancer (CRC) is a malignant growth that occurs in the colon or rectum. It is the second most common cause of cancer-related deaths in Australia. Screening for colorectal cancer aims to detect early-stage cancers or pre-cancerous conditions (such as polyps), allowing for early intervention and improving survival rates. Aetiology/Causes: Genetic Factors: Family history of colorectal cancer, Lynch syndrome, familial adenomatous polyposis (FAP). Lifestyle Factors: Diet (high in red/processed meat), alcohol consumption, smoking, and lack of physical activity. Other Risk Factors: Inflammatory bowel disease (IBD), personal history of colorectal polyps or cancer. Pathophysiology: CRC develops from abnormal growth in the cells lining the colon or rectum. Initially, benign polyps may form, which can over time develop into malignant tumours. Genetic mutations such as in the APC gene lead to the development of adenomatous polyps, which are precursors to colorectal cancer. Symptoms: Early stage: Often asymptomatic, making screening essential. Later stage: Blood in stool, unexplained weight loss, fatigue, abdominal pain, changes in bowel habits (diarrhoea or constipation), and a sensation of incomplete bowel evacuation. Differential Diagnosis: Irritable bowel syndrome (IBS): Symptoms overlap but IBS does not cause blood in the stool. Hemorrhoids: Can cause rectal bleeding, but typically painless. Gastrointestinal infections: Diarrhoea, blood, and mucus in stool. Diverticulosis/Diverticulitis: Can present with abdominal pain and changes in bowel habits. Investigations: Faecal Occult Blood Test (FOBT): A screening test for blood in the stool, indicative of colorectal issues. Recommended every 2 years for individuals aged 50–74 years. Colonoscopy: Gold standard for detecting colorectal polyps and cancers, especially for high-risk individuals or those with positive FOBT results. Flexible Sigmoidoscopy: May be used in conjunction with FOBT for screening. Screening Guidelines: Low Risk (<1% 10-year risk): 1st-degree relative >55 years: Regular screening recommended via FOBT every 2 years from age 50–74. 1st-degree relative + 1 second-degree relative: FOBT every 2 years from age 50–74. Moderate Risk (1–4% 10-year risk): 1st-degree relative <55 years: Screen starting at age 40, then every 2 years for FOBT until age 49. 2 first-degree relatives: Consider annual screening starting at age 40. 1st-degree + 2 second-degree relatives: Referral for colonoscopy, regular screening from age 50. High Risk (>4% 10-year risk): 3 first-degree relatives: Screening starts from age 35–44, with colonoscopy every 5 years. 3 first/second-degree relatives (at least one <55 years): Referral to familial cancer clinic, screening as per high-risk recommendations. Lynch syndrome: Consider annual screening from age 25, or earlier as directed by genetic counseling. Colorectal cancer + large adenomas: Screening with FOBT every 2 years from 35–44 years, with colonoscopy every 5 years. Risk Reduction: Limit Alcohol Consumption: High alcohol intake is a risk factor for colorectal cancer. Smoking Cessation: Smoking is a known carcinogen and contributes to colorectal cancer risk. Maintain BMI (Body Mass Index) between 20–25: Obesity is associated with a higher risk of CRC. Aspirin: Low-dose aspirin (100mg daily) for 2.5 years from ages 50–70 may reduce the risk of colorectal cancer. Dietary Changes: Increase dietary fibre intake, particularly from fruits and vegetables, and reduce consumption of red/processed meats. Management: For Low and Moderate Risk: Regular FOBT or colonoscopy, as per guidelines. If results are positive, further diagnostic evaluation with colonoscopy is recommended. For High-Risk Patients: Referral to a familial cancer clinic for genetic testing and individualized screening protocols. More frequent colonoscopy is recommended, with a focus on early detection of colorectal polyps or cancers. Complications: Advanced Colorectal Cancer: If not detected early, CRC can metastasize to the liver, lungs, and other organs. Polyps and Adenomas: If not removed early, adenomas can develop into malignant cancers over time. Prognosis: Early Detection: If CRC is detected early, survival rates are high, and treatments are more effective. Advanced CRC: Prognosis is poorer, with treatment focused on managing symptoms and prolonging life. NOTES: Lynch Syndrome: Considered high risk for colorectal cancer and associated with increased risks for other cancers like endometrial, gastric, and ovarian. Screening Frequency: Screening intervals and modalities should be adapted based on the individual’s risk category. Familial Cancer Clinics: Referral to these clinics for high-risk individuals ensures appropriate genetic testing and personalized care. 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 Viral Arthritis Common Causes High Likelihood (Presenting with Arthritis): Parvovirus B19 Ross River virus, Barmah Forest virus (Australia) Dengue virus, yellow fever virus Rubella Low Likelihood: Hepatitis A/B/C, HIV Epstein-Barr virus (EBV) Herpesviruses: CMV, VZV, HSV Adenovirus, enteroviruses Zoonotic Causes: Arboviruses: Chikungunya virus (mosquito-borne), hantavirus (rodent exposure) Bacterial Zoonoses: Brucellosis (unpasteurised dairy, livestock) Leptospirosis (contaminated water, rodents) Clinical Features Symmetrical Polyarthritis: Resembles early RA (parvovirus, arboviruses) Constitutional Symptoms: Fatigue, fever, myalgia, malaise Rash: Erythema infectiosum (parvovirus) Maculopapular rash (rubella, dengue) Exposure History: Viral illness, insect bites, zoonotic exposure (e.g., livestock, rodents) Duration: Usually self-limiting (1–3 weeks) but may persist longer in some cases Investigations Serology: IgM and IgG for specific viruses (e.g., parvovirus, Ross River virus) Hepatitis and HIV screening if appropriate ESR/CRP: Mildly elevated in viral arthritis FBC: May show lymphocytosis or thrombocytopenia Joint Aspirate: Mild WBC elevation; excludes bacterial arthritis When to Refer Severe or Prolonged Symptoms (>6 weeks): Exclude RA or CTDs Unclear Diagnosis: Atypical features or inconclusive investigations Recurrent/Disabling Arthritis: Post-viral autoimmune phenomena or other pathology Management Symptomatic Relief: NSAIDs or paracetamol for joint pain and inflammation Supportive Care: Rest, hydration, manage systemic symptoms (e.g., fever) Avoid Antibiotics: Viral arthritis is non-bacterial Arboviruses: Educate on mosquito protection (e.g., repellents, long clothing) Notes Most cases resolve without long-term sequelae. Early differentiation from autoimmune arthritis (RA, psoriatic arthritis) is crucial to prevent misdiagnosis. Viral Arthritis Common Causes High likelihood (Presenting with Arthritis): Parvovirus B19 Ross River virus, Barmah Forest virus (endemic in Australia) Dengue virus, yellow fever virus Rubella Low likelihood: Hepatitis A/B/C, HIV Epstein–Barr virus (EBV) Herpesviruses: CMV, VZV, HSV Adenovirus, enteroviruses Zoonotic causes: Arboviruses: Chikungunya virus (mosquito-borne), hantavirus (rodent exposure) Bacterial zoonoses (may mimic viral arthritis): Brucellosis (unpasteurised dairy, livestock exposure) Leptospirosis (contaminated water, rodents) Clinical Features Symmetrical Polyarthritis: Can resemble early rheumatoid arthritis (particularly with parvovirus B19, arboviruses such as Ross River). Constitutional Symptoms: Fatigue, fever, myalgia, malaise. Rash: Parvovirus B19: Erythema infectiosum (“slapped cheek” in children, arthropathy in adults). Rubella, dengue: Maculopapular exanthem. Exposure History: Recent viral-like illness, arthropod bites (mosquito), zoonotic exposures (livestock, rodent-infested environments). Duration: Usually self-limiting over 1–3 weeks, though some cases persist longer (especially in immunocompromised or certain viral strains). Investigations Serology IgM and IgG for suspected viruses (e.g., parvovirus B19, Ross River virus). Hepatitis serology, HIV testing if risk factors or clinical suspicion. Inflammatory Markers: ESR/CRP may be mildly elevated. Full Blood Count: Possible lymphocytosis or mild thrombocytopenia in viral infections. Joint Aspirate Mild WBC elevation typically <5–10 × 10^9/L (usually <2 × 10^9/L in purely viral). Essential to exclude bacterial arthritis if uncertain. When to Refer Severe or Prolonged Symptoms (>6 weeks): Exclude rheumatoid arthritis (RA) or connective tissue diseases (CTDs). Unclear Diagnosis: Atypical features, inconclusive serology, or suspicion of alternative diagnoses. Recurrent/Disabling Arthritis: Consider post-viral autoimmune phenomena or other underlying pathology (e.g., chronic inflammatory arthritides). Management Symptomatic Relief NSAIDs (e.g., ibuprofen) or paracetamol for joint pain and mild inflammation. Supportive Care Rest, adequate hydration, manage fever if present. Avoid Antibiotics: Not indicated for viral aetiologies unless a bacterial superinfection is suspected. Arboviruses (Ross River, Barmah Forest, dengue, chikungunya) Advise mosquito bite prevention (insect repellents, long clothing). Encourage local public health measures (reduction of breeding sites). Notes Most acute viral arthritides resolve spontaneously without long-term sequelae. Early distinction from autoimmune arthritis (e.g., RA, psoriatic arthritis) is crucial to avoid unnecessary treatment. Education on preventive measures (avoiding unpasteurised dairy for brucellosis, controlling rodent exposure for hantavirus, etc.) may reduce further infections. 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 PBC (Primary Biliary Cholangitis) Pathology Autoimmune, intrahepatic bile ducts Predominantly older women (90%), >45 years, smokers Associated autoimmune conditions: SLE, CREST syndrome, RA History Fatigue, pruritus, abdominal pain Extrahepatic symptoms such as arthralgia and dry eyes (Sjögren’s syndrome) are common Diagnosis AMA positive (95%) (Antimitochondrial antibody most specific) Cholestatic pattern of LFTs (↑ ALP, GGT > ALT/AST) Imaging (e.g., ultrasound) to exclude biliary obstruction before liver biopsy Treatment Ursodeoxycholic acid: Improves LFTs, delays disease progression Consider obeticholic acid if ursodeoxycholic acid inadequate Manage associated osteoporosis risk: Calcium, Vitamin D, and bisphosphonates Complications Cirrhosis, portal hypertension, HCC (small increased risk in advanced disease) PSC (Primary Sclerosing Cholangitis) Pathology Aetiology unclear: Autoimmune and genetic factors suspected Involves intra- and extrahepatic bile ducts Predominantly younger men (60%), often <40 years History Often asymptomatic at diagnosis Strong association with IBD (70–80% have UC) Symptoms: Fatigue, jaundice, pruritus Diagnosis MRCP/ERCP: Bile duct strictures with "beaded appearance" Liver biopsy: May show onion-skin fibrosis in severe cases Exclude secondary causes (e.g., biliary obstruction, infection, ischaemia) Treatment No curative treatment: Symptom-focused approach Ursodeoxycholic acid: Controversial, used in select patients for symptom control Consider liver transplant for advanced disease or recurrent cholangitis Complications Cirrhosis, portal hypertension, cholangiocarcinoma (lifetime risk 10–15%) Mnemonic for PBC “Old b****s treating themselves to a ciggie” Old b****s: Older women Treating: Treatable condition Themselves: Intrahepatic only A: Autoimmune, AMA-positive, ↑ ALP Ciggie: Associated with smoking Mnemonic for PSC “Sh*t - literally and figuratively”** Literal: IBD-associated diarrhoea Figurative: No curative treatment, high risk of cholangiocarcinoma PBC (Primary Biliary Cholangitis) vs PSC (Primary Sclerosing Cholangitis) Primary Biliary Cholangitis (PBC) Pathology Autoimmune disease targeting intrahepatic bile ducts Mostly older women (~90%), typically >45 years old, often smokers Strong associations with other autoimmune conditions (e.g. SLE, CREST, RA) History Fatigue, pruritus, RUQ abdominal pain Extrahepatic features like arthralgias and dry eyes (Sjögren’s syndrome) Diagnosis AMA (Antimitochondrial Antibody) positive ~95% (high specificity) Cholestatic LFT pattern: ↑ ALP, GGT > ALT/AST Imaging (e.g. ultrasound) to exclude obstructive causes Liver biopsy if diagnosis unclear Treatment Ursodeoxycholic acid: Improves LFTs, slows progression Obeticholic acid if inadequate response to ursodeoxycholic acid Address osteoporosis risk: Calcium, vitamin D, bisphosphonates Complications Cirrhosis, portal hypertension HCC (small but increased risk with advanced disease) Mnemonic – “Old b**s treating themselves to a ciggie” Old b****s = older women Treating = treatable condition Themselves = intrahepatic only A = Autoimmune, AMA-positive, ↑ ALP Ciggie = association with smoking Primary Sclerosing Cholangitis (PSC) Pathology Unknown aetiology: Likely autoimmune + genetic predisposition Affects intra- and extrahepatic bile ducts Predominantly in younger men (~60%), often <40 years History Often asymptomatic at diagnosis IBD association (70–80% have ulcerative colitis) Fatigue, jaundice, pruritus Diagnosis MRCP/ERCP: “Beaded appearance” of bile ducts (multifocal strictures) Liver biopsy: “Onion-skin” fibrosis in advanced cases Exclude secondary causes (biliary obstruction, infection, ischaemia) Treatment No curative treatment → mainly symptom management Ursodeoxycholic acid use is controversial, sometimes used for itch/liver enzyme improvement Liver transplant if advanced disease or recurrent cholangitis Complications Cirrhosis, portal hypertension Cholangiocarcinoma (~10–15% lifetime risk) Mnemonic – “Sht – literally and figuratively”* Literal: IBD-associated diarrhoea Figurative: No cure available, high risk of cholangiocarcinoma Key Points PBC → Intrahepatic ducts, older women, AMA-positive, responds to ursodeoxycholic acid PSC → Intra- and extrahepatic ducts, younger men, strong UC association, risk of cholangiocarcinoma Both can lead to cholestasis, cirrhosis, and require monitoring for complications 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 Candidiasis (Candida as an STI) Definition Fungal infection caused by overgrowth of Candida species, primarily Candida albicans Not a classical STI but can occur after sexual activity and is influenced by host factors Triggers (Factors Promoting Yeast Overgrowth) Recent antibiotic use: Disrupts normal vaginal flora, reducing lactobacilli and promoting fungal overgrowth Excess moisture: Warm, moist environments (e.g., tight clothing, poor hygiene) Pregnancy: Hormonal changes increase glycogen in the vaginal epithelium, promoting Candida proliferation Diabetes mellitus: Poorly controlled blood sugar increases susceptibility Combined oral contraceptive pills (COCP): Hormonal influences may predispose to recurrent infections Symptoms Vulvovaginal itching or burning Thick, white, curd-like vaginal discharge Erythema and swelling of the vulva Dysuria or dyspareunia (pain during urination or intercourse) Management Non-Pharmacological Management Avoid excessive moisture by wearing loose, breathable clothing Promote good genital hygiene (avoid scented soaps or douching) Maintain glycaemic control in diabetic patients Educate patients on avoiding unnecessary antibiotic use Pharmacological Treatment Topical antifungals (e.g., clotrimazole cream or pessaries) are first-line for uncomplicated cases Oral antifungal therapy (e.g., fluconazole single dose) for more severe or recurrent cases Complications Recurrent vulvovaginal candidiasis: ≥4 episodes per year Secondary bacterial infections from scratching or disrupted epithelium Candida (Candidiasis as an STI) Definition Candidiasis is a fungal infection caused by the overgrowth of Candida species, predominantly Candida albicans Not classified as a classic sexually transmitted infection, but may occur following sexual activity and be influenced by host factors Aetiology and Pathogenesis Overgrowth results from disruption of the normal microbial flora Hormonal changes, antibiotic use and immunosuppression facilitate Candida proliferation Non-albicans species can contribute to recurrent cases Risk Factors and Triggers Recent antibiotic use disrupting vaginal flora and reducing lactobacilli Excess moisture from tight clothing or inadequate hygiene promoting fungal growth Pregnancy with increased glycogen deposition in the vaginal epithelium Diabetes mellitus with poor glycaemic control creating an optimal environment Combined oral contraceptive pills influencing hormonal balance Underlying immunosuppression or other comorbidities increasing susceptibility Clinical Presentation Vulvovaginal itching or burning Thick, white, curd-like vaginal discharge Erythema and swelling of the vulva Dysuria or dyspareunia during urination or intercourse Recurrent irritation in patients with multiple episodes Diagnosis Primarily based on clinical history and examination findings Microscopy and culture recommended in atypical or recurrent presentations Differential diagnosis includes bacterial vaginosis, trichomoniasis and other vulval dermatoses Management Non-Pharmacological Management Advise wearing loose, breathable clothing to reduce moisture Promote good genital hygiene and avoid scented soaps or douching Emphasise optimal glycaemic control in diabetic patients Educate on cautious antibiotic use to prevent flora disruption Pharmacological Treatment Topical antifungals such as clotrimazole cream or pessaries as first-line for uncomplicated cases Oral antifungal therapy, for example a single dose of fluconazole, for severe or recurrent infections Consider maintenance therapy in cases of recurrent vulvovaginal candidiasis In pregnancy, prefer topical treatments to minimise systemic exposure Complications and Prognosis Recurrent vulvovaginal candidiasis defined as four or more episodes per year Risk of secondary bacterial infections due to scratching or epithelial disruption Full resolution expected with appropriate treatment and trigger management Recurrent cases warrant evaluation for underlying systemic conditions Notes Although not typically sexually transmitted, candidiasis may coincide with other infections or risk factors seen in STI assessments Evaluate for co-infections and consider partner assessment where indicated In recurrent cases, investigate for underlying immunosuppression or metabolic disorders Be aware of potential antifungal resistance, especially with non-albicans species Patient education on lifestyle modifications and trigger avoidance is crucial to preventing recurrence 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 Myocarditis Definition Inflammatory condition of the myocardium, presenting acutely, subacutely, or chronically, with focal or diffuse myocardial inflammation Causes Infectious: Viruses (e.g., Coxsackie, influenza), bacteria, fungi, spirochetes Non-infectious: Autoimmune diseases (e.g., sarcoidosis), hypersensitivity reactions, toxins (e.g., alcohol), drugs (e.g., anthracyclines) Pathophysiology Inflammation leads to myocyte damage, affecting cardiac contractility and potentially causing dilated cardiomyopathy Symptoms Variable; may include chest pain, flu-like symptoms, fatigue, heart failure signs (dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea), peripheral oedema, palpitations Differential Diagnosis Pericarditis Acute coronary syndrome Pulmonary embolism Investigations ECG: Conduction changes, ST/T wave abnormalities, arrhythmias Blood Tests: Elevated troponins, CK-MB, ESR, CRP, BNP Imaging: Echocardiography: Global hypokinesis Cardiac MRI: Late gadolinium enhancement Biopsy: Gold standard in severe cases Management Supportive Care: Rest Inpatient telemetry for arrhythmia monitoring Treatment of Underlying Cause: Antivirals Immunosuppression for autoimmune causes Heart Failure Management: Beta-blockers ARNI MRA Arrhythmia Control: Antiarrhythmics or pacemaker if necessary Complications Dilated cardiomyopathy Heart failure Sudden cardiac death Patients should restrict physical activity during the acute phase and for at least six months thereafter Myocarditis Aetiology Infectious Viruses (e.g. Coxsackie, influenza, adenovirus) Bacteria (e.g. Streptococcus) Fungi (e.g. Aspergillus) Spirochetes (e.g. Leptospira) Non-infectious Autoimmune diseases (e.g. sarcoidosis, giant-cell myocarditis) Hypersensitivity reactions (e.g. certain antibiotics) Toxins (e.g. alcohol, cocaine) Drugs (e.g. anthracyclines) Pathophysiology Inflammatory infiltrates lead to myocyte necrosis and dysfunction Cytokine release and immune-mediated injury contribute to impaired cardiac contractility Can result in systolic heart failure and dilated cardiomyopathy if severe or persistent Clinical Features Variable presentation, from asymptomatic to acute heart failure Common symptoms Chest pain (often pleuritic or similar to pericarditis) Flu-like prodrome (fever, myalgia) Fatigue, dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea Palpitations (arrhythmias) Signs of fluid overload (peripheral oedema) Pericardial involvement Myopericarditis can present with pericardial rub or effusion Differential Diagnosis Pericarditis Acute coronary syndrome Pulmonary embolism Dilated cardiomyopathy from other causes (e.g. ischaemic, alcoholic) Investigations ECG Conduction abnormalities, ST/T wave changes, possible arrhythmias Cardiac enzymes Elevated troponins and CK-MB suggest myocardial injury Blood tests Raised inflammatory markers (ESR, CRP, leukocytosis) BNP elevation if heart failure is present Echocardiography Global or regional wall motion abnormalities Potentially dilated ventricles or reduced ejection fraction Can detect pericardial effusion Cardiac MRI Late gadolinium enhancement indicative of active inflammation or fibrosis Useful for diagnosis and assessment of myocardial involvement Endomyocardial Biopsy (gold standard) Considered in severe, fulminant, or unclear cases Limited sensitivity but can confirm specific aetiologies (e.g. giant-cell myocarditis) Diagnostic Criteria Combination of clinical presentation (e.g. chest pain, dyspnoea), ECG and imaging abnormalities, elevated cardiac biomarkers, and sometimes biopsy confirmation MRI can confirm suspected myocarditis when clinical and standard investigations are inconclusive Management Supportive Care Rest and reduced physical exertion during acute phase Inpatient telemetry if arrhythmias or significant cardiac dysfunction are suspected Treat Underlying Cause Targeted therapy for identifiable infectious agents (e.g. antivirals) Immunosuppression (e.g. corticosteroids) in autoimmune or giant-cell myocarditis, guided by cardiology advice Discontinue any offending drug or toxin Heart Failure Management ACE inhibitors/ARNI, beta-blockers, mineralocorticoid receptor antagonists for systolic dysfunction Diuretics if volume overloaded Arrhythmia Control Antiarrhythmics if needed Consider temporary pacing or implantable devices in severe conduction disturbances Physical Activity Restriction Avoid intense exercise for at least 3–6 months, with specialist review before resuming sports Follow-up echocardiography or MRI to ensure resolution of inflammation Fulminant or Refractory Cases May require mechanical circulatory support (e.g. ECMO) Urgent transplant evaluation if not responsive to medical therapy Complications Dilated cardiomyopathy and chronic systolic heart failure Life-threatening arrhythmias and sudden cardiac death Cardiogenic shock in fulminant myocarditis Notes: Myocarditis can mimic acute coronary syndrome and pericarditis Consider in otherwise healthy adults with new-onset heart failure, chest pain, or significant arrhythmias Cardiac MRI is increasingly central in diagnosis and follow-up Early detection and restriction of strenuous activity improve outcomes Ongoing follow-up is essential to monitor for progression to chronic heart failure 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 Hypothyroidism History Common sx: Fatigue, weight gain, cold intolerance Depression, dry skin, constipation Hair thinning or loss Associated risk factors: Fam hx of autoimmune disease Previous thyroid disease or therapy (e.g., radioiodine, thyroidectomy) Certain meds (e.g., lithium, amiodarone) Examination General features: Dry skin, brittle nails, bradycardia Hyporeflexia, slow movement and speech Myxoedema (puffy facial features) Vitiligo (if autoimmune thyroiditis is present) Subclinical hypothyroidism: Normal T4 with elevated TSH Often asymptomatic; sx may be subtle Note: remember “subclinical” has NOTHING to do with actual sx (see below) Controversial - eTG and utd diff advice. as per eTG below If symptomatic commence tx If asymptomatic, commence tx if TSH >10 (on repeat) If asymptomatic and TSH 4-10, do TPO and monitor more closely if +ve (q3-6mo), otherwise q12mo. commence if incr TSH or sx develop. Management Overt hypothyroidism: Start levothyroxine (thyroxine): Full replacement: 1.6 mcg/kg/day (adjust based on lean body weight) Partial replacement: 25–50 mcg daily for elderly or those with cardiovascular disease Adjust dose every 4–8 weeks until TSH is within target range Subclinical hypothyroidism: TSH >10 mU/L: Commence treatment, even if asymptomatic TSH 4–10 mU/L: Assess for thyroid peroxidase antibodies (TPOAbs): TPOAb-positive: Monitor TSH closely and consider treatment if sx develop or TSH rises TPOAb-negative: Monitor TSH 6–12 monthly Symptomatic patients: Trial treatment regardless of TSH level Special considerations: Adjust treatment in pregnancy or severe cardiovascular disease (lower starting doses recommended) Referral Criteria Young patients (<18 years) Pregnancy or planning to conceive Complex or refractory cases (e.g., poor response to treatment) Presence of goitre or thyroid nodules Coexisting endocrine disorders (e.g., type 1 diabetes, Addison’s disease) Notes TPO antibodies: Positive in 15% of the general population; does not always indicate the need for treatment unless biochemistry or sx justify Thyroid US is unnecessary unless a goitre or nodules are palpable Adjust treatment targets for older patients: TSH: 1–5 mU/L for those >60 yrs Higher targets for frail or >80 yrs Hypothyroidism History Common symptoms: Weight gain, cold intolerance, depression, fatigue, constipation, hair loss, and dry skin. Additional symptoms: Lethargy, increased sleep, puffy face (often with periorbital edema), husky voice, slow speech. Menstrual abnormalities: Menorrhagia or oligomenorrhoea. Hyperlipidemia and associated cardiovascular risks. Cognitive symptoms: Depression, dementia, psychosis (in severe cases). Rare: Myxoedema coma (severe form), psychosis. Examination Signs of hypothyroidism: Hyporeflexia, bradycardia, dry skin, brittle nails, hair thinning, and slow movements. Neuromuscular signs: Muscle weakness, ataxia, and carpal tunnel syndrome. Severe cases: Myxoedema coma, manifesting as hypothermia, hypoventilation, and altered mental status. Loss of outer one-third of eyebrows, husky voice, slow speech, and possible goitre (in Hashimoto's thyroiditis). Aetiology Primary Hypothyroidism: Most common cause is chronic autoimmune thyroiditis (Hashimoto’s thyroiditis). Often associated with goitre or may present without it in atrophic thyroiditis. Postpartum Hypothyroidism: Often autoimmune in nature. Iodine Deficiency: Rare in Australia but common worldwide. Drug-Induced: E.g., amiodarone, lithium. Other Causes: Infiltrative diseases, thyroid surgery, radioactive iodine treatment, and congenital hypothyroidism. Central Causes: Hypothalamic or pituitary dysfunction leading to secondary hypothyroidism. Risk Factors Increased risk in patients with: Autoimmune diseases (e.g., Type 1 diabetes, rheumatoid arthritis). Genetic predispositions (e.g., Turner’s and Down syndromes). Investigations Serum TSH and T4: Initial and confirmatory test. Elevated TSH and low T4 indicate primary hypothyroidism. Normal T4 and elevated TSH suggest subclinical hypothyroidism. Thyroid Antibodies: TPO antibodies for autoimmune thyroiditis. Antithyroglobulin antibodies less commonly used, mainly in cancer follow-up. Additional Tests: Lipid profile, FBC (for anemia), ECG, and imaging if structural abnormalities are suspected. Management (Including Subclinical and Dosing) Overt Hypothyroidism: Start with levothyroxine replacement. Initial dose based on age, comorbidities, and body weight. Adjust dose every 4-8 weeks to reach target TSH levels. Usual maintenance dose ranges from 75-125 mcg daily. Subclinical Hypothyroidism: Treat if TSH >10 mU/L, or in symptomatic individuals. Lower TSH thresholds for treatment in younger patients or those with risk factors (e.g., cardiovascular disease). Special Populations: Pregnancy: Aim for trimester-specific TSH goals. Elderly: Aim for conservative TSH targets, consider starting with partial replacement. Children: Focus on growth and development; regular follow-ups. Thyroxine Counseling Take on an empty stomach, 30-60 minutes before breakfast or at bedtime. Avoid taking with calcium or iron supplements within 4 hours of ingestion. Referral Criteria Indications for referral: Young patients (<18 years) or pregnant individuals. Cardiac disease or other endocrine comorbidities. Goitre or nodules. Poor response to treatment or need for specialized care (e.g., myxoedema coma). Notes: Medication Considerations: Levothyroxine should be taken on an empty stomach, 30 minutes before meals or other medications. Avoid simultaneous intake with calcium, iron, or multivitamins due to reduced absorption. Adjustments: Dose adjustments may be necessary with new medications (e.g., OCP, antiepileptics). Storage: Keep levothyroxine in a cool, dry place, away from direct sunlight. Special Scenarios: Myxoedema coma requires emergency treatment with IV thyroxine, steroids, and supportive measures. 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 Spirometry Withholding Bronchodilators SABA: 4 hrs SAMA: 12 hrs ICS/LABA (bd): 24 hrs LAMA/LABA (od): 36 hrs Combo: Follow longer time Ensures accurate baseline for obstruction assessment Procedure Pre-test: Salbutamol 100 mcg x4 (via spacer), 30 secs apart, wait 10 mins Perform pre- and post-bronchodilator tests At least 3 acceptable blows, <5% variability (best 2 efforts) Avoid poor technique (coughing, submaximal effort, abrupt stop) Ventilatory Defects Obstructive: FEV₁/FVC <0.7 or LLN (concave loop) E.g. Asthma, COPD, overlap Restrictive: FVC <0.8 or LLN; FEV₁/FVC normal/increased E.g. Interstitial lung disease, obesity Mixed: Low FEV₁/FVC + Low FVC → Needs lung volume testing Reversibility Adults: ≥12% + 200 mL improvement in FEV₁ or FVC post-bronchodilator Children: ≥12% alone sufficient Severity (Post-Bronchodilator FEV₁) Mild: >80% Moderate: 50–80% Severe: 30–50% Very Severe: <30% Key Notes COPD: Post-FEV₁/FVC <0.7, FEV₁ <80% predicted confirms Asthma: ≥12% FEV₁ improvement supports diagnosis Pre vs. post helps differentiate asthma vs. COPD Repeat spirometry if unclear or to monitor treatment response Spirometry: Key Points Withholding Bronchodilators SABA (Short-Acting β₂-Agonist): 4 hours SAMA (Short-Acting Muscarinic Antagonist): 12 hours ICS/LABA (twice daily): 24 hours LAMA/LABA (once daily): 36 hours Combination: Follow the longer recommended time (Ensures accurate baseline for obstruction assessment.) Procedure Pre-Test Bronchodilator Administration Salbutamol 100 mcg ×4 puffs via spacer, 30 sec between puffs Wait 10 minutes before post-bronchodilator measurement Perform Pre- and Post-Bronchodilator Tests At least 3 acceptable blows; best 2 efforts should have <5% variability. Avoid common errors (coughing, submaximal effort, abrupt stop). Ventilatory Defects Obstructive Pattern FEV₁/FVC <0.7 or lower limit of normal (LLN) Flow-volume loop → concave in expiration Examples: Asthma, COPD, or overlap. Restrictive Pattern FVC <0.8 or LLN, with normal or increased FEV₁/FVC Examples: ILD, obesity, chest wall deformities. Mixed Defect Low FEV₁/FVC + Low FVC → needs lung volume testing to confirm. Reversibility Test Definition Adults: ≥12% and ≥200 mL improvement in FEV₁ or FVC post-bronchodilator indicates significant reversibility. Children: ≥12% improvement alone is sufficient. (Supports asthma diagnosis if present.) Severity (Based on Post-Bronchodilator FEV₁ % Predicted) Mild: >80% Moderate: 50–80% Severe: 30–50% Very Severe: <30% Key Notes COPD Diagnosis: Post-bronchodilator FEV₁/FVC <0.7 and FEV₁ <80% predicted. Asthma: Reversibility of ≥12% in FEV₁ or FVC. Pre vs Post results help differentiate asthma vs COPD. Repeat spirometry if results are unclear or to monitor treatment response over time. 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 Thyroid Nodules When to Investigate Any clinical thyroid nodule: order thyroid US High-risk features (suggestive of malignancy): Hoarseness, lymphadenopathy Rapid growth or previous radiation exposure Hyperthyroid patients: Use radionuclide scans to assess hyperfunction or hypofunction History Questions Sx of hypothyroidism or hyperthyroidism Pressure sx: dysphagia, dyspnoea, or cough Fam or personal hx of thyroid cancer, radiation exposure When to Perform FNA If hyperthyroid Radionucleotide scan to assess hyper/hypofunction Hyperfunction = rarely cancer = FNA not required Hypofunction = FNA as per sonographic criteria If hypothyroid Straight to FNA as per sonographic criteria Don't order if no lump on examination in hypothyroid patient Follow-up and Surveillance Benign nodules: Low risk: No surveillance needed for nodules <2 cm Low/intermediate risk: Surveillance every 1–2 years High risk: Reassess in 6–12 months Nodules of undetermined significance: Repeat FNA or consider referral to a specialist Use the Bethesda System for reporting thyroid cytology to guide further management Other considerations Refer nodules of non-benign or indeterminate cytology for further evaluation. Thyroid Nodules When to Investigate: Any palpable thyroid nodule warrants an ultrasound (US) evaluation. In cases with high cancer risk (i.e., hoarseness, lymphadenopathy, rapid growth, or history of radiation exposure), a fine-needle aspiration (FNA) biopsy may be performed directly without a preliminary radioisotope scan. History: Key symptoms and clinical history include: Symptoms of hypo- or hyperthyroidism. Respiratory symptoms, i.e., cough and dyspnoea. Voice changes, i.e., hoarseness. Swallowing difficulties, i.e., dysphagia. Initial Evaluation and Workup: TSH Measurement: Initial thyroid function assessment. If TSH is normal or elevated, proceed with ultrasound to evaluate FNA need. If TSH is subnormal, conduct a radionuclide scan to assess functionality. If Hyperthyroid: Radionuclide scan to assess whether the nodule is hyperfunctioning (hot) or hypofunctioning (cold). Hyperfunctioning (Hot): Rarely malignant; FNA usually not necessary. Hypofunctioning (Cold): Consider FNA if US criteria for malignancy are met. If Hypothyroid: Proceed to FNA if US findings meet criteria for malignancy. FNA is not indicated if no palpable lump is present in a hypothyroid patient. Follow-Up and Surveillance: Based on sonographic and FNA findings: Very Low-Risk Nodules: No surveillance required for >24 months. Low/Intermediate Risk: Surveillance every 1–2 years. High Risk: Follow-up within 6–12 months. Non-Benign or Indeterminate Results: Refer to a specialist for further management. Risk Stratification and Bethesda System: FNA results categorized using the Bethesda System, which guides management based on malignancy risk: Non-diagnostic/Unsatisfactory (5–10%): Repeat FNA or refer to an endocrinologist. Benign (0–3%): Follow-up based on sonographic risk. Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS, 10–30%): Endocrinology referral. Follicular Neoplasm/Suspicious for Follicular Neoplasm (FN/SFN, 25–40%): Specialist referral. Suspicious for Malignancy (50–75%): High likelihood; refer to a thyroid surgeon. Malignant (97–99%): High likelihood of malignancy; surgical intervention recommended. Notes: Surveillance intervals may be adjusted depending on the Bethesda category and sonographic features. The Bethesda System aids in standardized reporting and management decisions based on FNA cytology. 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 Congestive Cardiac Failure (CCF) Acute Pulmonary Oedema (APO) vs Decompensated CCF Definition APO: Medical emergency with rapid onset of severe breathlessness, widespread lung crackles, and hypoxia Decompensated CCF: Gradual worsening of symptoms (sx) over days to weeks, often presenting with bilateral crackles and increased breathlessness Initial Management of APO Sit patient upright Urgent ambulance transfer to ED with IV access using a large-bore cannula Medications: Furosemide: 20mg IV bolus or 40mg PO, repeat after 20 mins if no response GTN: 400 mcg sublingual (up to 3 doses) Morphine: 2.5mg IV slow bolus for symptomatic relief Monitoring: Continuous ECG, BP, O2 saturations (aim >94%) Consider IDC for urine monitoring if indicated Management of Decompensated CCF Outpatient management may be appropriate if clinically stable. Diuretics: Increase current diuretic dose or start furosemide 20-40mg PO daily Fluid Restriction: Limit to 1.5L/day if symptomatic with fluid overload Follow-Up: Review within 24–48 hours; repeat CXR if required Types of Heart Failure Based on EF: HFrEF: EF <40% (systolic dysfunction) HFpEF: EF >50% (diastolic dysfunction) Based on Ventricular Dysfunction: Right-sided HF: Peripheral oedema, elevated JVP, hepatomegaly Left-sided HF: Pulmonary congestion, SOB, bilateral crackles Investigations Bedside: ECG, BP, O2 sats, urine output (use IDC if severe) Bloods: FBC, UECs, LFTs, TFTs, BNP, troponin (if ?ACS) Imaging: CXR: Pulmonary congestion, cardiomegaly, pleural effusions Echo: Assess EF%, structural abnormalities (e.g., valves) Other: Coronary angiography if ischaemia suspected Complications Pulmonary oedema Renal impairment (due to diuretics, low output, cardiorenal syndrome) Arrhythmias - AF, VT, sudden cardiac death Hepatic congestion → chronic liver disease Malnutrition and cachexia Prognosis Dependent on NYHA class and EF% NYHA I: Mild sx → IV: Severe sx at rest Median survival for HFrEF: ~5 years Guidelines for Diuretics and Fluid Restriction Diuretics: Start furosemide 20–40mg PO daily and titrate as needed. IV therapy for severe APO or acute decompensation Fluid restriction: 1.5–2 L daily if symptomatic with fluid overload Indications for Inotropes and Mechanical Circulatory Support Inotropes: Indicated in acute decompensated HF with cardiogenic shock (e.g., dobutamine) Mechanical Circulatory Support: LVAD or intra-aortic balloon pump for severe cases or as a bridge to transplant Vaccination Recommendations Influenza Vaccine: Annually for all HF patients Pneumococcal Vaccine: Every 5 years to prevent respiratory infections Optimisation of Medications and Monitoring Renal Function ACEis/ARBs: Start low, titrate to max tolerated dose. Monitor K+ and Cr BBs: Bisoprolol, carvedilol for stable HF. Gradually titrate dose Spironolactone: Add for EF <35%. Monitor K+ closely SGLT2 Inhibitors: Emerging role in HFrEF regardless of diabetes status Monitoring: Regular UECs and electrolytes (K+, Na+). Risk of hypokalaemia and AKI Congestive Cardiac Failure (CCF) Acute Pulmonary Oedema (APO) vs Decompensated CCF Definition: APO: Medical emergency with rapid onset of severe breathlessness, widespread lung crackles, and hypoxia Decompensated CCF: Gradual worsening of symptoms over days to weeks, often presenting with bilateral crackles and increased breathlessness Initial Management of APO Positioning: Sit patient upright to reduce pulmonary congestion Transfer: Urgent ambulance transfer to ED with IV access using a large-bore cannula Medications: Furosemide: 20 mg IV bolus or 40 mg PO, repeat after 20 mins if no response GTN: 400 mcg sublingual (up to 3 doses) Morphine: 2.5 mg IV slow bolus for symptomatic relief Monitoring: Continuous ECG, BP, O₂ saturations (aim >94%) Additional: Consider IDC for urine monitoring if indicated Management of Decompensated CCF Outpatient Management: May be appropriate if clinically stable Diuretics: Increase current diuretic dose or start furosemide 20–40 mg PO daily Fluid Restriction: Limit to 1.5 L/day if symptomatic with fluid overload Follow-Up: Review within 24–48 hours; repeat CXR if required Types of Heart Failure Based on Ejection Fraction (EF): HFrEF: EF <40% (systolic dysfunction) HFpEF: EF >50% (diastolic dysfunction) Based on Ventricular Dysfunction: Right-Sided HF: Peripheral oedema, elevated JVP, hepatomegaly Left-Sided HF: Pulmonary congestion, SOB, bilateral crackles Investigations Bedside: ECG, BP, O₂ saturations, urine output (use IDC if severe) Bloods: FBC, UECs, LFTs, TFTs, BNP, troponin (if ?ACS) Imaging: CXR: Pulmonary congestion, cardiomegaly, pleural effusions Echo: Assess EF%, structural abnormalities (e.g., valves) Other: Coronary angiography if ischaemia suspected Complications Pulmonary oedema Renal impairment (due to diuretics, low output, cardiorenal syndrome) Arrhythmias – AF, VT, sudden cardiac death Hepatic congestion → chronic liver disease Malnutrition and cachexia Prognosis Dependent on NYHA class and EF% NYHA I: Mild symptoms NYHA IV: Severe symptoms at rest Median survival for HFrEF: ~5 years Guidelines for Diuretics and Fluid Restriction Diuretics: Start furosemide 20–40 mg PO daily and titrate as needed. IV therapy for severe APO or acute decompensation Fluid Restriction: 1.5–2 L daily if symptomatic with fluid overload Indications for Inotropes and Mechanical Circulatory Support Inotropes: Indicated in acute decompensated HF with cardiogenic shock (e.g., dobutamine) Mechanical Circulatory Support: LVAD or intra-aortic balloon pump for severe cases or as a bridge to transplant Vaccination Recommendations Influenza Vaccine: Annually for all HF patients Pneumococcal Vaccine: Every 5 years to prevent respiratory infections Optimisation of Medications and Monitoring Renal Function ACE inhibitors (ACEis)/ARBs: Start low, titrate to max tolerated dose. Monitor K⁺ and creatinine Beta-Blockers (BBs): Bisoprolol, carvedilol for stable HF. Gradually titrate dose Spironolactone: Add for EF <35%. Monitor K⁺ closely SGLT2 Inhibitors: Emerging role in HFrEF regardless of diabetes status Monitoring: Regular UECs and electrolytes (K⁺, Na⁺). Risk of hypokalaemia and AKI Patient Education and Self-Management Advise patients to monitor weight daily; an increase of >2 kg over 2 days may indicate fluid retention Recommend a low-sodium diet to help manage fluid balance Emphasise the importance of taking medications as prescribed to manage symptoms and improve prognosis Educate patients on recognising early signs of decompensation, such as increased breathlessness or swelling Lifestyle Modifications Strongly encourage quitting smoking to improve cardiovascular health Advise limiting alcohol consumption, as excessive intake can exacerbate HF symptoms and contribute to cardiomyopathy Encourage tailored physical activity based on functional capacity, avoiding excessive exertion in symptomatic patients Educate on the impact of stress on heart failure and encourage relaxation techniques Pre-hospital management of acute pulmonary oedema (AUS Prescriber) 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 Menorrhagia First-Line Treatment Levonorgestrel Intrauterine Device (LNG-IUD): Most effective for reducing menstrual blood loss Second-Line Treatments Tranexamic Acid: 1 g PO TDS–QID during the first 3–5 days of the cycle NSAIDs: Mefenamic acid 500 mg PO TDS Ibuprofen 400 mg PO TDS (first 3–5 days of the cycle) COCP: Ethinylestradiol 35 mcg + levonorgestrel 150 mcg in an extended (3-month) or continuous regimen Additional Pharmacological Options Progestogens Medroxyprogesterone Acetate (MPA): 10 mg PO 1–3 times daily (Day 1–21 of a 28-day cycle, up to 6 months) Norethisterone: 5 mg PO 2–3 times daily (Day 1–21 of a 28-day cycle, up to 6 months) Management of Anovulatory Menorrhagia Cyclic Progestogens: MPA 10 mg PO for the first 12 days of the month Norethisterone 5 mg PO for the first 12 days of the month Depot Medroxyprogesterone Acetate (DMPA): Not specifically studied for menorrhagia but induces amenorrhoea in 50–70% within 1 year Referral Criteria Refer to Gynaecology if: Symptoms persist >6 months despite treatment Severe dysmenorrhoea Fibroids >3 cm Increased risk of endometrial cancer (e.g., PCOS, oligomenorrhoea) Specialist Treatment Options Uterine artery embolisation Myomectomy Hysterectomy Hysteroscopic fibroid resection Early referral ensures timely intervention and management of underlying pathology Menorrhagia Definition Excessive menstrual blood loss interfering with physical, emotional, social and material quality of life Can result in symptomatic anaemia and significantly affect daily activities Causes and Differential Diagnoses Anovulatory cycles are the most common cause in adolescents and young women Structural causes such as fibroids, polyps, adenomyosis or malignancy Endocrine disorders including thyroid dysfunction and polycystic ovarian syndrome Coagulopathies such as von Willebrand disease and other bleeding disorders Iatrogenic causes including effects of certain medications Assessment and Investigations Detailed menstrual history including duration, frequency, volume of bleeding and its impact on daily life Physical examination with pelvic assessment for uterine size, tenderness and masses Laboratory tests: full blood count, serum ferritin, thyroid function tests, coagulation screen and pregnancy test Imaging: pelvic ultrasound to evaluate uterine pathology when indicated Consider endometrial sampling in patients with risk factors for endometrial pathology General Management Principles Tailor management to severity, underlying cause, patient’s age, fertility desires and risk factors Aim to reduce menstrual blood loss, improve haemoglobin levels and enhance quality of life Involve shared decision making through comprehensive patient education and use of a menstrual calendar First-Line Treatment Levonorgestrel intrauterine device (LNG-IUD) as the most effective option for reducing menstrual blood loss Provides contraception alongside endometrial suppression Second-Line Treatments Tranexamic acid: 1 g PO three to four times daily during the first 3–5 days of menstruation Nonsteroidal anti-inflammatory drugs (NSAIDs): Mefenamic acid 500 mg PO three times daily Ibuprofen 400 mg PO three times daily during the initial days of the cycle Combined oral contraceptive pill: Ethinylestradiol 35 mcg with levonorgestrel 150 mcg in an extended (3-month) or continuous regimen Additional Pharmacological Options Progestogens: Medroxyprogesterone acetate (MPA): 10 mg PO one to three times daily from day 1 to 21 of a 28-day cycle, for up to 6 months Norethisterone: 5 mg PO two to three times daily from day 1 to 21 of a 28-day cycle, for up to 6 months Management of Anovulatory Menorrhagia Cyclic progestogens: MPA 10 mg PO for the first 12 days of the cycle Norethisterone 5 mg PO for the first 12 days of the cycle Depot medroxyprogesterone acetate (DMPA) may be considered, noting it induces amenorrhoea in 50–70% of patients within 1 year Non-Pharmacological Management Lifestyle modifications including achieving an ideal body weight and smoking cessation Regular use of NSAIDs during menses may reduce blood loss and alleviate associated pain Patient education regarding dietary modifications and tracking menstrual patterns Referral Criteria Refer to gynaecology if symptoms persist for more than 6 months despite treatment Severe dysmenorrhoea affecting quality of life Presence of fibroids larger than 3 cm Increased risk of endometrial cancer such as in cases of PCOS or oligomenorrhoea Specialist interventions may include uterine artery embolisation, myomectomy, hysteroscopic fibroid resection or hysterectomy Early referral ensures timely intervention and management of underlying pathology Additional High-Yield Points Menorrhagia can have a profound impact on quality of life and requires assessment of its effect on daily activities Evaluation for bleeding disorders is particularly important in adolescents and young women Regular monitoring of haemoglobin and iron status is critical, with consideration for iron supplementation The LNG-IUD is highly effective yet underutilised; increased awareness and training may improve uptake Combined treatment approaches, integrating pharmacological and non-pharmacological strategies, often yield the best outcomes Shared decision making and informed choice are essential components of management to align treatment with patient preferences Bookmark Failed! 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