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

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 ECG How to calculate axis deviation: Identify isoelectric lead on the ECG; the axis is perpendicular to this lead. Use leads I and aVF for a quick estimation: Normal Axis: Positive QRS in both leads. LAD: Positive QRS in lead I and negative in aVF. Confirm with lead II (negative QRS indicates LAD). RAD: Negative QRS in lead I and positive in aVF, often due to right ventricular overload. Definition for T-Wave Inversion (TWI):TWI is only clinically relevant if observed in leads with a positive QRS complex. Normal: TWI in leads with negative QRS complexes (III, aVR, V1). TWI in V1–V3 is normal in children/young adults. Pathological: TWI >1mm deep in ≥2 contiguous leads, especially in V2–V6, indicates potential ischaemia, strain, or myocardial injury. Persistent, deep TWI in precordial leads (e.g., V2–V4) can signify apical hypertrophy or previous ischaemia. Additional Considerations: Biphasic T waves: May indicate ischaemia or Wellens’ syndrome if seen in V2–V3. Axis deviation or significant TWI should prompt further evaluation for underlying conditions (e.g., ischaemia, ventricular hypertrophy). Sinus Tachy vs SVT Sinus Tachy: Often identifiable triggers like emotion, dehydration, fever Gradual onset and offset Usually slightly lower HR than SVT (<150 bpm but can exceed in younger pts: max HR = 220 – age) P waves visible but depend on HR SVT: Sudden onset without obvious triggers HR >150 bpm Symptoms like palpitations or dizziness more prominent P waves absent or inverted in inferior leads MI Leads and Arterial Supply V1–2: Anteroseptal (LAD) V3–4: Anterior (LAD) V5–6: Anterolateral (LCx; reciprocal STD in inferior leads) I, aVL: Lateral (LCx) II, III, aVF: Inferior (RCA > LCx; reciprocal STD in anterolateral leads) Note: For exams, if ST elevation > ST depression in V5/V6, label as anteroseptal; otherwise say anterior or anterolateral Digoxin Toxicity Symptoms ECG: Down-sloping ST depression (“scooped” or “mustache” appearance) Possible arrhythmias: bradyarrhythmias or tachyarrhythmias (e.g., junctional tachycardia, AV block) CNS: Lethargy, confusion, headache GI: Anorexia, nausea/vomiting, diarrhoea CVS: Palpitations, syncope, dyspnoea Ophthalmologic: Yellow halos around lights (xanthopsia), blurred vision Notes: Consider alternative causes of tachycardia, especially dehydration or anaemia, before initiating treatment for SVT. Elevated ST elevation in V1–V2 with concurrent reciprocal changes is highly suggestive of anterior MI (validate with troponins). LVH Voltage Criteria: Sokolow-Lyon index: S wave in V1 + R wave in V5/6 >35mm R wave in aVL >11mm (alternate voltage criteria) Other findings: LV strain pattern: STD, STE, and TWI (opposite direction of prominent R wave – termed "appropriate discordance") Causes: Aortic stenosis Aortic regurgitation HOCM HTN Aortic coarctation Chronic mitral regurgitation (volume overload) CKD CHB (Complete Heart Block) Characteristics: Rate: ~40 bpm (ventricular or junctional escape rhythm, with 7–8 large squares between RR intervals) Dissociation: Atrial rate ~100 bpm, ventricular rate ~40 bpm, with no atrial impulses conducted to ventricles Regular PP and RR intervals, despite absence of conduction Management: Requires urgent admission and temporary pacing prior to permanent pacemaker (PPM) insertion Causes: Inferior MI (compromising AV node) AV nodal blocking medications (e.g., CCBs, beta-blockers, digoxin) Other causes: Lyme disease (early disseminated stage) Sarcoidosis (cardiac involvement) Amyloidosis ECG Axis Deviation Identify the isoelectric lead (where the QRS is equally positive and negative), then the axis is perpendicular to that lead Quick Estimation with Leads I and aVF Normal axis if QRS is positive in both leads (approximately −30° to +90°) Left Axis Deviation (LAD): QRS positive in I, negative in aVF. Confirm with lead II (if negative in II, strongly suggests LAD) Right Axis Deviation (RAD): QRS negative in I, positive in aVF, often due to conditions like right ventricular hypertrophy or chronic lung disease Extreme Axis Deviation (aka Northwest axis) if negative in both leads I and aVF Left Axis Deviation: Leads I and aVL are positive; leads II and aVF are negative Right Axis Deviation : leads II, III and aVF are POSITIVE; Leads I and aVL are NEGATIVE T-Wave Inversion (TWI) Clinically relevant if occurring in leads where the QRS is predominantly positive Normal Variants TWI in leads with predominantly negative QRS (III, aVR, V1) TWI in V1–V3 can be normal in children or young adults Pathological TWI 1mm deep in ≥2 contiguous leads (especially in V2–V6), suggesting possible ischaemia, strain, or injury Persistent, deep TWI in precordial leads (e.g. V2–V4) can indicate apical hypertrophy or prior ischaemia Biphasic T waves in V2–V3 may signify Wellens syndrome (critical LAD stenosis) Sinus Tachycardia vs SVT Sinus Tachycardia Usually triggered by pain, fever, anxiety, hypovolaemia Gradual onset/offset Heart rate often <150 bpm (though can exceed this in younger patients) P waves visible before each QRS, but may blend with preceding T wave if rate very high Sinus tachycardia: Heart rate 150 bpm; P waves are hidden within each preceding T wave. SVT (Supraventricular Tachycardia) Sudden onset/offset Often HR >150 bpm P waves typically absent, hidden within QRS, or inverted in inferior leads Patients may report palpitations or dizziness without an obvious precipitant Supraventricular tachycardia (SVT): Rhythm strip demonstrating a regular, narrow-complex tachycardia MI Leads and Arterial Supply V1–V2: Anteroseptal (LAD) V3–V4: Anterior (LAD) V5–V6: Anterolateral (often LCx, can be diagonal branch of LAD) I, aVL: Lateral (LCx or diagonal branch of LAD) II, III, aVF: Inferior (RCA > LCx in most individuals) Reciprocal changes often appear in opposite leads (e.g. ST depression in II, III, aVF when lateral leads are elevated) Compare ST elevation magnitude in V1–V2 to the remainder of the precordial leads to differentiate anteroseptal from anterolateral involvement Digoxin Toxicity ECG Findings Down-sloping ST depression (Salvador Dali moustache or “scooped” appearance) Arrhythmias: junctional tachycardia, AV block, bidirectional VT in severe cases Clinical Neurological: confusion, headache Gastrointestinal: anorexia, nausea, vomiting, diarrhoea Visual: yellow halos (xanthopsia), blurred vision Risk Factors: advanced age, renal impairment, electrolyte imbalances (hypokalaemia, hypomagnesaemia) Digoxin effect: Sagging ST segments resemble a “reverse tick” LVH (Left Ventricular Hypertrophy) Voltage Criteria Sokolow-Lyon: S wave in V1 + R wave in V5 or V6 >35mm R wave in aVL >11mm Strain Patterns ST depression and T-wave inversion in left-sided leads (I, aVL, V5–V6) with a prominent R wave Causes Hypertension, aortic stenosis/regurgitation, hypertrophic cardiomyopathy, coarctation of the aorta LVH can elevate risk of arrhythmias and ischaemic events Left ventricular hypertrophy (LVH): Markedly increased LV voltages: huge precordial R and S waves that overlap with the adjacent leads (SV2 + RV6 >> 35 mm); R-wave peak time > 50 ms in V5-6 with associated QRS broadening; LV strain pattern with ST depression and T-wave inversions in I, aVL and V5-6; ST elevation in V1-3; Prominent U waves in V1-3; Left axis deviation Complete Heart Block (CHB) Characteristics Atrial rate ~100 bpm with regular P waves Ventricular rate ~40 bpm (escape rhythm), no conduction from atria to ventricles PP and RR intervals are regular but dissociated Causes Inferior MI compromising the AV node AV nodal blocking medications (beta-blockers, non-DHP CCBs, digoxin) Structural diseases (Lyme carditis, sarcoidosis, amyloidosis) Management Urgent admission, potential need for temporary pacing if symptomatic or haemodynamically unstable Consider permanent pacemaker if not resolved after the acute cause is addressed Complete heart block: There is AV dissociation, with the atrial rate (~100 bpm) independent of the ventricular rate (~40 bpm) Additional Considerations Alternative Tachycardia Causes Dehydration, anaemia, hyperthyroidism can mimic or exacerbate sinus tachycardia Reciprocal Changes in MI ST depression in leads opposite the region of ST elevation may help confirm the diagnosis Identifying Infarct Location Detailed correlation of ECG changes in multiple leads enhances diagnostic accuracy LVH and Hypertension LVH on ECG significantly increases cardiovascular risk, warranting aggressive BP management Digoxin Caution Close monitoring of renal function and electrolytes to avoid toxicity Wellens Syndrome Biphasic or deeply inverted T waves in V2–V3 suggest critical LAD stenosis, high risk for anterior MI All suspicious ECG changes should be correlated clinically and, if necessary, investigated further with echocardiography, troponin assays, or advanced imaging. Early recognition and management of ECG abnormalities can prevent significant morbidity and mortality. 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 Urinary Tract Infections (UTIs) and Recurrent UTIs Prophylaxis Aim fluid intake about 1.5 L/day if low at baseline Intravaginal oestrogen for postmenopausal women Methenamine hippurate 1 g BD; review at 6 months Cranberry can help in selected premenopausal women Do not treat asymptomatic bacteriuria Recurrent UTI ≥2 symptomatic UTIs in 6 months or ≥3 in 12 months, with at least one culture-confirmed. Management Strategies Antibiotic prophylaxis options Continuous low-dose for 6 months with review: Trimethoprim 150 mg at night Cephalexin 250 mg at night Nitrofurantoin 50 mg at night Post-coital prophylaxis (single dose within 2 hours of intercourse, max once daily): Nitrofurantoin 50 mg Trimethoprim 150 mg Cephalexin 250 mg Self-start short course at symptom onset in suitable non-pregnant women. Investigations MSU for MCS during symptoms. Image or refer if relapsing pattern, stones, obstruction, gross haematuria, or recurrent pyelonephritis. In men, consider prostatic disease. Treatment Women First-line: Nitrofurantoin 100 mg QID for 5 days Second-line: Fosfomycin 3 g stat Third-line: Trimethoprim 300 mg nocte for 3 days If above unsuitable: Cephalexin 500 mg BD for 5 days Note: consider simple analgesia and review at 48 hours in mild cystitis; avoid urinary alkalinisers with nitrofurantoin Pregnancy Screen once at 12–16 weeks for asymptomatic bacteriuria; treat if positive and repeat culture 1–2 weeks after. Empirical acute cystitis or confirmed ASB: Nitrofurantoin 100 mg QID 5 days (avoid from 37 weeks and in G6PD deficiency) Cephalexin 500 mg BD 5 days Fosfomycin 3 g stat If susceptible: Amoxicillin 500 mg TDS 5 days or Amoxicillin-clavulanate 875/125 mg BD 5 days Trimethoprim 300 mg daily 3 days can be used in 2nd or 3rd trimester if suitable Recurrent UTI in pregnancy: post-coital nitrofurantoin 50 mg or cephalexin 250 mg once, or nightly nitrofurantoin 50 mg or cephalexin 250 mg until 37 weeks. Men Lower UTI (prostatitis unlikely): Nitrofurantoin 100 mg QID for 7 days, or Trimethoprim 300 mg daily for 7 days Alternative: Cephalexin 500 mg BD for 7 days Always consider prostatitis. Do not use nitrofurantoin if prostatitis is possible. Pyelonephritis Non-Severe Cases Criteria for outpatient oral therapy: clinically stable, not pregnant, no sepsis, able to maintain oral intake, reliable follow-up. Send MSU for MCS before antibiotics. Reassess at 48 hours. Adult treatment Empirical oral options: Amoxicillin-clavulanate 875/125 mg TDS for 10 days Penicillin allergy: Ciprofloxacin 500 mg BD for 7 days Step-down to narrowest effective agent when susceptible: Amoxicillin 1 g TDS for 10 days, or Trimethoprim–sulfamethoxazole 160/800 mg BD for 7 days, or Cephalexin 1 g QID for 10 days Do not use nitrofurantoin or fosfomycin. Consider single IV dose (for example ceftriaxone) before oral step-down if indicated. Children Route IV if risk factors for serious illness, systemic features, or cannot take oral. Otherwise oral. Empirical oral Amoxicillin-clavulanate 10 days: 1 to <2 months: 15/3.75 mg/kg TDS ≥2 months: 22.5/3.2 mg/kg up to 875/125 mg TDS Cephalexin 25 mg/kg up to 1 g QID 10 days If QID adherence unlikely and age ≥12 months: 45 mg/kg up to 1.5 g TDS 10 days Penicillin hypersensitivity: Ciprofloxacin 12.5 mg/kg up to 500 mg BD 7 days, or if liquid needed Trimethoprim–sulfamethoxazole 4/20 mg/kg up to 160/800 mg BD 7 days. Step-down to narrowest agent once culture available. Empirical IV (≥3 months) Gentamicin 7 mg/kg IV or Tobramycin 7 mg/kg IV initial dose. If IV likely ≥72 hours, or aminoglycoside unsuitable: Ceftriaxone 50 mg/kg IV daily or Cefotaxime 50 mg/kg IV 8-hourly. Switch to oral when stable. Duration and imaging Total course 7–10 days. Seven days reasonable with full IV beta-lactam course or oral ciprofloxacin or trimethoprim–sulfamethoxazole; otherwise use 10 days. If not improving within 48 hours of appropriate therapy, request renal ultrasound. Do not ultrasound for persistent fever alone. No post-treatment culture if asymptomatic. Notes Adults: cephalexin for cystitis 500 mg BD 5 days; step-down for pyelonephritis 1 g QID 10 days. Always narrow therapy to susceptibilities and review at 48 hours. Urinary Tract Infections (UTIs) and Recurrent UTIs Prophylaxis Maintain fluid intake to about 1.5 L per day for patients with low baseline intake. Intravaginal oestrogen for postmenopausal women can reduce recurrences. Methenamine hippurate 1 g every 12 hours can be used as a non-antibiotic preventive option. Review every 6 months. Cranberry may help some nonpregnant women under 50. Evidence is insufficient in older adults or with voiding problems. Not recommended: ascorbic acid. Evidence for D-mannose is not convincing. Do not use antibiotic prophylaxis for asymptomatic bacteriuria. Recurrent UTI Definition ≥2 symptomatic UTIs in 6 months or ≥3 in 12 months, with at least one culture-confirmed episode. Management Strategies Antibiotic prophylaxis options Continuous low-dose for 6 months with review: Trimethoprim 150 mg at night Cephalexin 250 mg at night Nitrofurantoin 50 mg at night Post-coital prophylaxis (single dose within 2 hours of intercourse, max once daily): Nitrofurantoin 50 mg Trimethoprim 150 mg Cephalexin 250 mg Self-initiated therapy at symptom onset is appropriate for selected nonpregnant women and reduces overall antibiotic use. Investigations MSU for MCS during symptomatic episodes. Consider imaging or referral if relapse with the same organism pattern, recurrent pyelonephritis, stones, obstruction or haematuria. In men, consider urology review to assess for prostatic disease. Treatment Women First-line: Nitrofurantoin 100 mg QID for 5 days. Second-line: Fosfomycin 3 g stat. Third-line: Trimethoprim 300 mg nocte for 3 days. If the above cannot be used: Cephalexin 500 mg BD for 5 days. Notes: Consider simple analgesia first in selected women under 65 with mild cystitis and no risk factors; review at 48 hours. Avoid urinary alkalinisers with nitrofurantoin. Reserve fluoroquinolones for specific indications or susceptibility-directed therapy. Pregnancy Screen once at 12–16 weeks for asymptomatic bacteriuria; treat if positive and repeat culture 1–2 weeks after completion. Acute cystitis or confirmed ASB (empirical while awaiting culture): Nitrofurantoin 100 mg QID for 5 days — avoid from 37 weeks and in G6PD deficiency Cephalexin 500 mg BD for 5 days Fosfomycin 3 g stat If susceptible: Amoxicillin 500 mg TDS for 5 days or Amoxicillin-clavulanate 875/125 mg BD for 5 days Trimethoprim 300 mg daily for 3 days may be considered in 2nd or 3rd trimester if suitable Recurrent UTI in pregnancy: consider post-coital nitrofurantoin 50 mg or cephalexin 250 mg once; or continuous prophylaxis with cephalexin 250 mg nocte or nitrofurantoin 50 mg nocte until 37 weeks. Men Lower UTI (prostatitis unlikely): Nitrofurantoin 100 mg QID for 7 days, or Trimethoprim 300 mg daily for 7 days Alternative: Cephalexin 500 mg BD for 7 days Always consider acute bacterial prostatitis if fever, pelvic/perineal pain or obstructive symptoms. Do not use nitrofurantoin if prostatitis is possible. Pyelonephritis Non-Severe Cases suitable for outpatient oral therapy Clinically stable, able to maintain oral hydration and take oral therapy, no sepsis, not pregnant, reliable follow-up. Send urine for MCS before treatment; reassess at 48 hours. Fever may take 48–72 hours to settle. Treatment Empirical oral options: Amoxicillin-clavulanate 875/125 mg TDS for 10 days Penicillin allergy: Ciprofloxacin 500 mg BD for 7 days Step-down to narrowest effective agent when susceptible: Amoxicillin 1 g TDS for 10 days, or Trimethoprim–sulfamethoxazole 160/800 mg BD for 7 days, or Cephalexin 1 g QID for 10 days Do not use nitrofurantoin or fosfomycin for pyelonephritis. Consider a single IV dose (eg ceftriaxone) before oral step-down if indicated by clinical context or local protocol. Children Who needs IV rather than oral Use IV therapy for children 3 months or older with risk factors for serious illness, systemic symptoms, or inability to tolerate oral therapy. Otherwise use oral therapy. Empirical oral therapy for acute pyelonephritis (age ≥1 month) Amoxicillin-clavulanate for 10 days 1 to <2 months: 15/3.75 mg/kg TDS ≥2 months: 22.5/3.2 mg/kg up to 875/125 mg TDS Cephalexin 25 mg/kg up to 1 g QID for 10 days If 6-hourly adherence is unlikely and age ≥12 months: 45 mg/kg up to 1.5 g 8-hourly for 10 days Penicillin hypersensitivity Ciprofloxacin 12.5 mg/kg up to 500 mg BD for 7 days, or If liquid required: Trimethoprim–sulfamethoxazole 4/20 mg/kg up to 160/800 mg BD for 7 days Modify to the narrowest agent once culture is available. Culture-directed oral options Amoxicillin 30 mg/kg up to 1 g TDS for a total of 10 days, or Trimethoprim–sulfamethoxazole 4/20 mg/kg up to 160/800 mg BD for a total of 7 days, or Cephalexin as above; if resistant to all except ciprofloxacin, use ciprofloxacin 12.5 mg/kg up to 500 mg BD for 7 days. Empirical IV therapy (age ≥3 months) Gentamicin 7 mg/kg IV initial dose, or Tobramycin 7 mg/kg IV initial dose If IV likely to continue ≥72 hours, or aminoglycoside unsuitable: Ceftriaxone 50 mg/kg IV daily, or Cefotaxime 50 mg/kg IV 8-hourly Switch to oral when clinically stable and able to tolerate oral therapy. Duration and imaging Total duration (IV + oral) 7–10 days. Seven days is reasonable if the whole course is IV beta-lactam, or if oral continuation is ciprofloxacin or trimethoprim–sulfamethoxazole; otherwise use 10 days. If not improving clinically within 48 hours of appropriate antibiotics, request a renal ultrasound. Do not request ultrasound for persistent fever alone. Do not perform post-treatment urine culture in asymptomatic children. Note: In adults, cephalexin is typically 500 mg BD for cystitis, and 1 g QID when used as step-down for pyelonephritis. Bookmark Failed! Bookmark Saved! Add Bookmark Refresh Refresh