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 Vitamin B12 Deficiency Causes Omeprazole, metformin, antihistamines Chronic alcoholism Atrophic gastritis Pernicious anaemia H. pylori (especially refugees) Strict vegan diet Coeliac disease Crohn’s disease Bariatric surgery Note: Long-term metformin use (>4 years) is associated with up to a 20% risk of B12 deficiency due to altered absorption Supplementation Initial Therapy: Hydroxocobalamin 1000 mcg IM on alternate days for 2/52 (if severe anaemia or neuro symptoms) Maintenance Therapy: Hydroxocobalamin 1000 mcg IM every 2–3/12 Alternative: Cyanocobalamin 500–1000 mcg SL daily OR oral 50–200 mcg daily (if no absorption issues) Monitoring: Recheck B12 levels 3–6/12 post-supplementation Note: Intranasal cyanocobalamin (500 mcg weekly) can be an option for maintenance in patients with absorption issues but without severe deficiency Key Notes Neuropathy may have residual effects if chronic; early intervention is key Pure dietary deficiency is rare except in strict vegans Iron and potassium levels may need monitoring post-B12 treatment Pernicious anaemia increases gastric cancer risk; patients may require long-term surveillance Vitamin B12 Deficiency Causes Omeprazole, metformin, antihistamines Chronic alcoholism Atrophic gastritis Pernicious anaemia Helicobacter pylori infection (especially in refugee populations) Strict vegan diet Coeliac disease Crohn’s disease Bariatric surgery Note: Long-term metformin use (>4 years) is associated with up to a 20% risk of B12 deficiency due to altered absorption Supplementation Initial Therapy: Hydroxocobalamin 1000 micrograms IM on alternate days for 2 weeks if severe anaemia or neurological symptoms Maintenance Therapy: Hydroxocobalamin 1000 micrograms IM every 2–3 months Alternative: Cyanocobalamin 500–1000 micrograms sublingual daily, or oral 50–200 micrograms daily (if no significant malabsorption) Monitoring: Recheck B12 levels 3–6 months after commencing supplementation Other Options: Intranasal cyanocobalamin 500 micrograms once weekly can be considered for maintenance in patients without severe deficiency but with chronic absorption issues Key Notes Early intervention is crucial to prevent irreversible neuropathy Pure dietary deficiency is uncommon unless strict vegan Monitor iron and potassium levels after B12 replacement (haematopoietic changes can affect these levels) Pernicious anaemia increases gastric cancer risk, may need long-term follow-up Bookmark Failed! Bookmark Saved! Add Bookmark Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Chronic Cough in Children Differentials Common: Postviral: Up to 8 weeks Sinusitis: Rhinorrhoea, itchy eyes, sneezing Asthma/Wheeze: Night cough, wheeze, family hx Others: Pertussis: Paroxysmal, post-tussive vomiting, sick contacts Foreign Body: Sudden onset, choking, absent during sleep Habit Cough: "Honking" (teens), "throat-clearing" (younger), absent during sleep PBB: Persistent wet cough, resolves with antibiotics Bronchiectasis: Recurrent wet cough, no antibiotic response Irritants: Smoke, reflux History Duration (>4 weeks), nature (wet/dry, paroxysmal, night-time) Associated symptoms (fever, weight loss, poor feeding) Exposures (smoke, allergens, sick contacts), choking episode, vaccination status Family hx (asthma, CF), response to prior treatments Management General: Treat underlying cause, avoid irritants, trial honey (>12 months), follow up 2–3 weeks PBB: Amoxicillin-clavulanate 3–4 weeks, reassess for resolution of wet cough Habit Cough: Distraction therapy, address stressors Persistent Symptoms: Imaging: CXR (first-line) Tests: Spirometry (if age-appropriate), nasopharyngeal swab (pertussis) Bronchoscopy: Foreign body or inconclusive findings When to Refer Poor weight gain, recurrent infections (e.g., CF) Cough with feeds (e.g., TOF, GORD) Clubbing, dyspnoea (e.g., bronchiectasis) PBB not resolving after antibiotics Habit cough >3 months or significant QoL impact Notes Chronic cough: >4 weeks Postviral: Often resolves spontaneously by 8 weeks PBB: May require extended antibiotics (anaerobic involvement) Early bronchiectasis recognition prevents long-term damage Chronic Cough in Children Differentials Condition Key Features Postviral Cough can last up to 8 weeks after infection Sinusitis Rhinorrhoea, nasal obstruction, possible itchy eyes, sneezing Asthma/Wheeze Night cough, wheeze, family history of atopy Pertussis Paroxysmal cough, post-tussive vomiting, known sick contacts Foreign Body Sudden onset, choking episode, often absent during sleep Habit Cough “Honking” cough in adolescents or throat-clearing in younger children, typically absent in sleep Protracted Bacterial Bronchitis (PBB) Persistent wet cough, typically resolves with appropriate antibiotic (e.g. amoxicillin-clavulanate) Bronchiectasis Recurrent wet cough, poor response to antibiotics, may see clubbing Irritants Exposure to smoke, reflux, environmental triggers History Duration >4 weeks, nature of cough (wet/dry, paroxysmal, nocturnal) Associated symptoms: Fever, weight loss, poor feeding, wheeze Environmental/exposure history: Smoke, allergens, sick contacts, choking episode, vaccination status Family history of asthma, cystic fibrosis, or chronic lung disease Response to previous therapies (e.g. bronchodilators, antibiotics) Management General Identify and address underlying cause; avoid irritants (e.g. smoke) Consider trial of honey (if child >12 months) for cough relief Review in 2–3 weeks to assess improvement PBB Amoxicillin-clavulanate for 3–4 weeks Reassess for resolution of the wet cough Habit Cough Distraction therapy, address any psychosocial stressors Persistent Symptoms Imaging: Chest X-ray as first-line Further tests: Spirometry (if age-appropriate), nasopharyngeal swab for pertussis Bronchoscopy if foreign body suspected or if findings are inconclusive When to Refer Poor weight gain, recurrent chest infections (suspect CF or immunodeficiency) Cough with feeds (possible TOF or severe GORD) Clubbing, dyspnoea, or suspicion of bronchiectasis PBB not resolving after adequate antibiotic course Habit cough >3 months or significant impact on quality of life Notes Chronic cough is defined as >4 weeks in children. Postviral cough can last up to 8 weeks, often resolves spontaneously. PBB may need prolonged antibiotics due to anaerobic bacteria. Early recognition and management of bronchiectasis can help prevent irreversible lung damage. 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 Breast Lump Differential Diagnoses Benign Fibrocystic disease Fibroadenoma Fat necrosis Cyst Lipoma Phyllodes tumour Malignant Breast cancer Paget’s disease of the nipple History Trauma (suggestive of fat necrosis) Tenderness Lump size or consistency changes Axillary lumps Nipple discharge Eczematous nipple changes (suggestive of Paget’s disease) Relation to menstrual cycle (fibrocystic changes settle post-menses) Skin changes (peau d’orange) Systemic symptoms (weight loss, night sweats) Risk Factors Nulliparity Early menarche (<12 years) or late menopause (>55 years) Family or personal history of breast/ovarian cancer BRCA1/2 mutations Hormone replacement therapy (HRT) use for >5 years Smoking Examination Inspect skin for dimpling, peau d’orange Systematic palpation of both breasts Assess for axillary and supraclavicular lymphadenopathy Lump location, nipple retraction or ulceration, and discharge Lump characteristics: Painless, hard, irregular, non-mobile (suggestive of malignancy) Triple Test 1. Clinical Assessment History and examination findings 2. Imaging <35 years, pregnant, or breastfeeding: Ultrasound first-line ≥35 years: Mammography + ultrasound 3. Biopsy Fine-needle aspiration (FNA) cytology and/or core biopsy for tissue diagnosis Notes The triple test (clinical, imaging, biopsy) guides management Concordant benign or malignant results: Proceed with appropriate treatment Non-concordant or indeterminate results: Require further imaging, repeat biopsy, or specialist referral Breast Lump Differential Diagnosis Benign Conditions Fibrocystic disease – often cyclically tender, with changes related to the menstrual cycle Fibroadenoma – typically painless, mobile, and well-defined Breast cyst – fluid-filled lesion that may be tender and fluctuate with the cycle Fat necrosis – usually follows trauma; presents as a firm, irregular lump Lipoma – soft, mobile benign fatty tumour Phyllodes tumour – rare, may be benign or malignant, usually large and fast-growing Malignant Conditions Breast cancer – hard, irregular, fixed mass often accompanied by skin changes (eg, dimpling, peau d’orange), nipple retraction/discharge and lymphadenopathy Paget’s disease of the nipple – eczematous changes of the nipple, frequently associated with an underlying malignancy History Elicit any history of trauma suggesting fat necrosis Note changes in lump size, consistency, or tenderness Ask about axillary lumps and nipple discharge Assess for eczematous nipple changes indicative of Paget’s disease Explore relationship to the menstrual cycle, with fibrocystic changes typically settling post-menses Inquire about systemic symptoms such as weight loss or night sweats that may indicate malignancy Risk Factors Nulliparity Early menarche (<12 years) or late menopause (>55 years) Family or personal history of breast or ovarian cancer, including BRCA mutations Prolonged hormone replacement therapy (>5 years) Smoking Examination Inspect breast skin for dimpling or peau d’orange suggesting lymphatic involvement Systematically palpate both breasts and regional lymph nodes (axillary and supraclavicular) Assess lump characteristics: size, consistency, mobility, and associated nipple changes Identify fixed, hard, irregular, non-mobile lumps as suspicious for malignancy Investigations Triple Test Clinical Assessment – Detailed history and examination Imaging Ultrasound first-line in women under 35, pregnant or breastfeeding Mammography with ultrasound for women aged 35 and above Biopsy – FNAC and/or core biopsy for tissue diagnosis, including immunohistochemical testing for ER/PR and HER2 if malignancy is suspected Additional Investigations MRI may be considered in cases of dense breast tissue or indeterminate findings Genetic testing may be warranted in patients with a strong family history or early-onset cancer Management Use the triple test to guide management Concordant benign results: Reassure and monitor with routine follow-up Concordant malignant results: Initiate multidisciplinary oncological referral Discordant or indeterminate findings: Consider repeat imaging or biopsy and specialist referral For benign conditions, management is typically conservative with regular monitoring and symptomatic treatment For malignant conditions, a multidisciplinary approach involving surgery, medical oncology and radiology is essential Notes Early detection and accurate diagnosis are crucial for improving outcomes in breast cancer Reassessment is essential; any changes in lump characteristics warrant prompt re-evaluation Educate patients on self-breast examination and normal breast changes Emphasise genetic counselling for patients with significant family histories Be aware of limitations in imaging, especially in younger women with dense breast tissue Multidisciplinary team meetings optimise management of complex cases Bookmark Failed! 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Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE GORD Non-Pharmacological Management Aim for weight loss 5–10% / BMI <25 Advise and support patients to stop smoking Avoid triggers (e.g., alcohol, spicy food, caffeine) Eat smaller meals Avoid lying down after eating Drink fluids between meals rather than with meals Elevate head of bed (if symptoms occur at night) Avoid eating or drinking within 3 hours before bedtime Avoid tight-fitting clothes that increase intra-abdominal pressure Mild (1x per week or less) Lifestyle modifications may be sufficient 1st line: Antacids Gaviscon 10–20 mL PRN Mylanta 10–20 mL PRN 2nd line: If antacids ineffective: Ranitidine 150 mg OD–BD PRN Esomeprazole 20 mg OD Review if utilising more than once per week Frequent (≥2x per week) or Severe Symptoms Lifestyle modifications + PPI: Esomeprazole 20 mg daily (1 hour before a meal) Duration: 4–8 weeks, then step down to PRN dosing, intermittent dosing, or trial cessation with H2 antagonists/antacids If no improvement after 8 weeks → refer for endoscopy Consider H. pylori testing if symptoms persist despite adequate PPI therapy Long-Term PPI Side Effects Increased fracture risk/osteoporosis (less calcium absorption) Interstitial nephritis C. difficile infection Interaction with other medications, especially clopidogrel Monitor magnesium levels in long-term PPI use due to hypomagnesaemia risk Indications for Upper GI Endoscopy Alarm Symptoms: Anaemia Dysphagia or odynophagia Haematemesis or melaena Vomiting Weight loss New symptoms in older adults Changing symptoms Severe or frequent symptoms Inadequate response to treatment Note: Endoscopy is not routinely required for typical GORD symptoms without alarm features Management of Extra-Oesophageal Symptoms Extra-oesophageal symptoms may include: Chronic cough Pharyngeal/laryngeal symptoms Non-cardiac chest pain Sleep disturbance Treatment: High-dose PPI trial for 8–12 weeks: Esomeprazole 20 mg BD 1 hour before meals OR Omeprazole, Pantoprazole, Rabeprazole, or Lansoprazole BD If no response → stop PPI and consider alternative diagnoses (e.g., laryngopharyngeal reflux, functional syndromes) GORD in Pregnancy Management: First-line: Lifestyle and dietary modification (e.g., smaller meals, avoiding lying down after eating) Drug Therapy: Safe options: Antacids and H2-receptor antagonists (e.g., ranitidine, famotidine) PPIs: If severe and unresponsive to other treatments Omeprazole has the most clinical safety data and experience GORD Non-Pharmacological Management Aim for 5–10% weight loss if overweight; target BMI <25 Encourage smoking cessation (smoking lowers LES tone) Avoid known triggers (alcohol, spicy foods, caffeine, carbonated drinks) Eat smaller meals; large meals increase gastric distension Avoid lying down immediately after eating (wait at least 2–3 hours) Fluids between meals rather than with meals to reduce gastric volume Elevate the head of the bed by 15–20 cm (e.g. bed risers) if nocturnal reflux Avoid tight-fitting clothing that increases intra-abdominal pressure Mild GORD (≤1 episode per week) Lifestyle modifications may suffice First Line: Antacids (e.g. Gaviscon 10–20 mL PRN, Mylanta 10–20 mL PRN) for on-demand relief Second Line: If antacids are ineffective or needed >1/week: H2-receptor antagonist (ranitidine 150 mg once or twice daily) or Proton pump inhibitor (PPI) e.g. esomeprazole 20 mg once daily Review if using more than once weekly to ensure no underlying complications Frequent (≥2 episodes/week) or Severe Symptoms Lifestyle measures plus a PPI: Esomeprazole 20 mg daily (or similar PPI) taken 1 hour before a meal Usual course: 4–8 weeks, then step down to PRN or intermittent dosing if controlled If inadequate response after 8 weeks → Refer for endoscopy Consider H. pylori testing (urea breath test or stool antigen) if symptoms persist despite adequate PPI therapy Long-Term PPI Side Effects Fracture risk/osteoporosis (possible decreased calcium absorption) Interstitial nephritis (rare but serious) C. difficile infection (altered gut flora) Possible interaction with clopidogrel (reduced antiplatelet effect) Hypomagnesaemia in prolonged use (monitor if long-term) (Sources: eTG – Gastrointestinal, AJGP/AFP articles, Murtagh’s.) Indications for Upper GI Endoscopy Alarm Symptoms: Anaemia (especially iron deficiency) Dysphagia or odynophagia (pain on swallowing) Haematemesis or melaena Persistent vomiting Unintentional weight loss New-onset reflux in older adults (>50–55 years) Change in previously stable symptoms Severe/frequent GORD not responding to treatment Note: Endoscopy is not routinely required for typical GORD in younger patients without alarm features. Management of Extra-Oesophageal Symptoms Possible chronic cough, pharyngeal/laryngeal symptoms, non-cardiac chest pain, or sleep disturbance High-dose PPI trial (8–12 weeks): e.g. Esomeprazole 20 mg BD (1 hour before meals) Alternative PPIs: Omeprazole, pantoprazole, rabeprazole, or lansoprazole BD If no response → discontinue PPI, consider alternative diagnoses (e.g. laryngopharyngeal reflux, functional chest pain, etc.) GORD in Pregnancy First-line: Lifestyle modifications (smaller meals, avoid lying down post-eating, elevate head of bed) Drug Therapy: Antacids or H2-receptor antagonists (ranitidine, famotidine) generally safe PPIs if severe or refractory to first-line measures; omeprazole has the most safety data in pregnancy Emphasise non-pharmacological measures due to limited data on medication safety in pregnancy Bookmark Failed! Bookmark Saved! Refresh Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Dyspepsia Symptoms Fullness, indigestion, bloating Upper abdominal discomfort Heartburn Note: Alarm symptoms (e.g., unintentional weight loss, anaemia, dysphagia) require urgent investigation Differentials Most Common: Gastritis: Alcohol, aspirin, steroids Peptic ulcer: NSAIDs, H. pylori (especially in patients with a household member with H. pylori) GORD Functional dyspepsia (no structural cause found, associated with visceral hypersensitivity) Gastroparesis: Vagus nerve damage: diabetes, previous abdominal surgery Slow gastric emptying: opioids Others: Gastric cancer IHD: constricting-type pain → consider until proven otherwise Oesophagitis/oesophageal cancer Cholecystitis Hepatitis IBS Chronic pancreatitis/coeliac disease (rarely presents with dyspepsia alone) Note: Hypercalcaemia (e.g., in malignancy or primary hyperparathyroidism) can mimic dyspepsia symptoms History Any heartburn/regurgitation → improves with milk/antacids (GORD) Radiation of pain to the back (pancreatitis) Vomiting: Gastroparesis → occurs with recurrent upper abdominal pain Any association with diarrhoea/bowel changes (IBS) Alcohol intake OTC medications: NSAIDs, aspirin Family history of gastric cancer/weight loss Symptoms worsening with: Exercise (IHD) Fatty foods (cholecystitis) Assess proper chewing habits Alarm Symptoms: Unintentional weight loss, dysphagia, haematemesis, melaena, anaemia Treatment Lifestyle Measures: Avoid smoking, alcohol, and spicy/triggering foods Encourage smaller, frequent meals and eating slowly Medications: Avoid aspirin/NSAIDs unless medically necessary Antacids/PPIs Other Interventions: Relaxation therapies Weight loss (for GORD) Functional dyspepsia: symptom management Treat NSAID-induced ulcers for 4 weeks post-cessation Repeat urea breath test 4 weeks post-treatment (for H. pylori) Test and treat H. pylori in patients with confirmed dyspepsia, particularly in high-prevalence areas or those with recurrent symptoms When to Refer: Persistent symptoms despite 8 weeks of PPI therapy Presence of alarm symptoms or suspicion of malignancy Dyspepsia Symptoms Fullness, indigestion, bloating Upper abdominal discomfort Heartburn Alarm symptoms (e.g. unintentional weight loss, anaemia, dysphagia) require urgent investigation Differentials Most Common: Gastritis (alcohol, aspirin, steroids) Peptic ulcer disease (NSAIDs, H. pylori) GORD (reflux) Functional dyspepsia (no structural cause, often visceral hypersensitivity) Gastroparesis: Vagus nerve damage (diabetes, post-abdominal surgery) Slow gastric emptying (opioids) Others: Gastric cancer IHD (ischaemic heart disease) – consider if chest-tight pain Oesophagitis/oesophageal cancer Cholecystitis Hepatitis IBS Chronic pancreatitis/coeliac disease (rarely presents with dyspepsia alone) Note: Hypercalcaemia (e.g. malignancy, hyperparathyroidism) can mimic dyspepsia History Heartburn or regurgitation, possibly improved by milk/antacids (suggestive of GORD) Pain radiating to the back (possible pancreatitis) Vomiting patterns (gastroparesis with recurrent upper abdominal pain) Bowel changes or diarrhoea (e.g. IBS) Alcohol intake OTC medications (NSAIDs, aspirin) Family history (gastric cancer, weight loss) Pain triggers: Exercise (IHD) Fatty foods (cholecystitis) Chewing habits Alarm symptoms: Unintentional weight loss, dysphagia, haematemesis, melaena, anaemia Treatment Lifestyle Measures: Avoid smoking, alcohol, spicy/triggering foods Smaller, more frequent meals; eat slowly Medications: Avoid or limit aspirin/NSAIDs unless essential Use antacids or PPIs (proton pump inhibitors) for symptom control Other Interventions: Relaxation therapies Weight reduction (helpful if GORD) Functional dyspepsia: Symptom-based management If NSAID-induced ulcer, treat for 4 weeks after stopping NSAIDs For H. pylori, test (e.g. urea breath test) and treat if positive; confirm eradication at 4 weeks post-treatment When to Refer Persistent symptoms despite 8 weeks of PPI therapy Alarm symptoms or suspicion of malignancy 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 Bronchiectasis Causes Common: Childhood pneumonia, cystic fibrosis, severe infections, asthma, COPD Less Common: RA, GORD/aspiration, ABPA, non-TB mycobacteria, immunodeficiency, primary ciliary dyskinesia Rare: Alpha-1 antitrypsin deficiency, yellow nail syndrome, foreign body Presentation Chronic productive cough, recurrent infections Purulent ± bloodstained sputum, fatigue, dyspnoea, pleuritic pain Coarse crackles, clubbing (<5%) Investigations HRCT: Gold standard (bronchial diameter > adjacent vessel) Spirometry: Obstructive pattern Sputum Culture: Key for pathogens (e.g. Pseudomonas, Haemophilus) Consider: FBC, immunoglobulins (IgG, IgA, IgM) Autoimmune markers (e.g., RF, ANA) CF sweat test (esp. children) Aspergillus-specific IgE or skin-prick testing Diagnosis Clinical features + HRCT: Persistent symptoms despite treatment Refer If: Wet cough >4 weeks, recurrent pneumonia, parenchymal changes Consider bronchoscopy for obstruction or foreign body Management General: Airway clearance with physiotherapy Regular exercise (30 min/day) Annual pneumococcal and influenza vaccination Smoking cessation, optimise nutrition Stable Disease: Pulmonary rehabilitation Bronchodilators for sx relief in select cases (e.g., severe breathlessness) Written action plan for exacerbations Macrolides (e.g. azithromycin) for frequent exacerbations Inhaled antibiotics (e.g. tobramycin) for chronic Pseudomonas Exacerbations: Mild: Oral antibiotics if signs of bacterial infection (e.g., increased sputum purulence) (e.g. doxycycline 100 mg BD for 14 days) Severe: Hospital admission, IV antibiotics If Pseudomonas colonisation: Ciprofloxacin 750 mg BD for 14 days If no colonisation: Amoxicillin 1 g TDS or doxycycline 100 mg BD for 14 days Haemoptysis: Massive: Urgent hospital transfer (embolisation/surgery) Recurrent: Specialist referral Bronchiectasis Causes Category Examples Common Childhood pneumonia, cystic fibrosis, severe infections, asthma, COPD Less Common Rheumatoid arthritis, GORD/aspiration, allergic bronchopulmonary aspergillosis (ABPA), non-TB mycobacteria, immunodeficiency, primary ciliary dyskinesia Rare Alpha-1 antitrypsin deficiency, yellow nail syndrome, foreign body Presentation Chronic productive cough and recurrent infections are hallmark features Sputum can be purulent or occasionally bloodstained Patients often report fatigue, dyspnoea, or pleuritic chest pain On examination, coarse crackles may be noted Clubbing is present in <5% of cases Investigations High-resolution CT (HRCT) is the gold standard, showing bronchial diameter greater than the accompanying vessel Spirometry typically shows an obstructive pattern Sputum culture is essential to identify key pathogens (e.g. Pseudomonas aeruginosa, Haemophilus influenzae) Additional tests may include: Full blood count (FBC) Immunoglobulins (IgG, IgA, IgM) Autoimmune markers (RF, ANA) Sweat chloride or CFTR genotyping (especially in children) Tests for Aspergillus (skin-prick or IgE) Diagnosis Based on a combination of clinical features and HRCT findings Typically involves persistent symptoms despite usual treatment Referral is indicated for a wet cough lasting more than four weeks, recurrent pneumonia, or if parenchymal changes are seen Bronchoscopy may be needed to rule out obstruction or foreign body Management General Measures: Airway clearance with physiotherapy Regular exercise (e.g. 30 minutes a day) Yearly pneumococcal and influenza vaccinations Smoking cessation Optimal nutrition Stable Disease: Pulmonary rehabilitation and bronchodilators may help symptom relief in select patients A written action plan for exacerbations is useful For frequent exacerbations, long-term macrolide therapy (e.g. azithromycin) may reduce flare-ups Patients with chronic Pseudomonas colonisation might benefit from inhaled antibiotics (e.g. tobramycin) Exacerbations: Mild: Oral antibiotics if signs of bacterial infection (e.g. increased sputum purulence) Example: doxycycline 100 mg BD for 14 days Severe: Consider hospital admission and intravenous antibiotics If Pseudomonas colonised, use ciprofloxacin 750 mg BD for 14 days If no Pseudomonas, options include: Amoxicillin 1 g TDS Doxycycline 100 mg BD for 14 days Haemoptysis: Massive haemoptysis requires urgent transfer for possible embolisation or surgical management Recurrent haemoptysis warrants specialist referral Notes: Regularly monitor for new or resistant pathogens and adjust therapy accordingly Consider immunoglobulin replacement if immunodeficiency is identified Emphasise adherence to airway clearance techniques to reduce exacerbation frequency and improve quality of life 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 Sarcoidosis Pathophysiology Cause unknown, likely exaggerated immune response in genetically predisposed individuals. Non-caseating granulomas form due to T-cell and macrophage activation. Clinical Features Pulmonary (90%) Symptoms: Dyspnoea, dry cough. Signs: Often minimal; may have wheeze or reduced breath sounds if fibrosis. Lymphatic Bilateral hilar lymphadenopathy (classic CXR finding) Dermatological Lupus pernio (violaceous lesions on nose, cheeks, ears – chronic disease). Erythema nodosum (good prognosis, often with hilar lymphadenopathy). Ocular Uveitis, conjunctival granulomas, vision loss if untreated. Other Hypercalcaemia (granulomas activate vitamin D → nephrolithiasis risk). Löfgren’s syndrome: Erythema nodosum + bilateral hilar lymphadenopathy + migratory polyarthritis (ankles) → good prognosis. Cardiac (arrhythmias, heart failure), neurological (facial nerve palsy, CNS involvement). Investigations CXR: Bilateral hilar lymphadenopathy ± pulmonary infiltrates. HRCT: If more detailed lung assessment needed. Pulmonary Function Tests (PFTs): Restrictive pattern. Biopsy (gold standard): Non-caseating granulomas (lymph nodes, skin, lung). Bloods: Serum ACE (non-specific), calcium (hypercalcaemia risk), FBC, LFTs, renal function. ECG/Echo: If cardiac symptoms. Slit-lamp exam: If ocular involvement. Management When to Treat? Mild cases: Often self-limiting → monitor. Moderate-severe (organ dysfunction or significant symptoms): Corticosteroids. First-Line Treatment Oral prednisolone, taper to lowest effective dose. Steroid-Sparing Agents (if chronic/refractory) Methotrexate, hydroxychloroquine (for cutaneous disease, hypercalcaemia), azathioprine. Biologic therapy (anti-TNF) if refractory. Cutaneous Disease Topical or intralesional corticosteroids if localised. Non-Pharmacological Smoking cessation, exercise, monitor calcium intake. Follow-Up & Referral Regular monitoring (CXR, PFTs, clinical review). Refer if pulmonary, ocular, cardiac, or neurological involvement. Prognosis Löfgren’s syndrome → good prognosis, often self-limiting. Chronic disease → risk of fibrosis, arrhythmias, neurological impairment. Early detection & treatment improve outcomes. Sarcoidosis Aetiology and Pathophysiology Aetiology: Unclear; thought to involve an exaggerated immune response to an unidentified antigen in a genetically predisposed individual. Pathophysiology: Formation of non-caseating (non-necrotising) granulomas, primarily due to accumulation and activation of T-lymphocytes and macrophages. Clinical Features Sarcoidosis is heterogeneous. Many patients are asymptomatic and identified incidentally on imaging. Others present with systemic or organ-specific features. General/Constitutional Fever, malaise, fatigue, weight loss, night sweats. Pulmonary Present in up to 90% of cases. Symptoms: Dyspnoea on exertion, dry cough, chest discomfort. Signs: Often minimal; can include wheeze or reduced breath sounds if fibrotic changes occur. Lymphatic Bilateral hilar lymphadenopathy is classic (readily detected on chest X-ray). Peripheral lymphadenopathy can occur. Dermatological Specific lesions: Yellowish-brown plaques or nodules (commonly on the face and extremities). Infiltrative plaques over old scars. Lupus pernio (violaceous lesions on the nose, cheeks, ears) is highly characteristic of chronic sarcoidosis. Non-specific lesions: Erythema nodosum (often with hilar lymphadenopathy and pulmonary involvement). Erythema multiforme, alopecia, ichthyosis, and other presentations are less common. Ocular Uveitis (anterior or posterior), conjunctival lesions, reduced vision, photophobia, and possible risk of blindness if untreated. Musculoskeletal Arthralgia or arthritis (commonly ankles, knees, wrists). Löfgren’s syndrome: Classic triad of erythema nodosum, bilateral hilar lymphadenopathy, and migratory polyarthritis (often affecting ankles). It is an acute presentation of sarcoidosis with a good prognosis. Cardiac Conduction abnormalities, arrhythmias, heart failure, or sudden cardiac death in rare but serious cases. Neurological Cranial nerve palsies (particularly facial nerve), peripheral neuropathy, meningitis, or intracranial lesions. Other Liver involvement (hepatomegaly, mild abnormal liver function tests). Splenic involvement. Renal involvement (hypercalcaemia, nephrolithiasis). Investigations Initial Work-up Detailed history and clinical examination: Check for pulmonary, cutaneous, ocular, and other systemic signs. Chest imaging: Chest X-ray is the mainstay initial investigation. Commonly shows bilateral hilar lymphadenopathy, sometimes parenchymal changes. High-resolution CT is more sensitive for pulmonary involvement. Pulmonary function tests (PFTs): Assess the extent of pulmonary involvement (restrictive pattern +/- reduced diffusion capacity). Additional/Confirmatory Tests Biopsy: Confirms diagnosis (non-caseating granulomas). May be obtained from accessible lymph nodes or skin lesions if present. Transbronchial lung biopsy or endobronchial ultrasound (EBUS)-guided biopsy may be needed for intrathoracic lesions. Serum angiotensin-converting enzyme (ACE): May be elevated in sarcoidosis, although not diagnostic on its own. Levels can be used to monitor activity in some patients. Blood tests: Full blood count, ESR/CRP (may be elevated). Serum calcium (hypercalcaemia can occur due to increased vitamin D activation by granulomas). Renal function tests (monitor for nephrolithiasis if hypercalcaemia is present). Liver function tests (if hepatic involvement suspected). Eye examination: Slit-lamp exam for uveitis. ECG and echocardiogram: To exclude cardiac involvement if indicated (e.g. arrhythmias, palpitations, syncope). Differential Diagnosis Tuberculosis or other granulomatous infections (e.g. fungal infections). Malignancies causing lymphadenopathy (e.g. lymphoma). Other causes of interstitial lung disease. Autoimmune conditions presenting with arthralgias and erythema nodosum (e.g. inflammatory bowel disease–associated erythema nodosum). Management Approach General Principles Treatment decisions are usually based on the presence of organ dysfunction, severity of symptoms, and risk of serious complications (e.g. cardiac or neurological involvement). Some patients with mild, asymptomatic disease only require monitoring (watchful waiting), especially if there is no risk of permanent organ damage. Pharmacological Treatment Corticosteroids First-line for moderate-to-severe disease (particularly with pulmonary, ocular, neurological, or cardiac involvement). Oral prednisolone improves symptoms and prevents organ damage in active disease. Dosage and duration vary according to severity and response. Taper gradually to the lowest effective dose. Steroid-sparing agents Indicated in chronic sarcoidosis or if steroid side effects are problematic. Options include: Methotrexate Hydroxychloroquine (particularly useful for cutaneous lesions and hypercalcaemia) Azathioprine Leflunomide (less commonly used) Cutaneous Lesions (Local Therapy) Potent topical corticosteroids (with or without occlusion) for localised plaque lesions. Intralesional corticosteroids for accessible lesions. Referral to a dermatologist if lesions are extensive or resistant. Biologic Therapy (e.g. Anti-TNF agents) Reserved for refractory sarcoidosis not controlled on conventional immunosuppression. Usually guided by specialist teams. Non-pharmacological Support Lifestyle measures: Smoking cessation if applicable. Exercise and physiotherapy for pulmonary involvement (as tolerated). Healthy diet and adequate hydration, especially if hypercalcaemia is a concern. Monitoring and follow-up: Regular clinical review (looking for disease progression or complications). Repeat imaging (chest X-ray/CT), PFTs, eye exams, and blood tests where indicated. Referral Considerations Respiratory physician: Most patients with pulmonary sarcoidosis for definitive management. Dermatologist: Significant or difficult-to-treat skin lesions. Ophthalmologist: If ocular involvement is suspected or diagnosed. Cardiologist / Neurologist: For cardiac or neurological involvement. Other specialists: As per organ-specific complications. Prognosis Many patients have a self-limiting course, particularly those with acute presentations (e.g. Löfgren’s syndrome). Chronic disease can lead to significant morbidity, particularly when there is chronic pulmonary fibrosis, cardiac, or neurological involvement. Timely diagnosis, regular monitoring, and appropriate therapy are key to optimising outcomes. Bookmark Failed! Bookmark Saved! Add Bookmark Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Pyogenic Granuloma Definition Benign, rapidly growing vascular lesion Small, red, fleshy bump with a raspberry-like appearance Prone to bleeding & ulceration, especially with trauma Aetiology & Causes Trauma (minor injuries can trigger growth) Infection (S. aureus frequently present) Hormonal (up to 5% of pregnancies, OCP use) Medications (retinoids, certain cancer therapies) Clinical Features Painless, red nodule (1–2 cm), rapid growth over weeks Easily bleeds with minor trauma Common sites: Head, neck, upper trunk, hands, feet Diagnosis Clinical diagnosis based on appearance & history Biopsy if malignancy suspected (melanoma, BCC) Management Curettage & cautery (scraping + heat to prevent regrowth) Laser therapy (for smaller lesions) Cryotherapy (freezing for small lesions) Chemical cautery (silver nitrate application) Imiquimod (effective in some cases, esp. children) Pregnancy-related lesions may resolve postpartum Pyogenic Granuloma Definition A benign, rapidly growing vascular lesion that appears as a red, fleshy bump (often described as "raspberry-like"). It’s prone to bleeding and potential ulceration with minor trauma. Aetiology & Causes Trauma: Minor injuries can stimulate vascular proliferation. Infection: Staphylococcus aureus can be present and trigger or exacerbate growth. Hormonal: Occurs in ~5% of pregnancies or with OCP use. Medications: Retinoids, certain cancer therapies. Clinical Features Painless, red nodule (1–2 cm), can grow quickly over weeks. Easily bleeds with minimal trauma. Common locations: Head, neck, upper trunk, hands, feet. Diagnosis Primarily clinical based on characteristic appearance and rapid growth history. Biopsy if there is any suspicion of malignancy (e.g. melanoma, BCC, amelanotic or nodular lesions). Management Curettage & Cautery Scraping (curette) the lesion followed by electrocautery to prevent regrowth. Laser Therapy Useful for smaller lesions or cosmetically sensitive areas. Cryotherapy Freezing small lesions with liquid nitrogen; may require multiple sessions. Chemical Cautery Application of silver nitrate to control bleeding and destroy tissue superficially. Imiquimod Occasionally effective, especially in children, though less commonly used. Pregnancy-related Lesions May resolve postpartum; wait and watch approach if lesion isn’t problematic. Bookmark Failed! Bookmark Saved! Refresh Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Familial Hypercholesterolaemia (FH) When to Suspect FH LDL ≥5 mmol/L or TC ≥7.5 mmol/L Personal or family history of premature CVD (<55yrs) Presence of tendon xanthomas or arcus cornealis (<45yrs) Confirm diagnosis using Dutch Lipid Clinic Network criteria: >8: Definite FH 3–8: Probable FH <3: Unlikely FH Management Smoking and alcohol cessation Reduce dietary saturated fat intake Weight loss (5–10%) and regular exercise (≥150 mins/week) High-potency statins (e.g., atorvastatin 40–80mg) → target ≥50% LDL reduction Consider ezetimibe or PCSK9 inhibitors if LDL goals not met despite statins ACEi if patient has confirmed FH (high CVD risk) with HTN or diabetes Counselling Advice Emphasise high lifetime CVD risk; screen all 1st-degree relatives (50% chance of inheritance) Educate patients to encourage family members to undergo lipid testing Provide regular annual reviews for CV risk factors and lipid control Refer to lipid or cardiology clinic if FH suspected but diagnostic uncertainty exists Investigations Bloods: Lipid profile (LDL ≥5 mmol/L, TC >7.5 mmol/L) FBC, UECs, LFTs (prior to statins), HbA1c, TFTs (rule out secondary causes) Imaging: Coronary artery calcium (CAC) score to detect subclinical atherosclerosis Genetic Testing: If strong clinical suspicion remains, confirm with LDLR gene testing Complications Premature CAD (e.g., MI, angina) Stroke/TIA → Increased cerebrovascular disease risk Peripheral artery disease Aortic stenosis (lipid deposition in valve) Tendon rupture (secondary to xanthomas) Additional notes: Most FH can be managed in GP settings if LDL well controlled Dietary changes alone are insufficient; pharmacological therapy required Familial Hypercholesterolaemia (FH) When to Suspect FH LDL ≥5 mmol/L or TC ≥7.5 mmol/L Personal or family history of premature cardiovascular disease (CVD) (men <55 years, women <60 years) Presence of tendon xanthomas or arcus cornealis (especially if <45 years) Diagnostic Criteria Use the Dutch Lipid Clinic Network (DLCN) criteria to assess FH probability: 8 points: Definite FH 6–8 points: Probable FH 3–5 points: Possible FH <3 points: Unlikely FH Management Lifestyle Modifications: Smoking and alcohol cessation Reduce dietary saturated fat intake Weight loss (5–10%) and regular exercise (≥150 mins/week) Pharmacotherapy: Initiate high-potency statins (e.g., atorvastatin 40–80 mg) aiming for ≥50% LDL reduction If LDL targets are not achieved with statins alone, consider adding ezetimibe or PCSK9 inhibitors For patients with hypertension or diabetes, ACE inhibitors are recommended due to their cardiovascular protective effects Counselling and Follow-Up Emphasise the high lifetime risk of CVD associated with untreated FH Encourage screening of all first-degree relatives, as there is a 50% chance of inheritance Educate patients to inform family members about the importance of lipid testing Provide regular annual reviews to monitor cardiovascular risk factors and lipid levels Refer to a lipid or cardiology clinic if there is diagnostic uncertainty or difficulty achieving lipid targets Investigations Blood Tests: Lipid profile to assess LDL and total cholesterol levels FBC, UECs, LFTs (prior to initiating statin therapy), HbA1c, and TFTs to rule out secondary causes of hyperlipidaemia Imaging: Coronary artery calcium (CAC) scoring can detect subclinical atherosclerosis and aid in risk stratification Genetic Testing: Consider LDLR gene testing if clinical suspicion remains high after initial assessments Complications Increased risk of premature coronary artery disease (e.g., myocardial infarction, angina) Elevated risk of cerebrovascular events such as stroke or transient ischaemic attacks Potential development of peripheral artery disease Aortic stenosis due to lipid deposition in the aortic valve Tendon rupture secondary to xanthomas Notes: Most cases of FH can be effectively managed in general practice if LDL levels are well controlled Dietary changes alone are often insufficient; pharmacological therapy is typically required to achieve lipid targets Clinical signs of FH (AJGP) A. Xanthoma knuckles; B. Xanthoma Achilles tendon; C. Arcus cornealis; D. Xanthelasma medial canthus Bookmark Failed! Bookmark Saved! Refresh Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Gout Triggers High purine foods (e.g., shellfish, organ meats, red meat) Fructose-rich drinks, alcohol (beer/spirits) Trauma to joints, systemic illness with fever Dehydration Medications: Aspirin (low dose), thiazides, loop diuretics Clinical Features Acute Gout: Sudden, monoarticular (commonly 1st MTP joint) Intense pain, erythema, swelling, warmth Pain peaks within 24 hours; fever and malaise common Mimics septic arthritis Chronic Gout: Recurrent, oligo-/polyarticular involvement Tophi: Deposits in joints (elbows, fingers, toes) causing deformity Chronic arthritis → joint destruction, disability Associated with cardiovascular and renal comorbidities Diagnosis Joint Aspiration: Needle-shaped monosodium urate crystals with negative birefringence (gold standard) Serum Uric Acid: May be normal during a flare; use for chronic monitoring Imaging: X-ray shows joint damage, erosions, or tophi Acute Flare Management First-Line: Prednisolone: 15–30 mg PO daily for 3–5 days Ibuprofen: 400 mg TDS for 5 days Intra-articular corticosteroids for ≤2 joints Second-Line: Colchicine: 1 mg stat, then 500 mcg 1 hour later (max 1.5 mg/day) Non-Pharmacological Advice: Hydration (2–3 L/day) Avoid high-purine foods, alcohol, and sugary drinks Weight loss, regular exercise, smoking cessation Rapid Symptom Relief: Combine colchicine with NSAIDs or prednisolone (avoid NSAID + steroid combo due to GI toxicity) Long-Term Treatment Urate-Lowering Therapy (ULT): Allopurinol: Start 50 mg daily, titrate every 2–4 weeks to max 900 mg daily Do not stop during flares; treat flares alongside ULT Target serum urate: <0.36 mmol/L (or <0.30 mmol/L with tophi) Alternatives: Febuxostat if allopurinol-intolerant Prophylaxis (6 months minimum): Colchicine: 500 mcg daily Ibuprofen: 200–400 mg TDS Prednisolone: 5 mg daily (specialist advice) Patient Counselling Importance of lifelong ULT to prevent flares, joint damage, and cardiovascular risk Explain triggers and how to avoid them (e.g., diet, hydration, alcohol moderation) Do not stop ULT during flares; use prophylaxis to prevent exacerbations Emphasise adherence to reduce flares and resolve tophi Complications Chronic gouty arthritis with joint deformity Tophaceous gout: Deposits in fingers, toes, elbows Chronic kidney disease, urate nephrolithiasis Increased cardiovascular disease risk Gout Triggers High Purine Foods: Shellfish, organ meats (liver, kidney), red meat Fructose-Rich Drinks: Soft drinks, fruit juices (particularly high-fructose corn syrup) Alcohol (beer, spirits) Trauma to Joints, systemic illness, or fever Dehydration Medications: Low-dose aspirin, thiazide/loop diuretics, cyclosporine Clinical Features Acute Gout Typically monoarticular (often the first metatarsophalangeal joint—podagra) Sudden onset of intense pain, erythema, swelling, and warmth Pain peaks within 24 hours, may have fever or malaise Can mimic septic arthritis (always consider joint aspiration if doubt) Chronic Gout Recurrent or oligo-/polyarticular involvement Tophi: Urate crystal deposits (elbows, fingers, toes) → deformities Leads to chronic arthritis, possible joint destruction Associated with cardiovascular and renal co-morbidities Diagnosis Joint Aspiration (Gold Standard): Needle-shaped monosodium urate (MSU) crystals showing negative birefringence under polarised light Serum Uric Acid: May be normal during acute flares; more useful for chronic monitoring Imaging: X-ray may show erosions or ‘punched-out’ lesions, tophi, joint damage in chronic cases Acute Flare Management First-Line Prednisolone: 15–30 mg PO daily for 3–5 days or short taper Intra-articular Corticosteroids if 1–2 joints involved, under sterile technique Second-Line Colchicine: 1 mg stat, then 500 mcg 1 hour later (max 1.5 mg/day) Lower doses if renal impairment or drug interactions Non-Pharmacological Advice Hydration: 2–3 L fluid/day unless contraindicated Avoid high-purine foods, excessive alcohol, and sugary drinks Weight loss, regular exercise, smoking cessation For rapid relief in severe attacks, combination therapy with colchicine plus NSAIDs or low-dose prednisolone may be used carefully (avoid combining NSAIDs + steroids due to GI toxicity) Long-Term Treatment Urate-Lowering Therapy (ULT) Allopurinol: Start at 50 mg daily, titrate every 2–4 weeks up to 900 mg/day as needed Continue ULT during acute flares (do not stop abruptly) Target serum urate <0.36 mmol/L (or <0.30 mmol/L if tophi present) Febuxostat: Alternative if allopurinol-intolerant or in case of allopurinol hypersensitivity Prophylaxis (During ULT Initiation, Minimum 6 Months) Colchicine 500 mcg once daily NSAIDs (e.g. ibuprofen 200–400 mg TDS) if no contraindications Low-Dose Corticosteroids (5 mg prednisolone daily) in special scenarios under specialist advice Patient Counselling Long-Term ULT is needed to prevent further flares, joint damage, and reduce cardiovascular risks Lifestyle modifications: diet (low purine), weight control, hydration, avoid triggers (alcohol, sugar-sweetened beverages) Do not stop allopurinol (or febuxostat) during acute flares; use prophylaxis to minimise flare frequency Emphasise adherence to reduce flares and help resolve tophi over time Complications Chronic Gouty Arthritis → progressive joint deformity Tophaceous Gout: Large urate deposits in joints and subcutaneous tissues Renal: Urate nephropathy, kidney stones Cardiovascular Risk: Hyperuricaemia associated with hypertension, metabolic syndrome 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 Spondyloarthritides Types Ankylosing Spondylitis Reactive Arthritis: Often follows STIs (e.g., Chlamydia) or gastroenteritis Enteropathic Arthritis: Associated with IBD (e.g., Crohn’s, UC) Psoriatic Arthritis Pathophysiology Inflammatory arthropathy with common clinical/radiological features HLA-B27 positivity: Found in 90% of ankylosing spondylitis cases 5% of HLA-B27+ individuals develop the disease Testing only when clinically indicated Hallmarks: Inflammatory back pain, enthesitis (tendon/ligament insertion inflammation) Often affects lower limb, larger joints (e.g., knees, ankles) Presentation Inflammatory Back Pain: Insidious onset, worse in the morning, improves with activity Stiffness >30 minutes Peripheral Arthritis: Larger joints Enthesitis: Heel pain (Achilles tendon tenderness) Spinal Involvement: Sacroiliitis: Pain and tenderness in SI joints Extra-Articular Features Bloody diarrhoea, abdominal pain (enteropathic arthritis) Psoriatic rash, nail pitting, keratoderma blennorrhagica (reactive arthritis) Urethral discharge (reactive arthritis, post-STI) Uveitis (pain, redness, blurred vision) Enthesitis Spondylitis (inflammation of spine) characterised sacroilitis (inflammation SI joints) - lower back pain/stiffness, SI joint tenderness Investigations Blood Tests: RF/anti-CCP negative (distinguishes from RA) ESR/CRP elevated, anaemia of chronic disease Joint Aspirate: Inflammatory (elevated WCC, neutrophilic predominance) Imaging: X-rays: Sacroiliitis, bamboo spine (ankylosing spondylitis) MRI: Early sacroiliitis or spinal inflammation Management 1. Non-Pharmacological Exercise/Physiotherapy: Maintain mobility, stretching exercises Occupational Therapy: Adaptive techniques 2. Pharmacological NSAIDs: First-line in all spondyloarthritides Corticosteroids: Intra-articular: For local joint inflammation Oral: 10–50 mg prednisone daily for severe reactive arthritis, taper as symptoms improve DMARDs: For peripheral joint involvement in psoriatic/enteropathic arthritis (e.g., methotrexate, sulfasalazine) Biologics: TNF-alpha inhibitors for severe or refractory cases, especially ankylosing spondylitis Notes Symptoms appear 1–3 weeks post-infection (STI, enteric) May feature keratoderma blennorrhagica (pustular rash on palms/soles) Treat infection with antibiotics; arthritis course unaffected Spondyloarthritides Types Ankylosing Spondylitis (AS) Reactive Arthritis: Commonly follows STIs (Chlamydia) or gastroenteritis Enteropathic Arthritis: Associated with IBD (Crohn’s, UC) Psoriatic Arthritis Pathophysiology Group of inflammatory arthropathies sharing clinical/radiological features. HLA-B27 positivity (~90% in AS, but only 5% of HLA-B27 carriers develop disease). Hallmarks: Inflammatory back pain, enthesitis (inflammation at tendon/ligament insertions). Commonly affects lower limbs and larger peripheral joints (knees, ankles). Presentation Inflammatory Back Pain Insidious onset, morning stiffness >30 minutes, improves with activity. Common in SI joints (sacroiliitis). Peripheral Arthritis Larger joints (knees, ankles), often asymmetric involvement. Enthesitis E.g. Achilles tendon tenderness, plantar fascia insertion pain. Extra-Articular Features IBD (bloody diarrhoea, abdominal pain) with enteropathic arthritis. Psoriasis (psoriatic rash, nail pitting) in psoriatic arthritis. Urethritis and cervicitis with reactive arthritis (post-STI). Uveitis (eye pain, redness, blurred vision) can occur in all spondyloarthritides. Investigations Blood Tests RF/anti-CCP typically negative (distinguishes from rheumatoid arthritis). ESR/CRP elevated, possible anaemia of chronic disease. Joint Aspirate: Inflammatory pattern (raised WCC, mostly neutrophils). Imaging X-ray: Sacroiliitis, “bamboo spine” in ankylosing spondylitis. MRI: Early detection of sacroiliitis or spinal inflammation. Management 1. Non-Pharmacological Exercise/Physiotherapy: Maintain mobility, stretching, posture training (especially in AS). Occupational Therapy: Support with adaptive techniques. 2. Pharmacological NSAIDs First-line for pain and inflammation in all spondyloarthritides. Corticosteroids Intra-articular injections for local joint flares. Oral steroids (10–50 mg prednisone daily) for severe reactive arthritis or significant flares; taper as symptoms improve. DMARDs For peripheral joint involvement (psoriatic/enteropathic arthritis): Methotrexate, sulfasalazine. Less effect on spinal disease in ankylosing spondylitis. Biologics (e.g., TNF-alpha inhibitors) Indicated in severe or refractory cases, especially ankylosing spondylitis. Notes Reactive arthritis onset 1–3 weeks post-infection (STI, enteric). Keratoderma blennorrhagica: Pustular rash on palms/soles (seen in reactive/psoriatic). Treat underlying infection with antibiotics; arthritis course may be unaffected by antibiotic therapy once the infection is cleared. HLA-B27 testing useful if clinical suspicion of spondyloarthropathy is high. 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 Stye, Chalazion, Blepharitis Stye (Hordeolum) External: Infection of eyelash follicle or glands (Zeis/Moll) Internal: Meibomian gland infection Features: Red, tender, painful swelling near lid margin Treatment: Warm compress 2–4x daily (resolve in ~1 month) Avoid squeezing (prevents spread) Persistent/large → I&D (ophthalmology referral) Recurrent → assess for blepharitis/meibomian dysfunction Chalazion (Meibomian Cyst) Features: Firm, painless, slow-growing lump (blocked meibomian gland) Treatment: Warm compress 2–4x daily (1 month) Persistent → I&C or steroid injection (ophthalmology) Recurrent → assess for rosacea/blepharitis Blepharitis Types: Anterior: Affects eyelid margins/eyelashes (crusting/scales) Posterior: Affects meibomian glands (blocked glands, foamy tears) Associations: Staphylococcal infection, seborrhoea, rosacea, allergy Treatment: General: Warm compress 2–4x daily Eyelid hygiene (proprietary cleansers; avoid baby shampoo) Lubricating eye drops Anterior: Chloramphenicol 1% ointment OD (if bacterial) Posterior: Doxycycline 100 mg OD (4–8 weeks, reduce to 50 mg) Topical azithromycin if severe (doxycycline contraindicated) Firm eyelid massage (express blocked oils) NB: Address underlying rosacea/seborrhoea to prevent recurrence Complications: Keratitis, chalazion, dry eye syndrome Stye (Hordeolum), Chalazion (Meibomian Cyst), and Blepharitis Stye (Hordeolum) Definition External Hordeolum: Infection of eyelash follicle or glands of Zeis/Moll. Internal Hordeolum: Meibomian gland infection (deep). Features Red, tender, painful swelling near the eyelid margin. May show a small pustule or localized swelling. Management Warm Compresses 2–4× daily for ~10–15 minutes; usually resolves within ~1 month. Avoid Squeezing: Prevents spread of infection or scarring. Persistent or Large: Incision & drainage (ophthalmology referral). Recurrent: Assess for underlying blepharitis or meibomian gland dysfunction. Chalazion (Meibomian Cyst) Definition A firm, painless lump in the eyelid from a blocked Meibomian gland. Slower-growing than a stye; typically not tender. Features Firm, non-tender nodule in tarsal plate. May cause mild lid swelling or cosmetic concern. Management Warm Compresses 2–4× daily for ~1 month to aid drainage. Persistent Chalazion: Incision & curettage or steroid injection by ophthalmology. Recurrent: Evaluate for rosacea or chronic blepharitis. Blepharitis Definition Inflammation of the eyelid margins, affecting eyelashes (anterior) or meibomian glands (posterior). Types & Associations Anterior Blepharitis Involves eyelid margin/eyelashes (crusting/scales). Often staphylococcal or seborrhoeic. Posterior Blepharitis Meibomian gland dysfunction (blocked glands, foamy tears). Linked to rosacea or allergy. Management General Measures Warm Compresses 2–4× daily → helps express blocked glands. Eyelid Hygiene: Use proprietary lid cleansers (avoid baby shampoo if possible). Lubricating Eye Drops: Relieve dryness. Anterior Blepharitis (If bacterial) Chloramphenicol 1% ointment once daily at night. Posterior Blepharitis Doxycycline 100 mg daily for 4–8 weeks (reduce to 50 mg if improved). Topical azithromycin if severe (contraindication to doxy). Firm Eyelid Massage to express oils from meibomian glands. Address underlying rosacea or seborrhoea to reduce recurrence. Complications Keratitis, chalazion, or dry eye syndrome. 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