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 Stridor and Croup Differentials and Key Features Croup: Viral (parainfluenza), barking cough, inspiratory stridor, ages 6 months–3 years, autumn/winter Bacterial Tracheitis: Toxic, acute onset, high fever, no response to adrenaline Epiglottitis: Drooling, muffled voice, tripoding, no barking cough; consider Hib vaccination history Foreign Body: Sudden choking, unilateral decreased breath sounds Retropharyngeal Abscess: Drooling, muffled speech, stiff neck, "hot potato" voice General Management Initial: Urgent transfer to paediatric care Keep calm, sitting upright; avoid throat exam Administer oxygen (SpO₂ >94%), nil by mouth Monitor airway and vitals If Severe: Minimal handling, position of comfort Prepare for advanced airway intervention Croup Management Mild/Moderate: Prednisolone 1 mg/kg PO (max 50 mg) or dexamethasone 0.15 mg/kg PO (max 12 mg) If unable to tolerate PO: Budesonide 2 mg nebulised every 12 hrs (48 hrs) Hydration, reassess for progression Moderate/Severe: Nebulised adrenaline + corticosteroids Monitor for rebound stridor Notes Antibiotics: Not for viral croup Signs of Worsening: Sternal/intercostal recession, stridor at rest Epiglottitis/Bacterial Tracheitis: Urgent antibiotics ± intubation Stridor and Croup Stridor is a high-pitched inspiratory sound suggesting upper airway obstruction. In children, croup is the most common cause, but life-threatening differentials exist and must be considered. Differential Diagnoses & Key Features Croup (Laryngotracheobronchitis) Cause: Typically viral (parainfluenza), ages 6 months–3 years, autumn/winter peak. Symptoms: Barking “seal-like” cough, inspiratory stridor, hoarse voice. Signs: Worse at night, often mild fever, responds to adrenaline and corticosteroids. Bacterial Tracheitis Presentation: Toxic appearance, high fever, thick purulent secretions. May appear like croup but does not respond well to adrenaline. Suspect in acute onset with severe airway compromise. Epiglottitis Key: Drooling, muffled voice, “tripod” posture, no barking cough. Rapid progression, possible airway occlusion, consider Hib vaccination history. Foreign Body Aspiration History of sudden choking, partial airway obstruction. Possibly unilateral decreased breath sounds or localized wheeze. Retropharyngeal Abscess Drooling, muffled “hot potato” voice, neck stiffness. More common in older children, can see bulge in posterior pharynx on exam/imaging. General Management for Stridor Initial Urgent transfer to paediatric facility if moderate-severe or uncertain cause. Keep child calm, upright (minimizes airway narrowing). Avoid throat exam (risk of airway spasm in epiglottitis). Oxygen if SpO₂ <94%. NBM (nil by mouth) if severe, risk of aspiration. Continuous monitoring of airway and vitals. Severe Cases Minimal handling; child in position of comfort. Prepare for advanced airway intervention (possible intubation, surgical airway in epiglottitis or if obstructed). Croup Management Mild/Moderate Croup Corticosteroids: Prednisolone 1 mg/kg PO once daily (max 50 mg) for up to 3 days, or Dexamethasone 0.15 mg/kg PO (max 12 mg), single or repeated dose if needed. If unable to tolerate oral: Nebulised budesonide 2 mg every 12 hours (48 hours). Ensure adequate hydration, observe for progression. Moderate/Severe Croup Nebulised Adrenaline (e.g. 5 mL of 1:1000 adrenaline) + Corticosteroids. Monitor for rebound stridor (usually 2–3 hours after adrenaline effect wears off). Key Notes Antibiotics are not for viral croup. Sign of Worsening: Stridor at rest, marked sternal/intercostal retractions. Other Serious Causes Epiglottitis/Bacterial Tracheitis Urgent antibiotics, potential intubation if airway compromised. Typically require hospital admission and ENT/ICU support. Quick Tips Foreign Body suspicion: Sudden onset choking + localized findings → urgent imaging/bronchoscopy. Retropharyngeal Abscess: Neck stiffness, drooling, “hot potato” voice → urgent ENT referral. If croup-like but toxic or no response to standard croup therapy → suspect bacterial tracheitis. 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 Legionella Pneumonia Risk Factors Age >50 years Smoking (past or current) Chronic lung disease Immunosuppression (corticosteroids, transplant recipients) Chronic renal impairment Travel (hotels, cruise ships with large water systems) Clinical Features Fever (often high, may have rigors) Respiratory: Non-productive cough, dyspnoea Extrapulmonary: Gastrointestinal: Nausea, vomiting, diarrhoea, abdominal pain Neurological: Confusion, headache Classic lab findings: Hyponatraemia Elevated liver enzymes Red flag: Pneumonia + prominent GI or neurological symptoms + hyponatraemia → suspect Legionella Diagnosis Chest imaging: Patchy/interstitial infiltrates, may progress to consolidation Urinary antigen test: Rapid, highly specific for L. pneumophila serogroup 1 Sputum PCR & culture: Detects Legionella species (esp. L. longbeachae) Blood tests: Electrolytes: Hyponatraemia FBC/CRP: Inflammatory response LFTs: Mild-moderate transaminitis When to Suspect Legionella Atypical pneumonia (GI or neurological symptoms) Unexplained hyponatraemia Exposure history (contaminated water sources, potting mix) Severity Assessment Use a validated pneumonia severity score (e.g. CORB, SMART-COP, CURB-65) to guide: Outpatient vs. hospital admission IV vs. oral antibiotics Need for supportive therapy Treatment Beta-lactams alone (e.g. penicillins, cephalosporins) do NOT cover Legionella Low- to Moderate-Severity Legionella Pneumonia Oral antibiotics: Azithromycin 500 mg daily (3–7 days) Mild cases: 3 days if rapid improvement Moderate cases: Up to 7 days based on response Ciprofloxacin 750 mg BD (5–7 days) 5 days if rapid clinical response Doxycycline 100 mg BD (10–14 days) Less effective against L. longbeachae → prefer azithromycin or ciprofloxacin High-Severity Legionella Pneumonia IV therapy (initially): Azithromycin 500 mg IV daily OR Ciprofloxacin 400 mg IV q8h Switch to oral therapy once improving Total duration: 7–10 days Combination therapy (e.g. azithromycin + ciprofloxacin, or rifampicin + azithromycin/ciprofloxacin) may be used in ICU for critical cases—seek expert advice Legionella pneumonia Overview and aetiology Legionella pneumonia (Legionellosis) is most commonly caused by Legionella pneumophila serogroup 1, although other species—particularly Legionella longbeachae—are also important in Australia . Infection occurs via inhalation of aerosolised water (eg, from cooling towers, air-conditioners, showers) or dust/soil containing Legionella (especially L. longbeachae in potting mix). Person-to-person transmission is extremely rare. Risk factors Older age (>50 years) Smoking (active or past) Chronic lung disease Immunosuppression (eg, corticosteroid therapy, transplant recipients) Chronic renal impairment Travel (especially hotels or cruise ships with large water systems) Clinical features Fever, often high and sometimes with rigours Respiratory symptoms: cough (often initially non-productive), dyspnoea Extrapulmonary manifestations: GI: nausea, vomiting, diarrhoea, abdominal pain Neurological: confusion, headache Hyponatraemia is classically associated with Legionella pneumonia Elevated liver enzymes can also be seen In clinical practice, a constellation of pneumonia plus prominent gastrointestinal or neurological symptoms and laboratory findings (eg, hyponatraemia) should increase suspicion of Legionella infection. Diagnosis Investigations Chest imaging: Typically shows patchy or interstitial infiltrates, which may progress to consolidation. Urinary antigen test: Rapid and highly specific for Legionella pneumophila serogroup 1. PCR and culture: Sputum samples can be used for PCR and culture of Legionella species. Blood tests: Electrolytes (looking for hyponatraemia) Full blood count and inflammatory markers Liver function tests (may show mild-to-moderate transaminitis) When to suspect Legionella Suspect Legionella pneumonia in patients with ‘atypical’ features of pneumonia (especially GI or neurological manifestations), unexplained hyponatraemia, or exposure histories (eg, contaminated water sources, potting mix) Severity assessment Use a validated pneumonia severity tool (eg, CORB, SMART-COP, or CURB-65) to determine if outpatient management is appropriate or if hospital admission is warranted. This step is critical in deciding the route of antibiotic administration and the need for supportive therapy. Treatment Legionella pneumonia often requires antibiotics that provide atypical coverage (as Legionella is not covered by beta-lactam monotherapy alone). Low- to moderate-severity One of the following (oral or enteral) regimens is recommended: Azithromycin 500 mg once daily for 3 to 7 days If pneumonia is low severity and the patient improves clinically, 3 days may suffice. For moderate severity, up to 7 days based on clinical response. Ciprofloxacin 750 mg twice daily for 5 to 7 days Use 5 days if there is a rapid clinical response. Doxycycline 100 mg twice daily for 10 to 14 days Note: Legionella longbeachae appears more resistant to doxycycline in vitro, and clinical data on doxycycline outcomes are limited. Consider azithromycin or ciprofloxacin for L. longbeachae. High-severity Requires intravenous therapy initially: Azithromycin 500 mg IV once daily, or Ciprofloxacin 400 mg IV every 8 hours Intravenous to oral switch is done once the patient demonstrates clinical improvement, with a total duration of 7 to 10 days usually recommended. Combination therapy (eg, azithromycin plus ciprofloxacin, or rifampicin plus either azithromycin or ciprofloxacin) is sometimes used in intensive care settings for critical cases, though evidence is limited and toxicity risk is higher. Seek expert advice if considering combination therapy. Additional management considerations Supportive care: Ensure adequate hydration, oxygen therapy, analgesia, and monitoring in moderate to severe cases. Monitoring: Regular review of clinical status, vital signs, and laboratory markers (including electrolytes) during therapy. Notification: Legionella pneumonia is a notifiable disease in Australia. Notify your state or territory public health authority promptly 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 Pertussis Key Stages Incubation: 1–3 weeks Infectious: Until 5 days post-antibiotics or 3 weeks untreated Avoid vulnerable contacts (e.g., daycare, unimmunised) Clinical: Catarrhal: Mild URTI (1–2 weeks) Paroxysmal: Coughing, whoop, vomiting (2–6 weeks) Convalescent: Gradual resolution (weeks–months) Close Contacts Criteria: <1 metre for >1 hr during infectious period Household or childcare exposure Management: Isolate unimmunised (household/childcare <7 yrs) Vaccinate if overdue dTpa booster if >10 yrs since last Treatment First-line: Azithromycin Adults: 500 mg day 1, 250 mg days 2–5 Children: 10 mg/kg day 1, 5 mg/kg days 2–5 (max doses) Alternatives: Clarithromycin, trimethoprim-sulfamethoxazole Timing: Treat if <3 weeks symptoms (reduces transmission) Prophylaxis Indications: Close contacts within 14 days of exposure Regime: Same as treatment Priority: Infants <6 months (includes household) Pregnant women (last month) Partially immunised children Notes Pregnancy: dTpa at 27–36 weeks every pregnancy Vaccine: DTPa (<10 yrs), dTpa (>10 yrs) Immunity wanes in 4–12 yrs → boosters needed Pertussis Definition Acute, highly contagious respiratory infection caused by Bordetella pertussis Characterised by a prolonged cough that may include paroxysms, inspiratory whoop and post-tussive vomiting Particularly severe in infants, with higher risk of complications such as apnoea, pneumonia, encephalopathy and death Key Stages Incubation: Typically 10–14 days, although clinical symptoms may not appear until 1–3 weeks after exposure Catarrhal Stage: Mild upper respiratory tract infection with fever, malaise, dry cough and runny nose lasting 1–2 weeks Paroxysmal Stage: Marked by severe, repetitive cough paroxysms, often with an inspiratory whoop and post-tussive vomiting, lasting 2–6 weeks Convalescent Stage: Gradual resolution of symptoms that may persist for weeks to months Close Contacts Defined as individuals within 1 metre for more than 1 hour during the infectious period Household members and those in childcare settings are at high risk Special attention to vulnerable groups such as infants under 6 months and pregnant women Management Isolation: Advise immediate isolation of suspected cases in a single room with appropriate PPE for staff (surgical mask plus N95 where indicated) Supportive Care: Ensure adequate hydration and symptomatic treatment with antipyretics such as paracetamol Hospitalisation may be necessary for infants less than 6 months or patients with severe symptoms such as apnoea or pneumonia Treatment First-line Antibiotic Therapy: Azithromycin is preferred Adults: 500 mg orally on day 1 followed by 250 mg daily for days 2–5 Children 6 months or older: 10 mg/kg (maximum 500 mg) on day 1, then 5 mg/kg (maximum 250 mg) daily for days 2–5 Alternatives include clarithromycin or trimethoprim-sulfamethoxazole for patients with contraindications Timing: Antibiotics are most effective in reducing transmission if given within 3 weeks of symptom onset, although they do not significantly alter the course of illness Prophylaxis Indicated for all close contacts within 14 days of exposure regardless of immunisation status Use the same antibiotic regimen as treatment Emphasise vaccination for contacts, particularly for infants under 6 months, pregnant women in their final month, and partially immunised children For individuals aged over 10 years, administer a dTpa booster if more than 10 years have elapsed since the last vaccination Investigations Diagnosis is primarily clinical but may be confirmed by: Nasopharyngeal swab for PCR testing, most sensitive within 3 weeks of symptom onset using dacron or rayon-tipped swabs Serology (IgM and IgG) if PCR is unavailable, noting that raised IgA indicates recent infection Routine laboratory tests are not required in uncomplicated cases Prevention and Public Health Measures Pertussis is a notifiable disease; promptly report cases to public health authorities Advise exclusion from daycare or school until at least 5 days of antibiotic therapy are completed Vaccination is critical: the primary course is given at 2, 4 and 6 months, with a booster (dTpa) recommended at 15–17 years Special consideration for individuals born between 1966 and 1994, as they may have received only one dose of measles-containing vaccine and are at higher risk Maternal immunisation programmes are under investigation to provide early protection to newborns Notes In older children and adults, pertussis may present as a persistent cough without the classic whoop Antibiotic treatment, while not altering the course of the illness, is essential to reduce infectivity and transmission Public health management includes contact tracing, isolation of exposed individuals and vaccination catch-up programmes Emphasise caregiver education regarding the signs of pertussis and the importance of timely medical review, particularly in outbreak settings Booster doses are necessary as immunity wanes within 4–12 years after the primary series In outbreak scenarios, update immunisation status and consider additional vaccination for high-risk groups to protect those too young to be immunised 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 Pericarditis ECG Findings Classic features: PR depression + concave widespread STE PR elevation and STD in aVR Causes Idiopathic (commonest cause) Viral infections: Influenza, Coxsackie B Autoimmune: SLE, RA, scleroderma Renal failure (uraemia) Dressler’s syndrome (post-MI/surgical) Malignancy: Direct invasion or metastasis affecting the pericardium TB: Especially in immunosuppressed individuals Treatment Hospitalisation criteria: T >38°C, subacute course, no improvement with colchicine/aspirin, pericardial effusion, or cardiac tamponade Outpatient management (for stable cases): Restriction of exercise until symptom-free Colchicine 500mcg BD (>70kg) or OD (<70kg) for 3/12 PLUS: Ibuprofen 600mg TDS for 1–2/52, then taper OR Aspirin 750–1000mg TDS for 1–2/52, then taper Diagnosis Clinical diagnosis (requires 2 of the 4 criteria): Chest pain: Sharp, pleuritic, improves when sitting forward Pericardial friction rub: Heard on auscultation ECG changes: PR depression, widespread concave STE Pericardial effusion: Confirmed on echocardiography Supporting tests: Raised inflammatory markers: CRP, ESR Troponin: Mildly elevated if myopericarditis Imaging: Echocardiography is essential for identifying effusion and ruling out tamponade Pericarditis ECG Findings Classic changes Diffuse concave ST elevation in multiple leads PR depression in most leads PR elevation and ST depression in aVR Differentiation from STEMI Pericarditis tends to cause widespread ST changes not confined to a single coronary territory ST morphology is typically concave (smiling), rather than convex Causes Idiopathic (most common) Viral infections (Coxsackie B, influenza) Autoimmune conditions (SLE, RA, scleroderma) Renal failure (uraemia) Post-cardiac injury syndromes (Dressler’s, post-surgical) Malignancy (direct invasion or metastatic to pericardium) TB (more common in immunosuppressed or endemic regions) Diagnosis Clinical diagnosis requires ≥2 of the following 4 criteria Characteristic chest pain: Sharp, pleuritic, improves on sitting forward Pericardial friction rub on auscultation ECG changes (diffuse concave ST elevation ± PR depression) Pericardial effusion on echocardiography Supporting tests Raised inflammatory markers (CRP, ESR) Mild troponin elevation in myopericarditis Echocardiography to detect effusion, check for tamponade physiology (right ventricular or atrial collapse), and assess any underlying structural heart disease Treatment Hospitalisation Criteria Temperature >38°C Subacute or protracted course No improvement with standard therapy (colchicine/NSAIDs) Presence of pericardial effusion or any suggestion of tamponade (hypotension, elevated JVP, pulsus paradoxus) Suspected bacterial or malignant pericarditis Outpatient Management for Stable Cases Restrict strenuous activity until symptom-free to prevent recurrence Colchicine 500 micrograms BD if >70 kg 500 micrograms OD if <70 kg Continue for 3 months to reduce recurrence NSAIDs (e.g. Ibuprofen 600 mg TDS for 1–2 weeks, then taper) Alternatively, aspirin 750–1000 mg TDS for 1–2 weeks if post-MI or other NSAIDs contraindicated Taper gradually to avoid rebound inflammation Adjunctive Therapy Consider acid suppression (PPI) with NSAIDs Corticosteroids reserved for refractory cases or specific aetiologies (autoimmune) as they can increase relapse risk if stopped abruptly Notes: Dressler’s syndrome (post-MI pericarditis) is usually managed with high-dose aspirin rather than other NSAIDs Large effusions can cause electrical alternans on ECG and raise concern for tamponade TB pericarditis may require prolonged anti-TB therapy and close monitoring for constriction Monitor for signs of constrictive pericarditis in chronic or recurrent cases (raised JVP, Kussmaul’s sign, diastolic knock on auscultation) Follow-up is essential to ensure resolution of inflammation, especially if high-risk features or recurrent episodes are present Treatment of pericarditis 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 Penile Abnormalities – Peyronie's Disease and Balanitis Peyronie's Disease Symptoms Curved, painful erections Palpable fibrous plaques along the penile shaft Associated with erectile dysfunction and cardiovascular risk factors Cause Abnormal wound healing post-penile trauma leading to fibrotic plaque formation Management Conservative: Sildenafil for erectile dysfunction Intralesional Therapy: Collagenase for plaque reduction Surgical: Considered for severe or refractory cases Balanitis Symptoms Redness, swelling, pain, dysuria Circumcision Status Circumcised: Often due to dermatoses (e.g., psoriasis, lichen sclerosus) Uncircumcised: More commonly linked to poor hygiene, candidal infection, or irritant dermatitis Management Uncircumcised Men First-line: Hydrocortisone + clotrimazole BD for 2 weeks Second-line: Oral fluconazole 150 mg stat for recurrent or persistent cases Additional measures: Screen for diabetes, improve genital hygiene Uncircumcised Boys Soap-free washes, saltwater soaks, barrier creams Antibiotics if streptococcal infection suspected Hydrocortisone for inflammation Circumcision Indications Pathological phimosis (e.g., balanitis xerotica obliterans) Recurrent UTIs or infectious balanitis after resolution of acute inflammation Notes Similar to nappy rash; consider irritant dermatitis as a differential Infants: Frequent nappy changes to prevent irritation Adults: Loose cotton underwear to reduce moisture and friction Severe inflammation: Methylprednisolone may be used, escalating to antifungals or antibiotics for secondary infections Penile abnormalities Peyronie's Disease Definition: A wound healing disorder in which subclinical penile trauma leads to fibrotic plaque formation within the tunica albuginea, resulting in penile curvature, pain and often associated erectile dysfunction Aetiology: Abnormal healing process following minor, often unnoticed trauma; associated with cardiovascular risk factors, smoking, diabetes, obesity, and Dupuytren’s contracture Clinical Presentation: Penile curvature that may progress over 6–12 months with a palpable, fibrous plaque (commonly dorsal) Penile shortening and narrowing with a hinge effect during erections Variable penile pain, particularly during the active inflammatory phase, which typically resolves within 12 months as curvature stabilises Co-existing erectile dysfunction is common, with up to 30% of patients also having diabetes Diagnosis: Primarily clinical based on history and physical examination in the flaccid state; degree of curvature is better assessed during an erection (patient may overestimate curvature when flaccid) Penile duplex ultrasound may be utilised by specialists to assess plaque characteristics, including calcification and vascular flow Management: Conservative measures include observation in cases of minimal curvature with preserved sexual function Oral therapy (e.g. PDE5 inhibitors) may be considered for co-existent erectile dysfunction and potential antiscarring effects, though evidence is limited Intralesional therapy with collagenase injections has shown modest improvement in curvature (approx. 37% reduction) and is recommended for patients with a curvature less than 60° and non-calcified plaques; requires specialist administration and multiple treatment cycles with penile modelling exercises Surgical intervention (tunica albuginea plication, plaque incision with grafting, or penile prosthesis implantation) remains the gold standard for patients with stable, chronic disease who have significant sexual dysfunction or psychological distress; surgery is typically considered after a minimum of 3 months of stable, pain-free disease Additional Considerations: Patients should be counselled that no treatment fully restores the penis to its pre-disease state and realistic expectations must be set Emotional and psychological support is important due to the significant impact on quality of life and self-esteem Balanitis Definition: Inflammation of the glans penis that may involve the foreskin, commonly seen in uncircumcised males and often due to irritant contact, poor hygiene or candida infection Clinical Presentation in Uncircumcised Men: Redness, swelling, pain and dysuria, often related to poor hygiene, urine trapping or irritant dermatitis May also present as a candidal infection with satellite pustules, particularly if associated with nappy rash in infants Clinical Presentation in Circumcised Men: More frequently due to dermatoses such as psoriasis, lichen sclerosus, or contact dermatitis Management for Uncircumcised Men: First-line treatment with topical hydrocortisone 1% combined with clotrimazole applied twice daily for 2 weeks For recurrent or persistent cases, consider a single dose of oral fluconazole 150 mg; emphasise improved hygiene and use of soap-free cleansers Management for Uncircumcised Boys: Recommend soap-free washing, lukewarm saltwater soaks and barrier creams to protect the skin Use topical hydrocortisone for inflammation and consider antibiotics if streptococcal infection is suspected Additional Considerations: Educate caregivers on proper care of the uncircumcised penis including avoiding forcible retraction during cleaning to prevent paraphimosis In cases with extensive inflammation or secondary infection, a multidisciplinary approach may be required to address both skin care and underlying medical issues Circumcision Indications Indicated in cases of pathological phimosis where scarring (e.g. balanitis xerotica obliterans) prevents retraction and causes urinary difficulties Considered for recurrent urinary tract infections or persistent infectious balanitis following resolution of acute inflammation Should be performed in a safe, child-friendly environment by trained personnel with appropriate postoperative care and analgesia Additional Notes Emphasise that a non-retractable foreskin in infants is a normal variant and should not be forcibly retracted as this increases the risk of paraphimosis Smegma accumulation is normal before the foreskin becomes fully retractable; routine gentle cleaning is sufficient Ballooning during urination may occur in non-retractable foreskins; treat with topical steroid cream (0.05% betamethasone applied sparingly to the preputial ring) if symptomatic Zipper injuries and hair tourniquets are recognised causes of acute penile injury requiring prompt, often simple, intervention Reassure patients that most penile abnormalities are managed conservatively with surgical options reserved for refractory or severe cases A multidisciplinary approach including referrals to urology or dermatology may be necessary in complex or recurrent cases Postoperative care following circumcision includes managing crusting and inflammation of the glans with liberal application of barrier creams such as Vaseline and monitoring for significant bleeding or infection In cases of priapism in older children, initiate conservative measures (e.g. cold packs, urination, cold bath) promptly and arrange urgent urology referral if not resolved within 2 hours, with special consideration in those with sickle cell disease 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 Troponin Testing Causes of Elevated Troponins Cardiac Causes: ACS Myocarditis Pericarditis Heart failure Arrhythmias Cardiac surgery or trauma Non-Cardiac Causes: Pulmonary embolism Sepsis Renal failure Burns Extreme physical exertion Critical illnesses (e.g., severe anaemia, hypotension) When to Order Troponins in General Practice Appropriate if >24 hours post-symptom onset and low-risk, without: Heart failure Abnormal ECG findings Syncope Immediate ED referral is recommended for high-risk presentations to avoid delayed treatment Troponin Kinetics Rise: 3–4 hours after myocardial injury Peak: 1–2 days Duration: Remains elevated for up to 2 weeks (2/52) Notes: Dynamic Troponin Changes: A rise and/or fall in serial troponin measurements confirms myocardial injury and improves diagnostic accuracy Non-Ischaemic Causes: Non-cardiac causes typically result in stable troponin elevations rather than dynamic changes seen in MI High-Sensitivity Troponins (Hs-Tn): Useful for early detection but can also identify non-significant elevations, necessitating clinical correlation with symptoms and ECG findings Troponin Testing Causes of Elevated Troponins Cardiac Causes ACS (including unstable angina that may not always show elevation, but NSTEMI does) Myocarditis or pericarditis Heart failure and cardiomyopathies Significant arrhythmias (sustained tachyarrhythmias) Cardiac procedures or trauma (including electrical cardioversion or ablation) Non-Cardiac Causes Pulmonary embolism (right ventricular strain) Sepsis, especially if hypotension or septic shock Renal failure with reduced clearance Severe burns, especially >30% total body surface area Extreme physical exertion (intense endurance events) Critical illnesses (severe anaemia, prolonged hypotension) When to Order Troponins in General Practice Reasonable if >24 hours since symptom onset and the patient is low-risk (chest pain fully resolved, normal observations, no new ECG changes) Avoid if patient has any high-risk features: Heart failure signs or syncope Abnormal ECG (ST/T changes, new bundle branch block) Chest pain suggestive of ongoing or unstable ACS High-risk patients should be referred promptly to the ED for urgent assessment and serial troponin testing rather than a single outpatient measurement Troponin Kinetics Rise: Begins 3–4 hours after myocardial injury Peak: Usually at 24–48 hours Duration: Can remain elevated up to 2 weeks High-Sensitivity Troponin (Hs-Tn) allows earlier detection of myocardial injury, but can be elevated in stable conditions (CKD, chronic cardiac disease), emphasising the need for clinical correlation Notes: Dynamic Changes Serial troponin measurements (e.g., baseline and repeat 3 hours later) confirm a rising or falling pattern consistent with acute myocardial injury A single borderline value may be inconclusive without a second measurement Non-Ischaemic Causes Often produce a persistent but relatively stable troponin elevation rather than the dynamic pattern seen in type 1 MI Interpretation Elevated troponin alone does not confirm ACS, but in the right clinical context (symptoms, ECG findings), it strongly suggests myocardial infarction Unstable angina can occur with normal troponins, so persistent suspicion warrants referral or further investigation Practical Points for GPs Be aware of conditions such as renal insufficiency or heart failure that can cause chronic mild troponin elevation If in doubt, discuss with cardiology or emergency services to avoid delayed treatment Advise patients to seek urgent review if symptoms recur, given potential for progression to complete occlusion or infarction 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 Kidney Cysts Suspicious Features Multiple cysts (especially bilateral) Symptomatic cysts (e.g., haematuria, infection, pain) Complex cysts or solid components (suggestive of malignancy) History of renal malignancy When to Suspect Polycystic Kidney Disease (PCKD) Suspect PCKD if 2+ cysts, differs pending on age Medication to Prevent Progression Tolvaptan (vasopressin receptor antagonist) Slows disease progression in rapidly progressing PCKD Available on PBS for selected patients Requires monitoring for hepatotoxicity (LFTs) Notes: Simple cysts are common and benign, requiring follow-up only if symptomatic or complex PCKD screening recommended for first-degree relatives of affected individuals BP control (ACE inhibitors/ARBs) is essential to slow progression in PCKD Annual renal ultrasound for monitoring in at-risk individuals Kidney Cysts Suspicious Features Multiple cysts (especially bilateral) Symptomatic cysts causing haematuria, infection, or flank pain Complex cysts or cysts with solid components (risk of malignancy) History of renal malignancy in the patient or close relatives When to Suspect Polycystic Kidney Disease (PCKD) Typically consider PCKD if the imaging shows 2 or more cysts per kidney, depending on the patient’s age. Family history of PCKD raises suspicion. Other clues: Hypertension at a young age, enlarged kidneys on palpation, or extrarenal manifestations (e.g. liver cysts, intracranial aneurysms). Medication to Prevent Progression Tolvaptan (a vasopressin V2 receptor antagonist): Shown to slow disease progression in rapidly progressing autosomal dominant PCKD. Listed on the PBS in Australia for selected patients (restricted criteria). Requires monitoring for hepatotoxicity (regular LFT checks). Notes Simple cysts: Very common, especially in older adults. Generally benign and require follow-up imaging only if they are symptomatic or display complex features (Bosniak classification on CT/MRI). PCKD Screening: Recommended for first-degree relatives (children, siblings) of individuals with PCKD. Typically starts with renal ultrasound, sometimes from late childhood/early adulthood. Blood Pressure Control: Essential in PCKD to slow progression of renal disease. ACE inhibitors or ARBs often first-line for BP management. Annual Renal Ultrasound: May be indicated in at-risk individuals to monitor cyst growth, detect complications (infection, haemorrhage), or screen for malignant transformation in complex cysts. 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 Pertussis Testing PCR: Best ≤3 weeks from cough onset; sensitivity ↓ after antibiotics or >3 weeks Serology: Optimal after 2 weeks, up to 12 weeks (ideal <8 weeks) Timing & Treatment Effective Treatment: ≤3 weeks of cough onset; reduces transmission but not disease if delayed Cough Duration: Up to 3 months, with prolonged convalescence Antibiotics First-Line: Azithromycin: 500 mg OD (Day 1), 250 mg OD (Days 2–5) Clarithromycin: 500 mg BD for 7 days Alternative: TMP-SMX: Adults: 160+800 mg BD; Kids >1 month: 4+20 mg/kg BD (max 160+800 mg) for 7 days Neonates: Azithromycin 10 mg/kg OD for 5 days Notes: Avoid roxithromycin; erythromycin poorly tolerated Diagnosis Cause: Bordetella pertussis Symptoms: Cough >2 weeks + paroxysms, whoop, or post-tussive vomiting Adults/Kids: Persistent, non-specific cough possible Notification: Mandatory to public health authorities Prevention Prophylaxis: Who: Infants <6 months, pregnant women, high-risk contacts Antibiotics: Same as treatment, start ≤14 days post-exposure Vaccination: Maternal: 20–32 weeks gestation dTpa boosters for adolescents/adults in close contact with infants Public Health: Isolate ≥5 days after starting antibiotics Untreated: Infectious for 21 days post-cough onset Notes Reinforce hand hygiene, cough etiquette Consider pertussis in prolonged cough, especially if vaccination incomplete Pertussis (Whooping Cough) Diagnosis Causative Organism: Bordetella pertussis Symptoms: Cough >2 weeks with paroxysms, characteristic “whoop,” or post-tussive vomiting. In Adults/Kids: May present as a persistent, non-specific cough. Notification: Pertussis is a notifiable disease in Australia; report to public health authorities. Testing PCR Best if done ≤3 weeks from cough onset. Sensitivity falls after starting antibiotics or >3 weeks of cough. Serology Ideal >2 weeks and <8–12 weeks from cough onset. May help confirm infection in subacute/chronic presentation. Timing & Treatment Effective Antibiotics: Start within 3 weeks of cough onset to reduce transmission, though may not alter the individual’s disease course if delayed. Cough Duration: Can last up to 3 months, often called the “100-day cough.” Prolonged convalescence is common. Antibiotics First-Line Azithromycin Adult: 500 mg orally Day 1, then 250 mg daily on Days 2–5 Neonates (<1 month): 10 mg/kg daily for 5 days Clarithromycin Adult: 500 mg BD for 7 days Alternative Trimethoprim-Sulfamethoxazole (TMP-SMX) Adult: 160+800 mg BD for 7 days Children >1 month: 4+20 mg/kg BD (max 160+800 mg) for 7 days Notes Avoid roxithromycin (less effective) Erythromycin is effective but often poorly tolerated (GI side effects) Prevention Prophylaxis Who needs prophylaxis? Infants <6 months, pregnant women, or high-risk close contacts Same antibiotic regimens as for treatment, ideally started ≤14 days post-exposure Vaccination Maternal: Single-dose dTpa recommended at 20–32 weeks gestation Boosters: Adolescents/adults who will have close contact with young infants Public Health Measures Isolation: At least 5 days after starting effective antibiotics Untreated persons remain infectious for 21 days post-cough onset Notes Emphasise hand hygiene and cough etiquette in preventing transmission Suspect pertussis in prolonged cough especially if vaccination status incomplete or uncertain 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 Hyperparathyroidism Causes of Primary, Secondary, and Tertiary Hyperparathyroidism Primary Parathyroid adenoma (85%) Parathyroid hyperplasia (15%) Parathyroid carcinoma (5%) Secondary Vitamin D deficiency CKD (2ry cause parathyroid hyperplasia) Tertiary Prolonged 2ry hyperparathyroidism (e.g., CKD, kidney transplantation) Autonomous parathyroid response leading to hypercalcaemia Blood Test Interpretation Primary: Raised PTH, raised calcium, low phosphate Secondary: Raised PTH, low/normal calcium, high/normal phosphate Tertiary: Raised PTH, raised calcium, raised phosphate Management Primary Hyperparathyroidism Definitive: Parathyroidectomy (95% cure rate) Conservative: Consider in asymptomatic patients ≥50 years, with: Serum calcium <2.90 mmol/L Normal kidney function, no nephrolithiasis/nephrocalcinosis BMD T-score > -2.5 Monitor calcium, renal function (6-12 monthly), and BMD (every 2 years) Lifestyle advice: Avoid high calcium intake (diet or supplements) Maintain hydration (2.5 L/day) Limit vitamin D supplementation to 25 mcg (1000 IU) daily Secondary Hyperparathyroidism Treat underlying cause (e.g., vitamin D deficiency, CKD) Vitamin D supplementation for deficiency Tertiary Hyperparathyroidism Partial parathyroidectomy if indicated Specialist use of calcimimetic drugs (e.g., cinacalcet) Note: Avoid excessive calcium intake or overcorrection of vitamin D to reduce kidney stone risk. Complication Post-Surgery: Hungry bone syndrome: Severe hypocalcaemia requiring specialist care; consider preoperative calcitriol in high-risk cases. Hyperparathyroidism Types and Causes Primary Hyperparathyroidism (PHPT): Caused by parathyroid adenoma (85%), parathyroid hyperplasia (15%), or parathyroid cancer (5%). Leads to elevated parathyroid hormone (PTH) levels, usually with elevated calcium levels and low/normal phosphorus. Clinical presentation often asymptomatic, but hypercalcaemia may be detected incidentally. Common Signs and Symptoms: Bone pain, kidney stones, gastrointestinal symptoms (nausea, constipation), and neuropsychiatric manifestations. Secondary Hyperparathyroidism (SHPT): Occurs as a response to hypocalcemia typically from chronic kidney disease (CKD) or vitamin D deficiency. Increased PTH secretion due to low calcium but typically with normal or low calcium levels. Tertiary Hyperparathyroidism: Occurs as a progression of secondary hyperparathyroidism, usually in long-standing CKD. Autonomously functioning parathyroid glands after prolonged secondary hyperparathyroidism, leading to high PTH and calcium levels. Blood Test Interpretation Primary Hyperparathyroidism: Raised PTH, raised calcium, low phosphorus. Secondary Hyperparathyroidism: Raised PTH, normal/low calcium, high/normal phosphorus. Tertiary Hyperparathyroidism: Very high PTH, high calcium, raised phosphorus. Pathophysiology PTH acts on kidneys, bones, and intestines to increase serum calcium levels: Kidneys: Increased calcium reabsorption and decreased phosphorus reabsorption. Bones: Increased bone resorption, releasing calcium and phosphorus. Intestines: Enhanced absorption of calcium via active vitamin D. Clinical Features Skeletal: Bone disease (osteopenia, osteoporosis, osteitis fibrosa cystica). Increased risk of fractures. Salt and pepper skull appearance on imaging. Renal: Nephrolithiasis (kidney stones). Nephrocalcinosis. Polyuria and polydipsia. Reduced renal concentrating ability. Gastrointestinal: Anorexia, nausea, vomiting, constipation. Peptic ulcer disease and pancreatitis. Neurological: Fatigue, depression, confusion. "Stones, bones, abdominal groans, and psychic moans" mnemonic for hypercalcaemia symptoms. Cardiovascular: Hypertension, bradycardia. Shortened QT interval. Investigations Calcium and Phosphorus: Elevated serum calcium, low serum phosphorus (PHPT). PTH Level: Elevated in PHPT and SHPT. 24-hour urinary calcium excretion: Helps differentiate PHPT from familial hypocalciuric hypercalcaemia (FHH). Vitamin D levels: Important in assessing SHPT. Bone Density Scan: To assess for osteoporosis. Imaging: Sestamibi scan or ultrasound for parathyroid adenoma. CT scan for detailed imaging, especially preoperatively. Management Primary Hyperparathyroidism: Parathyroidectomy is the definitive treatment for symptomatic cases or in patients with complications (e.g., nephrolithiasis, osteoporosis). For patients who are not surgical candidates: Maintain hydration (2.5L/day). Avoid calcium and vitamin D supplements. Use of bisphosphonates to prevent bone resorption. Cinacalcet (calcimimetic) to reduce serum calcium levels. Secondary Hyperparathyroidism: Treat underlying cause (e.g., vitamin D deficiency). Vitamin D analogues (e.g., calcitriol) and phosphate binders in CKD. Cinacalcet may also be used to control PTH levels. Tertiary Hyperparathyroidism: Parathyroidectomy in severe cases. Phosphate binders and vitamin D analogues to manage calcium and phosphate levels. Notes: Familial Hypocalciuric Hypercalcaemia (FHH): Genetic condition that can mimic PHPT with elevated serum calcium but with low urinary calcium excretion. Does not require surgery; usually benign and managed conservatively. Monitoring: Regular follow-ups with serum calcium, phosphorus, and PTH levels. Bone density assessment, particularly in postmenopausal women and elderly patients 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 Marfan Syndrome Inheritance Autosomal dominant Common Complications Heart Aortic root dilatation (aortic regurgitation) Thoracic aortic aneurysm/dissection Mitral valve prolapse (common valvular involvement in Marfan's) Eyes Lens subluxation (ectopia lentis) Iridodonesis (vibration of iris with eye movement) Increased risk of retinal detachment Lungs Spontaneous pneumothorax (due to lung bullae) MSK Joint hypermobility Scoliosis and kyphosis Symptoms & Signs Tall stature with long limbs and fingers (arachnodactyly) Hypermobile joints Chest deformities: pectus excavatum or carinatum High-arched palate Visual disturbances: myopia, lens dislocation SOB or chest pain (may indicate pneumothorax or aortic involvement) Cardiovascular Monitoring Echocardiography: Perform every 6–12 months to monitor aortic root size and progression of dilatation Refer for cardiology review if aortic diameter >4.5 cm, or earlier if rapid growth observed BP Target: Maintain <130/80 mmHg to reduce aortic stress Activity Restrictions Avoid high-intensity sports (e.g., weightlifting, contact sports) Promote low-intensity, non-straining activities (e.g., walking, swimming) Avoid activities that cause abrupt BP elevation (e.g., sudden exertion) Regular cardiology follow-up is critical to assess risk and progression Marfan Syndrome Inheritance Autosomal dominant Common Complications Heart Aortic root dilatation (aortic regurgitation) Thoracic aortic aneurysm/dissection Mitral valve prolapse (most common valvular involvement in Marfan’s) Eyes Lens subluxation (ectopia lentis) Iridodonesis (vibration of iris with eye movement) Increased risk of retinal detachment Lungs Spontaneous pneumothorax (due to lung bullae) Musculoskeletal Joint hypermobility Scoliosis and kyphosis Symptoms & Signs Tall stature with long limbs and fingers (arachnodactyly) Hypermobile joints Chest deformities: pectus excavatum or carinatum High-arched palate Visual disturbances: myopia, lens dislocation SOB or chest pain (may indicate pneumothorax or aortic involvement) Cardiovascular Monitoring Echocardiography Perform every 6–12 months to monitor aortic root size and progression of dilatation Refer for cardiology review if aortic diameter >4.5 cm, or earlier if rapid growth observed BP Target Maintain <130/80 mmHg to reduce aortic stress Medication Beta-blockers (e.g. atenolol) or ARBs (e.g. losartan) to help slow the rate of aortic root dilatation Typically introduced if there is evidence of root enlargement (>4.0 cm) or rapid progression Activity Restrictions Avoid high-intensity sports (e.g. weightlifting, contact sports) Promote low-intensity, non-straining activities (e.g. walking, swimming) Avoid activities that cause abrupt BP elevation (e.g. sudden exertion) Regular cardiology follow-up is critical to assess risk and progression Notes: Family Screening First-degree relatives should have clinical evaluation and echocardiography, as Marfan syndrome is autosomal dominant and may be under-recognised in mild cases Genetic Testing Consider if clinical features are borderline or to confirm diagnosis (FBN1 gene mutation), especially in unexplained aortic aneurysm/dilatation Pregnancy Considerations Increased risk of aortic complications during pregnancy Preconception counselling and close monitoring essential if aortic root is dilated or rapidly expanding Multidisciplinary Care Co-ordination with cardiology, ophthalmology, and genetic services is recommended for best outcomes GP oversight is vital for ongoing monitoring, lifestyle advice, and family education 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 Pneumonia Aetiology & Risk Factors Common bacterial causes: Streptococcus pneumoniae (most common in CAP, severe cases) Haemophilus influenzae (esp. in COPD) Staphylococcus aureus (post-influenza, cavitating pneumonia, incl. MRSA) Gram-negatives (Klebsiella, Pseudomonas) (esp. bronchiectasis, CKD, severe CAP) Atypical organisms: Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella spp. Viruses: Influenza, RSV, SARS-CoV-2 → primary infection or secondary bacterial pneumonia Tropical regions (Northern Australia): Burkholderia pseudomallei (melioidosis), Acinetobacter baumannii (esp. diabetes, alcohol use, CKD) Clinical Presentation Typical: Cough (± sputum), dyspnoea, fever, chills, pleuritic chest pain Atypical: Confusion (esp. elderly), GI symptoms (diarrhoea) Examination: Crackles, dullness to percussion (consolidation), ↓breath sounds Severity Assessment (Admission Criteria) ETG Criteria for Hospital Admission (More Conservative Than CURB-65): Acute confusion Multilobar involvement on CXR Deranged vitals: RR >22 HR >100 SBP <90 mmHg O₂ Sat <92% RA (or < baseline in chronic lung disease) Lactate >2 mmol/L High-Severity CAP (Consider ICU Admission): RR ≥30, O₂ Sat <90% RA, rapid radiological progression Sepsis (hypotension, lactate >4 mmol/L, shock) Acute kidney injury, altered mental state Investigations CXR: Confirms infiltrate, assesses consolidation, cavitation, effusion Sputum culture & Gram stain: If moderate-severe CAP Blood cultures: If moderate-severe CAP, pre-antibiotics if possible Urinary antigen tests: Legionella, Pneumococcus (if severe) PCR: Viral pathogens (influenza, SARS-CoV-2) + atypicals (Legionella, Mycoplasma, Chlamydia) Inflammatory markers (CRP, procalcitonin): May guide antibiotic use Antibiotic Therapy (Community-Acquired Pneumonia) Low-Severity (Outpatient) First-line: Amoxicillin 1 g TDS (5 days, extend to 7 days if slow response) If atypicals suspected OR penicillin allergy: Doxycycline 100 mg BD OR Clarithromycin 500 mg BD Combination therapy (Amoxicillin + Doxycycline) if uncertain follow-up or no improvement in 48h Moderate-Severity (Hospital Admission) Standard regimen: IV Benzylpenicillin + oral Doxycycline/Clarithromycin If penicillin allergy: IV Ceftriaxone + Doxycycline/Clarithromycin Severe allergy: Moxifloxacin monotherapy Duration: 5–7 days (IV-to-oral switch once stable) High-Severity (ICU/Severe CAP) Empirical therapy: IV Ceftriaxone 2 g daily + IV Azithromycin Septic shock: Ceftriaxone 1 g BD Tropical regions (wet season): IV Meropenem + Azithromycin (melioidosis coverage) Duration: ≥7 days (Azithromycin typically 3–5 days) Pneumonia Aetiology and Risk Factors Streptococcus pneumoniae is the most common cause of CAP in adults and remains the primary pathogen in severe and fatal cases. Atypical bacteria such as Mycoplasma pneumoniae, Chlamydophila (Chlamydia) pneumoniae, and Legionellaspecies also play important roles. Haemophilus influenzae is more frequently observed in individuals with chronic obstructive pulmonary disease (COPD). Staphylococcus aureus (including methicillin-resistant strains) is less common but can cause severe or cavitating pneumonia (especially post-influenza). Gram-negative bacilli, including Enterobacteriaceae (e.g. Klebsiella pneumoniae) and Pseudomonas aeruginosa, are more frequent in patients with comorbidities (e.g. bronchiectasis, chronic kidney disease) or in severe CAP. Respiratory viruses such as influenza, respiratory syncytial virus (RSV), metapneumovirus, and SARS-CoV-2 can act as sole pathogens or lead to secondary bacterial infections. In tropical regions of Australia (north of ~20°S latitude), Burkholderia pseudomallei (melioidosis) and Acinetobacter baumannii must be considered, especially in those with diabetes, excessive alcohol intake, or chronic lung/kidney disease. Clinical Presentation Typical symptoms include: Cough (with or without sputum) Dyspnoea Fever Chills Pleuritic chest pain Some patients, particularly older individuals, may present with confusion. Gastrointestinal symptoms, such as diarrhoea, can also occur. On examination, there may be crackles, dullness on percussion if consolidation is present, and reduced breath sounds. Severity Assessment Careful assessment helps determine whether outpatient or inpatient care is required and guides antibiotic selection. Red flags for hospital admission include: Tachypnoea (respiratory rate ≥22 breaths/min) Hypotension (systolic blood pressure <90 mmHg) Heart rate >100 beats/min Acute confusion Oxygen saturation <92% on room air (or < baseline in chronic respiratory conditions) Multilobar involvement on chest radiograph Lactate >2 mmol/L High-severity features (possible need for ICU) include: Respiratory rate ≥30 breaths/min Oxygen saturation <90% on room air, or PaO₂/FiO₂ <250 Rapid progression on chest X-ray or sepsis (elevated lactate, hypotension) Marked acute kidney injury or altered mental state Investigations Chest X-ray: Confirms an infiltrate and assesses for consolidation, cavitation, or effusions. Sputum Gram stain and culture: Ideally from a high-quality specimen, to detect bacterial causes. Blood cultures: Two sets in moderate to high-severity CAP, ideally before starting antibiotics. Pneumococcal and Legionella urinary antigen tests: Useful in moderate to high-severity CAP to guide targeted therapy. Nucleic acid amplification tests (PCR): Can identify influenza, SARS-CoV-2, and other viruses; also used for Legionella, Mycoplasma, and Chlamydophila if indicated. Biomarkers (CRP, procalcitonin): May assist with clinical decision-making regarding antibiotics but do not definitively distinguish viral from bacterial infection. Antibiotic Therapy for Community-Acquired Pneumonia Therapy depends on severity, local epidemiology (e.g. tropical vs non-tropical areas), and likelihood of atypical pathogens. Low-Severity CAP Patients without red flags can usually be managed in the community. First-line: Amoxicillin 1 g orally, three times daily for up to 5 days (extend to 7 days if response is slower). If atypical organisms are suspected or there is penicillin hypersensitivity: Doxycycline 100 mg orally, twice daily, or Clarithromycin 500 mg orally, twice daily. Combination therapy (amoxicillin plus doxycycline) may be needed if follow-up is uncertain or if minimal improvement is seen after 48 hours of monotherapy. Moderate-Severity CAP Hospital admission is generally indicated. Typical regimen: Benzylpenicillin IV plus doxycycline (or clarithromycin) orally. IV azithromycin is an alternative if the patient cannot tolerate oral doxycycline or clarithromycin. Duration: About 5–7 days in total (including IV-to-oral switch). Penicillin allergy: Consider ceftriaxone IV (or cefuroxime orally once stable) plus doxycycline or clarithromycin. In severe penicillin allergy, use moxifloxacin alone. High-Severity CAP Often requires ICU-level care. Empirical coverage: Ceftriaxone (2 g IV once daily, or 1 g twice daily if septic shock) plus IV azithromycin. In tropical regions during the wet season, meropenem plus azithromycin is recommended due to Burkholderia pseudomallei. Duration: At least 7 days in most cases; azithromycin is typically given for 3–5 days. Additional considerations: Suspected Staphylococcus aureus: add vancomycin. Risk of Pseudomonas aeruginosa: use an antipseudomonal beta-lactam (e.g. piperacillin+tazobactam or cefepime) plus azithromycin. Aspiration Pneumonia Many CAP regimens already cover typical oropharyngeal bacteria. Antibiotics specifically targeting anaerobes (e.g. metronidazole) may be considered if there is putrid sputum or severe periodontal disease. Differentiate aspiration pneumonitis (chemical injury) from aspiration pneumonia (bacterial infection); if in doubt, start standard CAP treatment and review early. Paediatric and Special Groups Children, residents of aged-care facilities, and immunocompromised individuals may require different regimens or specialist input. In older patients, comorbidities must be considered, and early follow-up is essential if managed in the community. Supportive Management Ensure adequate hydration and provide supplemental oxygen if the patient is hypoxic. Offer appropriate analgesia for pleuritic pain. Encourage early mobilisation. Monitor closely for sepsis, septic shock, or acute respiratory decompensation. Consider antiviral therapy (e.g. for influenza) during relevant seasons. 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 Hereditary Thrombophilia Indications for Testing Unprovoked VTE, <50 years, unusual sites (e.g., CNS, upper limb) 1st-degree relative with diagnosed thrombophilia Medicare rebate available for personal history of DVT/PE or 1st-degree relative with proven mutation (family history alone insufficient) Testing is typically performed at least 2 weeks after ceasing anticoagulation to ensure accurate levels Testing outcomes rarely alter acute management but can guide long-term prophylaxis decisions Types Factor V Leiden APCR test; FVL assay if abnormal Resistance to protein C → increased clotting Prothrombin Gene Mutation (PGM) Overproduction of prothrombin → increased clotting Protein C/S Deficiency Deficiency = less inhibition of factors Va/VIIIa → more clotting Levels can be falsely low during pregnancy or while on oral contraceptives Antithrombin III Deficiency Reduced coagulation inhibition → increased clotting May be acquired during acute thrombosis or heparin therapy MTHFR Mutation Mutation = elevated homocysteine → increased clotting No association with miscarriage; not recommended for routine thrombophilia screening Management Consider both acquired and hereditary causes of thrombophilia in clot history Use anticoagulation based on personal and family risk LMWH prophylaxis is recommended for high-risk situations such as surgery or pregnancy in carriers of certain mutations Special Considerations Elevated homocysteine increases risk of arterial and venous thrombus MTHFR mutation allows folate processing via B6/B12; use supplements as needed Inherited thrombophilia is not an absolute contraindication to combined oral contraceptives, but thorough risk assessment is essential Hereditary Thrombophilia Indications for Testing Unprovoked venous thromboembolism (VTE) at <50 years of age Recurrent VTE, or thrombosis at unusual sites (cerebral veins, mesenteric veins, upper limb veins) First-degree relative with a confirmed hereditary thrombophilia Medicare rebate requires personal history of DVT/PE or a first-degree relative with a proven mutation (family history alone is insufficient) Typically test ≥2 weeks after cessation of anticoagulation to avoid false results (protein C and S can be suppressed by warfarin) Testing rarely alters acute management but may guide duration of anticoagulation or prophylaxis during high-risk periods Types of Hereditary Thrombophilia Factor V Leiden (FVL) Most common inherited thrombophilia in Caucasian populations Tested by activated protein C resistance (APCR) assay followed by specific FVL test if abnormal Mutation makes factor V resistant to inactivation by protein C → increased clotting risk Prothrombin Gene Mutation (G20210A) Leads to increased prothrombin production → heightened coagulation Associated with a modestly increased risk of VTE Protein C or Protein S Deficiency Deficiency reduces the inactivation of factors Va and VIIIa → promotes thrombosis Levels can be falsely low in pregnancy, while on oral contraceptives, during acute thrombosis, or when on warfarin Antithrombin III Deficiency Decreased inhibition of thrombin and factor Xa → increased clot risk Acquired deficiency may occur in acute thrombosis or during heparin therapy Congenital antithrombin deficiency carries a high lifetime risk of VTE MTHFR Mutation Mutation may elevate homocysteine, contributing to vascular risk No proven association with recurrent miscarriage Not recommended for routine thrombophilia screening Elevated homocysteine responds to vitamin supplementation (folate, B6, B12) Management Considerations Risk Stratification Combine genetic findings with personal/family history of thrombosis, obesity, immobility, hormone therapy, and other acquired factors (e.g. antiphospholipid syndrome) High-risk thrombophilias (e.g. antithrombin deficiency, combined defects like FVL + PGM) may warrant lifelong anticoagulation after unprovoked VTE Anticoagulation Acute management of VTE follows standard protocols (LMWH then transition to warfarin/DOAC unless contraindicated) Duration of anticoagulation often prolonged if high-risk thrombophilia or strong family history In pregnant patients with high-risk thrombophilia, LMWH prophylaxis is commonly used to prevent VTE Factor V Leiden or prothrombin gene mutation carriers with no prior VTE usually do not need indefinite anticoagulation but require prophylaxis in high-risk situations (major surgery, prolonged immobilisation) Lifestyle & General Measures Smoking cessation, weight control, adequate hydration, and active lifestyle can reduce VTE risk Consider safer contraceptive options or use of progesterone-only methods if combined OCP is deemed high risk for VTE Counsel about symptoms of DVT/PE and importance of seeking urgent care if suspected Special Considerations Elevated Homocysteine Associated with arterial and venous thrombosis risk Correct deficiency of folate, vitamin B6, or B12 if found Pregnancy Thromboprophylaxis with LMWH in selected patients (history of previous VTE, high-risk thrombophilia) Avoid warfarin in pregnancy (teratogenic), monitor carefully for postpartum thrombosis risk Combined Oral Contraceptives or HRT Relative contraindication in high-risk thrombophilias (especially antithrombin deficiency or double heterozygotes) Detailed risk-benefit assessment if mild thrombophilia (heterozygous FVL) and no personal VTE history Surgery/Immobility Short-term prophylaxis with LMWH or DOAC (where appropriate) to prevent perioperative thrombosis Notes: Test only when results will influence clinical decisions (duration of anticoagulation, prophylaxis in pregnancy or surgery) Ensure testing is performed under stable conditions (off anticoagulants for ≥2 weeks unless bridging is impossible) Interpret in context of personal/family history and other risk factors Provide patient education on VTE risk, prophylactic measures, and early signs of DVT/PE Consider referral to haematology if results are uncertain, high-risk mutations are identified, or complex management is required Bookmark Failed! 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