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 Trachoma - Chronic Chlamydia trachomatis Conjunctivitis Pathophysiology Inflammation → recurrent infections → chronic conjunctival scarring Entropion/trichiasis → corneal abrasion, scarring, ulceration Symptoms Early: itchy/irritated eyes, mild conjunctivitis Recurrent sticky discharge (often misdiagnosed as bacterial) Vision loss from corneal opacity (late stage) Diagnosis Clinical: follicular conjunctivitis, scarring WHO grading system (endemic areas) Definitive: NAAT for C. trachomatis Management Medical: Azithromycin 20 mg/kg (max 1 g) stat dose Treat household contacts (prevent reinfection) Surgical: Refer for trichiasis correction Environmental: SAFE strategy: hand/face washing Fly control, waste management, hygiene education Reduce overcrowding, improve water access Key Points Avoid epilation without expert guidance (risk of corneal damage) Community-wide screening in endemic areas reduces transmission Trachoma (Chronic Chlamydia trachomatisConjunctivitis) Pathophysiology Chronic infection with Chlamydia trachomatis (serotypes A, B, Ba, C). Repeated inflammation of the conjunctiva → scarring, which can cause entropion (inward-turning eyelid) and trichiasis (lashes rubbing on cornea). Ongoing corneal abrasion leads to opacification and possible vision loss if untreated. Symptoms Early: Itchy, irritated eyes, mild conjunctivitis with sticky discharge (often mistaken for bacterial infection). Recurrent sticky or purulent discharge. Late: Vision loss from corneal opacity/scarring. Diagnosis Clinical: Follicular conjunctivitis, scarring in endemic regions. WHO Grading: TF (Trachomatous Follicular), TI (Trachomatous Intense), etc. Definitive: NAAT (Nucleic Acid Amplification Test) for C. trachomatis. Management Medical Therapy Azithromycin 20 mg/kg (max 1 g) single stat dose. Treat household contacts to prevent reinfection. Surgical Refer for trichiasis correction if lashes are abrading cornea. Environmental & Public Health (SAFE Strategy) S: Surgery for trichiasis A: Antibiotics (azithromycin) F: Facial cleanliness (hand/face washing) E: Environmental improvements (fly control, waste management, reduce overcrowding, increase water access) Key Points Avoid epilation of lashes by non-experts; can worsen corneal damage. Community-wide screening and mass treatment in endemic areas reduce transmission. Recognise recurrent or persistent “sticky” conjunctivitis in at-risk communities (remote, limited water supply, high fly burden). 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 Subacute Thyroiditis (de Quervain Thyroiditis) Presentation Post-viral illness (commonly follows an upper respiratory tract infection) Tender thyroid, diffuse goitre Pain radiating to ears or jaw Associated sx: fever, malaise Early stage: Variable thyrotoxicosis sx (e.g., palpitations, weight loss) Late stage: Hypothyroid sx (e.g., fatigue, cold intolerance) Differentials Infectious thyroiditis Hashimoto's thyroiditis Graves' disease Thyroid cancer Postpartum thyroiditis (resolves in 6–12 months; 1/3 develop permanent hypothyroidism) Diagnosis Radionuclide thyroid scan: No uptake ESR/CRP: Markedly elevated Monitor TFTs every 4–8 weeks Test for TPO in postpartum thyroiditis Management 1st-line (pain and inflammation relief): Aspirin: 300–600 mg QID Ibuprofen: 200–400 mg TDS Indomethacin: 25–50 mg every 6–12 hours Persistent/severe cases: Prednisolone: 40 mg daily, taper over 2–4 weeks Thyrotoxicosis sx relief: Propranolol: 10 mg BD (no need for thionamides as thyrotoxicosis is transient) Persistent hypothyroidism (if symptomatic or TSH >10): Thyroxine: 50–100 mcg daily, review in 4–8 weeks Subacute Thyroiditis (de Quervain Thyroiditis) Presentation Often post-URTI onset. Presents as a tender, painful thyroid with diffuse goitre. Pain may radiate to the ear or jaw. Associated symptoms may include fever and malaise. Disease Course Typically progresses through three phases: Hyperthyroid phase lasting a few weeks. Hypothyroid phase lasting up to 6 months. Returns to normal in most cases; however, 1/3 may develop permanent hypothyroidism. High recurrence rate for those who revert to normal. Differentials Infectious thyroiditis Hashimoto's thyroiditis Graves' disease Thyroid cancer Postpartum thyroiditis (resolve within 6–12 months; 1/3 may develop permanent hypothyroidism) Diagnosis Radionuclide scan: shows no uptake (indicative of thyroiditis). ESR/CRP: typically elevated. Thyroid function tests (TFTs): should be monitored every 4–8 weeks. Thyroid peroxidase (TPO) antibodies: test if postpartum thyroiditis is suspected to confirm diagnosis. Management Anti-inflammatory Medications: Aspirin: 600 mg QID for mild cases. Ibuprofen: 400 mg TDS. Beta-blocker (Propranolol): 10 mg BD for symptom management in hyperthyroid phase. No need for thionamides (antithyroid drugs) in hyperthyroid phase as it's not due to overproduction of thyroid hormones. Thyroxine: If symptomatic for hypothyroidism or TSH >10 mIU/L. Start at 50-100 mcg daily for 4-8 weeks, adjust as needed based on follow-up. Corticosteroids (for severe cases): Prednisolone: Start at 40 mg daily, downtitrating over 2-4 weeks if severe and if NSAIDs are ineffective. Prognosis and Follow-up Subacute thyroiditis typically resolves within 6–12 months. Monitor TSH levels every 4-8 weeks initially, then every 6-12 months if stable. Long-term risk of hypothyroidism; hence, continue yearly TSH monitoring even if thyroid function returns to normal. Notes: Etiology: Exact cause is unknown, but it is often triggered by viral infections, hence sometimes referred to as post-viral thyroiditis. Patient Education: Inform patients about the transient nature of the disease, typical course, and the importance of follow-up testing to prevent long-term complications. 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 Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Definition Abnormal uterine bleeding refers to menstrual bleeding that deviates from normal in quantity, duration, or schedule Includes: Intermenstrual bleeding (IMB) Menorrhagia Postmenopausal bleeding (PMB) Postcoital bleeding (PCB) Classification: PALM-COEIN Framework Structural Causes (PALM) Polyp: Cervical or endometrial polyps Adenomyosis: Common in women >35 years Typically presents with cyclical pain and menorrhagia Leiomyoma (Fibroids): Common >35 years Pain often non-cyclical, may cause dyspareunia Malignancy/Hyperplasia: Endometrial, cervical, or ovarian cancers Non-Structural Causes (COEIN) Coagulopathy: Von Willebrand disease, thrombocytopenia Ovulatory Dysfunction: PCOS, hypothyroidism Endometrial: Endometritis, hyperplasia Iatrogenic: Medications (e.g., anticoagulants, antipsychotics, IUD, COCP) Not Yet Classified: STIs, IBS/IBD (linked to dysmenorrhoea/pelvic pain) Type-Specific Differentials Postmenopausal Bleeding Atrophic vaginitis/endometritis (most common) Cervical or endometrial cancer/hyperplasia Cervical or endometrial polyps Intermenstrual Bleeding Pelvic inflammatory disease (PID) IUD or POP-related irregularities Cervical ectropion Endometrial hyperplasia or malignancy Postcoital Bleeding Cervical causes: Ectropion, polyps, malignancy Infectious causes: PID or STIs Atrophic vaginitis Investigations General Investigations Transvaginal ultrasound: Ideally performed on days 5–10 of the menstrual cycle STI screening if infection is suspected Specific to Postcoital Bleeding Cervical co-test (HPV + cytology) Endocervical swabs for Chlamydia, Gonorrhoea, Mycoplasma genitalium High vaginal swabs for Trichomonas, MCS Notes The first episode of PCB warrants a co-test, while recurrent episodes require gynaecology referral for colposcopy Always consider thyroid dysfunction as a potential cause of unexplained menorrhagia Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Definition Menstrual bleeding deviating from normal in quantity, duration or schedule Includes intermenstrual bleeding, menorrhagia, postmenopausal bleeding and postcoital bleeding Classification: PALM-COEIN Framework Structural Causes (PALM) Polyps: Cervical or endometrial Adenomyosis: Common in women over 35; presents with cyclical pain and heavy bleeding Leiomyoma (Fibroids): Often in women over 35; may cause non-cyclical pain and dyspareunia Malignancy/Hyperplasia: Involving endometrium, cervix or ovaries Non-Structural Causes (COEIN) Coagulopathy: Von Willebrand disease, thrombocytopenia Ovulatory Dysfunction: Seen in PCOS or hypothyroidism Endometrial Causes: Endometritis, hyperplasia Iatrogenic: Medications such as anticoagulants, antipsychotics, IUD or COCP Not yet classified: STIs, IBS/IBD associated with dysmenorrhoea and pelvic pain Type-Specific Differentials Postmenopausal Bleeding Atrophic vaginitis or endometritis are most common Exclude cervical or endometrial cancer/hyperplasia and polyps Intermenstrual Bleeding Consider PID, IUD-related irregularities, cervical ectropion, endometrial hyperplasia or malignancy Postcoital Bleeding Cervical causes: Ectropion, polyps, malignancy Consider PID, STIs and atrophic vaginitis Investigations General Transvaginal ultrasound on days 5–10 of the cycle to assess uterine and ovarian structure STI screening if infection is suspected Specific for Postcoital Bleeding Cervical co-test and endocervical swabs for chlamydia, gonorrhoea, Mycoplasma genitalium High vaginal swabs for Trichomonas and MCS Additional Testing Thyroid function tests for unexplained menorrhagia Endometrial sampling in postmenopausal women or if malignancy is suspected Consider bone mineral density assessment in long-standing cases Management General Principles Tailor management to the underlying cause identified through the PALM-COEIN framework Lifestyle modifications and medical therapy are first-line for many non-structural causes Medical Treatments Tranexamic acid to reduce menstrual blood loss NSAIDs to alleviate pain and reduce flow Hormonal therapies (combined oral contraceptives, progestogens) especially in ovulatory dysfunction Endometrial ablation may be considered for persistent heavy bleeding in selected cases Surgical Treatments Hysteroscopic polypectomy for polyps Myomectomy or uterine artery embolisation for fibroids Oncological management for malignancy or hyperplasia as indicated Follow-Up Regular monitoring of bleeding patterns, symptom response and overall well-being Referral to gynaecology for persistent or unexplained cases and postmenopausal bleeding Notes: Early evaluation is crucial in postmenopausal bleeding to exclude malignancy Detailed history including menstrual pattern, family history, medication use and systemic symptoms guides targeted investigation A multidisciplinary approach involving gynaecology, endocrinology and haematology improves patient outcomes Educate patients on treatment adherence, recognise red flags and the importance of follow-up to prevent complications Awareness of the impact of thyroid dysfunction and other endocrine disorders on menstrual irregularities is essential in the workup Public health guidelines emphasise screening and prevention strategies for common aetiologies in reproductive-age women 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 Keratoderma Definition Thickening of the palms and soles (palmoplantar keratosis) Types Diffuse: Affects most of the palms/soles Focal: Localised to pressure areas Punctate: Small bumps on palms/soles Non-transgradient: Limited to palms/soles Transgradient: Extends to dorsum of hands/feet Management Emollients (moisturises, softens skin) Keratolytics (salicylic acid 6%, propylene glycol 70%) Topical retinoids (reduces thickening) Topical vitamin D (calcipotriol) (softens skin) Systemic retinoids (acitretin) (for severe cases) Keratoderma Definition Keratoderma (palmoplantar keratosis) refers to thickening of the skin (hyperkeratosis) on the palms and/or soles. It can be inherited (genodermatoses) or acquired due to various conditions (psoriasis, eczema, environmental factors). Types Diffuse Widespread thickening across most of the palms/soles Focal Localised hyperkeratotic plaques at pressure areas (e.g. weight-bearing parts of soles, friction points on palms) Punctate Multiple small bumps or “dots” of thickened skin on the palms/soles Non-Transgradient vs Transgradient Non-Transgradient: Limited to palms/soles, spares the dorsal surfaces Transgradient: Extends beyond the palmoplantar margins onto the dorsum of hands/feet Management General Measures Emollients: Moisturise to soften thick skin, reduce cracking Choose products with urea or other humectants for better penetration Avoid triggers: Excess friction, repetitive trauma Keratolytics Salicylic Acid (6%) or Propylene Glycol (70%) solutions/ointments help dissolve thick keratin Apply under occlusion at night for deeper penetration Topical Retinoids Tretinoin or adapalene creams can reduce hyperkeratosis over time Start slowly to minimise irritation (e.g. alternate nights, gradually increase frequency) Topical Vitamin D Analogues Calcipotriol: Softens keratotic plaques, may be used alone or in combination with other topicals Systemic Retinoids Acitretin for severe or refractory palmoplantar keratoderma Requires monitoring for hepatic function and hyperlipidaemia Teratogenic → strict contraception for women of childbearing potential Notes Some keratodermas are part of genetic syndromes (e.g., pachyonychia congenita, palmoplantar keratoderma of various inheritance patterns). Assess for underlying diseases (psoriasis, eczema, tinea, or systemic conditions) if the keratoderma is new or atypical. Referral to dermatology if uncertain diagnosis or severe, unresponsive to standard measures. Bookmark Failed! Bookmark Saved! Add Bookmark Refresh Refresh

Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Febrile Seizures Presentation Age: 6 months–6 years Trigger: Fever >38°C, typically due to viral infections Types: Simple: Generalised tonic-clonic, <15 min, no recurrence within 24 hours Complex: Focal features, >15 min, or ≥2 seizures in same illness Recurrence Risk: ~50% within 1 year if onset before 12 months When to Refer Urgent (ED) Referral Seizure >10 minutes Focal features or prolonged postictal weakness Slow recovery (>1 hour) post-seizure Multiple seizures in the same illness Elective Referral Abnormal neurological exam between episodes Recurrent complex febrile seizures Family history of epilepsy Epilepsy Risk Factors Family history of epilepsy History of complex febrile seizures Neurological abnormalities or developmental delay Onset <12 months of age Management During Seizure Do not restrain or put anything in the mouth Recovery position to prevent aspiration Ensure safety, clear objects from surroundings Post-Seizure Call an ambulance if: Seizure lasts >5 minutes A second seizure occurs No full recovery of consciousness Parent Education Prognosis: Benign, low risk of epilepsy with simple febrile seizures Fever Management: Antipyretics (paracetamol, ibuprofen) for comfort but do not prevent seizures Seizure First Aid: Teach parents recovery steps and when to seek emergency care Seizure Diary: Record details of episodes Additional Notes Investigations: Not required for simple febrile seizures unless focal, prolonged, or meningitis is suspected Prophylaxis: No role for routine antiepileptic drugs Vaccination: Continue as normal, discuss MMRV timing due to slightly increased seizure risk Febrile Seizures Presentation Occur in children aged 6 months to 6 years Triggered by fever above 38°C, often during a viral illness Simple febrile seizures are generalised tonic-clonic, last under 15 minutes, and do not recur in 24 hours Complex febrile seizures may be focal, last over 15 minutes, or recur in the same illness Recurrence risk is about 50% by 1 year of the first episode if onset is early Antipyretics do not reliably prevent further febrile seizures in the same illness When To Refer Urgent (Emergency Department) Seizure lasting more than 10 minutes Focal features, prolonged limb weakness, or postictal confusion Recovery taking over 1 hour Multiple seizures during the same febrile illness Elective (Non-Urgent) Abnormal neurological examination or concerns about developmental delay Recurrent complex febrile seizures Family history of epilepsy or early onset under 12 months Epilepsy Risk Factors Family history of epilepsy Complex febrile seizures (focal or prolonged) Neurological deficits or significant developmental concerns Very early onset (under 12 months) Management During Seizure Do not restrain and avoid placing objects in the mouth Position the child on the side (recovery position) to prevent aspiration Keep the child safe by moving nearby objects Post-Seizure Call an ambulance if the seizure exceeds 5 minutes, repeats, or if consciousness is not regained Treat fever for comfort using paracetamol or ibuprofen, though this does not prevent recurrence Record details in a seizure diary Additional Considerations Investigations not routinely needed for simple febrile seizures unless signs suggest bacterial infection, focal seizure, or meningitis No role for ongoing prophylaxis with antiepileptic drugs in typical simple febrile seizures Vaccination schedules remain unchanged, though discuss timing of MMRV if febrile seizures are a concern Parent Education Explain that febrile seizures are generally benign and have a low risk of progressing to epilepsy when simple Emphasise correct first aid steps during a seizure and signs requiring urgent medical review Encourage families to maintain a seizure diary to document episodes and triggers 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 Hormone Replacement Therapy (HRT) Contraindications & Precautions Absolute Contraindications History of breast cancer Active or recent arterial thromboembolic disease (stroke, myocardial infarction) Undiagnosed vaginal bleeding (must be investigated first) Severe liver disease History of venous thromboembolism (VTE) Relative Contraindications Uncontrolled hypertension (must be controlled before starting HRT) Migraine with aura (higher stroke risk) Side Effects Common Breast tenderness Nausea Headaches Bloating Leg cramps Skin irritation Mood swings Acne Lower libido Serious Increased risk of VTE Increased risk of stroke Increased risk of gallbladder disease Increased risk of breast cancer (with long-term use) Notes Risk varies by HRT type and administration route Transdermal HRT (patch/gel/spray): Lower VTE risk than oral HRT Individualised risk-benefit discussion is essential before initiation Hormone Replacement Therapy (HRT) Contraindications & Precautions Absolute contraindications include history of breast cancer, active or recent arterial thromboembolic disease (eg stroke or myocardial infarction), undiagnosed vaginal bleeding that requires investigation, severe liver disease and a history of venous thromboembolism Relative contraindications include uncontrolled hypertension that must be controlled prior to initiating HRT and migraine with aura due to a higher stroke risk Side Effects Common side effects include breast tenderness, nausea, headaches, bloating, leg cramps, skin irritation, mood swings, acne and lower libido Serious side effects involve an increased risk of venous thromboembolism, stroke, gallbladder disease and breast cancer with long-term use Risk–Benefit Profile Prolonged use of combined oral HRT in postmenopausal women with an intact uterus is associated with a modest increase in the risks of breast cancer, coronary heart disease, stroke and pulmonary embolism when used for more than five years Extended HRT use may confer a reduced risk of colorectal cancer and fractures, although overall mortality is not increased with use for less than five years The risk profile varies according to the type of HRT, duration of use and individual patient risk factors Administration & Route Transdermal HRT formulations (patches, gels or sprays) are associated with a lower risk of venous thromboembolism compared with oral formulations Oestrogen-only HRT in women who have undergone hysterectomy has a different risk profile compared with combined HRT Individualised dosing and route selection is essential based on patient comorbidities and preferences Monitoring & Patient Evaluation A full medical workup, including a mammogram and Pap smear, is recommended before commencing HRT Regular monitoring of blood pressure, liver function and symptomatology is essential during treatment Reassessment of the continued need for HRT is advised, particularly if treatment extends beyond five years, with an individualised risk–benefit discussion Notes Individualised risk–benefit discussions are essential prior to HRT initiation The risk of adverse events varies by HRT type, duration and route of administration HRT is recommended for symptomatic menopausal women with an intact uterus and is not indicated solely for the prevention of heart disease or osteoporosis Gradual dose reduction is recommended when discontinuing HRT to prevent rebound flushing and other withdrawal symptoms 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 Sialolithiasis Management Conservative Milk the duct to expel the stone. Warm compresses for relief and salivary stimulation. Suck on sour candy (e.g., lemon drops). Stay hydrated to aid gland function. Analgesia: Ibuprofen 400 mg TDS PRN. If Infected (Sialadenitis) Antibiotics: Flucloxacillin 500 mg QID for 10 days. Severe infection: ED referral for IV flucloxacillin. Refractory/Recurrence ENT referral for sialoendoscopy or surgical removal. Imaging (ultrasound or CT) for unclear cases or large stones. Prevention Maintain good oral hygiene. Regular hydration to prevent recurrence. Sialolithiasis Formation of calcified stones (sialoliths) within the salivary ducts or gland parenchyma Most commonly affects the submandibular gland (up to 80–90%) because of its more alkaline saliva and high mucin content Can cause recurrent pain and swelling, particularly during meals when salivary flow increases Clinical Presentation Pain and swelling of the affected gland, often triggered by chewing or mealtime Palpable lump under the jaw or in the cheek if the stone is near the duct orifice Possible discharge of pus or foul-tasting fluid if infection (sialadenitis) co-exists Reduced salivary flow or dryness in the mouth if the gland is significantly obstructed Risk Factors Dehydration or reduced fluid intake Medications that decrease salivary flow (e.g. anticholinergics, diuretics) Poor oral hygiene Trauma or scarring within the salivary duct Chronic or recurrent infections of the salivary glands Diagnosis Usually clinical (palpation of the duct or submandibular area, expression of saliva) Imaging if diagnosis is uncertain or stone is not easily palpable Ultrasound often first-line to identify stone location and size CT scan for better anatomical detail if large, recurrent, or complicated stones are suspected Management Conservative Milk the affected salivary duct to expel the stone Warm compresses to the gland to encourage increased blood flow and salivary secretion Suck on sour or hard candy (lemon drops) to stimulate salivary flow and aid stone passage Adequate hydration to maintain salivary gland function Analgesia with NSAIDs (e.g. ibuprofen 400 mg TDS as needed) to relieve pain and inflammation If Infected (Sialadenitis) First-line antibiotics: Flucloxacillin 500 mg QID for 10 days if bacterial infection is suspected Consider alternative antibiotics if penicillin-allergic or if MRSA is possible If patient cannot swallow or is dehydrated, refer urgently to ED for IV antibiotics (e.g. IV flucloxacillin) Refractory or Recurrent Cases Refer to ENT for sialoendoscopy or surgical removal of the stone if it does not pass spontaneously Surgical intervention may be needed if the stone is large, impacted, or causing persistent obstruction Imaging (e.g. CT) helps localise the stone and guide further management Preventive Advice Good oral hygiene, including regular dental checks Maintain adequate hydration to promote continuous salivary flow Prompt treatment of any dental infections Address medications that reduce saliva production if feasible Notes: Most stones occur in the submandibular gland, presenting with pain and swelling exacerbated by meals Conservative measures (duct milking, hydration, sour lozenges) often succeed for small stones Antibiotics are required if signs of infection or sialadenitis ENT referral for persistent, recurrent, or complicated stones Early detection and intervention reduce the risk of chronic infection or irreversible gland damage 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 Chickenpox (Varicella) Oral Acyclovir Indications: Children with eczema (any stage post-rash) Adults ≤36 hrs post-rash Pregnant women ≤72 hrs post-rash IVIG Indications: Ideally ≤4 days (up to 10 days) post-exposure for: Immunocompromised, pregnant, neonates <1 month (esp. preterm) Vaccination Post-Exposure Indications: Within 3–5 days for: Unimmunised >12 months Exposure: Household, face-to-face ≥5 mins, or same room ≥1 hr IV Acyclovir Indications: Symptomatic individuals needing IVIG Chickenpox complications (e.g., pneumonia, encephalitis) Notes Infectious: 2 days pre-rash to full crusting Isolation: Avoid contact until blisters dry Chickenpox (Varicella) Definition Highly contagious infection caused by the varicella-zoster virus Characterised by pruritic vesicular lesions, mild to moderate fever, and malaise More severe in adults, pregnant women, neonates, and immunocompromised individuals Transmission and Infectious Period Spread by respiratory droplets or direct contact with vesicular fluid Infectious from 2 days before rash until all lesions have crusted Advise isolation at home until blisters have fully dried Oral Acyclovir Indicated for children with eczema at any stage of the rash Indicated for adults if started ≤36 hours after rash onset Indicated for pregnant women if started ≤72 hours after rash onset Reduces disease severity and risk of complications when initiated early Intravenous Acyclovir Indicated for individuals needing IV immunoglobulin who are symptomatic Indicated for chickenpox complications such as pneumonia or encephalitis Consider in immunocompromised patients at risk of severe or rapidly progressing infection Immunoglobulin (IVIG) Ideally given ≤4 days post-exposure (up to 10 days) Indicated for immunocompromised individuals, pregnant women, and neonates under 1 month (especially preterm) Reduces severity or prevents disease when administered promptly after exposure Vaccination Post-Exposure Recommended within 3–5 days of exposure For unimmunised individuals older than 12 months Significant exposure includes household contact, face-to-face contact ≥5 minutes, or sharing a room ≥1 hour May prevent or attenuate the illness if given early Complications Commonly include secondary bacterial skin infections Severe complications can involve pneumonia, encephalitis, or hepatitis Pregnant women are at risk of severe maternal illness and neonatal varicella Notes Advise individuals to avoid close contact with high-risk groups until crusting Monitor for signs of respiratory difficulty, neurological changes, or secondary skin infection Early recognition and treatment are crucial to minimise morbidity and transmission 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 Tinea Typical appearance: Annular/scaly lesion with well-defined edge, central clearing, ± pruritus/inflammation Clinical Presentations Tinea pedis (feet) – Most common in adults Maceration in toe webs, vesicles, or diffuse sole scaling Often coexists with tinea cruris or onychomycosis Tinea cruris (groin) – Common in males Well-demarcated erythematous rash in groin ± upper thighs/buttocks Tinea corporis (trunk, limbs, face) – "Ringworm" Annular, itchy lesions; more inflammatory if animal-derived Tinea manus (hands) – Unilateral scaling of palms or ring-shaped lesions on dorsum Tinea capitis (scalp) – Children Patchy hair loss, scaling, black dot sign (broken hairs) Kerion: Painful, pustular boggy mass (severe inflammatory variant) Onychomycosis (nails) – Requires separate management Thickened, brittle, discoloured nails Differential Diagnoses Eczema (dermatitis): Tinea has sharper border, central clearing Pityriasis rosea: Herald patch, follows skin cleavage lines Granuloma annulare: Ring-like but lacks scale/itch Psoriasis: Thicker scale, nail pitting, less annular Candidiasis: In moist skin folds, lacks true ring pattern Diagnosis Clinical suspicion: Annular scaly lesion ± itch Microscopy & culture (for confirmation before oral therapy) Skin scrapings, nail clippings, plucked hairs Wood lamp (fluoresces Microsporum canis) Indications for Topical vs. Oral Therapy Topical therapy: Recent onset, localised (trunk, groin, limbs, interdigital) Oral therapy: Widespread, hyperkeratotic, recurrent, scalp/palm/sole involvement, treatment failure Management Topical Therapy (Mild, Localised Infections) Terbinafine 1% cream/gel: Once/twice daily 1–2 weeks (preferred) Azoles (clotrimazole, ketoconazole, miconazole, bifonazole, econazole): Once/twice daily 2–4 weeks Key Points: Avoid steroid-antifungal combinations (does not improve cure rates) Keep feet dry, change socks, dry shoes thoroughly If no improvement → reassess diagnosis or consider oral therapy Oral Therapy (Extensive, Resistant, Hyperkeratotic, Palms/Soles, Recurrent Cases) Terbinafine 250 mg daily (adults) 2 weeks (corporis/cruris), 4 weeks (pedis) Children: <20 kg → 62.5 mg, 20–40 kg → 125 mg Fluconazole 150 mg weekly (6 weeks) Itraconazole (Sporanox) 100 mg daily (corporis/cruris 2 weeks, pedis 4 weeks) Lozanoc capsule: 50 mg daily (same duration) Griseofulvin 500 mg daily (cheaper, less effective) Child: 10 mg/kg (max 500 mg) 8–12 weeks Tinea Capitis (Scalp) – Always Requires Oral Therapy Terbinafine 250 mg daily x 4 weeks (Trichophyton) Children: Dose by weight Griseofulvin 20 mg/kg daily x 6–8 weeks (Microsporum) Alternatives: Itraconazole (Sporanox liquid) 5 mg/kg daily x 4 weeks Fluconazole 6 mg/kg daily (3–6 weeks) OR 8 mg/kg weekly (8–12 weeks) Kerion (Severe Inflammatory Tinea Capitis) Urgent referral Treat with oral antifungals ± antibiotics (secondary infection) Follow-Up Repeat culture at end of treatment If scalp clinically normal + negative culture → stop therapy Persistent positive culture → continue treatment, reassess every 4–6 weeks Tinea Overview Definition: Tinea (ringworm) is a superficial fungal infection caused by dermatophytes affecting the skin, scalp or nails Common species: Trichophyton, Microsporum, and Epidermophyton Typical appearance: Often presents as an annular or arcuate lesion with a scaly, well-defined edge and central clearing, and can be itchy or inflamed Clinical presentations Tinea pedis (feet) Most common in adults May present with maceration in the toe webs, small vesicles, or diffuse scaling on the soles Often associated with tinea of the groin (tinea cruris) and can spread to the toenails Tinea cruris (groin) Common in adult males Usually a well-demarcated, erythematous rash in the groin area Can spread to the upper thighs or buttocks Tinea corporis (trunk, limbs, face) Presents as annular, itchy lesions on non-hairy skin Can be more inflammatory if caused by animal-derived dermatophytes Often referred to as “ringworm” on the body Tinea manus (hands) Less common than tinea pedis May feature diffuse scaling on the palms or ring-shaped lesions on the dorsum of the hands Often unilateral Tinea capitis (scalp) Primarily in children Presents with patchy hair loss, scaling, and sometimes the “black dot” sign (broken hairs) The severe inflammatory form, kerion, appears as a boggy, painful, pustular mass Onychomycosis (nails) Tinea of the nails Involves thickening, brittleness, and discolouration of nails Requires separate management from skin-based tinea Differential diagnoses Eczema (dermatitis): Tinea lesions often have a sharper border with central clearing Pityriasis rosea: Typically presents with a herald patch and follows skin cleavage lines Granuloma annulare: Ring-like lesions that lack significant scale or itch Psoriasis: Usually thicker scale, can involve nail pitting, and is often less annular Candidiasis: Common in moist skin folds, does not typically produce a true ring pattern Diagnosis Clinical suspicionCharacteristic annular, scaly lesion, but can be confused with dermatitis, psoriasis or other skin conditions Microscopy and culture Skin scrapings, nail clippings, subungual debris, or plucked hairs (for tinea capitis) Confirm diagnosis before oral therapy or if clinical uncertainty exists before topical treatment Wood lamp examination helps with species like Microsporum canis Indications for topical vs oral therapy Topical therapy Recent onset, localised tinea affecting trunk, groin, limbs, or interdigital spaces Not indicated for hyperkeratotic, widespread, or scalp infection Oral therapy Widespread or resistant tinea Hyperkeratotic, vesicular, or pustular forms Tinea capitis or involvement of palms/soles Recurrence after topical therapy Tinea incognito (misuse of topical steroids) Management Topical therapy Suitable for mild, localised tinea on trunk, groin, limbs, or interdigital spaces Terbinafine 1% cream or gel once or twice daily for 1–2 weeks Azoles (bifonazole 1%, clotrimazole 1%, econazole 1%, ketoconazole 2%, miconazole 2%) typically once or twice daily for 2–4 weeks Key points Combination steroid–antifungal creams can relieve inflammation but do not improve cure rates Advise patients to keep feet dry, change socks often, and let shoes dry thoroughly If there is no improvement, re-check diagnosis or consider oral therapy Oral therapy (non-scalp, non-nail tinea) Indicated for extensive, hyperkeratotic, or unresponsive infection Terbinafine 250 mg daily (adult) 2 weeks Child <20 kg: 62.5 mg once daily; 20–40 kg: 125 mg once daily Fluconazole 150 mg weekly (adult) 6 weeks total Itraconazole Sporanox capsule: 100 mg once daily for 2 weeks (tinea cruris/corporis) or 4 weeks (tinea pedis) Lozanoc capsule: 50 mg once daily (same duration) Griseofulvin 500 mg daily Child: 10 mg/kg (max 500 mg) daily 8–12 weeks, cheaper but less effective Tinea capitis (scalp) Common in children, topical agents alone are ineffective Empirical regimen (frequently for Trichophyton): Terbinafine 250 mg daily for 4 weeks (dose adjusted by weight in children) Microsporum species: Griseofulvin 20 mg/kg daily (up to 500 mg) for 6–8 weeks Alternatives Itraconazole (Sporanox liquid) 5 mg/kg daily (up to 200 mg) for 4 weeks Fluconazole 6 mg/kg daily (up to 400 mg) for 3–6 weeks, or 8 mg/kg weekly (up to 800 mg) for 8–12 weeks in children Kerion Urgent referral recommended Often superinfected; manage with oral antifungals and possible adjunct antibiotics Follow-up Repeat culture at end of treatment If culture is negative and scalp is clinically normal, stop treatment If culture remains positive, continue therapy and repeat every 4–6 weeks until clear 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 Falls Risk Assessment Definition:Falls risk assessment identifies older adults, particularly those over 65, at high risk of falls to prevent injury and maintain independence. Causes/Aetiology: Age-related Decline: Decreased strength, balance, coordination. Chronic Conditions: Parkinson’s disease, stroke, multiple sclerosis. Medications: Psychotropics, sedatives, antihypertensives, anticholinergics. Sensory Impairment: Vision and hearing issues. Environmental Hazards: Poor lighting, slippery floors, tripping hazards. Incontinence: Urgency, especially at night, leading to rushing. Pathophysiology:Falls often result from intrinsic (e.g., muscle weakness, sensory deficits) and extrinsic (e.g., environmental hazards) factors. Age-related declines and medication side effects increase susceptibility to balance issues. Symptoms: Recurrent Falls: Two or more falls within the last year. Recent Fall: Presentation after a fall-related injury. Balance Issues: Difficulty walking, dizziness, lightheadedness. Leg Weakness: Difficulty rising from a chair or climbing stairs. Incontinence: Urgency increases the risk of falls. Vision Impairments: Difficulty seeing obstacles. Differential Diagnosis: Orthostatic Hypotension: Dizziness on standing, often due to medications. Vertigo: Inner ear issues like BPPV. Musculoskeletal Pain: Joint pain causing unsteadiness. Cardiovascular Issues: Arrhythmias or other causes of dizziness. Neurological Disorders: Conditions like Parkinson’s or stroke. Investigations: Postural Blood Pressure: Check for orthostatic hypotension. ECG: Assess arrhythmias or heart conditions. Vision Testing: Check for cataracts or macular degeneration. Neurological Exam: Cognitive and motor function assessment. Urinary Assessment: For urgency or frequency. Bone Density Testing: For osteoporosis if there’s a fall and fracture history. Screening Guidelines: Annual screening for those over 65 with: Two or more falls in the last year. Recent fall. Walking or balance difficulty. Management: Medication Review: Rationalize medications, especially those causing dizziness or balance issues. Exercise Programs: Home or community-based exercise focusing on strength and balance (150 minutes/week). Vitamin D: Maintain adequate levels (>60 ng/mL) to support muscle function. Home Modifications: Remove tripping hazards, improve lighting, add grab bars. Referrals: Optometrist/Ophthalmologist: Vision assessment and correction. Occupational Therapist (OT): Home safety assessments and modifications. Physiotherapist: Balance and strengthening exercises. Podiatrist: Foot health and footwear assessment. Notes: ATSI Individuals: Increased assessment frequency due to higher risk. Medication Review: Crucial for elderly with polypharmacy or drugs causing sedation, dizziness, or hypotension. Falls Risk Definition: Falls risk assessment is essential for older individuals, particularly those over 65 years of age, to prevent injury and maintain independence. Falls can lead to fractures, hospitalizations, and even death. Identifying individuals at high risk and implementing preventive measures is crucial for reducing the incidence of falls. Aetiology/Causes: Several factors contribute to an increased risk of falls: Age-related physical decline: Decreased strength, balance, and coordination. Chronic medical conditions: Conditions such as Parkinson’s disease, stroke, and multiple sclerosis can impair movement and coordination. Medications: Certain medications, especially psychotropics, sedatives, anticholinergics, and antihypertensives, can cause dizziness or orthostatic hypotension. Vision and hearing problems: Impaired vision (e.g., cataracts) and hearing loss can increase the risk of falls. Environmental hazards: Poorly lit areas, slippery floors, or tripping hazards in the home. Incontinence: Urgency or nocturia can increase the risk of falls due to rushing to the bathroom. Pathophysiology: Falls are typically caused by a combination of intrinsic (e.g., muscle weakness, vision impairment) and extrinsic (e.g., home hazards, slippery floors) factors. Decreased strength and balance from aging or neurological conditions, along with medications that cause dizziness or low blood pressure, significantly contribute to falls. Symptoms: Recurrent falls: Two or more falls within the past 12 months. Recent falls: Presenting after a recent fall or fall-related injury. Balance issues: Difficulty walking, dizziness, or lightheadedness. Leg weakness: Decreased muscle strength, making it hard to rise from a chair or climb stairs. Incontinence: Urgent need to urinate, which may lead to rushing and falls. Visual impairments: Difficulty seeing obstacles or hazards in the environment. Differential Diagnosis: Orthostatic hypotension: Dizziness and falls when standing up, commonly due to medications or dehydration. Vertigo: Dizziness caused by inner ear problems such as benign paroxysmal positional vertigo (BPPV). Musculoskeletal issues: Joint problems or pain may cause unsteadiness and a risk of falls. Cardiovascular causes: Arrhythmias or other heart conditions that cause dizziness or fainting. Neurological conditions: Conditions such as Parkinson’s disease, stroke, or multiple sclerosis that impair motor control. Investigations: Postural drop: Check for orthostatic hypotension by measuring blood pressure when the patient stands. Electrocardiogram (ECG): To identify arrhythmias or heart conditions contributing to falls. Vision assessment: Evaluate for conditions like cataracts or macular degeneration. Neurological examination: To assess for cognitive impairments, gait issues, and other neurological conditions. Urinary assessment: To evaluate for incontinence or urinary urgency, which may increase fall risk. Bone density tests: To evaluate for osteoporosis if there is a history of falls and fractures. Screening Guidelines: Annual screening for individuals over 65 years if they: Have had 2 or more falls in the past 12 months. Present following a recent fall. Report difficulty with walking or balance. If the patient answers "yes" to any of these criteria, they should undergo a thorough history, examination, and risk assessment to determine the underlying causes and appropriate interventions. History: Key points to gather during the history include: Detailed fall history: How many falls, where they occurred (inside/outside), and the perceived cause of the fall (e.g., tripping, dizziness). Dizziness or lightheadedness: Associated with standing up or during specific activities. Palpitations: May indicate arrhythmias. Walking or balance issues: Difficulty with ambulation or fear of falling. Vision changes: Assess for cataracts or other visual impairments. Leg weakness: Assess muscle strength and any known history of musculoskeletal problems. Home hazards: Look for tripping hazards such as rugs or clutter. Incontinence: Urinary urgency or frequency may contribute to falls. Examination: Cognition: Assess alertness and orientation using tools like the GPCOG (cognitive assessment). Postural hypotension: Check for a drop in blood pressure on standing (orthostatic hypotension). Heart rate: Irregular heart rhythms can contribute to dizziness or fainting. Vision and cataracts: Test for visual acuity and screen for cataracts. Gait and lower limb neurological function: Assess walking ability and any neurological deficits. Feet and shoes: Check for deformities, poorly fitted shoes, or conditions like bunions or ingrown toenails that may contribute to unsteadiness. Sit-to-stand and alternate step tests: Evaluate strength, balance, and coordination. Assessment: GPCOG: Use this cognitive tool to assess for cognitive impairments. Falls Risk Assessment Tool: Use a standardized tool (such as a redbook-based tool) to evaluate the patient’s fall risk. Occupational therapy (OT) assessment: OT assessment in the home to identify hazards and recommend modifications (e.g., grab bars, proper lighting). Management: Medication review: Rationalize medications, especially those that may contribute to dizziness or balance problems. This includes reviewing psychotropic drugs, sedatives, anticholinergics, and antihypertensives. Regular exercise: Encourage home-based or community-based exercise programs, especially those that target balance and strength training (at least 150 minutes per week). Vitamin D: Ensure adequate levels of Vitamin D (aiming for >60 ng/mL) to support muscle function and bone health. Home modifications: Recommend home safety modifications, such as removing tripping hazards, improving lighting, and adding support bars in bathrooms. Referrals: Optometrist/ophthalmologist: For vision assessment and correction, particularly for cataracts or poor vision. Occupational therapist (OT): For home safety assessments and modifications. Physiotherapist: To help with balancing exercises and strengthening, especially if balance issues are present. Podiatrist: For foot health, including addressing issues with footwear, gait, and any foot deformities. NOTES: ATSI individuals should be assessed more frequently due to their higher risk of falls and associated complications. Medication review is critical in elderly patients, especially with polypharmacy and the use of drugs that may cause sedation, dizziness, or hypotension. Bookmark Failed! Bookmark Saved! Add Bookmark Refresh Refresh

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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 Hyperthyroidism History Palpitations Weight loss Heat intolerance Hyperhidrosis Muscle weakness Vision changes Tremors Diarrhoea Anxiety Examination Irregular heart rate Tremors Goitre or nodule Proptosis (exophthalmos) Reduced extraocular movements Pretibial myxoedema Proximal muscle weakness Hyperreflexia Diagnosis Blood tests TSH-receptor antibodies (TRAb) confirm Graves’ disease (positive in 90–95% of cases) TPO antibodies: Often elevated in autoimmune thyroid disorders but not diagnostic for hyperthyroidism alone Radionuclide Thyroid Scan Graves’ disease: Diffuse increased uptake Toxic multinodular goitre: Multiple areas of increased uptake Toxic adenoma: Focal uptake with suppression of the surrounding tissue Subacute thyroiditis or thyroid hormone ingestion: Near-absent uptake Ultrasound with Doppler Useful for nodules (to assess malignancy risk) or for identifying Graves' hypervascularity When to consider testing Use TSH and T4 to confirm hyperthyroidism in symptomatic individuals or atypical presentations Follow up subclinical results (low TSH, normal T4/T3) with repeat testing in 6–8 weeks Management 1. Antithyroid Drugs Carbimazole: First-line for most patients Severe disease: 30–45 mg daily, adjusted every 4–6 weeks Mild disease: 10–20 mg daily Maintenance: Lowest dose to maintain euthyroidism (2.5–10 mg/day) Propylthiouracil: Reserved for pregnancy (first trimester), thyroid storm, or intolerance to carbimazole Dosing: 100–200 mg daily in divided doses 2. Beta Blockers Provide symptomatic relief (e.g., palpitations, tremors) Commonly used: Atenolol 25–50 mg once daily 3. Radioiodine Therapy Indicated for Graves’ disease, toxic adenoma, or multinodular goitre if unresponsive to medications or surgery is contraindicated CI: Pregnancy, severe ophthalmopathy 4. Surgery (Thyroidectomy) Indicated for large goitre, malignancy, or failure of other treatments Requires preparation with antithyroid drugs to achieve euthyroidism preoperatively Subclinical Hyperthyroidism - Low TSH with normal T4/T3 levels When to treat TSH < 0.1 and >65 years of age or postmenopausal Presence of complications (e.g., osteoporosis, atrial fibrillation) Treatment Thionamides Chance of permanent remission and avoid perm hypoT. cont 12-18mo or until TRAb conc returns to normal. Carbimazole 10-20mg (divided 2-3 doses) - if mild sx Carbimazole 30-45mg (divided 2-3 doses) - if sig symptoms ie sig weight loss, AF) or >2.5x normal limit of T3/4 (2) propylthiouracil 300-450mg (divided in 2-3 doses) Carbimazole and PTU Minor: rash, nausea Major: agranulocytosis (rare, stop and review if fevers, infection) PTU can also rarely cause severe liver injury (req transplant) + better in preg (can be cont throughout) (1) propanolol 10mg bd (40mg) (1) atenolol 25mg od (50mg) Radioiodine ablation and thyroidectomy Usually req thionamides to achieve euthyroid prior (esp if sig hyperT sx) Perm hypoT req lifelong thyroxine Preferable over meds: In those w large goitre esp MNG or TA Thionamide allergy Elevated TRAb despite pharm Cancer (surg) Radioiodine ablation Given as capsule of sodium iodine, absorbed GIT and conc thyroid tissue 90% pts only req 1 dose, can take up to 6mo to destroy tissue Educate on radiation precautions (avoid contact w young children, preg women for few days after) Thyroidectomy Perm hypoT req lifeling thyroxine Permanent voice hoarseness (RLN dmg). high cost. Note: use T3/4 to base dose adjustment as TSH can remain supp for several months. in hypothyroidism cont to use TSH to base adjustments. Hyperthyroidism History Symptoms: Palpitations, weight loss, heat intolerance, hyperhidrosis, muscle weakness, vision changes, tremors, diarrhoea, anxiety. Examination Physical findings: Cardiovascular: Irregular heart rate (HR), atrial fibrillation, sinus tachycardia. Neuromuscular: Tremors, proximal muscle weakness, hyperreflexia. Thyroid: Presence of goitre/nodules. Eye Signs: Proptosis/exophthalmos, lid lag, reduced extraocular movements, periorbital oedema (specific to Graves’ disease). Skin: Pretibial myxoedema (Graves’ specific), fine hair, thin skin, excessive sweating (hyperhidrosis). Diagnosis Laboratory Tests: TSH receptor antibodies (TRAb): Confirms Graves’ disease but may be negative in mild cases (~10%). Three Types: Stimulating: Increases iodide uptake and thyroid hormone production. Blocking: Inhibits TSH activity, seen in hypothyroidism. Neutral: No effect on TSH binding, may induce cell stress. TRAb levels decline with antithyroid therapy but persistently high levels may indicate relapse risk. Thyroid function tests: TSH levels: Low in primary hyperthyroidism. FT3/FT4: Increased levels; normal free T4 but elevated T3 suggests T3 toxicosis. Additional tests: thyroid antibodies: TPO (thyroid peroxidase) antibodies: Indicates autoimmune thyroid disease. Thyroglobulin (TG) antibodies. Imaging: Thyroid scintigraphy (Technetium-99m or RAI uptake): Used to identify functional status and structure of thyroid tissue. Findings: Diffuse uptake: Graves' disease. Multifocal uptake: Toxic multinodular goitre (TMNG). Focal uptake: Toxic adenoma. Reduced uptake: Thyroiditis or exogenous thyroxine ingestion. Thyroid ultrasound with Doppler: Can assess vascularity in Graves' disease or detect nodules if radioactive iodine is contraindicated. When to Treat Subclinical Hyperthyroidism Definition: TSH < 0.5 with normal T3 and T4. Complications: Osteoporosis, atrial fibrillation. Indications for Treatment: TSH 0.1–0.5 if high risk of cardiac or osteoporosis complications, age >65 years, postmenopausal (observe or treat). TSH <0.1 in healthy individuals (observe or treat). Monitoring: Serial TSH, T3, T4 every 6 months if observing. Treatment (Include Pertinent Side Effects and Pros/Cons of Each Treatment) Thionamides (Carbimazole, Propylthiouracil): Mechanism: Inhibit thyroid hormone synthesis. Dosing: Carbimazole: 10–45 mg/day depending on severity. Propylthiouracil (PTU): Used in pregnancy (first trimester), thyroid storm, or if allergic to carbimazole. Side Effects: Minor: Rash, nausea. Major: Agranulocytosis, hepatotoxicity (more with PTU). Pros/Cons: Pros: Non-invasive, reversible. Cons: Risk of relapse, agranulocytosis, hepatotoxicity (monitor liver function). Radioiodine Ablation: Indication: Preferred in TMNG, large goitres, or Graves' with persistent high TRAb post-antithyroid therapy. Mechanism: Destroys thyroid tissue using radioactive iodine. Side Effects: Hypothyroidism (late onset), acute thyrotoxicosis (7–10 days post-treatment). Contraindications: Pregnancy, severe orbitopathy, breastfeeding (48-hour post-ablation hold). Thyroidectomy: Indication: Large goitre, suspicion of malignancy, or failed medication and radioiodine treatment. Preoperative Preparation: Antithyroid medication 1–2 weeks before surgery. Complications: Hypoparathyroidism, recurrent laryngeal nerve palsy, airway obstruction due to haematoma. Post-op Management: Lifelong thyroxine replacement. Beta Blockers (e.g., Propranolol): Indications: Symptomatic relief for tachycardia, tremor, and anxiety. Contraindications: Asthma, heart block, diabetes mellitus. Alternatives: Diltiazem if beta-blockers contraindicated. Differentials Conditions: Toxic multinodular goitre, toxic adenoma, Graves' disease, thyroiditis (subacute, postpartum), exogenous thyroxine ingestion, amiodarone-induced thyrotoxicosis, TSH-secreting pituitary adenoma. Notes: Graves’ Specific Signs: Thyroid acropachy, ophthalmopathy, pretibial myxoedema. Management of orbitopathy includes corticosteroids or surgical decompression for severe cases. Prognosis Graves' disease: After 2 years of antithyroid medication, 25% may achieve remission, while others may relapse or develop hypothyroidism. Complications Cardiovascular: Atrial fibrillation, heart failure, myocardial infarction (thyroid storm). Bone health: Increased risk of osteoporosis and fractures due to accelerated bone turnover. Eye Disease: Thyroid eye disease (Graves' orbitopathy): can progress despite control of hyperthyroidism. Management includes lubricating eye drops, systemic corticosteroids for severe cases, and surgery in refractory cases. Special Considerations Subclinical Hyperthyroidism: TSH <0.5 mU/L with normal T3 and T4. Treatment indicated if TSH <0.1 mU/L in patients >65 years, postmenopausal women, or those with cardiovascular risk. Observe with serial TFTs if asymptomatic and lower risk. Thyroid Storm: Life-threatening exacerbation of hyperthyroidism. Presentation: Fever, tachycardia (often atrial fibrillation), diarrhoea, agitation. Management: Resuscitation, beta-blockers, PTU, iodine solution, glucocorticoids. Pregnancy: Hyperthyroidism may improve in later pregnancy due to reduced HCG levels. Graves' disease: Monitor TRAb levels in the 3rd trimester due to risk of fetal hyperthyroidism. PTU is preferred in the first trimester, transitioning to carbimazole thereafter. Gestational Hyperthyroidism (transient thyrotoxicosis due to elevated HCG in first trimester): Usually self-limiting, no treatment required. Notes: Definitions: Thyrotoxicosis: Clinical syndrome of elevated thyroid hormones from any cause. Hyperthyroidism: Overproduction of thyroid hormones specifically due to a hyperfunctioning thyroid gland. Risk of Complications from Antithyroid Drugs: Regular monitoring is essential to detect early signs of agranulocytosis and hepatotoxicity. Patients should be advised to seek medical help if they experience severe sore throat or fever. Beta-blocker Precautions: Propranolol is generally preferred, but atenolol may be used based on specific guideline recommendations. Bookmark Failed! Bookmark Saved! Add Bookmark Refresh Refresh