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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 Developmental Dysplasia of the Hip (DDH) Path Underdeveloped femoral head/acetabulum Risk: Tight swaddling Presentation 4Fs: Female, firstborn, family hx, funny birth (breech) Limb shortening, asymmetric gluteal creases Clicky hip: Resolves by 2 months → still investigate Diagnosis US: 4 weeks to 4 months XR: >6 months or earlier if US inconclusive Investigate even if clicky hip resolves Treatment Avoid tight swaddling Refer for Pavlik harness (paediatric ortho) Developmental Dysplasia of the Hip (DDH) Definition A spectrum of hip instability due to underdevelopment of the femoral head and/or acetabulum Can range from mild subluxation to complete dislocation Pathophysiology Shallow acetabulum fails to provide secure coverage of the femoral head Tight swaddling with the hips forced in extension and adduction can exacerbate dysplasia Genetic predisposition and in-utero positioning also contribute Presentation Female, firstborn, family history, and breech presentation are common risk factors Limb shortening and asymmetric gluteal or thigh creases Clicking hip on examination (Barlow and Ortolani tests may reveal instability) A “click” may resolve after 2 months but still warrants investigation if previously noted Diagnosis Ultrasound is preferred up to 4 months of age, typically initiated after 4 weeks of life X-ray is more accurate after 6 months once the proximal femoral epiphysis begins to ossify Further imaging is indicated even if early clinical signs appear to resolve Management Avoid tight swaddling, encourage free movement of the hips Refer to paediatric orthopaedics for possible Pavlik harness in infants Early harness use can reposition the femoral head and facilitate proper acetabular development Surgery may be required for severe or late-detected cases Notes Early recognition is crucial to prevent long-term complications such as gait disturbances and premature osteoarthritis Ongoing follow-up is essential to ensure stable hip development and detect any recurrence or residual dysplasia 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 Hernia Differentials for Inguinal Lump Inguinal/Femoral Hernia: Reducible/irreducible lump Lymphadenopathy: Tender, mobile (infection) Tumours: Testicular (males), lipoma, sarcoma Hydrocoele: Fluctuant, transilluminates, painless Ectopic/Undescended Testes: Non-palpable testes Ovarian Herniation (females): Firm, non-tender groin lump Umbilical/Epigastric Hernia Refer: Persistent >2 years Surgery: Usually by age 4; complications (rare) Inguinal Hernia Management: Follow "6-2 Rule" Birth–6 weeks: Operate in 2 days 6 weeks–6 months: Operate in 2 weeks 6 months: Operate in 2 months Strangulated/Incarcerated: Pain, irreducible, erythema → urgent surgery Femoral Hernia Referral: Always ASAP (high strangulation risk) Location: Lump below inguinal ligament Notes High Risk: Neonates, <6 months → prompt intervention prevents bowel ischemia US: Evaluate non-palpable testes, hydrocoele, ovarian herniation Hernia Differential Diagnosis for Inguinal Lump Inguinal or femoral hernia, which may be reducible or irreducible Lymphadenopathy: Tender and mobile, usually related to infection Tumours: Testicular tumours in males, lipoma, or sarcoma Hydrocoele: Fluctuant, transilluminates, painless Ectopic or undescended testes: Non-palpable or abnormal testicular location Ovarian herniation in females: Firm, non-tender groin lump Umbilical and Epigastric Hernia Midline defects presenting with a reducible lump Often resolve spontaneously by age 4 Referral indicated if persistent beyond 2 years or if complications occur Inguinal Hernia Management Follow the "6-2 Rule" for surgical timing Birth to 6 weeks: Operate within 2 days 6 weeks to 6 months: Operate within 2 weeks After 6 months: Operate within 2 months Urgent surgical intervention is required if there are signs of strangulation or incarceration (pain, irreducibility, erythema) Femoral Hernia Present as a lump below the inguinal ligament Carry a high risk of strangulation Require immediate referral and surgical management Additional Considerations Neonates and infants under 6 months are at high risk; prompt intervention prevents bowel ischaemia Ultrasound is useful for evaluating non-palpable testes, differentiating hydrocoele, and assessing ovarian herniation A thorough clinical examination and history are essential to distinguish hernias from other inguinal masses Parental education on recognising signs of strangulation, such as sudden pain or irreducibility, is vital Postoperative follow-up is important to monitor for recurrence or complications Notes Early surgical management in high-risk groups reduces the likelihood of bowel incarceration Femoral hernias in females have a higher risk of strangulation than inguinal hernias Imaging should be considered when the diagnosis is unclear Detailed documentation of findings guides appropriate management and referral decisions 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 Oesophageal Spasm Pathology Uncontrollable spasms of the oesophagus Cause unknown, but can be associated with oesophageal dysmotility disorders May be triggered by stress, cold/hot foods, or acid reflux Presentation Retrosternal acute onset sharp pains Radiation to the back Associated with dysphagia Episodes can mimic angina, with normal cardiac investigations Note: Pain may be relieved by nitroglycerin or calcium channel blockers, supporting a diagnosis of spasm Treatment Pantoprazole 40 mg orally once daily (initial treatment as per GORD with PPIs) Avoid cold/hot foods Drink warm water at the beginning of an episode Sublingual glyceryl trinitrate 400 mcg spray PRN Oral nifedipine, diltiazem Additional Notes: First-line: PPIs are beneficial for coexisting GORD, commonly linked with oesophageal spasms Lifestyle changes: Weight reduction, avoiding caffeine/alcohol, and smaller meals may reduce triggers Further management: Unresponsive cases may require oesophageal manometry to confirm diagnosis or referral to a gastroenterologist for consideration of botulinum toxin injection or myotomy Oesophageal Spasm Pathology Characterised by uncontrollable, intermittent spasms of the oesophagus. Exact cause unknown, but can be linked to oesophageal dysmotility disorders and triggered by stress, cold/hot foods, or acid reflux. Presentation Retrosternal, acute-onset, sharp chest pains which can mimic angina. Pain may radiate to the back. Often accompanied by dysphagia (difficulty swallowing). Normal cardiac investigations help exclude cardiac causes of chest pain. Notably, pain relief with nitroglycerin or calcium channel blockers supports a diagnosis of oesophageal spasm. Treatment Proton Pump Inhibitors (PPIs) Pantoprazole 40 mg daily is an initial choice, especially if GORD or acid reflux is suspected or coexisting. PPIs can help if acid-triggered spasm is relevant. Lifestyle Measures Avoid extremes of food temperature (cold or very hot). Drink warm water at the start of an episode to help relax the oesophagus. Manage any reflux triggers: Weight reduction, avoiding caffeine, alcohol, large meals. Stress management techniques (e.g. relaxation therapy). Symptomatic Relief Sublingual Glyceryl Trinitrate (400 mcg spray) PRN can relieve spasm. Calcium Channel Blockers (e.g. nifedipine, diltiazem) orally to reduce oesophageal muscle hypercontractility. Further Management If unresponsive to standard treatments, consider oesophageal manometry to confirm diagnosis of spasm versus other motility disorders (e.g. diffuse oesophageal spasm, nutcracker oesophagus). Referral to gastroenterologist if refractory: Options may include botulinum toxin injection into the oesophagus or myotomy in selected severe cases. Additional Notes First-line: Treat for possible coexisting GORD with PPIs. Reassure patients chest pain is non-cardiac if thorough cardiac workup is normal. Avoid triggers (cold drinks, large meals, stress) and adopt a healthy lifestyle. Confirm diagnosis by endoscopy and/or manometry if necessary. 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 Penile Abnormalities Phimosis Definition: Foreskin can't retract Types: Physiological: Normal, resolves by 17 yrs (99%) Pathological: Scarring, ballooning, recurrent balanitis Causes: Premature retraction, lichen sclerosus (BXO) Management: First-line: Betamethasone cream BD x 6–12 weeks Surgical: Circumcision if refractory or complications Complications: Balanitis, urinary retention, paraphimosis, rare penile cancer Paraphimosis Definition: Foreskin stuck behind glans, causing constriction Emergency: Risk of necrosis Management: Analgesia (oral/local) Oedema reduction: Compress penis for 15 min → manual reduction Refer urgently if unsuccessful Note: Circumcision not routine post-reduction Priapism Definition: Painful erection >4 hrs Types: Low flow (ischaemic): Most common, painful, rigid; causes: PDE5 inhibitors, sickle cell, leukaemia High flow (non-ischaemic): Post-trauma, painless, less rigid Management: Low Flow: Mild: Physical activity, cold packs (not in sickle cell), pseudoephedrine 120 mg Severe: Urology referral → aspiration ± phenylephrine injection High Flow: Urology consult; conservative or embolisation if needed Complications: ED, disfigurement, ischaemic necrosis Notes Avoid foreskin forceful retraction in children In sickle cell, manage underlying condition and avoid cold exposure Penile Abnormalities Phimosis Definition: Inability of the foreskin to retract over the glans; can be physiological (normal in young boys) or pathological (due to scarring, often from forced retraction or lichen sclerosus) Clinical Features: Physiological phimosis is common in infants and generally resolves by puberty (99% by 17 years) Pathological phimosis is characterised by a tight preputial ring, ballooning during urination and recurrent balanitis Management: First-line treatment with topical corticosteroid cream (eg, 0.05% betamethasone applied twice daily for 6–12 weeks) combined with improved hygiene Advise against forcible retraction to avoid further scarring Consider circumcision if conservative management fails or if complications such as urinary retention occur Notes: Evaluate for associated conditions such as balanitis xerotica obliterans if scarring is present Reassure caregivers that non-retractile foreskin in young children is often normal and improves with time Monitor for pain during voiding or evidence of infection, which would warrant re-assessment Paraphimosis Definition: Occurs when the retracted foreskin cannot be returned over the glans, causing a constricting band that may compromise blood flow Clinical Features: Presents with a painful, swollen foreskin that remains retracted behind the glans Risk of ischaemia and necrosis if not promptly reduced Management: Immediate management includes providing analgesia and applying a firm compression bandage for 10–15 minutes to reduce oedema followed by manual reduction If reduction is unsuccessful, repeat the compression technique or use local anaesthesia and refer urgently to urology Post-reduction, advise caregivers to avoid retraction for several days and ensure complete replacement of the foreskin over the glans Notes: Recognise paraphimosis as a urological emergency, particularly if signs of ischaemia (dusky or dark tissue) are present Emphasise that forced retraction during cleaning is a common cause and should be avoided Follow-up is essential to monitor for any recurrence or complications Priapism Definition: A persistent, often painful erection lasting more than 4 hours that is not related to sexual arousal Types: Low-flow (ischaemic) priapism: Most common; characterized by a rigid, painful erection with risk of ischaemia; associated with conditions such as sickle cell disease, use of PDE5 inhibitors or trauma High-flow (non-ischaemic) priapism: Typically painless and less rigid; usually secondary to arterial injury following trauma Clinical Features: Low-flow priapism presents with severe pain and rigidity, posing a risk for permanent tissue damage if not treated promptly High-flow priapism may present with a persistent erection but minimal pain Management: For low-flow priapism: Initiate conservative measures such as encouraging physical activity and urination, use oral pseudoephedrine (eg, 120 mg) if appropriate If symptoms persist, refer urgently to urology for corporal aspiration and intracavernosal injection of phenylephrine For high-flow priapism: Manage conservatively with urology consultation; consider interventions like arterial embolisation if conservative management fails Notes Low-flow priapism is a true urological emergency requiring prompt intervention to prevent ischaemic damage and subsequent erectile dysfunction Avoid cold packs in patients with sickle cell disease, as they may worsen vaso-occlusion Patient education is crucial, and early recognition of priapism signs can prevent long-term complications Document the duration of the erection and any associated symptoms to guide management decisions Notes Provide thorough education to patients and caregivers on proper genital hygiene and safe practices to avoid trauma Multidisciplinary management including referral to urology is essential for cases with complications or where initial management fails Regular follow-up is crucial to monitor treatment response and prevent recurrence of complications Bookmark Failed! 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Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE HbA1c Causes of Falsely Elevated HbA1c Decreased RBC Turnover: IDA Vitamin B12 or folate deficiency Chronic alcohol consumption Causes of Falsely Reduced HbA1c Increased RBC Turnover: Haemolytic anaemia Sickle cell disease or thalassaemia Splenomegaly Recent acute or chronic blood loss Recent blood transfusion Notes HbA1c is unreliable in the first 4 weeks of pregnancy or in conditions with altered red blood cell lifespan. Conversion of HbA1c between percentage (%) and mmol/mol is essential in clinical contexts (e.g., 7% = 53 mmol/mol). HbA1c Causes of Falsely Elevated HbA1c Decreased RBC turnover or prolonged RBC lifespan Iron deficiency anaemia (IDA) Vitamin B12 deficiency or folate deficiency Chronic alcohol intake can reduce RBC turnover Some haemoglobin variants can interfere with certain assay methods Causes of Falsely Reduced HbA1c Increased RBC turnover or shortened RBC lifespan Haemolytic anaemia (e.g. autoimmune, microangiopathic) Sickle cell disease or thalassaemia (abnormal haemoglobin variants) Splenomegaly (increased RBC destruction) Recent acute or chronic blood loss Recent blood transfusion (dilutes the patient’s haemoglobin pool) Notes: HbA1c may be unreliable in conditions that significantly alter RBC lifespan, including advanced liver or renal disease During the first 4 weeks of pregnancy, HbA1c does not accurately reflect glycaemic control due to dynamic changes in haemodilution and red cell turnover Consider alternative glucose monitoring (e.g. fructosamine) when HbA1c may be inaccurate Laboratory assays differ in their susceptibility to interference from uncommon haemoglobin variants (check local lab methods if suspicion arises) Conversion between % and mmol/mol (IFCC units) is essential (e.g. 7% ≈ 53 mmol/mol) Evaluate for iron deficiency or haemolysis if discordance between measured HbA1c and average home blood glucose levels is suspected Always correlate HbA1c with clinical context and other markers (e.g. fructosamine, home BGL readings) Investigate for haemolysis, iron deficiency, or haemoglobinopathies if unexplained discrepancies occur Use trimester-specific guidelines and validated assays in pregnancy In patients with known haemoglobinopathies or RBC disorders, emphasise alternative glycaemic measures like fructosamine or close capillary glucose monitoring 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 Back Pain Differentials Mechanical: Disc prolapse, spondylosis, spondylolysis, spondylolisthesis, muscular tear/spasm Fractures: Osteoporotic, pathological Infective: Epidural abscess, osteomyelitis, discitis, Pott’s disease Neoplastic: Bone mets (prostate, breast, lung), multiple myeloma Other Spinal: Stenosis, ankylosing spondylitis Referred Pain: AAA, renal colic, herpes zoster Endocrine: Paget’s disease, hyperparathyroidism Emergencies: Cauda equina syndrome Red Flags Age >50, fever, night sweats, weight loss Saddle anaesthesia, bladder/bowel dysfunction IVDU, immunosuppression, progressive neurological deficits Pain >4–6 weeks despite treatment Investigations Imaging: XR: Fractures, degenerative changes MRI: Neurological deficits, malignancy, infection, red flags Bloods: FBE, ESR/CRP (infection/inflammation) PSA (prostate cancer), calcium/ALP (Paget’s) Management General Back Pain: Non-Pharm: Stay active, physio (core strength/stretching), avoid bed rest Education: Most cases resolve in 4 weeks Follow-up in 3–6 days Pharm: NSAIDs (e.g., ibuprofen 400 mg TDS) or paracetamol (1 g QID) Consider muscle relaxants for spasm Bone Metastases: Pharm: Paracetamol, NSAIDs, corticosteroids (e.g., dexamethasone 4–8 mg), opiates (e.g., oxycodone 5 mg QID) Adjuvant: Radiotherapy, bisphosphonates, denosumab Supportive: Multidisciplinary care Back pain Differential Diagnosis Disc prolapse Facet joint arthropathy/pain (spondylosis) Muscular tear/spasm Osteoporotic fracture Pathological fracture Spinal epidural abscess Vertebral osteomyelitis Septic discitis Pott’s disease (tuberculosis of the spine) Spondylolysis Spondylolisthesis Spinal stenosis Paget’s disease of bone Multiple myeloma Abdominal aortic aneurysm (AAA) Herpes zoster (especially when pain is dermatomal) Cauda equina syndrome Ankylosing spondylitis Nephrolithiasis Hyperparathyroidism Mechanical back pain (particularly non-specific low back pain) Red Flags (Indications for Early Imaging) Age >50 years Unexplained fever, night sweats Unintentional weight loss Saddle anaesthesia Urinary retention or overflow incontinence Bladder or faecal incontinence Intravenous drug use (IVDU) Immunocompromised state (e.g. long-term steroid use) Night and rest pain Severe or progressive lower limb motor symptoms Bilateral leg symptoms Pain persisting >4–6 weeks despite conservative treatment Known malignancy history History Explore onset, duration, character, and radiation of pain Enquire about systemic symptoms (fever, weight loss), neurological deficits (numbness, weakness), and bladder or bowel incontinence Assess lifestyle factors, psychosocial issues, and any occupational or sports-related risk factors Document history of trauma, osteoporosis, malignancy, or risk factors for infection Examination Neurological assessment of the lower limbs (motor, sensory, and reflexes) Saddle anaesthesia testing and anal sphincter tone assessment where indicated Palpate the spine for tenderness and check for vertebral point tenderness Observe spinal range of motion (ROM) and assess gait Look for any postural abnormalities or signs of deformity (e.g. scoliosis) Investigations Imaging Plain X-ray: useful to identify fractures, significant degenerative changes, spondylolisthesis MRI: indicated for neurological deficits, suspected malignancy, infection, or unresolved red flags CT: may help delineate bony detail if MRI is contraindicated Laboratory Tests FBE, ESR, CRP to screen for infection/inflammation PSA (for prostate cancer), calcium/ALP (for Paget’s disease) when clinically indicated Management General Back Pain Encourage continued activity and discourage prolonged bed rest Paracetamol 1 g QID and/or NSAIDs (e.g. ibuprofen 400 mg TDS) as needed Consider a short course of muscle relaxants if severe spasm is present Early referral to physiotherapy for core strengthening, stretching, and manual therapy as appropriate Assess and address psychosocial factors (yellow flags) that may delay recovery (e.g. fear avoidance, depression, or workplace stress) Reassure most cases improve within 4–6 weeks with conservative measures Advise follow-up in 3–6 days for re-assessment, especially if symptoms worsen Back Pain with Bone Metastasis Analgesia ladder: paracetamol, NSAIDs, opioids (e.g. oxycodone 5 mg QID), and corticosteroids (e.g. dexamethasone 4–8 mg) Consider adjuvants such as bisphosphonates or denosumab and referral for radiotherapy Multidisciplinary management (palliative care, oncology, physiotherapy) Additional Considerations Avoid imaging in the first 4–6 weeks of non-specific back pain unless red flags are present Screen for psychological distress, as it can contribute to chronicity In older patients, assess for osteoporosis and fracture risk Chronic or recurrent back pain may warrant investigation for inflammatory causes (e.g. ankylosing spondylitis) Complications Chronic pain and associated functional limitations Neurological deficits if nerve roots or spinal cord are involved (e.g. cauda equina syndrome) Deconditioning due to fear avoidance of movement Psychological impact, including depression and anxiety Prognosis Most acute non-specific back pain resolves within a few weeks Persistent or severe pain requires thorough investigation to exclude serious pathology Early intervention addressing both physical and psychosocial factors improves outcomes 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 LP Headache Risk Reduction Needle bevel parallel to dural fibres Use atraumatic needle (smallest gauge possible, 22G minimum) Replace stylet before withdrawing needle Minimise attempts; operator experience is key Ineffective in Preventing LP Headache CSF volume removed Increased fluid intake Bed rest duration LP position (lying vs sitting) Key Features Onset: Within 3 days (can occur up to 12 days post-LP) Duration: Usually resolves within 1 week; may require an epidural blood patch Symptoms: Postural headache (worse standing, improves lying flat) Tinnitus, dizziness, neck stiffness, vision changes Possible nausea, photophobia LP Headache (Post-Dural Puncture Headache) Risk Reduction Measures Needle Bevel Orientation: Insert with the bevel parallel to the dural fibres (reduces dural tear). Atraumatic Needle: Use the smallest gauge possible (≥22G) to minimise dural disruption. Stylet Replacement: Reinsert stylet before withdrawing the needle. Minimise Multiple Attempts: Operator experience significantly decreases the risk of post-LP headache. Ineffective in Preventing LP Headache CSF Volume Removed: No proven impact on post-LP headache frequency. Increased Fluid Intake: Routine ‘forced fluids’ after LP is not supported by evidence. Bed Rest Duration: No proven benefit in preventing headache. LP Position (lateral decubitus vs. sitting): No clear difference in headache rates. Key Features Onset: Typically within 3 days post-LP (can be delayed up to ~12 days). Duration: Often resolves spontaneously within 1 week; some cases need further intervention. Symptoms: Postural headache: Worsens on standing, improves on lying flat. Tinnitus, dizziness, neck stiffness, vision changes possible. Nausea, photophobia may also occur in moderate to severe cases. Management Conservative: Encourage lying flat if symptomatic, oral analgesics (paracetamol, NSAIDs). Epidural Blood Patch: Definitive treatment if severe headache persists >24–48 hours and is incapacitating. Hydration: Standard fluid intake, no need for forced hydration. Follow-Up: Advise returning if headache worsens or new neurological symptoms develop. 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 Retinitis Pigmentosa and Fundoscopy Findings Retinitis Pigmentosa Pathophysiology: Hereditary (AD, AR, X-linked) retinal degeneration → rod/cone damage Melanin migration to peripheral retina Presentation: Early: Night blindness (rods affected) Progressive: Peripheral vision loss → tunnel vision Fundoscopy: Bone spicule pigmentation, optic disc pallor, attenuated vessels Management: No cure; limited evidence for vitamin A Supportive: Vision aids, mobility training, genetic counselling Fundoscopy Findings CRVO ("Blood and Thunder"): Diffuse haemorrhages, tortuous veins, macular oedema, cotton-wool spots CRAO ("Cherry Red Spot"): Pale retina, red macula, attenuated arteries; often after amaurosis fugax Diabetic Retinopathy: Microaneurysms, hard exudates, dot/blot/flame haemorrhages, neovascularisation Hypertensive Retinopathy: Flame haemorrhages, cotton-wool spots, AV nicking, "silver-wiring" arterioles Retinitis Pigmentosa & Fundoscopy Findings Retinitis Pigmentosa (RP) Pathophysiology Hereditary retinal degeneration affecting rod and cone photoreceptors Inherited in autosomal dominant (most common), autosomal recessive, or X-linked patterns Damaged rods lead to night blindness, then progressive peripheral vision loss Melanin migrates to peripheral retina (the classic ‘bone spicule’ appearance) Presentation Early: Night blindness (nyctalopia), difficulty in dim light Progressive: Tunnel vision, eventual central vision decline Onset: Usually childhood to early adult years, slow progression Fundoscopy Bone Spicule pigmentation in peripheral retina Optic Disc Pallor (waxy appearance) Attenuated (narrow) Retinal Vessels Management No definitive cure; supportive measures: Low-vision aids, orientation and mobility training Genetic counselling for families Vitamin A high-dose supplementation: Limited evidence Investigational therapies: Gene therapy, retinal implants (in development) Fundoscopy Findings: Other Retinal Conditions Central Retinal Vein Occlusion (CRVO) — “Blood and Thunder” Diffuse retinal haemorrhages Tortuous, engorged veins Cotton-wool spots Macular oedema frequently present Often presents with sudden, painless vision loss Central Retinal Artery Occlusion (CRAO) — “Cherry Red Spot” Pale retina (due to ischaemia), cherry-red fovea (macula) Attenuated retinal arterioles May have a preceding amaurosis fugax episode Emergency: Immediate ocular massage, consider stroke risk Diabetic Retinopathy Microaneurysms Hard exudates, dot/blot haemorrhages, sometimes flame haemorrhages (in more severe changes) Neovascularisation in proliferative stage Advanced cases: Vitreous haemorrhage, tractional retinal detachment Hypertensive Retinopathy Flame haemorrhages, cotton-wool spots (nerve fibre layer infarcts) AV Nicking (arteriovenous crossing changes) Silver-wiring or copper-wiring of arterioles in chronic hypertension Severe BP elevation → papilloedema 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 Asthma Treatment Targets SpO₂: >95% (mild-moderate), ≥92% (severe/critical) Mild/Moderate Asthma Salbutamol via spacer: <6 yrs: 6 puffs ≥6 yrs: 12 puffs 1 puff = 4 breaths, repeat every 20 min for 1 hr as needed Severe Asthma Salbutamol + Ipratropium via spacer: Salbutamol: Same doses as above Ipratropium: <6 yrs: 4 puffs, ≥6 yrs: 8 puffs If spacer ineffective: Nebulised therapy: <6 yrs: Salbutamol 2.5 mg + Ipratropium 250 mcg ≥6 yrs: Salbutamol 5 mg + Ipratropium 500 mcg Critical Asthma Immediate nebulisation: Double doses initially: <6 yrs: Salbutamol 2 × 2.5 mg + Ipratropium 250 mcg ≥6 yrs: Salbutamol 2 × 5 mg + Ipratropium 500 mcg Continuous salbutamol if critical Additional Management Corticosteroids: Prednisolone 1 mg/kg (max 50 mg) IV hydrocortisone 4 mg/kg (max 100 mg) if vomiting Oxygen: Target SpO₂ ≥92% Magnesium sulfate (IV): 50 mg/kg (max 2 g) over 20 min for life-threatening cases Monitoring Observe breathing effort, oxygenation, symptom improvement Escalate to critical care if no response (consider intubation) Asthma Treatment Targets Maintain SpO₂ >95% in mild to moderate exacerbations Maintain SpO₂ ≥92% in severe or critical presentations Aim to stabilise airway function promptly and prevent further deterioration Mild/Moderate Asthma Give salbutamol via spacer: <6 yrs 6 puffs, ≥6 yrs 12 puffs Use 1 puff followed by 4 breaths, repeat every 20 min for up to 1 hr as needed Consider early oral corticosteroids if response is suboptimal Provide a calm environment to reduce anxiety and respiratory distress Severe Asthma Administer salbutamol with ipratropium via spacer Salbutamol doses as for mild/moderate plus ipratropium <6 yrs 4 puffs, ≥6 yrs 8 puffs Switch to nebulised therapy if spacer is ineffective: <6 yrs salbutamol 2.5 mg + ipratropium 250 mcg, ≥6 yrs salbutamol 5 mg + ipratropium 500 mcg Give oral or IV corticosteroids promptly Provide oxygen to keep SpO₂ ≥92% Critical Asthma Nebulise immediately with double-dose salbutamol <6 yrs salbutamol 2×2.5 mg + ipratropium 250 mcg, ≥6 yrs salbutamol 2×5 mg + ipratropium 500 mcg Consider continuous salbutamol if poor response Involve critical care if child remains in severe distress or shows exhaustion Additional Management Corticosteroids: Prednisolone 1 mg/kg (max 50 mg) or IV hydrocortisone 4 mg/kg (max 100 mg) if vomiting Oxygen to maintain SpO₂ ≥92% IV magnesium sulfate 50 mg/kg (max 2 g) over 20 min for life-threatening attacks Ensure adequate hydration and correct any electrolyte imbalances Monitor serum potassium if frequent or continuous salbutamol is used Monitoring Assess respiratory effort, wheeze, SpO₂, and heart rate regularly Observe for clinical improvement or signs of worsening airway obstruction Reassess after each treatment dose to guide ongoing therapy Escalate care and consider intubation if no significant response Review inhaler technique and arrange a written action plan before discharge 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 Granuloma Annulare (GA) Definition Chronic skin condition with smooth, discoloured annular plaques/papules "String of pearls" appearance Types & Associations Localised GA: Linked to autoimmune thyroiditis (not responsive to thyroid treatment) Generalised GA: Associated with diabetes, hyperlipidaemia, rarely HIV, lymphoma, solid tumours Clinical Features Common sites: Hands, feet, other areas Asymptomatic, may be tender if knocked Differential Diagnosis Tinea manuum Pompholyx/contact dermatitis Palmoplantar psoriasis Management Often self-resolving (months–years) Local therapies (if persistent/unsightly): Topical corticosteroids (e.g. betamethasone dipropionate 0.05% BD x 4 weeks) under occlusion Intralesional steroid injections Cryotherapy/laser ablation When to Treat: If unsightly, painful, or interfering with daily life If no resolution in months, consider biopsy to confirm diagnosis Granuloma Annulare (GA) Definition Granuloma annulare (GA) is a chronic dermatological condition presenting as smooth, discoloured annular plaques or papules. Lesions can have a “string of pearls” appearance with raised borders and central clearing. Although it can occur at any age, GA commonly affects children and young adults, often on the hands and feet. Types & Associations Localised GA Tends to be limited to a few discrete areas (e.g., backs of hands, feet). Can be linked to autoimmune thyroiditis, though treating thyroid disease doesn’t always resolve GA. Generalised (Disseminated) GA More extensive involvement, potentially widespread. Associated with diabetes, hyperlipidaemia, and in rare cases, HIV, lymphoma, or solid tumours. Typically warrants further evaluation if abrupt or extensive onset. Clinical Features Commonly affects hands and feet, though can appear on other body areas. Lesions are often asymptomatic, though some patients report mild tenderness if the lesion is bumped or scraped. Characteristic ring-shaped plaques: Central area may appear slightly depressed or normal in colour, with a raised, annular border. Differential Diagnosis Tinea manuum: Fungal infection of the hands, typically has scale, pruritus, and a possible active leading edge. Pompholyx (dyshidrotic eczema) or contact dermatitis: Generally more vesicular or intensely pruritic, with a different distribution pattern. Palmoplantar psoriasis: Usually well-demarcated plaques with scaling, possible nail changes. Management Self-Resolving Many cases resolve spontaneously over months to a few years, without scarring. Reassure patients if lesions are not bothersome. Local Therapies (for persistent or unsightly lesions): Topical corticosteroids under occlusion (e.g. betamethasone dipropionate 0.05% BD for up to 4 weeks) Intralesional steroid injections for isolated plaques Cryotherapy or laser ablation (less commonly used, typically for resistant or cosmetically significant lesions) When to Treat: If lesions are unsightly, painful, or interfere with daily life (e.g. friction over joints) If no resolution in several months or uncertain diagnosis, consider skin biopsy to confirm and exclude other causes. Notes While GA may be associated with underlying conditions (e.g. thyroid disease, diabetes, dyslipidaemia), many patients have idiopathic disease. Checking fasting glucose or HbA1c and lipids may be considered if GA is widespread or recurrent, given some link with metabolic disturbances. Recurrences can happen even after lesions resolve. 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 Sepsis Criteria for sepsis T >38.3 or <36 HR >90 RR >20 Confusion BSL >7.1 in non-diabetic Oliguria Septic shock BP <90 Mottled or cold peripheries qSOFA (Not to diagnose sepsis but to predict mortality/need for ICU in suspected sepsis) 2 or more is concerning: BP <100 RR >22 Confusion Cap refill >3 sec Purpuric rash Lactate >2 Oliguria Complications Multi-organ failure (renal, respiratory, cardiac, hepatic) DIC ARDS Septic encephalopathy → confusion, delirium Hypoperfusion → limb ischaemia, necrosis Long-term immunosuppression → increased risk of recurrent infections Early intervention for sepsis or septic shock Rapid interventions within 1 hr of recognition: Measure blood lactate concentration; repeat within 2–4 hrs if >2 mmol/L Obtain blood cultures before antibiotics (2 sets in adults) Administer broad-spectrum antibiotics promptly (do not delay for investigations) Start IV fluid resuscitation (crystalloids) for hypotension or lactate >2 mmol/L Use vasopressors (e.g., noradrenaline) to maintain MAP ≥65 mmHg if hypotension persists If the source of infection is identified, initiate specific treatment (e.g., abscess drainage, device removal) in consultation with specialist teams Monitor response closely—repeat lactate and assess for perfusion markers (cap refill, BP, urine output) Additional Notes: Monitor for signs of progression to multi-organ dysfunction, particularly in the elderly or immunosuppressed. Sepsis Criteria for Sepsis Systemic Inflammatory Response Commonly indicated by ≥2 of: Temperature >38.3 or <36 HR >90 RR >20 Confusion or altered mental status BSL >7.1 mmol/L in non-diabetic patients Oliguria (<0.5 mL/kg/hr) Septic shock Systolic BP <90 or mean arterial pressure (MAP) <65 Mottled or cold peripheries, indicating hypoperfusion qSOFA (quick sequential organ failure assessment) Not diagnostic of sepsis but predicts mortality/need for ICU in suspected sepsis. 2 or more is concerning: BP <100 RR >22 Confusion Capillary refill >3 seconds Purpuric rash Lactate >2 Oliguria Complications Multi-organ failure (renal, respiratory, cardiac, hepatic) Disseminated intravascular coagulation (DIC) Acute respiratory distress syndrome (ARDS) Septic encephalopathy (delirium, confusion) Hypoperfusion (limb ischaemia, necrosis) Long-term immunosuppression (increased risk of recurrent infections) Early intervention for sepsis or septic shock Aim to initiate the following within 1 hour of recognition: 1. Measure blood lactate Repeat in 2–4 hours if initial lactate >2 mmol/L 2. Obtain blood cultures Ideally before antibiotics (2 sets in adults); consider other relevant cultures (urine, sputum) if indicated 3. Administer broad-spectrum IV antibiotics promptly Do not delay for investigations Tailor therapy as per local antimicrobial guidelines and culture results 4. Start IV fluid resuscitation Crystalloids (e.g. 0.9% saline or balanced solutions) if hypotension or lactate >2 mmol/L Consider a bolus of ~30 mL/kg in severe sepsis/shock Monitor fluid responsiveness (HR, BP, cap refill, lactate) 5. Use vasopressors Noradrenaline first-line to maintain MAP ≥65 if hypotension persists after fluids Add vasopressin if further support needed 6. Source control If infection source identified (abscess, device), arrange appropriate intervention (e.g. drainage, line removal) 7. Monitor response closely Repeat lactate and assess perfusion markers (cap refill, BP, urine output, mental status) Notes: Elderly or immunocompromised patients may have atypical presentations (lower fevers, vague confusion) Sepsis survivors benefit from structured follow-up (post-sepsis syndrome can include chronic fatigue, cognitive changes) In persistent hypotension, consider adjunct measures (steroids) if shock is refractory to fluids and vasopressors Early recognition and management significantly reduce mortality risk Optimise supportive care, including oxygenation and, if required, mechanical ventilation for ARDS Bookmark Failed! Bookmark Saved! Refresh Refresh Refresh