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 Cardiovascular Disease (CVD) Risk Assessment Definition:Cardiovascular disease (CVD) encompasses conditions affecting the heart and blood vessels, such as coronary artery disease, heart failure, and stroke. Risk assessment identifies high-risk individuals for early intervention to reduce morbidity and mortality. Causes/Aetiology: Hypertension: Major contributor to CVD. Dyslipidaemia: High LDL and low HDL cholesterol. Smoking: Increases atherosclerosis risk. Diabetes: Heightens heart disease and stroke risk. Family History: Early-onset CVD in first-degree relatives. Obesity and Inactivity: Contribute to diabetes, hypertension, and dyslipidaemia. Pathophysiology:CVD results from lifestyle, environmental, and genetic factors leading to atherosclerosis. Plaques in the arteries restrict blood flow, causing heart attack, stroke, and peripheral artery disease. Symptoms: Chest Pain: Often due to angina or heart attack. Shortness of Breath: Associated with heart failure. Fatigue: Commonly linked to heart disease. Palpitations: Irregular heartbeats signaling potential arrhythmia. Dizziness or Fainting: Indicates poor circulation or arrhythmias. Swelling: Often in legs, related to heart failure. Differential Diagnosis: Anxiety: Chest pain and palpitations, typically not exertion-related. GERD: Mimics chest pain, usually relieved by antacids. Musculoskeletal Pain: Discomfort often related to posture/activity. Panic Attacks: Palpitations and shortness of breath without exertion. Investigations: Blood Pressure: Hypertension screening. Lipid Profile: Total cholesterol, LDL, HDL, triglycerides. ECG: Checks arrhythmias, past heart attacks, ischemic changes. Blood Glucose and HbA1c: Diabetes screening. Kidney Function Tests (eGFR, ACR): CKD is a significant CVD risk factor. Cardiac Imaging: Echo or coronary CT scan for heart function and artery assessment. CVD Risk Assessment Guidelines: Ages 45-79: Routine CVD screening. Diabetes Patients (35-79): Earlier and more frequent assessment. First Nations (30-79): Begin screening from 18-29 based on individual risk. Automatic High-Risk Categories: Familial Hypercholesterolaemia: Elevated CVD risk. Chronic Kidney Disease (CKD): Moderate-to-severe cases with eGFR <45 or ACR >25 (men) / >35 (women). Management: Lifestyle Modifications: Weight loss, healthy diet, regular exercise, smoking cessation, limit alcohol. Medications: Statins for cholesterol, antihypertensives for BP, diabetes meds as required, aspirin for high-risk patients with history of CVD events. Complications:Heart attack, stroke, heart failure, disability, or death. Prognosis:Early identification and management can significantly reduce CVD complications. Long-term outcomes depend on adherence to treatment and lifestyle modifications. Notes: Annual Assessment for ATSI Patients: Even low or intermediate-risk individuals. High BP (>160/100 mmHg): Treat regardless of CVD risk. Reclassification: Adjust risk level based on additional factors (e.g., CAC score, CKD, family history, mental health conditions requiring specialist treatment). CVD Risk Assessment Definition: Cardiovascular disease (CVD) encompasses various conditions affecting the heart and blood vessels, including coronary artery disease, heart failure, and stroke. Risk assessment for CVD is essential to identify individuals at high risk and enable early intervention to reduce morbidity and mortality associated with these conditions. Aetiology/Causes: Key risk factors for CVD include: Hypertension: Chronic high blood pressure is a major contributor to heart disease. Dyslipidaemia: High cholesterol (especially LDL) and low HDL cholesterol levels increase the risk of atherosclerosis. Smoking: A leading risk factor for atherosclerosis and CVD. Diabetes: Increases the risk of both heart disease and stroke. Family history: First-degree relatives with premature CVD (before age 55 in men, 65 in women) significantly increase an individual's risk. Obesity: Excess weight contributes to diabetes, hypertension, and high cholesterol. Physical inactivity: Lack of exercise is linked to a higher risk of heart disease. Pathophysiology: CVD develops from a combination of environmental, lifestyle, and genetic factors that contribute to the formation of plaques in the arteries (atherosclerosis). These plaques can restrict blood flow, leading to conditions such as heart attack, stroke, and peripheral artery disease. Chronic conditions like diabetes, hypertension, and dyslipidaemia contribute to endothelial dysfunction, which accelerates the process of atherosclerosis. Symptoms: Chest pain or discomfort: Often associated with angina or heart attack. Shortness of breath: Can occur with heart failure. Fatigue: A common symptom of heart disease. Palpitations: Irregular heartbeats may signal an underlying CVD condition. Dizziness or fainting: Can indicate poor circulation or arrhythmias. Swelling: Often in the ankles or legs, associated with heart failure. Differential Diagnosis: Anxiety: May present with chest pain and palpitations but is typically not associated with exertion or physical activity. Gastroesophageal reflux disease (GERD): Can mimic chest pain, but it is typically relieved by antacids. Musculoskeletal pain: Can present as chest discomfort but is usually related to posture or physical activity. Panic attacks: Can cause palpitations and shortness of breath, but it is not typically associated with exertion. Investigations: Blood Pressure Measurement: Key to assessing hypertension, a major CVD risk factor. Lipid Profile: Total cholesterol, LDL, HDL, and triglycerides are measured to assess dyslipidaemia. ECG: Used to detect arrhythmias, past heart attacks, and ischemic changes. Blood Glucose and HbA1c: Important for diabetes screening. Kidney Function Tests (eGFR, ACR): Chronic kidney disease is a significant risk factor for CVD. Cardiac Imaging: Tests like echocardiograms and coronary artery CT scans help assess heart function and the presence of coronary artery disease. CVD Risk Assessment Guidelines: All individuals aged 45-79 years: Screening for CVD risk is recommended for all adults in this age group. People with diabetes aged 35-79 years: Diabetes increases the risk of CVD, requiring earlier and more frequent assessment. First Nations people aged 30-79 years: First Nations people are at higher risk for CVD, and individual risk factors should be assessed starting from age 18-29 years. Automatic High CVD Risk: Familial Hypercholesterolaemia: Individuals with a family history of high cholesterol are at an increased risk. Chronic Kidney Disease (CKD): Patients with moderate to severe CKD (eGFR <45 or urine ACR >25 for men, >35 for women) are automatically considered at high risk for CVD. Risk Calculation Variables: To calculate the CVD risk using the Australian CVD risk calculator, the following factors are considered: Age: Older individuals have a higher risk of CVD. Sex: Men typically have a higher risk of CVD at younger ages. Smoking status: Current smokers have a significantly higher CVD risk. Systolic blood pressure (BP): High BP is a major risk factor for CVD. Total cholesterol/HDL ratio: A higher ratio indicates a greater risk of heart disease. Use of CVD medications in the last 6 months: Patients on medications like antihypertensives or statins are considered to have a higher baseline risk. History of atrial fibrillation (AF): AF increases the risk of stroke and other CVD events. Postcode: Area of residence can indicate socio-economic and environmental factors impacting health. Diabetes: If the individual has diabetes, additional details such as HbA1c levels, uACR, eGFR, BMI, and use of insulin in the last 6 months are needed. CVD Risk Categories: Low Risk (<5%): Lifestyle changes alone are recommended. Reassess every 5 years. Medium Risk (5-10%): Consider medication. Reassess every 2 years. High Risk (>10%): Immediate action is necessary. BP control and statins should be considered. No further reassessment is needed in the short term. Reclassification of CVD Risk: Reclassify Downward: If the coronary artery calcium (CAC) score is 0 or below the 25th percentile, the individual’s risk can be reclassified down. For individuals of East Asian ethnicity (e.g., Chinese, Japanese, Korean), their risk may be lower, requiring reassessment. Reclassify Upward: If the CAC score is above 99 or in the >75th percentile, the risk should be increased. First-degree family history of premature CVD (men <55, women <65 with CAD or stroke) elevates risk. Chronic kidney disease (CKD) with an eGFR of 45-59 or microalbuminuria (>2.5 for men, >3.5 for women) is associated with increased CVD risk. Severe mental illness that requires specialist treatment over the last 5 years is a risk factor. Management: Lifestyle Modifications: Encourage weight loss, healthy eating (low-fat, high-fibre diet), and increased physical activity. Promote smoking cessation and limit alcohol consumption. Medications: Statins for cholesterol management. Antihypertensive medications to control blood pressure. Diabetes medications (insulin, metformin) as needed to manage blood glucose. Aspirin for patients with high CVD risk and history of cardiovascular events. Complications: Heart Attack and Stroke: CVD leads to these serious conditions, which may result in disability or death. Heart Failure: Progressive damage to the heart muscle due to long-standing CVD can lead to heart failure. Prognosis: Early identification and management of risk factors can significantly reduce the incidence of heart attacks, strokes, and other cardiovascular complications. Long-term outcomes depend on the severity of underlying risk factors and adherence to treatment and lifestyle changes. Notes: ATSI (Aboriginal and Torres Strait Islander) individuals should have their CVD risk assessed annually, even if they are classified as low or intermediate risk. High Blood Pressure: Blood pressure >160/100 mmHg should be treated regardless of the CVD risk level. Reclassification: Reclassifying risk is especially important for individuals whose risk is near the threshold of another category (e.g., transitioning from low to medium risk). 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 Chilblains (Perniosis) Definition Red or purple itchy, tender bumps caused by cold-induced vasoconstriction & ischemia Localised form of vasculitis; severe cases may cause microgeodic disease (small bone damage) Common Sites Fingers, toes, heels, lower legs, thighs, wrists, nose, ears Risk Factors Familial predisposition Females Impaired peripheral circulation (diabetes, smoking, hyperlipidaemia) Low body weight/malnutrition Hormonal changes (pregnancy) Connective tissue diseases (e.g. lupus, Raynaud’s phenomenon) Bone marrow disorders Symptoms Red/purple itchy bumps Blanchable discolouration Severe cases: Blistering, scabs, ulceration Lesions appear hours after cold exposure, resolve within 7–14 days Management Preventive Measures (1st Line) Avoid triggers: Cold, stress, beta-blockers Smoking cessation Keep warm: Thick socks, warm foot soaks, heated home environment Avoid caffeine & decongestants (vasoconstrictive effects) Topical Treatment Topical corticosteroids (e.g. betamethasone dipropionate 0.05%) for extensive or painful lesions GTN ointment (used preventatively, but evidence limited) Oral Treatment (2nd Line) Nifedipine (CCB) daily (for recurrent/severe cases) Other Options (For Severe/Recurrent Cases) Other vasodilators (e.g. low-dose aspirin, fish oil) Chilblains vs. Raynaud’s Phenomenon Feature Chilblains Raynaud’s Trigger Cold exposure Cold & stress Initial Appearance Red/purple itchy bumps White, numb fingers/toes → Blue → Red as blood returns Pathophysiology Localised vasculitis Vasospasm Types Not classified Primary (idiopathic, common) / Secondary (linked to scleroderma, atherosclerosis) Management Same 1st & 2nd line as Raynaud’s 3rd-line: GTN ointment, alpha-blockers (prazosin), PDE-5 inhibitors, sympathectomy (last resort) Notes Chilblains = inflammatory cold-induced vasculitis → resolves within 1–2 weeks Raynaud’s = vasospastic disorder, often linked to autoimmune conditions First-line treatment = prevention & warmth for both Second-line = nifedipine (CCB) for severe/recurrent cases Raynaud’s: Chilblains (Perniosis) Definition Red or purple itchy, tender bumps caused by cold-induced vasoconstriction and ischaemia Localised form of vasculitis; in severe cases, can lead to microgeodic changes in bone Typically resolve within 1–2 weeks if re-warming and avoidance of cold are maintained Common Sites Fingers, toes, heels, lower legs, thighs, wrists, nose, ears Risk Factors Familial predisposition Female sex Impaired peripheral circulation (e.g. diabetes, smoking, hyperlipidaemia) Low body weight or malnutrition Hormonal changes (e.g. pregnancy) Connective tissue diseases (e.g. lupus, Raynaud’s phenomenon) Bone marrow disorders (rare) Symptoms Red/purple itchy bumps that may blanch on pressure Lesions typically appear hours after cold exposure Can blister or ulcerate in severe cases Usually resolve spontaneously in 7–14 days Management Preventive Measures (First Line) Avoid cold exposure, stress, and vasoconstrictive medications (e.g. beta-blockers) Smoking cessation to improve peripheral circulation Keep warm with thick socks, gloves, and adequate heating Avoid caffeine and decongestants (both can induce vasoconstriction) Topical Treatment Topical corticosteroids (e.g. betamethasone dipropionate 0.05%) for extensive or painful lesions GTN ointment (limited evidence, sometimes used prophylactically) Oral Treatment (Second Line) Nifedipine (a calcium channel blocker) daily for recurrent or severe cases Other Options (Severe/Recurrent) Other vasodilators (e.g. low-dose aspirin, fish oil supplements) Investigate and treat any underlying connective tissue or haematological disorders Chilblains vs. Raynaud’s Phenomenon Feature Chilblains Raynaud’s Trigger Cold exposure Cold and emotional stress Initial Appearance Red/purple itchy bumps White, numb extremities → blue → red as blood flow returns Pathophysiology Localised inflammatory vasculitis Vasospasm of digital arteries Classification Not typically subdivided Primary (idiopathic, common) Secondary (associated with scleroderma, atherosclerosis) Management - Prevention (warmth, avoid triggers) - Nifedipine if severe - Prevention (warmth, avoid triggers) - Nifedipine or other CCB first-line - 3rd-line: GTN ointment, alpha-blockers, PDE-5 inhibitors, sympathectomy Notes Chilblains represent an inflammatory, cold-induced vasculitis. They generally resolve without intervention when the trigger is avoided. Raynaud’s phenomenon is a vasospastic disorder, often linked to autoimmune diseases, and may need more aggressive treatment to prevent tissue damage. First-line for both conditions includes preventive strategies (warmth, trigger avoidance). Second-line pharmacotherapy commonly involves calcium channel blockers (e.g. nifedipine) for recurrent or severe cases. 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 Myotomes & Nerves of the Hand Upper Limb Nerves Median Nerve: Motor: Wrist/hand flexors (except FCU, FDP to 4th/5th digits) Sensory: Lateral 3.5 digits (palmar) Test: OK sign (flexor pollicis longus, FDP – anterior interosseous branch) Ulnar Nerve: Motor: Finger adduction/abduction, FCU, FDP (4th/5th digits) Sensory: Medial 1.5 digits (palmar/dorsal) Test: Hold paper (interossei) Radial Nerve: Motor: Wrist/finger extensors Sensory: Dorsal thumb (web space) Test: "Shoot a gun" (thumb/finger extension) Myotomes (Upper Limb) C1, C2: Neck flexion/extension (nod) C3: Neck lateral flexion C4: Shoulder elevation C5: Shoulder abduction/flexion C5, C6: Elbow flexion, supination ("Pick up sticks") C7, C8: Elbow extension, pronation ("Lay them straight") C6, C7: Wrist flexion/extension C7: Finger extension ("Paper") C8: Finger flexion ("Rock") T1: Finger abduction/adduction ("Scissors") Myotomes (Lower Limb) L2, L3: Hip flexion ("Lift my knee") L3, L4: Knee extension ("Kick the door") L4, L5: Hip extension, dorsiflexion ("Foot to the sky") L5, S1: Knee flexion ("Kick my bum") S1, S2: Plantarflexion ("Stand on my shoes") Myotomes and Nerves of the Hand Upper Limb Nerves Median Nerve Motor: Wrist and hand flexors (excluding flexor carpi ulnaris and flexor digitorum profundus to 4th and 5th digits), thenar muscles (abductor pollicis brevis, opponens pollicis) Sensory: Lateral 3½ digits on the palmar side and nail beds dorsally Special Test: OK sign for anterior interosseous branch (flexor pollicis longus and FDP to index finger) Ulnar Nerve Motor: Finger abduction and adduction (interossei), flexor carpi ulnaris, flexor digitorum profundus to 4th and 5th digits, adductor pollicis Sensory: Medial 1½ digits on palmar and dorsal aspects Special Test: Paper grip test (interossei strength) Radial Nerve Motor: Wrist and finger extensors, brachioradialis Sensory: Posterior arm/forearm, dorsal hand (radial side), dorsal thumb web space Special Test: “Shoot a gun” sign (thumb and finger extension) Myotomes (Upper Limb) C1–C2 Neck flexion and extension Clinically tested by “nodding” the head C3 Neck lateral flexion Important for maintaining head posture C4 Shoulder elevation Assessed by shrugging the shoulders against resistance C5 Shoulder abduction or flexion Key muscle group includes deltoid C5–C6 Elbow flexion and forearm supination Tested with the biceps reflex and “pick up sticks” action C6–C7 Wrist extension and flexion Vital for grip stability and hand positioning C7 Elbow extension and finger extension Triceps reflex and “paper” sign for finger extension C8 Finger flexion Grip strength testing (e.g. “rock” sign) T1 Finger abduction and adduction Interossei function (“scissors” test) Myotomes (Lower Limb) L2–L3 Hip flexion (“lift my knee”) Iliopsoas strength assessment L3–L4 Knee extension (“kick the door”) Quadriceps power and patellar reflex L4–L5 Dorsiflexion of the foot and hip extension Gluteus maximus and tibialis anterior strength L5–S1 Knee flexion (“kick my bum”) Hamstring function S1–S2 Plantarflexion (“stand on my shoes”) Gastrocnemius and soleus power, Achilles reflex Dermatomes (Upper Limb) C1–C2 Scalp and upper posterior neck Rarely isolated in clinical testing C3 Lateral neck region Over the trapezius C4 Shoulder cap area Meets T2 dermatome around the axilla C5 Lateral upper arm Over the deltoid region C6 Lateral forearm, thumb “Six-shooter” thumb area C7 Middle finger Centre of the hand dorsally and ventrally C8 Ring and little finger medial side Medial forearm can also be tested T1 Medial forearm near elbow May overlap with T2 at the axilla Dermatomes (Lower Limb) L2–L3 Anterior thigh Below inguinal ligament and above the knee L4 Medial side of the leg and medial malleolus Overlaps with saphenous nerve distribution L5 Dorsum of the foot to the big toe Lateral leg transitioning to foot dorsum S1 Lateral foot and heel region Includes the little toe S2 Posterior thigh and calf Extends up to the popliteal fossa Additional Notes Median nerve compression commonly presents as carpal tunnel syndrome with numbness in the lateral 3½ digits Ulnar nerve pathology may lead to claw hand deformity and prominent wasting of interossei Radial nerve palsy often causes wrist drop due to loss of extensors C5–C6 lesions can compromise biceps strength and sensation over lateral forearm L4 pathology may reduce patellar reflex and cause difficulty in heel walking Early recognition of myotome or nerve deficits can prompt imaging and nerve conduction studies to detect root or plexus lesions Bookmark Failed! 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FRACGP, MD, BMsc Medical Examiner, Associate Lecturer Dr Shaun Tan Introduction Dr Shaun Tan is a GP, Medical Director, and Medical Educator with a passion for transforming medical education and optimizing study efficiency. Now, with Fellow Academy flashcards, I'm on a mission to help GP Trainees and IMGs pass the AKT & KFP in their first attempt I also want to help you save time, reduce stress and focus your efforts on what truly matters Honorary academic positions He holds honorary academic positions at the University of Queensland and Griffith University and is a mentor to a number of junior doctors. He is also an official examiner and contributes feedback towards the improvement of exams. In his spare time In his spare time he enjoys hiking, coffee and being outdoors. Dr Charles Wang Fellowed GP & Medical Author Introduction Dr. Charles is an experienced fellowed GP and clinical editor for Fellow Academy flashcards. Since becoming a GP, He has been serving the Campbelltown area, with professional stints in Westmead, Auburn, Coffs Harbour, and Rhodes. Where Dr. Charles graduated from Dr Charles graduated from the University of New South Wales in 2015 and completed further medical training at Westmead Hospital, Auburn Hospital, and Coffs Harbour Base Hospital. He enjoys caring for all patients, with specific interests in men’s health and chronic heath In his spare time Charles enjoys gyming, rockclimbing as well as running in his spare time. Dr May Tan Former RACGP Examiner and Author Introduction Dr May Tan is a GP in Sydney accredited GP registrar supervisor and RACGP Examiner and a South East Sydney HealthPathways Clinical Editor. She is a holistic GP with over 12 years of experience as a doctor in the Eastern Suburbs. Her special interest areas include dermatology, contraceptive advice, family planning and antenatal care, children’s health and neuroprotective developmental care. Special Interests Dr. May is a highly trained GP with specialist expertise in child health, obstetrics, and gynaecology. She has completed advanced training at both Sydney Children’s Hospital and the Royal Women’s Hospital and holds Diplomas in Child Health (USyd) and Obstetrics & Gynaecology (DRANZCOG). In her spare time Outside of her work, Dr May is a busy mother of three and enjoys running, tennis, and yoga whenever she can find a moment!

Prepare for the RACGP KFP MSQ with 500+ exam-style cases, 300+ topic notes and 1,500 flashcards. Try 10 free questions. Pass guarantee. 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Pass Your AKT/KFP With Australia's #1 Rated Question Bank Led by Former Official RACGP Examiners, GP Educators and Specialists Trial Fellow Academy for Free Access 35 free AKTs & KFP MSQs + Join Our Live Exam Prep Masterclass Which exam are you sitting next?* AKT only KFP only Both AKT and KFP Next Watch the video to see how to improve your exam results Trial Fellow Academy for Free Watch the video to see how to improve your exam results Access 35 free AKTs & KFP MSQs + Join Our Live Exam Prep Masterclass Trial Fellow Academy for Free Access 35 free AKTs & KFP MSQs + Sign Up For Our Live Exam Prep Masterclass Which exam are you sitting next?* AKT only KFP only Both AKT and KFP Next With 1 in 3 IMG GPs failing the AKT/KFP even after 1000+ hours of study, selecting the right quality resources is more important than ever Dr Sanjit Dulku Fellowed GP at Aboriginal Medical Services Sweat in Style, skip the crowded gyms and pump iron in peace Chooi Chean Chong General Practice Registrar. MD, AMC "Fellow Academy has been part of my journey in completing RACGP fellowship program with flying colours. Their questions are in good quality and compatible with real exams. On top of this, Shaun always share with candidates the tips in preparing for exams which I think this is essential. " Dr. Sarah Kulthum, MBBS, FRACGP Fellowed GP, Browns Plains Family Practice "Relying solely on lecture slides was too overwhelming, especially during busy clinic days. With these resources, I could also easily revise on my phone during short breaks, making study more manageable and less stressful." Dr Rajesh Gemnani, MBBS, MRC|GP IMG GP (FSP), Medical Director P4 scored 9 months ago, we faced a choice: create 3,000 easy questions, or 1,000 exceptional, exam-level ones We chose exceptional. Every detail - clinical depth, diagnostic reasoning and complexity - perfected to feel just like the real exam. WATCH THE VIDEO BELOW TO SEE HOW TO IMPROVE YOUR EXAM RESULTS "After sitting and failing the 2025.2 KFP, I realised the other question banks I'd practiced with were far too easy and they set me up for failure. Fellow Academy's questions are different. They are the closest match to the real exam I've found. The scenarios, the distractors, the complexity and the clinical reasoning required is near identical. It's rare to find a question bank that truly replicates the exam while also teaching you exam technique. I wish I'd found these before my first attempt." Dr. Nitin Mukesh, MD, FRACGP KFP Done Right Questions that actually feel like the exam The Challenge Most KFP question banks are setting you up to fail. Questions are oversimplified with obvious answers. They don't test genuine clinical judgment. The references provided often contradict the "correct" answers. The cases lack the complexity and nuance of the actual exam. And the explanations tell you what's right without teaching you why or how to approach similar cases next time How We Help Fellow Academy designs KFP MSQs to match the real exam and to teach reasoning. Every item uses the current multi select structure with strict timing. Choices and explanations are mapped to RACGP guidance, ETG, AJGP, Australian Prescriber, and PBS so your selections are defensible on exam day. We make the marking logic explicit by labelling correct, acceptable but less prioritised, and unsafe, and we explain why each verdict fits the case. Distractors are intentional and test priority, contraindications, and context. Stems are written as natural GP consultations so you practise judgement, not buzzword spotting. Our KFP Build Process 01 Choose high-yield topics from the RACGP blueprint and map them to real clinical scenarios GPs encounter 02 Build realistic cases with multiple comorbidities, subtle but critical diagnostic cues, clinical nuance, and biopsychosocial complexities that reflect the real exam's difficulty. 03 Build answer options where distractors are clinically plausible but not most appropriate for the context - testing your prioritisation, clinical reasoning, and decision-making under exam time constraints. 05 Test under timed conditions, review with examiners and GPs, then refine based on candidate feedback 04 Develop detailed rationales that include: (1) screenshot proof from guidelines for every answer (2) examination technique and clinical reasoning explaining why specific case details matter, and (3) key takeaways to maximise learning for each case 300+ KFP MSQ Cases Exam style stems and rationales that mirror official format 300+ Topics Exam Notes High yield summaries and full references built for GPs 1500+ Flashcards Spaced repetition that tracks your weak areas. 100% Money Back and Pass Guarantee Finally Pass the KFP Exam and Become a Fellowed Australian GP Resources by a GP Educator who scored 9/10 in the MCQ and RACGP Examiners Are you an IMG (International Medical Graduate) or an Australian GP trainee?* IMG AUS GP Trainee Next BUY ALL-IN-ONE AKT & KFP SYSTEM BUY AKT & KFP ALL-IN-ONE BUNDLE Numbers matter. Proven results. Built on rigour. 99.3% rate our AKT and KFP MSQ case banks as the highest quality they’ve seen. 0% 99.6% satisfaction rate - measured by members who kept access with no refund request 0% See how Fellow Academy candidates compare with national results from 2025.2 KFP National Pass Rate Fellow Academy Members Pass Rate Disclaimer: Actual pass rates vary slightly between cohorts (typically 91–98% depending on the exam cycle). 79.57% 91-94% 1.18 - 1.22x higher pass rate than the national average "Fellow Academy made AKT and KFP prep so much easier with clear explanations and exam-style cases. The platform is practical, focused, and perfectly aligned with RACGP expectations. Highly recommend to any GP trainee aiming for success!" Dr Rajesh Gemnani, MBBS, MRC|GP IMG GP (FSP), Medical Director GP Registrar, Smart Clinics Cairns "Relying solely on lecture slides was too overwhelming, especially during busy clinic days. With these resources, I could also easily revise on my phone during short breaks, making study more manageable and less stressful." Dr. Sarah Kulthum, MBBS, FRACGP Fellowed GP at Browns Plains Family Practice Voices from the cohort Join the Hundreds of Doctors Who Passed With Us AKT and KFP Done Right From clinical story to defensible choices "After sitting and failing the 2025.2 KFP, I realised the other question banks I'd practiced with were far too easy and they set me up for failure. Fellow Academy's questions are different. They are the closest match to the real exam I've found. The scenarios, the distractors, the complexity and the clinical reasoning required is near identical. It's rare to find a question bank that truly replicates the exam while also teaching you exam technique. I wish I'd found these before my first attempt." Dr. Nitin Mukesh, MD, FRACGP The Challenge Most KFP question banks are setting you up to fail. Questions are oversimplified with obvious answers. They don't test genuine clinical judgment. The references provided often contradict the "correct" answers. The cases lack the complexity and nuance of the actual exam. And the explanations tell you what's right without teaching you why or how to approach similar cases next time How We Help Fellow Academy designs KFP MSQs to match the real exam and to teach reasoning. Every item uses the current multi select structure with strict timing. Choices and explanations are mapped to RACGP guidance, ETG, AJGP, Australian Prescriber, and PBS so your selections are defensible on exam day. We make the marking logic explicit by labelling correct, acceptable but less prioritised, and unsafe, and we explain why each verdict fits the case. Distractors are intentional and test priority, contraindications, and context. Stems are written as natural GP consultations so you practise judgement, not buzzword spotting. Our KFP Process 01 Develop detailed rationales that include: (1) screenshot proof from guidelines for every answer (2) examination technique and clinical reasoning explaining why specific case details matter, and (3) key takeaways to maximise learning for each case 04 Choose high-yield topics from the RACGP blueprint and map them to real clinical scenarios GPs encounter Build realistic cases with multiple comorbidities, subtle but critical diagnostic cues, clinical nuance, and biopsychosocial complexities that reflect the real exam's difficulty. 02 Build answer options where distractors are clinically plausible but not most appropriate for the context - testing your prioritisation, clinical reasoning, and decision-making under exam time constraints. 03 Test under timed conditions, review with examiners and GPs, then refine based on candidate feedback 05 99.3% rate our AKT & KFP MSQ questions are the highest quality they’ve seen. EXTENSION GUARANTEE Complete our AKT & KFP All-In-One Bundle and if you don't pass, we'll extend your access for FREE until the next exam cycle 93.2% KFP Pass Rate from candidates who completed our resources. Proven Results, Backed by Data From quality ratings to pass rates, our AKT & KFP All-In-One Bundle is designed to give you confidence on exam day. BUY ALL-IN-ONE KFP SYSTEM BUY ALL-IN-ONE AKT & KFP SYSTEM View Sample Flashcards 1500+ High-Yield Flashcards Designed for Memory Retention The KFP covers an overwhelming amount of information, and it’s easy to forget what you’ve studied. Our 1,500+ exam-specific flashcards solve that problem. We’ve selected the highest-yield content you actually need to remember for the KFP and built them into flashcards that Strengthen your long-term memory so you retain information through to exam day Track your progress and show you exactly where your knowledge gaps are Focus only on high-yield content so you’re not wasting time on low-value facts View Sample Exam Notes 300+ Exam Notes Topic You'll Actually Use and Remember The KFP tests both quick recall and deep understanding. Our exam notes give you both (and with structure). You’ll get Concise Notes for fast revision and Comprehensive Notes for thorough learning. Together, they Break down each medical topic clearly without overwhelming you with unnecessary detail Provide in-depth coverage of each topic so you understand the clinical reasoning, not just memorise facts Keep everything organised in one simple portal so you can find any topic instantly 1,000+ AKT and 1,000+ KFP MSQs Realistic cases that train exam-day thinking Most practice questions don’t prepare you for how difficult the real AKT and KFP exams are. Our 2,000+ former examiner-written questions prepare you for the real challenge - the clinical complexity, tough distractors, and impossible time pressure you’ll face. They help you: Handle exam-level difficulty so nothing on test day surprises you Master the clinical reasoning the exam actually tests - prioritising between multiple plausible options under pressure Study with certainty using explanations with proof from guidelines, so you never second-guess what you’ve learned The All-in-One AKT & KFP Preparation System Everything you need to study smarter - 3 premium resources combined into one high-value bundle. The AKT and KFP cover an overwhelming amount of information, and it’s easy to forget what you’ve studied. Our 1,500+ exam-specific flashcards solve that problem. We’ve selected the highest-yield content you actually need to remember for the KFP and built them into flashcards that: Strengthen your long-term memory so you retain information through to exam day Track your progress and show you exactly where your knowledge gaps are Focus only on high-yield content so you’re not wasting time on low-value facts View Sample Flashcards View Exam Notes The KFP tests both quick recall and deep understanding. Our exam notes give you both (and with structure). You’ll get Concise Notes for fast revision and Comprehensive Notes for thorough learning. Together, they: Break down each medical topic clearly without overwhelming you with unnecessary detail Provide in-depth coverage of each topic so you understand the clinical reasoning, not just memorise facts Keep everything organised in one simple portal so you can find any topic instantly 300+ Exam Notes Topic You'll Actually Use and Remember Memory Retention High-Yield Flashcards Designed for 1500+ High-Yield Flashcards Designed for Memory Retention The All-in-One AKT & KFP Preparation System Everything you need to study smarter - 3 premium resources combined into one high-value bundle. 1,000+ Exam-Style KFP MSQ Questions and 1,000+ AKTs Realistic cases that train exam-level reasoning Most practice questions don’t prepare you for how difficult the real AKT and KFP exams are. Our 2,000+ former examiner-written questions prepare you for the real challenge - the clinical complexity, tough distractors, and impossible time pressure you’ll face. They help you: Handle exam-level difficulty so nothing on test day surprises you Master the clinical reasoning the exam actually tests - prioritising between multiple plausible options under pressure Study with certainty using explanations with proof from guidelines, so you never second-guess what you’ve learned + + Concise & Comprehensive Exam Notes 1500+ High Yield-Aligned Flashcards 100+ Exam-Standard CCE Cases The All-in-One CCE Preparation System: Everything You Need to Pass BUY ALL-IN-ONE KFP SYSTEM Why They Work Together One Integrated System. One Clear Goal: To Help You Pass Each component is designed to strengthen the others - so you study smarter, not harder: BUY AKT & KFP ALL-IN-ONE BUNDLE BUY AKT & KFP ALL-IN-ONE BUNDLE 01 Start with AKT & KFP practice questions → Identify your knowledge gaps and get used to exam-style thinking. 02 Review the concise exam notes → Quickly cover the key concepts related to your weak areas. 03 Dive into the comprehensive exam notes → Deepen your understanding when a topic needs more depth. 04 Use flashcards to consolidate memory → Reinforce high-yield concepts using active recall and spaced repetition WATCH TESTIMONIAL VIDEO HERE Trial Fellow Academy for Free Get 35 Free Sample Cases Buy Now AKT & KFP MSQ Question Bank $600.00 AKT & KFP MSQ Questions + Exam Notes $900.00 What We Offer BEST VALUE AKT & KFP All-In-One Bundle AKT & KFP MSQ Questions + Flashcards + Exam Notes $1099.00 $1400.00 AKT & KFP MSQ Question Bank $399.00 AKT & KFP MSQ Questions + Exam Notes $900.00 AKT & KFP MSQ Question Bank $600.00 BEST VALUE AKT & KFP All-In-One Bundle AKT & KFP MSQ Questions + Exam Notes + Flashcards $699.00 $1300.00 What We Offer KFP MSQ Question Bank $399.00 Frequently Asked Questions Is this worth the price? Our system combines three proven study tools in one - practice questions, flashcards, and exam notes - saving you the cost of buying from multiple providers and the time it takes to figure out what’s actually relevant. Plus, our pass guarantee and regular updates make it a safer investment. How does the 7-day money-back guarantee work? If you try our resources and find they don’t suit your learning style, simply let us know within 7 days and we’ll issue a full refund. No hidden conditions, no questions asked. I already have a subscription to another question bank.. Should I also get yours? The more high-quality practice questions you complete, the better prepared you’ll be. Many of our customers use us alongside other providers because our content offers a unique edge - longer, more realistic case stems, nuanced distractors, and guideline-referenced answers with screenshots. These features complement other question banks and strengthen your preparation. I’ve already failed the KFP before. How is this different? Our questions are based on surveys from hundreds of candidates and are rated the highest in terms of complexity, nuance, and alignment with RACGP exam standards. We also include flashcards - a proven, highly effective way to retain information. This means you’ll be preparing differently this time, with a more structured system designed for better recall and exam application. How do you decide what is high yield? We analyse thousands of AKT and KFP cases, SAPT questions, and RACGP exam reports to identify which topics and question types appear most often. This ensures we focus on what matters most for your exam success Do you cover all domains and common presentations? Yes. Our materials are mapped to the RACGP curriculum and exam domains, covering every common presentation along with a wide range of less common but high-yield topics that have been tested in past exams. How often are your questions and notes updated? 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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 Heart Failure (HFrEF, HFpEF) Causes Common to all HF types: CAD, HTN, valvular heart disease, COPD HFrEF DCM: Ischaemic (most common), viral (e.g., Coxsackie B, HIV), toxic (e.g., alcohol) Non-ischaemic causes: HTN, rheumatic heart disease, and idiopathic forms (≥2/3 of cases) Other associated conditions: IHD, COPD, or uncontrolled HTN HFpEF HCM: Genetic predisposition (e.g., HOCM) Restrictive cardiomyopathy: Caused by HTN, amyloidosis, sarcoidosis, haemochromatosis, and certain cancers Most common cause: CAD with increased myocardial oxygen demand Precipitants Cardiac: MI, arrhythmias, uncontrolled HTN Non-cardiac: PE, pneumonia, anaemia, kidney failure, noncompliance with medications, or alcohol misuse History Fatigue Paroxysmal nocturnal dyspnoea (PND), orthopnoea SOBOE Examination General Findings Elevated JVP with possible V waves in tricuspid regurgitation Third heart sound (specific for HF) Laterally displaced apex beat (suggestive of ventricular dilation) Pulmonary crackles and peripheral oedema RHF-specific Findings Elevated JVP with giant V waves (tricuspid regurgitation) Parasternal heave (right ventricular hypertrophy) Hepatomegaly, ascites, and peripheral oedema Investigations FBC, UEC, LFTs ECG, CXR, echo, and BNP (to assess severity if diagnosis is uncertain) Notes: Avoid NSAIDs, steroids, and TCAs, as they can worsen HF by fluid retention or reducing eGFR Symptom-focused management (e.g., diuretics for congestion) should accompany diagnostic work-up Echo and BNP are essential for confirmation if no alternative causes are identified NYHA Classes Class I: No symptoms, no limitation of physical activity Class II: Mild symptoms, slight limitation during ordinary activity Class III: Moderate symptoms, marked limitation during less-than-ordinary activity, but comfortable at rest Class IV: Severe symptoms, inability to perform any physical activity without discomfort, symptoms at rest HFrEF - Symptoms +/- signs of HF and EF <50% Pharmacological Management Initiate as soon as possible after diagnosis: ARNI (sacubitril/valsartan): First-line if tolerated (preferred over ACEI/ARB) ACEI or ARB: Use if ARNI is not available or tolerated HF-specific BBs (e.g. Bisoprolol, carvedilol, metoprolol succinate) Mineralocorticoid receptor antagonists (MRAs): E.g., spironolactone, eplerenone SGLT2 inhibitors: E.g., dapagliflozin, empagliflozin (regardless of diabetes status) Titrate renin-angiotensin system inhibitors (ACEI/ARB/ARNI) and BB every 2–4 weeks to target or maximum tolerated doses Up-titrate MRAs 4–8 weeks after initiation if required Loop diuretics (e.g., frusemide) for symptom (e.g., congestion, peripheral oedema). Note: Defer BB initiation until patients are euvolaemic (to avoid worsening congestion) HFpEF - Symptoms +/- signs of HF and and EF >50% + objective evidence of structural heart disease (LVH, LAH) or diastolic dysfunction with high filling pressure Pharmacological Management Focus: Treat contributing conditions like HTN and fluid overload Mainstay therapy: Diuretics for symptom relief and volume control Consider low-dose MRA: Reduces HF hospitalisations Non-Pharmacological Management Stress echo: Consider for first diagnosis to assess structural changes Lifestyle modifications: Cease smoking and alcohol Salt restriction: <6g/day Fluid restriction: 1.5L/day (if symptomatic) or 2L/day (if asymptomatic)** Daily weighing for fluid monitoring** Regular exercise: 150 min/week of moderate-intensity activity Weight loss: 5–10% if overweight/obese Limit caffeine to 1–2 cups/day (avoid diuresis) Referral to a dietitian for a low-calorie, heart-healthy diet Avoid triggers: Over-the-counter NSAIDs due to fluid retention risks Notes Repeat echo every 3–6 months for disease progression monitoring Up-titrate BBs only if HR >50 bpm and no signs of congestion Avoid MRAs if serum potassium >5mmol/L Use ARBs only if ACEIs are not tolerated Heart Failure Causes Common to All HF Types Coronary artery disease (CAD) Hypertension (HTN) Valvular heart disease Diabetes mellitus Arrhythmias (e.g., atrial fibrillation [AF]) Cardiomyopathies (ischaemic, dilated, hypertrophic) Anaemia Thyroid dysfunction Chronic lung disease Pericarditis Excessive alcohol or substance abuse HFrEF-Specific Causes Ischaemic cardiomyopathy (most common) Dilated cardiomyopathy (viral, alcoholic, chemotherapy-induced) Rheumatic heart disease Pulmonary hypertension HFpEF-Specific Causes Hypertrophic cardiomyopathy Restrictive cardiomyopathy (e.g., amyloidosis, sarcoidosis) Long-standing hypertension Precipitants Myocardial infarction Pulmonary embolism Infections (e.g., pneumonia) Anaemia Renal impairment Non-adherence to medications Uncontrolled hypertension Arrhythmias (e.g., AF, tachycardia) Thyrotoxicosis Medications exacerbating HF (e.g., NSAIDs, corticosteroids, non-dihydropyridine calcium channel blockers) Symptoms Fatigue Paroxysmal nocturnal dyspnoea (PND) Orthopnoea Dyspnoea (initially on exertion, progressing to rest) Peripheral oedema Palpitations Weight gain (due to fluid retention) Classification Heart Failure with Reduced Ejection Fraction (HFrEF) LVEF <50% Typically caused by ischaemic cardiomyopathy, dilated cardiomyopathy, or valvular heart disease Heart Failure with Preserved Ejection Fraction (HFpEF) LVEF ≥50% Commonly associated with hypertrophic cardiomyopathy, restrictive cardiomyopathy, and conditions like hypertension or diabetes Heart Failure with Mid-Range Ejection Fraction (HFmrEF) LVEF 41–49% Considered an intermediate group, sharing features with both HFrEF and HFpEF Examination Findings General Signs Elevated jugular venous pressure (JVP) Third heart sound (S3) Laterally displaced apex beat Pulmonary crackles Peripheral oedema Right Heart Failure Signs Elevated JVP with giant V waves Pansystolic murmur (tricuspid regurgitation) Hepatomegaly Ascites Lower limb oedema Diagnostic Criteria HFrEF: Symptoms ± signs of HF and LVEF <40% HFpEF: Symptoms ± signs of HF and LVEF ≥50% with evidence of structural heart disease or diastolic dysfunction HFmrEF: LVEF 41–49%, symptomatic HF, and structural or functional changes NYHA Classification Class I: No symptoms or limitations Class II: Mild symptoms, slight limitation Class III: Marked limitation, no symptoms at rest Class IV: Symptoms at rest, severe limitations Investigations Blood Tests Full blood count (FBC) Urea, electrolytes, and creatinine (UEC) Liver function tests (LFTs) Thyroid-stimulating hormone (TSH) B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) Imaging Echocardiogram: Gold standard for assessing LVEF and structural abnormalities Chest X-ray (CXR): Cardiomegaly, pulmonary congestion, pleural effusions Electrocardiogram (ECG): Assess for arrhythmias, ischaemia Other: Cardiac MRI, coronary angiography if ischaemia suspected Management Pharmacological Management HFrEF First-line: Angiotensin receptor neprilysin inhibitor (ARNI, e.g., sacubitril/valsartan) if tolerated (preferred over ACEI/ARB) ACEI or ARB if ARNI is not available or tolerated HF-specific beta-blockers (bisoprolol, carvedilol, metoprolol succinate) Mineralocorticoid receptor antagonists (MRAs, e.g., spironolactone, eplerenone) SGLT2 inhibitors (dapagliflozin, empagliflozin) regardless of diabetes status Loop diuretics (e.g., furosemide) for symptomatic relief (e.g., congestion, peripheral oedema) HFpEF Mainstay: Diuretics for symptom relief and volume control Antihypertensives (beta-blockers, ACEIs) to control blood pressure Low-dose MRAs to reduce hospitalisations Non-Pharmacological Management Lifestyle Modifications: Smoking cessation, limit alcohol intake Reduce dietary salt (<6g/day) Fluid restriction (1.5L/day if symptomatic, 2L/day if asymptomatic) Fluid balance monitoring with daily weighing Exercise and Rehabilitation: Regular physical activity (150 mins/week of moderate exercise) Dietary Considerations: Weight loss of 5–10% if overweight Limit caffeine intake to 1–2 servings per day Refer to a dietitian for dietary advice on a healthy, low-calorie diet Avoidance of Triggers: Over-the-counter NSAIDs due to fluid retention risks Complications Acute decompensation: Pulmonary oedema, cardiogenic shock Arrhythmias: AF, ventricular tachycardia Thromboembolism Sudden cardiac death Notes: Avoid NSAIDs, corticosteroids, and tricyclic antidepressants as they can exacerbate HF Beta-blocker Titration: Increase only if HR >50 bpm and patient is not congested MRAs: Avoid if serum potassium >5 mmol/L ARB Use: Only if ACEI is not tolerated High-Mortality Risk: ACEI, beta-blockers, and MRAs can reduce mortality by up to 60% BNP Levels: Age-adjusted for diagnostic 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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 Psychosis Types of Psychotic Disorders Schizophrenia ≥2 symptoms for ≥1 month within a 6-month period (1 must be top 3): Hallucinations Delusions Disorganised speech Disorganised behaviour Negative symptoms (anhedonia, blunted affect, poverty of speech) Functional impairment in work, social, or self-care Exclude mood disorders unless brief during psychotic episodes Schizophreniform Meets schizophrenia criteria but lasts 1–6 months No significant functional impairment Schizoaffective Two types: bipolar or depressive Requires 2 psychotic episodes: 1 with predominant mood symptoms 1 lasting ≥2 weeks with minimal mood symptoms Brief Psychotic Disorder Duration: 1 day–1 month Triggered by trauma or stress Symptoms resolve to premorbid functioning Delusional Disorder Persistent delusions >1 month (e.g., paranoid, grandiose) No other psychotic features Minimal impact on daily functioning ____________________________________ General Management Psychological CBT and psychoeducation Refer to support groups Social skills and engagement programs Lifestyle Encourage physical activity and balanced diet Baseline Monitoring (antipsychotic therapy risks): BP, heart rate, ECG (QT prolongation) Weight, BMI, waist circumference Lipids, glucose, HbA1c Prolactin levels, menstrual history (females) Full blood count, movement assessments ____________________________________ Treatment Duration Schizophrenia (or symptoms >6 months) Antipsychotics for at least 2 years post-resolution Brief Psychosis (or symptoms <6 months) Antipsychotics for at least 1 year post-resolution Monitor adherence and relapse risks Extend therapy if high relapse risk or comorbidities ____________________________________ Possible Diagnoses in Positive Psychotic Symptoms Primary Psychotic Disorders Schizophrenia, schizophreniform, schizoaffective, brief psychotic disorder, delusional disorder Secondary Causes Substance-Induced: Symptoms <4 weeks post-intoxication/withdrawal Medical Conditions: Autoimmune diseases, delirium, dementia (e.g., Lewy body), neurological disorders Other Psychiatric Conditions: Acute mania, postpartum psychosis, psychotic depression ____________________________________ Psychosis: Differentials Psychiatric Causes Schizophreniform, schizophrenia, schizoaffective disorder Brief psychotic disorder (1 day–1 month) Delusional disorder Bipolar mania with psychotic features Depression with psychotic features Organic Causes Neurological Intracranial infections: HIV encephalitis, neurosyphilis, meningitis, encephalitis Space-occupying lesions: tumours, haemorrhage Temporal lobe epilepsy Dementia (e.g., Alzheimer’s, Lewy body dementia), Parkinson’s, MS, Huntington’s Metabolic Electrolyte imbalances: hypoNa, hypoG B12 deficiency, thyrotoxicosis, hyperparathyroidism, Cushing’s Substance-Related Illicit drugs: amphetamines, hallucinogens Alcohol/medication withdrawal or overdose (e.g., anticholinergics, corticosteroids) Systemic Hepatic encephalopathy Uraemic encephalopathy Pertinent History Questions Any recent stressors/trauma Hallucinations (auditory, visual, tactile) Delusions (paranoid, grandiose, bizarre) History of depression, mania, or low mood Suicidal or self-harm thoughts Neurological symptoms or recent head injury Sleep pattern changes (insomnia/hypersomnia) Elevated mood or grandiosity (mania) Substance use, intoxication, or medication changes Additional Notes: Autoimmune Encephalitis: Consider anti-NMDA receptor encephalitis in young patients with unexplained acute psychosis Early Detection: Evaluate for prodromal psychosis (e.g., odd beliefs, social withdrawal) in young males Referral: Early specialist involvement in first-episode psychosis improves outcomes Psychosis Types of Psychotic Disorders Schizophrenia Diagnostic Criteria (simplified): ≥2 symptoms for ≥1 month within a 6-month period, with ≥1 symptom from: Hallucinations Delusions Disorganised speech Other possible symptoms: Disorganised or catatonic behaviour, negative symptoms (anhedonia, flat affect, alogia). Functional impairment in work, social, or self-care. Exclude mood disorders (unless mood symptoms are brief) and exclude substance/medical causes. Schizophreniform Disorder Same symptom criteria as schizophrenia, Duration: 1–6 months, No significant functional impairment required. Schizoaffective Disorder Two types: Bipolar type or Depressive type. Requires 2 psychotic episodes: One with predominant mood symptoms (mania or depression), Another lasting ≥2 weeks with minimal mood symptoms. Also must rule out primary mood or psychotic diagnoses. Brief Psychotic Disorder Duration: 1 day–1 month, Often triggered by trauma or stress, Symptoms resolve with return to premorbid functioning. Delusional Disorder Persistent delusions >1 month (paranoid, grandiose, jealous, erotomanic, somatic). No other psychotic features (e.g. hallucinations) or only related to the delusional theme. Minimal impact on daily functioning aside from delusions. General Management Psychological Approaches CBT and psychoeducation on psychosis and coping. Social Skills Training, community support programs. Lifestyle: Balanced diet, regular exercise, avoid substance use. Baseline Monitoring (Antipsychotic Therapy) Blood Pressure, Heart Rate, ECG (risk of QT prolongation). Weight, BMI, waist circumference. Lipids, Glucose, HbA1c. Prolactin levels, menstrual history in females. Full Blood Count (some antipsychotics can cause dyscrasias). Movement assessments for extrapyramidal side effects. Treatment Duration Schizophrenia or psychosis >6 months: Antipsychotics at least 2 years post-resolution of acute episode. Brief Psychosis (<6 months): Antipsychotics at least 1 year post-resolution. Extend therapy if high relapse risk or significant comorbidities. Possible Diagnoses with Positive Psychotic Symptoms Primary Psychotic Disorders Schizophrenia, Schizophreniform, Schizoaffective, Brief Psychotic Disorder, Delusional Disorder. Secondary Causes Substance-Induced: Symptoms <4 weeks post-intoxication/withdrawal (e.g. amphetamines, hallucinogens). Medical Conditions: Autoimmune diseases (e.g., lupus, anti-NMDA encephalitis), Delirium, dementia (Lewy body), Neurological (temporal lobe epilepsy, stroke, tumour). Other Psychiatric: Acute mania with psychotic features, Postpartum psychosis, Severe depression with psychosis. Differential Diagnosis in Psychosis Psychiatric Causes Schizophreniform, Schizophrenia, Schizoaffective. Brief Psychotic Disorder (1 day–1 month). Delusional Disorder. Bipolar mania with psychosis. Depression with psychotic features. Organic Causes Neurological: Intracranial infection (meningitis, encephalitis), space-occupying lesion (tumour, haemorrhage), delirium, dementia (Alzheimer’s, Lewy body), Parkinson’s, MS, Huntington’s, seizure disorders. Metabolic: Electrolyte imbalances (hypoNa, hypoG), B12 deficiency, thyrotoxicosis, hyperparathyroidism, Cushing’s syndrome. Substance-Related: Illicit drugs (amphetamines, hallucinogens), withdrawal from alcohol/meds (anticholinergics, corticosteroids). Systemic: Hepatic/uraemic encephalopathy. Pertinent History Questions Recent Stressors/Trauma, Hallucinations (auditory/visual/tactile), Delusions (paranoid, grandiose, bizarre), Depression or mania history, Suicidal/Self-Harm thoughts, Neurological Symptoms or recent head injury, Changes in sleep pattern (insomnia, hypersomnia), Elevated mood or grandiosity, Substance Use (type, frequency) or medication changes. Additional Notes Autoimmune Encephalitis (anti-NMDA receptor) in young patients → suspect if unexplained acute psychosis + neurological changes. Early Detection in young males with possible prodromal phase (odd beliefs, social withdrawal) → specialist referral (early psychosis service). Referral: Early involvement of mental health services improves outcomes in first-episode psychosis. 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 Eczema Craquelé (Asteatotic Eczema) Definition Also called: Winter Itch, Xerotic Eczema Associated with: Elderly, dry skin Characteristic appearance: "Crazy-paving" pattern: Diamond-shaped skin plates separated by red fissures Occurs on extensor surfaces (legs most common) May be a sign of: Hypothyroidism Medication-induced dryness (diuretics, lipid-lowering agents) Diagnosis Clinical diagnosis based on appearance Thyroid function tests (TFTs) if hypothyroidism suspected (e.g., thinning hair, weight gain) Further investigations if sudden onset + systemic signs (e.g., weight loss, malaise, unusual scaling) Management Skin Hydration & Protection (Mainstay) Reduce bath frequency Use cream cleansers (soap-free) Avoid direct heat on skin (e.g., hot showers, heaters) Apply thick emollients (e.g., petroleum jelly, oily creams) multiple times daily Once improved: Switch to lighter non-ionic creams Pharmacological Treatment Mild topical steroids (e.g., hydrocortisone 1%) for a few days if skin is red/inflamed Notes: Common in elderly & dry skin states (winter, hypothyroidism, medications) "Crazy-paving" rash pattern = hallmark sign Mainstay treatment = emollients & avoiding triggers Topical steroids (mild) if needed for redness Eczema Craquelé (Asteatotic Eczema) Definition Also known as Winter Itch or Xerotic Eczema Characterised by dry, cracked ("craquelé") skin, often in a "crazy-paving" or "cracked porcelain" pattern Most common in elderly individuals with inherently dry skin; exacerbated by winter months and low humidity Common sites: Extensor surfaces (especially lower legs) Aetiology & Associations Elderly & Dry Skin States Reduced skin barrier function with age, decreased natural oils Low humidity, overheated rooms, frequent hot showers Hypothyroidism Dry, brittle hair and nails; possible weight gain or lethargy Subclinical or overt hypothyroidism may manifest as severe dry, cracking skin Medication-Induced Dryness Diuretics, lipid-lowering agents (e.g., statins), possibly retinoids Underlying pathology (renal impairment, malnutrition) can worsen dryness Seasonality Often worse in winter due to colder, drier air Clinical Features Appearance Thin, dry, scaly plaques with fissures creating "crazy-paving" or "cracked porcelain" pattern Erythema within fissures; may weep if severely cracked Location Most commonly affects shins May also involve forearms, backs of hands, trunk Symptoms Itch (pruritus) ranging from mild to severe Stinging or burning if fissures are deep Mild exudate or localised infection possible in severe cases Red Flags Sudden onset with systemic symptoms (weight loss, malaise): investigate underlying causes Significant weeping/crusting: rule out secondary bacterial infection (e.g., staphylococcal) Differential Diagnosis Eczema (Atopic, Nummular): More inflammatory, potential weeping or lichenification Psoriasis: Sharply demarcated plaques, silvery scale, possible nail involvement Fungal Infections: Typically localised to feet (tinea pedis) or groin (tinea cruris) Ichthyosis: Congenital forms, lifelong dryness Hypothyroidism: Can mimic or exacerbate dry skin conditions Contact Dermatitis: Localised dryness/cracking, usually identifiable irritant or allergen Diagnosis Clinical Assessment Hallmark "craquelé" pattern on visual inspection Identify triggers: winter, indoor heating, bathing habits, hypothyroidism, medications Investigations TFTs (thyroid function tests) if suspicion of hypothyroidism (cold intolerance, hair thinning, weight gain) Additional tests (FBC, UEC, CRP/ESR) if sudden onset or systemic features present Management Skin Hydration & Protection (Mainstay) Reduced Bath Frequency Shorter, lukewarm showers; avoid hot water Use bath oils or soap-free washes Gentle Cleansing Cream cleansers or soap substitutes Pat skin dry; avoid vigorous rubbing Emollients Thick ointments (petroleum jelly) multiple times daily Apply immediately post-bathing (within 3 minutes) Transition to lighter creams/lotions once improved Avoid Direct Heat Limit direct exposure to heaters Use humidifiers if the environment is very dry Pharmacological Treatment Mild Topical Steroids Hydrocortisone 1% or mild corticosteroids once/twice daily (short courses: 3–5 days) for inflammation Minimise use; primary goal is rehydration Other Measures Non-sedating antihistamines if severe itch Antibiotics only if secondary infection evident (weeping, crusting) Prevention & Lifestyle Measures Daily moisturising to prevent recurrence Avoid overwashing or harsh soaps Protective clothing in cold weather, humidify environment Identify/correct underlying issues (thyroid disorders, medication side effects) Adequate nutrition and hydration to support skin integrity Prognosis & Follow-Up Chronic condition in predisposed individuals, especially elderly Typically responds well to regular moisturising and mild topical therapies Monitor for complications (infection, severe fissuring) requiring additional treatment Key Points Eczema Craquelé is eczema due to severe skin dryness. Characteristic "crazy-paving" pattern with red fissures. Common in elderly, especially during winter or with hypothyroidism. Primary treatment: emollients, minimise irritants, mild topical steroids if inflammation present. Investigate underlying causes: thyroid disorders, medications, possible malnutrition. 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 PERC criteria Should only be used if initial low suspicion (<15% chance) of PE HADCLOTS Hormone (OCP, HRT) Age 50 and over (incl 50yo) Dvt or pe prev Cough blood Leg swelling unilateral o2 94% and under (on RA) Tachy 100 and over (inc 100) Surgery or trauma within past 4w req GA 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 Hidradenitis Suppurativa (HS) Definition Chronic inflammatory skin disease affecting apocrine gland areas ( axillae, groin, under breasts ) Recurrent painful nodules, abscesses, pus discharge, sinus tracts, scarring Chronic, difficult to treat Symptoms Painful, swollen nodules/abscesses Pus-like discharge Sinus tract formation Scarring, tissue destruction Psychological impact (depression, anxiety) Assessment (Hurley Staging System) Aetiology & Risk Factors Autoinflammatory disorder, exact cause unclear Contributing factors: Friction (clothing, body folds) Aberrant immune response to commensal bacteria Abnormal follicular microbiome, follicular occlusion Pro-inflammatory cytokines, secondary bacterial infections Certain medications Differential Diagnosis Acne conglobata Folliculitis Boils Dissecting cellulitis of the scalp Management General Measures Loose clothing, weight loss if appropriate Smoking cessation (reduces flares) Topical Treatments (Mild Cases) Clindamycin 1% lotion BD (up to 3 months) Benzoyl peroxide 5% wash Oral Antibiotics (Moderate Cases) Doxycycline 50–100 mg OD x 6 weeks, then review Minocycline 50–100 mg OD x 6 weeks, then review Erythromycin 250–500 mg BD x 6 weeks Specialist Treatments (Severe/Recurrent Cases) Intralesional corticosteroids Long-term oral antibiotics Oral retinoids Biologic therapy (e.g. adalimumab) Hidradenitis Suppurativa (HS) Definition Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects apocrine gland-bearing areas (e.g. axillae, groin, inframammary regions). It is characterised by recurrent painful nodules, abscesses, sinus tract formation, and scarring, and can significantly impact quality of life. Symptoms Painful, swollen nodules/abscesses, often in body folds Purulent or pus-like discharge Sinus tract formation leading to chronic draining lesions Scarring, tissue destruction over time Notable psychological impact (anxiety, depression, social withdrawal) Assessment: Hurley Staging System Stage Description I Single/multiple abscesses, but no sinus tracts or scarring II Recurrent abscesses with sinus tract formation, but widely spaced lesions III Extensive sinus tracts/abscesses with interconnected lesions, leading to scarring, large areas of involvement Aetiology & Risk Factors Autoinflammatory disorder; precise pathogenesis not fully understood Contributory Factors: Friction in areas of tight clothing or skin folds Abnormal immune response to commensal bacteria or follicular occlusion Pro-inflammatory cytokines driving chronic inflammation Secondary bacterial infections can exacerbate flares Certain medications may worsen disease (e.g. lithium, androgens) Differential Diagnosis Acne conglobata Folliculitis Boils (staphylococcal abscess) Dissecting cellulitis of the scalp (similar sinus tract formation but on the scalp) Management General Measures Loose Clothing, reduce friction in susceptible areas Weight loss if overweight or obese (improves friction, reduces inflammatory burden) Smoking Cessation: Smoking is a known exacerbating factor Pain Management: NSAIDs or paracetamol for mild pain; consider opioids in severe cases short-term Topical Treatments (Mild Cases) Topical Clindamycin 1% lotion BD for up to 3 months Benzoyl Peroxide 5% wash once or twice daily Possible intralesional corticosteroids for smaller lesions Oral Antibiotics (Moderate Cases) Doxycycline 50–100 mg OD for ≥6 weeks Minocycline 50–100 mg OD for ≥6 weeks Erythromycin 250–500 mg BD for 6 weeks Consider prolonged therapy if improvement is noted Specialist Treatments (Severe/Recurrent) Long-term Oral Antibiotics (e.g. clindamycin + rifampicin) Oral Retinoids (e.g. acitretin) Biologic Therapy (e.g. adalimumab) – indicated for moderate to severe HS not responding to standard measures Surgical interventions: Excision of sinus tracts, unroofing of tunnels, or wider local excisions in advanced disease Notes HS is chronic with a relapsing–remitting course. A multidisciplinary approach (dermatologist, surgeon, mental health support) can be beneficial. Psychological support (address depression, low self-esteem) is crucial. Lifestyle modifications (smoking cessation, weight reduction) have a significant role in reducing flare frequencyand severity. 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 Lung Cancer Suspecting lung cancer Identify and evaluate red‐flag presentations: persistent cough, haemoptysis, unintentional weight loss, recurrent pneumonia. Early imaging and prompt referral for suspicious findings. Screening eligibility High‐risk patients: Smoking history (≥30 pack‐years), appropriate age bracket (often 50–70), and adequate organ reserve to undergo therapy if indicated. Discuss pros and cons of LDCT screening, false‐positive rates, and follow‐up requirements. Multidisciplinary care GPs play a crucial role in coordinating care, ensuring timely referrals to respiratory physicians, medical and radiation oncologists, thoracic surgeons, and allied health professionals. Staging and pathology Distinguish NSCLC from SCLC. Understand the basics of the TNM staging for NSCLC and limited vs extensive staging for SCLC. Treatment strategies Early‐stage NSCLC: surgical resection ± adjuvant therapy. Advanced NSCLC: combination of chemotherapy, immunotherapy, targeted therapies. SCLC: predominantly chemotherapy ± radiotherapy, with immunotherapy emerging for extensive disease. Lung Cancer Risk Factors Smoking: The principal risk factor. The risk increases with the duration and intensity of smoking; cessation significantly reduces risk. Occupational exposures: Asbestos, silica, diesel exhaust, and other inhaled carcinogens. Environmental exposures: Radon gas (less common in Australia compared to some other regions), passive smoking. Genetic predisposition: Family history of lung cancer may slightly increase risk. Other factors: Chronic lung disease (e.g. COPD) and poor general health. Screening for Lung Cancer Rationale for Screening Early detection can significantly improve survival, as curative treatments (surgery or combined chemoradiotherapy) are more effective in early‐stage disease. Low‐dose CT (LDCT) scanning has been shown internationally to reduce lung cancer mortality among high‐risk groups. Current Australian Recommendations At present, targeted screening is recommended for individuals at high risk, typically defined as: A significant smoking history (e.g. ≥30 pack‐years) and Age range generally 50–70 years (exact upper age thresholds can vary by guideline) A consideration of comorbidities and the ability to undergo potentially curative treatment. National lung cancer screening programme: As of the publication dates mentioned, Australia is working towards/has recommended a staged rollout of a national screening program using LDCT in high‐risk individuals. Specific details regarding frequency (usually annual LDCT) and precise eligibility criteria may evolve over time, so GPs should consult the most recent RACGP and government guidance. Role of the GP in Screening Risk stratification: Identify patients at high risk based on smoking history and other factors. Offer smoking cessation support. Discuss benefits and harms of LDCT screening (e.g. false positives leading to unnecessary investigations or interventions). Ensure adequate follow‐up for abnormal screening results. Clinical Presentation and Investigation Signs and Symptoms Common presenting features include: Persistent cough (often new or changed in a smoker/ex‐smoker) Haemoptysis Dyspnoea Chest pain (can be pleuritic or dull) Recurrent chest infections or pneumonia Unintentional weight loss, fatigue Hoarseness (recurrent laryngeal nerve involvement) Features of metastatic disease (e.g. bone pain, neurological symptoms) Red Flag: Any smoker or ex‐smoker aged >40 years with a new, persistent or altered cough should be investigated further. Initial Investigations in General Practice Chest X‐ray (CXR): First‐line imaging if lung cancer is suspected. CT chest: If CXR is abnormal or high suspicion remains despite a normal CXR, a contrast‐enhanced CT chest is warranted. Sputum cytology: Now less commonly used as a diagnostic tool, but might occasionally be done. Other relevant tests: Full blood count, renal function (especially prior to CT with contrast), liver function tests. Referral for Specialist Assessment Urgent referral to a respiratory physician or specialist multidisciplinary team if imaging suggests lung cancer. If a suspicious mass is identified, further investigations to confirm pathology often involve bronchoscopy, endobronchial ultrasound‐guided biopsy (EBUS), or CT‐guided biopsy. Staging and Pathology Histological Types Non–small cell lung cancer (NSCLC) Adenocarcinoma (most common histological subtype in Australia, especially in non‐smokers) Squamous cell carcinoma Large cell carcinoma Small cell lung cancer (SCLC) Staging NSCLC uses the TNM (Tumour, Node, Metastasis) staging system, which guides treatment decisions. SCLC is often categorised as either limited (confined to one hemithorax, potentially treatable within a tolerable radiation field) or extensive (disease spread beyond one hemithorax). Molecular Markers Testing for molecular alterations (e.g. EGFR mutation, ALK rearrangement, ROS1, PD‐L1 expression) is standard in NSCLC, guiding targeted therapies and immunotherapy decisions. Management Management of lung cancer should be delivered via a multidisciplinary team (MDT) approach involving respiratory physicians, oncologists, thoracic surgeons, radiologists, palliative care specialists, and GPs. Non–Small Cell Lung Cancer Surgical resection Main curative option for early‐stage disease (stage I or II, and selected stage III). Types: lobectomy, segmentectomy, pneumonectomy (depending on location, size, and patient fitness). Radiotherapy Curative radiotherapy (often combined with chemotherapy) for those with locally advanced disease who are not surgical candidates. Stereotactic ablative radiotherapy (SABR) may be used for small, peripheral tumours in patients unfit for surgery. Systemic therapies Chemotherapy: Platinum‐based combinations are standard in many cases. Targeted therapies: EGFR inhibitors (e.g. gefitinib, erlotinib), ALK inhibitors (e.g. crizotinib), etc. Immunotherapy: Anti–PD‐L1 therapies (e.g. pembrolizumab, nivolumab) for advanced or metastatic disease depending on PD‐L1 expression and other factors. Adjuvant therapy Postoperative chemotherapy or chemo‐radiotherapy in resected stage II or III disease to improve survival. 5.2 Small Cell Lung Cancer Tends to be more aggressive but often more responsive to chemotherapy. Limited‐stage disease: combined chemotherapy and radiotherapy. Extensive‐stage disease: chemotherapy (with or without immunotherapy), palliative radiotherapy for symptom control. Supportive and Palliative Care Role of the GP Continuity of care: Ongoing review of symptoms, psychosocial support, care coordination. Management of comorbidities: Especially COPD, cardiovascular disease, diabetes, etc. Smoking cessation support: Even after diagnosis, quitting smoking can slow disease progression and improve outcomes. Nutritional support: Address weight loss, cachexia, nutritional deficits. Palliative care referral: Early introduction can improve quality of life, symptom control, and possibly outcomes. Symptom Management Dyspnoea: Consider bronchodilators if coexisting COPD, opioids for severe breathlessness, oxygen therapy if indicated by hypoxaemia. Pain: WHO pain ladder approach, adjuvant therapies, radiotherapy for bone metastases. Psychological support: Referral to counselling services, psychology, or mental health services if required. Prevention and Health Promotion Smoking cessation The single most effective intervention to reduce lung cancer risk. Offer evidence‐based cessation support: nicotine replacement therapy (NRT), varenicline, bupropion, and counselling. Reinforce prevention strategies in the community and among family members. Occupational health measures Advise on minimising exposure to carcinogenic substances (e.g. asbestos, silica). Encourage use of protective equipment and regular workplace screening if relevant. Air quality and other lung health measures Awareness of environmental pollutants. Appropriate vaccinations (e.g. influenza, pneumococcal in at‐risk groups) to maintain respiratory health. 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 Male Sexual Dysfunction (ED, Low Libido, Premature Ejaculation) Differentials Psychological: Depression, anxiety, stress. Social: Relationship issues, SSRIs, antihypertensives, substance use. Neurological: Diabetic neuropathy, pelvic trauma/surgery. Endocrine: Hypogonadism, hyperthyroidism, hyperprolactinaemia. Cardiovascular: PVD, hypertension, obesity (CVD marker). Respiratory: OSA. Genital: Peyronie’s disease. History Symptoms: ED, low libido, premature ejaculation. Erections: Morning erections/masturbation (suggest psychogenic if present). Mood: Depression, anxiety. Substance Use: Alcohol, drugs. Meds: SSRIs, antihypertensives. Endocrine: Polyuria, gynaecomastia. CVD/OSA: Hypertension, snoring. Trauma: Pelvic injury, surgery. Genital: Penile deformity. Examination Obesity (BMI>30) Small testicular size / gynaecomastia Penile plaques Visual field defects Femoral pulse Investigations Routine: FBC, UEC, lipids, fasting glucose. Hormonal: Morning testosterone ± LH if abnormal. Other: TSH, prolactin (low libido, gynaecomastia). Cardio: Assess fitness (e.g., 20 steps in 15 seconds). Management Erectile Dysfunction (ED) Non-Pharm: Counselling, lifestyle changes. Pharm: First-line: Sildenafil 50 mg PO (1 hr pre-activity). Avoid with nitrates. Second-line: Intracavernosal alprostadil. Alternative: Vacuum device. Premature Ejaculation (PE) Non-Pharm: Topical anaesthetic (glans + shaft) or thick condoms. Pharm: First-line: Dapoxetine 30 mg PO (3 hrs pre-activity). Alternative: Paroxetine 20 mg (on-demand or regular). Low Libido Treat underlying issues: Depression, hypogonadism, substance use. Optimise lifestyle: Reduce weight, alcohol, stress. ____________________________________ Key Notes ED: Early CVD marker—assess broader CVD risks. Low testosterone is rare (<4%): Test only when clinically indicated. Premature ejaculation often improves with psychological and relationship support. Lithium Side Effects Short-Term CNS: Sedation, confusion, unsteadiness, tremors, dysarthria, seizures (in toxicity) Neuromuscular: Rigidity, hyperreflexia GI: Nausea, vomiting, diarrhoea Cardiovascular: QTc prolongation, possible hypovolaemia (especially from nephrogenic diabetes insipidus) Dermatological: Psoriasis flares or exacerbation Long-Term Chronic lithium toxicity Nephrogenic Diabetes Insipidus (NDI) Hypothyroidism Hyperparathyroidism (hypercalcaemia) Weight Gain Toxicity Toxic Doses/Levels Acute: Ingestion >5 g or serum level >5 mmol/L Chronic: Serum level >1.5 mmol/L raises toxicity risk Risk Factors Dehydration (reduces lithium clearance) Medications that decrease renal clearance: ACE inhibitors, ARBs, NSAIDs, diuretics Hypothyroidism, CKD Key Investigations Serum Lithium Levels: 6-hourly if suspected toxicity Renal Function: Check creatinine, urea Serum Sodium: Assess for hypernatraemia (NDI) ECG: Possible QTc prolongation or arrhythmias Monitoring on Treatment Lithium Levels: Every 3–6 months; target range ~0.6–1.0 mmol/L (1.2 mmol/L if manic) Renal Function & Electrolytes: Regular checks (UEC, CMP) Thyroid Function Tests (TFTs): 6–12 monthly Management of Toxicity Acute Toxicity Stop Lithium Immediately Hydration: IV 0.9% sodium chloride to promote lithium excretion Monitoring: ECG, serial serum lithium levels, renal function Haemodialysis (with toxicologist advice) if: Serum lithium >4 mmol/L + renal impairment Serum lithium >5 mmol/L Severe neurological toxicity (seizures, coma) Decontamination Activated Charcoal: Not effective (lithium not adsorbed) Whole-Bowel Irrigation: Consider if >50 g ingested <4 hrs earlier (toxicologist guidance) Haemodialysis Continue until serum lithium <1 mmol/L and clinical improvement Bookmark Failed! 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