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 Inflammatory Joint Symptoms Morning stiffness >1 hour Stiffness worsens after inactivity, improves with movement Fatigue, weight loss Rash (e.g., lupus, psoriatic arthritis) Low-grade fever or sweats Examination Findings Joint swelling (symmetrical in RA) Joint erythema, tenderness, warmth Reduced range of motion or deformity (chronic disease) Investigations Blood Tests ESR/CRP: Raised in active inflammation Anaemia: Normocytic or microcytic (chronic disease) RF: Positive in ~70% of RA cases (not specific) Anti-CCP: High specificity for RA ANA: Consider in lupus Imaging X-rays: Erosions, joint space narrowing, osteopenia in chronic RA Ultrasound/MRI: Early synovitis, erosions Differentials Autoimmune: Rheumatoid arthritis (RA), psoriatic arthritis, lupus, ankylosing spondylitis Infectious: Septic arthritis (urgent aspiration), viral arthritis (e.g., parvovirus, hepatitis B/C) Crystal Arthropathies: Gout (urate crystals), pseudogout (calcium pyrophosphate crystals) Reactive Arthritis: Post-GI or GU infections Management Non-Pharmacological Joint mobilisation and strengthening Joint protection strategies Encourage low-impact exercises (e.g., swimming, yoga) Pharmacological NSAIDs: Symptom control (e.g., ibuprofen, naproxen) DMARDs: Methotrexate or sulfasalazine for RA/psoriatic arthritis Steroids: Oral or intra-articular for acute inflammation Biologics: For DMARD-refractory cases (e.g., TNF-alpha inhibitors) Specific Treatments Septic Arthritis: Emergency aspiration + IV antibiotics (e.g., flucloxacillin, cefazolin) Gout: Colchicine/NSAIDs; urate-lowering therapy (e.g., allopurinol) for recurrent cases Pseudogout: NSAIDs or intra-articular steroids Regular Monitoring Disease activity (e.g., DAS28 for RA) Bloods and imaging to assess treatment response Inflammatory Joint Symptoms Morning stiffness lasting >1 hour Stiffness worsening after inactivity, easing with movement Fatigue, weight loss possible Possible rash (lupus, psoriatic arthritis) Low-grade fever or sweats in some cases Examination Findings Joint swelling (often symmetrical in rheumatoid arthritis) Erythema, tenderness, warmth over affected joints Reduced range of motion or deformity (chronic/advanced disease) Investigations Blood Tests ESR/CRP: Elevated in active inflammation Anaemia of chronic disease (normocytic) or microcytic (less common) RF (Rheumatoid Factor): Positive in ~70% of RA, but not specific Anti-CCP: More specific for RA ANA: Consider if suspicion of lupus or other connective tissue disease Imaging X-rays: Erosions, joint space narrowing, periarticular osteopenia in chronic RA Ultrasound/MRI: Can detect early synovitis, erosions, or enthesitis Differentials Autoimmune: Rheumatoid arthritis (RA), psoriatic arthritis, lupus (SLE), ankylosing spondylitis Infectious: Septic arthritis (urgent aspiration required) Viral arthritis (e.g. parvovirus, hepatitis B/C) Crystal Arthropathies: Gout (urate crystals) Pseudogout (calcium pyrophosphate) Reactive Arthritis: Post-GI or GU infections Management Non-Pharmacological Joint mobilisation and strengthening exercises Joint protection strategies (splints, ergonomic tools) Low-impact exercises (e.g. swimming, yoga) to maintain flexibility Lifestyle: Balanced diet, healthy weight, smoking cessation Pharmacological NSAIDs (e.g. ibuprofen, naproxen) for symptom control DMARDs (Disease-Modifying Anti-Rheumatic Drugs) for RA/psoriatic arthritis: Methotrexate or sulfasalazine as first-line Hydroxychloroquine, leflunomide also options Corticosteroids: Oral or intra-articular for acute flare-ups Biologic Therapies: e.g. TNF-alpha inhibitors, for DMARD-refractory cases Specific Treatments Septic Arthritis Emergency joint aspiration + IV antibiotics (e.g. flucloxacillin, cefazolin) Tailor antibiotics to culture results Gout Acute: Colchicine, NSAIDs (e.g. indomethacin), or steroids if contraindications to NSAIDs Recurrent: Urate-lowering therapy (allopurinol or febuxostat) Pseudogout (Calcium Pyrophosphate Deposition Disease, CPPD) NSAIDs or intra-articular steroids for acute flares Enthesitis-Related Conditions (e.g. ankylosing spondylitis) NSAIDs, physiotherapy, biologics if severe Regular Monitoring Evaluate disease activity (e.g. DAS28 for RA) Repeat blood tests (CRP, ESR) and imaging to assess treatment response and identify complications early Ongoing collaboration with rheumatology if moderate–severe disease or poor prognostic factors Bookmark Failed! 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Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Acute Swollen Joint Differentials Infective Septic arthritis: Emergency; Staphylococcus aureus, Group A strep, Neisseria gonorrhoeae (consider in sexually active adults) Osteomyelitis: May spread to the joint, particularly in children Viral arthritis: Parvovirus B19, rubella, mumps, hepatitis B/C, chikungunya virus Reactive arthritis: Post-infection (e.g., gastroenteritis, tonsillitis, chlamydia), may involve enthesitis and conjunctivitis Inflammatory Systemic JIA: Fever, rash, multiple joints, often associated with hepatosplenomegaly and lymphadenopathy Acute rheumatic fever: ATSI populations, recent sore throat, migratory polyarthritis, carditis, erythema marginatum Other Ross River virus: Arthralgia, rash, polyarthritis, lasting weeks to months Parvovirus arthritis: Mimics rheumatoid arthritis, often self-limiting Septic Arthritis Management Emergency Actions Orthopaedic referral: Urgent drainage/washout to prevent joint destruction Immobilise and elevate joint: Reduce pain and swelling IV fluids: 0.9% saline for haemodynamic stability if needed Investigations Joint aspirate: Appearance: Purulent fluid suggests infection Gram stain, culture, cell count (>50,000 WBCs highly suggestive of septic arthritis) Crystals: Rule out gout or pseudogout Blood tests: Blood cultures, CRP, ESR, FBC Imaging: X-ray: Rule out fracture, osteomyelitis Ultrasound: Detect effusion, guide aspiration MRI: Consider if osteomyelitis suspected Antibiotics Flucloxacillin IV: 25–50 mg/kg (max 2 g/dose) 6-hourly Cephazolin IV: Alternative for mild penicillin allergy Vancomycin IV: MRSA risk or severe penicillin allergy Ceftriaxone IV: Consider in sexually active adults for gonococcal arthritis Supportive Care Oxygen: Maintain SpO₂ >94% if unwell Analgesia: Paracetamol or ibuprofen, consider opioid if severe pain Key Points Red Flags: Fever >38°C, severe pain, erythema, weight-bearing difficulty, markedly elevated CRP/ESR Transient Synovitis vs Septic Arthritis: Transient: Post-viral, mild systemic symptoms, improves with NSAIDs Septic: High fever, severe systemic features, non-weight-bearing, elevated inflammatory markers Delayed treatment can lead to joint destruction and sepsis, so early intervention is critical Acute Swollen Joint Differentials Infective Septic arthritis: Often caused by Staphylococcus aureus or Group A streptococcus Osteomyelitis: Can extend into the joint space, leading to septic arthritis Viral arthritis: Parvovirus B19, rubella, mumps Reactive arthritis: Follows infections such as gastroenteritis or tonsillitis (commonly Campylobacter, Shigella, Salmonella) Inflammatory Systemic juvenile idiopathic arthritis (JIA): Associated fever, rash, multiple joint involvement Acute rheumatic fever: Polyarthritis, carditis, history of sore throat, prevalent in some populations Other Ross River virus infection: Fever, rash, polyarthritis lasting up to 3 months Parvovirus-associated arthritis: Can mimic rheumatoid arthritis Acute leukaemia: Leukaemic infiltration of joints presenting with arthritis Transient synovitis: Post-viral inflammation, can resemble septic arthritis Non-accidental injury: Unexplained or repeated trauma leading to joint swelling Acute Swollen Joint with Fever Systemic JIA: Fevers, evanescent rash, marked joint involvement Acute leukaemia: Persistent bone pain, bruising, fatigue Septic arthritis: Surgical emergency requiring drainage and antibiotics Osteomyelitis: Can be more common than septic arthritis, look for local bone tenderness Viral or reactive arthritis: Consider parvovirus, rubella, mumps, or Ross River infection Acute rheumatic fever: Common in some communities, polyarthritis and possible carditis Septic Arthritis Management Emergency actions Orthopaedic referral for urgent drainage and washout Immobilisation and elevation of the joint to reduce pain and swelling IV fluids (0.9% saline) if there are signs of haemodynamic compromise Investigations Joint aspirate for Gram stain, culture, and cell count Blood cultures, CRP, ESR, and FBC to assess infection and inflammation Imaging such as ultrasound or MRI to confirm effusion or adjacent osteomyelitis Antibiotics IV flucloxacillin 25–50 mg/kg (max 2 g/dose) 6-hourly IV cephazolin if mild penicillin allergy IV vancomycin if MRSA is suspected Supportive care Maintain oxygen saturation above 94% Adequate analgesia with paracetamol or ibuprofen Key Points Red flags include fever above 38°C, severe pain, erythema, unwillingness to bear weight, and markedly elevated inflammatory markers Differentiate transient synovitis from septic arthritis by evaluating fever, systemic signs, and response to NSAIDs Delaying treatment in suspected septic arthritis can lead to joint destruction or systemic sepsis Treatment of Septic Joint Urgent orthopaedic review and surgical drainage Support with oxygen therapy if needed Establish IV access for fluid resuscitation and antibiotics Blood cultures before antibiotic administration Immobility with limb elevation to reduce oedema and pain Start IV flucloxacillin or appropriate antibiotic cover based on local resistance patterns Administer an IV 0.9% normal saline bolus Bookmark Failed! 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Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Abdominal Pain in Kids Differentials Acute Pain Infections: UTI (upper quadrant pain possible) Pneumonia (lower lobe → upper abdo pain) Sepsis (systemic signs) Surgical: Testicular torsion (boys) Volvulus (infants, bilious vomiting) Appendicitis (peri-umbilical → RLQ) Other: DKA (polyuria, polydipsia, Kussmaul breathing) Trauma (accidental or NAI) Toxin ingestion (e.g., medications) Chronic Pain Functional pain (common) GI: Constipation IBD (bloody stool, weight loss) Coeliac (bloating, growth failure) PUD/GORD (H. pylori link) Eosinophilic oesophagitis (dysphagia, atopic history) Psychosocial: Bullying/school refusal Abuse (recurrent/unexplained pain) Anxiety/depression (somatic symptoms) Other: Abdominal migraine, UTI Functional Abdominal Pain Management Reassurance: Common and self-limiting Normal Activities: Encourage school and routines Diet/Lifestyle: Avoid triggers; use symptom diary Stress: Relaxation techniques, refer for CBT if anxiety present Medical: Treat constipation; avoid over-investigation Additional Notes Eosinophilic Oesophagitis: Symptoms: Dysphagia, vomiting, heartburn Management: Biopsy, allergen elimination, swallowed steroids UTI: Always consider, even without urinary symptoms Abdominal Pain in Kids Key Points Repeated assessments help track evolving symptoms and response to initial management Analgesia should not be delayed, as pain relief does not obscure significant pathology Investigations should be targeted according to the most likely diagnosis Bilious vomiting (dark green) signals a surgical emergency warranting urgent referral Differential Diagnosis Acute Causes Urinary tract infection: May present with upper quadrant pain, consider urine testing even without classic symptoms Abdominal migraine: Episodic pain often with a migraine pattern, possible family history of migraine Diabetic ketoacidosis: Possible abdominal pain, look for hyperglycaemia and ketonuria Pneumonia: Lower lobe consolidation may refer pain to the abdomen Sepsis: Can present with diffuse abdominal pain Abdominal trauma: Consider accidental or non-accidental injury Testicular torsion: Referred pain to the lower abdomen, urgent surgical review Toxin ingestion: Varied presentations, always consider accidental ingestion or poisoning Volvulus: Twisting of the bowel, often with bilious vomiting and severe pain Chronic Causes Functional abdominal pain: Prevalent in school-age children, no organic findings Depression or anxiety: Psychosocial stressors manifesting as somatic complaints Abdominal migraine: Intermittent, similar to headache migraine triggers Chronic constipation: A frequent cause of recurrent pain Inflammatory bowel disease: Chronic pain, altered bowel habits, weight loss Coeliac disease: Pain and malabsorption triggered by gluten Peptic ulcer disease, gastro-oesophageal reflux disease, gastritis: Upper abdominal pain worsened by acidic foods Eosinophilic oesophagitis: Allergic inflammation of the oesophagus, often with feeding difficulties Bullying or school refusal: Psychosocial stress may lead to recurrent pain Urinary tract infection: Chronic urinary issues causing intermittent abdominal pain Age-Based Differential Diagnosis (Time-Critical Causes) Neonates Hirschsprung disease, incarcerated hernia, intussusception, necrotising enterocolitis, volvulus Infants and Children Appendicitis, constipation, gastroenteritis, incarcerated hernia, intussusception, Meckel’s diverticulum, ovarian torsion, testicular torsion, volvulus Adolescents Appendicitis, cholecystitis, constipation, ectopic pregnancy, inflammatory bowel disease, ovarian torsion or rupture, renal calculi, testicular torsion Functional Abdominal Pain Management Reassurance that no organic pathology is identified Education about functional pain being common and often stress-related Encourage maintenance of normal activities, including attending school Identify and avoid known food triggers Employ relaxation strategies to mitigate stress and anxiety Keep a symptom diary to recognise patterns and triggers Refer for psychological support or CBT if indicated Assessment History Determine onset, character, and location of pain (sudden onset could imply testicular or ovarian torsion) Note associated symptoms like diarrhoea, fever, or vomiting (bilious vomiting suggests obstruction) Identify psychosocial factors including family dynamics and school stress Examination Observe posture and mobility for signs of discomfort Palpate all abdominal quadrants, noting rebound tenderness or guarding Check for peritonism by assessing the child’s ability to hop or move without pain Minimise intrusive examinations, especially rectal or vaginal, unless essential Investigations Most cases do not require extensive testing Urinalysis for UTI suspicion Blood tests (electrolytes, glucose, inflammatory markers) for suspected DKA or infection Imaging with AXR if obstruction is suspected, CXR for pneumonia, ultrasound for intussusception Specific Conditions Eosinophilic Oesophagitis Allergic inflammation often seen with atopy or food allergies Presents with vomiting, feeding difficulties, or dysphagia Diagnosis by endoscopic biopsy Managed with dietary modification and topical steroid therapy Non-Specific Abdominal Pain Commonly affects 10–15% of primary school-aged children Reassure and advise on relaxation, triggers, and maintaining regular routines Treatment General Management Provide adequate analgesia and hydration Refer for surgical evaluation if obstruction or torsion is suspected Supportive care with fluid replacement, rest, and antiemetics if needed When to Refer Severe or recurrent pain not responding to conservative measures Suspicion of surgical pathology Systemic symptoms raising concern for sepsis or malignancy Notes Psychosocial factors such as family issues or bullying can exacerbate or mimic organic pain Younger children with suspected surgical issues require stabilisation and possible transfer to a paediatric centre Follow-up is vital, especially if symptoms are recurrent or evolve over time Bookmark Failed! 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Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA) Definition PMR: Inflammatory condition causing proximal muscle pain and stiffness (shoulders, hips). GCA: Vasculitis of large/medium arteries, commonly temporal, with ischaemic risks (e.g., vision loss). Presentation PMR-Specific: Bilateral shoulder/hip pain and stiffness, worse in the morning Gradual onset, difficulty with daily activities GCA-Specific: Temporal headache (unilateral), scalp tenderness Jaw claudication Vision changes: Blurred vision, amaurosis fugax, vision loss Systemic symptoms: Fever, weight loss Shared Features (PMR/GCA): Age >50 (peak 70–79), women > men Morning stiffness >1 hour Investigations Blood Tests: ESR/CRP: Elevated in both PMR and GCA FBC: Normocytic anaemia LFTs: ALP elevation in ~20% Imaging: Ultrasound (GCA): Temporal artery halo sign, stenosis, occlusion PET-CT: For large-vessel GCA Definitive GCA Diagnosis: Temporal artery biopsy: Granulomatous inflammation, multinucleated giant cells Management PMR: Prednisolone 15 mg daily: Taper as symptoms/ESR normalise Regular ESR/CRP monitoring: Monthly x3, then 3-monthly GCA: Prednisolone 60 mg daily: Taper after 4 weeks Vision-threatening GCA: IV methylprednisolone 500–1000 mg daily x3 days, then oral steroids Add low-dose aspirin (100 mg daily) for thrombotic risk PPI for gastric protection with steroids Urgent temporal artery biopsy General: Monitor for steroid side effects: Osteoporosis, hypertension, diabetes Lifestyle: Weight-bearing exercise, calcium/vitamin D Complications PMR: Chronic pain syndrome Depression from disability GCA: Vision loss (irreversible if untreated) Stroke from large-vessel vasculitis Aortic aneurysm/dissection Prognosis PMR: Good with treatment, but relapses common during tapering. GCA: Good if treated early; untreated leads to vision loss and ischaemic complications. Patient Education Timely treatment: Prevents complications like vision loss. Steroids: Adherence to long-term regimens and tapering. Bone health: Exercise, calcium/vitamin D. Recognise relapse/complication symptoms: Headaches, vision changes. Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA) Definition PMR: Inflammatory condition causing proximal muscle pain/stiffness, especially in the shoulders and hips. GCA (Giant Cell Arteritis): Vasculitis of large/medium arteries (commonly temporal arteries) with a risk of ischaemic complications such as vision loss. Presentation PMR-Specific Bilateral shoulder/hip pain and stiffness, worse in the morning Gradual onset, difficulty with daily activities (e.g. dressing, combing hair) GCA-Specific Temporal headache (often unilateral), scalp tenderness Jaw claudication Visual changes: Blurred vision, amaurosis fugax, risk of permanent vision loss Systemic: Fever, weight loss, malaise Shared Features Typically age >50 (peak 70–79), female predominance Morning stiffness >1 hour, improved with low-dose steroids Investigations Blood Tests ESR/CRP: Elevated in both PMR and GCA FBC: Normocytic anaemia common LFTs: ALP elevation (~20%) Imaging Ultrasound for GCA: May show “halo sign” or arterial stenosis PET-CT: Can detect large-vessel involvement (subclavian, aorta) in GCA Definitive GCA Diagnosis Temporal Artery Biopsy: Shows granulomatous inflammation ± multinucleated giant cells Management PMR Prednisolone 15 mg daily initially Taper slowly based on symptom control and ESR/CRP Monitor ESR/CRP monthly for first 3 months, then 3-monthly GCA High-Dose Steroids: Prednisolone 60 mg daily, taper after ~4 weeks if stable If vision-threatening: IV methylprednisolone (500–1000 mg daily x3 days), then high-dose oral Low-dose Aspirin (100 mg daily) for thrombotic risk reduction PPI for gastric protection with long-term steroids Urgent Temporal Artery Biopsy ideally within 1 week of starting steroids General Monitor Steroid Side Effects: Osteoporosis, hypertension, hyperglycaemia Lifestyle: Weight-bearing exercise, calcium + vitamin D supplementation for bone health Complications PMR Chronic pain, risk of depression from prolonged disability or steroids GCA Vision loss (irreversible if untreated) Stroke from large-vessel involvement Aortic aneurysm/dissection (long-term complication) Prognosis PMR: Generally good with treatment, though relapses during steroid taper are common GCA: Good outcome if treated early; untreated can lead to severe ischaemic complications Patient Education Timely treatment prevents complications (e.g. vision loss in GCA) Adherence to long-term steroid regimens and proper tapering is vital Bone health: Emphasise exercise, adequate calcium/vitamin D Recognise relapse or complications: Renewed headache, vision changes, or systemic symptoms Bookmark Failed! 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Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE AAA + Rupture Risk Factors Smoking HTN Hypercholesterolaemia Personal & family history of AAA/aneurysm (can include others such as iliac, fem, popliteal) Male Increased age History AAA Unimpressive symptoms: Lower back, flank, or abdo/groin pain Pulsatile abdominal or flank mass Rupture Presyncope/syncope: Lightheadedness or dizziness (hypotension) Neurological signs: Limb paraesthesia or paralysis from spinal cord ischaemia Chest, abdo, or back pain: Sudden, severe, or tearing pain Criteria for Surgical Intervention Men >5.5cm or women >5cm: Repair strongly recommended Growth rate >1cm/year: Indicative of instability Symptomatic aneurysms: Unexplained abdo/back pain or tenderness Screening Recommendations AUS does not have a formal national screening program for AAA yet, but targeted screening is practiced based on individual risk factors. Men ≥65: One-off ultrasound reduces mortality Fam hx: Screen men/women >50 (20% lifetime risk) Women: Consider only w/ fam hx or risk factors Small aneurysms: <5.5 cm: Monitor regularly (grow 2–3 mm/yr) 5.5 cm (men) or >5.0 cm (women): Repair unless contraindicated Abdominal Aortic Aneurysm (AAA) Definition Most common type of true arterial aneurysm Segmental, full-thickness dilation of the aorta exceeding 50% of its normal diameter Typically considered aneurysmal if the diameter is >3.0 cm Aetiology/Causes Degenerative changes: Due to atherosclerosis Genetic predisposition: Family history of AAA Connective tissue disorders: Marfan syndrome, Ehlers-Danlos syndrome Infectious causes (rare): Mycotic aneurysms (e.g., bacterial infections) Risk Factors Modifiable: Smoking (current or past) Hypertension Hypercholesterolaemia Non-modifiable: Age >65 years Male sex Family history of AAA or other arterial aneurysms (e.g., iliac, femoral) Caucasian ethnicity Pathophysiology Progressive aortic wall weakening due to the degradation of elastin and collagen, often accelerated by risk factors like smoking and hypertension. This leads to vessel dilation and potential rupture. Symptoms Asymptomatic: Most AAAs are detected incidentally via imaging for other reasons. Symptomatic but not ruptured: Vague abdominal, back, or flank pain Pulsatile abdominal mass Limb ischaemia (acute or chronic) Ruptured: Severe abdominal or back pain, radiating to the groin or flank Hypotension or shock Pulsatile abdominal mass High mortality if not promptly treated (80–90%) Differential Diagnosis Renal colic Diverticulitis Lumbar spine disease Ischaemic bowel disease Gastrointestinal haemorrhage Acute cholecystitis Myocardial infarction Investigations Imaging: Abdominal ultrasound: First-line for asymptomatic patients and surveillance. CT angiography: Preferred for symptomatic or suspected ruptured AAA to assess extent and planning for surgery. MRI: Used if CT is contraindicated or for further assessment of surrounding structures. Surveillance intervals: Based on the size of the aneurysm: 3.0–3.9 cm: Ultrasound every 24 months 4.0–4.9 cm: Ultrasound every 12 months 5.0–5.4 cm: Ultrasound every 6 months >5.5 cm: Consider surgical repair Management Conservative: Surveillance: Regular ultrasound for smaller AAAs. Risk factor modification: Smoking cessation, blood pressure control, statins. Surgical Intervention: Indications for surgical repair: Male with AAA >5.5 cm Female with AAA >5.0 cm Rapid growth >1.0 cm/year Symptomatic AAA (abdominal/back pain/tenderness, distal embolisation) Urgent/Emergency Surgery: Indicated in ruptured AAA or symptomatic non-ruptured AAA. Surgical Approaches: Open AAA repair: A graft is sewn into place through a large incision in the abdomen. Endovascular Aneurysm Repair (EVAR): A minimally invasive technique using a graft delivered via the femoral arteries. Complications Rupture: Catastrophic event with a high mortality rate (80-90%). Thromboembolism: Can lead to limb ischaemia; Risk of distal embolisation. Post-repair complications: Endoleak, graft infection. Aortoenteric fistula: Rare but serious complication, especially after open surgical repair. Prognosis Untreated rupture: Mortality approaches 90%. Elective repair: Lower mortality risk (<5%). Long-term outcomes: Dependent on comorbid conditions and repair success. Notes: Screening recommendations vary; in Australia, targeted screening may apply to high-risk groups (e.g., males >65 years, smokers). Surveillance strategies differ between regions but are often based on diameter and growth rate. Lifestyle Modifications: Smoking cessation, managing hypertension and hyperlipidaemia are crucial in slowing the expansion of AAA. Regular Follow-Up: Essential for patients with known AAA, particularly as the aneurysm approaches the surgical threshold size. There is a high rate of misdiagnosis with ruptured AAA; symptoms may mimic renal colic, diverticulitis, or lumbar spine disease. No benefit in AAA screening for those at low risk (<10% on the Framingham Risk Score) . 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 Delirium Confusion Assessment Method (CAM) Requires 1 + 2 and either 3 or 4: Acute onset, fluctuating course (changes in mental status, attention deficits) Inattention (key criterion) Disorganised thinking Altered consciousness (hyperalert or drowsy) Alternative rapid tool: 4AT (validated for quick screening) Differentials Medications/withdrawal (alcohol, illicit drugs) Sleep deprivation, pain, abuse B12 deficiency Infections: UTI, pneumonia Constipation, urinary retention Dementia (including Lewy body dementia) Neurological: Stroke, brain tumour Organ failure: Respiratory, cardiac, renal Electrolytes: Hyponatraemia, hypoglycaemia MI, arrhythmia Prevention (also risk factors) Quiet environment, minimal stimulation Familiar objects, clocks, calendars Regular sleep schedule, optimise sleep hygiene Correct vision/hearing impairments Adequate pain relief, avoid deliriogenic meds Proper lighting (day-night cycle support) Encourage familiar person’s presence Hydration, nutrition Avoid restraints unless essential Structured reorientation, cognitive stimulation Management Non-Pharmacological Low-stimulus environment, minimise noise Frequent reorientation, clear/calm communication Approach from the front, maintain eye contact Encourage familiar person's presence, ensure personal belongings Secure sharp objects, one-to-one nursing if needed Inform family of status changes Review medications & fluid balance Pharmacological (if severe behavioural disturbance, hallucinations, or delusions) First-line: Risperidone 0.25 mg BD (max 1 mg BD) Second-line: Olanzapine 2.5 mg OD (max 10 mg OD) Dementia/Lewy body dementia: Low-dose quetiapine Use lowest effective dose, shortest duration, monitor vitals For Anxiety/Agitation Oxazepam 7.5 mg TDS PRN For Acute Behavioural Changes (Stat Dose) First-line: Haloperidol or risperidone 0.5 mg PO (repeat in 30 min if needed) If oral not feasible: Haloperidol 0.5 mg IM Monitor & adjust therapy based on response & EPSE risk Delirium Confusion Assessment Method (CAM) Requires 1 + 2 and either 3 or 4: Acute onset, fluctuating course (changes in mental status, attention deficits) Inattention (key criterion) Disorganised thinking Altered consciousness (hyperalert or drowsy) Alternative rapid tool: 4AT (validated for quick screening) Differentials Medications/withdrawal (alcohol, illicit drugs) Sleep deprivation, pain, possible abuse B12 deficiency Infections (UTI, pneumonia) Constipation, urinary retention Dementia (including Lewy body dementia) Neurological (stroke, brain tumour) Organ failure (respiratory, cardiac, renal) Electrolyte imbalances (hyponatraemia, hypoglycaemia) Cardiac (MI, arrhythmia) Prevention (Also Risk Factors) Quiet environment, minimal stimulation Familiar objects, clocks, calendars Regular sleep schedule, optimise sleep hygiene Correct vision/hearing impairments Adequate pain relief, avoid deliriogenic meds Proper lighting to maintain day-night cycle Encourage presence of familiar person Ensure hydration, nutrition Avoid restraints unless absolutely essential Structured reorientation and cognitive stimulation Management Non-Pharmacological Low-stimulus environment, minimise noise Frequent reorientation, clear and calm communication Approach from the front, maintain eye contact Encourage presence of a familiar person, use personal belongings Secure sharp objects, consider one-to-one nursing if needed Inform family of status changes Review medications and fluid balance Pharmacological (for severe agitation, hallucinations, delusions) First-line: Risperidone 0.25 mg BD (max 1 mg BD) Second-line: Olanzapine 2.5 mg OD (max 10 mg OD) Dementia or Lewy body dementia: Low-dose quetiapine Use lowest effective dose for the shortest duration; monitor vitals For Anxiety/Agitation Oxazepam 7.5 mg TDS PRN For Acute Behavioural Changes (Stat Dose) First-line: Haloperidol or risperidone 0.5 mg PO (can repeat in 30 min if needed) If oral not feasible: Haloperidol 0.5 mg IM Monitor and adjust based on response; watch for EPSE risks Bookmark Failed! 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Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Nephritic Syndrome Pathophysiology Glomerular inflammation (glomerulonephritis) leading to haematuria, proteinuria, and renal impairment Immune-mediated injury to glomerular capillaries, resulting in increased permeability and reduced glomerular filtration Causes Common causes: Post-infectious GN (e.g., post-streptococcal glomerulonephritis, PSGN) IgA nephropathy (Berger’s disease) – most common, especially in young males of Asian descent, typically 1–2 days post-URTI Small vessel vasculitis (ANCA-associated): Granulomatosis with polyangiitis (Wegener’s) Microscopic polyangiitis Anti-GBM disease (Goodpasture’s syndrome) – associated with pulmonary haemorrhage Other causes: SLE nephritis (can cause both nephritic and nephrotic syndrome) Membranoproliferative GN (MPGN) – rare, often secondary to autoimmune or chronic infections Presentation Haematuria – macroscopic (tea/coca-cola coloured urine) or microscopic Hypertension – due to fluid retention and renal impairment Oedema – often periorbital and lower limb Acute kidney injury (AKI) – rising creatinine, reduced eGFR Proteinuria – typically <3.5 g/day (often <1.5 g/day), ACR/PCR <300 mg/mmol Diagnosis Initial investigations: Bloods: UEC (assess renal function) FBC (anaemia of chronic disease, infection markers) Complement levels (low in PSGN, lupus nephritis) ASOT (post-streptococcal GN) ANA (SLE), ANCA (vasculitis), anti-GBM (Goodpasture’s) Urine tests: Urinalysis – haematuria, proteinuria Urine microscopy: Red cell casts (specific for glomerular pathology) Urine PCR/ACR (quantify proteinuria) or 24-hour urine protein Urine MCS to exclude infection Imaging: Renal ultrasound – assess kidney size, rule out obstruction Renal biopsy – required for definitive diagnosis Urine ACR reference range: Normal: Male <2.5 mg/mmol, Female <3.5 mg/mmol Microalbuminuria: Male 2.5–25 mg/mmol, Female 2.5–35 mg/mmol Macroalbuminuria: Male >25 mg/mmol, Female >35 mg/mmol Nephrotic range: >300 mg/mmol Treatment General measures: BP control: Aim for <130/80 mmHg ACE inhibitors/ARBs if proteinuria present (reduce glomerular pressure and proteinuria) Salt and fluid restriction if oedema present Diuretics (loop diuretics for volume overload) Immunosuppression: Corticosteroids (especially for IgA nephropathy, SLE nephritis, or vasculitis) Cyclophosphamide/MMF (vasculitis or severe autoimmune causes) Specific management: PSGN: Supportive care (self-limiting in most cases), antibiotics for active infection IgA nephropathy: BP control, fish oil, consider steroids if progressive disease ANCA-associated vasculitis: High-dose steroids and cyclophosphamide or rituximab Goodpasture’s syndrome: Plasmapheresis, steroids, and cyclophosphamide Notes IgA nephropathy is the most common cause of primary glomerulonephritis, often seen post-URTI or GI infection Think haematuria workup when considering differentials If urine protein is ≥4 g/day with only mild haematuria, consider nephrotic syndrome instead Early renal biopsy is key in guiding treatment for progressive or uncertain cases Nephritic Syndrome Pathophysiology Nephritic syndrome is characterised by inflammatory injury to the glomeruli (glomerulonephritis), resulting in haematuria, proteinuria, and renal impairment. Immune-mediated damage to glomerular capillaries leads to increased permeability (blood cells/ proteins leak into urine) and reduced filtration. Causes Common Causes Post-Infectious GN (e.g. post-streptococcal GN, typically 1–3 weeks after a strep throat/skin infection) IgA Nephropathy (Berger’s Disease): Most common primary GN; presents often 1–2 days post-URTI, especially in young males of Asian descent Small Vessel Vasculitis (ANCA-associated): Granulomatosis with Polyangiitis (Wegener’s) Microscopic Polyangiitis Anti-GBM Disease (Goodpasture’s Syndrome): Often also pulmonary haemorrhage Other Causes SLE Nephritis: Can cause nephritic or nephrotic features Membranoproliferative GN (MPGN): Rare, often secondary to autoimmune conditions or chronic infections Presentation Haematuria: Cola- or tea-coloured urine (macroscopic) or microscopic RBCs Hypertension: Due to fluid retention & sodium retention Oedema: Typically periorbital (morning swelling) and/or peripheral (ankles, feet) Acute Kidney Injury (AKI): Rising creatinine, reduced eGFR Proteinuria: Usually <3.5 g/day (often <1.5 g/day); ACR/PCR <300 mg/mmol Diagnosis Initial Investigations Bloods: UEC (renal function) FBC (anaemia of chronic disease, infection) Complement levels (C3/C4), often low in post-streptococcal GN or lupus nephritis ASOT (post-streptococcal), ANA (SLE), ANCA (vasculitis), anti-GBM (Goodpasture’s) Urine Tests: Urinalysis → RBC casts, RBCs Urine microscopy: Red cell casts confirm glomerular origin Urine PCR/ACR to quantify proteinuria Urine MCS to exclude infection Imaging Renal Ultrasound: Check kidney sizes, exclude obstruction Renal Biopsy (definitive diagnosis) Indicated in uncertain cases, progressive renal impairment, or atypical features Urine ACR Reference Range Normal: Male <2.5 mg/mmol, Female <3.5 mg/mmol Microalbuminuria: Male 2.5–25 mg/mmol, Female 2.5–35 mg/mmol Macroalbuminuria: Male >25 mg/mmol, Female >35 mg/mmol Nephrotic Range: >300 mg/mmol Management General Measures Blood Pressure Control: Aim <130/80 mmHg ACE Inhibitors or ARBs if significant proteinuria Salt and Fluid Restriction if oedema present Diuretics (loop diuretics) for volume overload Immunosuppression Corticosteroids: Commonly used in IgA nephropathy, SLE nephritis, and ANCA vasculitis Cyclophosphamide or Mycophenolate Mofetil: For severe vasculitis or lupus nephritis Specific Management Post-Streptococcal GN: Supportive care (self-limiting in children), antibiotics if active streptococcal infection IgA Nephropathy: BP control, fish oil, consider steroids if progressive or persistent proteinuria ANCA-Associated Vasculitis: High-dose steroids + cyclophosphamide or rituximab Goodpasture’s Syndrome (Anti-GBM): Plasmapheresis + steroids ± cyclophosphamide Notes IgA Nephropathy: Most common primary GN worldwide, often follows URTI or GI infection by 1–2 days. If urine protein ≥4 g/day with mild haematuria, consider nephrotic syndrome variant. Renal Biopsy helps guide targeted therapy if suspicion of rapid progression or unclear aetiology. 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 Pregnancy Indications for 5mg Folate Fat (obesity BMI >30) Diabetes Anticonvulsants (esp valproate, carbamazepine, phenytoin, phenobarbital) Personal/family history of NTDs Pre-pregnancy folate deficiency (malabsorption, bariatric surgery) Previous pregnancy affected by NTD Second Trimester Bleeding Differentials Bloody show of premature labour (post 20wks) (Can precede labour by 72hrs) Cervical insufficiency Painless, vaginal fullness, increased discharge Shortened cervix on ultrasound (high risk for preterm labour) Placenta praevia (DO NOT do a DRE) Placental abruption Bleeding (80%), uterine tenderness (70%), contractions (35%) Risk factors: Smoking, HTN, cocaine, trauma Early pregnancy loss (stillbirth post 20wks) Cervical ectropion Cervical cancer Pelvic inflammatory disease (PID) Vaginitis Cervical polyps/fibroids History Unusual vaginal discharge Abdominal pain Change in fetal movements Uterine contractions Amount of blood loss Vaginal fullness (suggests cervical insufficiency) Recent abdominal trauma Cocaine/smoking history New backache (cervical insufficiency) Previous episodes of vaginal bleeding Examinations Abdominal examination – Fundal height, uterine tenderness Fetal heart rate assessment Speculum examination – Assess cervix, os, fetal membranes Transvaginal ultrasound (TVUS) – EXCLUDE placenta praevia Investigations FBC, blood group & hold TVUS (definitive for placenta praevia) Fetal fibronectin (predicts preterm labour) Chickenpox Exposure Management Previous chickenpox history → No further management Unvaccinated or unsure → Check varicella IgG If IgG negative & exposure <4 days → VZIG (refer to ED) If >4 days post-exposure → Consider oral acyclovir for post-exposure prophylaxis If symptomatic with chickenpox: Consider oral acyclovir Greatest risk if infection occurs later in pregnancy VZIG only if no clinical symptoms present Sensitising Events & Safest SSRIs Sensitising Events (Anti-D Prophylaxis if Rh-negative) Miscarriage (complete, some guidelines exclude threatened miscarriage) Termination Ectopic pregnancy Invasive testing (CVS, amniocentesis) Delivery Antepartum bleeding (any bleeding >20wks, incl. placenta praevia) Abdominal trauma Safest SSRIs in Pregnancy Sertraline (preferred) Avoid: Paroxetine, fluoxetine, citalopram Gestational Diabetes Mellitus (GDM) Diagnostic Criteria RACGP criteria: Fasting BGL ≥5.5 mmol/L 2-hour BGL ≥8.0 mmol/L ADIPS criteria (different cutoff): Fasting BGL ≥5.1 mmol/L 2-hour BGL ≥8.5 mmol/L Diabetes in Pregnancy (pre-existing): Fasting BGL ≥7.0 mmol/L 2-hour BGL ≥11.1 mmol/L Glucose Monitoring Frequency & Targets 4x daily: Fasting + 1-hour post meals Targets: Fasting ≤5.0 mmol/L 1-hour postprandial ≤7.4 mmol/L Management BSL monitoring advice Dietary modification & physical activity Repeat OGTT 6–12 weeks postpartum GDM & Pre-eclampsia Risk Factors Hypertension Obesity (BMI >30) Age >40 Previous pregnancy loss Previous history of GDM or pre-eclampsia Diabetes ( in pre-eclampsia only) Preventative Treatment Pre-eclampsia: Calcium 1g/day Low-dose aspirin 100mg/day if high risk GDM: Early HbA1c or OGTT (12-14 weeks) if risk factors present Endocrinology referral for treatment decisions Antenatal & Preconception Counselling Preconception Counselling Genetic carrier screening (e.g., Prepair) Up-to-date cervical screening Optimise chronic disease management Ensure rubella & varicella immunity, vaccinate pre-pregnancy Prenatal supplementation (folate, vitamin D 1000 IU/day if BMI >30) Avoid alcohol & smoking, assess illicit drug use Encourage 150 min/week of moderate aerobic exercise Routine Antenatal Assessment EPDS for perinatal depression screening Domestic violence screening Urine dipstick for proteinuria First-trimester screening (NIPT or combined FTS after 11 weeks) Asthma in Pregnancy Good asthma control is crucial (risk of exacerbation outweighs medication risk) Budesonide (Cat A) preferred, but do NOT switch if stable on another ICS Exacerbation → CAN use oral steroids Bipolar Disorder in Pregnancy Management Considerations Refer to high-risk antenatal clinic Explain the need for regular GP visits to monitor mental health during pregnancy Advise that she is at an increased risk of relapse following childbirth Education on strategies to reduce the chance of relapse OR advise about the importance of medication compliance Discussion of signature relapse symptoms and ensure she presents early if this occurs Explain that child is at an increased risk of bipolar disorder More frequent monitoring of lithium levels whilst pregnant Close monitoring of thyroid levels during pregnancy Explain the need for frequent fetal monitoring via ultrasound for heart abnormalities caused by lithium Explain that lithium may increase the likelihood of congenital heart defects if taken in pregnancy (my ans) Preferred Mood Stabilisers 1st line: Lamotrigine 2nd line: Quetiapine, risperidone Lithium → Can be used if no other option (low but present teratogenic risk) AVOID: Valproate & carbamazepine unless absolutely necessary Note: Sertraline is the preferred SSRI in pregnancy GDM requires early OGTT in high-risk women (12–14 weeks) Bipolar disorder → Avoid valproate/carbamazepine, prefer lamotrigine Pre-eclampsia prophylaxis: Aspirin 100mg/day & calcium 1g/day Chickenpox exposure → Give VZIG if <4 days & IgG negative Asthma is best controlled with ICS; do NOT stop preventers Pregnancy Preconception Counselling Offer genetic carrier screening and up-to-date cervical screening Optimise chronic disease management and ensure rubella and varicella immunity with vaccination pre-pregnancy Commence folate supplementation at least one month before conception and advise vitamin D 1000 IU/day if BMI >30 Advise lifestyle modifications including smoking cessation, alcohol avoidance and regular moderate exercise (150 min/week) Folate Supplementation Indicated in women with obesity (BMI >30) Recommended for women with diabetes Essential for those on anticonvulsants (especially valproate, carbamazepine, phenytoin, phenobarbital) Necessary for personal or family history of neural tube defects Advised in pre-pregnancy folate deficiency due to malabsorption or bariatric surgery Indicated in women with a previous pregnancy affected by neural tube defects Second Trimester Bleeding Differential diagnoses include bloody show of premature labour, cervical insufficiency, placenta praevia and placental abruption History should assess unusual vaginal discharge, abdominal pain, uterine contractions, change in fetal movements and amount of blood loss Examination should include abdominal assessment of fundal height, uterine tenderness and fetal heart rate evaluation; speculum examination is crucial and transvaginal ultrasound is used to exclude placenta praevia Investigations include full blood count, blood group and hold, and fetal fibronectin to predict preterm labour Chickenpox Exposure If previous chickenpox history is confirmed, no further management is required For unvaccinated or uncertain women, check varicella IgG If IgG negative and exposure is less than 4 days, administer VZIG with urgent referral to ED If exposure is greater than 4 days post-exposure, consider oral aciclovir for post-exposure prophylaxis If symptomatic with chickenpox, treat with oral aciclovir noting that risk is highest if infection occurs later in pregnancy; VZIG is not indicated once clinical symptoms are present Sensitising Events and Safest SSRIs Provide anti-D prophylaxis for Rh-negative women in cases of sensitising events such as miscarriage, termination, ectopic pregnancy, invasive testing and antepartum bleeding Sertraline is the preferred SSRI in pregnancy; avoid paroxetine, fluoxetine and citalopram due to higher risk profiles Gestational Diabetes Mellitus (GDM) Diagnostic criteria vary: RACGP guidelines define fasting BGL ≥5.5 mmol/L and 2-hour BGL ≥8.0 mmol/L, whereas ADIPS uses fasting BGL ≥5.1 mmol/L and 2-hour BGL ≥8.5 mmol/L; pre-existing diabetes is diagnosed with fasting BGL ≥7.0 mmol/L or 2-hour BGL ≥11.1 mmol/L Glucose should be monitored four times daily (fasting and 1-hour post meals) with targets of fasting ≤5.0 mmol/L and 1-hour postprandial ≤7.4 mmol/L Management involves blood sugar monitoring, dietary modification, physical activity and repeat OGTT 6–12 weeks postpartum Early testing with HbA1c or OGTT (12–14 weeks) is recommended for high-risk women and an endocrinology referral is advised for treatment decisions GDM and Pre-eclampsia Recognise shared risk factors including hypertension, obesity (BMI >30), age over 40, previous pregnancy loss and history of GDM or pre-eclampsia For pre-eclampsia prevention, calcium 1 g/day and low-dose aspirin 100 mg/day are recommended for high-risk women Antenatal and Routine Pregnancy Assessment Routine assessments include screening for perinatal depression (EPDS), domestic violence and urine dipstick for proteinuria First-trimester screening (non-invasive prenatal testing or combined first-trimester screening) should be offered after 11 weeks Regular monitoring of fetal movements, growth via ultrasound and CTG is essential, particularly in high-risk pregnancies Asthma in Pregnancy Maintain good asthma control; the risk of exacerbation outweighs the potential risk of medications Budesonide (Category A) is preferred and stable patients should not be switched from their current inhaled corticosteroid In cases of exacerbation, oral steroids can be used Bipolar Disorder in Pregnancy Refer to a high-risk antenatal clinic for specialised care Ensure regular GP visits to monitor mental health and medication adherence during pregnancy Educate about increased risk of relapse postpartum and discuss early warning signs Monitor lithium levels frequently with target serum level of 0.6–0.8 mmol/L and adjust dose as maternal fluid volume changes; perform fetal echocardiography if lithium is continued Prefer lamotrigine as first-line mood stabiliser and avoid valproate and carbamazepine unless absolutely necessary Consider second-generation antipsychotics (eg quetiapine, risperidone) if indicated; advise that sertraline is the preferred SSRI in pregnancy General Pregnancy Management High-Yield Points Early identification and management of risk factors such as obesity, diabetes and mental health conditions optimise maternal and fetal outcomes Preventative strategies include preconception counselling, appropriate supplementation, and lifestyle modification Collaborative care involving general practitioners, obstetricians, endocrinologists and mental health professionals is essential Regular antenatal follow-up and tailored management plans, including telemedicine options in rural or remote settings, improve care quality and accessibility Postpartum follow-up with OGTT is crucial for women with GDM to monitor 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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 Cracked Heels Causes & Risk Factors Dry Skin – Common in Australian climates with low humidity Excessive Pressure – Prolonged standing, obesity, barefoot walking on hard surfaces Open Footwear – Increases friction and dryness Dermatological Conditions – Atopic dermatitis, psoriasis, keratoderma Medical Conditions – Diabetes (↓sensation, ↓sweat), hypothyroidism, nutritional deficiencies (zinc, essential fatty acids) Clinical Features Dry, thickened skin with fissures or cracks Pain, bleeding, or infection if deep Cracks may catch on socks/footwear Can be asymptomatic or mildly itchy, painful with weight-bearing Assessment Examine for dryness, thickness, infection (cellulitis) Check for foot deformities, obesity, footwear habits Diabetic foot check if patient has diabetes Management Non-Pharmacological Footwear – Supportive, closed shoes with heel cushioning Heel Pads/Cups – Redistribute pressure Foot Soaks – Warm water (5–10 min), followed by gentle pumice stone use Moisturising – Urea-based emollients daily Pharmacological Keratolytics – Urea cream (10–25%) or salicylic acid-based creams daily Antiseptics/Topical Antibiotics – If fissures are infected or high risk (e.g. diabetic foot) Steroid Creams – Only for significant inflammation or dermatitis When to Refer Suspected Infection – Deep fissures with cellulitis signs Diabetes – With peripheral neuropathy or severe cracks Refractory Cases – Persistent after 4–6 weeks of standard care Podiatry Referral – For offloading/orthotics if biomechanical issues Prevention Regular Emollient Use – Urea-based heel balms daily Avoid Walking Barefoot – Especially on hard surfaces Weight Management – If overweight/obese Protective Footwear – Closed-back shoes, socks Hydration & Nutrition – Balanced diet for skin integrity Quick Comparison of Keratolytic Options Product Type Concentration Application Frequency Notes Urea cream 10–25% 1–2 times daily Softens callus, retains moisture Salicylic acid ointment 5–10% 1–2 times daily May cause irritation if overused Combination creams e.g. Urea + SA 1–2 times daily Combined effect for persistent hyperkeratosis Notes Check for diabetes/vascular disease if recurrent or non-healing Encourage gentle filing after foot soak—avoid aggressive removal Consider regular podiatry visits for those unable to self-manage Cracked Heels Causes and Risk Factors Dry Skin: Common in Australian climates with low humidity Excessive Pressure: Prolonged standing, obesity, walking barefoot on hard surfaces Open Footwear: Exposes heels to friction and dryness Dermatological Conditions: Atopic dermatitis, psoriasis, keratoderma Medical Conditions: Diabetes (reduced sensation, decreased sweat), hypothyroidism, nutritional deficiencies (zinc, essential fatty acids) Clinical Features Dry, thickened skin on heels with fissures or cracks Possible pain, bleeding, or infection if deep cracks May catch on socks or footwear Can appear asymptomatic or mildly itchy, occasionally painful with weight-bearing Assessment Examine for dryness, thickness, possible infection (e.g. cellulitis) Check for underlying foot deformities, obesity, footwear habits Consider diabetic foot checks if patient has diabetes Management Non-Pharmacological Footwear: Use supportive, closed shoes with heel cushioning Heel Pads or cups to redistribute pressure Foot Soaks in warm water (5–10 minutes), followed by gentle pumice stone use Moisturising with emollients daily (e.g. urea-based creams) Pharmacological Keratolytics: Urea cream (10–25%) or salicylic acid-based creams daily to reduce hyperkeratosis Antiseptics/Topical Antibiotics if fissures are infected or at high risk (e.g. diabetic foot) Steroid creams rarely used except for significant inflammation or dermatitis When to Refer Suspected Infection: Deep fissures with signs of cellulitis Diabetes with peripheral neuropathy or severe cracks Refractory Cases: Persistent after 4–6 weeks of standard care Podiatry referral for offloading, orthotics if biomechanical issues Prevention Regular Emollient Use: Urea-based heel balms daily Avoid Walking Barefoot on hard or abrasive surfaces Weight Management if overweight or obese Protective Footwear: Closed-back shoes, socks Adequate Hydration & Nutrition: Ensure balanced diet for skin integrity Table: Quick Comparison of Keratolytic Options Product Type Concentration Application Frequency Notes Urea cream 10–25% 1–2 times daily Can soften thick callus, help retain moisture Salicylic acid ointment 5–10% 1–2 times daily May cause irritation if used excessively Combination creams e.g. Urea + SA 1–2 times daily Combined effect for persistent hyperkeratosis Notes Check for diabetes or vascular disease if recurrent or non-healing cracks Encourage gentle filing/pumice stone after foot soak, avoid aggressive removal Some patients benefit from regular podiatry visits if 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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 Premature Ovarian Failure (POF) Definition Amenorrhoea before age 40 Risk Factors Family history Previous chemotherapy or radiotherapy Autoimmune disorders Smoking Nulliparity Causes Idiopathic (most common) Autoimmune: Addison’s disease, hypothyroidism, coeliac disease Genetic: Turner syndrome, fragile X premutation Symptoms Menopausal symptoms: Hot flushes, mood swings, breast tenderness, bloating Infertility Amenorrhoea Diagnosis FSH >25 IU/L on two occasions, ≥1 month apart, after 4–6 months of oligo/amenorrhoea Exclude secondary causes (e.g., thyroid dysfunction, hyperprolactinaemia) Long-Term Sequelae Menopausal symptoms: Atrophic vaginitis, low libido, hot flushes Osteoporosis: Bone mineral density (BMD) scan every 2 years Increased cardiovascular risk Infertility Depression Management HRT: Start early, continue until ~51 years to reduce osteoporosis and CVD risk Lifestyle: Stop smoking, maintain a healthy weight, limit alcohol, weight-bearing exercise, adequate calcium & vitamin D Psychological support: Referral and support groups Fertility: Consider IVF with donor oocytes Premature Ovarian Failure (POF) Definition Amenorrhoea due to loss of ovarian function before age 40 Encompasses premature ovarian insufficiency and primary amenorrhoea Course may be variable with occasional spontaneous ovulation Risk Factors Family history of early menopause or POI Previous chemotherapy, radiotherapy or ovarian surgery Autoimmune disorders such as Addison’s disease, autoimmune thyroiditis or coeliac disease Cigarette smoking Nulliparity Aetiology Idiopathic is the most common cause Autoimmune causes including adrenal and thyroid autoimmunity Genetic abnormalities such as Turner syndrome and Fragile X premutation Iatrogenic causes related to medical therapies (eg chemotherapy, radiotherapy) Environmental factors like smoking accelerating ovarian follicle depletion Symptoms and Clinical Presentation Menstrual disturbance manifesting as oligomenorrhoea or amenorrhoea Menopausal symptoms including hot flushes, mood swings, atrophic vaginitis, breast tenderness and bloating Infertility due to diminished ovarian reserve Psychosocial impact with increased risk of depression, anxiety and negative body image Diagnosis Elevated follicle-stimulating hormone levels in the menopausal range on two occasions (at least 4–6 weeks apart) after >4 months of menstrual irregularity Low oestradiol levels with compensatory elevated gonadotropins Exclusion of secondary causes (eg hypothalamic or pituitary disorders, medications) Consider karyotyping and Fragile X premutation testing in suspected genetic cases Autoimmune screening (eg thyroid peroxidase, adrenal antibodies) where indicated Long-Term Sequelae Persistent menopausal symptoms such as atrophic vaginitis, low libido and hot flushes Increased risk of osteoporosis, necessitating bone mineral density assessments every 2 years Elevated cardiovascular risk due to oestrogen deficiency and adverse lipid changes Infertility with significant implications for reproductive planning Potential neurocognitive effects and increased incidence of depression Management Initiate hormone replacement therapy early and continue until approximately age 51 to mitigate osteoporosis and cardiovascular risks Individualise HRT regimen (eg transdermal oestrogen may be preferable in high-risk groups) Advise lifestyle modifications including smoking cessation, maintenance of a healthy weight, regular weight-bearing exercise, and adequate calcium and vitamin D intake Provide psychological support with counselling and referral to support groups For women desiring pregnancy, consider assisted reproductive techniques such as IVF with donor oocytes Arrange regular multidisciplinary follow-up to monitor therapy, screen for long-term complications and adjust management as needed Notes POI can have a fluctuating course with rare spontaneous resumption of ovarian function Early diagnosis is crucial to initiate timely HRT and prevent long-term morbidity Screen for associated autoimmune conditions and genetic causes where appropriate Educate patients about fertility implications and available assisted reproductive options Ongoing monitoring of cardiovascular risk factors and bone health should form part of long-term care Bookmark Failed! 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Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Migraines Diagnosis Duration: 4–72 hrs ≥2 of: Unilateral, pulsating, worse with activity, moderate-severe intensity ≥1 of: Nausea/vomiting OR photo/phonophobia Exclude secondary headache causes Management Non-Pharmacological Limit caffeine (triggered by routine changes, stress, coffee, chocolate, perfume) Regular sleep schedule Relaxation therapy: CBT, meditation, yoga, breathing exercises Hydration, regular meals 150 mins/week low-impact aerobic exercise Optimise workplace ergonomics (physio if neck tightness) Magnesium 500 mg daily x 3 months (limited evidence) Ice pack to neck during flare-ups Avoid analgesic overuse (>10–15 days/month → medication overuse headache) Avoid opioids/codeine Stepwise Pharmacological Approach Non-opioid analgesic: Ibuprofen 400 mg (10 mg/kg) + Antiemetic: Ondansetron 8 mg (0.1 mg/kg), even if no nausea (improves absorption) + Triptans: Sumatriptan 50 mg PO (repeat in 2 hrs if effective) Intranasal: 20 mg (adults & children) Can be combined with a non-opioid analgesic Prophylaxis (if >2 attacks/month): Amitriptyline: 10 mg up to 75 mg daily (trial max dose for 8–12 wks) Propranolol: 20 mg nocte (only proven prophylactic in children) CBT can also help Notes Riboflavin & ubidecarenone: Consider 3-month trial Avoid aspirin <16 yrs (Reye’s syndrome risk) Triptans: No initial response → do NOT repeat Positive response → can repeat in 2 hrs Can be given with SSRI/SNRI (warn about serotonin syndrome) Tension headache: Amitriptyline prophylaxis Tremor/vestibular migraine: Propranolol Migraine-specific prophylaxis: Pizotifen Sumatriptan = only triptan in injectable/intranasal form Migraine Prophylaxis – Choosing Medications Use in Specific Conditions Insomnia/fibromyalgia: TCA, pregabalin Diabetes/obesity: Topiramate, candesartan Anxiety: Propranolol Hot flushes: Propranolol, gabapentin, SSRI Neck tension/bruxism: TCA Depression: SSRI, SNRI, TCA Avoid in Specific Conditions Asthma: Propranolol Diabetes/obesity: Valproate, pizotifen Renal calculi: Topiramate Depression: Beta-blockers, topiramate (caution) Migraines Diagnosis Clinical Criteria (adapted from ICHD-3): Headache lasts 4–72 hours (untreated or unsuccessfully treated) ≥2 of the following: Unilateral location Pulsating quality Worsened by routine physical activity Moderate or severe intensity ≥1 of the following: Nausea ± vomiting Photophobia and/or phonophobia Exclude secondary headache causes (e.g. tumour, infection, giant cell arteritis) Management Non-Pharmacological Limit Caffeine: Watch for triggers (chocolate, certain perfumes) Regular Sleep: Maintain consistent sleep times Relaxation Therapy: CBT, meditation, yoga, breathing exercises Hydration, Regular Meals: Avoid hypoglycaemia triggers Low-Impact Aerobic Exercise: ~150 min/week (walking, swimming) Workplace Ergonomics: Address neck tension, physiotherapy if needed Magnesium 500 mg daily (3-month trial; evidence limited but commonly used) Ice Pack to neck or forehead during flares Avoid Analgesic Overuse: Limit painkillers to <10–15 days/month (prevent medication overuse headache) Avoid Opioids/Codeine: Risk of overuse, dependence, and analgesic rebound Stepwise Pharmacological Approach Non-Opioid Analgesic Ibuprofen 400 mg (adult) or 10 mg/kg (child), or paracetamol as alternative Combine with antiemetic (e.g. ondansetron 8 mg adult or ~0.1 mg/kg in children) → Can enhance analgesic absorption even if no nausea Triptans (e.g. sumatriptan) Sumatriptan 50 mg PO → can repeat in 2 hrs if effective. Intranasal sumatriptan 20 mg (adults/children) for those with severe nausea/vomiting If no initial response to triptan → do NOT repeat. If positive response → may repeat in 2 hours if recurrence. Caution with SSRI/SNRI (serotonin syndrome risk is low but possible). Prophylaxis (if >2 disabling attacks/month) Amitriptyline: 10 mg up to 75 mg daily. Trial a max tolerated dose for 8–12 weeks. Propranolol: 20 mg nocte (only prophylactic proven in children). CBT or other psychological support can reduce stress-related triggers. Notes Riboflavin (vitamin B2) and ubidecarenone (coenzyme Q10) can be tried for 3 months. Avoid aspirin <16 years (Reye’s syndrome risk). Sumatriptan is the only triptan available in injectable/intranasal form in Australia. Tension headache prophylaxis: amitriptyline. Tremor/vestibular migraine: Propranolol. Migraine-specific prophylaxis: Pizotifen an option. Migraine Prophylaxis – Choosing Medications Condition Suggested Prophylaxis Avoid Insomnia/Fibromyalgia TCA (e.g. amitriptyline), pregabalin – Diabetes/Obesity Topiramate, candesartan Valproate, pizotifen Anxiety Propranolol – Hot Flushes (Menopause) Propranolol, gabapentin, SSRI – Neck Tension/Bruxism TCA (muscle relaxation, sedation) – Depression SSRI, SNRI, TCA Beta-blockers (caution), topiramate (caution) Asthma – Propranolol (exacerbates bronchospasm) Renal Calculi – Topiramate (risk of stones) Explanation Propranolol may help with anxiety, tremor, but avoid in asthma. Topiramate beneficial for weight control/obesity but avoid with kidney stones. Valproate is typically avoided in women of childbearing potential due to teratogenicity (and in some guidelines also for obesity). TCAs can help insomnia or fibromyalgia (sedative and analgesic synergy) 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 Lichen Sclerosus Definition Chronic inflammatory disorder affecting genital and perianal areas Clinical Features White, thickened patches Vulval: Severe pruritus, blood blisters, bruising, ulcers, fissuring, scarring Penile: Glans involvement, firm white scarring Associated Conditions Vulval cancer: Requires annual surveillance Autoimmune associations: Hashimoto’s thyroiditis, pernicious anaemia, vitiligo Complications: Permanent scarring, vaginal deformation Management Referral Dermatology for diagnosis and confirmation Skincare Soap-free washes Avoid tight clothing Regular emollients Medications Potent topical steroids (betamethasone, clobetasol) High relapse rate (85%), likely lifelong treatment Vaginal oestrogen cream/pessary (postmenopausal women) Lichen Sclerosus Definition Lichen sclerosus is a chronic inflammatory disorder primarily affecting genital and perianal areas. It leads to atrophic, white, thickened patches of skin that can be very pruritic and prone to tearing and scarring. Clinical Features White, thickened patches: Often fragile, easily bruised or torn Vulval Involvement: Severe pruritus, possible bleeding or blood blisters Ulcers, fissuring, and scarring Can lead to vaginal narrowing or introital stenosis Penile Involvement: Typically the glans; firm, white scarring, phimosis Associated with intense itching, soreness, possible dyspareunia in women, painful erections in men Associated Conditions Vulval Cancer: Lichen sclerosus significantly increases the risk; annual surveillance recommended Autoimmune Associations: e.g. Hashimoto’s thyroiditis, pernicious anaemia, vitiligo Complications: Permanent scarring or deformity (vulval architecture distortion, meatal stenosis in men) Ongoing psychosocial impact (sexual dysfunction, body image issues) Management Referral Dermatology or gynaecology/urology referral for diagnosis confirmation (biopsy if atypical) and to rule out malignant transformation Skincare Soap-free washes: Gentle, non-irritant cleansers Avoid tight clothing: Reduce friction Regular Emollients: Soften and protect the skin, alleviate dryness Medications Potent Topical Steroids (e.g. clobetasol propionate, betamethasone dipropionate) Typically first-line, applied daily or on a tapering schedule High relapse rate (~85%), often requiring lifelong intermittent maintenance Vaginal Oestrogen Cream/Pessary Useful in postmenopausal women to improve atrophic changes and comfort Consider topical calcineurin inhibitors (e.g. tacrolimus) if steroids not tolerated or for rotation therapy Notes Annual surveillance essential to detect early vulval or penile carcinomas. Encourage regular follow-up to ensure adequate symptom control and monitor for steroid side effects (e.g., skin atrophy). Provide patient education on lifestyle modifications (loose clothing, gentle cleansing) and psychological support if chronic discomfort. Bookmark Failed! Bookmark Saved! Refresh Refresh Refresh