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 Strabismus Definition Misalignment of eyes → impaired binocular vision Esotropia: Turns inward Exotropia: Turns outward Hypertropia: Turns upward Hypotropia: Turns downward Complication: Amblyopia (lazy eye) → permanent vision loss if untreated before age 7 Examination Misalignment on inspection Hirschberg test: Asymmetric light reflex Cover test: Refocus of uncovered eye confirms strabismus Uncover test: Misaligned eye moves to refocus Asymmetric red reflex → underlying pathology Red Flags (Urgent Referral) Limited extraocular movement (e.g., CN palsy) Nystagmus (neurological/vestibular pathology) Dysmorphic features (syndromic conditions) Abnormal red reflex (retinoblastoma, cataract) Secondary causes: CN palsy, intracranial pathology, retinoblastoma Subtypes Esotropia: Intermittent/variable >3 months: Semi-urgent referral Constant at any age: Semi-urgent referral Exotropia: Intermittent/constant: Non-urgent unless red flags Acute-onset constant: Immediate referral Management Eye patching: Strengthens weaker eye, prevents amblyopia Glasses/contacts: Correct refractive errors Eye exercises: Improve coordination, muscle strength Surgery: Align eyes in persistent/severe cases Notes Routine screening critical to prevent amblyopia Strabismus in conditions like Down syndrome or cerebral palsy → multidisciplinary care Acute-onset strabismus: Neurological imaging if secondary causes suspected Strabismus (Squint) Definition Misalignment of the eyes, causing impaired binocular vision. Different forms based on direction of deviation: Esotropia: Eye turns inward Exotropia: Eye turns outward Hypertropia: Eye turns upward Hypotropia: Eye turns downward Complication: Amblyopia (“lazy eye”) – can lead to permanent vision loss if untreated before ~age 7 Examination Inspection Obvious misalignment of one or both eyes (constant/intermittent). Hirschberg Test Assess corneal light reflex; asymmetry suggests strabismus. Cover Test The uncovered eye will move/refocus if it was misaligned when the other is covered. Uncover Test If the “covered” (potentially misaligned) eye moves to fixate when uncovered, that eye had been deviated. Red Reflex Asymmetry or abnormal reflex → suspect an underlying pathology (e.g., cataract, retinoblastoma). Red Flags (Urgent Referral) Limited Extraocular Movements (possible cranial nerve palsy). Nystagmus (neurological or vestibular pathology). Dysmorphic Features (suspect syndromic conditions). Abnormal Red Reflex (rule out retinoblastoma, congenital cataract). Secondary Causes: Intracranial pathology, e.g., tumour, stroke, or retinoblastoma. Subtypes and Referral Recommendations Esotropia Intermittent/Variable lasting >3 months: Semi-urgent referral (ophthalmology). Constant at any age: Semi-urgent referral. Exotropia Intermittent or Constant: Usually non-urgent unless red flags present. Acute-Onset Constant: Immediate referral (concern for acute CN palsy or neurological cause). Management Eye Patching Occluding the stronger (non-amblyopic) eye to strengthen the weaker eye and prevent amblyopia. Corrective Lenses Glasses or contact lenses to correct refractive errors (hyperopia, myopia). Eye Exercises Orthoptic exercises may help improve ocular muscle coordination. Surgery Strabismus surgery to realign eyes in persistent or severe cases or when conservative measures fail. Notes Routine screening in children is critical to detect early strabismus and avoid permanent amblyopia. Strabismus often coexists in conditions like Down syndrome or cerebral palsy – consider multidisciplinary care. Acute-Onset Strabismus in an older child or adult may prompt neurological imaging to exclude CNS pathology. 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 Lymphoma Risk Factors Radiation, smoking, benzene exposure EBV, HIV, autoimmune diseases (SLE, RA) Family history, immunosuppression (e.g., post-transplant) Pathophysiology Abnormal lymphocyte proliferation → lymphadenopathy, immune dysfunction EBV may drive B-cell dysregulation Presentation Painless lymphadenopathy: Cervical (HL), widespread (NHL) B Symptoms: Night sweats, weight loss, fever (common in HL) Others: Infections, mediastinal mass → respiratory symptoms, SVC syndrome Hodgkin Lymphoma (HL) Features: Contiguous spread, bimodal (30s, 50s), more curable Investigations: Excisional biopsy: Reed-Sternberg cells PET/CT: Staging Treatment: Stage IIA↓: Radiation Stage IIB↑: ABVD chemotherapy ± radiation (bulky disease) Non-Hodgkin Lymphoma (NHL) Features: Haematogenous spread, less B symptoms Extranodal involvement: GI, mediastinal, skin, Waldeyer’s ring Subtypes: MALT lymphoma (H. pylori-related), Burkitt’s lymphoma Investigations: Excisional biopsy (not FNA) PET/CT: Staging Treatment: Stage IIA↓: Radiation Stage IIB↑: R-CHOP chemo H. pylori eradication for early MALT lymphoma Complications Tumor Lysis Syndrome: Prophylaxis (allopurinol/rasburicase) SVC Syndrome: Mediastinal mass → venous obstruction Infections: Opportunistic (disease or therapy-related) Bone Marrow Failure: Anemia, neutropenia, thrombocytopenia CNS Involvement: Aggressive NHL subtypes Lymphoma Risk Factors Exposure: Radiation, smoking, benzene or other solvents Infectious: EBV (especially in Hodgkin and Burkitt’s lymphoma), HIV, HTLV-1 Autoimmune Disorders: SLE, RA, Sjögren’s syndrome Immunosuppression: Post-transplant, long-term corticosteroid use Family History: Familial clustering noted in some subtypes Pathophysiology Malignant proliferation of lymphocytes (B, T, or NK cells) In Hodgkin Lymphoma (HL), EBV can drive B-cell dysregulation with Reed-Sternberg cells Non-Hodgkin Lymphoma (NHL) often involves more diverse genetic/epigenetic mutations leading to abnormal lymphocyte proliferation Presentation Lymphadenopathy HL: Often painless, contiguous spread, commonly cervical or mediastinal nodes NHL: Widespread nodal involvement, can be peripheral or central, often non-contiguous spread B Symptoms (fever >38°C, night sweats, weight loss >10% in 6 months) More common in classical HL but can occur in high-grade NHL Important for Ann Arbor staging classification Extranodal Disease NHL commonly affects GI tract (e.g. MALT lymphoma), skin, bone marrow, CNS Mediastinal Mass May cause cough, chest discomfort, SVC syndrome (facial swelling, venous engorgement) Other Signs Fatigue, pruritus, recurrent infections (immune dysfunction), or organ-specific symptoms if infiltration (e.g. hepatic, splenic) HODGKIN LYMPHOMA (HL) Features Often affects younger adults (bimodal peaks: 30s and 50s) Characterised by Reed-Sternberg cells (large, binucleate B cells) on excisional biopsy Typically spreads contiguously from one lymph node region to adjacent areas Generally higher cure rates compared to most NHL subtypes Investigations Excisional Lymph Node Biopsy: To identify Reed-Sternberg cells and classify HL subtype (e.g. nodular sclerosis, mixed cellularity) Baseline Staging PET/CT scan for both staging and assessment of metabolic activity FBC, ESR, LDH, albumin, LFTs, renal function, HIV status Bone marrow biopsy if indicated by PET findings or advanced disease Treatment Early Stage (I–II) Often combined modality: ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) for 2–4 cycles plus involved-site radiotherapy (especially bulky disease) Stage IIA disease might receive fewer chemo cycles plus radiation Advanced Stage (IIB–IV) ABVD for more cycles or escalated BEACOPP in high-risk disease Radiotherapy to bulky sites if needed Prognosis Generally excellent long-term survival in early stage Late toxicity includes secondary malignancies (breast, lung), cardiac or pulmonary complications NON-HODGKIN LYMPHOMA (NHL) Features Diverse group with various histologies: Indolent (follicular, MALT) vs Aggressive (diffuse large B-cell lymphoma [DLBCL], Burkitt’s) More common than HL, typically non-contiguous spread B symptoms less consistent but present in aggressive subtypes Extranodal involvement (GI tract, skin, CNS, Waldeyer’s ring, bone marrow) Subtypes MALT Lymphoma Often gastric, associated with H. pylori infection Early stage may resolve with H. pylori eradication Burkitt’s Lymphoma Highly aggressive, c-myc translocation Associated with EBV in endemic (African) form Diffuse Large B-Cell Lymphoma (DLBCL) Most common aggressive NHL in adults Presents with rapidly enlarging mass, can involve extranodal sites Investigations Excisional Biopsy (preferred) or core biopsy for histological diagnosis PET/CT for staging and treatment response Bone Marrow Biopsy if suspicion of marrow involvement Lab Tests: FBC, LDH (prognostic marker), LFTs, renal function, HIV, hepatitis B/C screening Treatment Early Stage (I–II) Involved-field or involved-site radiotherapy ± short-course chemo (e.g. R-CHOP for DLBCL) Indolent lymphoma (e.g. follicular) can be treated with radiotherapy alone in localised disease Advanced Stage (≥IIB) R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone) mainstay for B-cell lymphomas Intensive regimens (e.g. Hyper-CVAD, CODOX-M/IVAC) for high-grade subtypes (Burkitt’s) Consider autologous stem cell transplant in refractory or relapsed disease H. pylori-Positive MALT Eradication therapy (PPI + clarithromycin + amoxicillin/metronidazole) may induce remission in early gastric MALT Complications Tumour Lysis Syndrome High cell turnover (especially Burkitt’s, DLBCL) Prophylaxis with IV fluids, allopurinol or rasburicase SVC Syndrome Mediastinal mass compresses the superior vena cava → facial swelling, distended neck veins Urgent treatment with steroids or radiotherapy to relieve obstruction Infections Immunosuppression from disease or therapy (e.g. neutropenia, hypogammaglobulinaemia) Prophylactic antimicrobials or IVIG in select cases Bone Marrow Failure Anaemia, neutropenia, thrombocytopenia May require transfusions, growth factors, or dose adjustments CNS Involvement More common in aggressive subtypes (DLBCL, Burkitt’s) Prophylactic intrathecal chemo if high risk (testicular involvement, high IPI score) Follow-Up and Survivorship Response Evaluation Repeat PET/CT after therapy to assess remission or persistent disease Physical exams and blood tests at regular intervals (every 3–6 months initially) Long-Term Monitoring Look out for late relapses, secondary malignancies, cardiac/pulmonary toxicity (anthracyclines, bleomycin) Encourage vaccination (influenza yearly, pneumococcal, avoid live vaccines if immunosuppressed) Lifestyle advice (no smoking, manage CV risk factors) Fertility Consider fertility preservation prior to chemo (sperm/egg freezing) Palliative Care For refractory or relapsed disease, symptom control and quality of life remain priorities Notes: Suspect lymphoma in patients with unexplained lymphadenopathy (especially >2 cm, persistent >4 weeks), B symptoms, or mediastinal masses Excisional lymph node biopsy is crucial for histological classification (FNA not sufficient) Prompt referral to haematology/oncology for staging and management if suspicion is high Monitor for acute complications (TLS, SVC syndrome) and coordinate supportive care Emphasise adherence to follow-up: cure rates can be high in some subtypes (HL, DLBCL) but vigilant post-treatment surveillance is essential 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 Diarrhoea Acute For Gastro Causes Break down into parasitic, viral, bacterial: Parasitic: Giardia, cryptosporidium Viral: Enteric adenovirus, norovirus, rotavirus Bacterial: C. difficile, Vibrio, B. cereus, Salmonella, Campylobacter, Shigella, ETEC Giardia Watery, foul-smelling, greasy stools. Rotten egg burps. Float Viral: No fever, watery, no blood Bacterial: Fever, bloody stools Clostridioides difficile (C. diff) Risk factors: cephalosporins, quinolones, prolonged hospital stay, PPI use Vibrio: Uncooked seafood Yersinia: Pigs B. cereus: Undercooked rice Salmonella & Campylobacter: Undercooked poultry, eggs Shigella: Raw salads ETEC: Undercooked meats Non-Gastro Causes (Adults) Hyperthyroidism IBD (e.g., Crohn’s disease, ulcerative colitis) IBS Coeliac disease Ischaemic colitis SBO Constipation with overflow Lactose intolerance Non-Gastro Causes (Kids) UTI Appendicitis Coeliac disease Constipation with overflow Chronic IBS IBD Coeliac disease Lactose deficiency Small intestinal bacterial overgrowth (SIBO) Giardia Note: Consider microscopic colitis in older patients presenting with watery diarrhoea without blood, particularly those on NSAIDs Note: C. diff: Consider if antibiotics were used within 3 months or hospital stay >3 days SIBO: Decreased bowel transit → increased bacterial growth → diarrhoea Increased risk with: Recent abdominal surgery, Crohn’s disease, diabetes Chronic diarrhoea may require stool studies, faecal calprotectin (to differentiate IBD from IBS), and colonoscopy to identify inflammatory or neoplastic causes Diarrhoea Acute Gastrointestinal Causes (parasitic, viral, bacterial): Classification Common Pathogens Key Features Parasitic Giardia, Cryptosporidium Giardia: Watery, foul-smelling, greasy stools; “rotten egg” burps; stools may float. Viral Norovirus, Rotavirus, Enteric adenovirus Typically watery diarrhoea; often minimal or no fever; usually no blood in stool. Bacterial C. difficile, Vibrio, B. cereus, Salmonella, Campylobacter, Shigella, ETEC Often presents with fever and can be bloody (e.g. Campylobacter, Shigella); watery in others; associations with risk factors/food exposures (e.g. Vibrio from uncooked seafood, B. cereus from undercooked rice, Salmonella from poultry/eggs). C. difficile: Risk factors: Recent antibiotic use (especially cephalosporins, quinolones), prolonged hospital stays, PPI use Consider if antibiotics in the last 3 months or hospital stay >3 days Food-Specific Clues: Vibrio: Uncooked seafood Yersinia: Pigs/pork B. cereus: Undercooked rice Salmonella & Campylobacter: Undercooked poultry, eggs Shigella: Raw salads ETEC: Undercooked meats Non-Gastro Causes (Adults) Hyperthyroidism IBD (Crohn’s disease, ulcerative colitis) IBS Coeliac disease Ischaemic colitis SBO (small bowel obstruction) Constipation with overflow Lactose intolerance Non-Gastro Causes (Kids) UTI Appendicitis Coeliac disease Constipation with overflow Chronic IBS IBD Coeliac disease Lactose intolerance SIBO (small intestinal bacterial overgrowth) Giardia Note: Microscopic colitis in older patients with watery diarrhoea (especially if on NSAIDs) Notes SIBO: May arise from decreased bowel transit time (recent abdominal surgery, Crohn’s, diabetes). Chronic diarrhoea often requires stool studies, faecal calprotectin (to differentiate IBD from IBS), and possibly colonoscopy to evaluate for inflammatory or neoplastic causes. 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 Grief Normal vs Pathologic Grief Normal Grief Duration: ≤12 months; often improves within 6 months Features: Intense sadness, tearfulness Preoccupation with deceased Social withdrawal Fleeting hallucinations (e.g., hearing/seeing the deceased) Expressions of wanting to die to reunite with the deceased (no functional impact) Pathologic Grief (Chronic/Complicated) Duration: >12 months Features: Significant functional impairment Numbness, detachment from life Feelings of purposelessness or meaninglessness Prolonged Grief Disorder (Complicated Grief) Duration: Persistent, severe distress impairing functionality for ≥12 months Key Features: Preoccupation or intense yearning for the deceased Emotional numbness or detachment Intrusive distressing memories or images of the death Excessive guilt or remorse about the deceased or circumstances of death Perception of life as empty or meaningless Irritability, bitterness, or anger Management Psychological Support: Bereavement counsellors or mental health professionals (psychologist/psychiatrist) Therapies Complicated grief therapy Behavioural activation with exposure Interpersonal psychotherapy (IPT) Acceptance and commitment therapy (ACT) Family/group therapy Assessment Tools Prolonged Grief Disorder-13 Revised (PG-13-R) Brief Grief Questionnaire Referral: Specialist palliative care or bereavement support programs for persistent or severe cases Grief Normal vs Pathological Grief Normal Grief Duration: Typically ≤12 months; often shows improvement within 6 months. Features: Intense sadness, episodes of tearfulness Preoccupation with the deceased (memories, yearning) Social withdrawal but able to function in daily life (e.g. attending work, completing ADLs) May have fleeting hallucinations (briefly hearing or seeing the deceased) Occasional thoughts of wanting to die to “join” the deceased, but no sustained suicidal intention or significant functional impact Pathologic Grief (Chronic or Complicated) Duration: Persisting distress >12 months Features: Marked functional impairment (struggling to work, care for self/family) Persistent numbness or detachment from life’s usual activities Feelings of purposelessness or meaninglessness Possible persistent and intense guilt or blame about the death Now classified as Prolonged Grief Disorder if it meets specific criteria (see below). Prolonged Grief Disorder (Complicated Grief) Timeframe: Ongoing, severe distress impairing functionality for ≥12 months (adults) or ≥6 months in children/adolescents (per DSM-5-TR criteria) Key Features: Intense yearning or longing for the deceased Emotional numbness, detachment, or difficulty engaging with others Intrusive or distressing thoughts/memories of the deceased Excessive guilt or remorse regarding the circumstances of the death A sense that life is empty or meaningless without the deceased Irritability, anger, bitterness Management Psychological Support Consider bereavement counsellors, mental health professionals (psychologist/psychiatrist) Community-based palliative care or bereavement programs if available Therapies Complicated Grief Therapy: A specialised form of psychotherapy targeting prolonged grief symptoms Behavioural Activation with exposure-based approaches for trauma/loss reminders Interpersonal Psychotherapy (IPT): Focuses on social supports, role transitions Acceptance and Commitment Therapy (ACT): Helps with acceptance of painful feelings and commitment to personal values and life goals Family/Group Therapy: Can be helpful if multiple family members are grieving Assessment Tools Prolonged Grief Disorder-13 Revised (PG-13-R) Brief Grief Questionnaire Tools to gauge severity and functional impact of grief Referral Specialist palliative care or bereavement support if severe, persistent, or complicated grief. Consider psychiatry referral if coexisting depression, suicidal risk, psychosis, or severe functional decline. Notes Normal Grief varies widely in presentation and duration, but typically does not profoundly impair function long-term. Screen for depression or anxiety disorders if grief symptoms are intense or prolonged. Emphasise non-judgmental support and normalisation of grief while monitoring for pathological features. 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 Aortic Dissection Definition Life-threatening tear in the aortic intima, creating a false lumen, risking rupture or organ ischaemia Causes Conditions weakening the aortic wall (e.g., hypertension, Marfan syndrome, aortic aneurysms) Risk Factors Age >60, male Hypertension (most common) Genetic disorders (Marfan, Ehlers-Danlos) Bicuspid aortic valve Pregnancy, trauma Symptoms Severe, sudden-onset, tearing chest pain Ascending: Anterior chest Descending: Back Possible neurological signs (stroke symptoms), hypotension, syncope, aortic insufficiency Differential Diagnosis MI Pulmonary embolism Pericarditis Pneumothorax GI perforation Investigations Initial: Chest X-ray (may show widened mediastinum) ECG Blood tests Definitive: CT aorta with contrast (gold standard) TOE if unstable MRI if avoiding radiation Management Type A (Ascending Aorta): Immediate surgery Type B (Descending Aorta): Medical management (BP control) unless complications arise Consider endovascular repair if needed Acute Stabilisation IV beta-blockers (e.g., labetalol) to target SBP 100–120 mmHg Morphine for pain Complications Aortic rupture Cardiac tamponade Organ ischaemia (e.g., stroke, renal failure) Aortic Dissection Aetiology/Causes: Most cases are linked to conditions that weaken the aortic wall, i.e., hypertension, connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome), or pre-existing aortic aneurysms. Risk Factors: Age: >60 years. More common in males (2:1 ratio). Hypertension (most common risk factor) Genetic disorders: Marfan syndrome, Ehlers-Danlos syndrome Pre-existing aortic aneurysm Bicuspid aortic valve Coarctation of the aorta Turner syndrome Aortic instrumentation/surgery history Inflammatory conditions: giant cell arteritis, Takayasu arteritis, rheumatoid arthritis Pregnancy (especially third trimester and postpartum) Fluoroquinolone use Trauma: e.g., motor vehicle accidents. High-Intensity Physical Activities or Drug Use: e.g., cocaine Pathophysiology: Dissection begins with a tear in the intimal layer, allowing blood to enter the media and create a false lumen. The dissection can propagate proximally or distally, potentially involving branch vessels. Complications can include rupture into surrounding structures (pericardium, pleural space, or abdomen) and occlusion of aortic branch vessels. Symptoms: Pain: Sudden onset, severe, tearing, or ripping in nature, typically in the anterior chest (ascending dissection) or back (descending dissection). May radiate to the neck, jaw, or limbs. Neurological Symptoms: Syncope, hemiparesis, or stroke due to involvement of the carotid or subclavian arteries. Symptoms of Aortic Insufficiency: Dyspnoea, orthopnoea, or acute heart failure. Hypotension or Shock: Indicates rupture or tamponade. Other Symptoms: Flank pain, abdominal pain, or limb ischaemia. Differential Diagnosis: Acute myocardial infarction (especially STEMI) Pulmonary embolism Pericarditis Pneumothorax Musculoskeletal pain Gastrointestinal perforation Ruptured aortic aneurysm Investigations: Initial Tests: CXR: May show a widened mediastinum or pleural effusion. ECG: To exclude myocardial infarction. Cardiac Enzymes: If myocardial ischaemia is suspected. UEC and Lactate: Assess renal function and tissue perfusion. Definitive Imaging: CT Aorta (with contrast): Diagnostic test of choice; visualizes the intimal flap. Transoesophageal Echocardiography (TOE): Useful if CT is contraindicated or for unstable patients. MRI Aorta: Alternative imaging if radiation exposure is a concern. Management: Emergency measures: Stabilise haemodynamics: Aim for systolic BP 100-120 mmHg Intravenous beta-blockers (e.g., labetalol, esmolol): To reduce heart rate and shear stress on the aortic wall Analgesia: Morphine for pain control Surgical vs. Medical Management: Type A dissection (ascending aorta involvement): Immediate surgical intervention Type B dissection (descending aorta): Medical management initially if uncomplicated; surgical or endovascular repair for complications (e.g., persistent pain, rupture, ischaemia) Initial Stabilisation: Blood Pressure Control: IV beta-blockers (e.g., labetalol) to reduce shear stress; aim for systolic BP 100–120 mmHg. Analgesia: Morphine for pain control. Definitive Management: Type A (proximal): Requires urgent surgical repair due to risk of aortic rupture and cardiac tamponade. Type B (distal): Treated medically unless complications (e.g., rupture, end-organ ischaemia) arise; endovascular stent grafting may be considered. Long-Term Monitoring: Regular imaging (CT/MRI) for monitoring. Antihypertensives: Long-term BP control. Complications: Aortic rupture: Life-threatening and often fatal Cardiac tamponade Organ ischaemia: Stroke, mesenteric ischaemia, renal failure Aortic regurgitation: Secondary to aortic valve involvement. End-Organ Ischaemia: E.g., stroke, acute kidney injury. Chronic Dissection: May lead to aneurysm formation. Prognosis: Mortality is high without prompt treatment; survival improves significantly with early diagnosis and intervention. Type A dissections carry a higher mortality risk if not treated surgically. Notes: Classification: DeBakey Classification: Type I: Involves both the ascending and descending aorta Type II: Confined to the ascending aorta Type III: Confined to the descending aorta Stanford Classification: Type A: Involves the ascending aorta (with or without descending involvement) Type B: Involves only the descending aorta CT shows Stanford type A aortic dissection involving the ascending and descending aorta. Significant luminal narrowing with near-circumferential intimal detachment. Ascending aorta dilated to 55 mm. Small haemopericardium present. 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 Fatigue Differentials Psychological: Stress, burnout, depression, anxiety Sleep-related: Sleep deprivation, OSA Infectious: Viral/post-viral illness Haematological: Anaemia (low iron, melaena, menorrhagia), B12/folate deficiency Substance-related: Drug/alcohol abuse, medication side effects Endocrine/metabolic: Hypothyroidism, diabetes Cardiorespiratory: Arrhythmias, heart failure, COPD, CKD Malignancy: Lymphoma, leukaemia, multiple myeloma Gastrointestinal: Coeliac disease Red Flags Acute onset in previously well older patient Weight loss, lymphadenopathy, fever SOB, palpitations Signs of malignancy or cardiorespiratory compromise Neurological symptoms, significant functional decline History Acute vs chronic onset Impact on function, work, social life Support system (burnout assessment) Sleep patterns, caffeine intake Medication review (side effects) Investigations FBC, fasting BGL, UEC, LFTs, ESR/CRP, iron studies, TFTs Consider: B12, folate, renal profile if indicated Management No red flags: Reassurance, lifestyle advice Avoid alcohol/smoking if relevant Educate on self-limiting nature Regular sleep schedule Relaxation techniques (CBT, meditation, yoga, breathing exercises) 150 mins/week low-impact aerobic exercise Maintain healthy BMI (<25), balanced diet Review in 4 weeks to assess progress and red flags Fatigue Differentials Psychological Causes Stress, burnout, major depression, anxiety disorders Chronic fatigue syndrome (CFS) if fatigue persists >6 months with other features (unrefreshing sleep, post-exertional malaise) Sleep-Related Sleep deprivation (shift work, insomnia, poor sleep hygiene) Obstructive sleep apnoea (OSA) → snoring, witnessed apnoeas, daytime somnolence Infectious Viral/post-viral illness (EBV, CMV, influenza, COVID-19) Chronic infections (hepatitis B/C, HIV) less common but possible Haematological Anaemia (iron deficiency from menorrhagia or GI bleeding, B12/folate deficiency) Haemolytic anaemias, though rarer, can also cause chronic fatigue Substance-Related Excess alcohol or illicit drug use Medication side effects (e.g. beta-blockers, sedatives, analgesics) Endocrine/Metabolic Hypothyroidism (common cause in mid-older adults, especially females) Diabetes mellitus (poor glycaemic control) Addison’s disease (adrenal insufficiency; consider hyperpigmentation, hypotension) Cardiorespiratory Arrhythmias, heart failure, COPD, CKD Check for SOB, orthopnoea, chest pain or peripheral oedema Malignancy Lymphoma, leukaemia, multiple myeloma (look for weight loss, night sweats, bone pain) Gastrointestinal Coeliac disease (malabsorption → iron deficiency) Chronic liver disease Red Flags Acute onset in an older patient who was previously well Weight loss, lymphadenopathy, fever (suggestive of malignancy or chronic infection) SOB, palpitations (possible cardiac or respiratory disease) Neurological symptoms (e.g. weakness, functional decline) Severe functional decline or inability to perform daily tasks History Acute vs Chronic Onset: Chronic is more common, but acute or subacute changes prompt urgent investigation. Impact on Function: Work, social, academic performance. Support System: Evaluate for burnout if caring for others or high job stress. Sleep Patterns: Quality, duration, any daytime somnolence or snoring (OSA?). Caffeine Intake: Excess consumption can disrupt sleep. Medication Review: Look for side effects (sedation, hypotension). Substance Use: Alcohol, drugs. Associated Symptoms: E.g. menorrhagia or GI blood loss (possible anaemia), polyuria/polydipsia (diabetes), weight change (thyroid disorder). Investigations Initial Bloods: FBC (rule out anaemia) Fasting BGL or HbA1c (diabetes check) UEC (renal function) LFTs ESR/CRP (inflammatory markers) Iron studies (ferritin, transferrin saturation) TFTs (thyroid function) Further Tests (case-dependent): B12, folate (if macrocytosis or dietary risk) Coeliac serology (if GI symptoms or iron deficiency anaemia) HIV or hepatitis serology (risk factors) Sleep study (suspected OSA) ECG if palpitations or arrhythmias suspected Management No Red Flags Reassurance & Lifestyle Advice: Many cases are short-lived or mild. Avoid Alcohol/Smoking: If relevant to patient’s fatigue. Education: Emphasise self-limiting nature in post-viral or benign causes. Regular Sleep Schedule: Maintain good sleep hygiene. Relaxation Techniques: CBT-based strategies, mindfulness, meditation, yoga, guided breathing. Physical Activity: 150 mins/week low-impact aerobic exercise (walking, cycling), improving energy levels. Encourage a balanced pace—gradual increments if unfit. Nutritional Review: Balanced diet, adequate protein and micronutrients. Maintain healthy BMI (<25). Follow-up: Review in 4 weeks to assess progress, recheck for red flags. If persistent without improvement, reconsider investigations (e.g. for CFS, malignancy, organ dysfunction). Notes In older adults, new-onset fatigue may mask serious illness (e.g. malignancy, heart failure). Address psychosocial stressors (work overload, financial, relationship issues). If suspect Chronic Fatigue Syndrome (CFS), see specific guidelines (≥6 months duration, post-exertional malaise, rule out other causes). 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 HIV Symptoms Constitutional: Weight loss, fatigue, night sweats, lymphadenopathy. Flu-like: Fever, myalgia, rash, arthralgia. Opportunistic infections: Candidiasis, chronic diarrhoea, seborrhoeic dermatitis. Advanced (AIDS): PJP (dyspnoea, dry cough), Kaposi’s sarcoma (violaceous lesions), CMV retinitis. Risk Factors Condomless anal/vaginal sex (esp. uncircumcised males). Partner HIV-positive/high-risk behaviour. Shared needles, chemsex, tattoos, overseas blood transfusions. Hep B/C or STI history, needle-stick injuries. Pre-Test Counselling Explain: Test process, window period (3 months). Discuss: Implications of results, prevention (PEP <72h, PrEP). Screen: Hep B/C, syphilis, chlamydia, gonorrhoea. Diagnosis Screen: HIV Ag/Ab test. Confirm: Western blot or NAT. Baseline: CD4 count (immune status). Viral load (monitor treatment). Genotyping (resistance mutations). Management Contact tracing: Begin from risk onset. Education: ART prevents progression and transmission. Safe sex: Condoms, disclose status. ART When: Start ASAP regardless of CD4 count. Pre-tests: CD4, viral load, resistance genotyping, co-infections (Hep B/C, TB), FBC, UEC, CMP, fasting lipids/glucose. First-line regimens (once daily): Dolutegravir + abacavir + lamivudine (Triumeq) (HLA-B*57:01 negative). Tenofovir alafenamide + emtricitabine + bictegravir (Biktarvy). HIV in Pregnancy Test: All antenatal patients; repeat for high-risk later. ART: Start immediately; continue effective regimens unless contraindicated. Delivery: Caesarean if viral load >50 at 36 weeks; intrapartum zidovudine if detectable viral load. Neonatal prophylaxis: Zidovudine within 6–12h post-birth. Breastfeeding: Avoid in developed settings. Follow-Up Viral load/CD4: Every 3–6 months. Monitor ART adherence, side effects, co-infections. Prevention PrEP: Daily or on-demand for high-risk groups. PEP: Start within 72h of exposure. HIV Symptoms Constitutional: Weight loss, fatigue, night sweats, lymphadenopathy Flu-like: Fever, myalgia, rash, arthralgia (particularly in acute HIV or seroconversion illness) Opportunistic Infections: Candidiasis (oral thrush, oesophageal candidiasis) Chronic diarrhoea (Cryptosporidium, Isospora) Seborrhoeic dermatitis Advanced (AIDS): PJP (Pneumocystis jirovecii pneumonia): Dyspnoea, dry cough, bilateral interstitial infiltrates Kaposi’s Sarcoma: Violaceous lesions on skin or mucous membranes CMV Retinitis: Visual floaters, flashes, field loss Risk Factors Unprotected Anal/Vaginal Sex (especially with uncircumcised males, multiple partners) HIV-positive Partner or high-risk behaviour (e.g., sex workers, MSM) Shared Needles (IV drug use), chemsex, unsterile tattooing, overseas blood transfusions (historical risk in some regions) Hepatitis B/C or STI history; needle-stick injuries Pre-Test Counselling Explain the testing process (screening, confirmatory tests) and window period (up to 3 months for antibody detection, though modern Ag/Ab combo tests shorten this) Discuss implications of potential results, prevention strategies (e.g. PEP within 72 hours, PrEP for high-risk) Screen for co-infections: Hepatitis B/C, syphilis, chlamydia, gonorrhoea Diagnosis Screen: HIV Ag/Ab test (4th generation) Confirm: Western blot or NAT (nucleic acid testing) if initial positive or equivocal Baseline Investigations: CD4 count (assesses immune status) Viral load (monitors treatment response) Genotyping (detects resistance mutations) Additional labs: FBC, UEC, LFT, fasting lipids/glucose, co-infections (e.g. TB, hepatitis B/C) Management Contact Tracing: Identify sexual and needle-sharing partners dating back to risk onset Education: Emphasise that modern ART prevents progression to AIDS and reduces transmission (U=U principle if sustained viral suppression) Safe Sex: Regular condom use, status disclosure to partners, consider PrEP for at-risk partners ART (Antiretroviral Therapy) When to Start Initiate ASAP following diagnosis, regardless of CD4 count (improves outcomes, reduces transmission) Pre-ART Tests CD4, viral load, and resistance genotype Co-infection checks: Hepatitis B/C, TB status Baseline FBC, UEC, LFT, fasting lipids/glucose First-Line Regimens (Once Daily) Dolutegravir + abacavir + lamivudine (Triumeq) if HLA-B*57:01 negative (to avoid abacavir hypersensitivity) Tenofovir alafenamide + emtricitabine + bictegravir (Biktarvy) as an alternative integrase inhibitor–based regimen HIV in Pregnancy Testing: All antenatal patients offered HIV testing, repeat for high-risk if indicated ART: Initiate immediately and continue effective regimens unless contraindicated Omeprazole has no direct role here; but note that standard antiretroviral therapy is essential to reduce vertical transmission Delivery: Caesarean section if viral load >50 copies/mL at 36 weeks IV zidovudine intrapartum if detectable viral load Neonatal Prophylaxis: Zidovudine within 6–12 hours post-birth Breastfeeding: Avoid in developed settings (formula feeding recommended to prevent transmission) Follow-Up Viral load & CD4: Every 3–6 months, or more frequently if treatment changes Monitor ART adherence, side effects (hepatotoxicity, renal effects, metabolic changes) Screen for co-infections (Hep B/C, STIs) and comorbidities (diabetes, CVD) Prevention PrEP (Pre-Exposure Prophylaxis): Daily or on-demand TDF/FTC for high-risk groups (MSM, serodiscordant couples, IV drug users) PEP (Post-Exposure Prophylaxis): Start within 72 hours of potential exposure (sexual, needle-stick) Safe Sex: Condoms, regular STI screening, risk reduction counselling Harm Reduction: Clean needle programmes, supervised injecting facilities 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 Anticholinergics and Tricyclic Antidepressants (TCAs) Examples Anticholinergics Oxybutynin: Urinary incontinence Benztropine: EPSE management Sedating Antihistamines: Promethazine, doxylamine TCAs Amitriptyline, Nortriptyline Imipramine, Clomipramine, Trimipramine Dothiepin, Doxepin Side Effects Anticholinergic Side Effects (ABCCD’SS) Arrhythmias (tachycardia) Blurred vision Constipation Confusion (esp. elderly) Dry eyes/mouth Sedation Stasis of urine (urinary retention, esp. in BPH) TCA Side Effects All anticholinergic side effects Orthostatic intolerance (postural hypotension) Sexual dysfunction (e.g., ↓ libido, erectile dysfunction) QRS widening or QTc prolongation (high arrhythmia risk, esp. in overdose) Notes: Anticholinergics Caution in elderly → ↑ risk of confusion, falls, and delirium (RACGP, eTG) TCAs Avoid in cardiovascular disease (↑ arrhythmia risk) ECG monitoring: Recommended in high-risk patients Amitriptyline/Nortriptyline: Used at lower doses for neuropathic pain → fewer side effects Anticholinergics and Tricyclic Antidepressants (TCAs) Examples of Common Medications Anticholinergics Oxybutynin Indication: Urinary incontinence (urge incontinence/overactive bladder) Mechanism: Blocks muscarinic receptors in the bladder → reduces detrusor muscle overactivity Benztropine (Benzatropine) Indication: Extrapyramidal side effects (EPSE) management, e.g. in Parkinson’s disease or antipsychotic-induced EPSE Sedating Antihistamines Promethazine, doxylamine Often used for insomnia, motion sickness, or allergy relief, but sedation and anticholinergic effects can be problematic Tricyclic Antidepressants (TCAs) Amitriptyline, Nortriptyline Imipramine, Clomipramine, Trimipramine Dothiepin (dosulepin), Doxepin These medications inhibit the reuptake of noradrenaline (norepinephrine) and serotonin, improving mood in depressive disorders. However, their receptor-blocking profiles (anticholinergic, alpha-1 blockade, antihistamine) cause multiple side effects. Key Side Effects Anticholinergic Side Effects (Mnemonic: A B C C D’ S S) Arrhythmias (tachycardia) Blurred vision Constipation Confusion (especially in elderly) Dry eyes/mouth (xerostomia) Sedation Stasis of urine (urinary retention, especially in benign prostatic hyperplasia) These side effects can be remembered via the phrase: “Dry as a bone, Red as a beet, Hot as a hare, Blind as a bat, Mad as a hatter” for severe anticholinergic toxicity. Additional TCA-Specific Side Effects Orthostatic intolerance (postural hypotension) due to alpha-1 blockade Sexual dysfunction (e.g. decreased libido, erectile dysfunction) Cardiotoxicity: QRS widening QTc prolongation High risk of arrhythmias in overdose Note: The risk of life-threatening arrhythmias is substantial in TCA overdose, making them particularly hazardous if patients are at risk of intentional overdose. Special Considerations Anticholinergics Elderly: Increased risk of confusion, falls, delirium. Polypharmacy issues: Combining multiple anticholinergic drugs (including over-the-counter sedating antihistamines) can lead to anticholinergic burden. RACGP and Therapeutic Guidelines (eTG) advise caution, especially if there are safer alternatives. Urinary retention: High caution in men with benign prostatic hyperplasia (BPH). Ocular: Potential worsening of narrow-angle glaucoma due to mydriasis. Tricyclic Antidepressants (TCAs) Cardiovascular Disease Avoid or use with extreme caution in patients with known heart disease (e.g. ischaemic heart disease, conduction abnormalities, arrhythmias) due to arrhythmic risk. An ECG is advisable before starting in higher-risk individuals or in older adults. Overdose Risk TCAs are a frequent cause of fatal overdose due to cardiotoxicity and CNS toxicity (seizures, coma). Dose-Related Side Effects Lower doses (e.g. of amitriptyline or nortriptyline) can be used for neuropathic pain with fewer side effects. Monitor sedation levels, anticholinergic burden, and vital signs in at-risk patients. Therapeutic Monitoring Some TCAs (e.g. nortriptyline) can have serum levels measured. However, this is not commonly done in routine practice unless side-effect concerns or poor response. Clinical Pearls When prescribing anticholinergics or TCAs, thoroughly assess the patient’s comorbid conditions, including: Glaucoma (risk of acute angle-closure) Prostate issues (urinary retention) Elderly with cognitive impairment (risk of delirium) Cardiac history (for TCAs) In neuropathic pain management (e.g. diabetic neuropathy, post-herpetic neuralgia), low-dose TCAs may be considered (e.g. amitriptyline 10–25 mg nocte), though safer alternatives like SNRIs or gabapentinoids may be preferable in some cases. Medication Review is crucial if multiple anticholinergic or sedative agents are being used—deprescribing may reduce fall risk and cognitive impairment in older adults. Patient Education: Advise on hydration, monitoring for constipation or urinary symptoms, and avoiding other sedating/anticholinergic over-the-counter medications. 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 Warfarin Dosing and Management Dose Adjustment by INR <1.5: Increase weekly dose by 20% 1.5–1.9: Increase weekly dose by 10%; repeat INR in 1 week >3: Decrease dose or omit next dose based on elevation and clinical context Screening Questions Changes in diet (e.g., green leafy vegetables affecting vitamin K) New medications (e.g., antibiotics, NSAIDs, SSRIs) Recent illnesses (e.g., liver disease, thyroid dysfunction) Factors Affecting INR Increase INR: Reduced vitamin K intake, liver disease, hyperthyroidism, heart failure, infections Drugs: Doxycycline, omeprazole Decrease INR: Increased vitamin K intake, hypothyroidism Drugs: Antihistamines, penicillins When to Suggest Vitamin K INR >10 (no bleeding): 1–5 mg orally INR 4.5–10 + High Bleeding Risk: 1–2 mg orally or IV, recheck in 24 hrs Active Bleeding (any INR): Immediate reversal with IV vitamin K + prothrombin complex concentrate (PCC) Indications for Warfarin Therapy Stroke Prevention: AF with CHADS2 score ≥2 Venous Thromboembolism: Treatment and secondary prevention Prosthetic Heart Valves: Mechanical valves or rheumatic mitral stenosis Post-MI Thromboembolism Prophylaxis: Mural thrombus, LV dysfunction CHADS2 Scoring to decide warfarinisation in AF CHF (1), Hypertension (1), Age ≥75 (1), Diabetes (1), Stroke/TIA (2) Score 0: No anticoagulation or aspirin Score 1: Consider aspirin or warfarin Score ≥2: Warfarin strongly indicated Contraindications Absolute Active bleeding or recent major haemorrhage Severe bleeding disorders (e.g., haemophilia) Severe liver disease, platelets <50 x 10⁹/L Pregnancy Relative High falls risk Poor adherence or limited INR access Severe uncontrolled hypertension Additional Notes Educate patients on recognising bleeding, dietary consistency, and monitoring adherence Regular INR monitoring is critical to optimise therapy and minimise bleeding risk Warfarin Dosing and Management Dose Adjustment by INR Use the table below as a general guide for adjusting weekly warfarin doses based on INR: INR Range Recommended Action <1.5 Increase weekly dose by 20% 1.5–1.9 Increase weekly dose by 10%; repeat INR in 1 week >3 Decrease dose or omit next dose depending on elevation & clinical context (Important to consider the clinical scenario. Adjust slowly if large changes in INR are due to transient factors.) Screening Questions Changes in diet (especially green leafy vegetables → vitamin K variation) New medications (e.g., antibiotics, NSAIDs, SSRIs) Recent illnesses (liver disease, thyroid dysfunction) Adherence, possible errors in dosing Factors Affecting INR Factor Effect on INR Example Causes Increase INR Less vitamin K intake, Hyperthyroidism, liver disease, certain or increased warfarin drugs (doxycycline, omeprazole) Decrease INR More vitamin K intake, Hypothyroidism, certain drugs or reduced warfarin (antihistamines, penicillins) When to Suggest Vitamin K INR >10, no bleeding: Give 1–5 mg oral vitamin K INR 4.5–10 + High Bleeding Risk: 1–2 mg oral or IV vitamin K, recheck INR in 24 hrs Active Bleeding (any INR): Immediate reversal with IV vitamin K + prothrombin complex concentrate (PCC) Indications for Warfarin Therapy Stroke Prevention in Atrial Fibrillation: CHADS₂ score ≥2 Venous Thromboembolism (VTE): Treatment and secondary prevention Prosthetic Heart Valves: Mechanical valves or rheumatic mitral stenosis Post-MI Thromboembolism: Mural thrombus, LV dysfunction CHADS₂ Scoring (for decision-making in AF) Risk Factor Score C – Congestive Heart Failure 1 H – Hypertension 1 A – Age ≥75 1 D – Diabetes mellitus 1 S – Stroke/TIA 2 Score 0: No anticoagulation or aspirin Score 1: Consider aspirin or warfarin Score ≥2: Warfarin strongly indicated Contraindications Absolute Active bleeding or recent major haemorrhage Severe bleeding disorders (e.g., haemophilia) Severe liver disease, platelets <50 × 10⁹/L Pregnancy Relative High falls risk Poor adherence or limited INR testing access Severe uncontrolled hypertension Additional Notes Educate patients on recognising bleeding, maintaining dietary consistency, and the importance of INR monitoring. Regular INR monitoring is critical to optimise therapy and reduce haemorrhagic 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 Knee Pain Pathophysiology Patella-femur friction: Shallow trochlear groove, maltracking (weak medial quads, tight lateral quads/hamstrings) Excess ankle pronation causing biomechanical stress Microtrauma (repetitive use, pressure) Trauma (acute/chronic structural damage) Differentials Knee-Related: PFPS, chondromalacia patella, patella instability/dislocation, patella OA Ligaments/Tendons: Quad/patella tendinopathy, meniscal tears, ACL/PCL injuries Attachment Injuries: ITB syndrome, Osgood-Schlatter, pes anserine bursitis Bursal Inflammation: Pre/suprapatellar, infrapatellar bursitis, Baker’s cyst Bone: OA, osteochondritis dissecans, tumours (rare) Referred Pain: Lumbar radiculopathy, hip OA Systemic: RA, psoriatic arthritis, inflammatory arthritides Management Non-Pharm: Strengthen medial quads (e.g., VMO), stretch lateral quads/hamstrings Orthotics for pronation; modify activities (Osgood-Schlatter: sport as tolerated) Physio for strength/stretch/biomechanics Pharm: NSAIDs for pain/inflammation Ice (10–20 mins post-activity) Key Conditions PFPS: Anterior knee pain, worse with stairs, running, sitting ("cinema sign") Chondromalacia: PFPS + cartilage degeneration Patella Instability: Trauma/recurrent episodes, "giving way" sensation Tendinopathy: Pain/thickening at insertion sites (quad/patella) ITB Syndrome: Lateral knee pain, activity-related, responds to ITB stretches Bursitis: Local swelling, pressure pain (e.g., kneeling) Osteochondritis Dissecans: Subchondral bone loss → locking/clicking, swelling, limited extension Red Flags Swelling + systemic symptoms (fever): Septic arthritis/gout Locking/inability to extend: Mechanical obstruction (e.g., meniscal tear) Night pain/weight loss: Suspect malignancy Trauma + unstable knee: ACL rupture Interventions Injections: Steroids for inflammation (e.g., pes anserine bursitis, severe PFPS) Hyaluronic acid for OA (mixed evidence) Surgical Referral: Recurrent instability, large meniscal tears, persistent symptoms Knee Pain Pathophysiology Patellofemoral friction can be exacerbated by a shallow trochlear groove and maltracking due to weak medial quadriceps (e.g. vastus medialis obliquus) or tight lateral quadriceps and hamstrings Excessive ankle pronation may transfer abnormal stresses up the kinetic chain to the knee Microtrauma from repetitive use, prolonged kneeling, or athletic activity leads to gradual collagen breakdown and inflammation Acute or chronic trauma (e.g. direct blows, twisting injuries) can cause structural damage to ligaments or menisci and worsen patellar alignment Differentials Knee-related: Patellofemoral pain syndrome (PFPS), chondromalacia patella, patellar instability/dislocation, patellar osteoarthritis Ligaments/tendons: Quadriceps or patellar tendinopathy, meniscal tears, ACL/PCL injuries Attachment injuries: Iliotibial band (ITB) syndrome, Osgood-Schlatter disease, pes anserine bursitis Bursal inflammation: Prepatellar, suprapatellar, infrapatellar bursitis, Baker’s cyst Bone: Knee osteoarthritis, osteochondritis dissecans, rare tumours Referred pain: Lumbar radiculopathy (L3–L4 nerve roots), hip osteoarthritis Systemic: Rheumatoid arthritis, psoriatic arthritis, other inflammatory arthritides Management Non-pharmacological Strengthening of the medial quadriceps (especially VMO) and stretching tight lateral quadriceps or hamstrings Orthotics if ankle overpronation is contributing to maltracking or foot malalignment Activity modification with relative rest for acute flare-ups (e.g. Osgood-Schlatter typically allows continued sport if pain is tolerable) Physiotherapy focusing on muscle balance, core stability, and biomechanical corrections (including gait retraining) Pharmacological NSAIDs to reduce pain and inflammation Ice application for 10–20 minutes post-exercise to relieve acute inflammation Consider topical NSAIDs or oral analgesics based on severity and patient comorbidities Key Conditions PFPS (Patellofemoral Pain Syndrome) Anterior knee pain worsened by stairs, running, prolonged sitting (cinema sign) May involve maltracking, patellar tilt, or underlying cartilage wear (chondromalacia patella) Patellar Instability Lateral displacement or dislocation episodes with a sensation of “giving way” Often linked to trauma or congenital malalignment of the patella Tendinopathy (Patellar or Quadriceps) Local pain, tenderness, and potential thickening at the tendon insertions Aggravated by jumping or rapid deceleration (“jumper’s knee”) ITB Syndrome Lateral knee pain provoked by running or repetitive knee flexion Improves with ITB stretching, foam rolling, and hip abductor strengthening Bursitis Local swelling, tenderness over the affected bursa (e.g. prepatellar bursitis from kneeling) Baker’s cyst (popliteal cyst) can present with fullness in the posterior knee and occasional calf pain Osteochondritis Dissecans Loss of subchondral bone support leading to locking, clicking, swelling, and limited extension More common in adolescents and young adults Red Flags Knee swelling with fever or severe systemic symptoms suggests septic arthritis or inflammatory arthritis (e.g. gout) Mechanical locking or inability to extend fully points to meniscal tears or loose bodies Persistent night pain or significant weight loss raises suspicion of malignancy or infection Major trauma with an unstable knee often indicates ACL rupture or complex ligamentous injury Interventions Injections Corticosteroids for localised inflammation (e.g. pes anserine bursitis, recalcitrant PFPS) Hyaluronic acid for osteoarthritis, although evidence is mixed Platelet-rich plasma (PRP) may be considered in refractory tendinopathies Surgical Referral Recurrent patellar instability requiring repair or realignment Large or complex meniscal tears with mechanical symptoms Persistent pain or instability unresponsive to conservative measures 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Used by 1200+ IMG doctors across Australia (No credit card. Instant access.) Even If You’re an IMG Working Full- Time Pass the GP Fellowship Exam with Confidence Built for IMG doctors juggling work, family, and study. Master the KFP format with precision- crafted questions that mirror the real exam. Get some samples THE PROBLEM Why You’re Struggling If You’ve Been Studying Hard But Still Don’t Feel Ready, You’re Not Alone Why You’re Struggling Most people won’t talk about it, but it’s real: The fear of failing. The exhaustion of late nights after clinic The frustration of paying for courses that didn’t help. The struggles of trying to pass while raising a family We’ve heard things like: The fear of failing. “I forget everything after a few days.” The frustration of paying for courses that didn’t help. You don’t rise to the level of your goals. You fall to the level of your preparation. And if the system you’re learning from is flawed, it doesn’t matter how hard you work. Most question banks You’re not alone, and you’re not doing it wrong. You just need a system that works for you. Quick to create, but don’t actually teach Options that are too obvious or too vague Answer rationale is unclear or missing Don’t reference up to date Australian guidelines WHAT YOU GET The Solution Train with Questions That Teach, Not Just Test See Sample Questions Most people are practising the guitar… for a piano exam. The problem isn’t your effort. It’s that you’re building habits that don’t transfer. Our Study Program 1 RACGP Format KFP MSQ Questions RACGP Format KFP MSQ Questions 2 Concise and Comprehensive Exam Notes Perfectly aligned to the questions. Learn the why, not just the what. 3 High Yield Flashcards Refine what you’ve learned and commit it to memory, quickly. ALL TIED TOGETHER One Complete Learning System One Complete Learning System Start with high-quality questions Expand with evidence-based notes Refine with flashcards in targeted areas Each resource builds on the other to help you study smarter, not harder. Built by GPs who’ve passed with distinction. Reviewed by former RACGP examiners. Aligned to the most current RACGP guidelines. HOW WE BUILD OUR QUESTIONS Built with Intention. Reviewed for Accuracy. Designed to Teach. Every question is crafted and reviewed by a former RACGP examiner and a P4- scoring GP. See Sample Questions Built with Intention. Reviewed for Accuracy. Designed to Teach. Each question undergoes a rigorous process We start with high-yield, clinically relevant topics that commonly appear in real exams. Each case is written with 6.5/10+ complexity (because writing easy questions is easy). We follow the exact RACGP format, including structure, tone, and phrasing. Every answer is explained clearly, with references to current RACGP guidelines. We update all content quarterly based on guideline changes and real user feedback. We spend 3–5x longer on each question, prioritising clinical depth, reasoning, and clarity, not volume. Results That Speak Louder Than Promises 300+ expertly structured topics across 18 systems, available in concise and comprehensive formats. Includes flowcharts, Customer 6 300+ expertly structured topics across 18 systems, available in concise and comprehensive formats. Includes flowcharts, Customer 6 300+ expertly structured topics across 18 systems, available in concise and comprehensive formats. Includes flowcharts, Customer 6 Start the Study System Now Life After Success This Isn’t Just About Passing — It’s About Getting Your Life Back See Sample Questions You’re not just studying for an exam… You’re fighting for your future, your family, and your freedom. What Happens When You Pass You finally become a fully qualified Australian GP (VR) You gain permanent residency and job security You increase your income by $50,000+ a year You’re no longer working under supervision or stuck in DPA locations You stop working after-hours just to survive — and start choosing where and how you work You finally become a fully qualified Australian GP (VR) You gain permanent residency and job security You increase your income by $50,000+ a year You’re no longer working under supervision or stuck in DPA locations You stop working after-hours just to survive — and start choosing where and how you work No more late nights. No more second guessing. Just confidence, clarity, and peace of mind. Frequently Asked Question Are these questions suitable for IMG doctors? Yes. Most of our users are IMG GP trainees preparing for fellowship exams. What makes these questions different? They’re reviewed by former examiners, formatted to match the real exam, and focused on deep clinical reasoning. How often is the content updated? Every 3 months. Latest update: May 2025 What if I don’t find them helpful? We offer a 7 day money back guarantee with no questions asked. Can I use the questions offline? Yes. The free sample is provided as a downloadable PDF.

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 Complex Regional Pain Syndrome (CRPS) History Post-injury or surgery (even minor trauma) Severe distal limb pain, disproportionate to event Early signs of disuse, functional decline Diagnosis (Budapest Criteria) Requires symptoms in ≥3 of 4 categories & signs in ≥1 category: Sensory: Spontaneous pain, burning, hyperalgesia, allodynia Vasomotor: Temperature asymmetry, skin colour changes (red, blue, pale) Sudomotor/Oedema: Oedema, asymmetrical sweating Motor/Trophic: Weakness, tremors, ↓ movement, hair/skin/nail changes Additional Findings: ↓ ROM, pain with light touch Management Early physiotherapy (graded exercise, functional restoration) Psychological support (CBT) for pain-related distress Neuropathic pain management: Pregabalin/Gabapentin Pain clinic referral (consider sympathetic nerve blocks) Patient education: Early mobilisation, trigger avoidance Adjuncts (less evidence): Opioids, corticosteroids, carbamazepine Regular follow-up (monitor & adjust treatment) Refractory cases: Mirror therapy Complex Regional Pain Syndrome (CRPS) History Typically arises after an injury or surgery, often minor. Patients report severe distal limb pain disproportionate to the inciting event. Early signs can include limb disuse and functional decline. Diagnosis (Budapest Criteria) Diagnosis requires symptoms in ≥3 of the 4 categories and signs in ≥1 category: Category Examples Sensory Spontaneous pain, burning sensations, hyperalgesia, allodynia Vasomotor Temperature asymmetry, changes in skin colour (red, blue, pale) Sudomotor/Oedema Oedema, asymmetrical sweating Motor/Trophic Weakness, tremor, decreased movement, changes in hair/skin/nails Additional findings can include reduced range of motion and pain with light touch. Management Early physiotherapy focusing on graded exercise and functional restoration Psychological support such as cognitive behavioural therapy (CBT) to address pain-related distress Neuropathic pain management (e.g. pregabalin or gabapentin) Referral to a pain clinic for possible sympathetic nerve blocks Emphasise patient education on early mobilisation and avoiding triggers Adjuncts (with less evidence) include opioids, corticosteroids, carbamazepine Regular follow-up to monitor and adjust treatment as needed Refractory cases may benefit from mirror therapy Bookmark Failed! Bookmark Saved! Add Bookmark Refresh Refresh