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 Stye, Chalazion, Blepharitis Stye (Hordeolum) External: Infection of eyelash follicle or glands (Zeis/Moll) Internal: Meibomian gland infection Features: Red, tender, painful swelling near lid margin Treatment: Warm compress 2–4x daily (resolve in ~1 month) Avoid squeezing (prevents spread) Persistent/large → I&D (ophthalmology referral) Recurrent → assess for blepharitis/meibomian dysfunction Chalazion (Meibomian Cyst) Features: Firm, painless, slow-growing lump (blocked meibomian gland) Treatment: Warm compress 2–4x daily (1 month) Persistent → I&C or steroid injection (ophthalmology) Recurrent → assess for rosacea/blepharitis Blepharitis Types: Anterior: Affects eyelid margins/eyelashes (crusting/scales) Posterior: Affects meibomian glands (blocked glands, foamy tears) Associations: Staphylococcal infection, seborrhoea, rosacea, allergy Treatment: General: Warm compress 2–4x daily Eyelid hygiene (proprietary cleansers; avoid baby shampoo) Lubricating eye drops Anterior: Chloramphenicol 1% ointment OD (if bacterial) Posterior: Doxycycline 100 mg OD (4–8 weeks, reduce to 50 mg) Topical azithromycin if severe (doxycycline contraindicated) Firm eyelid massage (express blocked oils) NB: Address underlying rosacea/seborrhoea to prevent recurrence Complications: Keratitis, chalazion, dry eye syndrome Stye (Hordeolum), Chalazion (Meibomian Cyst), and Blepharitis Stye (Hordeolum) Definition External Hordeolum: Infection of eyelash follicle or glands of Zeis/Moll. Internal Hordeolum: Meibomian gland infection (deep). Features Red, tender, painful swelling near the eyelid margin. May show a small pustule or localized swelling. Management Warm Compresses 2–4× daily for ~10–15 minutes; usually resolves within ~1 month. Avoid Squeezing: Prevents spread of infection or scarring. Persistent or Large: Incision & drainage (ophthalmology referral). Recurrent: Assess for underlying blepharitis or meibomian gland dysfunction. Chalazion (Meibomian Cyst) Definition A firm, painless lump in the eyelid from a blocked Meibomian gland. Slower-growing than a stye; typically not tender. Features Firm, non-tender nodule in tarsal plate. May cause mild lid swelling or cosmetic concern. Management Warm Compresses 2–4× daily for ~1 month to aid drainage. Persistent Chalazion: Incision & curettage or steroid injection by ophthalmology. Recurrent: Evaluate for rosacea or chronic blepharitis. Blepharitis Definition Inflammation of the eyelid margins, affecting eyelashes (anterior) or meibomian glands (posterior). Types & Associations Anterior Blepharitis Involves eyelid margin/eyelashes (crusting/scales). Often staphylococcal or seborrhoeic. Posterior Blepharitis Meibomian gland dysfunction (blocked glands, foamy tears). Linked to rosacea or allergy. Management General Measures Warm Compresses 2–4× daily → helps express blocked glands. Eyelid Hygiene: Use proprietary lid cleansers (avoid baby shampoo if possible). Lubricating Eye Drops: Relieve dryness. Anterior Blepharitis (If bacterial) Chloramphenicol 1% ointment once daily at night. Posterior Blepharitis Doxycycline 100 mg daily for 4–8 weeks (reduce to 50 mg if improved). Topical azithromycin if severe (contraindication to doxy). Firm Eyelid Massage to express oils from meibomian glands. Address underlying rosacea or seborrhoea to reduce recurrence. Complications Keratitis, chalazion, or dry eye syndrome. 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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 Clozapine Monitoring and Management Monitoring Requirements 1. Blood (Neutropenia/Agranulocytosis) FBC Frequency: Weekly (first 18 weeks) → Fortnightly (weeks 18–52) → Monthly (after 1 year if stable) Action: Cease if neutrophils <1.5 × 10⁹/L → Consult psychiatrist Monitor closely if neutrophils 1.5–2.0 × 10⁹/L 2. Cardiovascular Troponin/CRP: Weekly for 4 weeks (detect myocarditis) Echocardiogram: Baseline, then annually (cardiomyopathy) ECG: Every 6–12 months or more during initiation 3. Metabolic Monitoring Weight, BMI, waist: At every GP visit Lipids/glucose: Every 6 months 4. Other Clozapine Levels: Every 6 months or if smoking cessation, drug changes, or clinical concerns (e.g., seizures) Constipation: Screen every visit (can be life-threatening) Adverse Effects 1. Constipation Prevent aggressively: Stool softeners/laxatives (e.g., docusate + senna) 2. Seizures Risk ↑ at clozapine levels >600 µg/L Treat with sodium valproate under specialist guidance 3. Hypersalivation Use non-pharmacological measures or sublingual atropine drops Myocarditis and Cardiomyopathy Myocarditis Onset: First 4 weeks Signs: Tachycardia, fever, chest pain Monitoring: Troponin, CRP, ECG Cardiomyopathy Onset: Median 9 months Action: Symptomatic → Same-day cardiology review (ECG/echo) Clozapine Poisoning Key Investigations ECG: QT prolongation or arrhythmias FBC: Neutrophil/granulocyte counts Bladder ultrasound: Screen for urinary retention Management Supportive Care: Airway protection, IV fluids (for hypotension) Seizures: IV benzodiazepines Activated Charcoal: Within 2 hrs if cooperative or via NG tube if intubated Discharge Advice Monitor for sedation/cognitive impairment for 3 days post-discharge Avoid driving or heavy machinery Notes If therapy interrupted >48 hrs → Re-titrate dose to avoid severe hypotension/seizures. Clozapine Monitoring and Management Monitoring Requirements Blood (Neutropenia/Agranulocytosis) FBC Frequency: Weekly for first 18 weeks → Fortnightly from weeks 18–52 → Monthly after 1 year if stable Action: Cease if neutrophils <1.5 × 10⁹/L; consult psychiatrist Monitor closely if neutrophils 1.5–2.0 × 10⁹/L Cardiovascular Troponin/CRP: Weekly for first 4 weeks to detect myocarditis Echocardiogram: Baseline, then annually (risk of cardiomyopathy) ECG: Every 6–12 months or more often during initiation Metabolic Monitoring Weight, BMI, waist circumference: At every GP visit Lipids and glucose: Every 6 months Other Clozapine Levels: Every 6 months or if smoking cessation, drug changes, or clinical concerns (e.g. seizures) Constipation: Screen each visit (life-threatening risk if severe) Adverse Effects Constipation Prevent aggressively with stool softeners/laxatives (e.g. docusate + senna) Seizures Risk increases if clozapine levels exceed 600 µg/L Treat with sodium valproate (under specialist guidance) Hypersalivation Manage with non-pharmacological measures or sublingual atropine drops Myocarditis and Cardiomyopathy Myocarditis Onset typically in the first 4 weeks Signs include tachycardia, fever, chest pain Monitoring involves troponin, CRP, ECG Cardiomyopathy Median onset around 9 months Symptomatic presentations require same-day cardiology review (ECG/echo) Clozapine Poisoning Key Investigations ECG for QT prolongation or arrhythmias FBC for neutrophil/granulocyte counts Bladder ultrasound to check for urinary retention Management Supportive care: Airway protection, IV fluids for hypotension Seizures: IV benzodiazepines Activated charcoal if within 2 hours and patient cooperative (or via NG tube if intubated) Discharge Advice Monitor for sedation/cognitive impairment for 3 days post-discharge Avoid driving or operating heavy machinery Notes If therapy is interrupted for >48 hours, re-titrate the dose to avoid severe hypotension or seizures. 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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 Hearing Loss (SNHL / CHL) and Tinnitus Differential Diagnoses Sensorineural Hearing Loss (SNHL) Presbycusis (bilateral, high-frequency loss) Noise-induced (occupational/recreational exposure) Ototoxic drugs (aminoglycosides, loop diuretics, chemotherapy) Sudden SNHL (urgent ENT referral if <72h) Hereditary SNHL (family history) Cerebrovascular ischaemia (AICA involvement) Barotrauma/head trauma (may have CHL component) Ménière’s disease (episodic vertigo, tinnitus, fluctuating hearing loss) Acoustic neuroma (unilateral tinnitus/SNHL) Conductive Hearing Loss (CHL) Outer Ear: Cerumen impaction, exostosis, SCC (rare) Middle Ear: ETD (URTI, sinusitis, allergies) Otitis media (serous, acute, chronic suppurative) Otosclerosis (stapes fixation, often bilateral) Cholesteatoma (erosive, can be mixed CHL/SNHL) Head trauma (ossicular disruption) TM perforation Tinnitus Primary (Idiopathic): Typically bilateral, high-pitched, usually SNHL Secondary: Associated with CHL or SNHL (otosclerosis, Ménière’s, cholesteatoma, trauma) Pulsatile tinnitus: Consider vascular lesion (glomus tumour, AV malformation) When to Image Pulsatile tinnitus Unilateral tinnitus or unilateral hearing loss Suspected middle ear pathology (otosclerosis, cholesteatoma) Significant head trauma History Onset (acute vs gradual), laterality (uni/bilateral) Noise exposure (occupational, recreational) Family history (early-onset SNHL) Medications (aminoglycosides, diuretics, chemotherapy, salicylates) Trauma (head injury, barotrauma) Associated symptoms: Otalgia, otorrhoea (infection, trauma) Vertigo, imbalance (Ménière’s, labyrinthitis, acoustic neuroma) Aural fullness Facial numbness/weakness (suspect acoustic neuroma, intracranial lesion) Examination Otoscopy (cerumen, exostosis, perforation, cholesteatoma) Pneumatic otoscopy (assesses TM mobility if effusion suspected) Tuning fork tests: Rinne: AC > BC = normal/SNHL; BC > AC = CHL Weber: Lateralises to affected ear in CHL, better ear in SNHL Cranial nerves (VII, VIII) assessment Audiometry (type, degree, speech discrimination) Investigations Audiological assessment: Pure tone & speech audiometry Tympanometry (middle ear pressure/compliance) Imaging: CT temporal bone (otosclerosis, cholesteatoma, trauma) MRI IAM (acoustic neuroma, unexplained unilateral SNHL/tinnitus) Bloods (if systemic causes suspected, e.g. autoimmune, syphilis) Tinnitus Management Address underlying cause (cerumen removal, otitis media treatment, Ménière’s management, medication review) Audiology referral: Hearing aids (if coexistent hearing loss) Sound therapy/masking (white noise, hearing aid noise generators) Psychological support: CBT for distress reduction Lifestyle: Limit caffeine, alcohol, nicotine Avoid loud environments (ear protection if needed) Other interventions: Relaxation, mindfulness, stress management Notes: Presbycusis & noise-induced SNHL = most common adult SNHL Cerumen impaction = frequent reversible CHL cause Sudden SNHL = ENT emergency (start high-dose corticosteroids if no contraindication) Pulsatile/unilateral tinnitus or SNHL → imaging to exclude vascular/retrocochlear lesion Tinnitus management focuses on education, treating causes, and minimising impact via sound therapy & psychological support Hearing aids can alleviate tinnitus by improving external sound perception Hearing Loss (SNHL / CHL) and Tinnitus Differential Diagnoses Sensorineural Hearing Loss (SNHL) Presbycusis (often bilateral, high-frequency loss) Noise-induced hearing loss (occupational or recreational exposure) Ototoxic medications (aminoglycosides, loop diuretics, chemotherapy agents) Idiopathic sudden sensorineural hearing loss (urgent ENT referral if within 72 hours) Hereditary SNHL (family history) Cerebrovascular ischaemia (e.g. anterior inferior cerebellar artery involvement) Barotrauma or head trauma (may also cause conductive component) Ménière’s disease (episodic vertigo, tinnitus, fluctuating hearing loss) Acoustic neuroma (vestibular schwannoma, often unilateral tinnitus/HL) Conductive Hearing Loss (CHL) Outer Ear Cerumen impaction (common, easily treated) Exostosis (surfer’s ear) Squamous cell carcinoma (rare) Middle Ear Eustachian tube dysfunction (URTI, sinusitis, allergies) Otitis media (serous, acute, or chronic suppurative) Otosclerosis (bony overgrowth at stapes footplate, classically bilateral) Cholesteatoma (erosive growth, can be mixed CHL/SNHL) Head trauma causing ossicular disruption Tympanic membrane perforation Tinnitus Primary (Idiopathic) May or may not have SNHL, but typically not CHL Often bilateral, high-pitched Secondary Can co-exist with CHL or SNHL Caused by underlying conditions (otosclerosis, Ménière’s, cholesteatoma, head trauma) Pulsatile tinnitus suggests possible vascular lesion (glomus tumour, arteriovenous malformation) When to Image Pulsatile tinnitus Unilateral hearing loss or unilateral tinnitus Suspected middle ear pathology (otosclerosis, cholesteatoma) Significant head trauma History Onset (acute vs gradual), unilateral or bilateral Noise exposure (occupational or recreational) Family history of early hearing loss Medications (e.g. aminoglycosides, diuretics, chemotherapy agents, salicylates) Trauma (head or barotrauma) Associated Symptoms Otalgia, otorrhoea (infection or trauma) Vertigo or imbalance (Ménière’s, labyrinthitis, vestibular schwannoma) Aural fullness or pressure Facial numbness or hemiparesis (suspect acoustic neuroma or intracranial lesion) Examination Otoscopy (look for cerumen impaction, exostoses, perforation, cholesteatoma) Pneumatic Otoscopy (assesses TM mobility if effusion suspected) Tuning Fork Tests Rinne (AC > BC is normal or SNHL, BC > AC is CHL in that ear) Weber (lateralises to the affected ear in CHL and to the better ear in SNHL) Cranial Nerves (especially CN VII and CN VIII) Audiometry (confirm type and degree of hearing loss, including speech discrimination) Investigations Formal Audiological Assessment Pure tone audiometry and speech audiometry Tympanometry (middle ear pressure and compliance) Imaging CT temporal bone (otosclerosis, cholesteatoma, trauma) MRI internal acoustic meatus if acoustic neuroma suspected or unexplained unilateral SNHL/tinnitus Laboratory Tests if systemic causes suspected (e.g. autoimmune markers, syphilis serology, etc) Tinnitus Management Evaluate for Anxiety or Depression (common comorbidities) Address Underlying Cause Remove cerumen, treat otitis media, manage Ménière’s, or review medication list Audiology Referral Hearing aids if coexistent hearing loss Sound therapy or masking devices (white noise machines, hearing aid noise generators) Counselling and Psychological Support Cognitive behavioural therapy (CBT) can reduce distress Lifestyle Modifications Limit caffeine, alcohol, nicotine Avoid loud environments or use ear protection Other Interventions Relaxation techniques, mindfulness, stress management Notes: Presbycusis and noise-induced SNHL are the most common adult SNHL causes Cerumen impaction is a frequent reversible cause of CHL Sudden SNHL is an ENT emergency (initiate high-dose corticosteroids if no contraindication) Pulsatile tinnitus or unilateral tinnitus/hearing loss warrants imaging to exclude vascular or retrocochlear lesion Tinnitus management focuses on education, addressing treatable causes, and minimising the impact on quality of life through sound therapy and psychological support Hearing aid fitting can alleviate tinnitus by improving external sound perception 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 Ink Spot Lentigo Presentation Solitary, dark macules with irregular borders Occurs in sun-exposed areas Management No treatment needed, unless for cosmetic reasons Monitor for melanoma-like changes Types of Lentigo Type Description Location Appearance Associated Conditions Lentigo Simplex Common in childhood, may fade. Precursor to junctional naevus. Trunk, limbs Small brown macule/plaque, round/oval, smooth/jagged edges, dry surface. None Solar Lentigo From chronic sun exposure, may resemble seborrhoeic keratosis. Hands, face, lower legs, shoulders Yellow/light/dark brown macule or thin plaque, moth-eaten outline, dry surface. Seborrhoeic keratosis, lichenoid keratosis Ink Spot Lentigo Follows sunburn, fewer than solar lentigines. Sun-exposed areas, trunk Dark brown/black, irregular "ink spot" macule. None PUVA Lentigo Follows PUVA photochemotherapy. PUVA-exposed areas Dark brown/black, irregular macule, similar to ink spot lentigo. PUVA therapy Tanning Bed Lentigo From indoor tanning. Tanning bed-exposed areas Brown macule. Indoor tanning Radiation Lentigo After irradiation, linked to late-stage radiation dermatitis. Irradiated site Dark brown macule, may have atrophy, fibrosis, telangiectasias. Radiation dermatitis Melanotic Macule Found on mucosal surfaces. Lips, vulva, anus Light/dark brown macule. Mucosal melanosis Generalised Lentigines Appear in childhood, merge into patches. Not syndromic. Exposed/covered sites Small brown macules merging into patches. Lentigines profusa Agminated Lentigines Segmental lentigines with sharp midline demarcation. Segmental area Clustered lentigines. Neurological/developmental abnormalities Patterned Lentigines Inherited, common in African ethnicity. Face, lips, buttocks, palms, soles Brown macules forming distinct patterns. Centrofacial neurodysraphic lentiginosis, intellectual disability Lentiginosis Syndromes Syndromic, autosomal dominant or sporadic. Widespread, present from birth/early childhood Diffuse lentigines. LEOPARD/Noonan, Peutz-Jeghers, Laugier-Hunziker, Xeroderma pigmentosum, Cowden disease, Bannayan-Zonana syndrome, etc Ink Spot Lentigo Presentation Solitary, dark macules with irregular, “ink spot” borders Typically appears in sun-exposed areas (commonly on the trunk) Generally asymptomatic, discovered incidentally Can appear after intense sun exposure or sunburn; fewer in number than solar lentigines Management No specific treatment is necessary unless for cosmetic reasons. Monitoring is prudent if there are any features suspicious for melanoma-like changes (e.g., rapid growth, colour change, irregular borders). Consider dermatological opinion if uncertain about differentiation from atypical naevus or melanoma. Types of Lentigo (Overview) Type Description Location Appearance Associated Conditions Lentigo Simplex Common from childhood; can fade over time; precursor to junctional naevus. Trunk, limbs Small brown macule/plaque, round/oval, smooth or jagged edges, dry surface. None Solar Lentigo From chronic sun exposure; can resemble seborrhoeic keratosis. Hands, face, lower legs, shoulders Yellow/light-brown to dark-brown macule or thin plaque, “moth-eaten” border, dry surface. Seborrhoeic keratosis, lichenoid keratosis Ink Spot Lentigo Follows sunburn, fewer than solar lentigines. Sun-exposed areas, trunk Dark brown/black “ink spot” macule, irregular border. None PUVA Lentigo From photochemotherapy (psoralen + UVA). PUVA-exposed areas Dark brown/black irregular macule, similar to ink spot lentigo. PUVA therapy Tanning Bed Lentigo Associated with indoor tanning. Tanning bed-exposed areas Brown macule. Indoor tanning Radiation Lentigo After radiation therapy, can accompany late radiation dermatitis. Irradiated site Dark brown macule, may have atrophy, fibrosis, telangiectasia in the area of prior radiation. Radiation dermatitis Melanotic Macule Found on mucosal surfaces. Lips, vulva, anus Light/dark brown macule. Mucosal melanosis Generalised Lentigines Appear in childhood, may merge into patches, usually non-syndromic. Exposed/covered sites Numerous small brown macules merging into larger patches. Lentigines profusa Agminated Lentigines Segmental lentigines with a sharp midline demarcation. Segmental area Clustered lentigines in one region. Possible neurological/developmental abnormalities Patterned Lentigines Inherited forms, often in African ethnicity. Face, lips, buttocks, palms, soles Brown macules forming distinct patterns. Can occur in syndromes with neurodysraphic features, intellectual disability Lentiginosis Syndromes Syndromic, autosomal dominant or sporadic. Widespread, from birth/early childhood Diffuse lentigines. LEOPARD/Noonan syndrome, Peutz-Jeghers, Laugier-Hunziker, Xeroderma pigmentosum, Cowden disease, Bannayan-Zonana syndrome, etc Notes Ink Spot Lentigo is typically benign but should be differentiated from atypical naevi or melanoma if suspicious changes occur. Sun protection (broad-spectrum sunscreen, protective clothing) is advised to prevent new lesions. If in doubt, consider dermatologist evaluation; occasionally, dermatoscopy or biopsy may be needed. 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 Prostatitis Types Acute bacterial prostatitis – Sudden onset, systemic symptoms, positive urine culture Chronic bacterial prostatitis – Recurrent UTI, positive prostatic fluid culture, no systemic symptoms Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) – Pelvic pain >3 months, no bacterial growth on culture Asymptomatic inflammatory prostatitis – No symptoms, incidental inflammation (e.g., on biopsy) Symptoms LUTS (dysuria, frequency, urgency, weak stream, hesitancy, dribbling) Fevers, chills, sweats Perineal, pelvic, or lower back pain Tender prostate on DRE Painful ejaculation Haematospermia / haematuria Acute urinary retention in severe cases Examination DRE: Tender ++, firm prostate (avoid vigorous palpation to prevent bacteraemia) Abdomen: Suprapubic tenderness if urinary retention Investigations Urinalysis & urine culture – Essential for all suspected cases Blood cultures – If systemic infection suspected PSA – May be elevated; avoid testing during acute infection Imaging (TRUS, CT, MRI) – If prostatic abscess suspected Two-glass test (pre- and post-massage urine culture) – For chronic bacterial prostatitis Treatment Acute Bacterial Prostatitis Non-severe: First-line: Trimethoprim 300 mg daily for 2 weeks Second-line: Cephalexin 500 mg QID for 2 weeks If resistant & pathogen susceptible: Ciprofloxacin 500 mg BD or Norfloxacin 400 mg BD for 2 weeks Confirm resolution with repeat urine culture 1 week post-treatment Severe (Fever >38°C, sepsis features): IV therapy: Gentamicin + amoxicillin 2 g IV Q6H (or ampicillin 2 g IV Q6H) If gentamicin contraindicated: Ceftriaxone 1 g IV daily or Cefotaxime 1 g IV Q8H Step down to oral therapy once stable (total duration ~4 weeks) Chronic Bacterial Prostatitis First-line: Ciprofloxacin 500 mg BD or Norfloxacin 400 mg BD for 4 weeks Alternative: Trimethoprim 300 mg daily for 4 weeks Avoid repeat antibiotic courses unless symptomatic with a positive culture Complications Acute urinary retention Chronic bacterial prostatitis Prostatic abscess (requires imaging ± drainage) Sepsis / bacteraemia Fistula formation Osteomyelitis (spine / SI joints) Acute vs. Chronic Prostatitis Feature Acute Chronic Onset Sudden Gradual Symptoms Systemic (fever, chills, sepsis) Recurrent UTI, no fever DRE Tender ++ Prostatic tenderness, less severe Culture Positive urine culture Positive prostatic fluid culture CP/CPPS Chronic pelvic pain >3 months, negative cultures Treatment Approach Acute: Empirical antibiotics, IV therapy if severe, hospitalisation if septic Chronic: Long-duration oral antibiotics, avoid unnecessary antibiotics if asymptomatic Note: Haematuria / haematospermia are symptoms, not complications PSA doubling within 12 months suggests prostate cancer or prostatitis over BPH Prostatic abscess requires imaging confirmation and possible surgical Prostatitis Types Acute Bacterial Prostatitis Sudden onset, systemic symptoms (fever, chills) Positive urine culture (typical pathogens: E. coli, other Enterobacteriaceae) Chronic Bacterial Prostatitis Recurrent UTIs, often fewer systemic symptoms Positive prostatic fluid culture; may have normal or mildly elevated WBC in urine Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) Pelvic pain >3 months, no bacterial growth on culture Inflammatory (white cells in semen/prostatic fluid) or non-inflammatory Asymptomatic Inflammatory Prostatitis No symptoms Incidental finding of prostatic inflammation (e.g. on biopsy) Symptoms (General) LUTS: Dysuria, frequency, urgency, weak stream, hesitancy, dribbling Systemic: Fevers, chills, sweats (mainly in acute cases) Pain: Perineal, pelvic, lower back pain, painful ejaculation Tender Prostate on DRE (digital rectal exam) Haematospermia / Haematuria occasionally Acute urinary retention if severe swelling or pain Examination DRE: Prostate is very tender in acute bacterial prostatitis (avoid vigorous palpation to prevent bacteraemia). Abdomen: Check for suprapubic tenderness if concern for urinary retention. Investigations Urinalysis & Urine Culture: Essential to identify bacterial cause, especially in acute/chronic bacterial prostatitis. Blood Cultures: If systemic infection or sepsis suspected. PSA: May be elevated; best avoided during acute infection due to transient elevation. Imaging: TRUS (transrectal ultrasound), CT, or MRI if prostatic abscess suspected. Two-Glass Test (Pre- and Post-Prostate Massage Urine Culture): Used in chronic bacterial prostatitis to identify pathogens in post-massage urine. Management Acute Bacterial Prostatitis Non-Severe (Outpatient) Trimethoprim 300 mg daily for 2 weeks (first-line) Cephalexin 500 mg QID for 2 weeks (alternative) Fluoroquinolones (ciprofloxacin 500 mg BD / norfloxacin 400 mg BD) if resistant or culture-sensitive Confirm resolution with repeat urine culture 1 week post-treatment Severe (Fever >38°C, sepsis features) IV Therapy: Gentamicin + amoxicillin 2 g IV Q6H (or ampicillin) If gentamicin is contraindicated: Ceftriaxone 1 g IV daily or cefotaxime 1 g IV Q8H Step down to oral therapy once stable; total duration ~4 weeks Chronic Bacterial Prostatitis First-Line: Ciprofloxacin 500 mg BD or Norfloxacin 400 mg BD for 4 weeks Alternative: Trimethoprim 300 mg daily for 4 weeks Avoid repeat antibiotic courses if asymptomatic with no positive culture. Complications Acute Urinary Retention Chronic Bacterial Prostatitis Prostatic Abscess (requires imaging ± drainage) Sepsis / Bacteraemia Fistula formation (rare) Osteomyelitis (spread to spine or SI joints) Acute vs. Chronic Prostatitis Feature Acute Chronic Onset Sudden Gradual Symptoms Systemic (fever, chills) Recurrent UTIs, less systemic involvement DRE Tender ++ Tender but less dramatic Culture Positive urine culture Positive prostatic fluid culture CP/CPPS Chronic pelvic pain >3 months, negative cultures Treatment Approach Acute: Empirical antibiotics; IV if severe or septic. Chronic: Longer duration oral antibiotics (4 weeks); only treat if symptomatic with positive culture. Note Haematuria or haematospermia are symptoms, not complications. PSA doubling in 12 months may indicate cancer or prostatitis. Prostatic Abscess: Imaging confirmation, may require drainage. 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 Henoch–Schönlein Purpura (HSP) Definition Most common vasculitis in children, affecting small vessels Self-limiting, typically in ages 2–8 (90% paediatric cases) Aetiology Often follows URTI/tonsillitis, usually group A streptococcus IgA immune complex deposition Symptoms Palpable purpura (lower limbs, buttocks, sometimes upper limbs/face) Arthritis/arthralgia (knees, ankles) Abdominal pain (sudden, diffuse, ± vomiting, bloody diarrhoea) Renal involvement (haematuria, proteinuria) Differential Diagnosis Idiopathic thrombocytopenic purpura (ITP) Systemic lupus erythematosus (SLE) Meningococcal sepsis Diagnosis Clinical diagnosis (purpura + joint pain + abdominal pain ± renal involvement) Urinalysis confirms kidney involvement Further tests only if complications arise Management Supportive care (self-limiting, resolves in weeks–months) Pain relief: Paracetamol or NSAIDs Monitor renal function if kidney involvement Prognosis Good, most recover within months Henoch–Schönlein Purpura (HSP) Definition Henoch–Schönlein purpura (HSP) is the most common vasculitis in children, predominantly affecting small vessels(capillaries, venules, arterioles). Approximately 90% of cases occur in paediatric populations aged 2–8 years. Usually self-limiting but can impact multiple organ systems: skin, joints, gastrointestinal tract, and kidneys. Aetiology & Causes Frequently follows an upper respiratory tract infection (URTI), often group A streptococcus Involves IgA immune complex deposition in small vessels (Type III hypersensitivity), leading to inflammation in skin, joints, gut, and kidneys Symptoms Palpable Purpura Typically on lower limbs and buttocks, though can also appear on arms or face Non-thrombocytopenic (platelet count normal) but raised lesions due to vasculitis Arthritis/Arthralgia Commonly affects knees and ankles, often migratory and transient Joint swelling and pain but usually no long-term damage Abdominal Pain Sudden onset, diffuse or colicky, possibly with vomiting or bloody diarrhoea Intussusception can occur as a rare but significant complication Renal Involvement Haematuria and/or proteinuria Ranges from mild (microscopic haematuria) to more severe nephritic or nephrotic syndromes Differential Diagnosis Idiopathic Thrombocytopenic Purpura (ITP): Usually low platelets (thrombocytopenia) Systemic Lupus Erythematosus (SLE): Multi-system involvement but often with ANA and other serologic findings Meningococcal Sepsis: Usually more acute presentation with significant systemic symptoms (fever, shock), non-blanching rash Diagnosis Clinical Diagnosis: Based on the classic tetrad of palpable purpura, arthralgia, abdominal pain, and renal involvement Urinalysis: Confirms kidney involvement (RBCs, RBC casts, proteinuria) Blood Tests: Normal platelet count differentiates from ITP, inflammatory markers (ESR, CRP) may be elevated Further Investigations only if complications or atypical features (e.g. severe abdominal pain, suspected intussusception, significant renal impairment) Management Supportive Care Self-Limiting in most children, typically resolving in weeks to months Pain Relief: Paracetamol or NSAIDs (e.g. ibuprofen) for joint/muscle aches Renal Monitoring Monitor urinalysis and BP if there is kidney involvement Persistent or severe proteinuria may necessitate nephrology referral Severe Cases Rarely, short-course corticosteroids are considered if severe abdominal pain or significant nephritis Intussusception requires urgent surgical evaluation General Advice Rest, hydration, reassurance to parents/caregivers Educate on signs of renal involvement (dark urine, oedema, hypertension) Prognosis Overall, good outcome: Most children recover spontaneously within 3–4 weeks, with <5% developing serious chronic renal complications Follow-up with urinalysis for a few months to detect delayed or persistent renal involvement 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 Head Lice Presentation Often asymptomatic, lice or nits (eggs) noticed in hair Itching, especially at occiput and nape Secondary bacterial infection possible Diagnosis Confirmed by observing live lice, best detected via wet combing Wet combing method: Apply conditioner, comb with fine-toothed comb to trap lice Regular checks recommended in high-risk settings (e.g. schools) x Management Non-Pharmacological Regular wet combing between treatments Wash bedding, towels in hot water to prevent re-infestation Inspect/treat close contacts & household members School notification if live lice found, but child may return after first treatment Pharmacological First-line treatments: Maldison 0.5% lotion: Apply 8 hours, repeat day 7 (not for <6 months) Maldison 1% lotion: Apply 30 minutes, repeat day 7 (not for <6 months) Permethrin 1% lotion: Apply 10 minutes, repeat day 7 Pyrethrins 0.165% + Piperonyl butoxide 1.65% lotion: Apply 10 minutes, repeat day 7 Treatment failure: Switch topical agent Resistant cases: Oral ivermectin 200 mcg/kg, repeat day 7 Head Lice Presentation Often asymptomatic, although lice or nits (eggs) may be noticed during grooming or regular checks. Itching can occur, particularly around the occipital area and nape of the neck. Secondary bacterial infection (impetigo) may develop if scratching breaks the skin. Diagnosis Confirm by finding live lice; best done via wet combing method: Apply conditioner to damp hair Use a fine-toothed comb to systematically comb sections, trapping lice on the comb Regular checks recommended in high-risk settings (e.g. schools, daycare centres). Management Non-Pharmacological Wet Combing: Continue between treatments (e.g. every 2–3 days) to remove newly hatched lice. Wash Bedding, towels, hats in hot water (60°C) or seal in plastic bag for ~2 weeks to reduce re-infestation risk. Inspect/Treat Close Contacts: Household members, friends with close contact. School Notification: If live lice are found, the school should be informed. However, the child may return to school after the first proper treatment. Pharmacological First-Line Treatments: Maldison 0.5% lotion Apply for 8 hours (overnight), repeat on day 7. Not recommended for infants <6 months (lack of data). Maldison 1% lotion Apply for 30 minutes, repeat on day 7. Not for <6 months. Permethrin 1% lotion Apply for 10 minutes, repeat on day 7. Pyrethrins 0.165% + Piperonyl butoxide 1.65% lotion Apply for 10 minutes, repeat on day 7. Treatment Failure: Switch to an alternative topical agent. Resistant Cases: Oral ivermectin 200 mcg/kg, repeat day 7 (consult product guidelines for age/weight restrictions). Notes Follow instructions carefully for each topical product, as application time and re-treatment intervals can vary. Comb through hair after treatment to remove eggs/nits and check treatment efficacy. Reinfection often occurs if close contacts are not treated simultaneously or if bedding/clothes are not managed appropriately. 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 Trigeminal Neuralgia Causes Vascular compression (artery/vein, most common) Tumour/mass effect Multiple sclerosis (demyelination at nerve root) History Severe, sharp, stabbing pain in V2/V3 distribution Paroxysmal attacks (seconds to minutes) with refractory periods Triggered by cold/hot drinks, brushing teeth, wind, shaving, light touch Can mimic migraine (sudden intense pain) More common in older adults, slight female predominance Examination Trigger zones (nasolabial fold, upper cheek) Tic douloureux (brief facial twitching from pain) Allodynia/hyperalgesia in affected area Neurological exam otherwise normal Investigations MRI brain with trigeminal nerve focus (rule out MS, tumours) Neurophysiological studies (if atypical presentation) Management Educate on nerve irritation, trigger avoidance Non-urgent neurology referral First-line: Carbamazepine (start 100 mg BD, titrate as needed) Second-line: Oxcarbazepine (if intolerant to carbamazepine) Monitor for side effects: Depression, hyponatraemia, dizziness Baclofen (adjunct or alternative in refractory cases) Surgical decompression (if severe, persistent, or confirmed neurovascular compression) Trigeminal Neuralgia Causes Vascular Compression of the trigeminal nerve root (most common) Tumour or Mass effect on the nerve Multiple Sclerosis (demyelination near nerve entry zone) History Severe, sharp, stabbing pain in V2 (maxillary) or V3 (mandibular) divisions of CN V Attacks last seconds to minutes with refractory periods Triggers: Cold/hot drinks, brushing teeth, shaving, gentle facial touch, wind Can mimic migraine but typically short, intense bursts of pain More common in older adults, slight female predominance Examination Trigger zones (e.g., nasolabial fold, cheek) → light touch can provoke pain Tic Douloureux: Brief facial twitch with severe pain Allodynia/Hyperalgesia in the affected dermatomes Otherwise normal neuro exam Investigations MRI Brain (focus on trigeminal nerve) to rule out: Vascular loops compressing nerve Tumours, demyelinating plaques (MS) Neurophysiological Studies if atypical features Management Education Explain nerve irritation, advise on trigger avoidance Pharmacotherapy Carbamazepine: First-line (start 100 mg BD, titrate gradually) Oxcarbazepine if carbamazepine intolerance Monitor for side effects (hyponatraemia, dizziness, mood changes) Baclofen: Adjunct or alternative in refractory cases Surgical Decompression Microvascular decompression if severe and recurrent or confirmed neurovascular conflict Referral Non-urgent neurology referral for ongoing management, possible imaging to exclude secondary 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 Anxiety Disorders: OCD & Social Anxiety Disorder Hallmark Features Obsessive-Compulsive Disorder (OCD) Obsessions: Persistent, intrusive thoughts/impulses causing anxiety Compulsions: Repetitive acts to reduce anxiety Insight present (unlike OCPD) Often comorbid with depression/anxiety Social Anxiety Disorder Generalised: Anxiety in all social interactions Non-Generalised: Limited to specific situations (e.g., public speaking) Management OCD First-Line: CBT with exposure and response prevention Pharmacotherapy: SSRIs (higher doses, 6–12 months) Clomipramine for SSRI-resistant or severe cases Social Anxiety Disorder Generalised: First-Line: CBT (exposure-based) Pharmacotherapy: SSRIs (e.g., sertraline, escitalopram) Venlafaxine if SSRIs fail Non-Generalised: Propranolol: 10–40 mg, 30–60 min pre-activity Diazepam: PRN before activity Additional Notes Tailor treatment for comorbidities (e.g., substance use, depression) Avoid propranolol in asthma, PVD, bradycardia Anxiety Disorders: OCD & Social Anxiety Disorder Hallmark Features Feature Obsessive-Compulsive Disorder (OCD) Social Anxiety Disorder Core Symptoms - Obsessions: Persistent, intrusive thoughts/impulses causing marked anxiety - Compulsions: Repetitive acts/rituals performed to reduce anxiety - Fear of social scrutiny or negative evaluation in social/performance situations - Avoidance of social events or enduring with intense distress Insight Typically has insight that obsessions/compulsions are excessive or irrational (unlike OCPD) Usually recognises the anxiety as excessive or out of proportion to the actual threat Subtypes/Presentation - Often comorbid with depression/anxiety - Obsessions can be contamination, symmetry, harm thoughts - Compulsions commonly include checking, washing, counting - Generalised: Anxiety across most social interactions - Non-Generalised: Anxiety limited to specific situations (e.g., public speaking) Management Condition First-Line Therapy Pharmacotherapy Additional Notes OCD - CBT with Exposure and Response Prevention - SSRIs (often higher doses, at least 6–12 months) - Clomipramine for SSRI-resistant or severe cases Monitor for comorbid depression/anxiety. Combination of therapy + medication often most effective. Social Anxiety Disorder(Generalised) - CBT (exposure-based) - SSRIs (e.g., sertraline, escitalopram) - Venlafaxine if SSRIs fail Evaluate for severity and functional impairment. Gradual exposure to feared social settings is key. Social Anxiety Disorder (Non-Generalised) - Specific situational therapy - Propranolol 10–40 mg 30–60 mins before anxiety-provoking event - Diazepam PRN before event (if no contraindications) Focus on situational triggers (e.g., public speaking). Propranolol helps with physical symptoms (tremor, palpitations); avoid in asthma, PVD, bradycardia. Additional Notes Tailor treatment to comorbidities (e.g., substance use, depression). Propranolol is contraindicated or used with caution in asthma, peripheral vascular disease, bradycardia. Emphasise psychoeducation and lifestyle strategies alongside therapy or medication. 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 Personality Disorders (PD) Aetiology & Risk Factors Multifactorial: Genetic predisposition, early trauma/neglect, ongoing maladaptive social experiences Not all with childhood adversity develop PD, and some with PD report no clear trauma Early intervention (adolescence/early adulthood) improves long-term outcomes Classification Traditional model (DSM-5/ICD-10): Categorical (e.g. borderline, antisocial, narcissistic) Emerging model (ICD-11/Alternative DSM-5): Dimensional (mild–severe) + trait domains (e.g. negative affectivity, detachment) Borderline pattern: Marked emotional instability, self-image issues, impulsivity Diagnosis in General Practice When to suspect PD Long-standing interpersonal difficulties, emotional instability, self-harm, crises History of multiple mental health presentations, frequent GP visits Key diagnostic features Pervasive: Across different contexts Long-standing: Typically evident from late adolescence Distress/impairment: Significant functional impact Not better explained by another disorder, substance use, or medical condition Management Principles Core Approach Therapeutic alliance: Trust, validation, structured approach Encourage responsibility: Empower patient ownership of decisions Clarify roles & boundaries to maintain consistent care Address stigma: Explain PD as a treatable condition Management Plan Collaborative care plan (patient + GP + mental health team) Key components: Crisis management & risk assessment (especially for suicidality) Short- & long-term goals First-line: Psychosocial interventions Pharmacotherapy (if used) – clear targets, limited duration, regular review Team-Based Care Moderate–severe cases: Involve psychologists, psychiatrists, mental health nurses, social workers Personality disorder-specific services (if available) First-Line Treatment: Psychosocial Interventions Evidence-Based Therapies Dialectical Behaviour Therapy (DBT) – emotional regulation, distress tolerance Mentalisation-Based Therapy (MBT) – improves understanding of self & others Schema Therapy – addresses deep-seated negative beliefs Transference-Focused Psychotherapy (TFP) – for severe interpersonal dysfunction Good Clinical Management (GCM) – structured, validating care without specialised therapy Pharmacological Treatment (Limited Role) No medication "treats" PD itself – only targets specific severe symptoms Indications: Cognitive-perceptual symptoms (paranoia, transient psychosis): Short-term low-dose antipsychotics Severe mood instability/anxiety: SSRIs/SNRIs (if comorbid depression/anxiety) Impulsivity/self-harm: Limited evidence; psychiatric input recommended Crisis management: Short course of benzodiazepines/hypnotics for acute distress but avoid long-term use Principles of Use: Clear rationale & short duration Avoid polypharmacy – single-agent trials preferred Minimise risk (e.g. overdose potential) Acute Crisis Management Presentation: Suicidality, self-harm, severe distress Principles: Listen with empathy, use de-escalation strategies Stick to agreed management plan if in place Involve family/supports (if patient consents) Short-term sedation (e.g. benzodiazepine) if severe distress persists Special Considerations Perinatal Context Higher risk of unplanned pregnancy, psychosocial stress, limited support Preconception counselling (contraception, parenting challenges) Perinatal mental health team involvement Minimise pharmacotherapy in pregnancy/breastfeeding unless treating clear comorbid disorder Stigma Reduction Use respectful language & educate clinical staff Explain PD as a treatable condition, not a label of blame Encourage self-compassion in patients Personality disorder (PD) Overview and epidemiology A personality disorder (PD) is characterised by pervasive and enduring patterns of inner experience and behaviour that deviate markedly from cultural expectations, are inflexible or maladaptive, and cause significant distress or impairment. These maladaptive patterns manifest in thoughts, emotions, interpersonal functioning, or impulse control. Personality disorder involves: Problems with the self (e.g. identity, self-worth, and self-direction). Interpersonal dysfunction (e.g. difficulties forming and sustaining relationships, empathising, and managing conflict). Aetiology and risk factors Multifactorial aetiology, incorporating genetics and temperament, early life experiences (e.g. trauma, neglect), and ongoing maladaptive social experiences. Not all people with adverse childhood experiences develop PD, and conversely some people with PD report no obvious adversity. Early intervention and detection in adolescence or early adulthood can help moderate poor long-term outcomes. Classification Traditional (categorical) model (DSM-5 / ICD-10) Ten categories (e.g. borderline, narcissistic, antisocial, obsessive–compulsive, etc.). However, these often overlap and can lead to complex or “mixed” diagnoses. Emerging (dimensional) model (ICD-11 / Alternative Model in DSM-5) Focuses on severity (mild, moderate, severe) plus specifiers describing prominent personality traits (e.g. negative affectivity, detachment, dissociality, disinhibition, and anankastia). A “borderline pattern” can be specified if pervasive interpersonal and self-image instability and marked impulsivity are present. Diagnosis in general practice When to suspect personality disorder Long-standing interpersonal difficulties, repeated crises, persistent patterns of dysfunctional coping, and self-harming or high-risk behaviour. A history of multiple mental health presentations or “frequent attender” patterns in primary care. Key diagnostic criteria Maladaptive behaviour and internal experiences that are: Pervasive (across contexts). Long-standing (chronic and stable over time, typically evident from late adolescence/early adulthood). Cause significant distress or functional impairment. Not better explained by another mental disorder or by substance misuse or physical health issues. Co-occurring disorders People with PD often have comorbid conditions (e.g. depression, anxiety, eating disorders, alcohol or other drug problems). High rates of comorbidity can obscure diagnosis. Importance of timely diagnosis Untreated PD can lead to severe functional disability, chronic suicidal risk, and high service utilisation. Recognising PD helps tailor management towards psychosocial therapies rather than relying on pharmacotherapy alone. Principles of management Key approach A trusting, consistent therapeutic relationship is central. Emphasise compassion, empathy, open communication, and validation. Adopt a structured approach; clarify roles and boundaries. Encourage the patient’s ownership of decisions and responsibility for behaviour change. Address stigma by openly and respectfully discussing the diagnosis, emphasising that PDs are treatable. Management plan Develop collaboratively with the patient (and, where appropriate, family/carers). Include: Key clinicians and contacts (including crisis and emergency supports). Risk assessment and crisis management strategies (especially for suicidal or self-harming behaviours). Short- and long-term treatment goals. Psychosocial interventions (first-line). If applicable, details on pharmacotherapy (targets, duration, and review timelines). Team-based or multidisciplinary care In moderate-to-severe PD, a combined approach involving GPs, psychologists, psychiatrists, mental health nurses, social workers, and sometimes dedicated personality disorder services can improve outcomes. Psychosocial interventions (first-line treatment) Mainstay of treatment Psychosocial therapies are the foundation of PD management. Evidence-based therapies include: Dialectical Behaviour Therapy (DBT) Mentalisation-Based Therapy (MBT) Schema Therapy Transference-Focused Psychotherapy Good Clinical (or Psychiatric) Management (structured, empathic care without a specific named modality) Common factors of evidence-based psychosocial interventions A structured approach, focusing on problems relevant to PD (e.g. emotional dysregulation, interpersonal conflict). A strong therapeutic alliance with a validating but boundaried stance. Collaborative goal-setting and crisis planning. Linking feelings with triggers, and encouraging reflective capacity. Pharmacological treatment Limited role overall No medication “cures” personality disorder or addresses its core interpersonal and self-related difficulties. Medications may be used short-term to target specific severe symptoms (e.g. extreme anxiety, transient psychotic-like symptoms, severe agitation) if psychosocial approaches alone are insufficient. Caution is essential: people with PD can be at increased risk of misuse, dependence, and overdose. Indications for medication in PD Cognitive-perceptual symptoms (e.g. transient paranoia, hallucinations): low-dose antipsychotics may be considered if severe, though evidence is limited. Affective dysregulation (e.g. dysphoria, marked mood lability, anxiety): consider antidepressants, particularly if comorbid mood or anxiety disorders are clearly present. Impulsivity / behavioural dyscontrol (e.g. severe self-harm, aggression): evidence is lacking; in complex cases, psychiatric advice is recommended. Principles of use Always provide a clear rationale. Avoid polypharmacy; prefer sequential single-agent trials. Use time-limited prescriptions with regular review. Tailor choice to minimise risk (e.g. choose agents with lower lethality in overdose). Short-term medication in crises A short course of a benzodiazepine or hypnotic may be considered for acute distress or insomnia. Cease once the crisis resolves and ensure the patient understands this plan to avoid dependence. Acute crisis management Presentation Often with severe distress, suicidality, or self-harm. Principles Provide space for the patient to discuss concerns; listen with empathy. Use de-escalation and problem-solving first. Involve family or supports (with patient consent) to enhance safety. Keep to the agreed management plan if one is in place. If the patient remains extremely agitated or unsafe, short-term pharmacological sedation (e.g. with a benzodiazepine) may be required under close observation. Special considerations Perinatal context Women with borderline patterns often have higher risk of unplanned pregnancy, psychosocial stressors, and limited support. Preconception counselling is vital; discuss contraception and the potential added challenges of pregnancy and parenting. Robust psychosocial support, possibly involving perinatal mental health services, is crucial. Pharmacotherapy should be minimised in pregnancy or breastfeeding unless treating a clear comorbid disorder. Stigma reduction “Personality disorder” is sometimes used pejoratively. Gently explaining the diagnosis with empathy can reduce self-stigma and improve engagement in care. As GPs, model respectful language and encourage your clinical team to do the same. 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 Hoarseness Differentials Laryngitis (viral, bacterial, or reflux-related) Vocal cord nodules, polyps, cysts Vocal cord paralysis (e.g., due to recurrent laryngeal nerve damage from thyroid surgery, lung cancer, or trauma) Smoking, excessive voice use (e.g., singers, teachers) Systemic illnesses such as rheumatoid arthritis or sarcoidosis Neurological disorders (e.g., Parkinson’s disease, stroke) Symptoms Changes in voice quality, vocal fatigue, throat discomfort Possible associated cough, sore throat, or dysphonia Investigations Laryngoscopy: Direct visualisation of vocal cords for lesions, inflammation, or paralysis Thyroid Function Tests: To exclude hypothyroidism as a cause CT or MRI: If mass or recurrent laryngeal nerve involvement is suspected Flexible nasoendoscopy: Used in primary care to assess for structural abnormalities Red Flags Significant smoking history 45 years + unexplained hoarseness persisting >3 weeks Dysphagia/odynophagia Neck mass Haemoptysis (lung cancer) Fevers, weight loss, night sweats Stridor Persistent otalgia (may indicate nasopharyngeal carcinoma) History - General Duration, gradual or sudden onset Associated symptoms: cough, sore throat, reflux, dysphagia Examination Goitre Cervical lymphadenopathy Stridor Oral cavity for signs of candida CN findings (e.g., cranial nerve palsies) Vocal quality, tone, and pitch Base of tongue/tonsils for masses or lesions Clubbing (lung cancer) Reduced AE (if respiratory-related cause suspected) Treatment Refer if >45 years and unexplained persistent hoarseness >3 weeks OR if red flags present Trial reflux management: proton pump inhibitors (PPI) or lifestyle modifications for suspected reflux-related hoarseness If cause identified: treat underlying condition and review in 6–8 weeks Figure: Hoarseness algorithm Hoarseness Differentials Laryngitis (viral, bacterial, or reflux-related) – viral laryngitis is most common; bacterial laryngitis is rare but may involve secondary bacterial infection Vocal cord nodules, polyps, cysts – typically due to phonotrauma, common in professional voice users Vocal cord paralysis (e.g., due to recurrent laryngeal nerve damage from thyroid surgery, lung cancer, or trauma) – left recurrent laryngeal nerve is more commonly affected due to its longer course Smoking, excessive voice use (e.g., singers, teachers) – chronic irritation leads to vocal cord oedema or dysplasia Systemic illnesses such as rheumatoid arthritis or sarcoidosis – can cause cricoarytenoid arthritis leading to hoarseness Neurological disorders (e.g., Parkinson’s disease, stroke) – may present with hypophonia or breathy voice Symptoms Changes in voice quality, vocal fatigue, throat discomfort – may indicate structural or functional voice disorders Possible associated cough, sore throat, or dysphonia – reflux-related hoarseness often presents with chronic throat clearing and postnasal drip sensation Investigations Laryngoscopy: Direct visualisation of vocal cords for lesions, inflammation, or paralysis; required for persistent or red flag cases Thyroid Function Tests: To exclude hypothyroidism as a cause of hoarseness CT or MRI: If mass or recurrent laryngeal nerve involvement is suspected; imaging is not recommended before laryngoscopy unless red flags are present Flexible nasoendoscopy: Used in primary care to assess for structural abnormalities; may help differentiate functional from organic causes Red Flags Significant smoking history – increased risk of malignancy 45 years + unexplained hoarseness persisting >3 weeks – requires urgent referral for malignancy exclusion Dysphagia/odynophagia – may indicate oesophageal or laryngeal malignancy Neck mass – concerning for metastatic lymphadenopathy Haemoptysis (lung cancer) – consider bronchogenic carcinoma affecting the recurrent laryngeal nerve Fevers, weight loss, night sweats – systemic symptoms concerning for malignancy or granulomatous disease Stridor – suggests airway compromise, requiring urgent ENT referral Persistent otalgia (may indicate nasopharyngeal carcinoma) – referred pain from cranial nerve involvement History - General Duration, gradual or sudden onset – sudden onset suggests traumatic or neurological causes, while gradual onset may indicate neoplastic or inflammatory conditions Associated symptoms: cough, sore throat, reflux, dysphagia – reflux is a common cause and may present without heartburn Examination Goitre – may suggest compressive thyroid pathology affecting recurrent laryngeal nerve Cervical lymphadenopathy – may indicate malignancy, TB, or sarcoidosis Stridor – high-pitched inspiratory sound, indicates airway obstruction Oral cavity for signs of candida – common in inhaled corticosteroid use CN findings (e.g., cranial nerve palsies) – consider neurological causes like brainstem stroke Vocal quality, tone, and pitch – assess for breathiness, strain, or tremor Base of tongue/tonsils for masses or lesions – oropharyngeal malignancies may cause referred hoarseness Clubbing (lung cancer) – may suggest underlying malignancy Reduced AE (if respiratory-related cause suspected) – pleural effusion or lung mass can cause hoarseness via phrenic nerve involvement Treatment Refer if >45 years and unexplained persistent hoarseness >3 weeks OR if red flags present Trial reflux management: proton pump inhibitors (PPI) or lifestyle modifications for suspected reflux-related hoarseness (e.g., elevate head of bed, avoid late-night meals, reduce caffeine, alcohol, smoking) If cause identified: treat underlying condition and review in 6–8 weeks Voice rest and speech therapy for phonotrauma-related cases – whispering should be avoided as it increases vocal strain Adequate hydration and vocal hygiene – steam inhalation or humidifiers may help reduce vocal cord irritation 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 Herpes Simplex Definition Common viral infection (HSV-1, HSV-2), causing localised blistering Recurs with triggers (stress, illness, sun exposure) Aetiology HSV-1: Primarily oral/facial HSV-2: Primarily genital Latent in nerves, reactivates with stress, fever, trauma Presentation Cold sores (fever blisters), genital sores Any skin or mucosal area affected Primary Infection Fever, malaise, lymphadenopathy Painful blisters/ulcers (oral/genital), affecting eating, swallowing, urination Recurrent Infection Clusters of vesicles on erythematous base Milder than primary infection Local lymphadenopathy Differential Diagnosis Aphthous ulcers Hand-foot-and-mouth disease Syphilis (genital lesions) Varicella-zoster (shingles) Diagnosis Clinical diagnosis PCR or viral culture for confirmation Management Mild Oral Mucocutaneous Herpes Benzydamine 1% gel or lidocaine 2% solution Severe Initial Episode Adults: Famciclovir 500 mg BD or Valaciclovir 1g BD x 7 days Children (>3 months): Aciclovir (weight-based) x 5–7 days Recurrent Infection Mild: Topical aciclovir or oral famciclovir x 1–5 days Severe/frequent recurrences: Famciclovir or valaciclovir daily x 6 months Prevention Sunscreen (prevents sun-triggered herpes labialis) Antivirals (aciclovir, valaciclovir) for frequent outbreaks Complications Eye: Conjunctivitis, corneal ulcers Throat: Severe pharyngitis, dysphagia Skin: Eczema herpeticum (widespread skin infection in atopic dermatitis) Erythema multiforme: Target-like lesions Neurological: Rare paralysis, meningitis Disseminated infection: Severe in immunocompromised Herpes Simplex Definition Herpes simplex virus (HSV) is a common viral infection causing localised blistering (vesicles on an erythematous base). Infection may recur with triggers such as stress, illness, or sun exposure. Aetiology HSV-1: Primarily oral/facial infections (cold sores) HSV-2: Primarily genital lesions Latency: HSV remains dormant in nerve ganglia, reactivated by triggers (stress, fever, trauma) Presentation Cold Sores / Fever Blisters: Common around lips, nose, chin Genital Sores: HSV-2 or occasionally HSV-1 via oral–genital contact Any Skin/Mucosal Surface: In immunocompromised or during autoinoculation Primary Infection Fever, malaise, regional lymphadenopathy Painful blisters or ulcers (oral, genital) – can affect eating, swallowing, urination More severe presentation than recurrent episodes Recurrent Infection Clusters of vesicles on an erythematous base Typically milder than primary infection May have local lymphadenopathy, prodromal tingling/burning Differential Diagnosis Aphthous ulcers (usually non-vesicular, occur on non-keratinised mucosa) Hand–foot–and–mouth disease (Coxsackie virus, typically in children) Syphilis (genital chancre, classically painless) Varicella-zoster (shingles): dermatomal distribution Diagnosis Clinical: Characteristic vesicles, ulcers, distribution Laboratory: PCR or viral culture if definitive diagnosis needed (e.g. atypical lesions, immunocompromised patients) Management Mild Oral Mucocutaneous Herpes Topical Anaesthetics: Benzydamine 1% gel or lidocaine 2% solution to ease pain Supportive Care: Keep lesions clean, consider analgesics (e.g. paracetamol, NSAIDs) Severe Initial Episode Adults: Famciclovir 500 mg BD or Valaciclovir 1 g BD for 7 days Children >3 months: Aciclovir (weight-based) for 5–7 days Recurrent Infection Mild: Topical aciclovir or penciclovir to reduce symptoms/duration Oral famciclovir (e.g. 1 g stat) for herpes labialis Severe/Frequent Recurrences: Daily prophylaxis with famciclovir or valaciclovir for up to 6 months Prevention Sunscreen on lips/face to reduce sun-triggered herpes labialis Antivirals (e.g. low-dose aciclovir, valaciclovir) for recurrent frequent outbreaks Avoid contact with active lesions, practise safe sex (especially for genital HSV) Complications Eye Involvement: Conjunctivitis, herpetic keratitis (corneal ulcers) Throat: Severe pharyngitis, odynophagia Skin: Eczema herpeticum (widespread HSV in atopic dermatitis) Erythema multiforme triggered by recurrent HSV Neurological: Rare paralysis, HSV meningitis Disseminated Infection: Potentially severe in immunocompromised patients Bookmark Failed! 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