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 Cholesteatoma Pathology Recurrent ear infections and ETD → TM retraction pocket → accumulation of old skin cells → enzymatic degradation of nearby structures Progressive invasion into middle ear, damaging ossicles, facial nerve, and increasing risk of intracranial infection Presentation (most common first) Progressive hearing loss (conductive) Foul-smelling ear discharge Persistent otitis media Vertigo (labyrinthine involvement) Facial weakness (facial nerve erosion) Differential Diagnosis Chronic otitis media with effusion Otosclerosis Ear canal or middle ear tumours TM perforation Benign ear masses (e.g. polyps) Diagnosis Otoscopy: Retraction pocket, pearly white mass, often posterosuperior TM Audiometry: Conductive hearing loss CT temporal bone: Assesses extent of disease and bone erosion Treatment Surgical (mainstay): Mastoid surgery to remove disease, aerate EAC, and prevent skin buildup Conservative (if surgery not immediate): Keep ear dry, regular suction, treat infections Complications Hearing Loss: Conductive; sensorineural if inner ear affected Intracranial Infections: Meningitis, abscess, sigmoid sinus thrombosis Vertigo: Labyrinthine involvement Facial Nerve Paralysis: Erosion of facial nerve canal Additional Notes Early recognition prevents complications Persistent otorrhoea with attic perforation/retraction pocket = “unsafe” → urgent ENT referral Post-op follow-up essential; risk of recurrence Mastoid bowl requires regular cleaning Cholesteatoma Aetiology Congenital cholesteatoma: Embryonic cell rest in the middle ear Acquired cholesteatoma Primary: Often linked to eustachian tube dysfunction (ETD) causing a retraction pocket in the tympanic membrane (TM) where squamous debris accumulates Secondary: Occurs when skin migrates through a TM perforation, commonly associated with chronic suppurative otitis media Pathophysiology Retraction or invasion of squamous epithelium into the middle ear or mastoid air cells Enzymes from keratin debris trigger chronic inflammation and progressive bone erosion (ossicles, mastoid cortex, even facial nerve canal) Symptoms May be asymptomatic initially Progressive conductive hearing loss (due to ossicular chain damage) Persistent foul-smelling, painless otorrhoea (discharge) Chronic middle ear infection or retraction pocket noted on otoscopy Possible otalgia, vertigo, or facial nerve weakness if advanced Differential Diagnosis Chronic otitis media with effusion Otosclerosis Tumours of the external ear canal or middle ear Simple tympanic membrane perforations Benign ear masses (e.g. polyp) Investigations Otoscopy Retraction pocket, visible white/pearly mass or granulation tissue Typically found in the posterosuperior quadrant of the TM “Unsafe” perforation signs (granulation tissue, bone erosion) are highly suspicious Audiometry Conductive hearing loss most common Mixed or sensorineural loss if labyrinth or cochlea involved Imaging High-resolution CT (Temporal Bone) to assess extent of bone erosion, mastoid involvement, and any complications MRI may help if intracranial extension or complications are suspected Management Surgical (Definitive) Mastoidectomy or tympanomastoid surgery to remove the cholesteatoma, prevent complications, and restore/maintain hearing Ossicular chain reconstruction may be needed if there is ossicle destruction Conservative/Supportive For patients unfit for surgery or awaiting surgical management Keep the ear dry (use earplugs during bathing) Aural toilet under microscopic guidance to remove debris Topical or oral antibiotics for acute infections Regular ENT follow-up to monitor disease progression Complications Hearing Loss Usually conductive from ossicular erosion, though can be sensorineural if the inner ear is involved Intracranial Infections Abscess, meningitis, or sigmoid sinus thrombosis if infection spreads Vertigo Signals labyrinthine involvement Facial Nerve Paralysis Occurs if the facial nerve canal is eroded Additional Notes Early recognition of cholesteatoma is crucial to avoid destructive complications Persistent otorrhoea with an attic perforation or retraction pocket is considered “unsafe” and warrants urgent ENT referral Postoperative follow-up is essential as cholesteatoma can recur Mastoid bowl management (if created during surgery) involves regular cleaning to prevent re-accumulation of debris or infection High suspicion warranted in patients with chronic ear infections not responding to standard treatment, especially when foul-smelling discharge and hearing loss are present 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 Acromegaly Pathophysiology Pituitary adenoma secreting excess GH → increased IGF-1 production by the liver → Overgrowth of bone, cartilage, soft tissue, and organs; impaired glucose tolerance Presentation Bones and Cartilage Enlarged facial structures (jaw, nose, lips, ears), hand/foot size, jaw protrusion (prognathism) Deep voice, joint pain, arthritis Soft Tissue Increased sweating and oily skin, paraesthesia due to nerve compression (e.g., carpal tunnel) Systemic Features HTN, cardiomyopathy, sleep apnoea, insulin resistance, or diabetes mellitus Diagnosis Biochemical Tests Elevated serum IGF-1 levels OGTT: GH does not suppress (GH > 1 µg/L confirms diagnosis) Imaging MRI of the pituitary to identify adenoma Baseline investigations Echocardiogram (cardiomyopathy), sleep study (apnoea), colonoscopy (colonic neoplasia risk) Management Surgery Transsphenoidal surgery is first-line for resection of the pituitary adenoma Pharmacological Management Somatostatin Analogues: Reduce GH secretion and tumour size Lanreotide: 60–120 mg deep SC injection every 4–8 weeks Octreotide: 10–30 mg IM injection every 4 weeks Pasireotide: Reserved for resistant cases (40–60 mg IM every 4 weeks) Monitoring: Adjust doses based on IGF-1 and GH levels Dopamine Agonists: Reduce GH in ~50% of patients Cabergoline: Start at 0.5 mg twice weekly, up to 2 mg twice weekly Bromocriptine: 1.25–30 mg daily in divided doses GH Receptor Antagonists (Pegvisomant) Loading dose: 80 mg SC, then 10 mg SC daily (increase to max 30 mg daily) Radiotherapy Considered if surgery and medical therapy fail Follow-up and Monitoring Target GH < 2.5 µg/L and age-normalised IGF-1 levels Screen and manage cardiovascular complications (e.g., hypertension, cardiomyopathy) Monitor for new or worsening comorbidities (e.g., diabetes, sleep apnoea, colonic neoplasms) Acromegaly Pathophysiology Pituitary adenoma secretes excess GH Leads to increased hepatic IGF-1 production Causes overgrowth of bone, cartilage, soft tissue, and organs Impairs glucose tolerance and can precipitate diabetes mellitus Clinical Presentation Bones and Cartilage Enlarged facial bones (prognathism, coarse facial features) Increased hand/foot size, requiring larger rings or shoe size Jaw protrusion leading to malocclusion Joint pain, early degenerative arthritis Soft Tissue Oily skin, hyperhidrosis (excessive sweating) Carpal tunnel syndrome, paraesthesia Deepened voice from laryngeal thickening Systemic Features Hypertension, cardiomegaly, heart failure (acral cardiomyopathy) Sleep apnoea (obstructive or mixed) Insulin resistance or overt T2DM Colonic polyps with increased neoplasia risk Diagnosis Biochemical Tests Elevated serum IGF-1 (age-adjusted reference range) Oral glucose tolerance test (75 g glucose) with GH measurement Lack of GH suppression (GH >1 µg/L) confirms acromegaly Normal physiology: GH should suppress to <1 µg/L Pituitary Imaging MRI of the pituitary gland to locate and characterise adenoma Consider macroadenoma compressing other pituitary tissue (possible hypopituitarism) Baseline Investigations Echocardiography to assess for cardiomyopathy Sleep study (polysomnography) to evaluate for sleep apnoea Colonoscopy to screen for colonic polyps, especially in older patients or those with long-standing disease Evaluate other pituitary hormones (LH, FSH, TSH, ACTH) to detect co-secretion or hypopituitarism Management Surgery (First-Line) Transsphenoidal resection of pituitary adenoma Can achieve rapid reduction in GH levels and tumour bulk Aim is biochemical remission (GH <1 µg/L on OGTT and normal IGF-1) Medical Therapy Somatostatin Analogues (reduce GH secretion) Octreotide LAR 10–30 mg IM every 4 weeks or Lanreotide (60–120 mg deep SC every 4–8 weeks) Pasireotide for resistant cases Monitor IGF-1 and GH levels, dose adjustments based on response Dopamine Agonists (Cabergoline, Bromocriptine) Effective in ~50% of patients, usually mild disease or co-secreting prolactin Cabergoline 0.5 mg twice weekly up to 2 mg twice weekly GH Receptor Antagonist (Pegvisomant) Blocks peripheral GH action, lowers IGF-1 Start with loading dose 80 mg SC, then 10 mg SC daily (up to 30 mg daily) Monitor IGF-1 but not GH (GH remains elevated) Radiotherapy Consider if surgery is incomplete or tumours recur and medical therapy is insufficient Long latency to see full effect, risk of hypopituitarism post-radiation Follow-Up and Monitoring Biochemical Targets GH <1 µg/L after OGTT or random GH <2.5 µg/L Age-normalised IGF-1 within reference range Comorbidity Screening Annual cardiovascular assessment (ECG, echocardiogram if needed), as cardiomyopathy is a major mortality factor Diabetes or glucose intolerance monitoring (HbA1c or fasting glucose) Repeat colonoscopy if polyps found or based on guidelines (some patients require 3-5 yearly scopes) Periodic pituitary MRI if residual tumour or rising IGF-1 Specific Management Points Address sleep apnoea, including CPAP if severe Monitor blood pressure and treat hypertension aggressively Evaluate for hypopituitarism (e.g. secondary adrenal insufficiency, hypothyroidism) Educate on signs of tumour recurrence (headache, visual changes) Notes Suspect acromegaly in patients with slowly evolving facial feature changes, enlarged hands/feet, or jaw malocclusion Elevated IGF-1 is the best initial screening test Confirm diagnosis with lack of GH suppression on OGTT Early transsphenoidal surgery can be curative, but medical therapy often needed if not fully resected Comorbidities (hypertension, DM, sleep apnoea, arthropathy) significantly impact quality of life and mortality risk Long-term follow-up ensures control of GH/IGF-1, detection of tumour recurrence, and management of complications Bookmark Failed! 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Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Limping Child Differentials Developmental/Mechanical: Perthes: Gradual painless limp, knee pain, short limb SCFE: Knee/hip pain, externally rotated, shortened leg Transient synovitis: Post-URTI, self-limiting Overuse injury: Stress fractures, growth plate irritation Minor injuries: Common in active children Infective/Inflammatory: Septic arthritis: Fever, NWB, effusion Osteomyelitis: Local tenderness, erythema, systemic signs Post-viral myositis: Resolves in days JIA: Chronic joint pain, stiffness Other: Malignancy: Night pain, systemic signs Trauma/NAI: Fractures, unexplained injuries HSP: Petechiae, joint swelling, abdominal pain Red Flags Systemic signs: Fever, weight loss, fatigue Pain: Night pain, worsening, localised tenderness Persistent limp >7 days NWB: Suspect septic arthritis or SCFE Petechiae/bruising: HSP, malignancy, NAI Examination Gait: Antalgic, Trendelenburg, stiff ROM: Restricted internal rotation → early pathology Joint/knee: Pain, effusion Systemic signs: Fever, pallor, bruising Position: External rotation/short limb → SCFE Investigations No tests: Mild limp <7 days, no red flags Bloods: FBC, CRP, ESR; cultures if infection suspected Imaging: X-ray: Structural issues US: Effusion (septic arthritis/synovitis) MRI: Suspected malignancy/osteomyelitis Management Transient synovitis: Rest, weight-bearing as tolerated, paracetamol/ibuprofen Perthes: Urgent: >8 yrs (surgery likely) Semi-urgent: <8 yrs (activity restriction, physio) SCFE: NWB, urgent ortho referral Risk: Osteonecrosis, early OA Hallmarks Perthes: Boys 4–8 yrs, gradual limp, ↓ internal rotation SCFE: Adolescents (obese), knee/hip pain, external rotation Transient synovitis: Boys 3–10 yrs, post-URTI, resolves <7 days Limping Child Differentials Developmental/Mechanical Perthes disease: Gradual, painless limp; knee pain; limb shortening; decreased internal rotation Slipped upper femoral epiphysis (SCFE): Presents in adolescents; knee or hip pain; externally rotated, shortened leg; often linked to obesity Transient synovitis: Occurs post-URTI or fever; self-limiting; typical in children aged 3–10 Overuse injury/stress fracture: Associated with increased physical activity and growth plate irritation Minor musculoskeletal injury: Common in active children with trivial trauma Infective/Inflammatory Septic arthritis: Presents with fever, inability to bear weight, and joint effusion; requires urgent treatment Osteomyelitis: Localised bone pain with tenderness, erythema, and systemic signs Juvenile idiopathic arthritis: Chronic joint pain and morning stiffness with persistent swelling Postviral myositis: Generally self-limiting and resolves within days Other Malignancy: Leukaemia, lymphoma, or bone tumour; characterised by night pain, systemic symptoms, and localized tenderness Non-accidental injury: Unexplained trauma with inconsistent history and possible bruising Henoch-Schönlein purpura: May present with petechiae, joint swelling, and abdominal pain Red Flags Systemic symptoms including fever, weight loss, night sweats and fatigue indicating severe infection or malignancy Persistent limp lasting over 7 days or non-weight bearing status suggestive of septic arthritis or SCFE Localised, worsening or nocturnal pain raising suspicion of bone tumour Skin findings such as petechiae or bruising which may point to HSP, malignancy or non-accidental injury Examination Gait analysis: Look for antalgic, Trendelenburg or stiff gait patterns Hip range of motion: Assess for limitation, especially reduced internal rotation which may indicate Perthes disease or SCFE Knee examination: Evaluate for pain, effusion and tenderness Limb alignment: Note external rotation or shortening suggestive of SCFE Systemic assessment: Check for fever, pallor or bruising and inspect skin for petechiae Investigations No immediate tests if limp is mild and lasts <7 days without red flags Blood tests: Full blood count, CRP and ESR to assess for infection or inflammation Imaging: X-ray of the hip and knee to evaluate for structural abnormalities such as Perthes disease or SCFE; Ultrasound of the hip to detect joint effusion in cases of suspected septic arthritis or transient synovitis MRI: Consider if there is a suspicion of osteomyelitis, malignancy or if initial imaging is inconclusive Management Observation: Review in 3 days if the child is otherwise well and symptoms are mild Activity modification: Encourage rest from aggravating activities and allow weight bearing as tolerated in transient synovitis Pain management: Use paracetamol 15 mg/kg QID as required Perthes disease: Semi-urgent orthopaedic referral for children <8 years with activity restriction and physiotherapy; urgent referral for children >8 years as surgery may be indicated SCFE: Non-weight bearing measures and urgent orthopaedic referral to prevent complications such as osteonecrosis and early osteoarthritis Provide safety netting advice and arrange close follow-up if symptoms persist or worsen Notes Perthes disease commonly affects boys aged 4–8 years and is typically painless with decreased internal rotation SCFE is seen in adolescents, frequently associated with obesity, and may present with knee pain rather than hip pain Transient synovitis usually follows an URTI and resolves within 7 days Persistent or worsening symptoms require further investigation to exclude serious pathology such as septic arthritis, malignancy or non-accidental injury Multidisciplinary management including orthopaedics and physiotherapy improves long-term outcomes Bookmark Failed! 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Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Cervical Spondylosis Presentation Pain: Dull, aching suboccipital pain ± tension-like headaches Unilateral, worsens with activity or prolonged neck positions ROM: Restricted neck rotation or lateral flexion Neurological: Upper limb paraesthesia (dermatomal) Possible cervical radiculopathy or myelopathy Spurling’s Test: Neck extension, lateral flexion, rotation + downward pressure Positive: Limb pain/paraesthesia (not neck pain alone) Investigations MRI Spine: Preferred for: Motor symptoms, red flags (e.g., malignancy, infection), progressive symptoms Failure to respond to conservative management Other: XR Cervical Spine: Degenerative changes (osteophytes, narrowing) Nerve Conduction Studies: If MRI unavailable Management (No Severe Neuro Deficits) Lifestyle: Avoid aggravating activities (e.g., prolonged flexion) Postural correction Pain Relief: NSAIDs ± short steroids for acute radicular pain Physiotherapy: Strengthening/stretching exercises, mobilisation Adjuncts: Soft cervical collar (short-term only) Steroid injections (epidural/facet joint) for persistent radicular pain Follow-Up 6–8 weeks: Assess symptom resolution/improvement Refer for advanced imaging or specialist review if worsening Cervical spondylosis Definition A degenerative disorder of the cervical spine characterised by age-related wear of the intervertebral discs, facet joints, and other surrounding structures. It commonly leads to osteophyte formation, disc narrowing, and ligamentous thickening, which can impinge on nerve roots or the spinal cord. Presentation Pain: Often presents as a dull, aching discomfort in the suboccipital region and may radiate unilaterally to the neck and shoulders. Some patients experience tension-type headaches Range of motion: Restricted neck rotation or lateral flexion due to pain or stiffness. Pain may worsen after prolonged neck positions (e.g. computer or desk work) Neurological involvement: Upper limb paraesthesia following a dermatomal pattern. Cervical radiculopathy (root compression) can lead to arm pain, while cervical myelopathy (spinal cord compression) can cause gait disturbance, hand clumsiness, or bowel/bladder issues in advanced cases Spurling’s test: Performed by extending the neck, laterally flexing and rotating it towards the symptomatic side, then applying gentle downward pressure. A positive test reproduces limb pain or paraesthesia, suggesting nerve root irritation Investigations MRI of the cervical spine: The imaging of choice when red flags (e.g. motor weakness, malignancy, infection) are present, or if conservative measures fail. It is sensitive for detecting neural element compression, disc herniation, and soft-tissue changes Plain X-ray: Demonstrates degenerative changes such as osteophytes, disc space narrowing, and spondylolisthesis. Often an initial screening tool but less sensitive for nerve root or cord pathology Nerve conduction studies or electromyography: Consider if MRI is unavailable, or to further clarify nerve root involvement, especially in complicated or atypical presentations Management (when no severe neurological deficits) Lifestyle and postural advice: Avoid prolonged neck flexion or extension (e.g. extended computer use without breaks) Encourage ergonomic assessment in the workplace Pain relief: NSAIDs can be used first-line for musculoskeletal neck pain, and short courses of oral corticosteroids may help in acute radicular episodes. Paracetamol can be added or substituted if NSAIDs are contraindicated Physiotherapy: Tailored exercises focusing on neck-strengthening, mobilisation, and postural training. Techniques may include gentle manual therapy and advice on maintaining flexibility and core neck stability Soft cervical collar: Can be used briefly for acute exacerbations, though prolonged use is generally discouraged to avoid neck muscle deconditioning Steroid injections: Epidural or facet joint injections can be considered for persistent radicular pain or localised facet joint inflammation. Ultrasound or fluoroscopic guidance may improve accuracy and efficacy Follow-up: Review at 6–8 weeks to assess improvement in pain and function. Escalation to advanced imaging or specialist referral is recommended if there is clinical deterioration, persistent severe pain, or developing neurological deficits Additional considerations Red flags prompting urgent imaging or specialist review include progressive neurological deficits, suspected cervical myelopathy (e.g. unsteady gait, hyperreflexia, bowel/bladder dysfunction), history of malignancy, weight loss, or severe unremitting night pain Physiotherapists and exercise physiologists can provide home-based exercise programmes to improve neck strength and mobility, with an emphasis on posture correction and activity modification Adjunct measures, such as topical analgesics or neuropathic pain agents (in radicular pain), may be utilised according to clinical judgement Prognosis varies depending on the degree of degenerative change and nerve involvement, but most mild-to-moderate cases respond well to conservative measures over weeks to months Bookmark Failed! Bookmark Saved! 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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 External Auditory Exostosis Aetiology / Pathology Chronic cold water/air exposure → periosteal bone growth in the external auditory canal (EAC) Common in surfers, divers, and swimmers ("surfer’s ear") Typically multiple, broad-based bony outgrowths near the tympanic ring Symptoms / Presentation Recurrent otitis externa (narrowed canal traps debris/moisture) Ear blockage or discomfort Progressive conductive hearing loss (advanced cases) Frequent cerumen impaction due to restricted canal diameter Examination Otoscopic findings: Bony mounds narrowing the EAC May limit TM visualisation, especially if inflamed or debris present Diagnosis Clinical: History of cold water exposure + otoscopic findings Audiometry: If hearing loss suspected CT temporal bone: If severe or for surgical planning Management Prevention Earplugs/neoprene hood in cold water Thorough drying after water exposure Avoid repeated cold exposure if possible Medical Treat infections/otitis externa with topical agents Manage wax impaction with drops or gentle suction Surgical (if severe stenosis, recurrent infections, or hearing loss) Exostoses removal under microscope with specialised drills Risks: SNHL, facial nerve injury, infection Long-term follow-up for regrowth monitoring ENT Referral Persistent symptoms, progressive hearing loss, frequent infections Obstructive exostoses affecting quality of life Notes Early prevention minimises complications Regular ear hygiene reduces cerumen impaction and infection risk Significant bony overgrowth increases risk of recurrent infections, warranting ENT assessment if persistent/worsening symptoms External Auditory Exostosis Aetiology / Pathology Chronic exposure to cold water and air stimulates periosteal bone growth in the canal Common in surfers, divers, swimmers, and others frequently in cold aquatic environments Typically presents as multiple, broad-based bony outgrowths near the tympanic ring Symptoms / Presentation Recurrent ear infections or otitis externa (due to narrowed canal trapping debris and moisture) Sensation of ear blockage or discomfort Progressive conductive hearing loss in advanced cases (from canal narrowing or impacted cerumen) May notice frequent ear wax impaction due to restricted canal diameter Examination Otoscopic inspection reveals bony mounds protruding into the EAC Canal may appear narrowed, limiting visualisation of the tympanic membrane Inflammation or debris can complicate the view if infection is present Diagnosis Primarily clinical based on history (repeated cold water exposure) and otoscopic findings Audiometry if hearing impairment is suspected Imaging (e.g. CT temporal bones) may be considered for severe cases or surgical planning Management Preventive Measures Wear earplugs or neoprene hood when surfing or swimming in cold conditions Thoroughly dry the ears after water exposure Encourage avoidance of repeated exposure to cold wind or water if possible Medical Management Treat infections or otitis externa promptly with topical agents to reduce inflammation and debris Ear drops or gentle suctioning to manage impacted wax Surgical Removal Indicated if canal stenosis is severe, recurrent infections, or significant hearing loss Performed under microscope, removing exostoses with specialised drills Risks include sensorineural hearing loss, facial nerve injury, and infection Long-term follow-up may be required to monitor for regrowth Referral to ENT Persistent or symptomatic cases Progressive hearing loss, frequent infections, or difficulty in removing obstructive exostoses Consideration of operative intervention if quality of life is affected Notes: Early intervention and consistent preventive strategies can minimise complications Regular ear hygiene and protection help prevent recurrent exostosis formation and reduce infection risk Patients with significant bony overgrowth are at higher risk of cerumen impaction and external ear canal infections, emphasising the importance of ENT assessment if symptoms persist or worsen 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 AC Joint Dislocation Types & Management Type I: AC sprain (ligaments intact) Sling, ice (2–3 days), paracetamol/NSAIDs, physio, avoid contact sports (3–6 weeks) Type II: AC torn, CC intact Same as Type I Type III: AC + CC torn, CC distance <100% Non-surgical: Sling, physio (most cases) Surgical: High-demand athletes/labourers Type IV: AC + CC torn, clavicle posterior displacement Urgent orthopaedic referral (likely ORIF) Type V: AC + CC torn, CC distance >100% Urgent orthopaedic referral (likely ORIF) Return to Sport Criteria Full ROM without pain No AC joint tenderness No pain with abduction/overhead activity Can weight-bear on an outstretched hand Complications Post-traumatic OA Chronic pain, impingement, instability with lifting/sports Cosmetic deformity (step-off, common in III–V, benign) Note: Type III: Controversial; conservative favoured. Surgery if persistent symptoms or high functional demands AC Joint Dislocation Definition A traumatic injury to the shoulder where the acromioclavicular (AC) joint, connecting the clavicle and the acromion, becomes disrupted Commonly caused by a direct fall or blow to the lateral shoulder, often in contact sports or high-impact activitiesMay also occur from an outstretched arm mechanism leading to upward force on the humerus Anatomy of the coracoclavicular joint (RACGP) Types Type I – AC and coracoclavicular (CC) ligaments intact Type II – Torn AC ligament; CC ligaments remain intact Type III – Both AC and CC ligaments torn, CC distance <100% of opposite side Type IV – Both AC and CC ligaments torn, clavicle displaced posteriorly Type V – Both AC and CC ligaments torn, CC distance >100% of opposite side X-ray images of acromioclavicular dislocation: (a) anteroposterior view bilateral shoulders and (b) axial view. Management Type I & II & III (Conservative) Broad arm sling for pain relief, typically 2–3 days Analgesia (e.g. paracetamol, NSAIDs) and ice therapy Early referral to physiotherapy for guidance on gradual range-of-motion exercises and scapular stabilisation work Avoid contact sports for approximately 3–6 weeks, depending on pain and function Most Type III injuries are managed conservatively, unless high functional demands or persistent pain indicate surgical review Type IV & V (Surgical) Urgent orthopaedic referral for likely open reduction and internal fixation (ORIF) More common in high-demand athletes, labourers, or cases with significant displacement Examination and Investigations Tenderness over the AC joint and visible step-off deformity (especially in Type III–V) Special tests such as the cross-arm adduction test can help localise AC joint pain Plain X-rays (AP, axillary lateral, and/or specialised views) to assess CC distance, displacement, and rule out associated fractures MRI considered if additional soft tissue or rotator cuff injury is suspected Return to Sport Criteria Full, pain-free range of motion in the shoulder No tenderness on palpation of the AC joint No pain on abduction or overhead activity Ability to weight-bear through an outstretched hand without discomfort Protective padding may be considered for contact sports Complications Post-traumatic osteoarthritis of the AC joint Chronic pain and possible impingement Instability or weakness with lifting and sporting activities Cosmetic deformity (step-off), more common in Type III–V injuries Notes Type III management remains controversial: conservative is generally preferred, but surgery can be indicated for athletes, labourers, or cases with ongoing pain and dysfunction Physiotherapy is crucial for maintaining and restoring shoulder strength and stability Prognosis for Type I–III is generally excellent with appropriate rehabilitation and a graded return to activity 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 Rheumatic Fever (RF) Diagnostic criteria Evidence of recent Streptococcus pyogenes infection (throat swab or elevated anti-streptolysin O titres/anti-DNase B) 2 major criteria OR 1 major + 2 minor criteria JONES PEACE Major criteria (JONES): J: Joints (polyarthritis, hot/swollen joints) O: Heart (carditis: endocarditis/myocarditis/pericarditis, murmurs) N: Nodules (subcutaneous, painless) E: Erythema marginatum (non-itchy, pink, ring-like rash) S: Sydenham chorea (involuntary movements, emotional lability) Minor criteria (PEACE): P: PR prolongation (on ECG) E: Elevated ESR >30 mm/hr A: Arthralgia (joint pain without swelling) C: CRP elevation >30 mg/L E: Elevated temperature (fever ≥38°C) Diagnosis Blood tests: FBC, ESR, CRP Infectious evidence: Streptococcal ASOT and anti-DNase B titres, throat swab MCS Imaging: ECG: Look for PR prolongation, signs of carditis Echocardiogram: Essential even in the absence of symptoms, particularly to identify subclinical carditis CXR: Assess for cardiomegaly in suspected severe carditis Treatment Short term: Antibiotics: IM benzathine benzylpenicillin (same dose as for streptococcal throat infections) For penicillin-allergic patients: Cephalexin or azithromycin (duration per guidelines) Symptomatic relief: Arthritis: Ibuprofen (10 mg/kg TDS) or paracetamol (15 mg/kg QID) Severe arthritis/arthralgia: Aspirin (continue until symptom-free for 1–2 weeks, usually for 6 weeks) Bed rest: Until CRP normalises Long term: Secondary prophylaxis: IM benzathine benzylpenicillin monthly Duration: 10 years post-episode or until age 21 (whichever is later) Until age 35 for moderate rheumatic heart disease (RHD) Until age 40 or lifelong for severe RHD or post-cardiac valve surgery Note: Perform an echocardiogram even in asymptomatic cases to detect subclinical carditis In patients with a previous history of RF, diagnosis may be based on 3 minor criteria alone Causes of elevated RF other than RA Normal variant Infections: Hepatitis, tuberculosis, Epstein-Barr virus (EBV) Autoimmune/connective tissue diseases: SLE, Sjögren’s syndrome, systemic sclerosis Liver cirrhosis Sarcoidosis Rheumatic Fever (RF) Diagnostic Criteria Evidence of Recent Streptococcus pyogenes Infection Positive throat swab culture for group A strep, or Elevated anti-streptolysin O (ASOT) / anti-DNase B titres. Major and Minor Criteria (JONES PEACE) 2 major OR 1 major + 2 minor criteria are required for diagnosis (with evidence of strep infection). Major Criteria (JONES) J: Joints → Migratory polyarthritis (hot, swollen joints) O: Heart → Carditis (endocarditis, myocarditis, pericarditis, new or changed murmurs) N: Nodules (subcutaneous, painless) E: Erythema marginatum (non-itchy, pink, ring-like rash) S: Sydenham chorea (involuntary movements, emotional lability) Minor Criteria (PEACE) P: PR prolongation (on ECG) E: Elevated ESR (>30 mm/hr) A: Arthralgia (joint pain without overt swelling) C: CRP elevation (>30 mg/L) E: Elevated temperature (fever ≥38°C) Diagnosis Blood Tests FBC, ESR, CRP Streptococcal serology: ASOT, anti-DNase B Throat swab MCS if pharyngitis suspected Imaging ECG: Look for PR prolongation, signs of carditis Echocardiogram: Essential even if no murmur (subclinical carditis possible) CXR: Assess for cardiomegaly in severe carditis or heart failure suspicion Important Note In patients with previous rheumatic fever, ≥3 minor criteria can suffice for re-diagnosis. Treatment Short Term Antibiotics IM Benzathine Benzylpenicillin (same dose as for strep throat) single dose If penicillin-allergic: Cephalexin or Azithromycin (duration per guidelines) Symptomatic Relief Arthritis: Ibuprofen (~10 mg/kg TDS) or paracetamol (15 mg/kg QID) Severe arthritis/arthralgia: Aspirin (continue until 1–2 weeks after symptom resolution, usually 6 weeks total) Bed Rest: Until CRP normalises Long Term (Secondary Prophylaxis) IM Benzathine Penicillin monthly Duration: Minimum 10 years post-episode or until age 21 (whichever is longer) if no RHD Until age 35 for moderate RHD Until age 40 or lifelong for severe RHD or post-valve surgery Note Echocardiogram recommended in all cases (including asymptomatic) to detect subclinical carditis. Consider repeating antibiotic prophylaxis in recurrent episodes. Causes of Elevated RF (Rheumatoid Factor) Other than RA (Not directly linked to Rheumatic Fever – “RF” can also mean Rheumatoid Factor) Normal Variant: Low titres in healthy older adults Infections: Hepatitis (B/C), TB, EBV Autoimmune: SLE, Sjögren’s, Systemic Sclerosis Liver Cirrhosis Sarcoidosis 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 Vasectomy History Discussed with partner; joint decision encouraged Plans for future children Reason for choosing vasectomy (e.g., family completion) History of scrotal surgery (e.g., hernia repair, varicocele surgery) Understanding of procedure (including the need for follow-up testing) History of clotting disorder, significant comorbidities, or cryptorchidism Counselling Irreversible nature: Stress that reversal success is not guaranteed and often dependent on time since procedure. Procedure timeline: Azoospermia confirmed after 3 months or 20 ejaculations (whichever is later). Requires semen analysis to confirm no sperm before stopping other contraception. Risks and side effects: Haematoma, infection, sperm granulomas, small failure rate (0.1–0.15%). Rare recanalisation of vas deferens, potentially leading to pregnancy. Does not impact libido, testosterone levels, or sexual function. No link to testicular or prostate cancer. Inform about non-scalpel technique (lower risk of complications). When to Refer History of scrotal/inguinal surgery, trauma, or infections (may require specialist assessment). Presence of large varicocele, hydrocele, or inguinal hernia requiring correction. Cryptorchidism (undescended testicle). Significant medical problems (e.g., uncontrolled bleeding disorders). Management of Complications Haematoma: Rest, cold compress, and analgesia. Surgical drainage for large haematomas. Infections: Oral antibiotics for mild infections; abscesses may need drainage. Epididymo-orchitis: Rapid-onset, painful swelling of scrotum; manage with: Antibiotics (e.g., doxycycline or ciprofloxacin based on likely pathogens). Testicular support and analgesia. Sperm granulomas: Often self-limiting; rarely cause significant discomfort or require intervention. No significant impact: Haematospermia, minor haematuria typically resolve without treatment. Reversal Success rates depend on: Time since vasectomy (higher success if <5 years). Surgeon’s expertise. Age and fertility status of partner. Alternatives: Testicular sperm aspiration (TESA) for use in IVF as an alternative to reversal. Intracytoplasmic sperm injection (ICSI) for fertilisation with extracted sperm. Educate that reversal does not guarantee natural conception, especially if >10 years post-vasectomy. Additional Notes Provide a written information leaflet for patient education. Advise follow-up to ensure effective contraception until semen analysis confirms azoospermia. Emphasise importance of using alternative contraception during the interim period. Vasectomy History Partner Involvement Encourage joint decision and discussion with partner regarding fertility plans. Future Children Confirm no more desired pregnancies or stable current family planning. Past Medical/Surgical History Any scrotal surgeries (e.g., hernia repair, varicocele surgery), prior infections or trauma. Coagulopathies or significant comorbidities. Cryptorchidism (undescended testicle). Patient Understanding Aware of the need for follow-up semen analysis (3 months or 20 ejaculations, whichever is later). Acceptance of irreversibility—reversal success is not guaranteed. Counselling Irreversibility Emphasize that reversal is not guaranteed; success depends on time since procedure. Procedure Timeline Azoospermia typically confirmed ≥3 months after vasectomy or after 20 ejaculations (whichever is later). Must continue alternative contraception until semen analysis confirms no sperm. Risks & Side Effects Haematoma, infection, sperm granulomas, minor scrotal discomfort. Small failure rate (~0.1–0.15%); rare recanalisation leading to pregnancy. No impact on libido, testosterone levels, or sexual performance. No link to testicular or prostate cancer. No-scalpel technique has lower complication rates. When to Refer History of scrotal/inguinal surgery: Specialist assessment might be necessary Large varicocele, hydrocele, or inguinal hernia needing correction. Cryptorchidism (undescended testicle) Significant bleeding disorders (uncontrolled) Management of Complications Haematoma Rest, cold compress, analgesia Surgical drainage if large or persistent Infections Oral antibiotics for mild scrotal/wound infections Abscess → drainage Epididymo-orchitis Rapid-onset, painful scrotal swelling Antibiotics (e.g. doxycycline or ciprofloxacin) depending on likely pathogens Scrotal support, analgesia Sperm Granulomas Usually self-limiting; rarely require intervention. Haematospermia or minor haematuria typically resolve spontaneously. Reversal Success Rates Depend on: Time since vasectomy (better if <5 years). Surgeon expertise. Partner’s age/fertility status. Alternatives: Testicular Sperm Aspiration (TESA) for IVF. Intracytoplasmic Sperm Injection (ICSI) with extracted sperm. Reversal does not guarantee natural conception, especially if >10 years post-vasectomy. Additional Notes Provide written information about the procedure, aftercare, and timelines. Emphasize the importance of alternative contraception until semen analysis confirms azoospermia. Follow local guidelines for post-procedure follow-up and documentation. 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 β-hCG in Pregnancy Use & Actions Placental hormone that stimulates progesterone release from the corpus luteum Useful in the first 6 weeks before confirming an intrauterine pregnancy (not useful after) Fetal cardiac activity should be visible by 6 weeks on transvaginal ultrasound (TVUS) Trajectory Doubles every 2–3 days, peaks at 10 weeks Red flag: <50% rise in 48 hours suggests abnormal pregnancy (e.g., ectopic, early pregnancy failure) TVUS Findings Based on β-hCG Gestational sac visible when β-hCG >1500–2000 IU/L If non-viable pregnancy suspected: Serial β-hCG q2–3 days + repeat TVUS in 1 week Monitoring in Failed Pregnancy Monitor β-hCG weekly until it returns to negative (<5 mIU/mL) Notes Early pregnancy bleeding + no visible gestational sac → Examine adnexa for ectopic Adnexal mass (seen in >88% of ectopics) is the most common ultrasound finding Discriminatory zone: β-hCG level where a gestational sac should be seen (typically 1500–2000 IU/L) Below zone: Diagnosis based on inadequate β-hCG rise Above zone: Diagnosis based on absent intrauterine pregnancy on TVUS β-hCG in Pregnancy Definition and Physiology β-hCG is a placental hormone produced by syncytiotrophoblast cells that supports the corpus luteum by stimulating progesterone release It plays a critical role in maintaining early pregnancy until the placenta takes over hormone production Use and Actions Essential for confirming early pregnancy status in the first 6 weeks before intrauterine pregnancy can be reliably visualised Fetal cardiac activity is expected to be visible by approximately 6 weeks of gestation on ultrasound Trajectory β-hCG levels typically double every 2–3 days during early pregnancy Levels peak around 10 weeks of gestation A rise of less than 50% over 48 hours is a red flag for a non-viable or ectopic pregnancy TVUS Findings Based on β-hCG A gestational sac is usually visible on transvaginal ultrasound when β-hCG exceeds the discriminatory zone of 1500–2000 IU/L In cases of suspected non-viable pregnancy, serial β-hCG measurements every 2–3 days are indicated along with a repeat TVUS in 1 week Monitoring in Failed Pregnancy β-hCG should be monitored weekly until levels become undetectable to ensure complete resolution of a failed pregnancy Notes In early pregnancy bleeding with no visible gestational sac on TVUS, careful examination of the adnexa is critical to rule out ectopic pregnancy An adnexal mass is the most common ultrasound finding in ectopic pregnancies, observed in over 88% of cases The discriminatory zone is key; below this threshold, diagnosis relies on inadequate β-hCG rise, while above this level, absence of an intrauterine pregnancy on TVUS indicates pathology Serial β-hCG trends help differentiate between viable intrauterine pregnancies, failing pregnancies and ectopic pregnancies Plateaued or suboptimal β-hCG rises warrant further investigation even if a gestational sac is not visualised Combining biochemical monitoring with TVUS findings enhances diagnostic accuracy in early pregnancy complications Bookmark Failed! 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Log In Get started Bookmarks Help Progress 0% Cardiovascular AAA + Rupture AC dislocation ATSI Abdominal pain in kids Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB) Acanthosis Nigricans Acne Acromegaly Actinic Cheilitis Acute Kidney Injury (AKI) Acute Swollen Joint with Fever Acute Vision Loss Acute and Progressive Vision Loss Addisons Adjustment Disorder and Anxiety Adjustment Disorder with Depressed Mood Age related macular degeneration Alcohol Cessation Allergic rhinitis Alopecia Amenorrhoea Anaphylaxis Angina Angular Cheilitis Ankylosing Spondylitis (AS) Anorexia Nervosa Anticholinergics and TCAs Antidepressants Antimetabolite drugs Antiphospholipid syndrome Antipsychotics Anxiety Disorders Aortic Dissection Arrhythmia Asthma Asthma Atrial Fibrillation Back pain Behavioural / learning disorders Behavioural disturbances Bell’s palsy and Ramsey Hunt syndrome Beta-Human Chorionic Gonadotropin (β-hCG) Biologic agents Bipolar Disorder Bleeding disorders Blepharitis Breast Cancer Breast Lump Bronchiectasis (Updated) CA-125 (Cancer Antigen 125) CRPS CVD Risk Assessment Calluses and Corns Candida (Candidiasis as an STI) Carpal tunnel syndrome and de quervains tenosynovitis Cellulite Cervical spondylosis Chest pain Chickenpox (Varicella) Chilblains Cholesteatoma Chronic Cough in Children Chronic Fatigue Syndrome (CFS) Chronic Kidney Disease (CKD) Chronic Rhinosinusitis Chronic Stridor Clavicular fracture Clozapine Coeliacs Colorectal Cancer Screening Recommendations Congestive Cardiac Failure Connective Tissue Diseases Constipation Contact Dermatitis Cracked Heel Croup Cushings Cutaneous Drug Eruptions DKA vs HHS Dacrocystitis, dacyrostenosis, dacyrocystocoele Deep Vein Thrombosis (DVT) Delerium Dementia Depression and Delirium Dermal melanocystosis (mongolian spot) Developmental Dysplasia of the Hip (DDH) Diabetes Diabetes Insipidus (DI) vs Primary Polydipsia Diabetic Neuropathy Diarrhoea Diplopia Dizziness / syncope Down syndrome Duchenne muscular dystrophy Dupuytrens / trigger finger Dyspepsia Dyspnoea (Shortness of Breath) ECG ECG Findings ECG Patterns CONCISE COMPREHENSIVE Antiphospholipid Syndrome (APS) Presentation Acquired thrombophilia → increased risk of arterial and venous thrombi Recurrent miscarriages, pre-eclampsia, fetal growth restriction, MI, CVA Associated with SLE and autoimmune disorders May present with livedo reticularis or thrombocytopenia Pathophysiology Antiphospholipid antibodies attack phospholipids in vessel linings → clot formation Triple positivity (lupus anticoagulant, anticardiolipin, beta-2 glycoprotein 1) confers higher risk of recurrent thrombosis Investigations Antibody tests: Lupus anticoagulant Anticardiolipin antibody Beta-2 glycoprotein 1 antibody Other tests: FBC (for thrombocytopenia), coagulation studies Repeat aPL testing at least 12 weeks apart to confirm persistent positivity Assess modifiable risk factors (smoking, hypertension, dyslipidaemia) to reduce vascular risk Diagnosis Requires 1 clinical manifestation (thrombotic or obstetric) + positive aPL antibodies on 2 occasions, 12 weeks apart Higher-risk profiles include triple positivity and history of severe thrombotic or obstetric complications Treatment Lifelong warfarin for thrombotic APS (target INR 2.5–3.5) Avoid NOACs (less effective in APS) Aspirin/clopidogrel for certain cases Specialist anticoagulation management during pregnancy Bridge warfarin with LMWH if anticoagulation must be paused Regular INR monitoring is crucial, especially in high-risk (triple-positive) patients (RACGP) Obstetric vs Thrombotic APS Clinical Manifestations Obstetric APS ≥3 early miscarriages (<10 weeks) ≥1 fetal death (>10 weeks) Preterm birth (<34 weeks) due to pre-eclampsia / placental insufficiency Thrombotic APS DVT/PE (most common initial presentation) Stroke/TIA in young patients Other: Myocardial infarction, retinal occlusion, microvascular thrombosis Management Obstetric APS Low-dose aspirin + LMWH during pregnancy and 6–12 weeks postpartum High-risk cases: Add hydroxychloroquine or IVIG (specialist decision) Postpartum period remains high risk for thrombosis; prophylaxis continuation advised Thrombotic APS Lifelong anticoagulation with warfarin Recurrent events: Combine warfarin with antiplatelet therapy (aspirin/dipyridamole) Antiphospholipid Syndrome (APS) Presentation Acquired thrombophilia → increased risk of arterial and venous thrombi Recurrent miscarriages, pre-eclampsia, fetal growth restriction, MI, CVA Associated with SLE and autoimmune disorders, also seen in Sjögren’s syndrome, RA, systemic sclerosis May present with livedo reticularis, thrombocytopenia, or cardiac valve disease (valve thickening and regurgitation) Catastrophic APS (CAPS) is a rare, life-threatening variant causing multi-organ failure due to microvascular thrombosis Pathophysiology Antiphospholipid antibodies (aPL) interact with inflammatory endothelial factors → disrupt coagulation → clot formation Triple positivity (lupus anticoagulant, anticardiolipin, beta-2 glycoprotein 1) confers highest risk of recurrent thrombosis aPL antibodies may be additive to traditional risk factors (smoking, hypertension, hyperlipidaemia) Investigations Antibody tests: Lupus anticoagulant Anticardiolipin antibody Beta-2 glycoprotein 1 antibody Other tests: FBC (thrombocytopenia, anaemia) Coagulation studies (aPTT prolongation, INR monitoring) Repeat aPL testing at least 12 weeks apart to confirm persistent positivity Assess modifiable risk factors (smoking, hypertension, dyslipidaemia) to reduce vascular risk Diagnosis Requires one clinical manifestation (thrombotic or obstetric) plus persistent aPL antibodies (two positive tests, 12 weeks apart) Higher-risk profiles: Triple positivity and history of severe thrombotic or obstetric complications Catastrophic APS diagnosed when thrombosis affects ≥3 organs in <1 week Treatment Thrombotic APS: Lifelong warfarin (target INR 2.5–3.5) Avoid NOACs (less effective in APS, increased risk of recurrent thrombosis) Recurrent events: Warfarin + antiplatelet therapy (aspirin/dipyridamole) Consider hydroxychloroquine for added protection in high-risk patients Statins may be considered in high-risk patients with atherosclerotic risk factors Specialist input for refractory cases, catastrophic APS Obstetric APS: Low-dose aspirin + LMWH during pregnancy and for 6–12 weeks postpartum High-risk cases: Add hydroxychloroquine or IVIG (specialist decision) Warfarin contraindicated in pregnancy → switch to therapeutic LMWH Postpartum remains high risk for thrombosis; extended prophylaxis advised Obstetric vs Thrombotic APS Clinical Manifestations Obstetric APS ≥3 early miscarriages (<10 weeks) ≥1 fetal death (>10 weeks) Preterm birth (<34 weeks) due to pre-eclampsia/placental insufficiency Thrombotic APS DVT/PE (most common initial presentation) Stroke/TIA in young patients Other: Myocardial infarction, retinal occlusion, microvascular thrombosis Management Obstetric APS Low-dose aspirin + LMWH during pregnancy and 6–12 weeks postpartum High-risk cases: Add hydroxychloroquine or IVIG (specialist decision) Postpartum period remains high risk for thrombosis; prophylaxis continuation advised Thrombotic APS Lifelong anticoagulation with warfarin Recurrent events: Combine warfarin with antiplatelet therapy (aspirin/dipyridamole) Catastrophic APS (CAPS) Acute multi-organ failure due to widespread microvascular thrombosis Precipitated by infection, surgery, malignancy, anticoagulation withdrawal Requires urgent hospitalisation, anticoagulation, high-dose steroids, IVIG, and plasma exchange Key Considerations Screening for aPL antibodies only in specific clinical contexts (young stroke, unprovoked VTE, recurrent pregnancy loss) Asymptomatic aPL positivity does not warrant routine anticoagulation, but may justify aspirin in high-risk individuals Hydroxychloroquine recommended for SLE patients with aPL antibodies Regular INR monitoring crucial, especially in high-risk (triple-positive) patients Avoid oestrogen-containing contraceptives and HRT in APS due to increased thrombotic risk 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 Mastalgia Differential Diagnoses Cyclical mastalgia (typically bilateral, worse premenstrually) Non-cyclical mastalgia (unilateral or bilateral) Pregnancy Breast cancer Contraceptive use Mastitis/breast abscess Costochondritis/thoracic back pain Management Reassurance & breast awareness Appropriate breast screening Supportive bra (sports bra may help) Analgesia: Paracetamol 1g QID PRN Topical NSAIDs for localised pain Evening primrose oil (EPO): 1000 mg 2–3× daily for 2–3 months may help Cease smoking Aim for ideal body weight Severe cases affecting lifestyle: Danazol, tamoxifen may be considered → Limited by side effects, specialist review required Mastalgia Definition Mastalgia is breast pain that affects up to 77% of women at some point in their lives It may be accompanied by tenderness, lumpiness, fullness, heaviness or an increase in breast size It is typically benign and not indicative of breast cancer, although it can cause significant discomfort and anxiety Differential Diagnoses Cyclical mastalgia, usually bilateral, worsening premenstrually and most common in premenopausal women in their 30s Non-cyclical mastalgia, which may be unilateral or bilateral, with burning, stabbing or throbbing pain, more common in women in their 40s Pregnancy-related breast changes Breast cancer Effects of hormonal contraceptive use Mastitis or breast abscess Chest wall pain from costochondritis or thoracic back pain Investigation Obtain a thorough history and encourage completion of a pain chart to characterise the pattern of pain Conduct a detailed physical examination of the breasts, including palpation for masses or asymmetry Arrange breast imaging with ultrasound and/or mammography based on clinical findings and patient age Consider triple assessment (clinical examination, imaging and non-surgical biopsy) for any significant findings such as asymmetrical thickening or a discrete palpable mass Management Reassure the patient that mastalgia is typically benign and not caused by breast cancer Promote breast awareness and ensure appropriate breast screening is in place Advise the use of a well-fitting supportive bra, for example a sports bra Recommend analgesia with paracetamol 1 g QID as needed Use topical NSAIDs for localised pain relief Suggest evening primrose oil at a dose of 1000 mg 2–3 times daily for 2–3 months Encourage lifestyle modifications such as smoking cessation and achieving an ideal body weight For severe cases affecting quality of life, consider hormonal treatments such as danazol or tamoxifen with referral for specialist review Notes Cyclical mastalgia typically improves with the onset of menstruation, whereas non-cyclical mastalgia does not vary with the menstrual cycle and may warrant further evaluation Chest wall pain should be considered when breast imaging is normal and the pain may originate from muscles, ribs or ligaments A combination of reassurance, conservative measures and tailored pharmacological therapy often yields the best outcomes Ongoing patient education and follow-up are crucial, as most cases of mastalgia tend to improve over time regardless of treatment 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 Erythrasma Definition Superficial bacterial skin infection, often in skin folds (axillae, groin, between toes) Hyperpigmented, thin patches Wood’s lamp: Coral-pink fluorescence Aetiology & Causes Corynebacterium minutissimum (Gram-positive, non-spore-forming) Often mistaken for fungal infections (tinea, Candida) Risk Factors Warm climates Excessive sweating Skin of colour Diabetes, obesity, poor hygiene Advanced age Clinical Features Well-defined pink/brown patches with fine scaling ± superficial fissures Sites: Axillae, groin, between toes Mild itching possible Diagnosis Wood’s lamp: Coral-pink fluorescence (porphyrin production) Microscopy (Gram/methylene blue stain): Identifies C. minutissimum Management Topical Treatment (First-Line) Fusidic acid 2% ointment BD x 2 weeks Whitfield’s ointment Oral Treatment (If Extensive) Clarithromycin 1g stat Erythromycin or tetracycline Other Options Photodynamic therapy (red light) Prevention Antibacterial soap to prevent recurrence Repeat treatment as needed Erythrasma Definition Erythrasma is a superficial bacterial skin infection typically found in skin folds (e.g. axillae, groin, interdigital spaces). It presents as hyperpigmented, thin patches that may be mistaken for fungal infections. Under a Wood’s lamp, erythrasma demonstrates a characteristic coral-pink fluorescence. Aetiology & Causes Caused by Corynebacterium minutissimum (Gram-positive, non-spore-forming bacillus). Commonly misdiagnosed as tinea or candidal infection due to similar rash patterns. Risk Factors Warm, humid climates Excessive sweating (hyperhidrosis) Skin of colour (hyperpigmentation more evident) Diabetes, obesity, poor hygiene Advanced age (compromised skin barrier) Clinical Features Well-demarcated pinkish-brown patches with fine scaling; can sometimes have superficial fissures. Usually mildly pruritic or asymptomatic, though some patients report mild itch or discomfort. Common sites: Axillae Groin (inguinal folds) Interdigital spaces (especially between the 4th and 5th toes) Submammary folds in women May co-exist with fungal infections (e.g. tinea). Diagnosis Wood’s Lamp Examination: Coral-pink fluorescence due to porphyrin production by C. minutissimum. Microscopy: Gram stain or methylene blue stain can identify C. minutissimum. Differential: Tinea cruris, intertrigo (candida), inverse psoriasis. Further Assessments: Check for underlying risk factors like diabetes if recurrent or extensive. Management Topical Treatment (First-Line) Fusidic Acid 2% Ointment BD for 2 weeks Whitfield’s Ointment (benzoic acid and salicylic acid) can also be used Alternatives: Topical clindamycin or erythromycin if fusidic acid is unavailable Oral Treatment (If Extensive or Recurrent) Clarithromycin 1 g stat (single dose) Erythromycin or Tetracycline (doxycycline) for 7–14 days if needed Oral therapy is particularly beneficial in widespread disease or if topical therapy fails Other Options Photodynamic Therapy (red light): Reported in some cases, though not routinely used in Australian practice Ensure adequate dryness of skin folds; consider antifungal if co-existing tinea Prevention Antibacterial soaps or washes to reduce skin colonisation Keep skin folds dry (use absorptive powders, wear loose clothing) Repeat treatment or maintenance topical therapy if recurring Address underlying factors: Weight reduction (if obesity) Optimise glycaemic control in diabetes Improve hygiene Notes Erythrasma can recur, especially if risk factors (e.g. sweating, obesity, diabetes) are not addressed. Consider checking for co-infection with dermatophytes (tinea) as it may coexist in similar sites. Some guidelines suggest combining topical antibacterial with antifungal if diagnosis is uncertain. Bookmark Failed! Bookmark Saved! Refresh Refresh Refresh