Latest Updates
Chronological feed of updated topics, guideline changes, and new content.
Abdominal Anatomy
Define/Describe - Overview of abdominal regions and divisions... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Abdominal Aortic Aneurysm
An Abdominal Aortic Aneurysm (AAA) represents a permanent, pathological, localised dilatation of the abdominal aorta to a diameter of ≥3.0 cm (or exceeding 50% of the expected normal arterial diameter). This...
Abdominal Aortic Aneurysm (AAA) in Adults
An Abdominal Aortic Aneurysm (AAA) is defined as a permanent, localised dilatation of the abdominal aorta having a diameter greater than 3.0 cm or exceeding the normal diameter by more than 50%. It is a critical...
Abdominal Trauma
Answer: Quick Answer : Abdominal trauma evaluation requires systematic assessment combining clinical examination, imaging (FAST and CT), and laboratory investigations. Blunt injuries are managed non-operatively in...
Abdominal Trauma
The management of abdominal trauma has undergone a paradigm shift over the last three decades, moving away from "mandatory laparotomy" for all penetrating wounds toward a sophisticated approach of Selective...
Absence Seizures (Paediatric)
Absence seizures are generalized onset non-motor seizures characterized by sudden, brief lapses in consciousness (typically 5–20 seconds) without loss of postural tone. They are the hallmark of Childhood Absence...
Acalculous Cholecystitis in Critical Care
Post-cardiac surgery patient with unexplained sepsis and RUQ tenderness... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Accessory Navicular Syndrome
The hallmark is a painful, palpable prominence on the medial arch. Biomechanically, the syndrome is significant because the TPT's insertion is displaced medially, reducing its lever arm for inversion and arch support....
Acetabular Fracture
Acetabular fractures: classification, imaging, surgical indications, and management of hip socket fractures in high-energy trauma.
Achalasia
The diagnosis has been refined by High-Resolution Manometry (HRM) and the Chicago Classification (v4.0) , which divides the disease into three distinct phenotypic patterns (Types I, II, and III) with significant...
Achilles Tendon Rupture
An Achilles tendon rupture is a complete disruption of the calcaneal tendon, the strongest and largest tendon in the human body. It most commonly occurs in the "watershed zone" (2–6 cm proximal to the calcaneal...
Achondroplasia
While patients have normal intelligence and a near-normal life expectancy, the condition is associated with significant neurological and orthopaedic complications. The most critical period is infancy, where foramen...
Acid-Base Disorders
Systematic Approach: pH → Primary disorder → Anion gap → Compensation → Delta ratio... CICM Second Part exam preparation.
Acid-Base Physiology
Acid-base balance maintains arterial pH 7.35-7.45 through chemical buffering, respiratory compensation, and renal regulation. pH: Negative logarithm of [H⁺]; normal [H⁺] 40 nEq/L (35-45); pH 7.40 = [H⁺] 40 nEq/L; pH...
Acid-Base Physiology
Acid-base homeostasis is maintained through the interplay of three major buffer systems: bicarbonate (primary), phosphate, and protein buffers. The Henderson-Hasselbalch equation (pH = pKa + log[HCO₃⁻/(0.03 × PCO₂)])...
Acid-Base Physiology
Answer: Acid-base physiology describes the mechanisms that maintain arterial pH within the narrow range of 7.35-7.45. This regulation occurs through three integrated systems: chemical buffers (immediate), respiratory...
ACL Injury
An Anterior Cruciate Ligament (ACL) injury is a complete or partial disruption of the primary intra-articular stabilizer of the knee. The ACL's primary role is to resist anterior translation of the tibia relative to...
Acne Vulgaris
While often dismissed as a "rite of passage," acne carries a significant psychological burden, with rates of depression and suicidal ideation comparable to chronic systemic diseases like epilepsy or diabetes....
Acromegaly
The condition is insidious, with a median delay in diagnosis of 7–10 years . During this period, patients develop significant comorbidities, including hypertension, diabetes mellitus, cardiomyopathy, and obstructive...
Acromioclavicular Joint Injury
Acromioclavicular joint injuries: mechanism, Rockwood classification, diagnosis, and evidence-based management from conservative treatment to surgical reconstruction.
Acute Adrenal Crisis
An Acute Adrenal Crisis (Addisonian Crisis) is a life-threatening endocrine emergency resulting from an absolute or rela... MRCP exam preparation.
Acute Angle Closure Glaucoma
The rapid IOP spike (often 50-70 mmHg) leads to ischaemic damage to the optic nerve, retina, and corneal endothelium. Treatment is a time-critical hierarchy: immediate medical reduction of IOP followed by definitive...
Acute Angle Closure Glaucoma
Acute Angle Closure Glaucoma (AACG), also termed Acute Primary Angle Closure (APAC), is an ophthalmic emergency characte... FRCOphth, MRCGP exam preparation.
Acute Angle-Closure Glaucoma
Acute angle-closure glaucoma (AACG) is a vision-threatening condition caused by sudden blockage of aqueous humor outflow... ACEM Fellowship Written, ACEM Fellow
Acute Appendicitis
Acute appendicitis is the most common surgical emergency worldwide, with a lifetime risk of 7-8% and an incidence of app... MRCS exam preparation.
Acute Appendicitis
Acute Appendicitis is the most common non-traumatic surgical emergency worldwide, characterized by the acute inflammatio... MRCS exam preparation.
Acute Appendicitis (Paediatric)
Acute appendicitis is the most common surgical emergency in children, affecting approximately 1-8% of children presenting with acute abdominal pain to the emergency department. It has a peak incidence between 10-12...
Acute Asthma Exacerbation
In the United Kingdom, asthma affects approximately 5.4 million people, leading to roughly 75,000 emergency hospital admissions and 1,400 deaths annually. A critical finding in the National Review of Asthma Deaths...
Acute Bacterial Prostatitis
Comprehensive evidence-based guide to the diagnosis and management of acute bacterial prostatitis
Acute Behavioural Disturbance
ABD encompasses a spectrum from mild agitation to life-threatening excited delirium syndrome (ExDS). Causes include subs... ACEM Primary Written, ACEM Fellowshi
Acute Bronchiolitis - Adult
Acute bronchiolitis in adults is an inflammatory condition of the small airways (bronchioles, below 2 mm diameter) most ... ACEM Primary Written, ACEM Primary V
Acute Bronchiolitis - Paediatric
Bronchiolitis is an acute viral infection of the lower respiratory tract, primarily affecting infants aged 2-12 months. ... ACEM Primary Written, ACEM Primary V
Acute Chest Syndrome
The clinical course is often unpredictable, with many cases developing 48–72 hours into an admission for a painful VOC. The pathophysiology involves a "vicious cycle" where regional hypoxia leads to red cell sickling...
Acute Cholangitis
Acute cholangitis is a life-threatening systemic infection arising from bacterial contamination of an obstructed biliary... MRCP, FRACS exam preparation.
Acute Cholecystitis
The modern management of acute cholecystitis is defined by the Tokyo Guidelines (TG18) , which provide a standardized framework for diagnosis and severity grading. The historical "cool it off" approach with...
Acute Cholecystitis
Acute cholecystitis is an acute inflammatory condition of the gallbladder, most commonly resulting from cystic duct obst... MRCS exam preparation.
Acute Compartment Syndrome
The hallmark clinical feature is pain out of proportion to the clinical findings , with pain on passive stretch of compartment muscles being the most reliable early sign. Pulselessness and paralysis are late...
Acute Conjunctivitis
Viral conjunctivitis, primarily caused by Adenovirus , accounts for 65–90% of all infectious cases in adults. Bacterial conjunctivitis is less common in adults than in children but remains significant, often caused by...
Acute Constipation
Management follows a stepwise "Laxative Ladder" approach, prioritizing lifestyle modification and osmotic laxatives (Macrogol) over stimulants. Identifying Opioid-Induced Constipation (OIC) is critical in acute...
Acute Coronary Syndrome
Acute Coronary Syndrome (ACS) is a life-threatening spectrum of myocardial ischaemia resulting from the acute disruption... MRCP exam preparation.
Acute Coronary Syndromes
Classification based on ECG and troponin: STEMI (ST elevation + troponin rise), NSTEMI (no ST elevation + troponin ri... CICM Second Part exam preparation.
Acute Cough in Adults
Acute cough is defined as a cough lasting less than 3 weeks . It is one of the most common reasons for seeking medical advice, representing approximately 3% of all primary care consultations. The vast majority...
Acute Dehydration - Paediatric
Acute dehydration in children represents a deficit in total body water resulting from fluid losses exceeding intake. It ... MRCPCH exam preparation.
Acute Diarrhoea and Gastroenteritis
Acute diarrhoea is defined as the passage of three or more loose or watery stools per day (or more frequent than normal for the individual) lasting less than 14 days . It is a leading cause of outpatient visits and...
Acute Disseminated Encephalomyelitis (ADEM)
ADEM is predominantly a disease of childhood (median age 5–8 years). The primary clinical challenge is differentiating it from the first presentation of Multiple Sclerosis (MS) or MOG Antibody-Associated Disease...
Acute Diverticulitis
Diagnosis is primarily confirmed by CT abdomen/pelvis with intravenous contrast, which demonstrates pericolic fat stranding, bowel wall thickening, and complications such as abscess or perforation. The modified...
Acute Epididymitis in Adults
Comprehensive evidence-based guide to acute epididymitis in adults: diagnosis, differential diagnosis from testicular torsion, age-stratified antibiotic management
Acute Epiglottitis
Management is defined by a fundamental safety principle: Secure the Airway First . Any intervention that disturbs the child—including throat examination, venipuncture, or radiological investigation—can precipitate...
Acute Epiglottitis
Acute epiglottitis is a life-threatening inflammatory condition of the epiglottis and supraglottic structures that can p... ACEM Primary Written, ACEM Primary V
Acute Epiglottitis in Adults
Acute epiglottitis is a life-threatening inflammatory condition affecting the epiglottis and surrounding supraglottic structures, capable of progressing rapidly to complete airway obstruction. Following widespread...
Acute Exacerbation of Bronchiectasis
Bronchiectasis is characterized by permanent, abnormal dilation of bronchi due to destruction of elastic and muscular components of bronchial walls, creating a favorable environment for chronic bacterial colonization....
Acute Gastritis and Gastropathy
The primary aetiologies include Helicobacter pylori infection, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), alcohol, and severe physiological stress (e.g., in ICU). The Maastricht VI/Florence Consensus (2022)...
Acute Gout in Adults
Acute gout is an intensely painful, inflammatory monoarthritis caused by the deposition of monosodium urate (MSU) crystals within joints and soft tissues. It is the most common form of inflammatory arthritis in men,...
Acute Haemolytic Crisis
An acute haemolytic crisis represents rapid, pathological destruction of red blood cells (RBCs), resulting in anemia, ja... MRCP exam preparation.
Acute Headache in Adults
Acute headache is one of the most common presentations in emergency departments, representing 2–4% of all visits. The primary clinical challenge is to distinguish common, benign primary headaches (migraine,...
Acute Heart Failure
Acute heart failure encompasses both new-onset heart failure and acute decompensation of chronic heart failure (ADHF), p... ACEM Primary Written, ACEM Fellowshi
Acute Heart Failure
Key Facts The "Flash" Phenomenon : In hypertensive AHF, symptoms arise from fluid redistribution (sympathetic-mediated vasoconstriction) rather than total body volume overload. Time is Myocardium : Every hour of delay...
Acute Heart Failure
The clinical presentation is heterogenous but typically involves signs of fluid overload (congestion) and, in more severe cases, reduced cardiac output (peripheral hypoperfusion). Management is prioritized into three...
Acute Heart Failure in ICU
Nohria-Stevenson classification divides AHF into four profiles based on congestion (wet/dry) and perfusion (warm/cold... CICM Second Part Written, CICM Secon
Acute Hepatitis
The majority of cases are self-limiting; however, a small percentage can progress to Acute Liver Failure (ALF) , defined by the development of coagulopathy (INR ≥1.5) and encephalopathy. Management is primarily...
Acute HIV Infection & Seroconversion
Acute HIV infection, also known as Primary HIV Infection or Acute Retroviral Syndrome (ARS), represents the period immediately following HIV acquisition until the development of a stable "viral set point." It...
Acute Intermittent Porphyria (AIP)
AIP is often referred to as a "little imitator" because its symptoms—severe abdominal pain, psychiatric disturbances, and neurological deficits—mimic many common conditions, frequently leading to delayed diagnosis or...
Acute Ischaemic Stroke
Epidemiology : 85% of strokes are ischaemic; 15% haemorrhagic. Stroke is the fourth leading cause of death in the UK ( 26,000 deaths annually) and the leading cause of adult disability. Pathophysiology : Arterial...
Acute Ischaemic Stroke
Comprehensive Gold Standard guide to acute ischaemic stroke diagnosis and management, including thrombolysis, thrombectomy, and secondary prevention.
Acute Ischemic Stroke - Thrombolysis
Acute ischemic stroke accounts for 87% of all strokes, with mortality of 15-30% at 30 days if untreated. Time is brain –... ACEM Primary Written, ACEM Fellowshi
Acute Ischemic Stroke - Thrombolysis and Thrombectomy
Acute ischemic stroke accounts for 87% of all strokes, with mortality of 15-30% at 30 days if untreated. Time is brain –... ACEM Fellowship Written, ACEM Fellow
Acute Kidney Injury - Emergency Management
Acute Kidney Injury (AKI) in the emergency department requires rapid assessment to identify reversible causes (pre-renal... ACEM Fellowship Written, ACEM Fellow
Acute Kidney Injury (Adult)
KDIGO 2012 Classification: Three-stage system based on creatinine and urine output... CICM Second Part exam preparation.
Acute Kidney Injury (AKI)
Acute Kidney Injury (AKI) is a clinical syndrome characterized by a rapid decline in renal excretory function, leading t... MRCP exam preparation.
Acute Kidney Injury (AKI)
The diagnosis is established using the KDIGO (2012) criteria , which defines AKI as a rise in serum creatinine of ≥26.5 µmol/L within 48 hours or a 1.5-fold increase from baseline. Management is focused on identifying...
Acute Kidney Injury in Children
Acute kidney injury (AKI) in children represents a sudden decline in kidney function characterised by rising serum creat... MRCPCH exam preparation.
Acute Kidney Injury Pathology
Acute Kidney Injury (AKI) is classified by KDIGO into Stages 1-3 based on creatinine rise and urine output. Pathophysiologically, AKI is divided into pre-renal (hypoperfusion), intrinsic (tubular, glomerular,...
Acute Leukaemia
Epidemiology: AML: Median age 68 years, incidence 4.3 per 100,000 in adults ALL: Bimodal distribution (peak ages 2-5 years and 50 years), incidence 1.7 per 100,000 Male predominance in both subtypes (M:F ratio...
Acute Limb Ischaemia
The pathophysiology involves two primary mechanisms: embolism (usually cardiac origin, e.g., atrial fibrillation) or thrombosis (in situ thrombosis of a pre-existing atherosclerotic plaque or bypass graft)....
Acute Liver Failure
Acute Liver Failure is a high-yield topic for CICM examinations, testing core ICU competencies:... CICM Second Part, FCICM exam preparation.
Acute Liver Failure
Key Facts The Definition Triad : 1. Acute onset (less than 26 weeks), 2. Coagulopathy (INR ≥1.5), 3. Encephalopathy. The "Killer" Mechanism : Cerebral oedema leading to brainstem herniation is the most common cause of...
Acute Low Back Pain
However, the critical clinical challenge lies in identifying the 5-15% of patients with potentially serious underlying pathology—collectively termed "red flag" conditions—including cauda equina syndrome, malignancy,...
Acute Lower GI Bleeding
Acute lower gastrointestinal bleeding (LGIB) is a medical emergency characterized by bleeding from the gastrointestinal tract distal to the ligament of Treitz, presenting as hematochezia (bright red or maroon blood...
Acute Mesenteric Ischemia
Acute mesenteric ischemia (AMI) is a life-threatening surgical emergency caused by inadequate blood flow to the intestin... CICM Second Part exam preparation.
Acute Multiple Sclerosis Relapse
An acute multiple sclerosis (MS) relapse, also termed exacerbation or attack, represents a clinical manifestation of new... MRCP exam preparation.
Acute Myocardial Infarction
Acute myocardial infarction (AMI) represents myocardial cell death (necrosis) due to prolonged ischemia, typically resul... MRCP exam preparation.
Acute Nausea and Vomiting in Adults
Comprehensive emergency diagnosis and management of acute nausea and vomiting in adults with evidence-based differential diagnosis and treatment protocols
Acute Nephritic Syndrome
Acute Nephritic Syndrome is a clinical constellation resulting from inflammatory injury to the glomerulus. It is charact... MRCP exam preparation.
Acute Oesophagitis
Acute oesophagitis represents sudden-onset inflammation of the oesophageal mucosa, most commonly secondary to gastro-oes... MRCP exam preparation.
Acute Osteomyelitis (Paediatric)
Acute Haematogenous Osteomyelitis (AHO) is a bacterial infection of the bone marrow, primarily affecting the rapidly growing metaphyses of long bones in children. It represents one of the most important paediatric...
Acute Otitis Media (Child)
Acute Otitis Media (AOM) is an acute bacterial or viral infection of the middle ear , representing one of the most common childhood infections and the leading cause of antibiotic prescriptions in children ....
Acute Pancreatitis
Diagnostic criteria: 2 of 3 (pain, lipase greater than 3× ULN, imaging)... CICM Second Part exam preparation.
Acute Pancreatitis
Acute Pancreatitis (AP) is an acute inflammatory process of the pancreas with variable involvement of other regional tis... MRCP exam preparation.
Acute Parkinson's Crisis (Parkinsonism-Hyperpyrexia Syndrome)
Acute Parkinson’s Crisis, also known as Parkinsonism-Hyperpyrexia Syndrome (PHS), Akinetic Crisis, or Malignant Syndrome... MRCP exam preparation.
Acute Pericarditis
Acute pericarditis is the most common pericardial disease, accounting for 5% of ED chest pain presentations. While most ... ACEM Fellowship Written, ACEM Fellow
Acute Pericarditis
Acute pericarditis is defined as inflammation of the pericardial sac, the double-layered fibroserous membrane that envel... MRCP exam preparation.
Acute Pharyngitis
Acute Pharyngitis is acute inflammation of the pharynx and/or tonsils, characterized by sore throat as the predominant s... FRCEM exam preparation.
Acute Poisoning - General Approach
Acute poisoning is exposure to a toxic substance causing harm through ingestion, inhalation, injection, or dermal contac... MRCEM exam preparation.
Acute Porphyria
The acute porphyrias are a group of rare, inherited metabolic disorders characterized by life-threatening "neurovisceral" attacks. These conditions result from partial deficiencies in enzymes of the heme biosynthetic...
Acute Post-Operative Bleeding
Post-operative bleeding (POB) is a potentially life-threatening surgical complication characterized by excessive hemorrh... MRCS exam preparation.
Acute Psychosis
Psychosis describes a syndrome of disordered thought, perception, and reality testing. In the ED, the priority is threef... ACEM Primary Written, ACEM Fellowshi
Acute Psychosis in Adults
Emergency diagnosis and management of acute psychosis in adults including first-episode psychosis, differential diagnosis, organic screening, and pharmacological intervention
Acute Psychotic Episode (Adult)
An acute psychotic episode is a psychiatric emergency characterized by loss of contact with reality, manifesting as hall... MRCPsych exam preparation.
Acute Pulmonary Oedema (APO)
Acute Pulmonary Oedema (APO) is a life-threatening medical emergency characterised by the rapid accumulation of fluid in... MRCP exam preparation.
Acute Respiratory Distress - Paediatric
Acute respiratory distress in children represents increased work of breathing or inadequate ventilation resulting from a... MRCPCH exam preparation.
Acute Respiratory Distress Syndrome (ARDS) - Adult
Comprehensive critical care guide to Acute Respiratory Distress Syndrome covering Berlin criteria, pathophysiology, lung-protective ventilation, prone positioning, ECMO, and evidence-based management for postgraduate...
Acute Respiratory Distress Syndrome (ARDS) - Adult
Comprehensive critical care guide to Acute Respiratory Distress Syndrome covering Berlin criteria, pathophysiology, lung-protective ventilation, prone positioning, ECMO, and evidence-based management for postgraduate...
Acute Rheumatic Fever
Key Facts Definition : Post-infectious inflammatory syndrome following Group A streptococcal pharyngitis, affecting heart, joints, brain, and skin Global Incidence : 8-51 per 100,000 in developing countries; 1-3 per...
Acute Rhinosinusitis (Adult)
Acute rhinosinusitis (ARS) is a symptomatic inflammation of the nasal cavity and paranasal sinuses lasting less than 4 w... MRCP exam preparation.
Acute Scrotal Pain in Adults
Evidence-based emergency diagnosis and management of acute scrotal pain including testicular torsion, epididymo-orchitis, and other scrotal emergencies
Acute Sepsis - Paediatric
Sepsis in children is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.... MRCPCH exam preparation.
Acute Severe Asthma in Adults
Acute severe asthma is a medical emergency characterised by progressive bronchospasm, airway inflammation, and mucus hyp... MRCP exam preparation.
Acute Severe Ulcerative Colitis (ASUC)
The management of ASUC is a race against time. The "Three-Day Rule" is the cornerstone of modern care: failure to demonstrate a significant biological response to high-dose intravenous corticosteroids by Day 3...
Acute Sinusitis (Adult)
Acute rhinosinusitis (ARS) is inflammation of the paranasal sinuses and nasal cavity lasting less than 12 weeks, most commonly following a viral upper respiratory tract infection (URI). The condition represents a...
Acute Soft Tissue Infection
Acute soft tissue infections (SSTIs) represent a spectrum of bacterial infections affecting the skin, subcutaneous tissu... MRCS exam preparation.
Acute Stroke in Adults
Critical Alerts "Time is Brain" : 1.9 million neurons lost per minute in large vessel occlusion FAST recognition : Face-Arm-Speech-Time enables immediate stroke pathway activation Thrombolysis window :...
Acute Upper Airway Obstruction
Key Facts Definition : Blockage of airway above the level of the carina (tracheal bifurcation) Incidence : 2-5% of emergency airway presentations; rare but critical Mortality : 5-10% if treated promptly; near 100% if...
Acute Urinary Retention
Acute urinary retention (AUR) is the sudden and painful inability to pass urine despite a full bladder, representing a u... MRCS exam preparation.
Acute Urticaria in Adults
Acute urticaria is a common dermatological condition characterized by the sudden onset of transient, pruritic, erythemat... MRCP exam preparation.
Acute Valvular Dysfunction
Acute valvular dysfunction represents sudden failure or severe deterioration of heart valve function, causing either reg... MRCP exam preparation.
Acute Vascular Injury
Acute vascular injury encompasses traumatic damage to arteries or veins resulting from penetrating or blunt mechanisms. ... FRCS exam preparation.
Acute Vertigo in Adults
Acute vertigo is the illusion of movement, typically rotational, resulting from asymmetric vestibular system input. It represents a diagnostic challenge in emergency and primary care settings, with critical importance...
Acute Wound Care
Critical Alerts Control hemorrhage first : Direct pressure for 5-10 minutes; tourniquet if life-threatening extremity bleeding Assess neurovascular status : Before anesthesia and after repair; document thoroughly...
Acute Wound Dehiscence
Wound dehiscence is the partial or complete separation of the layers of a surgical wound following closure. It represents a spectrum from superficial skin separation to complete fascial disruption with evisceration...
Acute-on-Chronic Liver Failure (ACLF)
Key Facts Incidence : Occurs in 25–35% of patients hospitalized for acute decompensation of cirrhosis. Mortality : 28-day mortality ranges from 23% (Grade 1) to 75% (Grade 3). Pathophysiology : Massive systemic...
Addison's Disease (Primary Adrenal Insufficiency)
Addison's disease is primary adrenal insufficiency (PAI) caused by destruction or dysfunction of the adrenal cortex, res... MRCP exam preparation.
Addisonian Crisis (Acute Adrenal Insufficiency)
Adrenal crisis presents with hypotension, hyponatraemia, hyperkalaemia, hypoglycaemia, and often hyperpigmentation (in p... ACEM Primary Written, ACEM Primary V
Adductor Canal Block
Roof (Superficial Wall): Sartorius muscle : Forms the roof of the canal for most of its length Fascial thickening : Strong fascia covering sartorius contributes to canal formation Attachment : Fascia blends with...
Adenomyosis
The condition predominantly affects multiparous women in their late reproductive years (40-50 years) , though increasing recognition through advanced imaging has identified cases in younger women and nulliparous...
Adrenal Crisis
Adrenal crisis is an acute, life-threatening state of cortisol deficiency that requires immediate recognition and treatm... CICM Second Part exam preparation.
Adult Attention Deficit Hyperactivity Disorder (ADHD)
Adult ADHD is a persistent neurodevelopmental disorder characterised by developmentally inappropriate levels of inattent... MRCPsych exam preparation.
Adult-Onset Still's Disease
Adult-onset Still's disease (AOSD) is a rare systemic autoinflammatory disorder characterized by the classic triad of qu... MRCP exam preparation.
Advanced Life Support - Adult
Adult Advanced Life Support provides the framework for managing cardiac arrest beyond basic CPR and AED use. ALS incorpo... ACEM Primary Written, ACEM Primary V
African Trypanosomiasis (Sleeping Sickness)
Human African Trypanosomiasis (HAT), commonly known as sleeping sickness, is a vector-borne parasitic disease caused by ... MRCP exam preparation.
Age-Related Macular Degeneration (AMD)
Dry AMD (Geographic Atrophy) represents 85-90% of cases and is characterised by drusen (extracellular deposits between the retinal pigment epithelium and Bruch's membrane) and progressive retinal pigment epithelium...
Age-Related Macular Degeneration (AMD)
Comprehensive evidence-based guide to age-related macular degeneration, covering pathophysiology, genetics, classification, anti-VEGF therapy, and the latest evidence from AREDS2 and landmark trials.
Airway Assessment
Systematic airway assessment identifies 80-90% of difficult airways but has limited positive predictive value ( 10-15%), meaning many predicted difficult airways are easily managed and some predicted easy airways...
Airway Fire in the Operating Room - Prevention and Management
Immediate Management (Critical First 60 Seconds): Simultaneously: Remove all airway devices (ETT, LMA, nasal tube, etc.) Disconnect oxygen source - flood circuit with air Pour sterile saline into airway (300-500 mL if...
Airway Foreign Body - Adult
Foreign body airway obstruction is a preventable cause of asphyxial death, causing 60-100 deaths annually in Australia. ... ACEM Primary Written, ACEM Primary V
AL Amyloidosis
AL amyloidosis (immunoglobulin light chain amyloidosis) is a rare, systemic protein misfolding disorder caused by the ex... MRCP exam preparation.
Alcohol Dependence (Alcohol Use Disorder)
Alcohol Use Disorder (AUD), previously termed alcohol dependence, is a chronic, relapsing neurobiological condition characterised by compulsive alcohol seeking and use despite harmful consequences, impaired control...
Alcohol Dependence & Withdrawal
Alcohol use disorder (AUD) is a chronic, relapsing neurobiological condition characterised by compulsive alcohol consump... MRCPsych exam preparation.
Alcohol Withdrawal in ICU
Compare symptom-triggered vs fixed-schedule benzodiazepine protocols (evidence, dosing, advantages)... CICM Second Part exam preparation.
Alcohol Withdrawal Syndrome
Comprehensive evidence-based guide to alcohol withdrawal syndrome: pathophysiology, CIWA-Ar scoring, benzodiazepine protocols, delirium tremens management
Alcohol-Related Liver Disease (ALD)
Alcohol-Related Liver Disease (ALD) encompasses the full spectrum of hepatic injury caused by chronic excessive alcohol ... MRCP exam preparation.
Alfentanil and Sufentanil Pharmacology
Alfentanil and sufentanil are synthetic 4-anilidopiperidine opioid agonists derived from fentanyl, sharing its characteristic phenylpiperidine structure but with distinct pharmacokinetic profiles that determine their...
Allergic Rhinitis in Adults
Allergic rhinitis (AR) is an IgE-mediated type I hypersensitivity reaction of the nasal mucosa to inhaled environmental ... MRCP exam preparation.
Alopecia
Hair loss presents in diverse patterns, from well-defined patches to diffuse thinning or total baldness. The most common types—androgenetic alopecia, alopecia areata, and telogen effluvium—account for the majority of...
Alopecia Areata (Adult)
Alopecia areata (AA) is a common, T-cell mediated autoimmune disorder characterised by non-scarring hair loss manifesting as well-demarcated, round or oval patches of complete alopecia. The condition affects...
Alpha-1 Antitrypsin Deficiency
Alpha-1 Antitrypsin Deficiency (AATD) is an autosomal codominant genetic disorder caused by mutations in the SERPINA1 ge... MRCP exam preparation.
Alport Syndrome
The classic clinical triad comprises progressive renal disease (haematuria progressing to proteinuria and renal failure), bilateral sensorineural hearing loss, and characteristic ocular abnormalities (anterior...
Alzheimer's Disease
Alzheimer's Disease (AD) is the most common cause of dementia, accounting for 60-80% of all cases worldwide. It is a pro... MRCP, PLAB exam preparation.
Alzheimer's Disease
Alzheimer's disease (AD) is the most common cause of dementia worldwide, accounting for 60-80% of all dementia cases.... MRCP exam preparation.
Amniotic Fluid Embolism
Hypoxia - Acute respiratory failure, cyanosis, pulmonary edema... CICM Fellowship Written, CICM Fellowship Viva exam preparation.
Amniotic Fluid Embolism (AFE)
Amniotic Fluid Embolism (AFE) is a catastrophic, unpredictable obstetric emergency characterised by the sudden onset of ... MRCOG exam preparation.
Amoebiasis (Amoebic Dysentery)
Amoebiasis is a parasitic infection caused by the protozoan Entamoeba histolytica, transmitted via the faecal-oral route... MRCP exam preparation.
Amphetamine Toxicity
Benzodiazepines are first-line for all amphetamine-induced agitation - titrate to effect, start high and go fast (IV ... ACEM Primary Written, ACEM Primary V
Amyloidosis
AL Amyloidosis (Light Chain) : Most common systemic form. Due to clonal plasma cell disorder producing toxic immunoglobulin light chains (kappa or lambda). Medical emergency requiring rapid intervention. ATTR...
Anaemia (Master Topic)
Anaemia is defined by the World Health Organization (WHO) as a haemoglobin (Hb) concentration below 130 g/L in men and 1... MRCP exam preparation.
Anaesthesia for Aortic Arch Surgery
Aortic arch surgery requires deep hypothermic circulatory arrest (DHCA) with or without selective cerebral perfusion (SCP) . Indications : Aortic aneurysm, acute dissection (Type A), atherosclerotic disease. Core...
Anaesthesia for Aortic Surgery
Aortic surgery ranges from open repair (high risk, physiological insult) to endovascular stent grafting (EVAR/TEVAR, less invasive but still significant). Anatomy: Ascending aorta (coronary arteries, aortic valve),...
Anaesthesia for Awake Craniotomy
Awake craniotomy allows direct cortical mapping of speech, motor, and sensory areas during resection of lesions near eloquent cortex. Indications : Low-grade gliomas, epileptogenic foci, deep brain stimulation...
Anaesthesia for Burns Patients
Burns anaesthesia presents challenges: airway management (inhalation injury, swelling), fluid resuscitation (Parkland formula: 4 mL/kg/%TBSA in 24 hours - half in first 8 hours), temperature control (massive heat loss...
Anaesthesia for Cardiac Valve Surgery
Valve surgery requires understanding of hemodynamic goals specific to each lesion . Aortic stenosis (AS): Maintain sinus rhythm, normal-high preload, avoid hypotension/tachycardia, treat dynamic obstruction with...
Anaesthesia for Carotid Artery Stenting (CAS)
Carotid artery stenting (CAS) is a minimally invasive alternative to carotid endarterectomy (CEA) for carotid stenosis. Indications : High surgical risk (medical comorbidities, hostile neck, previous CEA/restenosis),...
Anaesthesia for Carotid Endarterectomy
Carotid endarterectomy (CEA) removes atherosclerotic plaque to prevent stroke. Indications : Symptomatic carotid stenosis 50-70% (recent TIA/stroke), asymptomatic 80% (selective). Monitoring : Arterial line, cerebral...
Anaesthesia for Cerebral Aneurysm Clipping
Cerebral aneurysm clipping requires strict blood pressure control (avoid hypertension pre-clipping, maintain normotension/mild hypotension during dissection), brain relaxation (mannitol, CSF drainage), and readiness...
Anaesthesia for Coronary Artery Bypass Grafting
Coronary artery bypass grafting (CABG) requires myocardial protection during ischemic arrest, hemodynamic optimization , and management of bleeding/coagulopathy . Preoperative : Continue antiplatelet agents (aspirin),...
Anaesthesia for Day Surgery
Day surgery (ambulatory surgery) requires rapid, smooth emergence , effective analgesia allowing oral intake and mobility, minimal PONV , and safe discharge . Patient selection : ASA I-III generally acceptable, BMI...
Anaesthesia for Deep Brain Stimulation
Deep brain stimulation (DBS) requires awake intraoperative assessment for optimal electrode placement (microelectrode recording + clinical testing). Anaesthesia strategy : light general anaesthesia for frame...
Anaesthesia for Dental Extractions
Dental extraction anaesthesia requires managing the "shared airway" with the dental surgeon while ensuring patient safety and comfort. Key considerations: (1) Airway management : Nasal intubation, reinforced LMA...
Anaesthesia for Endoscopic Sinus Surgery
Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive technique for treating chronic rhinosinusitis, nasal polyps, and skull base pathology. Key anaesthetic challenges include:
Anaesthesia for Head Injury
Traumatic brain injury (TBI) affects 700 per 100,000 population annually in Australia, with anaesthetic management focused on preventing secondary brain injury by optimizing cerebral oxygenation and perfusion....
Anaesthesia for Heart Transplantation
Heart transplantation is the gold standard treatment for end-stage heart failure refractory to medical/device therapy. Indications : Dilated cardiomyopathy (50-60%), ischemic cardiomyopathy (25-35%), congenital heart...
Anaesthesia for Laparoscopic Surgery
Laparoscopic surgery presents unique physiological challenges: pneumoperitoneum (CO₂ insufflation 12-15 mmHg) increases intra-abdominal pressure causing cardiovascular effects (↓venous return initially, then ↑SVR and...
Anaesthesia for Laser Eye Surgery
Comprehensive guide to anaesthesia for PRK, LASIK, sedation requirements, and patient fixation for ANZCA Fellowship examination
Anaesthesia for Lung Resection
Lung resection includes pneumonectomy (entire lung), lobectomy (single lobe), segmentectomy/wedge (sublobar), and sleeve resection (bronchoplastic). Indications : Primary lung cancer (NSCLC 85%, SCLC 15%),...
Anaesthesia for Lung Transplantation
Lung transplantation is performed for end-stage lung disease refractory to medical therapy. Indications : COPD (30-35%), interstitial lung disease (25-30%), cystic fibrosis (15-20%), pulmonary hypertension (5-10%),...
Anaesthesia for Middle Ear Surgery
Middle ear surgery encompasses tympanoplasty, mastoidectomy, stapedectomy, and cholesteatoma surgery. Key anaesthetic considerations include:
Anaesthesia for Myasthenia Gravis
Myasthenia gravis (MG) is an autoimmune neuromuscular disorder causing fatigable muscle weakness due to anti-acetylcholine receptor (AChR) antibodies (80-85%) or anti-MuSK antibodies (5-8%). Anaesthetic challenges :...
Anaesthesia for Obesity
Obesity (BMI 30 kg/m²) affects 30% of Australian adults and presents significant anaesthetic challenges due to physiological changes including reduced functional residual capacity (FRC), increased airway resistance,...
Anaesthesia for Ophthalmic Trauma
Comprehensive guide to anaesthesia for open globe injuries, orbital fractures, and intraocular pressure management for ANZCA Fellowship examination
Anaesthesia for Organ Transplantation
Organ transplantation presents unique challenges: Kidney transplant (most common, end-stage renal disease) - avoid nephrotoxins, maintain perfusion, manage hyperkalemia, avoid hypotension post-anastomosis. Liver...
Anaesthesia for Parotid Surgery
Comprehensive guide to anaesthesia for parotidectomy including facial nerve monitoring, Frey syndrome, and sialogogue use for ANZCA Fellowship examination
Anaesthesia for Patients with Pacemakers and ICDs
Patients with cardiac implantable electronic devices (CIEDs) including pacemakers and implantable cardioverter-defibrillators (ICDs) require systematic perioperative management to prevent device malfunction from...
Anaesthesia for Posterior Fossa Surgery
Posterior fossa surgery (sitting/prone park bench position) carries unique risks: venous air embolism (VAE, 20-40% incidence, 1% clinically significant), trigeminal-cardiac reflex (TCR, severe bradycardia/asystole...
Anaesthesia for Pyloric Stenosis
Infantile hypertrophic pyloric stenosis (IHPS) is a medical emergency requiring correction of hypochloraemic hypokalaemic metabolic alkalosis BEFORE surgery - it is NOT a surgical emergency. Presentation is typically...
Anaesthesia for Radical Neck Dissection
Comprehensive guide to anaesthesia for radical neck dissection including airway compromise, carotid protection, and shoulder dysfunction for ANZCA Fellowship examination
Anaesthesia for Renal Transplantation
for ANZCA Finals : - ESRD Physiology : Cardiovascular disease (leading cause of death), anaemia, platelet dysfunction, hyperkalaemia, metabolic acidosis, altered drug pharmacokinetics - Preoperative : Dialysis within...
Anaesthesia for Salivary Gland Surgery
Salivary gland surgery requires meticulous attention to the facial nerve (parotid surgery) and airway management. Key considerations: (1) Facial nerve preservation : Electromyography (EMG) monitoring mandatory for...
Anaesthesia for Spinal Surgery
Spinal surgery anaesthesia requires positioning considerations (prone/lateral/sitting), neurophysiological monitoring (SSEPs/MEPs), blood loss management (cell salvage, controlled hypotension), and air embolism...
Anaesthesia for the Septic Patient
Sepsis is life-threatening organ dysfunction caused by dysregulated host response to infection, with septic shock defined as sepsis with persistent hypotension requiring vasopressors despite adequate fluid...
Anaesthesia for Thoracic Aortic Surgery
Thoracic aortic surgery includes open repair and endovascular (TEVAR) approaches. Open repair requires left heart bypass (partial) or deep hypothermic circulatory arrest (DHCA) for arch/proximal descending, with...
Anaesthesia for Tonsillectomy
Tonsillectomy presents unique anaesthetic challenges due to the shared airway with the surgeon, risk of post-tonsillectomy haemorrhage (PTH) , and frequent paediatric population. Key considerations include:
Anaesthesia for Trauma
Trauma is the leading cause of death in Australians aged 1-44 years, with major trauma requiring coordinated multidisciplinary care including damage control resuscitation (DCR) principles. Primary survey follows ABCDE...
Anaesthesia for Vitreoretinal Surgery
Comprehensive guide to anaesthesia for scleral buckle, pneumatic retinopexy, gas tamponade, and complex vitrectomy for ANZCA Fellowship examination
Anaesthesia in Liver Failure
Liver failure presents complex perioperative challenges due to impaired synthetic function, coagulopathy, fluid shifts, and multi-organ involvement. Classification: Acute liver failure (ALF—encephalopathy within 8...
Anaesthesia in Renal Failure
Chronic kidney disease (CKD) stage 4-5 (eGFR <30 mL/min) and acute kidney injury (AKI) present significant perioperative risks due to fluid overload, electrolyte abnormalities, coagulopathy, and altered drug...
Anaesthesia in the Elderly
Ageing physiology significantly impacts anaesthetic management due to reduced functional reserve in cardiovascular, respiratory, renal, hepatic, and neurological systems. Pharmacokinetic changes include reduced lean...
Anaesthesia in the Elderly
Geriatric anaesthesia (age 65-70) requires understanding of age-related physiological changes and pharmacokinetic/pharmacodynamic alterations . Cardiovascular : Reduced compliance, diastolic dysfunction, fixed stroke...
Anaesthetic Machine
Modern anaesthetic machines integrate gas delivery, vaporization, breathing systems, and monitoring with multiple safety features. Gas supply: Central pipeline (oxygen 400 kPa, air, nitrous oxide) or cylinders (oxygen...
Anaesthetic Monitoring Standards
ANZCA Professional Standard PS41 (Anaesthetic Machine Monitoring Standards) mandates minimum monitoring for all patients undergoing general, regional, or sedation anaesthesia. Continuous monitoring: Inspired and...
Anal Fissure
An anal fissure is a longitudinal tear in the squamous epithelium (anoderm) of the anal canal, extending from the dentat... FRCS exam preparation.
Analgesia in ICU
Pain Assessment: "I would use the BPS or CPOT score, validated in non-communicative ICU patients, with a threshold of... CICM Second Part exam preparation.
Anaphylactic Shock
Adrenaline is the ONLY first-line medication - IM 0.5 mg (1:1,000) into anterolateral thigh... CICM Second Part, ACEM Fellowship exam preparation.
Anaphylaxis
Anaphylaxis is a rapid-onset, IgE or non-IgE mediated systemic allergic reaction affecting multiple organ systems. It af... ACEM Primary Written, ACEM Primary V
Anaphylaxis
Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction characterised by rapidly de... MRCP exam preparation.
Anastomotic Leak
Anastomotic leak (AL) is the breakdown or failure of a surgical connection (anastomosis) between two segments of bowel o... FRCS exam preparation.
ANCA-Associated Vasculitis
1.1 Summary ANCA-associated vasculitis (AAV) represents a group of rare, heterogeneous, and life-threatening multi-system autoimmune disorders characterized by necrotizing inflammation of small-to-medium-sized blood...
Angelman Syndrome
Angelman syndrome (AS) is a rare neurogenetic disorder caused by loss of function of the maternally inherited UBE3A gene... MRCPCH exam preparation.
Ankle Arthritis (Adult)
Ankle arthritis represents a fundamentally different pathological entity from hip or knee osteoarthritis. While hip and ... FRCS (Tr&Orth) exam preparation.
Ankle Fractures in Adults: Comprehensive Clinical Management
1.1 Summary Ankle fractures represent a disruption of the bony and/or ligamentous architecture of the tibiotalar joint, which is a highly congruent hinge joint essential for locomotion. These injuries are among the...
Ankle Sprain
The acute lateral ankle sprain is the single most common musculoskeletal injury in the active population, accounting for approximately 2 million injuries annually in the United States alone. It involves stretching or...
Ankylosing Spondylitis
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease primarily affecting the axial skeleton, characte... MRCP exam preparation.
Ankylosing Spondylitis
AS is strongly associated with HLA-B27 positivity (present in 85-95% of patients), though only 1-5% of HLA-B27-positive individuals develop the disease, indicating additional genetic and environmental factors are...
Anorexia Nervosa (Adult)
Anorexia nervosa (AN) is a severe psychiatric disorder characterized by persistent restriction of energy intake leading to significantly low body weight (BMI less than 17.5 kg/m² in adults), an intense fear of gaining...
Anterior Cruciate Ligament (ACL) Rupture
The rupture is a catastrophic event for the knee joint, often referred to as the "beginning of the end" for the native joint, as it sets off a cascade of instability, meniscal tears, and eventual post-traumatic...
Anterior Uveitis
Anterior uveitis (iritis/iridocyclitis) is inflammation of the iris and ciliary body, presenting as a painful red eye wi... MRCP, FRCS Ophth exam preparation.
Anthrax
Bacillus anthracis is classified as a Category A bioterrorism agent by the CDC due to its stability as spores (surviving decades in soil), ease of dissemination, high mortality potential, and capacity to cause public...
Anticoagulation Reversal
Warfarin reversal: 4F-PCC 25-50 U/kg achieves INR below 1.5 in 10-30 minutes; vitamin K 5-10 mg IV for sustained reve... CICM Second Part exam preparation.
Antimicrobial Pharmacology in Critical Care
Time-dependent killing (beta-lactams): efficacy depends on duration above MIC (%T MIC). Target 50-100% of dosing inte... CICM First Part Written, CICM First
Antiphospholipid Syndrome
Diagnostic Pearl : Antiphospholipid antibodies must be positive on TWO separate occasions, at least 12 weeks apart, to confirm diagnosis. Transient aPL positivity is common following infections, medications, or...
Antisocial Personality Disorder (ASPD)
ASPD is distinguished from other personality disorders by its consistent pattern of antisocial behaviour beginning in childhood or early adolescence, though formal diagnosis cannot be made before age 18 years. The...
Anxiety Disorders in Adults: Comprehensive Clinical Management
Anxiety disorders represent the most prevalent class of mental disorders worldwide, characterized by excessive fear, anx... MRCP, MRCPsych exam preparation.
Aortic Dissection
Aortic dissection occurs when an intimal tear allows blood to enter the medial layer of the aorta, creating a false lume... ACEM Primary Written, ACEM Primary V
Aortic Dissection
Mechanism : Intimal tear → blood dissects into media → false lumen formation → propagation proximally/distally Incidence : 5-30 per million per year; peak age 60-70 years; male:female ratio 2-3:1 Presentation : Sudden...
Aortic Dissection
Beta-blockade FIRST: Esmolol or labetalol to target HR below 60 bpm (reduces dP/dt)... CICM Second Part exam preparation.
Aortic Dissection (Type A and B)
Gold standard evidence-based guide to aortic dissection covering Stanford and DeBakey classifications, IRAD registry insights, diagnostic strategies including ADD-RS and D-dimer, anti-impulse therapy protocols, TEVAR...
Aortic Regurgitation
The management of AR is heavily guided by symptom status and echocardiographic parameters of LV function. The 2020 AHA/ACC and 2021 ESC guidelines emphasize early surgical intervention in asymptomatic patients once...
Aortic Stenosis
Aortic Stenosis (AS) is the most common primary valvular heart disease requiring surgical intervention in high-income co... MRCP exam preparation.
Aplastic Crisis
The condition is most commonly triggered by parvovirus B19 infection, which selectively targets erythroid precursors via P antigen (globoside) receptor binding, causing direct cytotoxic lysis and arrest of red cell...
ARDS Pathology
Define/Describe - Berlin Definition, DAD as histopathological correlate... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Arrhythmogenic Right Ventricular Cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically determined cardiomyopathy characterized by progr... MRCP exam preparation.
Arterial Line Monitoring
An arterial line (arterial catheter) provides continuous invasive blood pressure monitoring and allows frequent arterial... CICM Second Part exam preparation.
Ascending Cholangitis
Ascending Cholangitis is a life-threatening bacterial infection of the biliary tree, classically occurring in the settin... MRCP exam preparation.
Ascites and Spontaneous Bacterial Peritonitis
Ascites is the pathological accumulation of fluid in the peritoneal cavity, occurring in 50% of patients with compensated cirrhosis within 10 years of diagnosis. It represents a critical transition from compensated to...
Ascites in Adults
Ascites is the pathological accumulation of fluid within the peritoneal cavity. It represents a cardinal manifestation of decompensated cirrhosis and portal hypertension, though diverse aetiologies including...
Ascites Management in Critical Care
Ascites and its complications are high-yield CICM Second Part topics appearing regularly in:... CICM Second Part Written, CICM Second Part Hot Case exam prepara
Aspiration Pneumonia
Key Facts Incidence : Accounts for 5-15% of community-acquired pneumonia; up to 30% in nursing home residents Pathogenesis : Failure of airway protective mechanisms → aspiration of colonised oropharyngeal/gastric...
Asthma - Adult
Acute asthma exacerbations result from acute bronchospasm, airway inflammation, and increased mucus production causing r... ACEM Primary Written, ACEM Primary V
Asthma - Paediatric
Acute paediatric asthma is a reversible obstructive airway disease characterised by bronchospasm, airway inflammation, a... ACEM Primary Written, ACEM Primary V
Asthma (Chronic Management)
Chronic Asthma is a heterogeneous respiratory disease characterised by chronic airway inflammation and bronchial hyper-r... MRCP exam preparation.
Asthma in ICU (Status Asthmaticus)
Comprehensive CICM Second Part clinical guide to Status Asthmaticus (acute severe asthma) in the ICU, covering pathophysiology, dynamic hyperinflation, auto-PEEP, mechanical ventilation strategies, permissive...
Asystole and Pulseless Cardiac Arrest
Asystole is complete absence of cardiac electrical activity (flat line ECG) with below 2% survival, while PEA (Pulseless... ACEM Fellowship Written, ACEM Fellow
Ataxia Telangiectasia
Ataxia telangiectasia (A-T) is a rare autosomal recessive neurodegenerative disorder caused by biallelic pathogenic muta... MRCP, MRCPCH, FRACP exam preparation
Atopic Eczema
The underlying pathophysiology involves a complex interplay of epidermal barrier dysfunction (commonly associated with filaggrin mutations), type 2 immune dysregulation (Th2-predominant response with IL-4, IL-13,...
Atopic Eczema (Adult)
Atopic eczema (atopic dermatitis, AD) is a chronic, relapsing inflammatory skin condition characterised by intense pruritus, xerosis, and eczematous lesions with age-dependent distribution patterns. It affects 15-20%...
Atracurium and Cisatracurium: Pharmacology
Atracurium is a benzylisoquinolinium non-depolarizing neuromuscular blocker with unique Hofmann elimination (chemical degradation at physiological pH and temperature) and ester hydrolysis by plasma cholinesterases....
Atracurium Pharmacology
Atracurium besylate is an intermediate-acting, non-depolarizing benzylisoquinolinium neuromuscular blocking agent (NMBA) characterised by organ-independent elimination through Hofmann elimination (spontaneous chemical...
Atrial Fibrillation
Atrial Fibrillation (AF) is a supraventricular tachyarrhythmia characterised by uncoordinated atrial electrical activati... MRCP exam preparation.
Atrial Fibrillation - Acute Management
Acute AF in the ED demands rapid evaluation for instability (immediate cardioversion), determination of onset timing (48... ACEM Primary Written, ACEM Fellowshi
Atrial Fibrillation in Adults
Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by uncoordinated atrial electrical activati... MRCP, PLAB exam preparation.
Atrial Fibrillation in ICU
Incidence 20–40% in ICU patients; new-onset AF (NOAF) associated with 2–4× increased mortality and prolonged ICU stay... CICM Second Part exam preparation.
Atrial Fibrillation with Rapid Ventricular Response
Atrial fibrillation with rapid ventricular response (AF-RVR) is a common cardiovascular emergency characterized by irreg... MRCP, FRACP exam preparation.
Atrial Septal Defect in Adults
Atrial septal defect (ASD) is a congenital cardiac anomaly characterised by an abnormal communication between the left a... MRCP exam preparation.
Atropine Pharmacology
Atropine is a naturally occurring tropane alkaloid and the prototypical competitive muscarinic acetylcholine receptor antagonist. As a tertiary amine with a pKa of 9.7, it crosses the blood-brain barrier and produces...
Australian Marine Envenomation
Immediate vinegar (4-6% acetic acid) for ALL jellyfish stings - inactivates undischarged nematocysts... CICM Second Part Written, CICM Second Part Hot Case e
Australian Snake Envenomation
Pressure Immobilisation Bandage (PIB) - DO NOT REMOVE until antivenom ready... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Australian Spider Envenomation
Funnel-web: Pressure Immobilisation Bandaging (PIB) immediately, CSL Funnel-Web Spider Antivenom, ICU admission... CICM Second Part Written, CICM Second Part
Autism Spectrum Disorder (ASD)
The global prevalence has increased substantially over recent decades to approximately 1 in 36 to 1 in 100 children , likely reflecting improved awareness, broadened diagnostic criteria (DSM-5), and enhanced...
Autism Spectrum Disorder in Adults
Autism Spectrum Disorder (ASD) in adults represents a lifelong neurodevelopmental condition characterized by persistent deficits in social communication and interaction coupled with restricted, repetitive patterns of...
Autoimmune Encephalitis
The most common subtype is anti-NMDA receptor encephalitis, which predominantly affects young women (median age 21 years) and is associated with ovarian teratoma in approximately 50% of female cases. Other important...
Autoimmune Hepatitis (Adult)
Autoimmune hepatitis (AIH) is a chronic, progressive inflammatory liver disease characterised by the triad of interface ... MRCP, USMLE exam preparation.
Autoimmune Polyglandular Syndrome (APS)
Autoimmune Polyglandular Syndromes (APS), also referred to as Autoimmune Polyendocrine Syndromes (APS) or Polyglandular ... MRCP exam preparation.
Autonomic Nervous System & Cardiovascular Control
The autonomic nervous system (ANS) regulates involuntary functions, divided into sympathetic (thoracolumbar T1-L2, fight-or-flight) and parasympathetic (craniosacral S2-S4, rest-and-digest) divisions. Sympathetic...
Autonomic Nervous System Anatomy
Define/Overview - Division of autonomic nervous system, general organization... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Autosomal Dominant Polycystic Kidney Disease (ADPKD)
ADPKD is a Systemic Disease with extrarenal manifestations including Hepatic Cysts (Most Common) , Intracranial Aneurysms (5-10%) , Cardiac Valve Abnormalities , and Colonic Diverticulae . Complications include...
Avascular Necrosis of the Hip - Adult
Avascular necrosis (AVN), also termed osteonecrosis, is the ischaemic death of bone tissue in the femoral head due to in... FRCS (Tr&Orth), FRACS (Orth) exam pr
Awake Intubation
Awake intubation maintains spontaneous ventilation while establishing a definitive airway in patients with predicted dif... ACEM Primary Written, ACEM Primary V
Awareness Under Anaesthesia
Accidental awareness during general anaesthesia (AAGA) is the unintended recall of intraoperative events by patients who received general anaesthesia, occurring in approximately 0.1-0.2% of general surgical cases (1-2...
Awareness Under Anaesthesia and Depth of Anaesthesia Monitoring
Accidental awareness during general anaesthesia (AAGA) is a rare but devastating complication with an incidence of approximately 1:19,000 anaesthetics in the UK (NAP5 data). It is defined as explicit recall of sensory...
Axillary Block
Axillary brachial plexus block targets the terminal branches of the brachial plexus as they surround the axillary artery in the axilla. Coverage : Forearm, wrist, hand (entire upper limb below mid-humerus)....
Bacterial Conjunctivitis in Adults
Bacterial conjunctivitis represents one of the most common ocular conditions encountered in primary care and emergency s... MRCP exam preparation.
Bacterial Meningitis
Clinical Significance : Annual incidence is 1-2 per 100,000 in developed countries. Streptococcus pneumoniae (pneumococcus) is the most common cause in adults (60%). Early recognition and empirical antibiotics within...
Bacterial Meningitis - Adult
Bacterial meningitis is a life-threatening infection of the meninges requiring immediate empirical antibiotics (Ceftriax... ACEM Fellowship Written, ACEM Fellow
Bacterial Meningitis - Paediatric
Never delay antibiotics for lumbar puncture - Draw blood cultures, give antibiotics, then perform LP if safe... ACEM Primary Written, ACEM Primary Viva exam
Bacterial Vaginosis
While not strictly classified as a Sexually Transmitted Infection (STI), BV is sexually associated, with increased prevalence among women with new or multiple sexual partners, and particularly high concordance among...
Bag-Mask Ventilation
Bag-mask ventilation (BMV) provides manual positive pressure ventilation using a self-inflating bag, one-way valve, and ... ACEM Primary Written, ACEM Primary V
Baker's Cyst (Popliteal Cyst)
A Baker's cyst (popliteal cyst) is a fluid-filled synovial cyst that forms in the popliteal fossa, typically as a distension of the gastrocnemius-semimembranosus bursa. It is almost always secondary to intra-articular...
Balanitis
Key Facts Prevalence : 3% of boys; 11% of adult men; 12-14% of men attending GUM clinics Most common causes : Candida albicans (30-35%), poor hygiene/irritant dermatitis (25-30%), bacterial (15-20%), dermatoses...
Bariatric Surgery Anaesthesia
Mechanical Alterations: Increased intra-abdominal pressure : Elevated by 5-15 mmHg above normal due to central adiposity, reducing diaphragmatic excursion Decreased FRC : Reduced by 30-50% in morbid obesity (BMI 40...
Barrett's Oesophagus
It represents an adaptive response to chronic gastro-oesophageal reflux disease (GORD) and is the single most important precursor lesion for oesophageal adenocarcinoma (OAC), which has shown a dramatic increase in...
Bartter's and Gitelman's Syndromes
These conditions are distinguished by their site of tubular dysfunction: Bartter's syndrome affects the thick ascending limb of the Loop of Henle (mimics loop diuretics such as furosemide) Gitelman's syndrome affects...
Basal Cell Carcinoma
While BCC has an exceptionally low metastatic rate (less than 0.1%), it remains a significant clinical challenge due to its high incidence, potential for local invasion and tissue destruction, and substantial...
Beach Chair Position Anaesthesia
Beach chair position (BCP) involves elevating the head and torso 30-70 degrees from supine with legs lowered, primarily used for shoulder surgery. Physiological effects : Gravitational effects on cerebral perfusion...
Behavioural and Psychological Symptoms of Dementia (BPSD)
The cornerstone of BPSD management is the systematic identification and treatment of reversible underlying causes , particularly pain, infection (especially urinary tract infections and pneumonia), constipation,...
Behçet's Disease
Behçet's disease (BD) is a chronic, relapsing, multisystem inflammatory disorder characterised by recurrent oral and gen... MRCP exam preparation.
Bell's Palsy
Comprehensive evidence-based guide to Bell's palsy: acute idiopathic unilateral peripheral facial nerve palsy
Bell's Palsy (Adult)
Bell's palsy is the most common cause of acute unilateral peripheral facial paralysis, accounting for approximately 60-7... MRCP exam preparation.
Benign Breast Disease
Benign Breast Disease encompasses a heterogeneous spectrum of non-malignant conditions affecting the breast, accounting ... MRCS, MRCOG exam preparation.
Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of peripheral vertigo, accounting for approximately... MRCP exam preparation.
Benign Prostatic Hyperplasia (BPH)
The pathophysiology involves both static and dynamic components: the static component arises from physical urethral compression by hyperplastic tissue, while the dynamic component reflects increased smooth muscle tone...
Benign Prostatic Hyperplasia (BPH)
The clinical cascade involves four distinct but related entities: BPH (Benign Prostatic Hyperplasia): Histological diagnosis - cellular proliferation BPE (Benign Prostatic Enlargement): Anatomical diagnosis -...
Bennett's Fracture
The fracture is characterized by a two-part fracture pattern : a small volar-ulnar fragment remains attached to the trapezium via the strong anterior oblique ligament (volar beak ligament), while the main metacarpal...
Benzodiazepine Overdose
Understanding the pharmacological basis of benzodiazepine toxicity, recognition of high-risk scenarios (particularly opioid co-ingestion), and appreciation of the risks associated with antidote administration are...
Benzodiazepine Overdose
Benzodiazepine overdose causes CNS depression ranging from mild sedation to coma, typically described as "coma with stab... ACEM Primary Written, ACEM Primary V
Beta-Blocker and Calcium Channel Blocker Overdose
ABCDE, high-flow O₂, secure large-bore IV access (2 x 14G)... CICM Primary Written, CICM Fellowship Written exam preparation.
Beta-Blocker Overdose
Beta-blocker overdose represents a life-threatening cardiovascular emergency characterized by profound bradycardia, hypo... MRCP, FRACP exam preparation.
Beta-Blockers Pharmacology
Beta-adrenergic receptor antagonists (beta-blockers) competitively inhibit catecholamine binding at beta-adrenoceptors, producing negative chronotropy (reduced heart rate), negative inotropy (reduced contractility),...
Biliary Atresia
The hallmark presentation is conjugated hyperbilirubinaemia with persistent jaundice beyond the physiological neonatal period, accompanied by acholic (pale) stools and dark urine. Early diagnosis is critical because...
Biliary Colic & Acute Cholecystitis
Biliary colic and acute cholecystitis represent a clinical spectrum of gallstone-related disease affecting the gallbladder. Biliary colic is transient right upper quadrant (RUQ) pain caused by temporary cystic duct...
Bipolar Affective Disorder
The disorder typically manifests in late adolescence or early adulthood, with a mean age of onset between 20-25 years. BPAD carries substantial morbidity and mortality, with standardised mortality ratios approximately...
Bipolar Affective Disorder (BPAD)
A chronic mood disorder characterized by episodes of Mania/Hypomania alternating with Depression.
Bladder Cancer
Recent advances in molecular characterization have identified distinct molecular subtypes (luminal and basal) with differential responses to therapy, enabling precision oncology approaches. The treatment landscape for...
Bleeding Disorders in Adults
Bleeding disorders encompass a heterogeneous group of conditions characterized by impaired haemostasis, leading to exces... MRCP exam preparation.
Blepharitis (Adult)
Blepharitis is a chronic inflammatory condition affecting the eyelid margins, representing one of the most common causes... FRCOphth exam preparation.
Blood Component Therapy
Restrictive transfusion (Hb 70 g/L): TRICC, TRISS, and TRICS-III trials support restrictive thresholds in most ICU po... CICM Second Part Written, CICM Secon
Blood Gas Analyzers in ICU
Comprehensive guide to blood gas analyzer technology, measurement principles (pH electrode, Severinghaus CO2 electrode, Clark O2 electrode), co-oximetry, electrolyte measurement, lactate, pre-analytical errors, quality...
Blunt Chest Trauma
Blunt chest trauma accounts for 25-50% of all trauma deaths and is the second leading cause of mortality after head inju... ACEM Primary Written, ACEM Primary V
Borderline Personality Disorder (EUPD)
Borderline Personality Disorder (BPD), also known as Emotionally Unstable Personality Disorder (EUPD) in ICD-10, is a severe mental disorder characterised by a pervasive pattern of instability in interpersonal...
Both Bone Forearm Fracture (Paediatric)
Both bone forearm fractures (BBFF) represent one of the most common fracture patterns in the paediatric population, acco... FRCS Orth exam preparation.
Botulism
Botulism is a rare but potentially life-threatening neuroparalytic illness caused by botulinum toxin, produced by the an... MRCP, USMLE exam preparation.
Bowel Obstruction
SBO vs LBO: Small bowel (60-70% adhesions) vs large bowel (50-60% cancer)... CICM Second Part exam preparation.
Boxer's Fracture (5th Metacarpal Neck Fracture) (Adult)
A Boxer's Fracture is a fracture through the neck of the 5th metacarpal bone, representing the most common metacarpal fr... MRCS exam preparation.
Brachial Plexus and Regional Anaesthesia
Formation - Roots from ventral rami, contributions from C5-T1... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Brachial Plexus Blocks
The brachial plexus (C5-T1 roots) provides motor and sensory innervation to the upper limb. Four principal approaches exist for brachial plexus blockade: interscalene (shoulder surgery, 100% phrenic nerve palsy),...
Bradyarrhythmias & Heart Block in ICU
Atropine 0.5-1 mg IV (max 3 mg) - first-line for symptomatic bradycardia... CICM Second Part exam preparation.
Bradycardia and Cardiac Conduction Disorders
Symptomatic bradycardia (heart rate below 50 bpm) with hypotension, altered conscious level, or signs of shock is a medi... ACEM Fellowship Written, ACEM Fellow
Bradycardia in Adults
Bradycardia is defined as a heart rate below 60 beats per minute (bpm) on resting electrocardiogram. While bradycardia can be a normal physiological finding in well-conditioned athletes and during sleep, pathological...
Brain Death and Organ Donation
Brain death and organ donation appear in multiple CICM exam formats:... CICM Second Part, FCICM exam preparation.
Brain Injury Pathology - Primary and Secondary Injury Mechanisms
Define Primary vs Secondary Injury - Temporal and mechanistic distinction... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Brain Tumour
Key Facts Epidemiology : Primary brain tumours: 7-8 per 100,000/year; metastases 10x more common Most common primary tumour : Meningioma (benign); Glioblastoma (malignant) Most common sources of metastases : Lung...
Breaking Bad News (SPIKES)
Breaking bad news is one of the most challenging and important communication tasks in clinical medicine. It refers to the process of conveying information that adversely and seriously affects an individual's view of...
Breaking Bad News in Intensive Care
Breaking bad news is one of the most challenging and frequent tasks in intensive care practice. Studies indicate ICU cli... CICM Fellowship Written, CICM Fellow
Breast Cancer
Triple assessment—comprising clinical examination, imaging (mammography/ultrasound), and tissue diagnosis (core biopsy)—remains the diagnostic gold standard. Management is multimodal, integrating surgery...
Breathing Circuits and Systems
Anaesthetic breathing circuits deliver fresh gas to patient and remove expired CO₂, classified by rebreathing characteristics and presence of CO₂ absorption. Mapleson classification (non-rebreathing): A (Magill):...
Broad-Complex Tachycardia
Broad-complex tachycardia accounts for 20-30% of ED tachyarrhythmias. Approximately 80% are VT, rising to 95% in patient... ACEM Primary Written, ACEM Fellowshi
Bronchiectasis
Comprehensive evidence-based guide to non-cystic fibrosis bronchiectasis covering pathophysiology, etiology, diagnosis with HRCT findings, microbiology including Pseudomonas aeruginosa and NTM, airway clearance...
Bronchiolitis
Key Clinical Features : Coryza prodrome (1-3 days) followed by cough, tachypnoea, wheeze, crackles Work of breathing: subcostal and intercostal recession, nasal flaring, grunting Hypoxia (SpO2 <92%) indicating need...
Bronchiolitis in Children
Evidence-based diagnosis and management of acute viral bronchiolitis in infants and young children
Bronchopulmonary Dysplasia (BPD)
Bronchopulmonary Dysplasia (BPD), also known as Chronic Lung Disease of Prematurity (CLD), is the most common serious re... MRCPCH, DCH exam preparation.
Bronchoscopy Equipment
Bronchoscope Types: Flexible video (standard adult OD 5.0-5.5mm, slim 3.5-4.2mm, therapeutic 6.0-6.4mm), rigid (stain... CICM Second Part Written, CICM Secon
Brown Snake Envenomation
Brown snakes (Pseudonaja species) are responsible for the majority of snakebite deaths in Australia. The venom contains ... ACEM Primary Written, ACEM Primary V
Brucellosis (Malta Fever)
Brucellosis is a systemic zoonotic infection caused by Brucella species, small Gram-negative, facultatively intracellula... MRCP exam preparation.
Bulimia Nervosa (BN) - Adult
Bulimia Nervosa (BN) is a severe eating disorder characterised by recurrent episodes of binge eating followed by inappro... MRCPsych exam preparation.
Bullous Pemphigoid
Key Facts Epidemiology : Most common autoimmune blistering disease; incidence 6-43 per million/year globally, increasing over past 3 decades Mean age of onset : 75-80 years; rare before 60 years Target antigens :...
Bupivacaine
Bupivacaine is a potent, long-acting amide local anaesthetic widely used for neuraxial blocks (epidural, spinal), peripheral nerve blocks, and labour analgesia. Structure: Amide local anaesthetic (pipecoloxylidide),...
Burnout and Wellbeing in ICU
Organizational/Structural (most effective): Workload modification, adequate staffing, rostering... CICM Second Part Written, CICM Second Part Hot Case exam p
Burns - Adult
Burns are tissue injuries caused by thermal, chemical, electrical, or radiation sources. In Australia, burns affect 25-3... ACEM Primary Written, ACEM Primary V
Burns - Emergency Assessment and Management
Burn Depth Classification: Superficial (epidermis, red, painful), Superficial Partial (blisters, moist, blanches, ver... ACEM Fellowship Written, ACEM Fellow
Burns Assessment and Management
Burns are tissue injuries caused by heat (thermal), chemicals, electricity, radiation, or friction, representing one of ... MRCS, FRACS exam preparation.
Burns in ICU
Burns in ICU require systematic assessment of total body surface area (TBSA) and burn depth, aggressive fluid resuscitat... CICM Second Part exam preparation.
Burns Pathology
Define/Describe - Jackson zones, burn depth classification... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Caesarean Section
Caesarean section (CS) is the surgical delivery of a baby through incisions in the abdominal wall and uterus. It is one ... MRCOG exam preparation.
Caesarean Section Anaesthesia
Caesarean section is the most common major surgical procedure in Australia, with approximately 30-35% of births delivered by caesarean section. Neuraxial anaesthesia (spinal, epidural, or combined spinal-epidural) is...
Calcaneus Fracture
Calcaneus fractures represent the most common tarsal bone injury, accounting for approximately 60% of all tarsal fractur... FRCS, FRACS exam preparation.
Calcium Channel Blocker Overdose
Calcium channel blocker (CCB) overdose is a potentially lethal cardiovascular poisoning characterized by profound bradycardia, hypotension, cardiogenic shock, and metabolic derangements including hyperglycaemia....
Calcium Channel Blockers Pharmacology
Calcium channel blockers (CCBs) inhibit voltage-gated L-type calcium channels, reducing calcium influx into cardiac and vascular smooth muscle cells. Classification is based on chemical structure : dihydropyridines...
Calcium Disorders: Hypocalcemia and Hypercalcemia
Calcium gluconate 10% 10-20 mL IV over 10-20 minutes (0.9-1.8 mmol Ca2+)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Calcium Pyrophosphate Deposition Disease (CPPD)
CPPD predominantly affects older adults, with radiographic chondrocalcinosis present in 15-30% of people aged 70 years and up to 50% of those 90 years . However, symptomatic disease is considerably less common than...
Can't Intubate Can't Oxygenate (CICO)
What is it? Can't Intubate Can't Oxygenate (CICO) is a life-threatening airway emergency where tracheal intubation has failed AND oxygenation cannot be achieved via facemask or supraglottic airway (SGA). This...
Cancer Pain Management - WHO Ladder and Beyond
Cancer pain affects 30-50% of patients during treatment and 70-90% of patients with advanced disease. It is the most feared symptom of cancer and significantly impacts quality of life, function, and psychological...
Cancer Surgery and Anaesthesia
What is it? Anaesthesia for cancer surgery requires specialized knowledge of cancer biology, immunosuppression effects, optimal surgical timing, and perioperative considerations that differ significantly from...
Capnography - Physics, Waveform Analysis, and Clinical Applications
Capnography is the continuous measurement and graphical display of carbon dioxide (CO₂) concentration in respiratory gases. It utilises infrared absorption spectroscopy at the characteristic CO₂ wavelength of 4.26 μm...
Carbon Dioxide Transport
Carbon dioxide (CO2) is transported from tissues to lungs via three mechanisms: dissolved CO2 (5-10%), bicarbonate (60-70%), and carbamino compounds (20-25%). The bicarbonate pathway involves carbonic anhydrase...
Carbon Dioxide Transport & Elimination
Answer: Carbon dioxide (CO2) is transported in blood via three mechanisms: dissolved CO2 (7-10%) , bicarbonate (70-80%) , and carbamino compounds (20-23%) . The enzyme carbonic anhydrase catalyzes the reversible...
Carbon Monoxide and Cyanide Poisoning
100% oxygen via non-rebreather or intubation (reduces CO half-life from 4-5 hours to 60-90 minutes)... CICM Second Part Written, CICM Second Part Hot Case ex
Carbon Monoxide Poisoning
Carbon monoxide (CO) poisoning is a leading cause of fatal poisoning worldwide, resulting from inhalation of CO gas which binds haemoglobin with 200-250 times greater affinity than oxygen, forming carboxyhaemoglobin...
Carcinoid Syndrome
Key Facts Tumour Origin : Midgut NETs (Appendix, Ileum) most common to cause syndrome. Syndrome Appears : Usually only after Liver Metastases (Hepatic first-pass metabolism bypassed). 10% of NET patients develop the...
Carcinoid Syndrome and Neuroendocrine Tumours
Neuroendocrine tumours (NETs) represent a heterogeneous group of neoplasms arising from neuroendocrine cells distributed... MRCP exam preparation.
Cardiac Amyloidosis
Cardiac amyloidosis is an infiltrative cardiomyopathy caused by extracellular deposition of misfolded proteins (amyloid ... MRCP exam preparation.
Cardiac Anatomy & Coronary Circulation
Define/Describe - Overview of cardiac chambers, orientation in thorax... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Cardiac Arrest - Adult
Cardiac arrest is the cessation of mechanical cardiac activity confirmed by the absence of a palpable central pulse, unr... ACEM Primary Written, ACEM Primary V
Cardiac Arrhythmias in ICU
Cardiac arrhythmias are common in ICU patients (10-20% incidence) and require systematic assessment of hemodynamic stabi... CICM Second Part exam preparation.
Cardiac Cycle & Pressure-Volume Loops
The cardiac cycle consists of systole (isovolumetric contraction, ejection) and diastole (isovolumetric relaxation, filling). Pressure-volume (PV) loops graphically represent left ventricular pressure vs volume...
Cardiac Monitors and Telemetry in ICU
Comprehensive guide to cardiac monitoring in the intensive care unit including ECG acquisition, lead placement, continuous monitoring parameters, alarm management, derived indices (HRV, QTc), arrhythmia detection,...
Cardiac Tamponade
Cardiac tamponade is life-threatening compression of the heart by fluid (blood, effusion) in the pericardial space impairing diastolic filling and reducing cardiac output. Pathophysiology: Pericardial pressure...
Cardiac Tamponade
Cardiac tamponade occurs when pericardial fluid accumulates faster than the parietal pericardium can stretch, causing in... ACEM Primary Written, ACEM Primary V
Cardiac Tamponade in Adults
Cardiac tamponade is a life-threatening cardiovascular emergency characterized by accumulation of fluid within the pericardial space, resulting in elevated intrapericardial pressure and impaired ventricular filling....
Cardiogenic Shock
Cardiogenic shock occurs when the heart fails to pump sufficient blood to meet metabolic demands, resulting in systemic ... ACEM Primary Written, ACEM Fellowshi
Cardiogenic Shock
Cardiogenic shock is cardiac pump failure causing inadequate tissue perfusion despite adequate or elevated filling press... CICM Second Part exam preparation.
Cardiomyoplasty and Skeletal Muscle Ventricle
Cardiomyoplasty is an experimental surgical technique using skeletal muscle to assist or replace cardiac function. Two approaches exist: (1) Dynamic cardiomyoplasty—wrapping the latissimus dorsi muscle around the...
Cardiopulmonary Bypass Cannulation
Cardiopulmonary bypass (CPB) cannulation establishes extracorporeal circulation for cardiac surgery. Arterial cannulation (ascending aorta 95%, femoral 3%, axillary 2%) delivers oxygenated blood (cannula size: 20-24...
Cardiopulmonary Resuscitation (CPR) - Adult
Cardiopulmonary resuscitation (CPR) is a lifesaving technique combining chest compressions and rescue ventilations to maintain circulatory flow and oxygenation during cardiac arrest. High-quality CPR is the...
Cardiovascular Physiology
The cardiovascular system maintains perfusion to all tissues through coordinated heart function, vascular tone, and blood volume regulation. Cardiac output (CO): 5-6 L/min (HR 60-100 bpm × SV 60-100 mL); determined by...
Cardiovascular Physiology
Cardiovascular physiology forms the foundation of critical care practice, informing haemodynamic monitoring, vasoactive ... CICM Fellowship Written, CICM Fellow
Carotid Artery Stenosis
Carotid Artery Stenosis is the atherosclerotic narrowing of the Internal Carotid Artery (ICA) at the bifurcation. It cre... FRCS exam preparation.
Carpal Tunnel Syndrome
Diagnosis is primarily clinical, supported by provocative maneuvers including Phalen's test and Durkan's carpal compression test . Nerve Conduction Studies (NCS) provide objective severity grading and guide management...
Cataract (Adult)
A cataract is defined as any opacity of the crystalline lens that interferes with the passage of light to the retina, resulting in reduced visual acuity. Cataracts represent the leading cause of reversible blindness...
Cataracts
A cataract is an opacification of the crystalline lens of the eye, leading to progressive visual impairment. It represen... FRCOphth, Medical Finals exam prepar
Cauda Equina Syndrome
The most common cause is massive central lumbar disc herniation (typically at L4/5 or L5/S1), accounting for approximately 45% of cases, though tumors, trauma, epidural abscess, and hemorrhage are important...
Cauda Equina Syndrome (Adult)
Cauda Equina Syndrome (CES) is a rare but potentially catastrophic neurosurgical emergency caused by compression of the lumbosacral nerve roots below the level of the conus medullaris (typically L1/L2 vertebral...
Cavovarus Foot
The cavovarus foot is a complex three-dimensional deformity characterized by a pathologically elevated longitudinal arch (cavus), hindfoot varus angulation, and forefoot adduction. Unlike the more common and often...
Cellulitis and Erysipelas
Cellulitis is a common, spreading bacterial infection of the deep dermis and subcutaneous tissue, typically presenting with localised heat, redness (erythema), swelling (oedema), and pain. Erysipelas is a superficial...
Central Retinal Artery Occlusion
Key Facts Presentation : Sudden painless profound monocular vision loss (typically counting fingers or worse) Incidence : 1-2 per 100,000 per year; peak incidence 60-70 years Fundoscopy : Pale retina + cherry-red spot...
Central Retinal Artery Occlusion
Incidence : 1-2 per 100,000/year, increasing with age Presentation : Sudden painless monocular vision loss (typically count fingers or worse) Critical time window : 90-110 minutes for irreversible retinal damage...
Central Venous Access
High-Yield Topics: Indications and contraindications (absolute vs relative) Site selection: IJ (preferred), subclavian, femoral, PICC Ultrasound guidance (mandatory, complication reduction) Seldinger technique vs...
Cerebral Blood Flow & Autoregulation
Normal CBF values: 50 mL/100g/min total; grey matter 80-100, white matter 20-25 mL/100g/min... CICM First Part Written, CICM First Part Viva exam preparation
Cerebral Blood Flow and Metabolism
Cerebral blood flow (CBF) is tightly regulated to maintain constant oxygen and glucose delivery to the brain, which has high metabolic demand (20% of resting oxygen consumption, 2% of body weight). Normal CBF: 50...
Cerebral Palsy
Cerebral palsy (CP) is defined as a group of permanent disorders of movement and posture, attributed to non-progressive ... MRCPCH exam preparation.
Cerebral Venous Sinus Thrombosis
Cerebral venous sinus thrombosis (CVST) is thrombosis of the dural venous sinuses and/or cerebral veins, causing impaire... MRCP exam preparation.
Cerebrovascular Surgery: AVMs, Moyamoya, and Stroke Revascularisation
Cerebrovascular surgery (AVM resection, Moyamoya bypass, stroke revascularisation) requires meticulous haemodynamic control to maintain cerebral perfusion while avoiding catastrophic complications. Key principles:
Cervical Cancer
The overwhelming majority (99.7%) of cervical cancers are caused by persistent infection with high-risk Human Papillomavirus (hrHPV) , particularly types 16 and 18. The disease typically develops over 10-15 years...
Cervical Intraepithelial Neoplasia
CIN is typically asymptomatic and detected through organized cervical screening programmes using HPV testing and/or cervical cytology. The introduction of HPV-based primary screening has significantly improved...
Cervical Lymphadenopathy in Children
Cervical lymphadenopathy is one of the most common clinical presentations in paediatric practice, representing a diagnos... MRCPCH exam preparation.
Cervical Radiculopathy (Adult)
Cervical radiculopathy is a neurological condition characterized by compression or inflammation of a cervical nerve root, resulting in radicular pain, sensory disturbance, and/or motor weakness in a dermatomal and...
Cervical Spine Injury in Adults
Comprehensive evidence-based guide to emergency diagnosis and management of cervical spine injury in adults including clinical clearance protocols, spinal cord syndromes, and definitive treatment
Cervical Spine Trauma
NEXUS Criteria (PMID: 9971872): No midline tenderness, no focal deficit, normal alertness, no intoxication, no painfu... ACEM Primary Written, ACEM Primary V
Cervical Spondylotic Myelopathy (CSM)
The clinical syndrome is characterised by an insidious onset of neurological dysfunction manifesting as deterioration in fine motor control of the hands, gait disturbance with spastic features, and a distinctive...
Chagas Disease (American Trypanosomiasis)
Chagas disease is a potentially life-threatening systemic parasitic infection caused by the protozoan hemoflagellate Try... MRCP exam preparation.
Charcot Neuroarthropathy
The hallmark of acute Charcot is a red, hot, swollen foot in a patient with peripheral neuropathy, often triggered by minor trauma that goes unnoticed due to sensory loss. This acute inflammatory phase is...
Charcot Neuroarthropathy (Charcot Foot)
Charcot neuroarthropathy (CN), commonly referred to as Charcot foot, is a progressive destructive arthropathy affecting ... MRCP Part 2 exam preparation.
Charcot-Marie-Tooth Disease (CMT)
CMT is characterised by Progressive Distal Muscle Weakness and Atrophy , Sensory Loss , Foot Deformities (Particularly Pes Cavus and Hammer Toes) , and Reduced or Absent Deep Tendon Reflexes . The hallmark clinical...
Charcot-Marie-Tooth Disease (Hereditary Motor-Sensory Neuropathy)
Charcot-Marie-Tooth disease (CMT) is the most common inherited peripheral neuropathy, affecting approximately 1 in 2,500 individuals globally. It represents a genetically heterogeneous group of disorders characterized...
Chemical Restraint and Acute Behavioural Disturbance
Acute behavioural disturbance (ABD) affects 5-10% of ED presentations and represents a medical emergency requiring rapid... ACEM Fellowship Written, ACEM Fellow
Chest Drain (Tube Thoracostomy) Insertion
Anatomical safety zone: 5th intercostal space, mid-axillary line (nipple line in males, inframammary fold in females)... ACEM Fellowship Written, ACEM Fellow
Chest Trauma
<Flashcard question="What is the approximate incidence of blunt vs penetrating chest trauma?" answer="Blunt trauma accou... CICM Second Part exam preparation.
Chest Trauma (Adult)
Comprehensive evidence-based guide to adult chest trauma covering life-threatening injuries (tension pneumothorax, massive hemothorax, cardiac tamponade, flail chest), rib fractures, pulmonary contusion, blunt cardiac...
Chest Tube Insertion (Intercostal Drain)
Chest tube insertion (intercostal drain, tube thoracostomy) is a critical procedure for evacuation of air or fluid from the pleural space. The triangle of safety (anterior border of latissimus dorsi, lateral border of...
Chest Wall Pain
Critical Alerts Chest wall pain is a diagnosis of exclusion : Rule out cardiac, pulmonary, and aortic causes first Reproducible tenderness does NOT exclude serious causes : Coronary artery disease is present in 3-6%...
Chiari Malformations
The classification encompasses four types, though Type I and Type II account for the vast majority of clinical presentations:
Chickenpox (Varicella)
Chickenpox (varicella) is a highly contagious primary infection caused by varicella-zoster virus (VZV), a member of the ... MRCPCH, RCPCH Progress Test exam pre
Childhood Asthma
Comprehensive evidence-based guide to diagnosis, acute exacerbation management, and chronic stepwise therapy in paediatric asthma
Chlamydia trachomatis Infections
Chlamydia trachomatis is an obligate intracellular Gram-negative bacterium that causes the most prevalent bacterial sexu... MRCP exam preparation.
Cholera
The cornerstone of cholera management is rapid and aggressive fluid replacement with oral rehydration solution (ORS) or intravenous fluids. With appropriate rehydration therapy, case fatality rates can be reduced from...
Chondromalacia Patellae (Patellofemoral Pain Syndrome)
Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain, particularly affecting adole... FRCS Orthopaedics exam preparation.
Chondrosarcoma (Adult)
Chondrosarcoma is a malignant bone tumour producing cartilaginous matrix and represents the second most common primary bone malignancy after osteosarcoma, accounting for approximately 20% of primary bone malignancies....
Chopart Injury
The Chopart Joint (Midtarsal Joint, Transverse Tarsal Joint) is a complex articulation consisting of the Talonavicular (TN) and Calcaneocuboid (CC) joints. This S-shaped joint complex is critical for the foot's...
Chronic Ankle Instability
The condition has significant implications for quality of life, athletic performance, and long-term joint health, with CAI patients demonstrating a 3-4 fold increased risk of developing ankle osteoarthritis by middle...
Chronic Fatigue Syndrome (ME/CFS)
Comprehensive evidence-based guide to myalgic encephalomyelitis/chronic fatigue syndrome diagnosis and management including IOM/CDC criteria, post-exertional malaise, severity classification, and energy management...
Chronic Heart Failure
1.1 Gross Cardiac Anatomy The human heart is a four-chambered muscular pump located within the middle mediastinum, oriented obliquely with its apex directed anteriorly, inferiorly, and to the left. Understanding the...
Chronic Heart Failure
Heart failure (HF) is a complex clinical syndrome resulting from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. It represents a major and growing...
Chronic Heart Failure
Historically viewed as a "pump failure" problem, it is now understood as a neurohormonal malignancy . Maladaptive activation of the Sympathetic Nervous System (SNS) and Renin-Angiotensin-Aldosterone System (RAAS)...
Chronic Kidney Disease
Chronic Kidney Disease (CKD) is a progressive, irreversible syndrome characterised by structural or functional renal abn... MRCP exam preparation.
Chronic Kidney Disease
It is a silent killer. Most patients are asymptomatic until advanced stages (eGFR less than 15). However, even mild CKD is a potent risk factor for Cardiovascular Disease (Section 9). Patients are far more likely to...
Chronic Kidney Disease in the ICU
Assess dialysis access patency and recent dialysis schedule... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Chronic Limb Ischaemia (Peripheral Arterial Disease)
Chronic limb ischaemia represents the spectrum of peripheral arterial disease (PAD) affecting the lower extremities, ranging from asymptomatic disease through intermittent claudication to critical limb-threatening...
Chronic Liver Disease and Cirrhosis
Cirrhosis represents the end-stage of chronic liver disease, characterised by diffuse hepatic fibrosis with replacement ... MRCP exam preparation.
Chronic Liver Disease and Cirrhosis
Chronic Liver Disease (CLD) represents a spectrum of progressive liver injury and fibrosis, culminating in Cirrhosis . Cirrhosis is defined histologically as diffuse hepatic fibrosis with the formation of regenerative...
Chronic Obstructive Pulmonary Disease (COPD) in Adults
Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable heterogeneous lung condition charac... MRCP, USMLE, FRACP exam preparation.
Chronic Pain Assessment
"Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."
Chronic Pancreatitis
The clinical hallmark is chronic abdominal pain, which affects 80-90% of patients and significantly impairs quality of life. As the disease progresses, patients develop exocrine pancreatic insufficiency (EPI)...
Chronic Spontaneous Urticaria
Chronic Urticaria (CU) is defined as the recurrent occurrence of wheals (hives), angioedema, or both for more than 6 weeks . It affects 0.5-1% of the population and has a profound impact on quality of life comparable...
CKD Mineral Bone Disorder (CKD-MBD)
CKD Mineral Bone Disorder (CKD-MBD) is a systemic disorder of mineral and bone metabolism due to Chronic Kidney Disease,... MRCP exam preparation.
Clavicle Fracture
The landmark Canadian Orthopaedic Trauma Society (COTS) Trial in 2007 fundamentally changed practice by demonstrating that plate fixation of completely displaced midshaft clavicle fractures reduces non-union rates...
Cleft Lip and Palate
Cleft Lip and/or Palate (CLP) represents the most common congenital craniofacial anomaly, arising from failure of fusion of the facial prominences during embryogenesis between weeks 4-12 of gestation. The defect...
Clinical Governance in Anaesthesia
Comprehensive guide to quality improvement, audit, morbidity meetings, and clinical governance frameworks for ANZCA Fellowship examination
Clonidine Pharmacology
Clonidine is a selective alpha-2 (α2) adrenergic receptor agonist with central sympatholytic, sedative, and analgesic properties that make it valuable in perioperative medicine. It is an imidazoline derivative that...
Clostridioides difficile Infection
Key Facts Pathogen : Toxin-producing Clostridioides difficile (formerly Clostridium difficile) Toxins : Toxin A (enterotoxin), Toxin B (cytotoxin, 10-100x more potent), Binary toxin CDT (hypervirulent strains)...
Clostridioides difficile Infection (CDI)
"Stop Unnecessary Antibiotics" : First and most important step. Discontinue the inciting antibiotic and any other unnecessary antibiotics immediately.
Clostridioides difficile Infection (CDI)
The clinical spectrum of CDI ranges from mild, self-limiting diarrhoea to life-threatening pseudomembranous colitis, tox... MRCP exam preparation.
Clozapine
Clozapine is the prototypical atypical (second-generation) antipsychotic and remains the most effective pharmacological ... MRCPsych exam preparation.
Clubfoot (Talipes Equinovarus)
Clubfoot, or congenital talipes equinovarus (CTEV), represents one of the most common congenital musculoskeletal deformities, affecting approximately 1-2 per 1,000 live births worldwide. The deformity comprises four...
Cluster Headache
Critical Alerts Most severe primary headache disorder : Described as "suicide headache" due to excruciating pain intensity High-flow oxygen (100%, 12-15 L/min) is first-line acute treatment : Achieves 80% response...
Coagulation and Haemostasis
Haemostasis maintains blood fluidity while preventing bleeding through vascular, platelet, and coagulation factors working in concert. Primary haemostasis: Vascular spasm, platelet adhesion (glycoprotein Ib-von...
Coagulation Cascade & Fibrinolysis
Primary haemostasis involves platelet adhesion (via vWF-GPIb), activation (shape change, granule release), and aggreg... CICM First Part Written, CICM First
Coagulation Disorders Pathology
Coagulation disorders in critical illness result from complex interactions between inflammation, endothelial dysfunction, and haemostatic pathways. DIC involves simultaneous coagulation activation (tissue factor...
Coarctation of the Aorta
CoA accounts for 5-8% of all congenital heart disease with an incidence of approximately 4 per 10,000 live births. The condition represents a paradigm of duct-dependent physiology in severe cases: neonates may appear...
Cocaine Toxicity
Presynaptic Catecholamine Reuptake Inhibition: Blocks reuptake of noradrenaline, dopamine, and serotonin in synaptic ... ACEM Primary Written, ACEM Primary V
Coeliac Disease (Adult)
Coeliac disease is a chronic, immune-mediated enteropathy triggered by the ingestion of dietary gluten in genetically su... MRCP exam preparation.
Coeliac Disease in Adults
Coeliac disease is a chronic, immune-mediated systemic disorder triggered by dietary gluten in genetically predisposed i... MRCP exam preparation.
Collateral Ligament Injuries (MCL & LCL)
Pellegrini-Stieda: Calcification at the proximal origin of the MCL seen on X-ray weeks/months after injury. A sign o... FRCS exam preparation.
Colonic Polyps
Colonic polyps are abnormal tissue growths that protrude from the colonic mucosa into the bowel lumen. They represent a ... MRCP exam preparation.
Colorectal Cancer
The disease demonstrates significant geographical variation in incidence, with highest rates observed in developed countries, reflecting the impact of dietary factors, sedentary lifestyle, and increased longevity....
Communication Skills in Anaesthesia
Comprehensive guide to difficult conversations, breaking bad news, escalation protocols, and patient-centered communication for ANZCA Fellowship examination Professional Skills component
Community Acquired Pneumonia
Community Acquired Pneumonia (CAP) is an acute infection of the lung parenchyma acquired outside of the hospital setting... MRCP, USMLE exam preparation.
Community-Acquired Pneumonia
Community-Acquired Pneumonia (CAP) is an acute infection of the lung parenchyma (alveoli and respiratory bronchioles) in... MRCP exam preparation.
Community-Acquired Pneumonia - Adult
Community-acquired pneumonia (CAP) is an acute lower respiratory tract infection acquired outside hospital, presenting w... ACEM Fellowship Written, ACEM Fellow
Community-Acquired Pneumonia (CAP)
Successful management is predicated on the "Early Recognition and Rapid Intervention" paradigm. This involves immediate clinical suspicion, prompt severity stratification using validated scoring systems (CURB-65 or...
Complex Regional Pain Syndrome (CRPS)
Reflex Sympathetic Dystrophy (RSD): Originally described by Mitchell et al. (1864) in Civil War soldiers with persistent burning pain after nerve injury. The term implied sympathetic nervous system involvement.
Conduct Disorder
Comprehensive evidence-based guide to conduct disorder including DSM-5 criteria, childhood-onset vs adolescent-onset subtypes, callous-unemotional traits, risk factors, comorbidities, parent training, multisystemic...
Congenital Adrenal Hyperplasia (CAH)
21-Hydroxylase Deficiency (21-OHD) accounts for 95% of all CAH cases and is the most common cause of: Ambiguous genitalia in genetic females (46,XX) Life-threatening salt-wasting crisis in neonates Primary adrenal...
Congenital Diaphragmatic Hernia (CDH)
CDH is a developmental defect where abdominal contents herniate into the thorax through a defect in the diaphragm, causing pulmonary hypoplasia and pulmonary hypertension. Key anaesthetic principles:
Congenital Diaphragmatic Hernia (CDH)
Congenital Diaphragmatic Hernia (CDH) is a major neonatal surgical emergency characterized by a developmental defect in ... MRCPCH exam preparation.
Congenital Heart Disease in ICU
Congenital Heart Disease (CHD) encompasses structural abnormalities of the heart and great vessels present at birth, affecting 8-10 per 1,000 live births. CHD represents the most common congenital malformation and a...
Conjunctivitis
Conjunctivitis is the inflammation of the conjunctiva, the thin transparent mucous membrane that covers the white of the... MRCP exam preparation.
Conn's Syndrome (Primary Hyperaldosteronism)
Conn's syndrome, or primary aldosteronism (PA), represents the most common cause of secondary hypertension and potentially curable form of hypertension. First described by Jerome Conn in 1955, it is characterised by...
Conn's Syndrome (Primary Hyperaldosteronism)
Primary Hyperaldosteronism (PA) is the autonomous hypersecretion of aldosterone from the adrenal cortex (zona glomerulosa), leading to suppression of renin. It represents the most common cause of secondary...
Consent and Capacity in Intensive Care
Valid consent requires three elements: voluntary decision (free from coercion), informed (adequate disclosure of mate... CICM Second Part Written, CICM Secon
Constipation (Adult)
Constipation is a highly prevalent gastrointestinal disorder characterised by infrequent bowel movements, difficulty passing stools, or a sensation of incomplete evacuation. It affects approximately 16% of adults...
Constrictive Pericarditis
Constrictive pericarditis (CP) is a clinical syndrome resulting from fibrotic thickening and/or calcification of the per... MRCP exam preparation.
Contact Dermatitis
Comprehensive evidence-based guide to contact dermatitis: allergic and irritant mechanisms, diagnosis, patch testing, and management
Contrast-Induced Nephropathy / Contrast-Associated Acute Kidney Injury (CA-AKI)
Definition (KDIGO): Serum creatinine rise ≥26.5 μmol/L within 48 hours OR ≥50% increase within 7 days of contrast exp... CICM Second Part Written, CICM Secon
COPD Exacerbation
An Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is defined by the GOLD 2024 Report as an event c... MRCP exam preparation.
COPD Exacerbation in ICU
Corticosteroids for 5 days (REDUCE trial evidence)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Corneal Abrasion
Comprehensive evidence-based guide to diagnosis and management of corneal abrasion and corneal injury
Corticosteroids Pharmacology
Corticosteroids are synthetic analogues of endogenous cortisol with varying ratios of glucocorticoid (anti-inflammatory, metabolic) to mineralocorticoid (sodium retention) activity. In anaesthesia, they are used for...
Costochondritis
The pathognomonic feature is reproducible, localized tenderness on palpation of the affected costochondral junctions, most frequently involving the 2nd to 5th ribs. Unlike cardiac pain, costochondritis is typically...
COVID-19
COVID-19 (Coronavirus Disease 2019) is a systemic viral illness caused by the novel coronavirus SARS-CoV-2 (Severe Acute... MRCP, USMLE exam preparation.
Cricothyroidotomy
Critical Management Principles : Indication : CICO situation (Plan D) - cannot intubate AND cannot oxygenate Preferred technique : Scalpel-bougie-tube (DAS 2015) - transverse stab incision through CTM Cricothyroid...
Crisis Resource Management in Intensive Care
Crisis Resource Management (CRM) represents a systematic approach to managing extreme demand for critical care services,... CICM Fellowship Written, CICM Fellow
Crohn's Disease
Crohn's disease is a chronic, relapsing-remitting inflammatory bowel disease (IBD) characterised by transmural inflammat... MRCP exam preparation.
Crohn's Disease
Crohn's disease is a chronic, relapsing-remitting inflammatory bowel disease characterised by transmural granulomatous i... MRCP exam preparation.
Croup (Laryngotracheobronchitis)
Comprehensive evidence-based guide to croup in children: diagnosis, Westley score, dexamethasone and nebulized epinephrine management for MRCPCH and emergency medicine
Croup (Laryngotracheobronchitis)
Key Clinical Features : Viral prodrome (1-2 days of coryza, low-grade fever) Barking "seal-like" cough (hallmark) Inspiratory stridor (biphasic = severe) Hoarse voice Worse at night, often improves during day NO...
Croup (Laryngotracheobronchitis)
Answer: Croup is acute viral laryngotracheobronchitis causing subglottic airway oedema in children aged 6 months to 3 years. Classic triad: barking seal cough, inspiratory stridor, hoarseness. Severity assessed using...
CRRT Pharmacology
Continuous Renal Replacement Therapy (CRRT) profoundly alters drug pharmacokinetics through three primary mechanisms: co... CICM Fellowship Written, CICM Fellow
Crush Injury
Crush injury is defined as compression of extremities or other body parts for prolonged periods, leading to tissue ischa... ACEM Primary Written, ACEM Primary V
Crush Injury & Crush Syndrome
Crush injury is compressive trauma to body parts causing direct tissue damage through mechanical disruption and ischemia... MRCP, EDIC exam preparation.
Cryoglobulinaemic Vasculitis
Cryoglobulinaemic vasculitis is a systemic small-vessel vasculitis mediated by cryoglobulins—immunoglobulins that revers... MRCP exam preparation.
Cryotherapy (Liquid Nitrogen Treatment)
Cryotherapy is one of the most commonly performed dermatological procedures worldwide, utilizing extreme cold—most frequently liquid nitrogen at -196°C—to selectively destroy abnormal or unwanted tissue through...
Cryptococcosis
Cryptococcosis is a potentially life-threatening systemic fungal infection caused by encapsulated yeasts of the Cryptoco... MRCP exam preparation.
Crystal Arthropathies (Gout & CPPD)
Crystal arthropathies represent a group of inflammatory joint diseases caused by the deposition of crystals within synovial fluid and periarticular tissues. The two principal conditions in this category are gout...
Cubital Tunnel Syndrome
The ulnar nerve traverses five recognized sites of potential compression (Proximal to Distal):... FRCS exam preparation.
Cuboid Fracture
The cuboid bone is the keystone of the lateral column of the foot, articulating proximally with the calcaneus and distally with the fourth and fifth metatarsals. Cuboid fractures are uncommon injuries, accounting for...
Cushing's Syndrome
The most common cause worldwide is iatrogenic (exogenous glucocorticoid therapy), seen in patients receiving chronic corticosteroid treatment for inflammatory, autoimmune, or malignant conditions. Endogenous Cushing's...
Cushing's Syndrome
The pathophysiology involves systemic dysregulation of protein and fat metabolism, creating a catabolic state characterized by proximal muscle wasting, skin thinning, and paradoxical central obesity. Diagnostic...
Cystic Fibrosis in Children
Cystic fibrosis (CF) is the most common life-limiting autosomal recessive disorder affecting Caucasian populations, with... MRCPCH exam preparation.
Cytomegalovirus (CMV) Infection
Cytomegalovirus (CMV), also known as Human Herpesvirus 5 (HHV-5) , is a ubiquitous β-herpesvirus that establishes lifelong latent infection after primary exposure. CMV infection represents a critical spectrum of...
Damage Control Resuscitation
Damage Control Resuscitation (DCR) is a systematic approach to managing life-threatening hemorrhagic shock that prioriti... ACEM Fellowship Written, ACEM Fellow
Day Surgery Anaesthesia
Day surgery (ambulatory surgery) constitutes 70-80% of elective surgical procedures in Australia, requiring rapid recovery, minimal side effects, and safe discharge criteria. Patient selection: ASA 1-2 (selected ASA 3...
De Quervain's Tenosynovitis
The condition is characterized by pain and tenderness over the radial styloid, aggravated by thumb and wrist movements. It classically affects new mothers (hence "Mother's Thumb" or "Baby Wrist") due to repetitive...
Deep Vein Thrombosis (DVT)
Deep Vein Thrombosis (DVT) is a common and potentially life-threatening condition involving the formation of a thrombus ... MRCP exam preparation.
Deep Vein Thrombosis (DVT) - Adult
Deep Vein Thrombosis (DVT) is the formation of a blood clot (thrombus) within the deep venous system, most commonly affe... MRCP exam preparation.
Defibrillators and Cardioversion
Comprehensive guide to defibrillation physics, waveforms, device types, energy selection, pad placement, synchronized cardioversion, transcutaneous and transvenous pacing for CICM Second Part examination.
Deliberate Self-Harm
Deliberate self-harm affects 200-250 per 100,000 Australians annually presenting to emergency departments. It encompasse... ACEM Primary Written, ACEM Primary V
Delirium (Acute Confusional State)
Delirium is an acute, fluctuating disturbance of consciousness, attention, and cognition that represents "acute brain failure" in response to a physiological stressor. It is a medical emergency and a powerful...
Delirium in ICU
Delirium is an acute fluctuating disturbance of consciousness and cognition affecting 30-50% of ICU patients (70-80% of ... CICM Second Part exam preparation.
Delirium in ICU: Assessment, Prevention and Management
Definition (DSM-5): Acute disturbance in attention and awareness that develops over hours to days and fluctuates in s... CICM Second Part Written, CICM Secon
Delirium in the Emergency Department
Delirium affects 10-25% of older ED patients and is a medical emergency with 10-26% in-hospital mortality and 25-33% mor... ACEM Primary Written, ACEM Fellowshi
Dementia
Diagnosis requires comprehensive assessment including cognitive testing (MMSE, MoCA, ACE-III), exclusion of reversible causes (B12 deficiency, hypothyroidism, normal pressure hydrocephalus, depression), and...
Dementia with Lewy Bodies (DLB)
Dementia with Lewy Bodies (DLB) is the second most common neurodegenerative dementia after Alzheimer's disease, accounti... MRCP, USMLE exam preparation.
Dengue Fever
Dengue fever is the most prevalent mosquito-borne viral infection worldwide, caused by the dengue virus (DENV), a single... MRCP exam preparation.
Dental Abscess (Adult)
Comprehensive evidence-based guide to diagnosis and management of odontogenic infections including Ludwig angina
Dental Anaesthesia
Challenges: Airway obstruction : Surgeon's hands and instruments in airway Monitoring difficulty : Face and airway obscured by surgical drapes Limited access : Cannot easily perform laryngoscopy or adjust airway...
Depth of Anaesthesia Monitoring
Depth of anaesthesia (DoA) monitors process electroencephalogram (EEG) signals to assess the hypnotic component of general anaesthesia. The three main technologies are: (1) Bispectral Index (BIS)—algorithm combining...
Dermatitis Herpetiformis
Dermatitis herpetiformis (DH) is a chronic, intensely pruritic vesiculobullous skin disease characterized by grouped ves... MRCP exam preparation.
Dermatofibroma
While dermatofibromas are entirely benign and require no treatment in the majority of cases, they serve as important clinical entities for several reasons: they are frequent causes of patient anxiety requiring...
Dermatomyositis
Dermatomyositis (DM) is an idiopathic inflammatory myopathy characterised by the combination of proximal muscle weakness... MRCP exam preparation.
Desflurane: Pharmacology and Clinical Use
Desflurane is a fluorinated methyl ethyl ether with lowest blood/gas partition coefficient (0.42), providing most rapid emergence of volatile agents. Physical properties : High vapor pressure (669 mmHg at 20°C),...
Developmental Dysplasia of the Hip (Child)
Developmental Dysplasia of the Hip (DDH) represents a spectrum of abnormalities affecting the developing hip joint, ranging from mild acetabular dysplasia through subluxation to complete dislocation of the femoral...
Developmental Dysplasia of the Hip in Adults
Developmental Dysplasia of the Hip (DDH) in adults represents the persistence or evolution of congenital hip abnormalities that were either undetected, untreated, or inadequately treated during infancy and childhood....
Dexmedetomidine Pharmacology
Dexmedetomidine is a highly selective alpha-2 adrenoceptor agonist (α2:α1 ratio 1620:1 ) used for sedation in intensive care and procedural settings. It produces "cooperative sedation" via inhibition of noradrenergic...
Dexmedetomidine: Pharmacology and Clinical Use
Dexmedetomidine is a highly selective alpha-2 adrenergic agonist with sedative, anxiolytic, and analgesic properties. Mechanism : Acts on alpha-2A receptors in locus coeruleus (sedation), spinal cord (analgesia), and...
Diabetes Insipidus (DI)
In health, AVP is synthesised in the hypothalamus and released from the posterior pituitary in response to rising plasma osmolality or falling blood volume, promoting water reabsorption in the renal collecting ducts...
Diabetes Insipidus and SIADH: Water Balance Disorders in ICU
Confusing SIADH with cerebral salt wasting - Volume status is key: euvolemic (SIADH) vs. hypovolemic (CSW)... CICM Second Part Written, CICM Second Part Hot
Diabetic Emergencies in Children
Comprehensive evidence-based guide to diagnosis and management of diabetic ketoacidosis and hypoglycemia in pediatric patients
Diabetic Foot
Comprehensive evidence-based guide to diabetic foot disease covering pathophysiology, neuropathy, peripheral arterial disease, ulcer classification, Charcot neuroarthropathy, infection management, and multidisciplinary...
Diabetic Foot Ulcer
A Diabetic Foot Ulcer (DFU) is a full-thickness wound below the ankle in a patient with diabetes mellitus, arising from the complex interaction of peripheral neuropathy, peripheral arterial disease, and biomechanical...
Diabetic Ketoacidosis (Adult)
Diabetic Ketoacidosis (DKA) is a life-threatening acute metabolic emergency characterized by the pathognomonic triad of hyperglycemia , ketosis , and metabolic acidosis . It represents a state of absolute or relative...
Diabetic Ketoacidosis (DKA)
Diabetic Ketoacidosis represents absolute or relative insulin deficiency combined with counter-regulatory hormone excess... ACEM Fellowship Written, ACEM Fellow
Diabetic Ketoacidosis (DKA)
Diabetic Ketoacidosis (DKA) is a profound metabolic emergency defined by the biochemical triad of Hyperglycaemia, Ketona... MRCP exam preparation.
Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State
Comprehensive evidence-based guide to DKA and HHS management in the intensive care unit, covering pathophysiology, fluid resuscitation, insulin therapy, electrolyte replacement, and complications
Diabetic Nephropathy (Diabetic Kidney Disease)
Diabetic Nephropathy (DN), now comprehensively termed Diabetic Kidney Disease (DKD) , represents the leading cause of Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD) globally, accounting for...
Diabetic Retinopathy
DR progresses through distinct stages: Non-Proliferative Diabetic Retinopathy (NPDR) – subdivided into Background (R1), Pre-Proliferative (R2) – and Proliferative Diabetic Retinopathy (PDR, R3) , characterised by...
Dialysis Machines (IHD, CRRT)
Three Clearance Mechanisms: Dialysis machines remove solutes via diffusion (small molecules <500 Da), convection (... CICM Second Part Written, CICM Secon
Diazepam: Pharmacology and Clinical Applications in Anaesthesia
Diazepam is a long-acting benzodiazepine that acts as a positive allosteric modulator at the GABA-A receptor, producing anxiolysis, sedation, amnesia, and anticonvulsant effects. Its clinical utility is limited in...
Difficult Airway in ICU
ICU intubation is high-risk: Peri-intubation adverse events occur in 45% of ICU intubations (INTUBE study), including... CICM Second Part exam preparation.
Difficult Airway Management
The upper airway consists of the nasal cavity, oral cavity, pharynx, and larynx. Critical anatomical relationships determine the ease or difficulty of airway management:
Difficult Airway Management
The difficult airway occurs in 1-6% of emergency department intubations and carries mortality of 25-30% if mismanaged, p... ACEM Primary Written, ACEM Primary V
Difficult Ventilation - Can't Intubate Can't Ventilate (CICV) Management
Immediate Recognition of Can't Intubate Can't Ventilate (CICV/CICO): Failed intubation: Multiple attempts unsuccessful Failed face mask ventilation: Cannot achieve chest movement, EtCO2, or SpO2 Failed SGA rescue:...
DiGeorge Syndrome (22q11.2 Deletion Syndrome)
DiGeorge Syndrome, now more accurately termed 22q11.2 Deletion Syndrome (22q11DS), is the most common chromosomal microd... MRCPCH exam preparation.
Digoxin and Lithium Toxicity
Digoxin Na+/K+-ATPase inhibition: Results in increased intracellular Na+, which reduces the Na+/Ca2+ exchanger activi... CICM Second Part exam preparation.
Digoxin Toxicity
Digoxin toxicity occurs when serum levels exceed the therapeutic window (0.5-2.0 ng/mL), inhibiting myocardial Na+/K+ AT... ACEM Primary Written, ACEM Primary V
Digoxin Toxicity (Adult)
Gold standard evidence-based guide to digoxin toxicity covering narrow therapeutic index pharmacology, clinical recognition, ECG arrhythmias, hyperkalemia management, digoxin-specific antibody fragment therapy, and...
Dilated Cardiomyopathy (DCM)
High-Yield Points: - Always exclude reversible causes: alcohol, thyroid disease, tachycardia-induced, peripartum, inflammatory, nutritional deficiencies - Genetic testing is recommended for all DCM patients without...
Diphtheria
The diphtheria exotoxin is absorbed systemically and causes serious complications including myocarditis (Heart failure, Arrhythmias, Complete Heart Block) and neuropathy (Cranial nerve and peripheral nerve paralysis)....
Direct Oral Anticoagulants (DOACs) Pharmacology
Direct Oral Anticoagulants (DOACs), also termed Non-vitamin K Antagonist Oral Anticoagulants (NOACs), represent a pharmacological revolution in anticoagulation therapy, offering predictable pharmacokinetics, fixed...
Disaster Medicine and Mass Casualty ICU
Disaster medicine encompasses the medical response to events that overwhelm local healthcare capacity, requiring extraor... CICM Fellowship Written, CICM Fellow
Disaster Preparedness in Intensive Care
Activate Hospital Incident Command System (HICS)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Discitis & Vertebral Osteomyelitis
Discitis (also termed spondylodiscitis or vertebral osteomyelitis) represents an infection of the intervertebral disc space and adjacent vertebral bodies. This condition constitutes a diagnostic and therapeutic...
Disseminated Intravascular Coagulation
Treat the underlying cause (definitive treatment - sepsis source control, delivery in obstetric DIC)... CICM Second Part exam preparation.
Disseminated Intravascular Coagulation (DIC)
Key Facts Always secondary : DIC is never a primary diagnosis — identify and treat the underlying cause Pathophysiology : Uncontrolled thrombin generation → microthrombi formation → consumption of platelets and...
Dissociative Disorders
These disorders exist on a spectrum from transient dissociative symptoms experienced by many individuals to severe, chronic conditions such as Dissociative Identity Disorder (DID). The DSM-5 recognises four main...
Distal Femoral Fractures
Distal femoral fractures involve the distal metaphyseal and epiphyseal regions of the femur, typically within 15cm of th... FRCS Trauma & Orthopaedics exam prep
Distal Radius and Wrist Fractures (Adult)
Distal radius fractures (DRF) are the most common fractures in adults, accounting for approximately 18% of all fractures... MRCS, FRCS (Tr & Orth), FRACS exam p
Distal Radius Fracture
Exam Detail: Key Revision Focus: Radiographic parameters (11mm height, 22° inclination, 11° volar tilt), Eponyms (Colles vs Smith vs Barton), Criteria for instability (Lafontaine), and EPL rupture mechanism....
Distributive Shock (Adult)
Distributive shock is characterized by profound systemic vasodilation leading to maldistribution of blood flow and inadequate tissue perfusion despite normal or elevated cardiac output. Unlike hypovolemic or...
DNACPR & Advance Decisions
Comprehensive evidence-based guide to DNACPR decision making, legal framework (Mental Capacity Act), ReSPECT process, capacity assessment, best interests decisions, communication strategies, and ethical considerations...
DOAC-Associated Bleeding in Adults
Direct oral anticoagulants (DOACs) have revolutionized anticoagulation therapy, offering predictable pharmacokinetics wi... MRCP, FRCEM exam preparation.
Dog & Human Bites
Mammalian bites (Dog, Cat, Human) are common injuries with significant infection risk due to inoculation of polymicrobial oral flora deep into tissues. Dog bites account for 60-90% of mammalian bite injuries...
Domestic Violence and Abuse
Domestic and family violence (DFV) is a pervasive public health issue affecting 1 in 3 women and 1 in 4 men in their lif... ACEM Fellowship Written, ACEM Fellow
Donation after Brain Death (DBD) - Expanded Donor Management
Donation after Brain Death (DBD) is the process of organ retrieval following formal determination of death by neurological criteria. Brain death triggers a biphasic autonomic response : an initial catecholamine storm...
Donation After Circulatory Death (DCD)
DCD appears frequently in CICM Second Part examinations as a standalone topic or combined with end-of-life care:... CICM Second Part, FCICM exam preparation.
Down Syndrome (Trisomy 21)
Down Syndrome (DS) is the most common autosomal chromosomal abnormality and the leading genetic cause of intellectual di... MRCPCH, USMLE exam preparation.
Drowning
Key Facts Definition : Respiratory impairment from submersion/immersion in liquid (WHO 2002) Global burden : 236,000 deaths annually; 90% in low- and middle-income countries Primary injury mechanism : Hypoxia from...
Drowning - ICU Management
Day 1-3 post-drowning with ARDS requiring mechanical ventilation... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Drowning Resuscitation
Drowning is a respiratory impairment process caused by submersion/immersion in liquid, leading to hypoxia and potentiall... ACEM Primary Written, ACEM Primary V
Drug Eruptions: Stevens-Johnson Syndrome (SJS) & Toxic Epidermal Necrolysis (TEN)
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) represent severe, life-threatening mucocutaneous dru... MRCP, Emergency Medicine exam prepar
Drug Interactions in Critical Care
Drug interactions represent one of the most significant preventable causes of adverse events in the intensive care unit, affecting up to 70-80% of critically ill patients. The ICU environment is uniquely hazardous:...
Drug-Induced Liver Injury
Pattern classification is fundamental: hepatocellular (ALT-predominant), cholestatic (alkaline phosphatase-predominant), or mixed, determined by the R-ratio: (ALT/ULN) ÷ (ALP/ULN). R ≥5 indicates hepatocellular...
DRUJ Injury & TFCC Tear
The Distal Radioulnar Joint (DRUJ) is the critical pivot point for forearm rotation, contributing approximately 150° of combined pronation-supination arc. Stability is provided by the Triangular Fibrocartilage Complex...
Dupuytren's Contracture
Dupuytren's Disease is a benign, progressive fibroproliferative disorder of the palmar fascia characterized by pathologi... FRCS Orth, FRACS Orth exam preparati
Dyslipidaemia and Lipid Management
Dyslipidaemia encompasses a spectrum of lipid abnormalities characterized by elevated low-density lipoprotein cholestero... MRCP exam preparation.
Dyspepsia (Adult)
Dyspepsia is defined as epigastric pain or burning, postprandial fullness, or early satiation . It affects 10-40% of the global population , making it one of the most common reasons for gastroenterology consultations....
Dystonia
The most common form in adults is Cervical Dystonia (Spasmodic Torticollis) , affecting 5-10 per 100,000 individuals, with a female predominance (2:1) . A pathognomonic clinical feature is the "Sensory Trick" (Geste...
Eating Disorders (Anorexia, Bulimia & BED)
Anorexia Nervosa (AN): Restriction of energy intake leading to low body weight. Intense fear of gaining weight. Disturbance in body image.
Eating Disorders in Adults
Eating disorders are serious, potentially life-threatening mental health conditions characterised by persistent disturba... MRCPsych exam preparation.
ECG Monitoring in Anaesthesia
Electrocardiography (ECG) monitors cardiac electrical activity through surface electrodes that detect voltage changes generated by myocardial depolarization and repolarization. The signal represents the algebraic sum...
Eclampsia
Comprehensive evidence-based guide to the diagnosis and emergency management of eclampsia in pregnancy
ECMO Cannulation and Vascular Access
Extracorporeal membrane oxygenation (ECMO) cannulation establishes vascular access for temporary mechanical circulatory and/or respiratory support. Two configurations exist: (1) Veno-arterial (VA) - femoral vein...
ECMO Circuits and Equipment
VV-ECMO Configuration: Drains deoxygenated blood from venous system (typically femoral/jugular), passes through oxyge... CICM Second Part Written, CICM Secon
ECMO Pharmacology
Extracorporeal membrane oxygenation (ECMO) profoundly alters drug pharmacokinetics (PK) and pharmacodynamics (PD) throug... CICM Fellowship Written, CICM Fellow
ECMO/ECPR
Extracorporeal Membrane Oxygenation (ECMO) is a modified heart-lung machine providing temporary cardiopulmonary support ... ACEM Fellowship Written, ACEM Fellow
Ectopic Pregnancy
Ectopic pregnancy accounts for 1-2% of all pregnancies but remains a leading cause of maternal mortality in the first tr... ACEM Primary Written, ACEM Primary V
Ectopic Pregnancy
An ectopic pregnancy is the implantation of a fertilized ovum outside the normal uterine endometrial cavity. Over 95% of ectopic pregnancies occur in the Fallopian tube, with the ampulla being the most common site....
Eczema Herpeticum
Key Facts Aetiology : HSV-1 (85-90% of cases) or HSV-2 infection on disrupted skin barrier Risk population : Predominantly atopic dermatitis patients (especially moderate-to-severe, childhood-onset disease) Incidence...
Edwards Syndrome (Trisomy 18)
The condition carries a grave prognosis, with an estimated 50-95% of affected fetuses dying in utero, and median survival of liveborn infants ranging from 3-15 days depending on the study population. However, the...
eFAST Examination
eFAST (Extended Focused Assessment with Sonography for Trauma) is a rapid, bedside ultrasound examination to detect free... ACEM Fellowship Written, ACEM Fellow
Ehlers-Danlos Syndrome
Ehlers-Danlos Syndromes (EDS) comprise a clinically and genetically heterogeneous group of hereditary connective tissue ... MRCPCH, FRACP exam preparation.
Electrical Cardioversion
ALWAYS press SYNC button before cardioversion - asynchronous shock in R-on-T can precipitate ventricular fibrillation... ACEM Fellowship Written, ACEM Fellow
Electrical Injury and Lightning Strike
Electrical injuries cause devastating deep tissue damage, cardiac arrhythmias, and systemic complications disproportionate to visible burns. Key principles:
Electroconvulsive Therapy (ECT) Anaesthesia
Electroconvulsive therapy (ECT) involves inducing a generalized tonic-clonic seizure under general anaesthesia for treatment of severe psychiatric disorders. Anaesthetic goals : Provide brief unconsciousness (2-5...
Electrolyte Disorders in ICU
Hyponatremia correction rate: Maximum 8-10 mmol/L per 24 hours; high-risk patients (alcoholism, malnutrition, hypokal... CICM Second Part exam preparation.
Electrolyte Emergencies
Electrolyte emergencies are critical disturbances in serum potassium, sodium, calcium, or magnesium that pose immediate ... ACEM Fellowship Written, ACEM Fellow
Electrolyte Emergencies
Electrolyte emergencies are critical disturbances in serum sodium, potassium, calcium, or magnesium that pose immediate ... ACEM Primary Written, ACEM Primary V
Electrolyte Physiology
Answer: Electrolyte physiology encompasses the regulation of sodium, potassium, calcium, magnesium, phosphate, and chloride ions that are essential for cellular function, neuromuscular activity, and acid-base balance....
Emergency Delivery
Emergency delivery (precipitous birth) occurs in 1-3% of births and carries 2-5 times higher neonatal mortality than pla... ACEM Primary Written, ACEM Primary V
Emollients & Moisturisers
Emollients are medical moisturisers that form the cornerstone of therapy for all dry skin conditions including atopic de... MRCP(UK), MRCGP exam preparation.
Empyema Thoracis (Adult)
Comprehensive evidence-based guide to adult empyema thoracis covering pathophysiology, three-stage disease progression (exudative, fibrinopurulent, organizing), diagnostic criteria including Light's criteria and...
Encephalitis
Empiric acyclovir (10 mg/kg IV q8h) must be started immediately upon suspected HSV encephalitis—do NOT wait for lumba... ACEM Fellowship Written, ACEM Fellow
End of Life Care (Last Days of Life)
End of Life Care encompasses the multidimensional care provided during the last days to hours of life when a person is recognised as approaching death. This critical phase represents a transition from...
End-of-Life Care in Anaesthesia
Comprehensive guide to palliative care, organ donation in Australia/NZ, and withholding/withdrawing treatment for ANZCA Fellowship examination Professional Skills component
End-of-Life Discussions in Intensive Care
End-of-life (EOL) discussions in the intensive care unit (ICU) represent some of the most challenging and consequential ... CICM Fellowship Written, CICM Fellow
Endocrine Physiology (Adrenal, Thyroid, Pituitary)
Endocrine physiology is fundamental to understanding the stress response in critical illness, metabolic regulation, and ... CICM First Part Written, CICM First
Endometrial Cancer
This aphorism encapsulates the fundamental pathophysiology of Type I endometrial cancer, where prolonged exposure to estrogen without adequate progesterone opposition drives malignant transformation.
Endometriosis
Common anatomical sites include the ovaries (where it forms blood-filled cysts termed "endometriomas" or "chocolate cysts"), the pouch of Douglas, uterosacral ligaments, rectovaginal septum, and pelvic peritoneum....
Enteral Nutrition in Critical Care
Enteral nutrition (EN) is the preferred method of nutritional support in critically ill patients with a functioning gast... CICM Fellowship Written, CICM Fellow
Environmental Medicine - Australia
Australian environmental emergencies involve venomous snakes, spiders, and marine creatures unique to our region. Snake ... ACEM Fellowship Written, ACEM Fellow
Ephedrine Pharmacology
Ephedrine is a non-catecholamine sympathomimetic amine with both direct and indirect actions at alpha and beta adrenergic receptors. It is a naturally occurring alkaloid found in plants of the Ephedra species....
Epidermoid & Pilar Cysts
Epidermoid and pilar (trichilemmal) cysts are the most common cutaneous cysts encountered in clinical practice, often incorrectly termed "sebaceous cysts." This terminology is a misnomer because these cysts contain...
Epididymo-orchitis
Epididymo-orchitis is an acute or chronic inflammatory condition affecting the epididymis and/or testis, representing th... MRCP, FRCS, PLAB exam preparation.
Epidural Anaesthesia
Epidural anaesthesia involves injection of local anaesthetic into the epidural space (potential space between ligamentum flavum and dura) producing segmental sensory block with less motor block than spinal. Anatomy:...
Epilepsy in Adults: Clinical Diagnosis and Management
1.1 Summary Epilepsy is defined by the International League Against Epilepsy (ILAE) as a disease of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiological,...
Epilepsy Surgery and Awake Craniotomy
Epilepsy surgery requires seamless transitions between general anaesthesia (GA), conscious sedation, and awake cooperative states to enable intraoperative electrocorticography (ECoG) and functional cortical mapping....
Epistaxis (Nosebleed)
Epistaxis (nosebleed) is bleeding from the nasal cavity, affecting up to 60% of the population at some point in their li... MRCS, MRCP exam preparation.
Erectile Dysfunction
Erectile dysfunction (ED) is defined as the persistent or recurrent inability to achieve and/or maintain an erection suf... MRCS exam preparation.
Erector Spinae Plane Block
Composition: The erector spinae is a large, complex muscle group located posterior to the vertebral column, consisting of three columns:
Erysipelas
Primary Pathogen : Group A Streptococcus ( Strep pyogenes ) - 80-90% of cases Secondary Pathogens : Group G/C Streptococcus ( S. dysgalactiae ) - increasingly recognized Anatomical Depth : Upper dermis and superficial...
Erythema Multiforme
Historically, EM was incorrectly grouped with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) as part of a single disease spectrum. Current evidence firmly establishes EM as a distinct entity with...
Erythema Nodosum
The condition demonstrates female predominance (3-6:1) with peak incidence in the third and fourth decades. Löfgren's syndrome—the triad of erythema nodosum, bilateral hilar lymphadenopathy, and...
Esophageal Foreign Body
Emergency diagnosis and management of esophageal foreign body ingestion in adults
Essential Tremor
Essential tremor (ET) is the most common movement disorder worldwide, with prevalence estimates ranging from 0.9% in the... MRCP exam preparation.
Ethanol Toxicity
Ethanol toxicity ranges from mild intoxication to life-threatening withdrawal, hypoglycaemia, and Wernicke encephalopath... ACEM Primary Written, ACEM Primary V
Ethics, Consent, and Capacity in Anaesthesia
Comprehensive guide to informed consent, capacity assessment, advance directives, and refusal of treatment for ANZCA Fellowship examination Professional Skills component
Etomidate Pharmacology
Etomidate is an imidazole-derived intravenous anaesthetic agent distinguished by its remarkable haemodynamic stability, making it the induction agent of choice for patients with cardiovascular compromise or...
Evidence-Based Medicine and Research in Anaesthesia
Evidence-based medicine (EBM) integrates individual clinical expertise with the best available external clinical evidence from systematic research. Hierarchy of evidence : Systematic reviews and meta-analyses of RCTs...
Ewing's Sarcoma
Histologically, Ewing's sarcoma belongs to the Ewing sarcoma family of tumours (ESFT) , characterized as a "small round blue cell tumour" with a pathognomonic molecular signature: the EWSR1-FLI1 fusion gene resulting...
Exomphalos (Omphalocele)
Exomphalos (also known as omphalocele) is a congenital anterior abdominal wall defect in which abdominal contents (bowel, liver, spleen, and occasionally other organs) herniate through the umbilical ring and are...
Extensor Tendon Injuries
The extensor mechanism differs fundamentally from the flexor system: extensors form an interconnected aponeurotic network rather than discrete tendons in sheaths, making them more vulnerable to adhesion but also...
Extensor Tendonitis of the Foot
This condition manifests as pain and swelling over the dorsum (top) of the foot and ankle, exacerbated by activities involving repetitive ankle dorsiflexion—running (especially uphill), prolonged walking, dancing, or...
External Ventricular Drain
An external ventricular drain (EVD), also known as a ventriculostomy, is a temporary catheter placed into the lateral ve... CICM Second Part exam preparation.
Extracorporeal Membrane Oxygenation
VV-ECMO for severe ARDS: Indications, timing, patient selection, management strategies... CICM Second Part exam preparation.
Extracorporeal Membrane Oxygenation (ECMO): VV and VA Configurations, Cannulation, and Management
Extracorporeal Membrane Oxygenation (ECMO) provides temporary cardiopulmonary support by draining venous blood, removing carbon dioxide and adding oxygen through a membrane oxygenator, and returning oxygenated blood...
Extradural Haematoma
The classic presentation features the "lucid interval" an initial brief loss of consciousness following trauma, apparent recovery to near-normal neurological status, followed by rapid deterioration as the haematoma...
Extradural Haemorrhage (Epidural Haematoma)
Extradural Haemorrhage (EDH), also known as epidural haematoma, is a neurosurgical emergency characterised by arterial b... MRCP, FRCS Neurosurgery exam prepara
Extrapyramidal Side Effects (EPS)
Recognition of EPS is paramount for the clinician. These effects not only cause profound physical and psychological distress but are also the primary drivers of medication non-adherence, leading to disease relapse....
Extubation Criteria
Extubation is the planned removal of an endotracheal tube after determining a patient can maintain adequate spontaneous ... ACEM Primary Written, ACEM Fellowshi
Eye Anatomy and Pupillary Reflexes
Overview - Pupil anatomy and control mechanisms... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Facial Lacerations
Evidence-based emergency diagnosis and management of facial lacerations in adults
Factitious Disorder (Munchausen Syndrome)
Factitious Disorder is a complex psychiatric condition characterized by the intentional production, feigning, or exaggeration of physical or psychological symptoms with the primary motivation being to assume the "sick...
Failed Intubation Drill
Failed intubation occurs in 1-3% of emergency department intubations and can rapidly deteriorate to a CICO (Can't Intuba... ACEM Primary Written, ACEM Primary V
Failed Spinal Anaesthesia: Management Options and Intubation Strategy
Failed spinal anaesthesia occurs in 1-5% of caesarean sections , with complete failure reported in 0.5-1% of cases. When spinal anaesthesia fails to provide adequate surgical anaesthesia, the anaesthetist must rapidly...
Falls in Elderly Adults
Comprehensive evidence-based guide to falls in older adults covering multifactorial assessment, falls history, investigations, and multifactorial interventions including exercise, medication review, home hazard...
Family Conferences and Communication in ICU
70-90% of ICU Deaths Involve Treatment Decisions: Most deaths in ICU are preceded by decisions to limit or withdraw t... CICM Second Part Written, CICM Secon
Fanconi Syndrome
The clinical hallmarks include: Renal glycosuria despite normoglycaemia Generalised aminoaciduria Phosphaturia leading to hypophosphataemic rickets/osteomalacia Type 2 (proximal) renal tubular acidosis from...
Fat Embolism Syndrome
Key Facts Timing : 12-72 hours after injury (peak 24-48 hours; rarely less than 12 hours or >1 week) Classic triad : Respiratory insufficiency (75-95%) + neurological dysfunction (60-80%) + petechial rash (20-50%)...
Febrile Convulsion (Febrile Seizure) in Children
Febrile convulsions are seizures occurring in children aged 6 months to 5 years, associated with fever (temperature ≥38°... MRCPCH exam preparation.
Febrile Seizures in Children
Comprehensive evidence-based guide to diagnosis, classification, investigation, and management of febrile seizures in the paediatric population
Femoral Hernia
The clinical presentation ranges from asymptomatic groin swelling detected incidentally to acute surgical emergencies with bowel obstruction and peritonitis. Physical examination revealing a lump below and lateral to...
Femoral Nerve Block
Origin and Course: Formed from : L2-L4 lumbar plexus (posterior divisions) Exits : Lateral border psoas muscle Passes : Beneath inguinal ligament Position : Lateral to femoral artery, deep to fascia iliaca,...
Femoral Shaft Fractures
Modern management is universally surgical, with intramedullary nailing (IMN) being the gold standard treatment, achieving union rates exceeding 95%. Early definitive fixation (within 24 hours) in physiologically...
Fentanyl
Fentanyl is a synthetic phenylpiperidine opioid agonist with 100× potency of morphine and rapid onset (1-2 minutes IV), making it ideal for intraoperative analgesia and balanced anaesthesia. Mechanism: Selective...
Fetal Alcohol Spectrum Disorder (FASD)
FASD represents the leading preventable cause of intellectual disability in the developed world. There is no known safe level of alcohol consumption during pregnancy — the safest approach is complete abstinence. The...
Fetal and Neonatal Physiology
The CICM First Part examination frequently tests fetal and neonatal physiology as it underpins understanding of duct-dep... CICM First Part Written, CICM First
Fibroadenoma
Diagnosis requires triple assessment comprising clinical examination, imaging (ultrasound in women less than 40 years, mammography in older women), and tissue sampling via core needle biopsy. The majority of...
Fibromyalgia
Management is multidisciplinary and centres on patient education, graded aerobic exercise, and pharmacological interventions targeting central pain mechanisms (tricyclic antidepressants, serotonin-norepinephrine...
Flexible Bronchoscopy in ICU
Red Flag Warning: Hypoxemia and hemodynamic instability are the most common life-threatening complications. Always pre-oxygenate with 100% FiO₂, monitor vital signs continuously, and have immediate airway rescue...
Flexor Hallucis Longus (FHL) Tendonitis
The FHL is unique anatomically as it passes through a fibro-osseous tunnel at the posterior ankle, curves around the sustentaculum tali, and crosses the Flexor Digitorum Longus (FDL) at the Knot of Henry . These...
Flexor Tendon Injuries
Modern management has evolved dramatically from the nihilistic "benign neglect" approach of the 1950s to sophisticated primary repair techniques. The cornerstone of contemporary surgical treatment involves 4-strand or...
Fluid and Electrolyte Physiology
Total body water (TBW) is approximately 60% body weight in males, 50% in females, 65-70% in infants, 50% in elderly. Distribution : 2/3 intracellular (ICF), 1/3 extracellular (ECF). ECF divided into interstitial fluid...
Fluid Compartments & Distribution
Answer: Total body water (TBW) comprises approximately 60% of body weight in adult males (42L in a 70kg individual), distributed between the intracellular fluid (ICF) compartment (40% body weight, 2/3 TBW, 28L) and...
Flumazenil Pharmacology
Flumazenil is a competitive benzodiazepine antagonist at the GABA-A receptor benzodiazepine binding site. Chemically classified as an imidazobenzodiazepine, it reverses the sedative, anxiolytic, and amnestic effects...
Focal Seizures (Partial Seizures)
Focal seizures originate from a localized area within one cerebral hemisphere, representing approximately 60% of all epilepsy cases. The International League Against Epilepsy (ILAE) 2017 classification replaced the...
Foreign Body Airway Obstruction - Paediatric
Immediate Action : If conscious with ineffective cough → Call for help, 5 back blows, 5 chest thrusts (infants: chest thrusts only, no abdominal thrusts). If unconscious → Start CPR, check mouth for visible object...
Foreign Body Aspiration - Acute Upper Airway Obstruction and Bronchoscopy
Foreign body aspiration is the inhalation of objects into the airway, most commonly affecting children aged 1-3 years (peak incidence). It is a life-threatening emergency requiring prompt diagnosis and intervention....
Foreign Body Aspiration (Adult)
Foreign body aspiration (FBA) is the inhalation of exogenous material into the larynx or tracheobronchial tree, represen... MRCP exam preparation.
Foreign Body Nasal - Paediatric
Nasal foreign bodies are common paediatric emergencies, peaking at 2-5 years. Immediate airway assessment is critical, e... ACEM Fellowship Written, ACEM Fellow
Fournier's Gangrene
Fournier's gangrene is a rare but life-threatening form of necrotising fasciitis affecting the perineum, genitalia, and ... MRCS, MRCP exam preparation.
Fournier's Gangrene
Fournier's Gangrene is a fulminant, life-threatening necrotising fasciitis of the perineum, genitalia, and perianal regi... FRCS exam preparation.
Fragile X Syndrome (Child)
Fragile X Syndrome (FXS) is the Most Common Inherited Cause of Intellectual Disability and the Most Common Single-Gene Cause of Autism Spectrum Disorder (ASD) . It is an X-Linked Dominant Disorder caused by a CGG...
Freiberg Infraction
Key Facts The Victim : The classic patient is a 14-year-old female athlete (dancer, gymnast, or runner) presenting with insidious onset forefoot pain. The Site : Second metatarsal head in 68% of cases, third...
Friedreich's Ataxia
The disease typically manifests before age 25 years (mean onset 10-15 years) with progressive gait ataxia, followed by limb ataxia, dysarthria, sensory loss, and loss of deep tendon reflexes. The pathognomonic...
Frontotemporal Dementia
FTD encompasses three main clinical syndromes: behavioral variant FTD (bvFTD), semantic variant primary progressive aphasia (svPPA), and nonfluent variant primary progressive aphasia (nfvPPA). The underlying...
Frozen Shoulder (Adhesive Capsulitis)
The hallmark pathological feature is capsular contracture with loss of the axillary recess , leading to global restriction of shoulder movement following a characteristic capsular pattern (External Rotation Abduction...
Functional Neurological Disorder (FND)
Functional Neurological Disorder (FND) represents one of the most common and challenging presentations in neurology and ... MRCPsych, MRCS exam preparation.
Funnel-Web Spider Envenomation
Funnel-web spider envenomation is a life-threatening emergency caused by delta-hexatoxin (robustoxin) from the Sydney Fu... ACEM Primary Written, ACEM Primary V
Futility and Ethics Consultation in Intensive Care
Futility and ethics consultation appear frequently in CICM examinations:... CICM Second Part Written, CICM Second Part Viva exam preparation.
Gabapentinoids Pharmacology (Gabapentin and Pregabalin)
Gabapentinoids (gabapentin and pregabalin) are anticonvulsant medications that bind to the α2δ subunit of voltage-gated calcium channels (VGCCs) , reducing presynaptic calcium influx and neurotransmitter release...
Galeazzi Fracture-Dislocation
A Galeazzi fracture-dislocation is a fracture of the distal third of the radius (typically within 7.5 cm of the radiocar... FRCS Orth, FRACS Orth exam preparati
Gallstones (Cholelithiasis)
The pathophysiology centres on supersaturation of bile with cholesterol or bilirubin, leading to nucleation and crystal aggregation. Approximately 75-80% of gallstones are cholesterol stones, while 15-20% are pigment...
Gamekeeper's Thumb (UCL Injury)
Gamekeeper's thumb refers to insufficiency of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (MCP)... MRCS exam preparation.
Gamma-Hydroxybutyric Acid (GHB) Toxicity
GHB toxicity presents with rapid-onset CNS depression (GCS often 3), respiratory depression, bradycardia, hypothermia, a... ACEM Primary Written, ACEM Primary V
Ganglion Cyst
While the diagnosis is predominantly clinical, ganglion cysts pose both cosmetic and functional concerns for patients. The natural history is remarkably benign: approximately 50% resolve spontaneously , particularly...
Ganglion Cyst (Foot)
A ganglion cyst is the most common benign soft tissue mass of the foot and ankle, accounting for approximately 18-22% of all foot soft tissue tumors. It is a cystic structure filled with mucinous, gelatinous fluid...
Gas Laws in Anaesthesia - Boyle's, Charles', Dalton's, Henry's, Graham's, Fick's
Gas laws form the foundation of respiratory physiology and anaesthetic practice. Boyle's law (P₁V₁ = P₂V₂) describes the inverse relationship between pressure and volume at constant temperature, governing lung...
Gastric Cancer
The strongest modifiable risk factor is chronic infection with Helicobacter pylori , classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC). Other significant risk factors include...
Gastritis
The most clinically significant forms are Type B (bacterial) gastritis caused by Helicobacter pylori infection and Type A (autoimmune) gastritis associated with parietal cell antibodies. Chronic gastritis represents a...
Gastritis and Peptic Ulcer Disease
Comprehensive evidence-based review of gastritis and peptic ulcer disease, including pathophysiology, diagnosis, H. pylori eradication, and management of complications
Gastro-Oesophageal Reflux Disease
Gastro-oesophageal reflux disease (GORD) is defined as a condition that develops when reflux of gastric contents causes ... MRCP, USMLE exam preparation.
Gastro-Oesophageal Reflux Disease (GORD)
GORD represents one of the most common gastrointestinal disorders in Western populations, with significant impact on quality of life and healthcare costs. The condition exists on a spectrum from Non-Erosive Reflux...
Gastrointestinal Physiology
The gastrointestinal tract performs four critical functions: motility (propulsion and mixing), secretion (digestive enzy... CICM First Part Written, CICM First
Gastroparesis
The cardinal symptoms are nausea ( 90%), vomiting (particularly of undigested food hours after eating), early satiety , postprandial fullness , bloating , and abdominal pain . These symptoms are often debilitating and...
Gastroschisis
Gastroschisis is a congenital abdominal wall defect characterised by herniation of abdominal viscera through a full-thic... MRCPCH exam preparation.
Gender Dysphoria (Gender Incongruence)
Gender Dysphoria is the clinical distress caused by a discrepancy between a person's Gender Identity (internally experienced gender) and their Sex Assigned at Birth . The condition is characterized by marked...
General Anaesthesia Induction
General anaesthesia induction is the transition from consciousness to unconsciousness with loss of protective airway reflexes, requiring controlled manipulation of physiology and airway management. Rapid sequence...
Generalised Anxiety Disorder (GAD)
GAD affects approximately 5-6% of the population during their lifetime, with a 2:1 female predominance . The condition typically begins in early adulthood (peak onset 30s-40s), though childhood and adolescent onset is...
Generalised Anxiety Disorder (GAD)
GAD affects approximately 5-6% of people over their lifetime, with a 12-month prevalence of 2-3%. It is the most common anxiety disorder in primary care and represents a significant burden due to its chronic,...
Generalised Epilepsy
Generalised epilepsies account for approximately 30-40% of all epilepsy cases, with a strong genetic component in many subtypes, leading to the term "genetic generalised epilepsies" (GGE) replacing the older...
Generalized Anxiety Disorder (GAD)
The core pathology involves dysregulation of the amygdala-prefrontal cortex circuit, with deficits in GABAergic inhibition and Serotonin signaling. Patients live in a state of constant "Fight or Flight" arousal,...
Generalized Anxiety Disorder (GAD)
Generalized Anxiety Disorder (GAD) is a pervasive, chronic mental health condition defined by excessive, uncontrollable ... MRCPsych exam preparation.
Genital Herpes (HSV)
Genital herpes is a chronic, lifelong sexually transmitted infection caused by herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). It is characterized by painful genital ulceration during primary and recurrent...
Genitourinary Syndrome of Menopause (GSM)
GSM encompasses vaginal, vulval, and urinary symptoms including vaginal dryness, dyspareunia, vulval irritation, recurre... MRCOG, DFSRH exam preparation.
Gentamicin Prescribing in Adults
Gentamicin is a bactericidal aminoglycoside antibiotic with potent activity against aerobic Gram-negative bacteria, including Pseudomonas aeruginosa . It is characterized by:
Gestational Diabetes Mellitus (GDM)
GDM is distinct from pre-existing diabetes mellitus (Type 1 or Type 2) diagnosed before pregnancy. The condition typically resolves within hours to days of placental delivery, as the primary driver of insulin...
Giant Cell Arteritis (GCA)
Giant Cell Arteritis (GCA) is a chronic, systemic, granulomatous vasculitis of large and medium-sized arteries, preferen... MRCP exam preparation.
Giant Cell Arteritis (Temporal Arteritis)
A comprehensive, evidence-based guide to Giant Cell Arteritis, covering emergency management of visual loss, temporal artery ultrasound, tocilizumab therapy, and steroid-sparing strategies. Essential reading for MRCP,...
Giardiasis
Transmission occurs primarily via the fecal-oral route through ingestion of infectious cysts in contaminated water, food, or via person-to-person contact. The infection is particularly prevalent among travelers to...
Gilbert's Syndrome
Gilbert's Syndrome (GS) is a common, benign, hereditary condition characterized by mild, intermittent unconjugated hyper... MRCP, USMLE exam preparation.
Glaucoma (Adult)
Glaucoma is a group of progressive optic neuropathies characterised by structural damage to the optic nerve head and ret... FRCOphth exam preparation.
Glioblastoma (GBM)
Glioblastoma is the most common and most aggressive primary malignant brain tumour in adults, representing approximately 45-50% of all malignant primary brain tumours. It is classified as a WHO Grade 4 astrocytoma...
Glomerulonephritis
Glomerulonephritis (GN) represents a heterogeneous group of immune-mediated kidney diseases characterised by inflammatio... MRCP exam preparation.
Glomerulonephritis (Nephritic Syndrome)
Glomerulonephritis (GN) represents a heterogeneous group of immune-mediated disorders characterized by inflammation of the glomeruli, the microscopic filtration units of the kidney. The condition classically presents...
Glomus Tumor (Subungual)
A Glomus Tumor is a rare, benign, but exquisitely painful vascular neoplasm arising from the glomus body (Sucquet-Hoyer canal). The glomus body is a specialized arteriovenous anastomosis involved in thermoregulation,...
Glucagonoma
Dermatosis – Necrolytic Migratory Erythema (NME) Diabetes Mellitus – usually mild to moderate Deep Vein Thrombosis – hypercoagulable state Depression – neuropsychiatric manifestations
Glyceryl Trinitrate (GTN) Pharmacology
Glyceryl trinitrate (GTN), also known as nitroglycerin, is an organic nitrate vasodilator that has been used clinically for over 150 years for the treatment of angina pectoris and heart failure. It is a triester of...
Glycopyrrolate
Glycopyrrolate is a quaternary ammonium anticholinergic agent with peripheral muscarinic receptor antagonism, used primarily to counteract muscarinic side effects of anticholinesterases during neuromuscular blockade...
Glycopyrrolate Pharmacology
Glycopyrrolate (glycopyrronium bromide) is a synthetic quaternary ammonium anticholinergic agent that acts as a competitive muscarinic receptor antagonist at M1, M2, and M3 receptor subtypes. Its quaternary ammonium...
Golfer's Elbow (Medial Epicondylitis)
Medial Epicondylitis ("Golfer's Elbow") is a degenerative overuse tendinopathy affecting the Common Flexor Origin (CFO) at the medial epicondyle of the humerus. Despite its colloquial name, over 90% of cases are...
Gonorrhoea
The organism is an obligate human pathogen that primarily infects mucosal surfaces lined by columnar or cuboidal epithelium: Urethra, Endocervix, Rectum, Pharynx, and Conjunctiva . Stratified squamous epithelium...
Goodpasture's Disease (Anti-GBM)
Goodpasture's disease (anti-GBM disease) is a rare but life-threatening autoimmune disorder characterized by circulating antibodies directed against the α3 chain of type IV collagen in the glomerular basement membrane...
Gout and Crystal Arthropathies
Gout is the most common inflammatory arthritis worldwide, affecting approximately 2.5% of adults in developed countries. It is a crystal deposition disease caused by the precipitation of Monosodium Urate (MSU)...
Granulomatosis with Polyangiitis (GPA)
A comprehensive, evidence-based guide to Granulomatosis with Polyangiitis (GPA), covering c-ANCA/PR3 pathogenesis, pulmonary-renal syndrome, necrotising granulomatous inflammation, and modern immunosuppressive therapy...
Graves' Disease
Diffuse thyroid hyperplasia (smooth, diffusely enlarged goitre) Graves' Ophthalmopathy (Thyroid Eye Disease) - present in 25-50% of patients Pretibial myxoedema (dermopathy) - rare, less than 5% of cases Thyroid...
Greater Trochanteric Pain Syndrome (GTPS)
GTPS affects approximately 1.8-3.3 per 1000 patients annually, with a cumulative prevalence of 10-25% in the general adult population. The condition demonstrates a marked female predominance (female:male ratio of 4:1)...
Greenstick Fracture in Children
A greenstick fracture is an incomplete fracture of long bones unique to the paediatric skeleton, characterized by cortical breach on the tension (convex) side while the compression (concave) side remains intact. The...
Grief and Bereavement
Grief is the universal, multi-dimensional response to loss, encompassing emotional, cognitive, behavioural, somatic, and spiritual dimensions. While most individuals (approximately 90%) navigate the grieving process...
Group B Streptococcus in Pregnancy
Group B Streptococcus (GBS, Streptococcus agalactiae ) is a gram-positive, β-hemolytic bacterium that colonizes the gastrointestinal and genitourinary tracts of approximately 18-20% of pregnant women worldwide. While...
Growth Failure (Short Stature)
Comprehensive evidence-based guide to evaluation and management of growth failure in children, covering auxological assessment, differential diagnosis, investigation protocols, and growth hormone therapy indications...
Guillain-Barré Syndrome
\u003e One-liner: Guillain-Barré Syndrome is an acute immune-mediated polyradiculoneuropathy causing rapidly ascending f... CICM Second Part exam preparation.
Guillain-Barré Syndrome
The pathophysiology involves molecular mimicry, where antibodies generated against infectious agents cross-react with peripheral nerve components, leading to demyelination (in acute inflammatory demyelinating...
Guillain-Barré Syndrome
GBS is the most common cause of acute flaccid paralysis worldwide, affecting 1-2 people per 100,000 annually. Up to 30% ... ACEM Fellowship Written, ACEM Fellow
Guillain-Barré Syndrome (Adult)
Guillain-Barré Syndrome (GBS) is an acute, post-infectious, immune-mediated polyneuropathy representing the most common ... MRCP exam preparation.
Gynaecomastia
Physiological gynaecomastia occurs at three life stages: Neonatal (transplacental maternal oestrogen exposure, resolves within weeks), Pubertal (transient oestrogen-androgen imbalance, affects 60% of boys aged 10-16...
Haemodynamic Monitoring in ICU
Comprehensive guide to invasive and non-invasive haemodynamic monitoring techniques in critically ill patients, including arterial lines, central venous pressure, pulmonary artery catheters, pulse contour analysis,...
Haemodynamics: Blood Flow, Pressure, and Resistance
Haemodynamics describes blood flow through the cardiovascular system based on pressure gradients and vascular resistance. Poiseuille's Law: Q = ΔP × πr⁴ / (8ηL), where Q = flow, ΔP = pressure gradient, r = vessel...
Haemolytic Uraemic Syndrome (HUS)
Haemolytic Uraemic Syndrome (HUS) is a thrombotic microangiopathy (TMA) characterized by the classic triad of:... MRCPCH exam preparation.
Haemophagocytic Lymphohistiocytosis
Haemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome characterized by pathological... MRCP, USMLE Step 2/3 exam preparatio
Haemophilia (Adult)
Haemophilia is a group of X-linked recessive bleeding disorders characterized by deficiency of specific clotting factors in the intrinsic coagulation pathway. It represents the archetypal "deep tissue bleeding...
Haemoptysis
Comprehensive evidence-based guide to the diagnosis and management of haemoptysis in adults
Haemorrhoids (Adult)
A comprehensive, evidence-based clinical guide to haemorrhoids (piles) for postgraduate surgical training. Covers anatomy, Goligher classification, office-based treatments (rubber band ligation, sclerotherapy),...
Hallux Fracture
Fractures of the hallux (great toe) are common foot injuries resulting from direct trauma (dropping heavy objects), stubbing mechanisms (axial load), or hyperextension injuries. Unlike lesser toes, the hallux plays a...
Hallux Rigidus
The pathognomonic feature is the formation of large dorsal osteophytes (bone spurs) on the metatarsal head that create a mechanical block to dorsiflexion, causing impingement pain during the terminal stance phase of...
Hallux Valgus (Bunion)
Exam Detail: Key Revision Focus: Radiographic angles (HVA, IMA, DMAA). Joint Congruency vs Incongruency. Algorithm for Osteotomy Selection (Chevron vs Scarf vs Lapidus vs Akin). Complications (AVN, Hallux Varus,...
Hand Infections
Unlike infections elsewhere in the body, hand infections carry an exceptionally high risk of permanent disability if not recognized and treated urgently. The tendon nutrition depends on synovial fluid circulation and...
Hand Injuries
Comprehensive emergency diagnosis and management of acute hand injuries including high-pressure injection, tendon injuries, fractures, and fight bites
Hand, Foot and Mouth Disease (Child)
Hand, Foot and Mouth Disease (HFMD) is a highly contagious viral illness predominantly affecting children under 5 years of age , characterised by the classical triad of painful oral ulcers , vesicular rash on hands...
Hashimoto's Thyroiditis
Comprehensive, evidence-based guide to Hashimoto's Thyroiditis covering molecular pathophysiology, autoantibody testing, Levothyroxine management, pregnancy considerations, and complications including thyroid lymphoma.
Head Injury (Adult Traumatic Brain Injury)
Evidence-based emergency diagnosis and management of head injury and traumatic brain injury in adults
Head Lice (Paediatric)
Head lice infestation (Pediculosis Capitis) is caused by Pediculus humanus capitis , a small obligate ectoparasitic insect that lives exclusively on the human scalp and feeds on blood. Head lice are extremely common...
Headache in Children
Headache is one of the most common neurological complaints in childhood, affecting up to 75% of children by age 15 years. While parental anxiety frequently centres on the possibility of brain tumours, more than 90% of...
Headache Red Flags
Headache is a common ED presentation (2-4% of all visits), but 1-4% harbour life-threatening pathology. The SNOOP mnemon... ACEM Fellowship Written, ACEM Fellow
Health Advocacy in Emergency Medicine
One-liner : Health advocacy in emergency medicine is the systematic identification and mitigation of barriers to optimal patient care through individual, institutional, and systemic action.
Health Anxiety (Illness Anxiety Disorder)
Health Anxiety, classified in DSM-5 as Illness Anxiety Disorder (IAD) or Somatic Symptom Disorder (SSD) depending on presentation, is a condition characterised by Preoccupation with Having or Acquiring a Serious,...
Health Literacy and Patient Education in ICU
Assume universal low health literacy - Use plain language with everyone... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Healthcare-Acquired Infections
ICU Impact: HAIs affect 10-30% of ICU patients, associated with 2-3-fold increased mortality, prolonged ICU stay (median +8 days), and excess healthcare costs (AUD 18,000-50,000 per case).
Hearing Loss in Adults
Hearing loss is one of the most prevalent chronic conditions affecting adults worldwide, with profound implications for quality of life, cognitive function, and social participation. Approximately 1.5 billion people...
Heart Block (AV Block)
Atrioventricular (AV) block represents impaired electrical conduction between the atria and ventricles, ranging from mild PR interval prolongation (first-degree) to complete absence of AV conduction (third-degree or...
Heart Failure
Heart Failure (HF) is a complex clinical syndrome characterised by the heart's inability to maintain sufficient cardiac ... MRCP exam preparation.
Heart Failure with Preserved Ejection Fraction (HFpEF)
Heart Failure with Preserved Ejection Fraction (HFpEF) is a clinical syndrome characterised by symptoms and signs of hea... MRCP exam preparation.
Heart Failure with Reduced Ejection Fraction (HFrEF)
The pathophysiology involves initial myocardial injury (commonly from ischaemic heart disease in 60-70% of cases) followed by maladaptive neurohormonal activation, ventricular remodelling, and progressive cardiac...
Heat Emergencies
Critical Alerts Heat stroke is life-threatening : Core temp ≥40°C (104°F) + CNS dysfunction Rapid cooling is essential : Target less than 39°C within 30 minutes Classic vs Exertional heat stroke : Different...
Heat Illness Prevention
Acclimatization reduces heat illness risk by 40-60% and requires 7-14 days of progressive heat exposure with earlier ... ACEM Fellowship Written, ACEM Fellow
Heat Stroke in Adults
Comprehensive evidence-based guide to the diagnosis and emergency management of heat stroke in adults, including pathophysiology, cooling methods, and multi-organ complications
Helicobacter Pylori
Key Facts Global Prevalence : 4.4 billion people infected worldwide (58% of global population), with marked geographic variation (20-30% in developed nations, 70-90% in developing countries). Discovery : Nobel Prize...
HELLP Syndrome
Maternal stabilisation: Airway, breathing, circulation with blood product support... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Henoch-Schönlein Purpura (IgA Vasculitis)
Henoch-Schönlein Purpura (HSP), now formally known as IgA Vasculitis (IgAV) , is the most common systemic vasculitis in children , with an incidence of 10-20 per 100,000 children per year. It is a small vessel...
Heparin-Induced Thrombocytopenia
STOP ALL HEPARIN (including flushes, heparin-coated catheters, LMWH)... CICM Second Part exam preparation.
Heparin-Induced Thrombocytopenia (HIT)
The hallmark of HIT is the combination of: Thrombocytopenia (platelet drop 50% from baseline) Timing (5-10 days after heparin initiation, or less than 24 hours if recent prior exposure) Thrombosis (30-50% of untreated...
Hepatic Drug Dosing in ICU
Answer: Hepatic drug dosing in critical illness requires understanding of liver physiology, drug metabolism pathways, and the impact of liver disease on pharmacokinetics. The liver receives 25-30% of cardiac output...
Hepatic Encephalopathy
Domain Key Focus Areas ------------ --------------------- Classification Type A/B/C, West Haven Grades 0-4, Covert vs Overt HE Pathophysiology Ammonia-glutamine-astrocyte swelling hypothesis, neuroinflammation,...
Hepatic Encephalopathy
The clinical course is typically episodic, often precipitated by identifiable triggers including infection (particularly spontaneous bacterial peritonitis), gastrointestinal bleeding, constipation, electrolyte...
Hepatic Encephalopathy in Adults
Comprehensive evidence-based guide to hepatic encephalopathy diagnosis, classification, and management in adults with chronic liver disease
Hepatic Failure Pathology
Acute liver failure (ALF) is defined as severe hepatic dysfunction with coagulopathy (INR ≥1.5) and encephalopathy in a patient without pre-existing liver disease, developing within 26 weeks of symptom onset....
Hepatic Physiology
The liver is the largest solid organ (1.5 kg) performing over 500 functions including metabolism, detoxification, protein synthesis, and bile production. Blood supply: Dual supply from hepatic artery (25% flow, 50%...
Hepatic Physiology
The liver is the largest solid organ (1.4-1.8 kg), receiving 25% of cardiac output through a unique dual blood supply: p... CICM First Part Written, CICM First
Hepatitis A
The disease demonstrates significant geographic variation in endemicity, with high prevalence in regions with poor sanitation and hygiene infrastructure. In developed countries, most cases are imported through...
Hepatitis B (Adult)
Hepatitis B virus (HBV) is a partially double-stranded DNA hepatotropic virus of the Hepadnaviridae family that causes both acute and chronic liver disease. Unlike other hepatitis viruses, HBV establishes a persistent...
Hepatitis C
Transmission occurs predominantly via parenteral exposure : injection drug use (IVDU), blood transfusions prior to universal screening (pre-1992 in the UK, pre-1990 in the USA), needlestick injuries, vertical...
Hepatocellular Carcinoma (HCC)
The major risk factors are chronic viral hepatitis (hepatitis B virus [HBV] and hepatitis C virus [HCV]), alcohol-related liver disease, and increasingly non-alcoholic steatohepatitis (NASH), now termed metabolic...
Hepatorenal Syndrome (HRS)
Volume expansion with 20-25% albumin (1 g/kg/day for 2 days, max 100g/day)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Hepatorenal Syndrome (HRS)
HRS occurs almost exclusively in the context of decompensated cirrhosis with ascites, though it can occasionally complicate acute liver failure and alcoholic hepatitis. The syndrome carries an extremely poor...
Hereditary Haemochromatosis
Hereditary haemochromatosis (HH) is an autosomal recessive disorder of iron metabolism characterized by excessive intest... MRCP exam preparation.
Herpes Zoster (Shingles)
Herpes zoster (shingles) results from reactivation of latent varicella zoster virus (VZV) from dorsal root, cranial nerv... MRCP, PLAB exam preparation.
Hiatus Hernia
The condition exists on a spectrum from incidental radiological findings to symptomatic disease requiring surgical correction. Type I (sliding) hernias account for approximately 95% of cases and are primarily...
Hidradenitis Suppurativa
The disease manifests predominantly in areas with high concentrations of apocrine glands: axillae, groin, perineum, inframammary regions, and buttocks. It presents after puberty (typically second to third decade) and...
High Ankle Sprain
A High Ankle Sprain (syndesmotic injury) refers to injury of the syndesmosis —the fibrous complex of ligaments that binds the distal tibia and fibula together, maintaining the integrity of the ankle mortise. Unlike...
High Spinal and Total Spinal Block - Recognition and Management
Immediate Recognition: Sensory level above T4 (high spinal) with respiratory symptoms Progressive ascending weakness (numbness in hands T1-T4, respiratory C3-C5) Severe hypotension with bradycardia (sympathetic...
Hip Fracture (Neck of Femur)
What is it? Hip fractures are fractures of the proximal femur, classified as intracapsular (within the hip joint capsule, risk of avascular necrosis) or extracapsular (trochanteric/subtrochanteric, risk of mechanical...
Hirschsprung's Disease
A comprehensive, evidence-based guide to Hirschsprung's Disease covering molecular genetics (RET proto-oncogene), neural crest migration failure, diagnostic approaches including rectal suction biopsy and anorectal...
Hirsutism
Key Facts Definition : Excessive terminal hair growth in androgen-sensitive areas in women, quantified by modified Ferriman-Gallwey score ≥8. Prevalence : 5-15% of women of reproductive age; varies significantly by...
HIV & AIDS
Human Immunodeficiency Virus (HIV) is a lentivirus belonging to the Retroviridae family that selectively infects and dep... MRCP exam preparation.
HIV Infection (Adult)
Human Immunodeficiency Virus (HIV) is a lentivirus (subfamily of retroviruses) that targets the human immune system, specifically CD4+ T-lymphocytes (helper T cells), macrophages, and dendritic cells. Progressive...
Hodgkin Lymphoma
The disease exhibits a bimodal age distribution with peaks at 15-35 years (young adults) and 55 years (older adults). Patients typically present with painless lymphadenopathy , often cervical or supraclavicular, with...
Hormone Replacement Therapy (HRT) Protocols
Hormone Replacement Therapy (HRT), also termed Menopausal Hormone Therapy (MHT) , involves the administration of systemic Oestrogen (with or without Progestogen ) to replace declining ovarian hormones in...
Hospital-Acquired Pneumonia
Hospital-acquired pneumonia (HAP) is pneumonia that develops ≥48 hours after hospital admission and was not incubating a... MRCP exam preparation.
Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia
Hospital-acquired pneumonia (HAP) is defined as pneumonia that develops 48 hours or more after hospital admission and wa... MRCP, FFICM exam preparation.
Human & Animal Bites
Mammalian bite wounds present a significant infectious disease challenge due to polymicrobial oral flora, with infection rates varying from 5% (dog bites) to 50% (cat bites). The unique anatomy of bite...
Human Papillomavirus (HPV) Infection
Human Papillomavirus (HPV) is a double-stranded DNA virus of the Papillomaviridae family, representing the most common sexually transmitted infection (STI) worldwide . Over 200 HPV genotypes have been identified, with...
Humeral Shaft Fracture
The Sarmiento functional bracing protocol , introduced in the 1970s, revolutionized treatment by demonstrating that rigid immobilization is unnecessary and that controlled fracture motion promotes healing through...
Huntington's Disease
Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder caused by an expanded CAG trinucleotide re... MRCP exam preparation.
Huntington's Disease
The mutant huntingtin protein (mHTT) with an elongated polyglutamine tract undergoes toxic aggregation, causing selective degeneration of GABAergic medium spiny neurons in the striatum (caudate nucleus and putamen),...
Hydatid Disease (Echinococcosis)
Humans are accidental intermediate hosts, infected through ingestion of parasite eggs from contaminated food or contact with definitive hosts (primarily dogs). The larvae migrate to the liver (60-70%) or lungs...
Hydralazine: Direct Vasodilator Pharmacology and Clinical Use
Hydralazine is a direct-acting arterial vasodilator that relaxes vascular smooth muscle through unclear mechanisms, possibly involving interference with calcium influx and activation of potassium channels. It produces...
Hypercalcaemia (Emergency)
Hypercalcaemia is a common and potentially life-threatening electrolyte disturbance defined by a corrected serum calcium... MRCP exam preparation.
Hyperemesis Gravidarum
Affects 0.3-3% of pregnancies, peaks at 8-12 weeks gestation. Life-threatening complications include Wernicke encephalop... ACEM Fellowship Written, ACEM Fellow
Hyperemesis Gravidarum
Hyperemesis Gravidarum (HG) is a severe form of nausea and vomiting in pregnancy (NVP) characterised by persistent intra... MRCOG, FRANZCOG exam preparation.
Hyperhidrosis
The condition is classified into: Primary (Idiopathic) Focal Hyperhidrosis : Localized excessive sweating without identifiable cause, typically affecting axillae, palms, soles, or craniofacial regions Secondary...
Hyperkalaemia (Emergency)
Hyperkalaemia is a life-threatening electrolyte emergency defined by a serum potassium concentration 5.5 mmol/L. It is... MRCP exam preparation.
Hyperkalemia in Adults
Peaked T waves → Wide QRS → Sine wave → VF/Asystole : ECG changes progress rapidly and unpredictably ECG changes require immediate treatment regardless of potassium level : Calcium gluconate FIRST for membrane...
Hypernatraemia (Adult)
Comprehensive evidence-based guide to hypernatraemia covering definition, classification by volume status, causes including diabetes insipidus, water deprivation testing, clinical features, and safe correction...
Hyperosmolar Hyperglycaemic State (HHS)
Hyperosmolar Hyperglycaemic State (HHS, formerly HONK/HHNS) is the most lethal hyperglycaemic emergency with 15-20% mort... ACEM Fellowship Written, ACEM Fellow
Hyperosmolar Hyperglycaemic State (HHS)
HHS is characterised by a relative insulin deficiency that is sufficient to prevent lipolysis and ketogenesis but insufficient to facilitate glucose utilisation or suppress hepatic gluconeogenesis. This results in...
Hyperosmolar Hyperglycaemic State (HHS)
Unlike Diabetic Ketoacidosis (DKA), HHS develops insidiously over days to weeks, leading to a much more profound fluid deficit (often 10–22 litres). The mortality rate of HHS remains high (15–20%), significantly...
Hyperparathyroidism (Adult)
Hyperparathyroidism encompasses a spectrum of disorders characterised by excessive parathyroid hormone (PTH) secretion, ... MRCP exam preparation.
Hypertension
Hypertension (HTN) is a chronic medical condition characterised by persistently elevated systemic arterial blood pressur... MRCP exam preparation.
Hypertensive Emergency
Hypertensive emergencies affect 1-2% of all hypertensive patients and carry 5-25% mortality depending on end-organ invol... ACEM Primary Written, ACEM Fellowshi
Hypertensive Emergency
Select appropriate parenteral antihypertensive agents... CICM Second Part exam preparation.
Hypertensive Emergency in Adults
Hypertensive emergency is severe hypertension (typically SBP 180 mmHg and/or DBP 120 mmHg) with evidence of acute end-organ damage requiring immediate blood pressure reduction within minutes to hours to prevent...
Hypertensive Nephropathy
It is conventionally cited as the second most common cause of end-stage renal disease (ESRD) worldwide (after diabetic kidney disease), although the true contribution of hypertension as a primary cause versus a...
Hyperthermia and Heat Stroke
Heat stroke is a life-threatening hyperthermic emergency with core temperature 40°C and neurological dysfunction. Rapid cooling is the priority. Key principles:
Hyperthermia Emergency (Heat Illness)
Heat stroke is defined by core temp greater than 40°C + CNS dysfunction - confusion, seizures, coma. Mortality 10-50%... ACEM Fellowship Written, ACEM Fellow
Hyperthyroidism in Adults
Hyperthyroidism is a clinical syndrome characterized by the excessive synthesis and secretion of thyroid hormones (thyro... MRCP, USMLE exam preparation.
Hypertrophic Cardiomyopathy - Anaesthetic Considerations
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder (1:500 population), characterised by asymmetric left ventricular hypertrophy with myocardial disarray, presenting significant anaesthetic...
Hypertrophic Cardiomyopathy (HCM)
Hypertrophic Cardiomyopathy (HCM) is a genetic cardiac disorder characterised by unexplained left ventricular hypertroph... MRCP exam preparation.
Hypertrophic Pyloric Stenosis
Examination demonstrating 'olive' mass and gastric peristaltic waves... ACEM Fellowship Written, ACEM Fellowship OSCE exam preparation.
Hyperviscosity Syndrome
Key Facts Cause : IgM paraprotein (Waldenström's 85%), IgA/IgG3 (myeloma 10-15%), cellular (polycythaemia less than 5%) Classic triad : Neurological (70%) + visual (60%) + bleeding (50%) symptoms Diagnosis : Serum...
Hypocalcaemia
Common aetiologies include hypoparathyroidism (most frequently post-surgical following thyroidectomy or parathyroidectomy), vitamin D deficiency, chronic kidney disease-mineral bone disorder (CKD-MBD),...
Hypoglycaemia - Emergency Management
Hypoglycaemia is a medical emergency defined by the clinical triad of low blood glucose (below 4.0 mmol/L in ED context)... ACEM Primary Written, ACEM Primary V
Hypoglycaemia in Adults
Hypoglycaemia is defined as blood glucose below 4.0 mmol/L (72 mg/dL) and represents one of the most common acute complications of diabetes management. It occurs when glucose delivery or production fails to meet...
Hypoglycaemia in Critical Care
Comprehensive evidence-based guide to hypoglycaemia recognition, prevention, and management in the ICU, including NICE-SUGAR trial evidence, counter-regulatory hormone physiology, treatment protocols, and glucose...
Hypokalaemia
Clinical manifestations include muscle weakness, cramps, constipation, polyuria, and cardiac effects ranging from palpitations to ventricular arrhythmias. ECG changes are pathognomonic: U waves, flattened T waves, ST...
Hypomagnesaemia
The most important clinical consequences include life-threatening ventricular arrhythmias (particularly Torsades de Pointes), neuromuscular irritability (tetany, seizures), and electrolyte disturbances that cannot be...
Hyponatraemia in Adults
The clinical significance of hyponatraemia extends far beyond a laboratory abnormality. Acute symptomatic hyponatraemia ... MRCP exam preparation.
Hyponatremia in Adults
Severe symptomatic hyponatremia is a medical emergency : Cerebral edema can cause seizures, coma, respiratory arrest, and death Treat based on symptoms, not just sodium level : A sodium of 118 mEq/L may be...
Hypoparathyroidism (Adult)
Hypoparathyroidism is a rare endocrine disorder characterized by insufficient secretion of parathyroid hormone (PTH) from the parathyroid glands, resulting in hypocalcaemia and hyperphosphataemia . Unlike other...
Hypophosphataemia
The most clinically significant scenario is refeeding syndrome , where malnourished or starved patients develop acute, life-threatening hypophosphataemia upon carbohydrate refeeding due to rapid intracellular...
Hypospadias
A comprehensive guide to Hypospadias, covering the classic triad, classification, surgical repair (TIP/Snodgrass urethroplasty), and the 'double diaper' post-operative care technique.
Hypothermia
Critical Alerts "Not dead until warm and dead" : Hypothermic patients may survive prolonged resuscitation with excellent neurological outcomes even after hours of arrest Handle gently : Cold myocardium is extremely...
Hypothermia - Emergency Medicine
Accidental hypothermia is defined as an involuntary drop in core body temperature below 35°C (95°F). It ranges from mild... ACEM Fellowship Written, ACEM Fellow
Hypothyroidism in Adults
Hypothyroidism is a common clinical syndrome resulting from a deficiency of thyroid hormones, which leads to a generaliz... MRCP, USMLE exam preparation.
Hypovolaemic Shock
Hypovolaemic shock is a clinical state of inadequate tissue perfusion resulting from reduced intravascular volume. It is... CICM Second Part exam preparation.
Hypovolemic Shock (Adult)
Hypovolemic shock is a life-threatening circulatory failure state characterised by inadequate intravascular volume to ma... MRCP, FRCEM exam preparation.
Hypoxic Ischaemic Encephalopathy (HIE)
HIE represents the leading cause of acquired neonatal brain injury worldwide, accounting for 23% of the estimated 2.5 million global neonatal deaths annually and affecting 1-3 per 1000 live births in high-income...
ICD Emergencies in ICU
"What is the difference between magnet application and device deactivation?"... CICM Second Part exam preparation.
ICU Administration and Management: Structure, Staffing, Governance, and Quality
ICU Levels (IC-1): Level 1 = stabilization and short-term ventilation before transfer; Level 2 = indefinite multi-sys... CICM Second Part Written, CICM Secon
ICU Design and Environment
The ICU physical environment significantly impacts patient outcomes, staff well-being, and family experience. Evidence-b... CICM Fellowship Written, CICM Fellow
ICU Outreach and Rapid Response Systems
Afferent limb: Monitoring, track-and-trigger systems, escalation protocols... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
ICU Ventilators - Types and Modes
Ventilator Classification: ICU ventilators are classified by pressure type (positive vs negative), power source (pneu... CICM Second Part Written, CICM Secon
ICU-Acquired Weakness (ICUAW)
Definition and Classification: ICUAW umbrella term; CIP vs CIM vs overlap... CICM Second Part exam preparation.
Idiopathic Intracranial Hypertension (IIH)
Idiopathic Intracranial Hypertension (IIH) is a disorder characterized by elevated intracranial pressure (ICP) in the ab... MRCP Part 2 exam preparation.
Idiopathic Pulmonary Fibrosis
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and irreversible fibrosing interstitial pneumonia of unkn... MRCP exam preparation.
Idiopathic Pulmonary Fibrosis (IPF)
Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive, fibrosing interstitial lung disease (ILD) of unknown aeti... MRCP exam preparation.
IgA Nephropathy
Feature Description --------- ------------- Pathognomonic finding Dominant or co-dominant mesangial IgA deposits on immunofluorescence Classic presentation Synpharyngitic haematuria (macroscopic haematuria within...
IgA Vasculitis (Henoch-Schönlein Purpura)
IgA Vasculitis (IgAV), formerly known as Henoch-Schönlein Purpura (HSP) , is the most common systemic vasculitis in childhood , characterised by IgA1-dominant immune complex-mediated small vessel vasculitis affecting...
IgA Vasculitis (Henoch-Schönlein Purpura)
IgA Vasculitis (IgAV), formerly known as Henoch-Schönlein Purpura (HSP), is the most common systemic vasculitis in childhood, with an annual incidence of 10-20 per 100,000 children. It is an immune-complex mediated...
IgG4-Related Disease
IgG4-RD typically affects middle-aged to elderly men with a median age of 60 years and a male-to-female ratio of 2-3:1, though head and neck involvement shows equal sex distribution. The disease is characterised by...
Immune Dysfunction Pathology in Critical Illness
Immune dysfunction in critical illness encompasses both hyperinflammation (SIRS) and immunosuppression (CARS/immunoparalysis). The initial pro-inflammatory response involves PAMP/DAMP recognition, cytokine release...
Immune System Physiology
Answer: Immune system physiology describes the coordinated network of cells, tissues, and molecules that protect the host from pathogens. The immune system comprises two interconnected arms: innate immunity...
Immune Thrombocytopenia (ITP)
A comprehensive guide to Immune Thrombocytopenia (ITP), covering diagnostic exclusion criteria, differentiation from TTP, and the management ladder (Steroids - IVIg - TPO-RAs - Splenectomy).
Impetigo (Child)
Impetigo is a highly contagious superficial bacterial skin infection that represents the most common bacterial skin infection in children worldwide , with peak incidence in 2-5 year olds . The condition is...
Incarcerated Hernia in Adults: The Definitive Gold Standard Reference
1.1 Summary An incarcerated hernia occurs when the contents of a hernia sac—be it omentum, small bowel, large bowel, or other viscera—become trapped outside their native cavity and cannot be manually reduced. This...
Infantile Seborrhoeic Dermatitis (Cradle Cap)
Infantile seborrhoeic dermatitis (ISD), commonly known as "cradle cap," is a benign, self-limiting inflammatory skin condition affecting infants primarily in the first 3 months of life. It presents characteristically...
Infantile Spasms (West Syndrome)
Infantile Spasms (IS), also known as West Syndrome or Infantile Epileptic Spasms Syndrome (IESS) , is a severe age-specific epileptic encephalopathy predominantly affecting infants between 3-12 months of age . It...
Infectious Mononucleosis
Key Facts Causative Agent : Epstein-Barr virus (EBV/HHV-4), a double-stranded DNA gamma-herpesvirus. Incidence : 45-50 per 100,000 population annually in Western countries; peaks in adolescents aged 15-24. Incubation...
Infective Endocarditis
Infective endocarditis (IE) is infection of the endocardial surface, most commonly affecting heart valves. Diagnosis req... CICM Second Part exam preparation.
Infective Endocarditis (Adult): The Gold Standard Comprehensive Resource
Infective endocarditis (IE) is a microbial infection of the endocardial surface of the heart, most commonly involving th... MRCP exam preparation.
Infective Gastroenteritis
While the majority of adult cases in developed nations are viral (Norovirus) and self-limiting, bacterial gastroenteritis ( Campylobacter , Salmonella , E. coli ) presents a more severe clinical picture, often with...
Inflammatory Bowel Disease (IBD)
Inflammatory Bowel Disease (IBD) comprises two principal chronic, immune-mediated inflammatory disorders of the gastroin... MRCP, USMLE exam preparation.
Inflammatory Bowel Disease (IBD) in Adults
Inflammatory Bowel Disease (IBD) comprises a group of chronic, immune-mediated inflammatory conditions of the gastrointe... MRCP exam preparation.
Influenza (Flu)
Influenza is an acute viral respiratory infection caused by Influenza viruses A and B, representing one of the most sign... MRCP, FRACP exam preparation.
Infusion Pumps and Drug Delivery
Pump Classification: ICU infusion pumps include volumetric pumps (peristaltic mechanism, 0.1-999 mL/h), syringe pumps... CICM Second Part Written, CICM Secon
Ingrown Toenail
The condition affects predominantly the great toe (hallux), with the lateral nail edge involved in approximately 85% of cases. Without appropriate treatment, the natural history progresses through stages of increasing...
Inguinal Hernia
An inguinal hernia is the abnormal protrusion of abdominal contents (most commonly omentum or small bowel) through a defect in the inguinal canal. Inguinal hernias represent the most common type of abdominal wall...
Insect Bites and Stings
Comprehensive evidence-based guide to diagnosis and management of insect bites and stings
Insomnia
Insomnia is a sleep-wake disorder characterised by persistent difficulty with sleep initiation, maintenance, consolidati... MRCP, MRCPsych exam preparation.
Instrumental Delivery (Forceps and Ventouse)
Instrumental delivery (also termed Operative Vaginal Delivery [OVD] or Assisted Vaginal Delivery [AVD] ) refers to the use of forceps or ventouse (vacuum extractor) to expedite vaginal birth during the second stage of...
Insulinoma
Over 90% of insulinomas are benign, solitary, and less than 2 cm in diameter . Approximately 5-10% are associated with Multiple Endocrine Neoplasia Type 1 (MEN1) , where they may be multiple. Malignancy occurs in...
Interprofessional Communication in ICU
Interprofessional communication is a cornerstone of safe, effective intensive care delivery. Communication failures are ... CICM Fellowship Written, CICM Fellow
Interscalene Brachial Plexus Block
Formation: Roots : C5, C6, C7, C8, T1 (ventral rami) Interscalene location : C5-C7 roots between anterior and middle scalene muscles Trunks : Form superior (C5-C6), middle (C7), inferior (C8-T1) trunks Interscalene...
Interstitial Cystitis / Bladder Pain Syndrome
The pathophysiology remains incompletely understood but is thought to involve multifactorial mechanisms including: Glycosaminoglycan (GAG) layer deficiency leading to increased urothelial permeability Mast cell...
Interstitial Lung Disease
Comprehensive evidence-based guide to interstitial lung disease covering pathogenesis, HRCT patterns, diagnosis, antifibrotic therapy, acute exacerbations, and multidisciplinary management across all ILD subtypes.
Interventional Pain Procedures
Interventional pain procedures provide diagnostic information and therapeutic benefit for chronic pain conditions when conservative management fails. Epidural steroid injection (ESI): Indicated for radicular pain from...
Intestinal Obstruction
Intestinal Obstruction represents a mechanical or functional blockage preventing the normal transit of intestinal conten... MRCS exam preparation.
Intra-Abdominal Hypertension and Abdominal Compartment Syndrome
"Define IAH and ACS. Outline the grading system for IAH."... CICM Second Part exam preparation.
Intra-abdominal Sepsis and Peritonitis
Intra-abdominal sepsis represents a spectrum from localized infection to generalized peritonitis with systemic organ dys... CICM Second Part exam preparation.
Intra-aortic Balloon Pump
IABP-SHOCK II trial is practice-changing: Randomized 600 patients with AMI-related cardiogenic shock to IABP vs optim... CICM Second Part exam preparation.
Intra-Aortic Balloon Pump (IABP): Physiology, Timing, and Clinical Applications
The intra-aortic balloon pump (IABP) is a mechanical circulatory support device that improves myocardial oxygen supply-demand balance through diastolic augmentation and systolic unloading (counterpulsation). The...
Intracerebral Haemorrhage
Comprehensive Gold Standard guide to intracerebral haemorrhage (ICH) for postgraduate medical examinations including MRCP, FRCS, and medical finals.
Intracerebral Haemorrhage
Intracerebral haemorrhage (ICH) accounts for 10-15% of all strokes and has the highest mortality of stroke subtypes at 3... ACEM Fellowship Written, ACEM Fellow
Intracerebral Hemorrhage
Blood pressure control : Target SBP 140-180 mmHg within 1 hour (INTERACT2), avoiding aggressive lowering to 110-139 mmHg (ATACH-2 showed no benefit and increased renal adverse events) Reversal of coagulopathy :...
Intracranial Haemorrhage in Adults
Comprehensive emergency diagnosis and management of intracranial haemorrhage including intracerebral, subarachnoid, subdural, and epidural haemorrhage in adults
Intracranial Pressure Management
Intracranial pressure (ICP) is normally 5-15 mmHg (supine). Cerebral perfusion pressure (CPP) = MAP - ICP (target 60-70 mmHg). Monro-Kellie doctrine : Fixed intracranial volume (brain 80%, CSF 10%, blood 10%). ICP...
Intracranial Pressure Monitoring Systems
Monro-Kellie Doctrine: The cranium is a rigid box with fixed volume ( 1,400-1,700 mL); the sum of brain (80%), blood ... CICM Second Part Written, CICM Secon
Intrahepatic Cholestasis of Pregnancy (Obstetric Cholestasis)
Intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis, is the most common pregnancy-specific liver disorder, characterised by pruritus and elevated serum bile acids. It typically presents in...
Intraoperative Bronchospasm - Recognition and Management
Immediate Recognition: Rising peak airway pressure ( 30 cmH₂O with plateau pressure unchanged suggests bronchospasm) Expiratory wheeze (may be absent in severe bronchospasm = "silent chest") Decreased tidal volume...
Intraosseous (IO) Access
IO is second-line to IV (ANZCOR: IV preferred, IO if IV cannot be rapidly achieved within 2 attempts)... ACEM Primary Written, ACEM Primary Viva exam prepara
Intraosseous (IO) Vascular Access
IO access is a bridge, not a destination - Replace with IV/CVC within 24 hours. Risk of osteomyelitis increases signi... ACEM Primary Written, ACEM Primary V
Intraosseous Access
Intraosseous (IO) access provides rapid, reliable vascular access when peripheral IV cannulation fails or is unlikely to succeed within 90 seconds. It is the recommended second-line vascular access route in cardiac...
Intraventricular Haemorrhage (Neonatal)
Intraventricular Haemorrhage (IVH), also termed Germinal Matrix Haemorrhage-Intraventricular Haemorrhage (GMH-IVH), repr... MRCPCH exam preparation.
Intussusception - Adult
Adult intussusception is rare (5% of intestinal obstructions, 2-3 cases per million adults/year) and has a lead point... ACEM Fellowship Written, ACEM Fellow
Intussusception - Paediatric
Lethargy as presenting feature: Not just pain—lethargy occurs in 20-30% and may be the first sign... ACEM Primary Written, ACEM Primary Viva exam preparation
Intussusception in Children
Intussusception is the invagination (telescoping) of a proximal segment of bowel (the intussusceptum) into an adjacent d... MRCS, FRCS Paediatric Surgery, MRCPC
Invasive Aspergillosis
Invasive Aspergillosis (IA) is a life-threatening opportunistic fungal infection caused predominantly by Aspergillus fum... MRCP exam preparation.
Invasive Candidiasis
Risk factors are ubiquitous in intensive care: broad-spectrum antibiotics, central venous catheters (CVCs), Total Parenteral Nutrition (TPN), abdominal surgery, neutropenia, immunosuppression, renal replacement...
Invasive Fungal Infections in ICU
Echinocandins are first-line for candidemia in critically ill patients (PMID: 28635507, 28482886)... CICM Second Part exam preparation.
Invasive Pressure Monitoring in ICU
Comprehensive guide to invasive haemodynamic pressure monitoring including arterial lines, central venous pressure, pulmonary artery catheters, transducer physics, waveform analysis, dynamic response testing, and...
Iron Overdose
Comprehensive evidence-based guide to iron poisoning covering toxic dose thresholds, five phases of toxicity, serum iron interpretation, deferoxamine chelation therapy, whole bowel irrigation, and critical care...
Irritable Bowel Syndrome
Diagnosis is clinical, based on the Rome IV criteria, which require recurrent abdominal pain at least 1 day per week in the last 3 months, associated with two or more of: (1) related to defecation, (2) associated with...
Irritable Bowel Syndrome (IBS)
IBS is not a diagnosis of exclusion, but rather a positive clinical diagnosis based on symptom-based criteria (Rome IV) combined with judicious use of investigations to exclude alarm features. The pathophysiology is...
Ischaemic Stroke
Clinical Significance : Stroke is the second leading cause of death globally and a leading cause of adult disability. From 1990 to 2021, the global burden increased substantially with a 70% increase in incident...
Ischaemic Stroke (Adult)
Ischaemic stroke is the sudden onset of focal neurological deficit resulting from arterial occlusion, leading to cerebral infarction. It represents approximately 85% of all strokes, with the remaining 15% being...
Ischemic Stroke
Time-critical interventions include NIHSS assessment, non-contrast CT brain, CT angiography, and rapid team activation f... CICM Second Part exam preparation.
Isoflurane Pharmacology
Isoflurane (1-chloro-2,2,2-trifluoroethyl difluoromethyl ether) is a halogenated methyl ethyl ether volatile anaesthetic agent introduced in 1981 that remains widely used globally for maintenance of general...
Japanese Encephalitis
A comprehensive gold-standard guide to Japanese Encephalitis, covering the Culex mosquito vector, classic thalamic MRI changes, CSF findings, vaccination protocols, supportive care, and neurological sequelae.
Jellyfish Envenomation
Jellyfish envenomation in Australia ranges from mild stings to life-threatening emergencies. Box jellyfish (Chironex fle... ACEM Primary Written, ACEM Primary V
Jersey Finger
This injury is a classic sports-related trauma seen predominantly in contact sports (Rugby, American Football, Basketball, Judo) caused by forced hyperextension of the distal interphalangeal joint (DIPJ) while the...
Joint Dislocation in Adults
A joint dislocation occurs when the articular surfaces of a joint lose complete contact with one another, resulting in j... FRCS (Tr&Orth) exam preparation.
Juvenile Idiopathic Arthritis (JIA)
JIA affects approximately 1 in 1,000 children and represents a major cause of chronic disability in the paediatric population. The condition is characterised by chronic synovial inflammation leading to joint pain,...
Kallmann Syndrome
The condition affects approximately 1 in 8,000 males and 1 in 40,000 females , with a male predominance of 4-5:1. Males typically present with absent pubertal development , micropenis , cryptorchidism , and...
Kawasaki Disease
The primary concern is the development of coronary artery aneurysms (CAAs) , which occur in 15-25% of untreated cases but can be reduced to less than 5% with prompt treatment using intravenous immunoglobulin (IVIG) 2...
Keloid & Hypertrophic Scars
Keloid and hypertrophic scars represent aberrant wound healing characterized by excessive fibroproliferative responses and abnormal collagen deposition . These pathological scars arise from dysregulation of the normal...
Keratoacanthoma
However, the benign classification of KA remains one of dermatology's most contentious issues. Histologically, KA is often indistinguishable from well-differentiated squamous cell carcinoma (SCC), and rare cases of...
Ketamine
Ketamine is a phencyclidine (PCP) derivative dissociative anaesthetic producing analgesia, amnesia, and unconsciousness while preserving airway reflexes and cardiovascular stability. Mechanism: Non-competitive...
Ketamine Pharmacology
Ketamine is a phencyclidine derivative dissociative anaesthetic that exists as two stereoisomers: S(+)-ketamine and R(-)-ketamine. The S(+)-enantiomer demonstrates 3-4 times greater analgesic potency and 1.5-2 times...
Kidney Stones (Nephrolithiasis)
Nephrolithiasis (kidney stones) is one of the most common urological conditions, affecting 10-12% of the global populati... FRCS(Urol) exam preparation.
Kienböck's Disease (Adult)
Kienböck's disease is avascular necrosis (AVN) of the lunate bone, one of the eight carpal bones in the wrist. Fir... FRCS(Tr&Orth), FRACS(Orth) exam prep
Klinefelter Syndrome
The syndrome results from non-disjunction during parental meiosis, leading to testicular dysgenesis and progressive loss of seminiferous tubule function. The pathognomonic triad comprises hypergonadotropic...
Knee Ligament and Meniscal Injuries (Adult)
Knee ligament and meniscal injuries represent some of the most common musculoskeletal injuries presenting to emergency departments and orthopaedic clinics worldwide. The knee joint is a modified hinge joint that...
Koehler Disease
Koehler Disease (often spelled Kohler's Disease) is a rare, self-limiting avascular necrosis (osteochondrosis) of the ta... FRCS (Orth) exam preparation.
Labour Analgesia
Cervical Dilation and Uterine Contractions (0-10 cm): Origin: Uterine contractions, cervical dilation, lower uterine segment distension Pathway: Visceral afferents via hypogastric plexus → sympathetic chain → enter...
Labyrinthitis (Adult)
Labyrinthitis is acute inflammation of the membranous labyrinth of the inner ear, affecting both the vestibular apparatu... MRCP, FRCS ENT exam preparation.
Lambert-Eaton Myasthenic Syndrome (LEMS)
Lambert-Eaton Myasthenic Syndrome (LEMS) is a rare autoimmune disorder of the neuromuscular junction characterized by pr... MRCP exam preparation.
Lambert-Eaton Myasthenic Syndrome (LEMS)
The clinical hallmark is proximal muscle weakness , predominantly affecting the lower limbs, producing the characteristic complaint of "heavy legs" and difficulty rising from a chair or climbing stairs. The...
Large for Gestational Age (Macrosomia)
Large for Gestational Age (LGA) is defined as a fetal or neonatal weight exceeding the 90th centile for gestational age on standardized growth charts. Macrosomia is defined by absolute birthweight thresholds,...
Laryngomalacia
Laryngomalacia accounts for 60-75% of all congenital stridor cases. Most infants (90%) have mild disease that resolves s... ACEM Primary Written, ACEM Primary V
Laryngomalacia
A comprehensive guide to Laryngomalacia, the most common cause of stridor in infants, covering clinical features, the 'omega-shaped epiglottis', and indications for supraglottoplasty.
Laryngotracheobronchitis
Croup is the most common cause of acute upper airway obstruction in children, affecting 3-5% annually with a mortality b... ACEM Primary Written, ACEM Primary V
Lateral Epicondylitis (Tennis Elbow)
Lateral epicondylitis, commonly known as "tennis elbow," is a degenerative tendinopathy affecting the common extensor origin at the lateral epicondyle of the humerus, most commonly involving the extensor carpi...
Lateral Epicondylitis (Tennis Elbow)
Lateral epicondylitis, colloquially termed "tennis elbow," represents the most common cause of lateral elbow pain in adults and constitutes a significant cause of occupational morbidity. The condition is characterised...
Legionnaires' Disease
The disease represents 2-9% of community-acquired pneumonia (CAP) cases but accounts for a disproportionately high number of severe pneumonia cases requiring ICU admission. Mortality ranges from 5-10% in...
Leishmaniasis
Comprehensive evidence-based guide to Leishmaniasis covering all three clinical forms (Cutaneous, Mucocutaneous, Visceral), epidemiology, pathophysiology, diagnosis, and management strategies with emphasis on liposomal...
Leptospirosis
Leptospirosis is endemic in tropical and subtropical regions, particularly northern Australia (Queensland, Northern Terr... ACEM Primary Written, ACEM Primary V
Leptospirosis (Weil's Disease)
Leptospirosis is a spirochaetal zoonosis of global significance, representing the most common zoonotic infection worldwi... MRCP exam preparation.
Leukaemia (Adult)
Leukaemia represents a heterogeneous group of clonal haematological malignancies characterised by the uncontrolled proliferation of abnormal white blood cells (WBCs) in the bone marrow and peripheral blood. These...
Lichen Planus (Adult)
Lichen planus (LP) is a chronic, immune-mediated inflammatory disorder affecting the skin, mucous membranes, hair follicles, and nails. First described by Erasmus Wilson in 1869, it is characterized by a distinctive...
Lichen Sclerosus
The disease presents a diagnostic and therapeutic challenge requiring long-term management and surveillance. Despite being a benign condition, LS profoundly impacts patients through intractable pruritus, dyspareunia,...
Lignocaine (Lidocaine)
Lignocaine (lidocaine) is the prototypical amide local anaesthetic, widely used for infiltration, nerve blocks, spinal and epidural anaesthesia, intravenous regional anaesthesia (Bier's block), and as an...
Limb Trauma
Limb trauma encompasses a spectrum of injuries from simple fractures to severe mangled extremities. The emergency physic... ACEM Primary Written, ACEM Primary V
Lipoma
A lipoma is a benign mesenchymal tumour composed of mature adipose tissue, representing the most common soft tissue neoplasm in adults with an estimated prevalence of 1-2% in the general population. These tumours are...
Lisfranc Injury
The Lisfranc injury refers to a disruption of the tarsometatarsal (TMT) joint complex, specifically involving the Lisfranc Ligament which anchors the 2nd Metatarsal base to the Medial Cuneiform. This ligament is the...
Lithium Toxicity in Adults
Comprehensive evidence-based guide to lithium toxicity covering pharmacokinetics, acute vs chronic presentations, clinical features, EXTRIP hemodialysis criteria, and critical care management.
Liver Cirrhosis
Liver Cirrhosis is the histological end-stage of diverse chronic liver insults, characterised by diffuse hepatic fibrosi... MRCP exam preparation.
Liver Transplantation ICU Management
Liver transplantation is a high-frequency CICM Hot Case and SAQ topic because it integrates:... CICM Second Part Written, CICM Second Part Hot Case exam prepara
Local Anaesthetic Systemic Toxicity (LAST)
Local anaesthetic systemic toxicity (LAST) is a life-threatening emergency occurring when local anaesthetics enter systemic circulation, causing CNS and cardiovascular toxicity. Incidence: 0.1-0.3% of peripheral nerve...
Local Anaesthetic Systemic Toxicity (LAST) - Management and Lipid Emulsion
Immediate Recognition (Early Warning Signs): Prodromal symptoms: Circumoral numbness, metallic taste, tinnitus Neurological: Agitation, confusion, drowsiness, seizures Cardiovascular: Hypertension, tachycardia...
Local Anaesthetics
Local anaesthetics (LAs) block nerve conduction by inhibiting voltage-gated sodium channels (VGSC) in neuronal membranes, preventing action potential generation and propagation. Classification: Esters (procaine,...
Local Anaesthetics
Define - What are local anaesthetics, classification... CICM First Part Written, CICM First Part Viva exam preparation.
Low Back Pain and Sciatica
Low Back Pain (LBP) is the leading cause of disability worldwide. 85% of cases are "Non-specific Mechanical LBP" where no specific anatomical cause (like cancer or infection) is found.
Lower Airway & Bronchial Tree Anatomy
Overview - Define lower airway, list structures... CICM First Part Written, CICM First Part Viva exam preparation.
Lower Gastrointestinal Bleeding
Lower gastrointestinal bleeding (LGIB) refers to bleeding originating from a source distal to the ligament of Treitz, en... MRCP, FRCS exam preparation.
Lower Limb Nerve Blocks
The lumbar plexus forms within the psoas major muscle from the anterior rami of L1-L4 nerve roots. It gives rise to several important branches that innervate the anterior and medial thigh:
Ludwig's Angina
The infection typically originates from odontogenic sources (80-90% of cases), most commonly from the mandibular second and third molars whose roots extend below the mylohyoid muscle into the submandibular space. The...
Lumbar Disc Herniation (Adult)
Lumbar disc herniation (LDH) is the displacement of nucleus pulposus material beyond the normal boundaries of the interv... MRCS, FRCS Orth, FRACS Orth, MRCP ex
Lumbar Disc Herniation (Sciatica)
Lumbar Disc Herniation (LDH) is the displacement of intervertebral disc material—specifically the nucleus pulposus—beyon... FRCS, FRACS exam preparation.
Lumbar Puncture
ICU-Specific Considerations : Meningitis: Do NOT delay antibiotics for LP - give ceftriaxone/vancomycin + dexamethasone immediately SAH: LP for xanthochromia if CT negative and presentation greater than 12 hours from...
Lumbar Puncture (Emergency)
CT before LP is required if: age greater than 60, immunocompromised, CNS disease history, recent seizure, focal neuro... ACEM Fellowship Written, ACEM Fellow
Lumbar Spine and CSF Dynamics
Define/Describe - Overview of lumbar spine anatomy... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Lung Abscess
Lung abscess is a circumscribed collection of pus within the lung parenchyma resulting from suppurative necrosis and cav... MRCP exam preparation.
Lung Cancer
Comprehensive, evidence-based guide to Lung Cancer covering epidemiology, molecular pathophysiology, TNM 8 staging with detailed substaging, EGFR/ALK/ROS1 molecular subtypes, immunotherapy (PD-L1 testing), LDCT...
Lupus Nephritis
Lupus nephritis (LN) represents one of the most serious manifestations of systemic lupus erythematosus (SLE), characteri... MRCP exam preparation.
Lyme Disease
A comprehensive evidence-based guide to Lyme Disease covering epidemiology, pathophysiology, the two-tier diagnostic testing protocol, stage-based management with antibiotic regimens, and complications including...
Lymphadenopathy
The generalist's challenge is to filter the "benign majority" from the "malignant minority". While less than 1% of primary care patients with lymphadenopathy have malignancy, this rises to 40-60% in specialist...
Lymphoma (Adult)
Lymphomas are a heterogeneous group of malignancies arising from lymphoid tissue, representing the fifth most common cancer in developed countries. They are broadly classified into Hodgkin lymphoma (HL) and...
Magnesium Pharmacology
Magnesium (Mg²⁺) is the fourth most abundant cation in the body and second most abundant intracellular cation, with critical roles in over 300 enzymatic reactions, neuromuscular transmission, and cardiac...
Magnesium Toxicity and Management in Obstetrics
One-liner : Magnesium toxicity in obstetrics is a potentially life-threatening iatrogenic complication of therapeutic magnesium sulfate administration, characterized by progressive neuromuscular and cardiovascular...
Maisonneuve Fracture
Mechanism: Pronation-External Rotation (PER). The foot is planted (pronated) and the body rotates externally.... FRCS exam preparation.
Major Depressive Disorder
Major Depressive Disorder (MDD) is a common, serious, and potentially life-threatening mood disorder characterised by pe... MRCPsych exam preparation.
Major Depressive Disorder in Adults
Major Depressive Disorder (MDD) is a common, serious, and potentially life-threatening psychiatric condition characteriz... MRCP, PLAB exam preparation.
Major Haemorrhage in Adults
Major haemorrhage is life-threatening acute blood loss requiring immediate massive transfusion and source control. It is defined by transfusion of ≥4 units of packed red blood cells (pRBC) in less than 1 hour, ≥10...
Major Trauma in Adults
Comprehensive evidence-based guide to the assessment, resuscitation, and management of major trauma in adults following ATLS principles
Malaria
Comprehensive evidence-based guide to malaria covering pathophysiology, species-specific features, diagnostic approaches, artemisinin-based treatment protocols, severe malaria management, and G6PD deficiency...
Male Hypogonadism
Classic presentation involves reduced libido, erectile dysfunction, fatigue, and regression of secondary sexual characteristics. However, the clinical picture is highly variable depending on the age of onset...
Malignant Hyperthermia: Recognition and Management
Malignant hyperthermia (MH) is a pharmacogenetic disorder triggered by volatile anaesthetics (sevoflurane, isoflurane, desflurane, halothane) and suxamethonium . Pathophysiology : Ryanodine receptor (RYR1) or DHPR...
Malignant Melanoma
Global Burden : Over 324,000 new cases diagnosed annually worldwide, with melanoma representing the 17th most common cancer globally. Incidence Variation : Highest in Australia/New Zealand (50-60 per 100,000),...
Malignant Mesothelioma
This malignancy is intrinsically linked to asbestos exposure, with a characteristic latency period of 20-50 years between first exposure and clinical presentation. Due to peak asbestos utilization in the...
Mallet Finger (Adult)
Mallet finger represents a disruption of the terminal extensor mechanism at the distal interphalangeal (DIP) joint, resulting in loss of active DIP extension. The injury occurs when sudden forceful flexion is applied...
Mallory-Weiss Tear
A Mallory-Weiss tear is a longitudinal mucosal or submucosal laceration occurring at or near the gastro-oesophageal junction (GOJ), typically caused by a sudden and forceful increase in intra-abdominal pressure...
Malrotation and Volvulus (Child)
Intestinal malrotation is a Congenital Anomaly of Midgut Rotation and Fixation occurring during embryological development, resulting in an Abnormal Position of the Small and Large Bowel within the abdominal cavity....
Marfan Syndrome (Paediatric)
Marfan Syndrome (MFS) is the most common heritable disorder of connective tissue worldwide, with profound implications for paediatric care. Caused by pathogenic variants in the FBN1 gene encoding Fibrillin-1 , this...
Massive Haemoptysis
Massive haemoptysis represents a true time-critical emergency with mortality rates of 30-80% if untreated, primarily fro... ACEM Fellowship Written, ACEM Fellow
Massive Haemorrhage and Transfusion
Massive haemorrhage is defined as loss of 50% total blood volume within 3 hours, or blood loss exceeding 150 mL/min. Mortality ranges from 30-40% for trauma-related massive transfusion and 10-20% for surgical...
Massive Hemoptysis - ICU Management
Position bleeding side DOWN - protect the non-bleeding lung... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Massive Pulmonary Embolism
Emergency diagnosis and management of massive (high-risk) pulmonary embolism with hemodynamic instability in adults
Massive Transfusion Protocol
Definition of massive transfusion: greater than 10 units PRBC/24h OR greater than 4 units/1h with ongoing bleeding OR... CICM Second Part exam preparation.
Massive Transfusion Protocol
Massive transfusion occurs in approximately 10-25% of major trauma patients requiring blood products. Mortality ranges f... ACEM Primary Written, ACEM Primary V
Massive Transfusion Protocol (Adult)
A massive transfusion protocol (MTP) is a standardized institutional approach to rapidly deliver large volumes of blood products to patients with life-threatening hemorrhage. MTP activation streamlines blood bank...
Massive Transfusion Protocol (MTP) - Hemorrhage Management
Activation Criteria (Activate MTP if ANY present): Blood loss 1500 mL or 30% blood volume Blood loss 150 mL/min sustained Need for 4 units PRBC in <1 hour Systolic BP <90 mmHg with ongoing bleeding Base deficit...
Mastitis (Lactational)
Lactational mastitis is an inflammatory condition of the breast tissue that occurs predominantly during breastfeeding, representing a clinical spectrum from non-infectious milk stasis (blocked duct) through infectious...
Maternal Cardiac Arrest
Maternal cardiac arrest requires immediate resuscitation with pregnancy-specific modifications: manual uterine displacem... ACEM Primary Written, ACEM Primary V
Maternal Physiological Changes in Pregnancy
Pregnancy induces profound physiological adaptations that significantly impact anaesthetic management. By term, cardiac output increases 40-50% (stroke volume +30%, heart rate +15-20%), blood volume expands 40-50%...
Maternal Sepsis
One-liner : Maternal sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection during pregnancy, childbirth, or the postpartum period, requiring early recognition using modified...
Maternal Sepsis (Puerperal Sepsis)
Maternal sepsis, also known as puerperal sepsis when occurring postpartum, is a life-threatening condition defined as or... MRCOG exam preparation.
Maxillofacial Trauma
Maxillofacial trauma encompasses injuries to the facial skeleton including mandible, maxilla, zygoma, orbit, and nasoeth... ACEM Primary Written, ACEM Primary V
Maze Procedure and Atrial Fibrillation Ablation
The Maze procedure is a surgical treatment for atrial fibrillation (AF) that creates lines of conduction block in the atrial myocardium to restore sinus rhythm. Modern techniques include cut-and-sew Cox-Maze III/IV,...
McBurney's Point (Acute Appendicitis)
Comprehensive evidence-based guide to McBurney's Point, acute appendicitis diagnosis, clinical examination techniques, anatomical variations, surgical approaches, and management protocols for postgraduate medical and...
Measles
Clinical Pearls: One of the most contagious diseases known (R0 = 12-18) Koplik spots appear 1-2 days before rash, pathognomonic Rash starts behind ears, spreads cephalocaudally Vitamin A supplementation reduces...
Mechanical CPR
Mechanical cardiopulmonary resuscitation devices (AutoPulse load-distributing band, LUCAS piston device, ZOLL) deliver a... ACEM Fellowship Written, ACEM Fellow
Mechanical Ventilation in the Emergency Department
Emergency physicians must initiate ventilation with lung-protective settings (tidal volume 6-8 mL/kg predicted body weig... ACEM Primary Written, ACEM Primary V
Mechanical Ventilation Modes
Define the mode (control variable, trigger, limit, cycle)... CICM Second Part exam preparation.
Mechanical Ventilators
Mechanical ventilators provide controlled ventilation during general anaesthesia or in critical care settings. Classification: Pneumatic (gas-driven, no electricity required, simple), electronic...
Mechanical Ventilators
Pneumatic (Gas-Powered): Driven entirely by compressed gas (oxygen or air at 280-600 kPa) No electrical power required for basic function Examples: Ohmeda 7000, Penlon Nuffield 200 Advantages: Simple, reliable,...
Meckel's Diverticulum
Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, representing a persistent rem... MRCS, MRCPCH exam preparation.
Meconium Aspiration Syndrome
Meconium Aspiration Syndrome (MAS) is a severe respiratory disorder occurring in newborns who have inhaled meconium-stai... MRCPCH exam preparation.
Medical Ethics in ICU
Medical ethics in intensive care provides a framework for navigating complex decisions involving critically ill patients... CICM Fellowship Written, CICM Fellow
Medical Ultrasound Physics: Knobology, Artifacts, and Doppler Principles
Medical ultrasound imaging relies on the piezoelectric effect —certain crystals (lead zirconate titanate, PZT) convert electrical energy to mechanical sound waves and vice versa. Image generation follows:...
Medication Overuse Headache
The condition typically develops in patients with an underlying primary headache disorder (most commonly migraine or tension-type headache) who escalate their use of acute symptomatic medications beyond safe...
Medicolegal Aspects in Intensive Care
Medicolegal aspects in intensive care encompass the legal framework governing consent, capacity, substitute decision-mak... CICM Second Part Written, CICM Secon
Medicolegal Issues in Anaesthesia
Comprehensive guide to medical negligence, duty of care, documentation requirements, and expert witness responsibilities for ANZCA Fellowship examination Professional Skills component
Melanoma
A comprehensive guide to Malignant Melanoma covering epidemiology, molecular pathophysiology (BRAF/NRAS/KIT mutations), AJCC 8th edition staging, sentinel lymph node biopsy, and modern immunotherapy/targeted therapy...
Melioidosis
Melioidosis is the most important tropical infection in northern Australia, with incidence rates of 16.5-50 per 100,000 ... ACEM Primary Written, ACEM Primary V
Membranous Nephropathy
The seminal discovery of the M-type Phospholipase A2 Receptor (PLA2R) as the target antigen in 2009 revolutionized our understanding of primary MN, transforming it from an idiopathic condition to a well-characterized...
MEN-1 Syndrome
A comprehensive guide to MEN-1 Syndrome, covering the '3 Ps' (Parathyroid, Pituitary, Pancreas), the genetics of the MEN1 gene, molecular mechanisms, screening protocols, and evidence-based management.
Ménière's Disease (Adult)
Ménière's disease is a chronic disorder of the inner ear characterised by endolymphatic hydrops (excessive endolymph accumulation in the membranous labyrinth), resulting in the classic triad of episodic vertigo ,...
Meningioma
Comprehensive evidence-based guide to meningiomas - the most common primary intracranial tumour. Covers WHO grading, molecular classification, the pathognomonic 'dural tail' sign, Simpson grading for surgical...
Meningitis and Encephalitis
Nasopharyngeal colonization → bacteremia → blood-brain barrier (BBB) penetration... CICM Second Part exam preparation.
Meningitis and Encephalitis in Adults
Meningitis and encephalitis are life-threatening infections of the central nervous system requiring immediate recognition and treatment. Bacterial meningitis is inflammation of the meninges caused predominantly by...
Meniscal Tear (Adult)
The menisci are C-shaped fibrocartilaginous structures that serve as critical load distributors and shock absorbers in the knee joint, transmitting 50-70% of joint loads through hoop stress mechanisms. Meniscal tears...
Menopause Management
A comprehensive guide to Menopause management, covering HRT prescribing algorithms (Uterus vs No Uterus), risks (VTE, Breast Cancer), and managing Premature Ovarian Insufficiency.
Mental Health Act - Australia & New Zealand
Each Australian state/territory and New Zealand operates under separate Mental Health legislation with significant varia... ACEM Fellowship Written, ACEM Fellow
Mesenteric Ischaemia
Key Facts Incidence : Acute: 0.1-0.2% of acute surgical admissions; Chronic: Rare (less than 1 per 100,000). Mortality : Acute: 30-90% (highest of abdominal emergencies); Chronic: less than 5% with treatment. Age...
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), formerly known as Non-Alcoholic Fatty Liver Disease (N... MRCP exam preparation.
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
The global prevalence of MASLD is estimated at 25-30% of the general adult population, with significantly higher rates i... MRCP exam preparation.
Metabolic Syndrome
The unifying pathophysiological mechanism is Insulin Resistance , predominantly driven by excessive visceral adipose tissue accumulation. This creates a vicious cycle: adipose tissue dysfunction leads to ectopic fat...
Metaraminol Pharmacology
Metaraminol is a synthetic sympathomimetic amine used primarily as a vasopressor for the management of intraoperative hypotension, particularly during spinal anaesthesia for caesarean section. It acts through both...
Metastatic Bone Disease
The "Big 5" primary carcinomas responsible for over 80% of bone metastases are Breast, Prostate, Lung, Kidney (Renal), and Thyroid - remembered by the mnemonic "Pb KTL" (Lead Kettle). Bone metastases are classified by...
Metastatic Spinal Cord Compression
Metastatic spinal cord compression (MSCC) is an oncological emergency occurring in 5-10% of cancer patients where spinal... MRCP, FRACP exam preparation.
Metastatic Spinal Cord Compression (MSCC)
The cardinal presenting symptom is pain (present in 83-95% of cases), which characteristically precedes neurological deterioration by weeks to months. This pain is often nocturnal (worse at night due to venous...
Metatarsal Fractures
Fractures of the metatarsals represent the most common traumatic foot injuries, accounting for approximately 35% of all foot fractures and occurring at an incidence of 6.7 per 10,000 person-years. Management is highly...
Micronutrient Deficiencies in Critical Care
Micronutrient deficiencies are common in critically ill patients, with prevalence ranging from 30-80% depending on the m... CICM Fellowship Written, CICM Fellow
Midazolam Pharmacology
Midazolam is a water-soluble imidazobenzodiazepine that acts as a positive allosteric modulator of GABA-A receptors at the alpha-gamma subunit interface, enhancing chloride conductance to produce anxiolysis, amnesia,...
Midazolam: Pharmacology and Clinical Use
Midazolam is a short-acting benzodiazepine with anxiolytic, amnestic, sedative-hypnotic, and muscle relaxant properties. Mechanism : Positive allosteric modulation of GABA-A receptors (increases chloride conductance,...
Migraine Headache
Comprehensive evidence-based guide to migraine diagnosis, acute treatment, and prophylaxis in adults
Migraine in Adults: Comprehensive Clinical Management
Migraine is a chronic, episodic neurovascular disorder characterized by recurrent attacks of moderate-to-severe headache... MRCP exam preparation.
Minimal Change Disease (Adult)
Minimal change disease (MCD) is a primary glomerular disorder characterised by nephrotic-range proteinuria with normal g... MRCP exam preparation.
Miscarriage (Early Pregnancy Loss)
Miscarriage (spontaneous abortion) is the spontaneous loss of pregnancy before 24 weeks of gestation, with the vast majo... MRCOG, MRCP exam preparation.
Miscarriage (Types and Management)
Miscarriage is the spontaneous loss of pregnancy before viability, defined as before 24 weeks gestation in the UK (befor... MRCOG, MRCP exam preparation.
Mitochondrial Diseases
These conditions arise from mutations in either mitochondrial DNA (mtDNA) genes (showing maternal inheritance) or nuclear DNA (nDNA) genes (showing Mendelian inheritance patterns). Because mitochondria are present in...
Mitral Regurgitation
Mitral Regurgitation (MR) is a valvular heart disease characterised by the abnormal backward flow of blood from the left... MRCP exam preparation.
Mixed Connective Tissue Disease
The defining serological hallmark is the presence of high-titre anti-U1 RNP antibodies, which are essential for diagnosis. Clinical manifestations typically evolve over time, with early disease characterized by...
Molar Pregnancy (Hydatidiform Mole)
A molar pregnancy (hydatidiform mole) is a form of gestational trophoblastic disease (GTD) characterised by abnormal pro... MRCOG exam preparation.
Molluscum Contagiosum (Child)
Molluscum contagiosum is a Common, Benign, Self-Limiting Viral Skin Infection caused by the Molluscum Contagiosum Virus (MCV) , a member of the Poxviridae family. It is characterised by Discrete, Dome-Shaped,...
Monteggia Fracture-Dislocation
A Monteggia fracture-dislocation is a fracture of the proximal third of the ulna with an associated dislocation of the radial head at the proximal radioulnar joint (PRUJ). First described by Giovanni Battista...
Morphine
Morphine is the prototypical phenanthrene μ-opioid receptor (MOR) agonist, the gold standard against which other opioids are compared. Structure: Phenanthrene backbone (5-ring structure), tertiary amine, two hydroxyl...
Morphine Pharmacology
Morphine is the prototypical natural opioid analgesic derived from the phenanthrene alkaloid class, acting as a full agonist at mu (μ), kappa (κ), and delta (δ) opioid receptors with primary clinical effects mediated...
Morton's Neuroma
Key Facts The 3rd Webspace Predilection : Multiple anatomical factors explain why Morton's neuroma most commonly affects the 3rd intermetatarsal space (80-85% of cases). The 3rd common digital nerve receives dual...
Motor Evoked Potentials in Anaesthesia
Motor evoked potentials (MEPs) monitor corticospinal tract integrity during surgeries risking spinal cord or brain motor pathway injury. Indications : Spinal deformity correction (scoliosis), spinal cord tumor...
Motor Neurone Disease
The hallmark of MND is the combination of upper motor neurone (UMN) and lower motor neurone (LMN) signs in the same body region, without sensory involvement. This distinguishes it from other neuromuscular conditions....
Motor Neurone Disease (ALS)
Motor neurone disease (MND) is a progressive, fatal neurodegenerative disorder characterised by selective degeneration o... MRCP exam preparation.
Mucormycosis
A comprehensive guide to Mucormycosis, covering epidemiology, molecular pathophysiology of angioinvasion, clinical manifestations across all forms (rhinocerebral, pulmonary, disseminated, cutaneous), diagnostic...
Muller-Weiss Syndrome
The hallmark radiographic feature is the "comma-shaped" navicular on lateral radiographs, reflecting compression of the lateral portion and extrusion of the medial fragment dorsally. As the lateral column collapses,...
Multi-Organ Dysfunction Syndrome (MODS) Pathology
Multi-Organ Dysfunction Syndrome (MODS) is the progressive, potentially reversible dysfunction of two or more organ systems arising from an acute threat to systemic homeostasis. MODS represents the final common...
Multiple Endocrine Neoplasia Type 2 (MEN 2)
A comprehensive, evidence-based guide to Multiple Endocrine Neoplasia Type 2 syndromes (MEN 2A and 2B), focusing on RET proto-oncogene mutations, genotype-phenotype correlations, prophylactic thyroidectomy timing,...
Multiple Gestation and Anaesthesia
Multiple gestations (twins, triplets, higher-order multiples) complicate 1.6% of pregnancies in Australia but account for 10-15% of perinatal mortality and morbidity. Twin pregnancies are classified as monochorionic...
Multiple Myeloma
The disease primarily affects older adults with a median age at diagnosis of approximately 70 years (range 65-74 years). The classic clinical features are remembered by the mnemonic "CRAB" : C alcium elevation...
Multiple Sclerosis (Adult)
Multiple Sclerosis (MS) is a chronic, immune-mediated inflammatory demyelinating disease of the central nervous system (... MRCP, Neurology Specialty exam prepa
Multiple Sclerosis (MS)
Multiple Sclerosis (MS) is a chronic, immune-mediated, inflammatory demyelinating disease of the Central Nervous System ... MRCP exam preparation.
Mumps (Child)
Mumps is an acute, highly contagious viral infection caused by the Mumps virus (genus Rubulavirus , family Paramyxoviridae ), characterised clinically by painful, bilateral parotid gland swelling (epidemic parotitis)....
Murphy's Sign (Acute Cholecystitis)
Comprehensive guide to Murphy's Sign: examination technique, diagnostic accuracy, pathophysiology, and clinical application in acute cholecystitis diagnosis. Evidence-based approach to right upper quadrant pain...
Myasthenia Gravis
Clinically, MG presents with ptosis and diplopia in 85% of cases at onset, progressing to generalised weakness in 50-80% within 2 years. Bulbar symptoms (dysarthria, dysphagia) and proximal limb weakness are...
Myasthenia Gravis Crisis
Pathophysiology: Anti-AChR antibodies (85%), anti-MuSK (5%), complement-mediated destruction vs functional blockade... CICM Second Part exam preparation.
Myasthenic Crisis
One-liner : Myasthenic crisis is life-threatening respiratory failure from severe weakness in myasthenia gravis requiring early intubation, immunotherapy (IVIg or plasma exchange), and ICU management.
Myasthenic Crisis (Adult)
Comprehensive evidence-based guide to myasthenic crisis covering definition, pathophysiology, precipitating factors, differentiation from cholinergic crisis, respiratory monitoring, immunotherapy, ICU management, and...
Mycoplasma Pneumonia (Atypical Pneumonia)
Mycoplasma pneumoniae is a cell wall-deficient bacterium representing one of the smallest free-living organisms capable of self-replication. It is the most common cause of atypical pneumonia in children and young...
Myelodysplastic Syndromes
The diagnosis of MDS requires bone marrow examination demonstrating dysplastic changes in ≥10% of cells in one or more myeloid lineages, with exclusion of other causes of dysplasia including nutritional deficiencies...
Myelofibrosis (Adult)
Myelofibrosis (MF) is a clonal myeloproliferative neoplasm (MPN) characterised by progressive bone marrow fibrosis, extr... MRCP exam preparation.
Myocarditis
Fulminant myocarditis (rapid onset below 2 weeks, severe LV dysfunction EF below 35%, cardiogenic shock) has better l... CICM Second Part exam preparation.
Myocarditis
The diagnosis requires high clinical suspicion, particularly in young patients presenting with cardiac symptoms following viral illness. Cardiac magnetic resonance imaging (CMR) has emerged as the gold standard...
Myotonic Dystrophy (DM1 & DM2)
Myotonic dystrophy (DM) is the most common inherited muscular dystrophy in adults, with a prevalence of approximately 1 in 8,000 for DM type 1 (DM1). It represents a multisystem disorder characterized by progressive...
Myxedema Coma
Management requires immediate IV thyroid hormone replacement (T4 loading dose 200-500 mcg, or combination T4 + T3), but ... CICM Second Part, FCICM exam prepara
Myxoedema Coma
Myxoedema coma (myxedema crisis) is the extreme decompensated state of hypothyroidism with mortality 20-60% despite inte... ACEM Primary Written, ACEM Primary V
Myxoedema Coma
Key Facts The "Winter Peak" : Over 90% of cases occur during winter months due to cold-induced stress on minimal thermogenic reserves. The T4-T3 Block : In severe illness, the peripheral conversion of T4 to active T3...
Myxoedema Coma
Myxoedema coma represents the most severe manifestation of decompensated hypothyroidism with mortality rates of 25-60% e... ACEM Fellowship Written, ACEM Fellow
Nail Bed Injuries
Nail bed injuries are among the most common hand injuries presenting to Emergency Departments, accounting for approximat... FRCS (Plast) exam preparation.
Nappy Rash
The key clinical distinction is between Irritant Dermatitis (which characteristically affects convex surfaces and spares the flexures ) and Candidal Dermatitis (which involves the deep flexures and presents with...
Narcolepsy
There are two distinct subtypes: Narcolepsy Type 1 (NT1) : Defined by cataplexy and/or low CSF hypocretin-1 (less than 110 pg/mL). Strongly associated with HLA-DQB1 06:02 ( 95% of cases). Narcolepsy Type 2 (NT2) :...
Nausea and Vomiting in Palliative Care
Nausea and vomiting are among the most distressing and debilitating symptoms in palliative care, affecting 40-70% of patients with advanced cancer and up to 60% of patients in the terminal phase. Effective management...
Navicular Fracture
The tarsal navicular is the keystone of the medial longitudinal arch , occupying a critical position in foot biomechanics and force transmission during gait. Navicular fractures occur in two distinct clinical...
Near-Drowning
Hypoxia is the primary cause of death - start rescue breathing immediately, even before checking for a pulse... ACEM Fellowship Written, ACEM Fellowship OSCE
Near-Drowning and Submersion Injury
Near-drowning (submersion with survival 24 hours) causes severe hypoxic brain injury, pulmonary complications, and often hypothermia. Key principles:
Neck and Laryngeal Anatomy
Define/Describe - Overview of neck and laryngeal divisions and boundaries... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Neck of Femur Fracture in Adults
A neck of femur (NOF) fracture, commonly referred to as a hip fracture, is a critical orthopedic injury involving the pr... FRCS (Tr&Orth) exam preparation.
Necrotising Enterocolitis
Necrotising enterocolitis (NEC) is a devastating gastrointestinal emergency predominantly affecting premature and very l... MRCPCH exam preparation.
Necrotising Enterocolitis
Necrotising Enterocolitis (NEC) is the most common and devastating gastrointestinal emergency affecting neonates, charac... MRCPCH exam preparation.
Necrotising Fasciitis
One-liner : Necrotising fasciitis is a rapidly progressive, life-threatening soft tissue infection requiring emergency surgical debridement within 6-12 hours to prevent death.
Necrotising Fasciitis
The hallmark clinical feature is severe pain that appears disproportionate to the physical examination findings—a result of deep fascial involvement and nerve ischaemia occurring before significant skin changes become...
Necrotizing Fasciitis
Necrotizing fasciitis is classified by microbiology into four types:... CICM Second Part exam preparation.
Neonatal Anaesthesia
Fetal circulation physiology - PVR SVR, PDA-dependent lesions, transition challenges Immature organ systems - Low lung compliance, immature cardiac calcium handling, impaired thermoregulation Pharmacokinetic...
Neonatal and Paediatric ICU Transport
Neonatal and paediatric ICU transport represents a critical component of modern perinatal and paediatric critical care s... CICM Fellowship Written, CICM Fellow
Neonatal Emergencies
One-liner : Neonatal emergencies encompass critical conditions in the first 28 days of life requiring urgent ICU intervention, characterised by unique transitional physiology, immature organ systems, and different...
Neonatal Hypoglycaemia
The operational threshold for intervention varies between international guidelines, but the British Association of Perinatal Medicine (BAPM 2017) defines the intervention threshold as less than 2.6 mmol/L (47 mg/dL)...
Neonatal Jaundice
Key Facts Incidence : Visible jaundice in 60% of term and 80% of preterm infants; clinically significant hyperbilirubinaemia requiring treatment in 5-10% Physiological jaundice : Appears after 24 hours, peaks at 3-5...
Neonatal Respiratory Distress Syndrome (RDS)
Comprehensive evidence-based guide to Neonatal Respiratory Distress Syndrome (RDS), covering surfactant biology, respiratory support strategies (CPAP vs mechanical ventilation), surfactant administration techniques...
Neonatal Resuscitation
PPV Ventilation: Rate: 30-60 breaths/minute (40-60 in term infants, 30-45 in preterm) PIP: 20-25 cm H2O (term), 20-30 cm H2O (preterm) PEEP: 5 cm H2O (avoid in term infants if airway not secured) T-piece device...
Neonatal Resuscitation
Neonatal resuscitation affects 2-10 per 1000 live births, with mortality reaching 20-30% without appropriate interventio... ACEM Primary Written, ACEM Primary V
Neonatal Resuscitation
Comprehensive evidence-based approach to emergency resuscitation of the newborn in the delivery room using NRP guidelines
Neonatal Sepsis
Key Facts Global Incidence : EOS affects 0.5-1.0 per 1000 live births in term infants; 10-20 per 1000 in preterm infants Mortality : Overall 10-20%; up to 50% in very low birth weight (VLBW) infants (less than 1500g)...
Neostigmine
Neostigmine is a reversible acetylcholinesterase inhibitor used to reverse non-depolarizing neuromuscular blockade (NMB) by increasing acetylcholine (ACh) concentration at the neuromuscular junction, overcoming...
Neostigmine and Anticholinesterase Pharmacology
Neostigmine is a quaternary ammonium anticholinesterase agent that reversibly inhibits acetylcholinesterase through carbamylation, increasing acetylcholine concentration at the neuromuscular junction to reverse...
Nephritic Syndrome
Comprehensive evidence-based guide to Nephritic Syndrome in adults, covering the classic pentad of haematuria, hypertension, oliguria, oedema and proteinuria. Distinguishes IgA nephropathy from post-streptococcal GN,...
Nephrotic Syndrome in Adults
Nephrotic syndrome is a clinical syndrome characterized by massive proteinuria leading to hypoalbuminaemia, oedema, and hyperlipidaemia. It represents glomerular dysfunction with loss of the filtration barrier's...
Nerve Blocks in the Emergency Department
Indications and contraindications for common ED nerve blocks... ACEM Fellowship Written, ACEM Fellowship OSCE exam preparation.
Neuraxial Anaesthesia in Obstetrics
What is it? Neuraxial anaesthesia encompasses epidural, spinal, and combined spinal-epidural (CSE) techniques for labour analgesia and caesarean delivery. These techniques provide superior pain relief with minimal...
Neuroanatomy - Brain & Cerebral Circulation
Overview - Major brain divisions and their functions... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Neuroblastoma
The clinical spectrum is remarkably heterogeneous, ranging from spontaneous regression in low-risk infants to aggressive metastatic disease in older children. This biological diversity reflects profound differences in...
Neurofibromatosis (NF1 & NF2)
Neurofibromatosis encompasses two distinct autosomal dominant neurocutaneous disorders: neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2). NF1, also known as von Recklinghausen disease, is the most...
Neurofibromatosis Type 1 (NF1)
NF1 is an autosomal dominant disorder caused by loss-of-function mutations in the NF1 tumour suppressor gene located on chromosome 17q11.2 . This gene encodes neurofibromin , a large cytoplasmic protein of 2,818 amino...
Neurogenic Shock
Pathophysiology: Explain the haemodynamic changes in neurogenic shock following C5 SCI... CICM Second Part exam preparation.
Neuroleptic Malignant Syndrome (NMS)
Supportive care: Aggressive cooling, IV crystalloid resuscitation, benzodiazepines for rigidity/agitation... CICM Second Part Written, CICM Second Part Hot C
Neuromuscular Blockade in ICU
Indications: Severe ARDS, intracranial hypertension, ventilator dyssynchrony, shivering... CICM Second Part, ANZCA Final exam preparation.
Neuromuscular Blocking Agents
Mechanism - NMJ physiology, receptor pharmacology... CICM First Part Written, CICM First Part Viva exam preparation.
Neuromuscular Junction Physiology
Neuromuscular junction (NMJ) is cholinergic synapse between motor neuron and skeletal muscle. Motor neuron action potential → voltage-gated Ca²⁺ channels open → Ca²⁺ influx → ACh vesicle exocytosis (quantal release)....
Neuromuscular Monitoring
Concept Key Facts --------- ----------- Supramaximal stimulation Current 20-25% above maximal response; ensures all motor fibres activated Electrode placement Ulnar nerve at wrist (adductor pollicis); cathode distal...
Neuromyelitis Optica Spectrum Disorder (NMOSD)
A comprehensive, evidence-based guide to Neuromyelitis Optica Spectrum Disorder (NMOSD), covering aquaporin-4 antibody pathophysiology, diagnostic criteria, differentiation from MS and MOGAD, acute management...
Neuropathic Pain - Mechanisms and Management
Neuropathic pain is defined by the International Association for the Study of Pain (IASP) as "pain caused by a lesion or disease of the somatosensory nervous system." It affects 6-10% of the general population, with...
Neurophysiological Monitoring
Intraoperative neurophysiological monitoring (IONM) detects neurological injury during surgery allowing prompt intervention to prevent permanent damage. SSEP (Somatosensory Evoked Potentials): Stimulation of...
Neurophysiology
Neurophysiology encompasses the electrical and chemical processes underlying neuronal function, cerebral blood flow regu... CICM Fellowship Written, CICM Fellow
Neurophysiology for Anaesthesia
Cerebral blood flow (CBF) is normally 50 mL/100g/min (15% cardiac output). Cerebral metabolic rate for oxygen (CMRO₂) : 3.5 mL/100g/min. Cerebral perfusion pressure (CPP) = MAP - ICP (or CVP, whichever higher), normal...
Neurostimulation & Ultrasound in Regional Anaesthesia
Neurostimulation and ultrasound guidance have transformed regional anaesthesia by improving block success rates and reducing complications. Ultrasound provides real-time visualization of nerves, needle trajectory, and...
Neutropenic Sepsis
Neutropenic Sepsis (Febrile Neutropenia, FN) is a life-threatening oncological emergency defined by fever in the presenc... MRCP exam preparation.
Newborn Resuscitation
85% of term newborns transition spontaneously within 10-30 seconds of birth; only 10% require any assistance; under 1... ACEM Primary Written, ACEM Primary V
Nitrous Oxide Pharmacology
Nitrous oxide (N2O) is a colorless, odorless, non-irritating gas and the only inorganic compound used as a general anaesthetic. It is the weakest inhalational anaesthetic with a MAC (minimum alveolar concentration) of...
Nitrous Oxide Pharmacology
Nitrous oxide (N2O) is a colourless, sweet-smelling inhalational anaesthetic agent with unique physicochemical properties that distinguish it from volatile anaesthetics. Key ANZCA Primary exam points include:...
Non-Alcoholic Fatty Liver Disease (NAFLD / MASLD)
Non-Alcoholic Fatty Liver Disease (NAFLD), recently renamed Metabolic Dysfunction-Associated Steatotic Liver Disease (MA... MRCP Part 2 exam preparation.
Non-Invasive Blood Pressure Monitoring
Non-invasive blood pressure (NIBP) monitoring is a fundamental monitoring modality in anaesthesia, with the oscillometric method being the most widely used automated technique. An inflatable cuff occludes arterial...
Non-Invasive Ventilation (NIV)
CPAP vs BiPAP mechanisms - Physiology of positive pressure, effects on work of breathing, preload/afterload... CICM Second Part exam preparation.
Non-Invasive Ventilation (NIV/BiPAP/CPAP)
BiPAP is first-line for COPD exacerbation with respiratory acidosis (pH 7.25-7.35) - NNT 5 to prevent intubation, NNT... ACEM Primary Written, ACEM Primary V
Noonan Syndrome
Unlike Turner syndrome (45,X), which affects only females and predominantly causes left-sided cardiac lesions, Noonan syndrome affects both sexes equally and primarily manifests right-sided cardiac pathology. The...
Noradrenaline (Norepinephrine) Pharmacology
Noradrenaline (norepinephrine) is an endogenous catecholamine and the primary neurotransmitter of the sympathetic nervous system, acting predominantly at alpha-1 adrenoceptors (potent vasoconstriction) with additional...
Normal Pressure Hydrocephalus
The classic clinical presentation includes three cardinal features that typically develop in a characteristic sequence:
NSTEMI and Unstable Angina (Non-ST-Elevation ACS)
Non-ST-elevation acute coronary syndrome (NSTE-ACS) encompasses NSTEMI and unstable angina, characterized by acute cardi... ACEM Primary Written, ACEM Fellowshi
Nutritional Deficiencies in Critical Illness
Nutritional deficiencies are highly prevalent in critically ill patients (30-80%), arising from inadequate intake, incre... CICM Second Part Written, CICM Secon
Obesity Drug Dosing in ICU
Obesity significantly alters drug pharmacokinetics (PK) and pharmacodynamics (PD) in critically ill patients, creating complex dosing challenges. The combination of increased adipose tissue, altered organ blood flow,...
Obesity Management
Obesity is a chronic, relapsing, neurohormonal disease characterised by excessive adipose tissue accumulation (Body Mass Index ≥30 kg/m²) that poses significant health risks. It represents one of the greatest public...
Obsessive-Compulsive Disorder (Adult)
Obsessive-Compulsive Disorder (OCD) is a chronic, debilitating psychiatric condition characterised by the presence of obsessions (recurrent, intrusive, unwanted thoughts, images, or urges causing marked anxiety)...
Obsessive-Compulsive Disorder (OCD)
The hallmark feature of OCD is that obsessions are ego-dystonic – experienced as inconsistent with the person's self-concept, unwanted, and distressing – which distinguishes them from delusions (which are...
Obstetric Haemorrhage - PPH and Massive Transfusion
Primary PPH is defined as blood loss ≥500 mL within 24 hours of vaginal delivery or ≥1000 mL following cesarean section. Major PPH is blood loss 1000 mL or blood loss accompanied by signs of hypovolemia. PPH affects...
Obstetric Hemorrhage
Obstetric hemorrhage is a leading cause of maternal morbidity and mortality worldwide, representing one of the most crit... CICM Fellowship Written, CICM Fellow
Obstructive Shock
Obstructive shock is caused by mechanical obstruction to cardiac filling (tamponade, tension PTX) or ejection (massiv... CICM Second Part exam preparation.
Obstructive Shock (Adult)
Obstructive shock is a form of circulatory failure caused by mechanical obstruction to blood flow into or out of the heart, resulting in critically reduced cardiac output despite normal or increased intravascular...
Obstructive Sleep Apnoea (Adult)
Obstructive Sleep Apnoea (OSA) is a prevalent sleep-related breathing disorder characterized by recurrent episodes of complete (apnoea) or partial (hypopnoea) upper airway obstruction during sleep , resulting in...
Obstructive Sleep Apnoea (OSA)
The core pathology is a "Starling Resistor" failure: the negative pressure generated by the diaphragm overcomes the structural stability of the pharyngeal dilator muscles, causing the airway to suck closed like a wet...
Oesophageal Atresia & TOF
Gold Standard comprehensive guide to oesophageal atresia and tracheo-oesophageal fistula. Covers Gross Classification (A-E), Waterston and Spitz risk stratification, VACTERL association screening, surgical repair...
Oesophageal Cancer (Adult)
Oesophageal cancer is a highly aggressive malignancy of the oesophagus with two distinct histological subtypes: adenocar... MRCP, FRCS exam preparation.
Oesophageal Varices
Approximately 50% of patients with cirrhosis have varices at the time of diagnosis , with the prevalence increasing to 60-80% in those with decompensated cirrhosis. The annual incidence of new varix formation is 5-8%...
Olecranon Bursitis (Adult)
Olecranon Bursitis is inflammation of the superficial subcutaneous bursa overlying the olecranon process at the posterior aspect of the elbow. It represents one of the most common superficial bursitides encountered in...
Olecranon Fracture
Because the olecranon forms the articular surface of the ulnohumeral joint (the primary stabilizer of the elbow), anatomical reduction is mandatory to restore joint congruity and prevent post-traumatic arthritis. The...
Oliguria in Adults
Oliguria is defined as urine output less than 0.5 mL/kg/hr in adults, or less than 400 mL per 24 hours in an average 70 ... MRCP exam preparation.
Ondansetron Pharmacology
Ondansetron is a selective 5-HT₃ (serotonin type 3) receptor antagonist used primarily for the prevention and treatment of postoperative nausea and vomiting (PONV) and chemotherapy-induced nausea and vomiting (CINV)....
Open Fracture
An open fracture (compound fracture) is defined as a fracture with a direct communication between the external environment and the fracture haematoma, either through traumatic disruption of the overlying soft tissues...
Opioid Analgesics
Classification: Natural, semi-synthetic, synthetic opioids... CICM First Part Written, CICM First Part Viva exam preparation.
Opioid Overdose
Opioid overdose occurs when excessive opioid agonism at mu-receptors causes life-threatening respiratory depression thro... ACEM Primary Written, ACEM Primary V
Opioid Overdose
Opioid overdose causes life-threatening respiratory depression through μ-opioid receptor agonism in the brainstem. Immed... CICM Fellowship Written, CICM Fellow
Opioid Overdose in Adults
Emergency diagnosis and management of opioid overdose in adults including naloxone administration, harm reduction, and observation protocols
Opioid Toxicity
:::danger[Immediate Life Threats] Airway is priority : Bag-valve-mask ventilation BEFORE and WHILE giving naloxone Apnea kills : Respiratory arrest leads to death within minutes Naloxone is the antidote : Administer...
Opioid Use Disorder
The opioid epidemic has evolved through three distinct waves: prescription opioid overprescribing (1990s-2000s), heroin resurgence (2010s), and synthetic opioid proliferation particularly fentanyl (2015-present)....
Oral Candidiasis (Adult)
Oral candidiasis, commonly known as oral thrush, is a fungal infection of the oral mucosa caused predominantly by Candid... MRCP exam preparation.
Orbital Cellulitis
Orbital cellulitis is a vision- and life-threatening emergency characterized by infection of the orbital soft tissues po... MRCP, Emergency Medicine exam prepar
Organophosphate and Carbamate Poisoning
Decontamination: Remove clothing, copious water irrigation (staff PPE mandatory)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Organophosphate Poisoning
Organophosphate (OP) poisoning is a life-threatening toxicological emergency resulting from exposure to insecticides (ag... MRCP, FRCA exam preparation.
Organophosphate Poisoning
Organophosphate (OP) poisoning is a medical emergency requiring immediate antidotal therapy with atropine and pralidoxim... ACEM Primary Written, ACEM Primary V
Osgood-Schlatter Disease
The pathophysiology involves repetitive microtrauma to the secondary ossification centre of the tibial tubercle, occurring predominantly during activities involving powerful quadriceps contractions such as jumping,...
Osteoarthritis
It is a "Whole Joint Failure". The cardinal features are pain (mechanical), stiffness (short duration), and loss of function. It predominantly affects weight-bearing joints (Hips, Knees) and the hands (DIPs, CMC thumb).
Osteochondritis Dissecans in Children
Osteochondritis dissecans (OCD) is a localised disorder of subchondral bone characterised by separation of an osteochond... MRCS, FRCS Orth exam preparation.
Osteogenesis Imperfecta (Child)
Osteogenesis Imperfecta (OI) is a heritable connective tissue disorder characterised by bone fragility, resulting from quantitative or qualitative defects in type I collagen. First described by Ekman in 1788 and...
Osteomalacia (Adult Rickets)
Osteomalacia is a metabolic bone disease characterised by defective mineralisation of the osteoid matrix in adults, resulting in the accumulation of unmineralised or inadequately mineralised bone. The term derives...
Osteomalacia & Rickets
Osteomalacia and rickets represent a spectrum of metabolic bone disorders characterised by defective mineralisation of b... MRCP exam preparation.
Osteomyelitis
Biofilm: The primary reason for treatment failure. Bacteria adhere to implant/bone and secrete a glycocalyx matrix (... FRCS exam preparation.
Osteoporosis
Clinically, it is known as the "silent thief" because bone loss occurs without symptoms until a fragility fracture occurs. A fragility fracture is defined as a fracture resulting from a fall from standing height or...
Osteosarcoma
Osteosarcoma is the most common primary malignant bone tumour, accounting for approximately 20% of all primary bone canc... MRCP, MRCS, FRCS Orth, FRACS Orth ex
Otitis Externa
Comprehensive evidence-based guide to acute and necrotizing otitis externa including diagnosis, management, and complications
Otitis Media (AOM and OME)
Otitis Media encompasses a spectrum of inflammatory conditions affecting the middle ear cleft, representing one of the most common reasons for paediatric consultation and antibiotic prescription worldwide. The two...
Ovarian Cancer (Adult)
Ovarian cancer is the deadliest gynaecological malignancy and the fifth leading cause of cancer death in women in developed countries. Despite accounting for only 3% of all female cancers, it causes more deaths than...
Ovarian Cysts
Ovarian cysts are fluid-filled or semisolid structures within or on the surface of an ovary, representing one of the mos... MRCOG exam preparation.
Ovarian Torsion
The condition predominantly affects women of reproductive age (20-40 years) but can occur at any age from infancy to post-menopause. The presence of an ovarian mass—particularly cysts or tumours exceeding 5cm in...
Overactive Bladder Syndrome (OAB)
Overactive bladder (OAB) is a symptom syndrome characterised by urinary urgency, usually accompanied by increased daytime frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary...
Oxycodone and Tramadol Pharmacology
Oxycodone and tramadol represent two distinct approaches to opioid analgesia with fundamentally different pharmacological profiles essential for ANZCA Primary examination. Oxycodone is a semi-synthetic opioid derived...
Oxygen Delivery Systems
Oxygen delivery systems provide supplemental oxygen to patients with varying degrees of efficiency and control. Variable performance devices (nasal cannula, simple mask): Delivered FiO2 depends on patient's...
Oxygen Transport & Delivery
The CICM First Part examination places significant emphasis on oxygen transport physiology as it underpins critical care... CICM First Part Written, CICM First
Oxygen Transport & Haemoglobin Dissociation Curve
Oxygen transport from lungs to tissues occurs via two mechanisms: physically dissolved in plasma (3%) and chemically bound to hemoglobin (97%). Each gram of hemoglobin can bind approximately 1.34 mL of oxygen, giving...
Pacemaker Emergencies in ICU
Failure to pace/capture in dependent patient: Apply magnet (asynchronous pacing), prepare TCP, correct metabolic abno... CICM Second Part exam preparation.
Paediatric Advanced Life Support (PALS)
Paediatric cardiac arrest differs fundamentally from adult arrest. Most paediatric arrests are asphyxial (respiratory in... ACEM Primary Written, ACEM Primary V
Paediatric Airway Anatomy & Physiology
Paediatric airway management requires understanding of profound anatomical and physiological differences from adults. Infants have a proportionally larger occiput, larger tongue, higher larynx (C3-C4), and...
Paediatric Airway Management
The paediatric airway differs fundamentally from the adult airway in anatomy, physiology, and pathology. Children are NO... ACEM Primary Written, ACEM Primary V
Paediatric Anaesthesia Principles
Paediatric anaesthesia requires understanding of age-related physiological differences . Airway : Large tongue, cephalad larynx (C3-4 vs C4-5 in adults), narrow cricoid (subglottic region), short trachea, prominent...
Paediatric Cardiac Anaesthesia
Understanding circulation patterns - Systemic vs pulmonary blood flow balance, Qp:Qs ratios Shunt physiology - Direction and magnitude affect oxygenation and cardiac output Single ventricle physiology - Series...
Paediatric Cardiac Arrest
Survival depends on early recognition of pre-arrest states (bradycardia, respiratory failure), rapid initiation of BLS w... ACEM Primary Written, ACEM Primary V
Paediatric Respiratory Failure
High-flow oxygen therapy or HFNC (humidified 2 L/kg/min)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Paediatric Resuscitation
Evidence-based emergency resuscitation of infants and children in cardiac arrest
Paediatric Sepsis
One-liner : Paediatric sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection in children, characterised by age-specific physiological responses, "cold shock" predominance,...
Paediatric Status Epilepticus
Paediatric SE affects 17-23 per 100,000 children annually with highest incidence in infants <1 year . Febrile seiz... CICM Second Part Written, CICM Secon
Paediatric Trauma
Blood volume - 80 mL/kg (neonate) to 70 mL/kg (older child); hypovolaemic shock manifests late TBI management - Age-specific GCS, higher tolerance for hypotension but avoid hypoxia at all costs Hypotensive...
Paediatric Trauma
Paediatric trauma accounts for a significant proportion of ED presentations and mortality in children. Unlike adults, ch... ACEM Fellowship Written, ACEM Fellow
Paediatric Trauma
Trauma is the leading cause of death in children 1-14 years, with TBI accounting for 70-80% of trauma-related mortali... CICM Second Part Written, CICM Secon
Paget's Disease of Bone
The disease typically affects individuals over 55 years of age and is frequently asymptomatic, discovered incidentally through elevated serum alkaline phosphatase (ALP) or characteristic radiological findings. When...
Paget's Disease of Bone
A comprehensive guide to Paget's Disease of Bone, covering pathophysiology, the 'Cotton Wool' skull appearance, isolated raised Alkaline Phosphatase, bisphosphonate therapy, and complications including osteosarcoma.
Pain Pathways & Transmission (Gate Control Theory)
Pain transmission involves first-order neurons (Aδ myelinated, 5-30 m/s, sharp/fast pain; C unmyelinated, 0.5-2 m/s, dull/slow pain) from peripheral nociceptors → dorsal horn (substantia gelatinosa, Rexed laminae I,...
Palliative & Oncological Emergencies
Oncological emergencies represent acute, life-threatening or function-threatening complications that can occur at any stage of malignancy, from initial presentation through to end-of-life care. These emergencies...
Palliative Care Principles in Intensive Care
Palliative care in the intensive care unit (ICU) represents a fundamental component of high-quality critical care, focus... CICM Fellowship Written, CICM Fellow
Palliative Pain Management
Effective pain management is the cornerstone of palliative care, affecting 70-90% of patients with advanced cancer and requiring systematic, evidence-based approaches. The principles are guided by the WHO Analgesic...
Pancreatic Cancer
Pancreatic Ductal Adenocarcinoma (PDAC) represents approximately 95% of all pancreatic malignancies and is the 4th leading cause of cancer-related mortality in Western countries, with a devastating 5-year survival...
Pandemic Response in Intensive Care
Activate Hospital Incident Command System (HICS)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Panic Disorder
Panic disorder is a disabling anxiety disorder characterized by recurrent, unexpected panic attacks followed by at least... MRCPsych exam preparation.
Paracentesis
Ultrasound guidance is mandatory - reduces dry taps by 95%, complications by 50-70% (PMID: 23867388)... CICM Second Part Written, CICM Second Part Hot Case e
Paracetamol (Acetaminophen) Overdose
Assess risk: Time of ingestion, dose ingested, coingestants, chronic use... CICM Final Written, CICM Final Viva exam preparation.
Paracetamol Overdose
Paracetamol (Acetaminophen) overdose is one of the most common poisonings in the Western world. It causes hepatotoxicity... MRCP exam preparation.
Paraphimosis
Pearl 1 : Prevention is paramount — ALL healthcare staff performing catheterisation must be trained to replace the foreskin after the procedure. Failure to do so accounts for the majority of paraphimosis cases.
Paraquat Poisoning
Paraquat (1,1'-dimethyl-4,4'-bipyridylium) is a highly toxic bipyridyl herbicide with 60-90% mortality. Toxicity results... ACEM Primary Written, ACEM Primary V
Paravertebral Block
Medial: Vertebral body (posterior aspect) Intervertebral disc Intervertebral foramen Lateral border of vertebral canal
Parkinson's Disease
Parkinson's disease (PD) is a progressive neurodegenerative disorder characterised by the loss of dopaminergic neurons i... MRCP exam preparation.
Parkinson's Disease (Adult)
Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by the selective loss of dopaminergic... MRCP, USMLE exam preparation.
Patau Syndrome (Trisomy 13)
Patau syndrome, also known as trisomy 13, is a severe chromosomal disorder caused by the presence of an additional copy ... MRCPCH exam preparation.
Patella Dislocation (Adult)
Acute patellar dislocation is a common traumatic knee injury characterized by lateral displacement of the patella from the trochlear groove of the femur. It represents the second most common cause of acute traumatic...
Patella Fracture (Adult)
The patella is the largest sesamoid bone in the human body and serves a critical biomechanical function in the extensor ... MRCS, FRCS (Tr & Orth) exam preparat
Patellar Tendinopathy (Jumper's Knee)
Patellar tendinopathy, commonly known as Jumper's Knee , is a chronic overuse injury characterized by activity-related anterior knee pain localized to the inferior pole of the patella. The condition predominantly...
Patellar Tendon Rupture (Adult)
Patellar tendon rupture is a complete disruption of the knee extensor mechanism occurring predominantly in younger, active adults (less than 40 years) . It represents a surgical emergency requiring prompt diagnosis...
Patient Safety in ICU
Patient safety in the intensive care unit (ICU) represents one of the most critical domains of modern critical care practice. ICU patients are among the most vulnerable in healthcare, with physiological instability,...
PEA and Asystole (Non-Shockable Rhythms)
PEA is defined as an organised electrical rhythm on the monitor in the absence of a palpable central pulse, while asysto... ACEM Primary Written, ACEM Primary V
Pediatric Bacterial Meningitis
Comprehensive evidence-based guide to diagnosis and management of bacterial meningitis in neonates, infants, and children - emergency recognition, age-specific pathogens, CSF interpretation, empiric antibiotics, and...
Pediatric Gastroenteritis
Comprehensive evidence-based guide to diagnosis, dehydration assessment, and management of acute gastroenteritis in children
Pediatric Traumatic Brain Injury
Traumatic brain injury (TBI) is a leading cause of death and disability in children worldwide. Pediatric TBI differs sig... CICM Fellowship exam preparation.
Pelvic Anatomy (Obstetric Relevance)
Define/Describe - Overview of pelvic boundaries and contents... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Pelvic Fracture Trauma
Pelvic fractures represent high-energy injuries with significant mortality, primarily due to haemorrhage. Immediate mana... ACEM Fellowship Written, ACEM Fellow
Pelvic Fracture: Haemorrhage Control and Anaesthetic Management
Pelvic fractures in trauma are associated with life-threatening haemorrhage due to disruption of the extensive pelvic venous plexus and arterial network. Immediate haemorrhage control involves application of a pelvic...
Pelvic Fractures (Adult)
Pelvic fractures represent the most lethal orthopaedic injury encountered in trauma, with mortality rates ranging from 10% in stable fractures to 40-50% in open fractures. The pelvis is an osseoligamentous ring...
Pelvic Inflammatory Disease (PID)
Pelvic Inflammatory Disease (PID) is an infection and inflammation of the upper female genital tract, encompassing the u... MRCOG, MRCS exam preparation.
Pelvic Organ Prolapse (POP)
The condition exists on a spectrum from asymptomatic anatomical findings to severe prolapse causing significant functional impairment and reduced quality of life. While not life-threatening in most cases, severe...
Pelvic Trauma
Pelvic fractures with hemodynamic instability have mortality of 30-50%. Immediate pelvic binder application and multidis... CICM Second Part exam preparation.
Pemphigus Vulgaris
Unlike Bullous Pemphigoid, the blisters are superficial (intra-epidermal) and rupture easily, often leaving large, painful, raw areas that are prone to infection. The disease typically begins with oral mucosal...
Penetrating Abdominal Trauma
Penetrating abdominal trauma is a surgical emergency with mortality 15-25% for major vascular injuries. Immediate priori... ACEM Primary Written, ACEM Primary V
Penetrating Chest Trauma
Penetrating chest trauma requires rapid assessment and immediate life-saving interventions. Follow ATLS primary survey w... ACEM Primary Written, ACEM Primary V
Penile Cancer
Human papillomavirus (HPV), particularly high-risk types 16 and 18, is detected in 30-50% of penile cancers through molecular studies, establishing a viral oncogenic pathway analogous to cervical cancer. Chronic...
Peptic Ulcer Disease
Test-and-Treat Strategy : NICE recommends non-invasive H. pylori testing (UBT or stool antigen) followed by eradication therapy for patients less than 55 years without alarm features, avoiding endoscopy. This strategy...
Peptic Ulcer Disease in Adults
Peptic ulcer disease (PUD) is a distinct break in the mucosal lining of the stomach (gastric ulcer) or the first portion... MRCP exam preparation.
Perforated Viscus
Incidence : Perforated peptic ulcer 3.8-10 per 100,000/year; perforated diverticulitis 4 per 100,000/year Classic triad : Sudden severe abdominal pain + peritonism + pneumoperitoneum Examination hallmark : Board-like...
Perianal Abscess and Fistula-in-Ano
This condition represents one of the most common anorectal emergencies encountered in surgical practice, with significant implications for patient quality of life and functional outcomes. The fundamental surgical...
Pericardiectomy for Constrictive Pericarditis
Pericardiectomy is the surgical removal of the pericardium for constrictive pericarditis, a condition where a thickened, fibrotic, or calcified pericardium restricts diastolic filling, creating a "stiff shell" around...
Pericardiocentesis
Ultrasound-guided pericardiocentesis has 90-97% success rate compared to 50-80% for blind technique (PMID: 12628672, ... ACEM Primary Written, ACEM Primary V
Pericarditis and Cardiac Tamponade
Acute pericarditis diagnosis requires ≥2 of 4 criteria: chest pain, friction rub, ECG changes, pericardial effusion (... CICM Second Part exam preparation.
Periductal Mastitis (Non-Lactational)
Periductal Mastitis (PDM) is a chronic inflammatory condition of the subareolar ducts, predominantly affecting women of reproductive age, with a strong association with cigarette smoking ( 90% of cases). It is...
Perimortem Caesarean Section (Resuscitative Hysterotomy)
Maternal cardiac arrest occurs in approximately 1 in 30,000 deliveries with high mortality (60-70% if delayed). The grav... ACEM Primary Written, ACEM Primary V
Perineal Tears & OASI
Perineal trauma affects approximately 85% of women having a vaginal birth, making it one of the most common obstetric complications. While most tears are minor (1st/2nd degree), severe tears involving the anal...
Perioperative Anaemia Management
Comprehensive guide to patient blood management, iron deficiency, EPO, and transfusion triggers for ANZCA Fellowship examination
Perioperative Anaphylaxis
Anaphylaxis is an acute, potentially life-threatening systemic hypersensitivity reaction mediated by immunological (IgE or IgG) or non-immunological mechanisms. In the perioperative setting, IgE-mediated (Type I)...
Perioperative Anaphylaxis: Recognition, Adrenaline Dosing, and Refractory Management
Perioperative anaphylaxis is a severe, life-threatening systemic hypersensitivity reaction occurring during or immediately after anaesthesia, with an estimated incidence of 1 in 10,000 to 1 in 20,000 anaesthetics....
Perioperative Arrhythmia Management
Comprehensive guide to atrial fibrillation management, beta-blockers, amiodarone, and perioperative cardiac rhythm disturbances for ANZCA Fellowship examination
Perioperative Aspiration: Mendelson Syndrome, Rapid Sequence Induction, and Cricoid Pressure
Perioperative pulmonary aspiration occurs in 1 in 3,000 to 1 in 6,000 general anaesthetics , with significant aspiration (leading to respiratory compromise) in approximately 1 in 10,000 . Mendelson syndrome —the...
Perioperative Cardiac Arrest
Hypoxaemia (25-30% of cases): Inadequate airway: Difficult intubation, CICV scenario, airway obstruction Ventilation failure: Equipment malfunction, circuit disconnection, esophageal intubation Pulmonary pathology:...
Perioperative Diabetes Management
Diabetes mellitus affects 5-10% of Australian surgical patients, with perioperative hyperglycaemia associated with increased wound infections (30% higher), mortality, and hospital length of stay. Preoperative...
Perioperative Diabetes Management: Glycemic Control, Insulin Protocols, and Hypoglycemia Prevention
Diabetes mellitus affects 10-15% of surgical patients , with perioperative hyperglycemia associated with increased morbidity including surgical site infections, delayed wound healing, cardiovascular events, and...
Perioperative Medicine and Optimisation
Comprehensive guide to perioperative optimisation, comorbidity management, and multidisciplinary care pathways for ANZCA Fellowship examination
Perioperative Myocardial Infarction
Perioperative myocardial infarction (PMI) represents acute myocardial injury occurring within 30 days of surgery, result... FRCA exam preparation.
Perioperative Temperature Management
Comprehensive guide to thermoregulation physiology, hypothermia prevention, temperature monitoring, and therapeutic temperature management for ANZCA Fellowship examination
Peripartum Cardiomyopathy
One-liner : Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with heart failure (LVEF <45%) in the last month of pregnancy to 5 months postpartum, characterised by potential for recovery...
Peripheral Intravenous Access
Peripheral IV access is the most common invasive procedure - 80-90% of hospitalized patients, 330 million PIVCs inser... CICM Second Part Written, CICM Secon
Peripheral Neuropathy
The hallmark of successful management lies in accurate phenotyping : Is it Axonal or Demyelinating? (NCS/EMG distinguishes). Is it Symmetric or Asymmetric? (Systemic vs Local/Vasculitis). Is it Large Fiber or Small...
Peritonitis in Adults
Comprehensive evidence-based guide to diagnosis and management of peritonitis including spontaneous bacterial peritonitis (SBP), secondary peritonitis from perforation, and emergency surgical intervention
Peritonsillar Abscess (Quinsy)
Peritonsillar abscess (PTA), also known as quinsy, is a collection of pus between the tonsillar capsule and the superior pharyngeal constrictor muscle in the peritonsillar space. It represents the most common deep...
Peroneal Tendon Dislocation
Acute injuries are commonly mistaken for lateral ankle sprains, leading to delayed diagnosis and chronic instability. The hallmark clinical feature is a painful "snapping" or "popping" sensation at the posterolateral...
Peroneal Tendon Disorders
Superior Peroneal Retinaculum (SPR): The primary restraint preventing subluxation out of the retromalleolar groove.... FRCS exam preparation.
Persistent Pulmonary Hypertension of the Newborn (PPHN)
A comprehensive, evidence-based guide to persistent pulmonary hypertension of the newborn (PPHN), covering pathophysiology of failed circulatory transition, molecular mechanisms, diagnostic criteria including...
Personality Disorders
Personality disorders (PDs) represent enduring patterns of inner experience and behavior that deviate markedly from cult... MRCPsych exam preparation.
Perthes Disease (LCPD)
Legg-Calvé-Perthes Disease (LCPD) is an idiopathic Avascular Necrosis (AVN) of the developing femoral head in children, typically aged 4-8 years. The condition represents a self-limiting disorder characterized by...
Perthes Disease (Legg-Calvé-Perthes Disease)
Legg-Calvé-Perthes disease (LCPD), commonly known as Perthes disease, is an idiopathic avascular necrosis (AVN) of the c... MRCPCH exam preparation.
Pertussis
While pertussis affects all age groups, it poses the greatest threat to young infants, particularly those under 6 months of age who have not completed their primary vaccination series. In this vulnerable population,...
Phaeochromocytoma and Paraganglioma
Phaeochromocytoma is a rare catecholamine-secreting tumour arising from chromaffin cells of the adrenal medulla. When arising from extra-adrenal sympathetic ganglia (paraganglia), the tumour is termed paraganglioma....
Phaeochromocytoma Crisis
Domain Key Focus Areas ------------ --------------------- Catecholamine Synthesis Tyrosine → L-DOPA → Dopamine → Noradrenaline → Adrenaline pathway; rate-limiting enzyme (tyrosine hydroxylase) Receptor Pharmacology...
Phaeochromocytoma Crisis
The cornerstone of acute management is alpha-adrenergic blockade FIRST using phentolamine (IV) or phenoxybenzamine (oral), followed only then by beta-blockade to control tachycardia. Beta-blockers administered alone...
Pharmacodynamics
The concept of receptors as specific drug recognition sites originated with Langley (1878) and Ehrlich (1900), establishing that drugs exert effects by interacting with discrete molecular targets rather than through...
Pharmacokinetics
The relevance of pharmacokinetics to anaesthesia is profound. Intravenous anesthetics, opioids, neuromuscular blocking agents, and vasoactive drugs all exhibit complex pharmacokinetic profiles that influence onset...
Pharmacokinetics and Pharmacodynamics in Critical Care
Pharmacokinetics (PK) and pharmacodynamics (PD) are fundamentally altered in critically ill patients, leading to unpredi... CICM Fellowship Written, CICM Fellow
Phenylephrine Pharmacology
Phenylephrine is a synthetic, non-catecholamine sympathomimetic amine that acts as a selective alpha-1 adrenergic receptor agonist with minimal beta-adrenergic activity. Unlike catecholamines (epinephrine,...
Phenylephrine: Pharmacology and Clinical Use
Phenylephrine is a direct-acting α-1 adrenergic receptor agonist with potent vasoconstrictor effects and no β-activity. Mechanism : Stimulates postsynaptic α-1 receptors on vascular smooth muscle → vasoconstriction →...
Phimosis and Paraphimosis
Phimosis is the inability to retract the foreskin (prepuce) over the glans penis. It exists on a spectrum from physiological (normal and expected in infants and young children) to pathological (abnormal scarring in...
Phosphate and Magnesium Disorders in the ICU
Identify and treat underlying cause (refeeding, DKA treatment, diuretics, alcoholism)... CICM Second Part Written, CICM Second Part Hot Case exam preparation
Pierre Robin Sequence
The primary clinical challenges are upper airway obstruction (UAO) and feeding difficulties , both directly attributable to glossoptosis. PRS can occur as an isolated anomaly (40-50% of cases) or as part of a...
Pilon Fracture (Adult)
A pilon fracture (from the French pilon, meaning "pestle" or "hammer") is a complex intra-articular fracture of the dist... FRCS (Tr&Orth) exam preparation.
Pilonidal Sinus (Adult)
Pilonidal sinus disease (PSD) is a chronic inflammatory condition affecting the natal cleft (intergluteal region), characterised by midline pits, subcutaneous sinus tracts containing hair and keratin debris, and a...
Pituitary Surgery and Transsphenoidal Hypophysectomy
Transsphenoidal pituitary surgery requires managing endocrine dysfunction, fluid balance, and unique surgical positioning. Key principles:
Placenta Praevia
The RCOG Green-top Guideline No. 27a (2018) has modernized the classification system, moving away from outdated grading systems (Grade I–IV or major/minor) toward descriptive ultrasound-based terminology:
Placental Abruption
Placental abruption is a life-threatening obstetric emergency affecting 0.5-1% of pregnancies with perinatal mortality r... ACEM Primary Written, ACEM Primary V
Placental Abruption
Comprehensive evidence-based guide to placental abruption covering pathophysiology, risk stratification, maternal-fetal assessment, emergency management, and delivery decision-making.
Plantar Fasciitis
Plantar Fasciitis is the most common cause of inferior heel pain, affecting approximately 10% of the general population ... FRCS, FRACS exam preparation.
Plantar Fibromatosis
The hallmark of management is conservative first : surgery is fraught with extremely high recurrence rates (57-100% for simple excision), making non-operative modalities including custom orthotics, intralesional...
Plantar Warts (Verrucae)
Plantar warts (verrucae plantares) are benign epithelial proliferations on the plantar surface of the feet caused by inf... MRCP, Primary Care exam preparation.
Platelet Function and Hemostasis
Define/Describe - Platelet structure and origin... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Pleural Effusion
Pleural effusion is the abnormal accumulation of fluid in the pleural space, the potential space between the visceral an... MRCP exam preparation.
Pleural Effusion - Emergency Management
Pleural effusion affects 1.5 million people annually in developed countries, with causes ranging from transudative (CHF,... ACEM Fellowship Written, ACEM Fellow
Pneumocystis Pneumonia (PCP)
Pneumocystis Pneumonia (PCP), caused by the fungus Pneumocystis jirovecii, is a life-threatening opportunistic infection... MRCP exam preparation.
Pneumonia - Adult
CURB-65 score (0-1: outpatient, 2: consider admission, ≥3: severe - ICU assessment) is the most validated severity to... ACEM Fellowship Written, ACEM Fellow
Pneumonia - Community and Hospital-Acquired
Definition: Acute infection of the lung parenchyma acquired outside hospital or within first 48 hours of admission.... CICM Second Part exam preparation.
Pneumonia - Paediatric
Tachypnoea is the most sensitive clinical sign of pneumonia: greater than 60/min (below 2 months), greater than 50/mi... ACEM Fellowship Written, ACEM Fellow
Pneumothorax in Adults
Pneumothorax is defined as air in the pleural space, resulting in partial or complete lung collapse. It represents a com... MRCP, FRACP exam preparation.
Pneumothorax in ICU
Comprehensive CICM Second Part clinical guide to Pneumothorax in the ICU, covering classification, aetiology, tension pneumothorax pathophysiology, detection in ventilated patients, needle decompression, chest drain...
Point-of-Care Ultrasound (POCUS)
Parameter Detail ----------- -------- Core Applications eFAST, cardiac views, lung ultrasound, IVC, AAA, DVT, procedural guidance ACEM Credential Core skill - required for Fellowship Minimum Training 25-50 supervised...
Poliomyelitis (Child)
Poliomyelitis (polio) is an acute viral infection caused by poliovirus , a human enterovirus belonging to the Picornaviridae family. While the majority of poliovirus infections are asymptomatic or cause only minor...
Polyarteritis Nodosa
Polyarteritis nodosa (PAN) is a rare necrotizing vasculitis that primarily affects medium-sized muscular arteries, leadi... MRCP exam preparation.
Polyarteritis Nodosa (PAN)
PAN can be idiopathic (most cases in developed countries) or associated with Hepatitis B Virus (HBV) infection (classic association, now less than 5% due to vaccination programs). The disease affects multiple organ...
Polycystic Ovarian Syndrome (PCOS)
Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, affecting approxi... MRCOG exam preparation.
Polycystic Ovary Syndrome (PCOS)
PCOS is not simply an ovarian disorder but a systemic metabolic condition with far-reaching health implications. Women with PCOS face substantially elevated risks of type 2 diabetes mellitus (4-fold increase),...
Polycythaemia Vera
PV represents the most common cause of primary erythrocytosis and is distinguished from secondary causes by the presence of the JAK2 V617F mutation in 95% of cases . The remaining cases harbour mutations in JAK2 exon...
Polymyalgia Rheumatica
The disease has a striking demographic profile: it is almost never seen in individuals under 50 years of age, with peak incidence occurring between 70-80 years. Women are affected approximately twice as frequently as...
Polymyositis (Adult)
Polymyositis (PM) is a rare, chronic autoimmune inflammatory myopathy characterized by symmetric proximal muscle weakness without the cutaneous manifestations seen in dermatomyositis. It represents one of the...
Polytrauma
Polytrauma management requires systematic, prioritized care following ATLS principles with damage control resuscitation ... CICM Second Part exam preparation.
Popliteal Sciatic Nerve Block
The popliteal fossa is a diamond-shaped space posterior to the knee joint containing the neurovascular structures supplying the lower leg and foot.
Portal Hypertension
Key Facts Definition : HVPG greater than 5 mmHg. Clinically Significant : HVPG greater than or equal to 10 mmHg (varices start forming). Bleeding Risk : HVPG greater than or equal to 12 mmHg (varices can bleed)....
Post-Brain Death Donor Management
Post-brain death donor management (PBDM) refers to the comprehensive physiological optimisation of the potential organ d... CICM Fellowship Written, CICM Fellow
Post-Cardiac Arrest Care
Post-cardiac arrest care focuses on minimizing secondary brain injury through targeted temperature management (32–36°C f... CICM Second Part exam preparation.
Post-Cardiac Arrest Care (Adult)
Post-cardiac arrest care encompasses the comprehensive management of patients who achieve return of spontaneous circulation (ROSC) following cardiac arrest. This critical phase addresses the systemic consequences of...
Post-Cardiac Surgery ICU Management
Structured handover using SBAR format (PMID: 21255531)... CICM Second Part exam preparation.
Post-Extubation Stridor & Laryngeal Oedema
Patient extubated 2-4 hours ago with progressive stridor, using accessory muscles, SpO2 falling despite high-flow oxygen... CICM Second Part exam preparation.
Post-Intensive Care Syndrome (PICS)
Definition: PICS encompasses new or worsening impairments in physical, cognitive, or mental health status arising aft... CICM Second Part Written, CICM Secon
Post-Intubation Management
Immediate post-intubation management requires systematic verification of correct ETT placement, secure fixation, and ini... ACEM Primary Written, ACEM Primary V
Post-Resuscitation Care
Post-resuscitation care is the critical phase between ROSC and definitive outcome, determining whether a patient survive... ACEM Primary Written, ACEM Primary V
Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) is a debilitating psychiatric disorder that develops in susceptible individuals fo... MRCP, PLAB exam preparation.
Post-Traumatic Stress Disorder (PTSD)
A disorder developing after exposure to a traumatic event involving actual or threatened death, serious injury, or sexual violence.
Posterior Urethral Valves (PUV)
The condition is increasingly diagnosed antenatally via ultrasound, typically manifesting as bilateral hydronephrosis, a distended thick-walled bladder, dilated posterior urethra (the pathognomonic "keyhole sign"),...
Postnatal Depression (PND)
Postnatal depression (PND), also termed postpartum depression (PPD), is a non-psychotic depressive episode occurring wit... MRCOG, MRCPCH, MRCPsych exam prepara
Postoperative Nausea and Vomiting Prophylaxis
Postoperative nausea and vomiting (PONV) affects 20-30% of surgical patients and 70-80% of high-risk patients, significantly impacting patient satisfaction, delaying discharge, and increasing costs. Risk...
Postoperative Pain Management
Somatic Pain: Tissue injury from surgical incision and manipulation Mediators: Bradykinin, histamine, prostaglandins, substance P, serotonins Receptors: Aδ and C fibers (Aδ: sharp, localized; C: dull, aching)...
Postpartum Endometritis
The condition is characterised by the classic triad : fever ( 38°C), uterine tenderness, and offensive lochia. Caesarean section is the single most important risk factor, increasing the risk 10-20 fold compared to...
Postpartum Haemorrhage
PPH is defined as blood loss ≥500ml following vaginal delivery or ≥1000ml following Caesarean section. However, these definitions are based on estimated blood loss, which is notoriously inaccurate—visual estimation...
Postpartum Haemorrhage
PPH affects 10-15% of deliveries and remains a leading cause of maternal mortality globally. The most common cause is ut... ACEM Primary Written, ACEM Primary V
Postpartum Hemorrhage (PPH)
Comprehensive evidence-based guide to postpartum hemorrhage covering definition, classification, 4Ts etiology, quantitative blood loss, uterotonic management, tranexamic acid, surgical interventions, and massive...
Postpartum Mental Health
Perinatal mental health disorders represent a spectrum of psychiatric conditions occurring during pregnancy and the first year postpartum, ranging from the common, self-limiting Baby Blues to severe, life-threatening...
Potassium Disorders: Hypokalemia and Hyperkalemia
Cardiac membrane stabilisation: Calcium gluconate 10% 10-20 mL IV over 2-5 min (or calcium chloride 10% 5-10 mL via C... CICM Second Part Written, CICM Secon
Prader-Willi Syndrome (PWS)
Prader-Willi Syndrome (PWS) is a complex multisystem genetic disorder caused by loss of expression of paternally inherit... MRCPCH, FRACP exam preparation.
Pre-eclampsia
Key Facts: Definition : Hypertension ≥140/90 mmHg + proteinuria or end-organ dysfunction after 20 weeks Prevalence : 2-8% of pregnancies globally Incidence : 3-5% in developed countries, higher in developing countries...
Pre-eclampsia and Anaesthesia
Pre-eclampsia affects 3-5% of pregnancies in Australia and is a leading cause of maternal morbidity and mortality, with higher incidence in Aboriginal and Torres Strait Islander women (5-8%). It is defined as...
Pre-eclampsia and Eclampsia
Pre-eclampsia affects 2-8% of pregnancies globally and remains a leading cause of maternal mortality, accounting for 10-... CICM Fellowship Written, CICM Fellow
Pre-eclampsia and Eclampsia
Pre-eclampsia affects 2-8% of pregnancies globally and remains a leading cause of maternal mortality, accounting for 10-... ACEM Fellowship Written, ACEM Fellow
Pre-Hospital Critical Care
Pre-hospital critical care represents the extension of intensive care interventions into the pre-hospital environment, d... CICM Fellowship Written, CICM Fellow
Pre-operative Assessment for Cardiac Surgery
Cardiac surgery represents one of the most extensively studied surgical specialties, with robust outcome data:
Pre-operative Cardiovascular Assessment
Perioperative cardiac stress results from sympathetic activation, fluid shifts, pain, and inflammation. Surgical stress increases myocardial oxygen demand while simultaneously compromising supply through tachycardia...
Premature Ovarian Insufficiency (POI)
Premature Ovarian Insufficiency (POI), previously termed Premature Ovarian Failure (POF), is defined as the loss of norm... MRCOG, USMLE exam preparation.
Preoperative Cardiac Risk Assessment
Comprehensive guide to cardiac risk stratification including RCRI, functional capacity assessment, and preoperative testing for ANZCA Fellowship examination
Prepatellar Bursitis (Housemaid's Knee)
Prepatellar bursitis is inflammation of the prepatellar bursa, a superficial synovial-lined sac located anterior to the patella between the skin and the kneecap. It presents as a discrete, localised swelling over the...
Pressure Transducers & Invasive Monitoring
Pressure transducers convert mechanical pressure into electrical signals for continuous hemodynamic monitoring. Modern disposable transducers use piezoresistive strain gauges arranged in a Wheatstone bridge circuit ,...
Pressure Ulcers
The National Pressure Ulcer Advisory Panel (NPUAP) and European Pressure Ulcer Advisory Panel (EPUAP) provide the gold standard for classification, prevention, and management.
Priapism
Ischaemic priapism accounts for 95% of cases and is a compartment syndrome of the penis. The aetiology is diverse: sickle cell disease (most common in children, affecting up to 40% over their lifetime),...
Primary Biliary Cholangitis
Primary biliary cholangitis (PBC) is a chronic, progressive autoimmune cholestatic liver disease characterised by immune... MRCP exam preparation.
Primary Biliary Cholangitis (PBC)
The disease predominantly affects middle-aged women (female to male ratio 9:1), with peak diagnosis between ages 40-60 years. The pathognomonic serological feature is the presence of anti-mitochondrial antibodies...
Primary Hyperaldosteronism
First described by Jerome Conn in 1955 as a syndrome of hypertension, hypokalaemia, and adrenal adenoma, PA was initially considered rare. However, the introduction of the aldosterone-renin ratio (ARR) as a screening...
Primary Hyperaldosteronism (Conn's Syndrome)
Primary Hyperaldosteronism (PA), also known as Primary Aldosteronism or Conn Syndrome (when due to an adenoma), represen... MRCP exam preparation.
Primary Hyperparathyroidism
The condition is usually caused by a solitary parathyroid adenoma (80-85% of cases), though multigland hyperplasia (10-15%) and double adenomas (2-5%) also occur. Parathyroid carcinoma is rare, accounting for less...
Primary Open Angle Glaucoma
POAG is the leading cause of irreversible blindness worldwide, affecting approximately 70 million people globally. The condition is aptly termed "The Silent Thief of Sight" because it typically remains asymptomatic...
Primary Postpartum Haemorrhage (PPH)
Primary postpartum haemorrhage (PPH) is defined as blood loss of ≥500ml following vaginal delivery or ≥1000ml following ... MRCOG exam preparation.
Primary Sclerosing Cholangitis (PSC)
Primary Sclerosing Cholangitis (PSC) is a chronic, progressive cholestatic liver disease characterised by inflammation, ... MRCP exam preparation.
Primary Survey - ATLS
Primary survey is the systematic ABCDE approach to identify and immediately treat life-threatening injuries in trauma pa... ACEM Primary Written, ACEM Primary V
Procedural Sedation in the Emergency Department
Parameter Detail ----------- -------- Indications Fracture/dislocation reduction, cardioversion, laceration repair, abscess drainage, foreign body removal, diagnostic procedures (CT in agitated patient)...
Progressive Multifocal Leukoencephalopathy (PML)
A comprehensive guide to Progressive Multifocal Leukoencephalopathy (PML), covering JC Virus pathophysiology, risk stratification with Natalizumab, diagnostic criteria, MRI features including subcortical U-fibre...
Prolactinoma (Adult)
A prolactinoma is a benign monoclonal adenoma arising from lactotroph cells of the anterior pituitary that autonomously ... MRCP exam preparation.
Prone Positioning for Surgery
Prone positioning is essential for posterior spinal, neurosurgical, and some plastic/ENT procedures. Physiological effects : Reduced cardiac output (10-20% decrease), increased central venous pressure, decreased...
Prone Positioning in ARDS
Mortality benefit: PROSEVA trial demonstrated 50% relative risk reduction in mortality (16% vs 32%, ARR 16%, NNT=6) i... CICM Second Part exam preparation.
Propofol
Propofol (2,6-diisopropylphenol) is the most commonly used intravenous anaesthetic agent for induction and maintenance of general anaesthesia and sedation in ICU. Structure: Simple phenol derivative with two isopropyl...
Propofol Infusion Syndrome
"Describe the pathophysiology of propofol infusion syndrome."... CICM Second Part, FCICM exam preparation.
Propofol Pharmacology
Propofol (2,6-diisopropylphenol) is a phenol derivative intravenous anaesthetic that acts primarily as a positive allosteric modulator of GABA A receptors, particularly at the beta-subunit, increasing chloride...
Prostate Cancer
Prostate cancer represents the most common non-cutaneous malignancy in men worldwide, with an estimated 1.4 million new ... MRCP, FRCS(Urol) exam preparation.
Prostate-Specific Antigen (PSA) Testing in Adults
Prostate-Specific Antigen (PSA) is a serine protease glycoprotein produced almost exclusively by prostatic epithelial cells. It functions physiologically to liquefy the seminal coagulum, but its clinical utility lies...
Prostatitis
Type I (Acute Bacterial Prostatitis) is a urological emergency characterised by acute systemic infection with fever, rigors, and an exquisitely tender prostate. This represents approximately 5-10% of cases and...
Proximal Humerus Fracture (Adult)
Proximal humerus fractures (PHF) represent the third most common osteoporotic fracture in adults, accounting for approximately 5-6% of all fractures, following hip and distal radius fractures. They predominantly...
Psoriasis
Plaque psoriasis (psoriasis vulgaris) accounts for 80-90% of cases and follows a relapsing-remitting course with significant impact on quality of life. Management follows a stepwise approach: topical therapy (vitamin...
Psoriatic Arthritis
CASPAR Criteria Gold Standard : Diagnosis requires established inflammatory arthritis (peripheral, spinal, or entheseal) PLUS ≥3 points from: current psoriasis (2), history of psoriasis (1), family history of...
Pulled Elbow (Nursemaid's Elbow)
A Pulled Elbow (Radial Head Subluxation) is the most common upper limb injury in toddlers (1-4 years). It involves the Annular Ligament slipping proximally over the radial head and becoming entrapped in the...
Pulmonary Artery Catheters in ICU
Comprehensive guide to pulmonary artery catheter (Swan-Ganz) monitoring in critically ill patients, including indications, insertion technique, waveform progression, hemodynamic parameters, thermodilution cardiac...
Pulmonary Embolism
"Think PE in Unexplained Dyspnoea" : PE can present with isolated dyspnoea, pleuritic chest pain, syncope, or even just tachycardia. The classic triad of dyspnoea, chest pain, and haemoptysis occurs in less than 20%...
Pulmonary Embolism
Risk stratification systems: Wells score, PERC rule, PESI/sPESI, ESC 2019 classification (high/intermediate-high/inte... CICM Second Part exam preparation.
Pulmonary Embolism (PE)
Pulmonary Embolism (PE) is a life-threatening cardiovascular emergency caused by the occlusion of one or more pulmonary ... MRCP exam preparation.
Pulmonary Gas Exchange
Gas exchange between alveolar air and pulmonary capillary blood occurs through passive diffusion across the alveolar-capillary membrane driven by partial pressure gradients. The alveolar-capillary membrane consists of...
Pulmonary Hypertension
Pulmonary Hypertension (PH) is a haemodynamic and pathophysiological condition defined by an increase in mean pulmonary ... MRCP exam preparation.
Pulmonary Hypertension in ICU
Pulmonary hypertension (PH) in ICU represents a critical intersection of elevated pulmonary vascular resistance and righ... CICM Second Part Written, CICM Secon
Pulse Oximetry
Core Physics: Two wavelengths : Red (660 nm) absorbed more by deoxyhemoglobin (Hb); Infrared (940 nm) absorbed more by oxyhemoglobin (HbO2) Ratio of Ratios (R) : R = (AC/DC)660 / (AC/DC)940, empirically calibrated to...
Pyloric Stenosis
Hypertrophic pyloric stenosis is a condition of acquired gastric outlet obstruction caused by hypertrophy of the pyloric muscle, typically presenting at 3-8 weeks of life with projectile vomiting. Key anaesthetic...
Pyloric Stenosis
Infantile Hypertrophic Pyloric Stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants, characterised by progressive hypertrophy and hyperplasia of the pyloric smooth muscle causing...
Pyogenic Granuloma
The cardinal clinical feature is a dome-shaped, glistening, friable nodule that bleeds disproportionately to the degree of trauma, often with a characteristic collarette of scale at the base. While the lesion appears...
Q Fever
Acute Q fever presents in a spectrum from asymptomatic infection (60%) to three main clinical syndromes: flu-like illness , atypical pneumonia , and granulomatous hepatitis . Most acute cases are self-limiting, but...
Quadratus Lumborum Block
Structure: The quadratus lumborum (QL) is a thick, quadrilateral muscle located in the posterior abdominal wall, extending between the 12th rib and the iliac crest.
Quality and Safety in Anaesthesia
Patient safety is a core competency for anaesthetists. Human factors : Understanding how humans interact with systems, equipment, and each other; human error inevitable, systems must be designed to prevent or catch...
Quality Improvement Principles
Quality Improvement in intensive care combines rigorous scientific methodology with practical approaches to enhance pati... CICM Fellowship Written, CICM Fellow
Quality Metrics: APACHE, SOFA, ANZROD, and ICU Benchmarking
APACHE II (1985): 12 physiological variables (worst in first 24h) + age points + chronic health points; score 0-71; m... CICM Second Part Written, CICM Secon
Quinsy (Peritonsillar Abscess)
Quinsy, also known as Peritonsillar Abscess (PTA) , is a collection of pus in the peritonsillar space —the potential space located between the tonsillar capsule and the superior pharyngeal constrictor muscle. It is...
Rabies
Key Facts Causative Agent : Lyssavirus genus (14 species); rabies virus (genotype 1) causes 95% of human cases Transmission : Primarily via bite from rabid animal; saliva contact with broken skin or mucous membranes;...
Rabies Post-Exposure Prophylaxis
One-liner : Rabies PEP is a medical emergency requiring immediate wound washing (15 min), rabies immunoglobulin (20 IU/kg infiltrated into wound), and vaccine series (day 0/3/7/14/28) to prevent 100% fatal encephalitis.
Radial Head Fracture (Adult)
Radial head fractures represent the most common fracture of the elbow in adults, accounting for approximately 33% of all elbow fractures and 4% of all fractures. These injuries typically result from a fall onto an...
Radial Nerve Palsy
The clinical picture depends entirely on the level of the lesion : Axillary injuries (e.g., crutch palsy) cause triceps loss; Humeral shaft injuries at the spiral groove (most common) cause wrist drop but spare...
Raised Intracranial Pressure
Raised ICP occurs when the volume of brain parenchyma, blood, or CSF exceeds the compensatory capacity of the rigid cran... ACEM Primary Written, ACEM Primary V
Rapid Sequence Intubation (RSI)
RSI is the gold standard for emergency airway management in the ED, used in greater than 90% of intubations. The 7 Ps fr... ACEM Primary Written, ACEM Primary V
Rapid Tranquillisation (RT)
Comprehensive, evidence-based guide to Rapid Tranquillisation protocols (NICE NG10/BAP-NAPICU 2018), detailing the stepped approach from de-escalation techniques to IM medication, pharmacological comparisons...
Reactive Arthritis (Adult)
Reactive arthritis (ReA) is a sterile inflammatory arthritis that develops following an infection at a distant site, typically gastrointestinal or genitourinary . It is classified as one of the seronegative...
Reconstructive Flaps
A flap is a unit of tissue that is transferred from a donor site to a recipient site while maintaining its own blood sup... FRCS (Plast) exam preparation.
Rectal Prolapse
Full-thickness rectal prolapse predominantly affects elderly women (6:1 female:male ratio), with peak incidence in the 7th-8th decades. Key risk factors include chronic constipation with straining , multiparity...
Rectus Sheath Block
Formation: The rectus sheath is a fibrous compartment formed by the aponeuroses of the three lateral abdominal wall muscles (external oblique, internal oblique, transversus abdominis) as they envelop the rectus...
Recurrent Miscarriage
Despite comprehensive evaluation, approximately 50% of cases remain unexplained (idiopathic RM), yet even these couples have a 60-75% chance of successful pregnancy with supportive care alone in subsequent attempts....
Redback Spider Envenomation
Critical Alert: Redback Spider Envenomation Redback spider ( Latrodectus hasselti ) envenomation causes latrodectism through alpha-latrotoxin-mediated massive neurotransmitter release. Clinical features include...
Reduced Fetal Movements
Reduced fetal movements (RFM) represents maternal perception of decreased fetal activity compared to the established ind... MRCOG, FRANZCOG exam preparation.
Refeeding Syndrome
The clinical consequences are severe and multisystem: cardiac arrhythmias and heart failure (from ATP depletion and electrolyte disturbances), respiratory failure (from diaphragmatic weakness), Wernicke's...
Remifentanil Pharmacology
Remifentanil is a synthetic ultra-short-acting mu-opioid agonist distinguished by its unique ester linkage that allows rapid hydrolysis by non-specific tissue and plasma esterases, resulting in organ-independent...
Renal Abscess
A renal abscess is a focal collection of purulent material within or around the kidney parenchyma, representing a severe and potentially life-threatening complication of upper urinary tract infection. Renal abscesses...
Renal and Retroperitoneal Anatomy
Define/Describe - Overview of kidney position, relations, and structure... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Renal Artery Stenosis
The clinical significance of RAS extends beyond hypertension to include ischaemic nephropathy, cardiovascular destabilisation syndromes such as recurrent flash pulmonary oedema (Pickering syndrome), and progressive...
Renal Cell Carcinoma (RCC)
A comprehensive guide to RCC, covering molecular pathophysiology, histological subtypes, Von Hippel-Lindau association, paraneoplastic syndromes, nephron-sparing surgery, and contemporary targeted biological therapies...
Renal Colic (Adult)
Comprehensive evidence-based guide to adult renal colic covering epidemiology, pathophysiology, clinical recognition, advanced imaging strategies, pain management protocols, medical expulsive therapy, surgical...
Renal Drug Dosing in ICU
Answer: Assess renal function using multiple measures (eGFR, creatinine clearance, cystatin C) Determine if drug is renally eliminated (≥30% unchanged in urine) Assess loading dose (depends on volume of distribution,...
Renal Physiology
The kidneys maintain homeostasis through filtration, reabsorption, secretion, and excretion, processing 180 L/day of glomerular filtrate to produce 1-2 L urine. Renal blood flow: 20-25% cardiac output (1.0-1.2 L/min),...
Renal Physiology
Renal physiology encompasses nephron anatomy and function, glomerular filtration, renal blood flow autoregulation, tubul... CICM Fellowship Written, CICM Fellow
Renal Replacement Therapy
Renal Replacement Therapy (RRT) refers to extracorporeal techniques that replace normal kidney function by removing solu... CICM Second Part exam preparation.
Renal Replacement Therapy (RRT)
Haemodialysis (HD) : Extracorporeal blood purification using diffusive and convective solute removal across a semipermeable membrane. Usually performed in-centre 3 times weekly for 4 hours. Peritoneal Dialysis (PD) :...
Renal Stones (Urolithiasis)
Comprehensive evidence-based guide to urolithiasis covering epidemiology, stone composition, pathophysiology, emergency presentations, diagnostic imaging, medical expulsive therapy, and surgical interventions (ESWL,...
Renal Tubular Acidosis (RTA)
A comprehensive guide to renal tubular acidosis encompassing all four types, with detailed pathophysiology, molecular genetics, diagnostic algorithms, and evidence-based management strategies for postgraduate medical...
Renal Vein Thrombosis
Renal Vein Thrombosis (RVT) is the formation of thrombus within the main renal veins or their tributaries, leading to im... MRCP exam preparation.
Research Methodology in ICU: Study Design, Statistics, and Critical Appraisal
Study Design Hierarchy: RCTs provide highest internal validity for intervention effects; observational studies (cohor... CICM Second Part Written, CICM Secon
Research Methodology, Statistics and Critical Appraisal
Hierarchy of Evidence: Systematic reviews/Meta-analyses (highest) Randomised Controlled Trials (RCTs) Cohort studies Case-control studies Case series/Case reports Expert opinion (lowest)
Respiratory Failure (Adult)
Comprehensive evidence-based guide to acute and chronic respiratory failure in adults
Respiratory Mechanics
The respiratory system functions as a pump that moves gas between the atmosphere and alveoli through cyclical changes in thoracic volume. Respiratory mechanics characterizes this pump's performance through three...
Respiratory Physiology
The respiratory system maintains gas exchange through ventilation, diffusion, and perfusion, tightly regulated to maintain PaO₂ 80-100 mmHg and PaCO₂ 35-45 mmHg. Ventilation: Tidal volume (500 mL) × respiratory rate...
Respiratory Physiology
Respiratory physiology provides the foundation for understanding mechanical ventilation, oxygen therapy, and pulmonary p... CICM Fellowship Written, CICM Fellow
Restless Legs Syndrome
The disorder was first comprehensively described by Karl-Axel Ekbom in 1945, though earlier descriptions exist dating back to the 17th century. The modern diagnostic criteria were established by the International...
Resuscitative Thoracotomy
Emergency Department thoracotomy is indicated for penetrating thoracic trauma with witnessed arrest, allows release of p... ACEM Primary Written, ACEM Primary V
Retinal Detachment
Classic presentation follows a characteristic sequence: sudden onset floaters, photopsia (flashes of light), progressive "curtain" or shadow obscuring vision, culminating in visual field loss or complete vision loss...
Retinoblastoma
The disease typically presents before the age of 5 years, with a median diagnosis at 18 months in bilateral cases and 24 months in unilateral disease. The critical clinical challenge lies in achieving the optimal...
Retinoblastoma - Ocular Oncology and Intra-Arterial Chemotherapy
Retinoblastoma is the most common primary intraocular malignancy in children , with an incidence of 1 in 15,000-20,000 live births (approximately 300 new cases per year in the USA, 8-10 per year in Australia). It is...
Retinopathy of Prematurity
Key Facts Definition : A disorder of retinal vessel development in preterm infants caused by the interplay of hyperoxia, hypoxia, and growth factors (VEGF/IGF-1). Prevalence : ROP affects approximately 60% of infants...
Retroperitoneal Fibrosis (RPF)
RPF is classified as: Idiopathic (Primary) : 60-70% of cases, increasingly recognised as part of the IgG4-Related Disease (IgG4-RD) spectrum Secondary : 30-40%, caused by medications (ergot derivatives, methysergide,...
Reye's Syndrome
The pathognomonic triad consists of: Acute encephalopathy with altered consciousness Hepatic dysfunction without hyperbilirubinaemia (non-icteric hepatopathy) Elevation of serum transaminases and ammonia
Rhabdomyolysis
Life-threatening muscle breakdown syndrome (CK greater than 1,000 U/L) from trauma, drugs, exertion, or seizures causing... ACEM Primary Written, ACEM Primary V
Rhabdomyolysis
Rhabdomyolysis represents a clinical syndrome ranging from asymptomatic CK elevation to life-threatening multi-organ fai... ACEM Fellowship Written, ACEM Fellow
Rhabdomyolysis
Comprehensive evidence-based review of rhabdomyolysis diagnosis and management in adults
Rhabdomyolysis in the ICU
Aggressive IV crystalloid resuscitation: Target urine output 200-300 mL/hr (3 mL/kg/hr)... CICM Second Part Written, CICM Second Part Hot Case exam preparati
Rhesus Isoimmunisation
Comprehensive evidence-based guide to Rhesus D Isoimmunisation and Haemolytic Disease of the Fetus and Newborn (HDFN), covering pathophysiology, Anti-D prophylaxis protocols, Kleihauer testing, MCA Doppler...
Rheumatic Fever
Acute Rheumatic Fever (ARF) is a delayed, non-suppurative, autoimmune sequela of Group A Streptococcus (GAS) pharyngitis. It represents a multisystem inflammatory disorder characterized by migratory polyarthritis,...
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterised by symmetrical inflammatory polyarthrit... MRCP exam preparation.
Rheumatoid Arthritis
Rheumatoid Arthritis (RA) is a chronic, systemic, inflammatory autoimmune disorder primarily characterised by a symmetri... MRCP exam preparation.
Rickets
While nutritional rickets (vitamin D deficiency) accounts for the majority of cases globally, clinicians must recognize genetic and metabolic forms including hypophosphataemic rickets, vitamin D-dependent rickets, and...
Rickets and Osteomalacia
The underlying aetiology is multifactorial but globally dominated by Vitamin D Deficiency (nutritional rickets/osteomalacia), which remains a significant public health problem despite being entirely preventable....
Robotic Surgery Anaesthesia
Robotic-assisted surgery (RAS) presents unique anaesthetic challenges due to the combination of pneumoperitoneum, steep Trendelenburg position (25-45°), and reduced patient access once robot docked. Da Vinci system :...
Rocuronium
Rocuronium is an aminosteroid non-depolarizing neuromuscular blocking agent (NMBA) with rapid onset (60-90 seconds) making it suitable for rapid sequence intubation (RSI) when succinylcholine contraindicated....
Rosacea (Adult)
Rosacea is a chronic inflammatory facial skin condition characterised by episodic or persistent central facial erythema, telangiectasia, inflammatory papules and pustules, and in advanced cases, phymatous tissue...
Roseola Infantum
HHV-6 seroprevalence reaches 95% by age 2-3 years in most populations worldwide, establishing roseola as a near-universal childhood infection with lifelong viral latency following primary infection. The infection is...
Rotator Cuff Disorders
The pathophysiology is predominantly degenerative, arising from age-related tendon degeneration, vascular insufficiency, and repetitive microtrauma in the subacromial space. Clinical presentation typically includes...
Rotator Cuff Tear (Adult)
Rotator cuff tears represent the most common pathology of the shoulder, affecting approximately 20-30% of the general population and increasing dramatically with age to over 50% in individuals aged 60 years and older....
Rotator Cuff Tendinopathy and Tears
Rotator cuff disease encompasses a spectrum of pathology affecting the four rotator cuff tendons (supraspinatus, infraspinatus, subscapularis, teres minor), ranging from acute inflammatory tendonitis through...
Rovsing's Sign
Rovsing's sign is a clinical examination finding used in the assessment of acute appendicitis, characterized by pain eli... MRCS exam preparation.
Rubella (German Measles)
Rubella, also known as German measles, is an acute viral infection caused by the rubella virus , a single-stranded RNA virus of the Togaviridae family. The clinical significance of rubella exists on two distinct...
Ruptured Abdominal Aortic Aneurysm
Ruptured abdominal aortic aneurysm (rAAA) represents one of the most time-critical vascular emergencies, with overall mo... FRCS exam preparation.
Safeguarding (Children & Adults)
Safeguarding is the statutory duty to protect the health, well-being, and human rights of individuals (children and vuln... MRCPCH, General Practice exam prepar
Salicylate Overdose
Volume resuscitation with dextrose-containing fluids (correct dehydration, provide glucose for cerebral metabolism) [... CICM Second Part exam preparation.
Salicylate Overdose
Comprehensive emergency medicine guide to salicylate toxicity covering clinical recognition, metabolic derangements, urinary alkalinization, hemodialysis indications, and critical care management.
Sarcoidosis
Diagnostic Pearl : Löfgren's Syndrome (erythema nodosum, bilateral hilar lymphadenopathy, polyarthritis/arthralgia) is highly specific (95%) for sarcoidosis. In this specific setting, biopsy is generally not required...
Scabies
Nocturnal Itch Pearl : The characteristic nocturnal pruritus occurs because mites are more active in warm environments. Night-time scratching + web space involvement = think scabies.
Scaphoid Fracture (Adult)
The scaphoid is the most frequently fractured carpal bone, accounting for 60-70% of all carpal fractures and representin... MRCS exam preparation.
Scarlet Fever
The condition manifests with pathognomonic clinical features including Strawberry Tongue (initially white-coated with erythematous papillae, later denuded and beefy-red), flushed cheeks with circumoral pallor ,...
Schistosomiasis (Bilharzia)
Schistosomiasis is a chronic parasitic disease caused by blood flukes (trematodes) of the genus Schistosoma . It ranks as the second most devastating parasitic disease globally after malaria, affecting over 240...
Schizophrenia
A severe, chronic psychotic disorder characterized by distortions in thinking, perception, emotions, language, sense of self, and behavior.
Sciatic Nerve Block
Origin: Formed from : L4-S3 nerve roots (sacral plexus) L4 contribution : From lumbar plexus via lumbosacral trunk Sacral contributions : L5, S1, S2, S3 ventral rami unite in greater sciatic foramen Formation : Within...
Sciatica (Adult)
Sciatica is a syndrome characterized by radiating pain along the distribution of the sciatic nerve (L4-S3 dermatomes), typically extending from the lower back into the posterior thigh and leg, usually below the knee....
Scoliosis (Child)
Scoliosis is a three-dimensional structural deformity of the spine characterised by:
Scrotal Lumps
The diagnostic approach relies on systematic clinical examination incorporating three cardinal questions: (1) Can you get above the swelling? (2) Is the mass separate from the testis? (3) Does it transilluminate?...
Seborrhoeic Keratosis
Seborrhoeic Keratosis (SK) is the most common benign tumour of the skin, originating from keratinocytes in the stratum b... MRCP, MRCGP exam preparation.
Secondary Postpartum Haemorrhage
The condition poses unique clinical challenges: the postpartum uterus is soft and friable (increasing surgical perforation risk), diagnosis of RPOC by ultrasound is fraught with false positives (blood clots mimicking...
Secondary Survey
The Secondary Survey is a comprehensive, head-to-toe physical examination performed after the Primary Survey confirms no immediate life threats. It begins with obtaining a history (using the AMPLE mnemonic), followed...
Sedation and Analgesia Protocols in ICU
Analgesia-First Approach: Treat pain before sedation; 50-70% of ICU patients have significant pain, and untreated pai... CICM Second Part Written, CICM Secon
Sedation in ICU
ICU sedation requires titration to target depth using validated scales (RASS), daily interruption protocols, and agent s... CICM Second Part exam preparation.
Sedatives in ICU
Sedatives in ICU primarily act via three mechanisms: (1) GABA-A receptor potentiation (propofol, benzodiazepines), (2) a... CICM First Part Written, CICM First
Self-Harm in Adults
Comprehensive evidence-based guide to assessment and management of intentional self-injury in adults, with or without suicidal intent
Sepsis - Paediatric
Phoenix Sepsis Score (2024) replaces SIRS: Score 2+ indicates sepsis (respiratory, cardiovascular, coagulation, neuro... ACEM Fellowship Written, ACEM Fellow
Sepsis and Septic Shock
Sepsis is defined by the Sepsis-3 (2016) consensus as life-threatening organ dysfunction caused by a dysregulated host r... MRCP exam preparation.
Sepsis and Septic Shock
Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Conse... CICM Second Part exam preparation.
Sepsis Bundles and Early Management
Sepsis-3 validation in external cohorts demonstrated superior predictive validity for mortality compared to SIRS (AUROC ... CICM Second Part exam preparation.
Septic Arthritis
The classic presentation is a short history (less than 1 week) of a single hot, swollen, painful joint with restricted range of movement and systemic upset. Inability to weight bear is a key sign.
Septic Arthritis (Paediatric)
Septic arthritis in children is an orthopaedic emergency requiring immediate diagnosis and surgical intervention. It represents bacterial infection of the joint space that results in rapid, irreversible destruction of...
Septic Shock (Adult)
Septic shock is defined as a subset of sepsis characterized by profound circulatory, cellular, and metabolic abnormalities that substantially increase mortality. Under the Sepsis-3 definitions, septic shock requires:
Septic Shock (Adult)
Septic shock is defined as a subset of sepsis characterized by profound circulatory, cellular, and metabolic abnormalities that substantially increase mortality. Under the Sepsis-3 definitions, septic shock requires:
Septic Shock Management
Septic shock represents the most severe end of the sepsis spectrum with mortality 25-40%. Early recognition using qSOFA ... ACEM Primary Written, ACEM Fellowshi
Serotonin Syndrome
Remove precipitating agents immediately (cease all serotonergic drugs)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.
Serotonin Syndrome and Neuroleptic Malignant Syndrome
Serotonin Syndrome (SS) and Neuroleptic Malignant Syndrome (NMS) are serious, potentially life-threatening drug-induced hyperthermic syndromes characterised by Hyperthermia, Altered Mental Status, Autonomic...
Sesamoid Injury & Turf Toe
The First Metatarsophalangeal (MTP) Joint is a complex mechanism designed to withstand 50-80% of body weight during the push-off phase of gait. Crucial to this function are the two Sesamoid Bones (Tibial and Fibular),...
Sever's Disease
The condition was first described by James Warren Sever in 1912 and represents a distinct entity within the broader family of paediatric osteochondroses. Unlike traumatic injuries, Sever's disease develops gradually...
Severe Burns
A burn is tissue injury caused by heat, chemicals, electricity, radiation, or friction. Severe burns are those involving... MRCP exam preparation.
Severe Malaria
Severe malaria occurs when P. falciparum parasitemia is complicated by organ dysfunction (cerebral malaria, ARDS, AKI, s... ACEM Fellowship Written, ACEM Fellow
Severe Preeclampsia, HELLP Syndrome, and Eclampsia
Severe preeclampsia is defined as preeclampsia with severe features that indicate end-organ dysfunction and increased risk of maternal and fetal complications. It affects 2-8% of pregnancies globally and remains a...
Severe Sepsis - Adult
Sepsis-3 Definition: Organ dysfunction (SOFA score increase ≥2) caused by infection - SIRS criteria abandoned... ACEM Primary Written, ACEM Primary Viva exam
Severe Traumatic Brain Injury and Decompressive Craniectomy
Severe traumatic brain injury (TBI) is defined by Glasgow Coma Scale (GCS) score of 3-8 following head injury, representing a critical neurosurgical emergency with significant mortality and morbidity. The management...
Sevoflurane
Sevoflurane is a fluorinated ether inhalational anaesthetic with blood:gas partition coefficient 0.65 (low solubility), enabling rapid induction and emergence compared to isoflurane (1.4) and halothane (2.4). MAC...
Shigellosis (Bacillary Dysentery)
Shigellosis is an acute invasive bacterial colitis caused by species of the genus Shigella , manifesting as inflammatory diarrhoea with blood and mucus (dysentery). Distinguished by an extraordinarily low infectious...
Shock
Shock is a life-threatening syndrome of acute circulatory failure resulting in inadequate cellular oxygen delivery and t... MRCP, MRCEM exam preparation.
Shock Pathology (Cellular & Mitochondrial)
The CICM First Part examination considers shock pathophysiology a core topic requiring detailed understanding of cellula... CICM First Part Written SAQ, CICM Fi
Shockable Rhythms - Ventricular Fibrillation and Pulseless Ventricular Tachycardia
Ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) represent the most treatable causes of cardiac... ACEM Primary Written, ACEM Primary V
Shoulder Dislocation (Adult)
The glenohumeral joint is the most commonly dislocated major joint in the body, accounting for approximately 45% of all joint dislocations. This high susceptibility to dislocation stems from the joint's unique...
Shoulder Dystocia
This is a time-critical emergency occurring in 0.2-3% of vaginal deliveries, characterized by the pathognomonic "turtle ... ACEM Fellowship Written, ACEM Fellow
Shoulder Dystocia
The underlying mechanism in most cases is impaction of the anterior fetal shoulder behind the maternal pubic symphysis , creating a bony obstruction that cannot be relieved by episiotomy alone. This is fundamentally a...
SIADH (Syndrome of Inappropriate ADH) - Adult
The Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) is the most common cause of euvolaemic hyponatraemi... MRCP exam preparation.
Sickle Cell Crisis in Adults
Comprehensive evidence-based guide to diagnosis, management, and prevention of acute sickle cell crises including vaso-occlusive crisis, acute chest syndrome, stroke, and other life-threatening complications
Sigmoid Volvulus
The condition is characterized by acute massive abdominal distension, absolute constipation, and relatively mild abdominal pain initially. Diagnosis is typically established by the pathognomonic "coffee bean sign" on...
Sinus Tarsi Syndrome
Anatomy: The Sinus Tarsi is a conical tunnel between the talus neck and the calcaneus.... FRCS exam preparation.
SIRS and Sepsis Pathology
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The pathophysiology involves recognition of PAMPs and DAMPs by pattern recognition receptors (TLRs), triggering a...
Sjögren's Syndrome (Adult)
Sjögren's Syndrome (SS) is a chronic systemic autoimmune disease characterised by lymphocytic infiltration of exocrine g... MRCP, MRCPCH exam preparation.
Skeletal Muscle Physiology
Define - Skeletal muscle structure at macroscopic and microscopic levels... CICM First Part Written, CICM First Part Viva exam preparation.
Skin and Soft Tissue Abscess in Adults
A skin abscess is a localized collection of purulent material (pus) within the dermis and subcutaneous tissue, presentin... MRCEM exam preparation.
Skin Biopsy Techniques
Skin biopsy is a fundamental diagnostic procedure in dermatology, primary care, and plastic surgery, used to obtain tiss... MRCS exam preparation.
Skin Grafts
A skin graft is the transfer of epidermis and variable amounts of dermis from a donor site to a recipient wound bed, where it survives by developing a new blood supply from the underlying tissue. Unlike flaps (which...
Slapped Cheek Syndrome (Fifth Disease/Parvovirus B19)
Slapped Cheek Syndrome (Erythema Infectiosum), historically termed "Fifth Disease" as the fifth described childhood exanthem, is a common viral infection caused by Human Parvovirus B19 (B19V). This small,...
SLE Flare in Adults
Comprehensive evidence-based guide to systemic lupus erythematosus flares covering clinical recognition, SLEDAI/BILAG activity scoring, organ-threatening manifestations, differentiation from infection, and stepwise...
Sleep and Circadian Rhythms in ICU
Sleep is a fundamental physiological process essential for cognitive function, immune modulation, tissue repair, and met... CICM First Part Written SAQ, CICM Fi
Slipped Capital Femoral Epiphysis (SCFE)
The pathophysiology involves mechanical overload of a weakened physis during the adolescent growth spurt , strongly associated with obesity ( 80% of patients), endocrine disorders (hypothyroidism, growth hormone...
Slipped Upper Femoral Epiphysis (SUFE)
The incidence ranges from 0.33 per 100,000 in Asian populations to 50.5 per 100,000 in high-risk populations, with marked ethnic variation. The condition predominantly affects obese males aged 10-16 years, with the...
Slipped Upper Femoral Epiphysis (SUFE)
Slipped Upper Femoral Epiphysis (SUFE), also known as Slipped Capital Femoral Epiphysis (SCFE), is a displacement of the... FRCS exam preparation.
Small Bowel Obstruction (SBO)
The pathophysiology involves mechanical occlusion of the intestinal lumen, leading to proximal bowel dilatation, fluid sequestration, electrolyte derangements, and potential vascular compromise. The classic clinical...
Small for Gestational Age (SGA) & Fetal Growth Restriction (FGR)
Small for Gestational Age (SGA) refers to a fetus or neonate with an Estimated Fetal Weight (EFW) or birthweight below t... MRCOG exam preparation.
Smith's Fracture
Smith's fracture is a distal radius fracture characterised by volar (palmar) displacement and angulation of the distal f... FRCS exam preparation.
Smoke Inhalation Injury
Comprehensive CICM Second Part topic on smoke inhalation injury covering pathophysiology, carbon monoxide and cyanide poisoning, airway management, and ICU treatment strategies for burn patients with evidence-based...
Smoke Inhalation Injury
Comprehensive evidence-based guide to diagnosis and management of smoke inhalation injury in adults
Snake Bite Envenomation in Adults
Gold-standard evidence-based guide to venomous snake bites covering Elapidae (neurotoxic), Viperidae (hemotoxic/cytotoxic), envenomation syndromes, first aid, antivenom therapy, and supportive care for emergency...
Social Anxiety Disorder (Social Phobia)
Social Anxiety Disorder (SAD), also known as Social Phobia, is a chronic psychiatric condition characterised by marked a... MRCPsych exam preparation.
Sodium Disorders: Hyponatremia and Hypernatremia
Acute symptomatic hyponatremia: Hypertonic saline (3%) 100-150 mL bolus over 10-20 minutes... CICM Second Part Written, CICM Second Part Hot Case exam prepar
Sodium Nitroprusside Pharmacology
Sodium nitroprusside (SNP) is a potent, rapid-acting, direct-acting vasodilator that produces arteriolar and venous dilation through non-specific release of nitric oxide (NO). It is a complex inorganic compound...
Soil Transmitted Helminths
A comprehensive, evidence-based guide to the 'Big Three' Soil Transmitted Helminths (Ascaris, Trichuris, Hookworm). Covers detailed life cycles, Loeffler's syndrome, Th2 immunology, Mass Drug Administration (MDA)...
Spina Bifida (Myelomeningocele)
Spina bifida represents a spectrum of neural tube defects (NTDs) arising from incomplete closure of the embryonic neural tube during the fourth week of gestation (days 21-28). The term encompasses a range from...
Spinal Anaesthesia
Spinal anaesthesia involves injection of local anaesthetic into the subarachnoid space producing rapid, dense sensory and motor block with predictable dermatomal distribution. Mechanism: Local anaesthetic acts on...
Spinal Cord and Peripheral Nerve Anatomy
Define/Describe - Overview of spinal cord structure and boundaries... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Spinal Cord Compression - Emergency Management
Spinal cord compression (SCC) results from extrinsic pressure on the spinal cord from malignancy (most common), trauma, ... ACEM Primary Written, ACEM Fellowshi
Spinal Cord Compression (Adult)
Comprehensive evidence-based guide to adult spinal cord compression covering aetiology (metastatic cancer, trauma, disc herniation, epidural abscess, hematoma), red flags, clinical features with upper vs lower motor...
Spinal Cord Injury Anaesthesia
Spinal cord injury (SCI) patients present unique challenges due to autonomic denervation, altered drug responses, and multisystem complications. Key principles:
Spinal Cord Stimulation - Indications, Trial Period, and Complications
Spinal cord stimulation is a neuromodulation therapy that delivers electrical impulses to the dorsal columns of the spinal cord via implanted electrodes, modulating pain signals before they reach the brain. It is...
Spinal Fracture (Adult)
Spinal fractures represent a spectrum of vertebral injuries ranging from stable compression fractures to complex unstabl... FRCS Orth, FRACS Orth exam preparati
Spinal Injury Anaesthesia in Trauma
Acute spinal cord injury requires immediate spinal protection, cardiovascular stabilisation, and prevention of secondary injury. Key principles:
Spinal Shock
Spinal shock is a complex neurophysiological phenomenon characterized by temporary loss of all neurological function bel... MRCP exam preparation.
Spinal Stenosis
Lumbar Spinal Stenosis (LSS) is a degenerative narrowing of the spinal canal, lateral recess, or neural foramina, leadin... FRCS, FRACS exam preparation.
Splenic Sequestration Crisis
The pathophysiology involves acute vaso-occlusion within the splenic red pulp, trapping erythrocytes and leading to a dramatic reduction in circulating blood volume. Unlike other sickle cell crises, SSC predominantly...
Splenomegaly
The spleen's unique anatomical position in the portal circulation and its role as a reticuloendothelial filter make it susceptible to enlargement via three primary mechanisms: congestion (e.g., cirrhosis),...
Spondylolisthesis (Adult)
Spondylolisthesis is the anterior (forward) displacement of one vertebral body relative to the adjacent caudal vertebra,... FRCS(Tr&Orth), Neurosurgery exam pre
Squamous Cell Carcinoma (Skin)
Cutaneous Squamous Cell Carcinoma (cSCC) is a malignant neoplasm arising from epidermal keratinocytes, representing the second most common skin cancer after basal cell carcinoma. Unlike basal cell carcinoma, cSCC...
Stable Angina
Comprehensive evidence-based guide to stable angina diagnosis and management including CCS classification, investigations, medical therapy, and revascularization
Stable Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable chronic respiratory condition characterised by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar...
Staphylococcal Scalded Skin Syndrome
Staphylococcal Scalded Skin Syndrome (SSSS) is an acute toxin-mediated exfoliative dermatosis caused by epidermolytic ex... MRCPCH, DCH exam preparation.
Status Epilepticus
For the CICM Second Part Examination, candidates must demonstrate:... CICM Second Part exam preparation.
Status Epilepticus
One-liner : Status epilepticus is continuous seizure activity lasting greater than 5 minutes or ≥2 seizures without recovery of consciousness; treat immediately with IV lorazepam or IM midazolam, escalate rapidly to...
Status Epilepticus
Status Epilepticus (SE) is a state of failure of seizure termination mechanisms, leading to abnormally prolonged seizure... MRCP exam preparation.
Status Epilepticus in Adults
Status epilepticus (SE) is a neurological emergency defined as continuous seizure activity lasting ≥5 minutes or recurrent seizures without recovery of consciousness between episodes. It represents a failure of the...
STEMI Management in ICU
Comprehensive CICM Second Part clinical guide to STEMI Management in the ICU, covering reperfusion strategies (primary PCI vs fibrinolysis), antiplatelet and anticoagulation therapy, mechanical complications,...
STEMI Management in the Emergency Department
ST-elevation myocardial infarction represents complete occlusion of an epicardial coronary artery causing transmural myo... ACEM Fellowship Written, ACEM Fellow
Strabismus Surgery - Oculocardiac Reflex, PONV, and Suxamethonium Alternatives
Strabismus surgery (squint surgery) is one of the most common paediatric surgical procedures , correcting misalignment of the eyes by tightening, loosening, or repositioning extraocular muscles. It is typically...
Stress Response and Critical Illness
The stress response to critical illness is a coordinated neuroendocrine-metabolic-inflammatory cascade designed for short-term survival. The HPA axis releases cortisol (essential for vascular tone and...
Stress Ulcer Prophylaxis in Critical Care
Stress-Related Mucosal Disease (SRMD): Distinct from peptic ulcer disease; caused by splanchnic hypoperfusion, mucosa... CICM Second Part Written, CICM Secon
Stress Urinary Incontinence
Stress urinary incontinence (SUI) is defined by the International Continence Society (ICS) as the involuntary leakage of... MRCOG exam preparation.
Stroke and TIA
Stroke is a medical emergency defined by the rapid onset of focal or global neurological deficit lasting more than 24 ho... MRCP exam preparation.
Sturge-Weber Syndrome (SWS)
Sturge-Weber Syndrome (SWS) is a rare, non-hereditary neurocutaneous disorder characterized by the clinical triad of:... MRCPCH, MRCP exam preparation.
Subarachnoid Haemorrhage (SAH)
Subarachnoid haemorrhage (SAH) accounts for 5% of strokes but carries disproportionate mortality (40-50% at 30 days) and... ACEM Fellowship Written, ACEM Fellow
Subarachnoid Haemorrhage (SAH)
Subarachnoid Haemorrhage (SAH) is a catastrophic neurological emergency defined by the presence of blood within the suba... MRCP exam preparation.
Subarachnoid Hemorrhage
Early aneurysm securing within 24-72 hours (coiling or clipping) to prevent rebleeding (4% within 24 hours, 50% withi... CICM Second Part exam preparation.
Subdural Haematoma
Key Facts Incidence : 10-25 per 100,000 population; higher in elderly ( 65 years: 50-80 per 100,000). Mortality : 30-90% overall; acute SDH 40-60%, chronic SDH 0-8% with surgical intervention. Age Distribution :...
Subdural Haemorrhage (SDH)
SDH is predominantly a venous bleed caused by rupture of bridging veins that traverse the subdural space, connecting the cerebral cortex to the dural venous sinuses. On neuroimaging, it characteristically appears as a...
Subtalar Arthritis
Patients present with a characteristic inability to walk on uneven ground (the "cobblestone sign"), deep lateral or medial hindfoot pain (sinus tarsi region), and progressive loss of hindfoot motion. The condition is...
Subtalar Dislocation
Key Facts The "Acquired Clubfoot" : A medial subtalar dislocation produces a clinical appearance identical to congenital talipes equinovarus (clubfoot deformity) in an adult, with the foot locked in inversion,...
Subungual Exostosis
The condition is clinically significant because it is frequently misdiagnosed as verruca vulgaris, onychomycosis, or ingrown toenail, leading to delayed treatment and prolonged symptoms. The diagnostic hallmark is a...
Sudden Infant Death Syndrome (SIDS)
SIDS remains the leading cause of post-neonatal death in developed countries, despite dramatic reductions following public health campaigns. The condition represents a diagnostic exclusion—only after comprehensive...
Sugammadex Pharmacology
Sugammadex is a modified gamma-cyclodextrin designed specifically to encapsulate and inactivate steroidal neuromuscular blocking agents (rocuronium vecuronium pancuronium), providing rapid and complete reversal of...
Suicidal Patient Assessment
Emergency Department (ED) suicide assessment has shifted from "predicting" suicide (statistically impossible with accept... ACEM Fellowship Written, ACEM Fellow
Suicide Risk Assessment
The clinical approach to SRA has undergone a paradigm shift in the last decade, moving away from "risk prediction" (which has been shown to be mathematically impossible at the individual level) toward "risk...
Sun Protection & Photoprotection
Sun protection encompasses the comprehensive strategies employed to prevent ultraviolet (UV) radiation-induced skin dama... MRCP exam preparation.
Superior Vena Cava Obstruction
Superior vena cava obstruction (SVCO) represents compression, invasion, or thrombosis of the superior vena cava (SVC), i... MRCP exam preparation.
Superior Vena Cava Syndrome
Superior vena cava syndrome (SVCS) is a clinical syndrome resulting from obstruction of blood flow through the superior ... MRCP exam preparation.
Supraclavicular Brachial Plexus Block
Location: Level : Divisions of brachial plexus (after trunks, before cords) Position : Posterior and lateral to subclavian artery, superior to first rib, inferior to clavicle Space : Interscalene groove continues,...
Supracondylar Fracture (Child)
Supracondylar fractures of the humerus are the most common elbow fracture in children, accounting for 50-60% of all paediatric elbow injuries. They typically occur in children aged 5-7 years following a Fall On...
Supracondylar Humerus Fracture (Paediatric)
Supracondylar humerus fractures represent the most common elbow fracture in children, accounting for 50-60% of all paediatric elbow injuries and approximately 3% of all paediatric fractures. These fractures occur in...
Supraglottic Airway Devices
description: "ACEM comprehensive guide to SGA use in emergency medicine",... ACEM Primary Written, ACEM Primary Viva exam preparation.
Suprapubic Bladder Catheterization
Parameter Detail ----------- -------- Indications Acute urinary retention, failed urethral catheterization, urethral trauma/stricture, long-term catheterization Contraindications Empty bladder, pelvic malignancy,...
Supraventricular Tachycardia (Narrow Complex)
SVT accounts for 50,000 ED presentations annually in the US, with incidence 35 per 100,000 person-years. Most cases (60... ACEM Fellowship Written, ACEM Fellow
Surgical Airway - Cricothyroidotomy
Cricothyroidotomy is a life-saving procedure performed when all other airway management options have failed. The scalpel... ACEM Primary Written, ACEM Primary V
Surgical Site Infection in Adults
Surgical site infection (SSI) remains the most common healthcare-associated infection (HAI) in surgical patients, accounting for nearly 20% of all HAIs. Defined by the Centers for Disease Control and Prevention (CDC)...
Suxamethonium (Succinylcholine)
Suxamethonium (succinylcholine) is the only depolarizing neuromuscular blocker in clinical use, providing rapid onset (30-60 seconds) and ultra-short duration (5-10 minutes) ideal for rapid sequence intubation....
SVT (Supraventricular Tachycardia) - Adult
Comprehensive evidence-based guide to diagnosis and management of supraventricular tachycardia in adults including AVNRT, AVRT, WPW syndrome
Symptom Management in Palliative Care
Palliative care symptom management requires a systematic approach to physical, psychological, and spiritual distress. Pa... CICM Fellowship Written, CICM Fellow
Syncope - Emergency Department Assessment
Syncope accounts for 1-3% of ED presentations and 6% of hospital admissions. While reflex syncope is most common (40-50%... ACEM Primary Written, ACEM Fellowshi
Syncope Evaluation in Adults
Comprehensive evidence-based approach to the diagnosis, risk stratification, and management of syncope in emergency and acute care settings
Syncope in Adults
Syncope is transient loss of consciousness (TLOC) due to transient global cerebral hypoperfusion, characterised by rapid onset, short duration, and spontaneous complete recovery. It is one of the most common...
Syndesmosis Injury
Syndesmosis injuries, commonly referred to as "High Ankle Sprains" , represent 1-11% of all ankle sprains but account for disproportionate morbidity, with recovery times 2-3 times longer than lateral ankle ligament...
Syndrome of Inappropriate ADH Secretion (SIADH)
The Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), also termed Syndrome of Inappropriate Antidiuresis... MRCP, USMLE exam preparation.
Syphilis (Treponema pallidum Infection)
Syphilis is a sexually transmitted infection (STI) caused by the spirochaete bacterium Treponema pallidum subspecies pallidum . Dubbed "The Great Imitator" for its remarkably diverse clinical manifestations, syphilis...
Syringe Drivers (CSCI)
A Syringe Driver, clinically known as Continuous Subcutaneous Infusion (CSCI), is a portable, battery-operated electrome... MRCGP exam preparation.
Syringomyelia
Syringomyelia is a chronic progressive disorder characterized by a fluid-filled cavity (syrinx) within the central spina... FRCS(Neuro) exam preparation.
Systemic Lupus Erythematosus
Systemic lupus erythematosus (SLE) is a chronic, relapsing-remitting multisystem autoimmune disease characterised by los... MRCP exam preparation.
Systemic Lupus Erythematosus (SLE)
Systemic Lupus Erythematosus (SLE) is the distinct prototype of a systemic autoimmune disease. Unlike organ-specific des... MRCP exam preparation.
Systemic Mastocytosis
Clinical manifestations arise from two principal mechanisms: mast cell mediator release (causing flushing, urticaria, pruritus, anaphylaxis, gastrointestinal symptoms) and organ infiltration by neoplastic mast cells...
Systemic Sclerosis (Scleroderma)
SSc represents one of the most challenging rheumatological conditions due to its heterogeneous clinical manifestations, ... MRCP exam preparation.
Systemic Sclerosis (Scleroderma)
Systemic sclerosis (SSc) is a chronic, progressive autoimmune connective tissue disease characterised by the triad of fi... MRCP exam preparation.
Tachycardia in Adults
Comprehensive evidence-based guide to adult tachycardia covering SVT vs VT differentiation, adenosine protocol, cardioversion indications, Wolff-Parkinson-White syndrome, and antiarrhythmic drug selection for emergency...
Takotsubo Cardiomyopathy
Takotsubo cardiomyopathy (TTC), also known as stress cardiomyopathy or "broken heart syndrome," is an acute, reversible ... MRCP exam preparation.
Talonavicular Arthritis
Talonavicular (TN) arthritis represents pathological degeneration of the "Coxa Pedis" or "Hip of the Foot"—the critical ball-and-socket articulation formed between the head of the talus and the concave socket created...
Talus Fracture (Adult)
Talus fractures represent a unique and challenging injury pattern in orthopaedic trauma, accounting for approximately 0.... MRCS exam preparation.
Targeted Temperature Management (TTM)
Targeted Temperature Management (TTM) involves controlled regulation of body temperature post-cardiac arrest to reduce s... ACEM Primary Written, ACEM Primary V
Tarsal Tunnel Syndrome
Baxter's Nerve (First Branch of Lateral Plantar Nerve - FBLPN):... FRCS exam preparation.
Teaching and Supervision in ICU
Knowles' Andragogy (1984): Adults learn differently from children - they need to know why, are self-directed, bring e... CICM Second Part Written, CICM Secon
Telemedicine in Intensive Care (Tele-ICU)
Tele-ICU provides intensivist expertise to hospitals lacking 24/7 specialist coverage, reducing mortality by 15-25% a... CICM Second Part Written, CICM Secon
Temperature Regulation
Temperature regulation maintains core temperature 36.5-37.5°C through balance of heat production, conservation, and loss, regulated by the hypothalamus. Heat production: Basal metabolic rate (BMR, 80 W at rest),...
Temperature Regulation
Temperature regulation is a fundamental homeostatic mechanism that maintains core body temperature within a narrow range... CICM Fellowship Written, CICM Fellow
Temporary Cardiac Pacing
Assess hemodynamic stability (hypotension, altered mental status, chest pain, heart failure)... ACEM Fellowship Written, ACEM Fellowship OSCE exam preparatio
Tendon Rupture
Tendon rupture is the complete or partial discontinuity of a tendon resulting from acute trauma, chronic degeneration, o... FRCS (Tr&Orth) exam preparation.
Tension Pneumothorax
Tension pneumothorax develops when air enters the pleural space through a one-way valve mechanism, progressively increas... ACEM Primary Written, ACEM Primary V
Tension Pneumothorax
Key Facts Definition : Progressive accumulation of air in pleural space under pressure, causing mediastinal shift and cardiovascular compromise Incidence : 5-10% of traumatic pneumothoraces develop tension; rare in...
Tension-Type Headache
Fact Value ------ ------- Definition Bilateral, non-pulsating, pressing/tightening headache of mild-moderate intensity Prevalence Lifetime 80%, 1-year 40-60% Peak Age 30-40 years Sex Ratio Female Male (Slight...
Tension-Type Headache in Adults
Comprehensive evidence-based guide to diagnosis and management of tension-type headache - the most common primary headache disorder
Termination of Pregnancy (Abortion)
Termination of Pregnancy (TOP) is the intentional medical or surgical ending of pregnancy before viability . It is one of the most common gynaecological procedures worldwide. In the UK, TOP is legally regulated under...
Termination of Resuscitation
Termination of resuscitation occurs when further CPR and advanced life support are unlikely to result in sustained retur... ACEM Fellowship Written, ACEM Fellow
Testicular Cancer
The fundamental clinical distinction is between Seminomas (slow growing, radiosensitive, elderly men) and Non-Seminomatous GCTs (NSGCTs - aggressive, early metastasis, young men).
Testicular Torsion
The classic presentation comprises sudden-onset severe unilateral scrotal pain, a high-riding testis with horizontal lie, and an absent cremasteric reflex. The condition is primarily a clinical diagnosis and should...
Tetanus
Tetanus presents with characteristic trismus (lockjaw), risus sardonicus, opisthotonos, and generalized muscle spasms tr... ACEM Fellowship Written, ACEM Fellow
Tetanus
The global burden of tetanus has decreased dramatically over the past three decades, with deaths falling by nearly 90% between 1990 and 2019, primarily due to the WHO's Maternal and Neonatal Tetanus Elimination...
Thalassaemia
The two principal types are beta-thalassaemia (reduced beta-globin chain production due to mutations in the HBB gene on chromosome 11) and alpha-thalassaemia (reduced alpha-globin chain production due to deletions or...
The Acute Abdomen
The "Acute Abdomen" is a clinical syndrome characterized by sudden, severe abdominal pain that typically develops over a period of hours and may require urgent surgical intervention. It is a working diagnosis that...
The Mental Capacity Act (MCA) 2005
The Mental Capacity Act 2005 (MCA) is the primary legislation in England and Wales governing decision-making for adults (aged 16+) who lack mental capacity. It provides a comprehensive statutory framework that...
The Mental Health Act (1983)
The Mental Health Act (MHA) 1983 (amended 2007) is the primary legislation in England and Wales allowing for the compuls... MRCPsych, MRCGP exam preparation.
Therapeutic Drug Monitoring in Critical Care
Therapeutic Drug Monitoring (TDM) involves the measurement of drug concentrations in biological fluids to optimize pharm... CICM Fellowship Written, CICM Fellow
Thermoregulation
The hypothalamus serves as the central thermoregulatory integrator, functioning as a biological thermostat with remarkable precision. The preoptic anterior hypothalamus (POAH) contains warm-sensitive neurons that fire...
Thermoregulation Pathology
Define/Describe - Normal thermoregulation, hypothalamic control... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Thiopentone (Thiopental) Pharmacology
Thiopentone (thiopental sodium) is a thiobarbiturate intravenous anaesthetic agent that was the original gold standard for anaesthetic induction for over 50 years before propofol's dominance. Its structure features a...
Thoracentesis
"Describe the technique for diagnostic thoracentesis, including patient positioning, site selection, ultrasound guidance, and Z-track method" (10 marks) "A patient with pneumonia develops a pleural effusion. The...
Thoracic Anaesthesia
Thoracic anaesthesia requires one-lung ventilation (OLV) for most intrathoracic procedures to provide surgical exposure and protect the dependent lung from contamination. Indications for OLV: Thoracotomy (lobectomy,...
Thoracic Anatomy
Define/Describe - Overview of thoracic boundaries and contents... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Thoracic Aortic Aneurysm & Dissection
Thoracic aortic aneurysm (TAA) represents pathological dilatation of the thoracic aorta, defined as diameter exceeding 1.5 times the expected normal size for a given aortic segment, age, sex, and body size. The...
Thoracic Aortic Dissection
Classification : The Stanford Classification is most clinically relevant: Type A : Ascending aorta involved (regardless of entry site) → Surgical Emergency Type B : Descending aorta only (distal to left subclavian) →...
Thrombotic Thrombocytopenic Purpura (Adult)
Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy (TMA) characterised by ... MRCP exam preparation.
Thrombotic Thrombocytopenic Purpura and Haemolytic Uraemic Syndrome in Adults
Thrombotic thrombocytopenic purpura (TTP) and haemolytic uraemic syndrome (HUS) are life-threatening thrombotic microang... MRCP exam preparation.
Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome
TTP is defined by severe ADAMTS13 deficiency (below 10%) - this distinguishes it from other TMAs and predicts respons... CICM Second Part exam preparation.
Thyroid Cancer
The vast majority ( 90%) of thyroid cancers are differentiated thyroid cancers (DTC) , comprising papillary and follicular subtypes, which originate from thyroid follicular epithelial cells and retain the ability to...
Thyroid Nodule (Adult)
A thyroid nodule is a discrete lesion within the thyroid gland that is radiologically distinct from the surrounding thyr... MRCP, FRACP exam preparation.
Thyroid Nodules & Goitre
Thyroid nodules are discrete lesions within the thyroid gland that are palpably or radiologically distinct from surrounding thyroid parenchyma. They represent one of the most common endocrine disorders, with a...
Thyroid Storm
Thyroid storm (thyrotoxic crisis) is an acute, severe, life-threatening exacerbation of thyrotoxicosis with multiorgan d... ACEM Primary Written, ACEM Primary V
Thyroid Storm
Thyroid storm (thyrotoxic crisis) is a rare but life-threatening endocrine emergency characterized by severe, decompensa... MRCP exam preparation.
Thyroid Storm
Diagnose thyroid storm using Burch-Wartofsky Point Scale (≥45 = storm)... CICM Second Part exam preparation.
TIA (Transient Ischaemic Attack) - Adult
Comprehensive evidence-based guide to transient ischaemic attack covering tissue-based definitions, ABCD2 risk stratification, urgent investigation protocols, dual antiplatelet therapy, carotid intervention, and...
Tibia Shaft Fracture (Adult)
Tibial shaft fractures represent the most common long bone fracture in adults, with an incidence of 16-26 per 100,000 person-years. The tibia's unique anatomy—with approximately one-third of its circumference being...
Tibial Plateau Fracture
Tibial plateau fractures are complex intra-articular injuries of the proximal tibia, representing approximately 1% of al... FRCS (Tr&Orth) exam preparation.
Tibial Shaft Fracture (Adult)
Tibial shaft fractures represent the most common long bone fracture in the adult population, accounting for approximatel... MRCS exam preparation.
Tinea Infections
The three principal genera of dermatophytes are Trichophyton , Microsporum , and Epidermophyton . Trichophyton rubrum accounts for 60-80% of all dermatophyte infections globally and is the most common cause of chronic...
Tinea Infections (Dermatophytosis)
Dermatophytosis (tinea infections) represents a group of superficial mycoses caused by keratinophilic fungi of the genera Trichophyton , Microsporum , and Epidermophyton . These organisms infect keratinized...
TMT Arthritis
Arthritis of the Tarsometatarsal (TMT) joints, also known as Midfoot Arthritis, is a common cause of dorsal foot pain and difficulty wearing shoes. It primarily affects the 2nd and 3rd TMT joints (the rigid "Keystone"...
Tonsillitis
Tonsillitis is acute inflammation of the palatine tonsils, predominantly caused by viral or bacterial infection. It repr... MRCP, MRCGP exam preparation.
Topical Corticosteroids
Potency: Matching strength to the site and severity (e.g., Mild for face, Super-potent for palms).
Torticollis in Children
Torticollis (derived from Latin tortus meaning "twisted" and collum meaning "neck") is an abnormal posturing of the head and neck characterized by lateral head tilt toward the affected side and chin rotation toward...
Total Intravenous Anaesthesia (TIVA) and Target Controlled Infusion (TCI)
Total intravenous anaesthesia (TIVA) provides complete anaesthesia without volatile agents using continuous IV drug infusions, offering advantages in PONV reduction (50% lower than volatiles), neurosurgery (reduced...
Tourette's Syndrome
Tics are sudden, rapid, recurrent, non-rhythmic motor movements or vocalisations that are experienced as irresistible but can be suppressed temporarily. The hallmark feature distinguishing tics from other involuntary...
Toxic Alcohol Poisoning (Methanol & Ethylene Glycol)
Toxic alcohol poisoning encompasses the ingestion of methanol and ethylene glycol, two substances that undergo hepatic metabolism via alcohol dehydrogenase to produce highly toxic organic acid metabolites. Methanol is...
Toxic Alcohol Poisoning (Methanol and Ethylene Glycol)
ADH inhibition - Fomepizole (preferred) or ethanol to prevent formation of toxic metabolites ... CICM Second Part, CICM Primary exam preparation.
Toxicology - General Approach
The initial approach to any poisoned patient follows a structured ABCDE assessment with simultaneous history-taking and ... ACEM Fellowship Written, ACEM Fellow
Toxoplasmosis
The parasite's complex life cycle involves cats as the definitive host, with humans and other warm-blooded animals serving as intermediate hosts. Transmission occurs through ingestion of oocysts from cat feces,...
Tracheo-Oesophageal Fistula (TOF)
TOF is a congenital anomaly where the trachea and oesophagus fail to separate during embryological development, creating abnormal connections. Oesophageal atresia (OA) is usually present. Key anaesthetic principles:
Tracheostomy
Timing of tracheostomy: TracMan trial, early vs late... CICM Second Part exam preparation.
Tracheostomy Care
Tracheostomy patients presenting to the ED require systematic assessment and immediate action for airway emergencies. The most critical emergencies are:
Tranexamic Acid Pharmacology
Tranexamic acid (TXA) is a synthetic lysine analogue antifibrinolytic agent that competitively inhibits plasminogen activation by blocking lysine-binding sites, thereby preventing fibrin clot degradation. TXA is...
Transfusion Reactions
Recognition requires high clinical suspicion—any new symptom during transfusion warrants immediate cessation and systematic investigation. The two most challenging differential diagnoses are TRALI (transfusion-related...
Transient Ischaemic Attack (TIA)
A Transient Ischaemic Attack (TIA) is a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction. Historically defined by the 24-hour rule...
Transient Synovitis (Irritable Hip)
Transient synovitis (TS), colloquially known as irritable hip , is a self-limiting, non-infective inflammatory condition of the hip joint. It represents the single most common cause of acute hip pain and limp in the...
Transient Synovitis (Irritable Hip)
Transient Synovitis, commonly known as "Irritable Hip" or "Observation Hip", is the most common cause of acute hip pain and limp in children aged 3-10 years, with peak incidence at 5-6 years. It represents a benign,...
Transient Tachypnoea of the Newborn (TTN)
Transient tachypnoea of the newborn (TTN) is a common, self-limiting respiratory disorder caused by delayed clearance of... MRCPCH exam preparation.
Transport Equipment for Critical Care
CICM IC-1 Guideline: Minimum standards require appropriate personnel (trained in transport medicine), equipment (vent... CICM Second Part Written, CICM Secon
Transverse Myelitis
The term "transverse" refers to inflammation spanning the full or partial width of the spinal cord, disrupting ascending and descending neural pathways. Prompt recognition and treatment are critical, as early...
Transversus Abdominis Plane (TAP) Block
The TAP block provides analgesia to the anterior abdominal wall (T7-L1 dermatomes) by depositing local anaesthetic in the transversus abdominis plane between internal oblique and transversus abdominis muscles where...
Trauma Resuscitation - Adult
One-liner : Trauma resuscitation requires immediate, systematic assessment using ATLS ABCDE protocol, damage control resuscitation (permissive hypotension, balanced blood product ratio, early TXA), and rapid...
Trauma Scene Safety
Trauma scene safety is the critical first step in emergency medicine, following the hierarchy: Self Partner/Crew Pub... ACEM Fellowship Written, ACEM Fellow
Traumatic Brain Injury
Traumatic Brain Injury (TBI) is a leading cause of death and disability worldwide, with severity classified by Glasgow C... CICM Second Part exam preparation.
Traumatic Brain Injury
Traumatic brain injury (TBI) affects 180-250 per 100,000 Australians annually with 10-20% mortality for moderate-severe ... ACEM Primary Written, ACEM Primary V
Traumatic Brain Injury: Secondary Injury Prevention and Neuroprotection
Traumatic brain injury (TBI) management focuses on preventing secondary brain injury caused by hypotension, hypoxia, hypercapnia, and intracranial hypertension. Cerebral perfusion pressure (CPP) should be maintained...
Traumatic Cardiac Arrest
Traumatic cardiac arrest differs fundamentally from medical cardiac arrest in aetiology and management . While medica... ACEM Primary Written, ACEM Primary V
Trichomoniasis
Fact Value ------ ------- Definition STI caused by flagellated protozoan Trichomonas vaginalis Global Incidence 156 million new cases/year (WHO) Organism Protozoan parasite (NOT bacteria or virus) Transmission...
Tricyclic Antidepressant Overdose
Sodium bicarbonate 1-2 mmol/kg IV bolus for QRS greater than 100 ms or hypotension (target pH 7.50-7.55)... CICM Second Part exam preparation.
Tricyclic Antidepressant Overdose
Tricyclic antidepressant (TCA) overdose is a medical emergency characterised by sodium channel blockade causing QRS prol... ACEM Fellowship Written, ACEM Fellow
Tricyclic Antidepressant Overdose
Tricyclic antidepressant (TCA) overdose is a life-threatening toxicological emergency requiring immediate recognition and aggressive management. TCAs remain a significant cause of poisoning-related morbidity and...
Trigeminal Neuralgia
Classical (idiopathic) TN is most commonly caused by neurovascular compression of the trigeminal nerve root at the root entry zone, typically by the superior cerebellar artery. Secondary TN occurs due to underlying...
Trigger Finger
The condition affects approximately 2-3% of the general adult population, with a marked female predominance (6:1) and peak incidence in the 5th-6th decades of life. Prevalence increases substantially in patients with...
Triple Arthrodesis
The Triple Arthrodesis is the definitive salvage procedure for severe, rigid hindfoot deformity and pan-talar arthritis.... FRCS exam preparation.
Tropical Infections (Australia)
Australia's tropical north and remote Indigenous communities experience unique infectious disease profiles not seen else... ACEM Fellowship Written, ACEM Fellow
Tuberculosis (Adult)
Tuberculosis (TB) is a chronic granulomatous infectious disease caused by organisms of the Mycobacterium tuberculosis co... MRCP exam preparation.
Tuberculosis (Pulmonary) - Adult
TB affects primarily the lung parenchyma but has the biological capacity to disseminate to virtually every organ system ... MRCP, Respiratory Medicine exam prep
Tuberous Sclerosis Complex (TSC)
Tuberous Sclerosis Complex (TSC) is an autosomal dominant multisystem genetic disorder caused by mutations in either the... MRCP, FRACP exam preparation.
Tubulointerstitial Nephritis (TIN)
TIN accounts for 15-27% of all cases of AKI in hospitalized patients and up to 10-15% of cases requiring renal biopsy for unexplained AKI. The condition has evolved considerably over the past two decades, with proton...
Tumour Lysis Syndrome
Key Facts Timing : Usually 12-72 hours after chemotherapy initiation; can be spontaneous High-risk tumours : Burkitt lymphoma, ALL, high-grade NHL, AML with hyperleukocytosis Metabolic tetrad : ↑K+, ↑uric acid,...
Turf Toe (Adult)
Turf toe is a sprain of the plantar capsulo-ligamentous complex of the first metatarsophalangeal (MTP) joint, resulting ... MRCS, FRCS (Tr&Orth) exam preparatio
Turner Syndrome (Child)
Turner syndrome (TS) is a chromosomal disorder affecting phenotypic females, characterised by complete or partial absenc... MRCPCH exam preparation.
Type 1 Diabetes Mellitus
Comprehensive evidence-based guide to Type 1 Diabetes diagnosis, insulin management, technology, and complications
Type 2 Diabetes Mellitus
Type 2 Diabetes Mellitus (T2DM) is a chronic, progressive cardiorenal-metabolic syndrome characterized by hyperglycemia ... MRCP exam preparation.
Type 2 Diabetes Mellitus (Adult)
Type 2 Diabetes Mellitus (T2DM) is a chronic progressive metabolic disorder characterized by chronic hyperglycemia resul... MRCP, USMLE exam preparation.
Typhoid and Paratyphoid Fever (Enteric Fever)
Enteric fever is a life-threatening systemic infection caused by the invasive bacteria Salmonella enterica serovar Typhi (typhoid fever) or Paratyphi A, B, C (paratyphoid fever). This condition remains a major global...
Ulcerative Colitis
Ulcerative Colitis (UC) is a chronic, relapsing-remitting inflammatory bowel disease (IBD) characterized by continuous m... MRCP exam preparation.
Ulcerative Colitis (Adult)
Ulcerative colitis (UC) is a chronic, idiopathic inflammatory bowel disease (IBD) characterized by continuous mucosal inflammation of the colon, always involving the rectum and extending proximally to varying degrees....
Ultrasound in ICU
Ultrasound Physics: Frequency (2-15 MHz) determines penetration and resolution trade-off. Higher frequency = better r... CICM Second Part Written, CICM Secon
Umbilical & Paraumbilical Hernia (Adult)
An umbilical hernia is a protrusion of abdominal contents through a defect in the linea alba at or adjacent to the umbil... MRCS, FRCS, FRACS exam preparation.
Umbilical Cord Prolapse
Cord prolapse is an obstetric emergency with perinatal mortality of 9-47% if untreated. It occurs in 0.14-0.62 per 1,000... ACEM Primary Written, ACEM Primary V
Umbilical Cord Prolapse
Key Facts Incidence : 0.14-0.62% of deliveries (1.4-6.2 per 1000 births) Presentation : Visible/palpable cord at vulva; acute fetal bradycardia or severe variable decelerations immediately following spontaneous or...
Undescended Testes (Cryptorchidism) (Child)
Undescended testis (UDT), or cryptorchidism, is the most common congenital anomaly of the male genitourinary system, aff... MRCPCH exam preparation.
Undescended Testis (Cryptorchidism)
Undescended Testis (UDT), or Cryptorchidism, is the failure of one or both testes to descend from the retroperitoneum into the scrotum by term gestation. It represents the most common genital anomaly in male neonates...
Upper Airway Anatomy
Define/Describe - Overview of upper airway divisions and boundaries... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Upper Gastrointestinal Bleeding
Resuscitation: Two large-bore IV cannulae, crystalloid bolus, restrictive transfusion strategy (Hb target 70 g/L in m... CICM Second Part exam preparation.
Upper Gastrointestinal Bleeding
Upper Gastrointestinal Bleeding (UGIB) is defined as haemorrhage originating proximal to the Ligament of Treitz (oesopha... MRCP exam preparation.
Upper Gastrointestinal Bleeding (Adult)
Upper gastrointestinal bleeding (UGIB) is a common and potentially life-threatening medical emergency defined as bleedin... MRCP exam preparation.
Urethral Stricture
A urethral stricture is a narrowing of the urethral lumen caused by scarring (spongiofibrosis) of the corpus spongiosum and urethral epithelium. It is a common urological condition predominantly affecting males, with...
Urge Urinary Incontinence (Overactive Bladder)
Urge urinary incontinence (UUI) is the involuntary leakage of urine accompanied by or immediately preceded by a sudden, compelling desire to void that is difficult to defer (urgency). UUI is a key component of...
Urinary Incontinence (Adult)
Urinary Incontinence (UI) is defined by the International Continence Society as "the complaint of involuntary loss of urine." It represents a major public health issue affecting millions of individuals worldwide, with...
Urinary Retention in Adults
Urinary retention is defined as the inability to voluntarily pass an adequate amount of urine, resulting in increased post-void residual (PVR) volume. It is classified into acute urinary retention (AUR) and chronic...
Urinary Tract Infection (Adult)
Urinary tract infection (UTI) represents one of the most prevalent bacterial infections worldwide, accounting for approximately 150 million cases annually and significant healthcare expenditure. UTIs are classified...
Urinary Tract Infection (Paediatrics)
Urinary Tract Infection (UTI) is the most common serious bacterial infection in children , accounting for approximately 7 million office visits and 100,000 hospitalizations annually. It ranges from benign lower tract...
Urinary Tract Infection and Pyelonephritis (Adult)
Urinary Tract Infections (UTIs) represent the most common bacterial infection in adults, accounting for over 150 million... MRCP exam preparation.
Urinary Tract Infection in Adults
Urinary tract infection (UTI) is bacterial infection of any component of the urinary system, most commonly the bladder (... MRCP exam preparation.
Urosepsis
Key Facts Definition : Sepsis (life-threatening organ dysfunction) arising from urinary tract source Incidence : Most common source of community-acquired sepsis in patients >65 years Mortality : 10-15% overall;...
Urticaria (Hives)
CSU, representing approximately 70% of chronic cases, is frequently driven by autoimmune mechanisms involving autoantibodies against the high-affinity IgE receptor (FcεRI) or IgE itself. Angioedema , affecting deeper...
Uterine Fibroids (Leiomyoma)
Uterine fibroids (leiomyomas) are benign monoclonal tumours arising from the smooth muscle cells (myometrium) of the ute... MRCOG exam preparation.
Uterine Fibroids (Leiomyomas)
Uterine leiomyomas, commonly known as fibroids, are benign monoclonal tumours arising from the smooth muscle cells of th... MRCOG exam preparation.
Uterine Rupture
The condition occurs on a spectrum from incomplete rupture (scar dehiscence) , where the uterine serosa remains intact, to complete rupture with full-thickness tearing and potential extrusion of the fetus and placenta...
Vaginal Birth After Caesarean (VBAC)
The principal concern with TOLAC is uterine scar rupture , occurring in approximately 0.5% (1 in 200) of attempted vaginal births after one previous lower segment caesarean section (LSCS). This rare but potentially...
Valvular Emergencies in ICU
Acute aortic regurgitation does not allow time for LV dilatation and compensation; presents with severe pulmonary oed... CICM Second Part exam preparation.
Vaporizers
Vaporizers convert liquid volatile anaesthetic agents into vapor for delivery to patients, requiring precise concentration control under varying conditions. Types: Variable bypass (most common, Tec type), measured...
Varicella Zoster Virus (Chickenpox & Shingles)
Varicella Zoster Virus (VZV), also known as Human Herpesvirus 3 (HHV-3), is a neurotropic alphaherpesvirus that causes two clinically distinct syndromes separated by decades: varicella (chickenpox) as the primary...
Varicose Veins
Chronic venous disease encompasses a continuum from telangiectasias and reticular veins to varicose veins, skin changes, and venous ulceration, classified using the internationally recognized CEAP...
Vascular Access Anatomy
Define/Describe - Anatomy of the specific access site... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.
Vascular Dementia
The pathophysiology involves multiple mechanisms: macrovascular disease causing cortical infarcts, microvascular disease (arteriolosclerosis) affecting white matter and deep grey structures, and strategically placed...
Vasculitis - Comprehensive
Vasculitis is inflammation of blood vessel walls leading to vessel damage, narrowing, occlusion, and subsequent organ is... MRCP exam preparation.
Vasculitis Emergency
Vasculitis emergencies occur when inflammation of blood vessels causes acute life-threatening organ damage requiring imm... MRCP, FRACP exam preparation.
Vasopressin and Analogues Pharmacology
Vasopressin (arginine vasopressin, AVP), also known as antidiuretic hormone (ADH), is an endogenous nonapeptide synthesised in the hypothalamic supraoptic and paraventricular nuclei and released from the posterior...
Vasopressors & Inotropes
Define - What is a vasopressor? What is an inotrope?... CICM First Part Written, CICM First Part Viva exam preparation.
Vecuronium: Pharmacology and Clinical Use
Vecuronium is an intermediate-acting aminosteroid non-depolarizing neuromuscular blocker . Structure : Steroid nucleus with quaternary ammonium groups (bisquaternary). Mechanism : Competitive antagonist at nicotinic...
Venous Air Embolism - Detection and Management
Immediate Recognition: Sudden drop in EtCO2 (earliest sign) 2 mmHg drop from baseline Mill wheel murmur on precordial Doppler (characteristic churning sound) Sudden cardiovascular collapse during sitting position...
Venous Leg Ulcers
The pathognomonic presentation comprises a shallow, exudating ulcer typically located in the "gaiter area" (distal third of the leg, particularly the medial malleolar region), surrounded by characteristic stigmata of...
Venous Thromboembolism (VTE): Deep Vein Thrombosis and Pulmonary Embolism
Venous thromboembolism (VTE) encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), representing a spectrum... MRCP, USMLE exam preparation.
Ventilator Waveform Interpretation
Ventilator waveform analysis is essential for optimizing mechanical ventilation, detecting patient-ventilator dyssynchro... CICM Second Part exam preparation.
Ventilator-Associated Pneumonia (VAP)
Definition: VAP occurs ≥48 hours after intubation; early-onset (below 5 days) vs late-onset (≥5 days) determines micr... CICM Second Part, ANZICS exam prepar
Ventral Hernias (Incisional & Umbilical)
Ventral hernias encompass all anterior abdominal wall defects, primarily classified into three major subtypes: incisiona... MRCS, FRACS exam preparation.
Ventricular Arrhythmias in ICU
Comprehensive CICM Second Part clinical guide to Ventricular Arrhythmias in ICU, covering VT/VF classification, pathophysiology (re-entry, triggered activity, automaticity), Torsades de Pointes, Brugada syndrome,...
Ventricular Assist Device Implantation
Ventricular assist device (VAD) implantation is a major cardiac surgical procedure for patients with end-stage heart failure. The three configurations are: (1) Left VAD (LVAD) - most common (80%), blood inflow from...
Ventricular Assist Devices (VADs) in ICU
Comprehensive guide to ventricular assist devices in critically ill patients, including indications (bridge to transplant, recovery, destination therapy), INTERMACS profiles 1-7, device types (HeartMate 3, HVAD,...
Ventricular Tachycardia
Key Facts Definition : VT = ≥3 consecutive ventricular beats at 100 bpm with wide QRS (≥120ms) Classification : Sustained ( 30s) vs non-sustained (less than 30s); monomorphic vs polymorphic ECG features : Wide QRS, AV...
Vesicoureteral Reflux (VUR)
VUR arises from either primary (congenital) abnormalities of the vesicoureteral junction or secondary causes such as increased bladder pressure from posterior urethral valves or neuropathic bladder. The fundamental...
Vestibular Neuritis
Critically, hearing is preserved in vestibular neuritis, distinguishing it from labyrinthitis which involves both vestibular and cochlear divisions of the vestibulocochlear nerve (cranial nerve VIII). Vestibular...
Vestibular Schwannoma
The classic clinical triad comprises: Unilateral progressive sensorineural hearing loss (95% of cases) Tinnitus (unilateral, typically high-pitched) Vestibular dysfunction (imbalance more common than true vertigo)
Video Laryngoscopy
First-pass success: VL increases first-pass success from 70-75% (DL) to 80-85% in most ED studies... ACEM Primary Written, ACEM Primary Viva exam preparati
VIPoma
A VIPoma is an exceptionally rare functional pancreatic neuroendocrine tumour (pNET) that secretes excessive amounts of Vasoactive Intestinal Peptide (VIP). This hormone hypersecretion drives massive fluid and...
Viral Conjunctivitis
The disease is highly contagious , spreading through direct contact with infected ocular secretions and contaminated fomites (towels, pillowcases, ophthalmic equipment). Most cases follow a self-limiting course , with...
Viral Encephalitis
Herpes Simplex Virus Type 1 (HSV-1) is the most common identified cause of sporadic, severe viral encephalitis in developed countries, accounting for 10-20% of all cases. Without treatment, HSV encephalitis carries a...
Viral Haemorrhagic Fevers
VHFs are classified as high-consequence infectious diseases (HCID) due to their high case-fatality rates (ranging from 1% to 90% depending on the pathogen), potential for person-to-person transmission, limited...
Viral Warts (Verrucae)
Viral warts are benign epithelial proliferations caused by infection of keratinocytes with Human Papillomavirus (HPV) . They represent one of the most common dermatological conditions, affecting up to 10-20% of...
Vitamin B12 Deficiency & Pernicious Anaemia
Vitamin B12 (cobalamin) deficiency represents a critical nutritional disorder with potentially devastating haematologica... MRCP exam preparation.
Vitiligo
Vitiligo is an acquired, chronic pigmentary disorder characterized by the autoimmune destruction of melanocytes, resulti... MRCP exam preparation.
Volar Plate Injury to the PIPJ
The volar plate is a fibrocartilaginous ligamentous structure on the palmar aspect of the proximal interphalangeal (PIP) joint, providing the primary restraint to hyperextension. Volar plate injuries represent the...
Volvulus (Adult)
Volvulus is the twisting of a segment of bowel around its mesentery , causing closed-loop obstruction and vascular compromise with risk of ischaemia, gangrene, and perforation . It accounts for 3-5% of large bowel...
Von Hippel-Lindau Disease (VHL)
Von Hippel-Lindau (VHL) disease is an autosomal dominant hereditary cancer syndrome caused by germline mutations in the VHL tumour suppressor gene on chromosome 3p25.3. The condition predisposes individuals to the...
VTE Prophylaxis in ICU
All ICU patients need VTE prophylaxis: Near-universal high risk due to immobility, critical illness, CVC, mechanical ... CICM Second Part exam preparation.
Vulval Cancer
HPV-dependent pathway (30-40%): Affects younger women (40-60 years), associated with High-Risk HPV infection (types 16, 18), characterized by usual-type Vulval Intraepithelial Neoplasia (uVIN), and demonstrates...
Vulvovaginal Candidiasis (Thrush)
Comprehensive evidence-based guide to Vulvovaginal Candidiasis covering epidemiology, molecular pathophysiology, Sobel classification, diagnosis, management of uncomplicated and complicated disease, recurrent VVC...
VV-ECMO for Respiratory Failure
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a salvage therapy for severe acute respiratory distress syn... CICM Second Part, EDIC exam preparat
Warfarin Reversal and Over-Anticoagulation Management
Warfarin reversal is a time-critical emergency procedure required for patients presenting with major bleeding, life-threatening haemorrhage, or those needing urgent/emergency surgery while on vitamin K antagonist...
Weaning from Mechanical Ventilation
Weaning (or "liberation") from mechanical ventilation is the process of transitioning a mechanically ventilated patient ... CICM Second Part exam preparation.
Weedkiller (Paraquat) Poisoning
Redox cycling mechanism: Paraquat is reduced intracellularly to a free radical, then re-oxidised by oxygen, producing... ACEM Primary Written, ACEM Fellowshi
Wernicke-Korsakoff Syndrome
Wernicke's Encephalopathy (WE) : An acute, potentially reversible neurological emergency characterized by the classical triad of confusion, ataxia, and ophthalmoplegia. Without immediate treatment, mortality...
Wilms' Tumour (Nephroblastoma)
The condition has an excellent prognosis with modern multimodal therapy, achieving 5-year survival rates exceeding 90% for localised disease. Treatment involves a coordinated approach of chemotherapy, surgery, and...
Wilson Disease
The hallmark of WD is impaired biliary copper excretion and defective incorporation of copper into ceruloplasmin, resulting in toxic accumulation of free copper. Clinical presentations are highly heterogeneous,...
Wilson's Disease
Clinical manifestations are highly variable, ranging from asymptomatic hepatic transaminitis discovered incidentally to fulminant hepatic failure , cirrhosis with portal hypertension , and progressive neuropsychiatric...
Withdrawal of Life-Sustaining Therapy
Withdrawal of life-sustaining therapy (WOLST) is the deliberate discontinuation of interventions that sustain life when ... CICM Fellowship Written, CICM Fellow
Yellow Fever
The clinical spectrum ranges from asymptomatic or mild febrile illness in approximately 85% of cases to severe disease characterised by hepatorenal failure, haemorrhage, and shock in 15% of infected individuals. The...
Zika Virus Infection
Zika virus (ZIKV) is a mosquito-borne Flavivirus that emerged from relative obscurity to become a major public health concern following massive outbreaks in the Americas from 2015-2016. While Zika virus infection...
Zollinger-Ellison Syndrome
Key Features : Sporadic : 75–80% of cases. Usually solitary pancreatic or duodenal tumours, potentially curable with surgical resection. MEN1-Associated : 20–25% of cases. Multiple gastrinomas, often microadenomas,...