@About this App@Contributers@DeveloperACTH (Adrenocorticotropic hormone)AFP (Alpha-fetoprotein) TestingAIDS Dementia Complex (HIV)AIDS HIV InfectionAPGAR Scoring (Children)APTT and CoagulationAbacavirAbataceptAbbreviated Mental Test Score (AMTS)AbciximabAbdominal Aortic AneurysmAbdominal paracentesis for ascitesAbducent NerveAbetalipoproteinaemiaAbnormal Vaginal bleedingAcamprosateAcanthocytosisAcanthosis NigricansAcarboseAccelerated Idioventricular RhythmAcetazolamideAcetylcholine Receptor AntibodiesAcetylcholinesterase inhibitorsAchalasiaAchilles Tendon ruptureAchondroplasia (Children)AciclovirAcid maltase deficiency (Pompe disease)Acne RosaceaAcne VulgarisAcoustic Neuroma (Schwannoma)Acrodermatitis enteropathica (Children)Acromegaly and GiantismAcromio-clavicular jointActinomyces israeliAction PotentialActivated CharcoalActrapid (Insulin)Acute Abdominal Pain - Acute PeritonitisAcute Acalculous CholecystitisAcute Anaphylactoid ReactionsAcute AnaphylaxisAcute Angle Closure GlaucomaAcute AppendicitisAcute Bacterial MeningitisAcute BronchitisAcute CholangitisAcute CholecystitisAcute Colonic Pseudo-obstructionAcute Coronary Syndrome (ACS) GeneralAcute Coronary Syndrome (ACS) NSTEMI USAAcute Coronary Syndrome (ACS) STEMIAcute Coronary Syndrome (Cardiac Troponins)Acute Coronary Syndrome Grace scoreAcute DeliriumAcute Disc lesionsAcute Disseminated EncephalomyelitisAcute Diverticulitis - Diverticular diseaseAcute Dystonic ReactionAcute EncephalitisAcute Eosinophilic PneumoniaAcute EpiglottitisAcute Exacerbation of COPDAcute HepatitisAcute HydrocephalusAcute HypotensionAcute InflammationAcute Intermittent Porphyria (AIP)Acute Interstitial nephritisAcute Kidney Injury (AKI)Acute Limb IschaemiaAcute Liver FailureAcute Lymphoblastic Leukaemia (ALL)Acute MastoiditisAcute MonoarthritisAcute Myeloid Leukaemia (AML)Acute MyocarditisAcute PancreatitisAcute Pelvic Inflammatory DiseaseAcute PericarditisAcute Phase reactantsAcute PorphyriasAcute Promyelocytic LeukaemiaAcute Respiratory Distress Syndrome (Adults)Acute Retroviral Syndrome (HIV)Acute RhabdomyolysisAcute Rheumatic feverAcute Rotator cuff tearAcute Severe AsthmaAcute Severe ColitisAcute SinusitisAcute Stroke Assessment (ROSIER&NIHSS)Acute TonsilitisAcute Urinary RetentionAcute and Chronic GoutAcute and Chronic Heart FailureAcute on Chronic Liver Disease DecompensationAcutely Ill PatientAdalimumabAddenbrooke's Cognitive Examination-Revised (ACER)Addison Disease (Adrenal Insufficiency)AdefovirAdenosineAdenosine deaminase deficiencyAdhesive Capsulitis (Frozen Shoulder)Adjustment - Anxiety disordersAdrenal AntibodiesAdrenal PhysiologyAdrenaline (Epinephrine)AdrenoleukodystrophyAdrenomyeloneuropathyAdult Onset Still's DiseaseAfrican Trypanosomiasis (Sleeping sickness)Age related macular degenerationAicardi syndromeAir EmbolismAlbuminAlbumin-Protein Creatinine Ratio (PCR)Alcohol AbuseAlcohol Withdrawal (Delirium Tremens)Alcoholic (Steato)HepatitisAlcoholic KetoacidosisAldosterone PhysiologyAlendronate (Alendronic acid)AlfacalcidolAlkaline phosphatase (ALP)Alkalinisation of urineAlkaptonuriaAllergic Bronchopulmonary AspergillosisAllogeneic stem cell transplantationAllopurinolAlogliptin (Vipidia)AlopeciaAlpha FetoproteinAlpha ThalassaemiaAlpha subunit (ASU) of TSHAlpha-1 Antitrypsin (AAT) deficiencyAlport's SyndromeAlteplaseAltitude sicknessAluminium and Magnesium AntacidsAlveolar Gas EquationAlzheimer disease (Dementia)AmantadineAmenorrhoeaAmerican Trypanosomiasis (Chagas Disease)AmilorideAmino acidsAminoglycosidesAminophyllineAminosalicylatesAmiodaroneAmiodarone and Thyroid diseaseAmitriptylineAmlodipineAmmonia EncephalopathyAmnestic syndromesAmoebiasis (Entamoeba histolytica)AmoxicillinAmphetamine toxicityAmphotericin BAmpicillinAnaemia of Chronic DiseaseAnagrelideAnakinraAnal CancerAndexanet alfaAndrogen insensitivity syndromeAneurysmsAngina bullosa haemorrhagicaAngiodysplasiaAngiomyolipomaAngioneurotic OedemaAngiotensin Converting Enzyme InhibitorsAngiotensin Converting enzyme (ACE)Angular Stomatitis - CheilitisAnion GapAnkle and Foot fractures and InjuriesAnkle-Brachial pressure Index (ABPI)Ankylosing spondylitisAnorexia NervosaAntacid medicationAntepartum haemorrhageAnterior Horn Cell diseasesAnterior circulationAnti Dementia DrugsAnti-Cyclic Citrullinated Peptide (CCP) AntibodyAnti-D immunoglobulinAnti-Hu antibodiesAnti-OKT3 antibodiesAnti-RNP AntibodyAnti-Yo antibodiesAnti-neutrophilic cytoplasmic antibodies (ANCA)Antibiotics for Abdominal InfectionsAnticholinergic BurdenAnticholinergic syndromeAnticipationAnticoagulation and AntithromboticsAntidiuretic hormone (Vasopressin)Antigen presenting cellsAntimicrobial ChoicesAntimuscarinic drugsAntiphospholipid syndromeAntithrombin III deficiency (AT3)Aorta anatomyAortic DissectionAortic Regurgitation (Incompetence)Aortic SclerosisAortic StenosisAortoenteric fistulaApathetic thyrotoxicosisApixabanAplastic anaemiaApomorphineAppendix Cancer TumoursApproach to Assessing Sick ChildApproach to child with Acute GastroenteritisApproach to child with respiratory DistressArnold Chiari malformationArrhythmogenic Right ventricular CardiomyopathyArtemisininsArterial Blood gas analysisArterial Pulse assessmentArterial blood gas samplingArterial vs Venous vs Other Leg UlcersArteriovenous malformationsArtery of Percheron strokeArtery-to-artery embolic strokeArtesunateAsbestos Related Lung diseaseAscites Assessment and ManagementAspergillomaAspergillus fumigatusAspirinAspirin Salicylates toxicityAssessing Abdominal PainAssessing BreathlessnessAssessing Chest PainAssessing FallsAsteatotic eczemaAsthmaAstigmatismAstrocytomasAsystoleAtaxia TelangiectasiaAtazanavirAtenololAtherosclerosisAtopic Eczema or Atopic DermatitisAtorvastatinAtracuriumAtrial Ectopic beatsAtrial Fibrillation (Chemical cardioversion)Atrial Natriuretic Peptide (ANP)Atrial fibrillation (AF)Atrial flutterAtrial myxomaAtrial septal defect (ASD)Atrioventricular nodal reentrant tachycardiaAtropine SulfateAutoantibodiesAutoimmune Haemolytic anaemia (AIHA)Autoimmune HepatitisAutonomic neuropathyAutosomal DominantAutosomal Dominant Polycystic kidney diseaseAutosomal RecessiveAzathioprineAzithromycinB lymphocytesBRCA genes (Familial Breast Cancer)Bacillus anthracisBacillus cereus poisoningBackpain / BackacheBaclofenBacteriaBacteroides fragilisBalanitis (Adults)Balanitis (Children)Balkan endemic nephropathy (BEN)Balsalazide (Aminosalicylate)Barrett's oesophagusBartonellaBartters syndromeBasal Cell Carcinoma (BCC)Basic Fracture managementBasilar artery thrombosisBecker Muscular dystrophyBeclometasoneBeer PotomaniaBehavioural and Psychological Symptoms of DementiaBehcet's syndromeBell's palsyBendroflumethiazide (Bendrofluazide)Benign Paroxysmal Positional Vertigo (BPPV)Benign Prostatic HyperplasiaBenign recurrent intrahepatic cholestasisBenzodiazepine ToxicityBenzodiazepinesBenzylpenicillin Sodium (Penicillin G)Berg Balance ScaleBeriplexBerylliosisBeta AgonistsBeta Blocker toxicityBeta ThalassaemiaBeta-2 MicroglobulinBeta-lactamasesBetahistine (Serc)BezafibrateBiceps ruptureBilateral adrenalectomyBiliary atresiaBilirubinBiochemical Lab valuesBisacodylBisoprololBisphosphonatesBladder CancerBladder StonesBleedingBleeding disordersBleeding due to DrugsBleomycinBlindness - global causesBlood products - Packed cells blood transfusionBlood Products - CryoprecipitateBlood Products - Fresh Frozen PlasmaBlood Products - PlateletsBlood film interpretationBlood gas valuesBloody DiarrhoeaBlotting Techniques: Gel ElectrophoresisBone Marrow TransplantationBone disease Lab resultsBone metabolism RANK RANKL OPG pathwayBone scintigraphy (Bone scan)Bordetella pertussis - Whooping coughBorrelia burgdorferiBorrelia recurrentisBotulismBrachial neuritis (neuralgic amyotrophy)Brachial plexus anatomyBrachial plexus and associated injuryBrain AbscessBrain Anatomy and functionBrain MRIBrain Natriuretic Peptide (BNP)Brain PhysiologyBrain Tumours (Cancer)Brainstem anatomyBranchial cleft cystBreast CancerBreast FibroadenomaBretyliumBroad complex TachycardiaBromocriptineBronchial adenomaBronchiectasisBronchiolitisBronchoscopyBrown-Sequard syndromeBrucellaBrugada syndromeBudd-Chiari syndromeBudesonideBuerger disease (Thromboangiitis obliterans )Bulbar vs Pseudobulbar palsyBulimia NervosaBullous PemphigoidBumetanideBunionsBuprenorphineBupropionBurkholderia cepaciaBurkitt's lymphomaBurnsBusulphan (Busulfan)ByssinosisC reactive protein (CRP)CADASILCARASILCHADS2 - CHA2DS2-VASc scoreCMV retinitisCNS fungal InfectionsCNS infectionsCSF RhinorrhoeaCT Head Basics (Stroke)CT Pulmonary angiogram (CTPA)CT imaging basics for StrokeCURB 65 scoreCabergolineCaecal VolvulusCaisson Disease - Decompression sicknessCalcitoninCalcitriol (1,25 Dihydroxycholecalciferol)Calcium Chloride or GluconateCalcium PhysiologyCalcium Pyrophosphate Deposition (Pseudogout)Calcium ResoniumCalcium channel blockers toxicityCalot's triangleCampylobacterCancer of Unknown PrimarCandesartanCandidiasisCannabis toxicityCapecitabineCapnocytophaga canimorsusCapnographyCapreomycinCaptopriCarbamazepineCarbapenemase-producing EnterobacteriaceaeCarbimazoleCarbon monoxide poisoningCarcinoembryonic antigen (CEA)Carcinoid Heart DiseaseCarcinoid Tumour SyndromeCarcinoma of the Bile DuctCarcinoma of the GallbladderCardiac Amyloid heart diseaseCardiac Anatomy and PhysiologyCardiac Catheter ablationCardiac InfectionsCardiac MRICardiac Resynchronisation Therapy (CRT) PacemakerCardiac Valve replacementCardioembolic strokeCardiogenic Pulmonary OedemaCardiogenic shockCardiology - History TakingCardiology Exam ListCardiology ExaminationCardiology Valves SummaryCardiopulmonary bypassCarmustineCarotid Artery anatomyCarotid Body TumourCarotid EndarterectomyCarotid Sinus SyncopeCarotid StentingCarotid artery DissectionCarotid sinus massageCarpal tunnel syndromeCarvedilolCase 01 Sudden weaknessCase 02 Loss of speechCase 03 Adult male weak legsCase 04 High calciumCase 05 High Potassium and heart failureCase 06 High calcium and weight lossCase 07 Weak eyesCase 08 Weak faceCase 09 A cause of DeliriumCase 10 Older patient presenting post strokeCase 11 Young patient with acute headacheCase 20 Young patient with acute headacheCase 21 HypoglycaemiaCase 22Case 23 Old man with tremorCase 24 Cancer and weakCase 99 (Acute breathlessness)Case TemplateCat Scratch DiseaseCataractCatheter Related Urinary Tract infection UTICatheter related Blood stream infectionCatheter related UTICauda equina syndromeCaudate NucleusCauses of Airway ObstructionCauses of Avascular Necrosis of Femoral headCauses of Sore throatCauses of WeaknessCavernous angiomas (Cavernomas)Cavernous sinusCavernous sinus thrombosisCefaclorCefalexinCefotaximeCeftazidimeCeftriaxoneCefuroximeCelecoxibCell Response to InjuryCellular Anatomy and PhysiologyCellulitisCentral Cord SyndromeCentral Retinal Vein Occlusion (CRVO)Central Retinal artery Occlusion (CRAO)Central Venous line InsertionCentral pontine myelinolysisCephalosporinsCerebellar Anatomy Physiology Signs DiseaseCerebellar HaemorrhageCerebellar StrokeCerebral Amyloid angiopathy (CAA)Cerebral AneurysmsCerebral AngiitisCerebral Atrophy vs HydrocephalusCerebral CortexCerebral MetastasesCerebral PalsyCerebral PerfusionCerebral Salt WastingCerebral Venous Sinus thrombosisCerebral arteritisCerebral microbleedsCervical Cancer screeningCervical Spine injuryCervical cancerCervical spondylosisCetirizineChancroidCharcot Foot Syndrome (CFS)Charcot Marie Tooth (CMT) diseaseChediak Higashi syndromeChest Abdomen anatomyChest X Ray #1Chest X Ray InterpretationChest drain InsertionChlamydia - Chlamydophila pneumoniaeChlamydia psittaciChlamydia trachomatisChlorambucilChloramphenicolChlordiazepoxideChloroquineChlorphenamine(Chlorpheniramine)ChlorpromazineCholangiocarcinomaCholera (Vibrio cholera)Cholestatic JaundiceCholesteatomaCholesterol - LipidsCholinergic crisis-syndromeChondrocalcinosisChorea - BallismusChoreoacanthocytosisChromosome instability syndromesChronic BronchitisChronic HepatitisChronic InflammationChronic Inflammatory Demyelinating polyneuropathyChronic Interstitial NephritisChronic Kidney Disease (CKD)Chronic Lymphocytic leukaemia (CLL)Chronic Myeloid Leukaemia (CML)Chronic Obstructive Pulmonary Disease (COPD)Chronic PancreatitisChronic PeritonitisChronic Radiation EnteritisChronic Urinary RetentionChronic Vision Uni-Bilateral loss (Blindness)Chronic and recurrent MeningitisChronic liver diseaseChronic mucocutaneous candidiasisChronic stable anginaChylomicronsCiclosporinCimetidineCinacalcetCiprofloxacinCirrhosisCisplatinCitalopramCladribineClarithromycinCleft lip or palateClindamycinClopidogrelClostridium botulinumClostridium difficileClostridium perfringensClostridium tetani - TetanusClotrimazole creamClotting pathwaysClozapineCo Careldopa (Sinemet)Co-Amoxiclav (Augmentin)Co-Beneldopa (Madopar)Co-codamolCo-trimoxazoleCoagulopathyCoal Worker's PneumoconiosisCoarctation of the Aorta (CoA aortopathy)Cocaine abuseCocaine induced chest painCocaine toxicityCoccidioidomycosisCodeineCoeliac diseaseCogan SyndromeColchicineCold Agglutinin Disease (CAD/AIHA)CollagenColloid cyst in the third ventricleColloidsColonic (Large bowel) ObstructionColonoscopyColorectal cancerColorectal polypsColposcopyComa managementCombined Oral contraceptive pill (COCP)Common Peroneal Nerve (CPN)Common variable immunodeficiencyComparing Rheumatoid and OsteoarthritisComplementComprehensive Geriatric Assessment (CGA)Confirming DeathCongenital Acyanotic Heart Disease (Children)Congenital Adrenal hyperplasiaCongenital Complete Heart BlockCongenital Cyanotic Heart Disease (Children)Congenital HypothyroidismCongenital Talipes Equinovarus - ClubfootConstipationConstrictive PericarditisContact allergic dermatitisContinuous Positive Airways Pressure (CPAP)Continuous ambulatory peritoneal dialysisContraceptionConus Medullaris syndromeCor PulmonaleCoronary artery bypass graft surgeryCoronavirus SARS-CoV-2 COVID 19Corticobasal degeneration (Dementia)Corticosteroid-related psychosisCorticosteroidsCorynebacterium diphtheriaeCotard delusionCoxiella BurnetiiCranial nerves and examinationCraniopharyngiomaCreatinine ClearanceCremation forms (UK)Creutzfeldt Jakob disease (Dementia)Crimean-Congo haemorrhagic feverCritical illness neuromuscular weaknessCrohn's diseaseCroupCryptococcus neoformans infectionsCryptogenic Fibrosing AlveolitisCryptogenic Organising Pneumonia (COP-BOOP)CryptosporidiosisCrysal arthritisCrystalloidsCushing diseaseCushing syndromeCutaneous LeishmaniasisCyanide toxicityCyanosis - Central and PeripheralCyclizineCyclo-oxygenase (COX) enzymesCyclophosphamideCycloserineCys leukotriene receptor antagonistsCystic FibrosisCystinosisCystinuriaCytokinesCytomegalovirus infectionsD DimerDNA and RNA short notesDNA replicationDabigatranDalteparinDandy Walker syndromeDantroleneDapagliflozinDarier's DiseaseDarunavirDeQuervain's thyroiditisDeath Certificates (UK)Deep brain stimulationDeep vein thrombosis (DVT)Dehydration PhysiologyDelayed Puberty CriteriaDemeclocyclineDementia with Lewy bodiesDementiasDemyelinating DiseasesDengue FeverDenosumab (Prolia)Dental AnatomyDentatorubral pallidoluysian atrophyDepressionDermatitis HerpetiformisDermatology termsDermatomesDermatomyositisDermoid cystsDesferrioxamineDesmopressin (DDAVP)Desogestrel (Progestogen Only Pill)Developmental Dislocation (Dysplasia) of the HipDevelopmental MilestonesDexamethasoneDiGeorge syndrome (thymic aplasia)Diabetes Insipidus (Cranial and Nephrogenic)Diabetes Mellitus Type 1Diabetes Mellitus Type 1 and DKA (children)Diabetes Mellitus Type 2Diabetes Mellitus in pregnancyDiabetes on the wardDiabetic Autonomic Neuropathy (DAN)Diabetic Ketoacidosis (DKA) AdultsDiabetic Ketoacidosis (DKA) with SGLT2 InhibitorsDiabetic NephropathyDiabetic RetinopathyDiabetic amyotrophyDiabetic footDiamond-Blackfan anaemiaDiamorphineDiaphragmatic disordersDiarrhoeaDiazepamDidanosine (ddI)DiethylstilbestrolDifferentials causes of Foot DropDifferentials of ABCDifferentials of Generalised lymphadenopathyDifferentials of Painful thighDifferentials of XXXDiffuse Oesophageal spasmDiffuse large B-cell lymphomaDiffusion CapacityDigoxinDigoxin ToxicityDihydrocodeineDilated cardiomyopathyDiltiazemDiphtheriaDipyridamoleDischarges against adviceDiscoid lupus erythematosus (DLE)Disease templateDiseases with associated cancersDislocation Sternoclaivcular jointDisopyramideDisseminated Intravascular Coagulation (DIC)Distributive ShockDisulfiram (Antabuse)DobutamineDog BitesDog Bites HandDominant R wave in V1DomperidoneDonepezil (Aricept)DonovanosisDopamine HydrochlorideDopamine agonistsDown's syndrome (Trisomy 21)DoxapramDoxazosin (Cardura)DoxepinDoxorubicin (Adriamycin)DoxycyclineDrivingDrowningDrug Induced Parkinson diseaseDrug Reaction Eosinophilia Systemic Symptoms DRESSDrug TemplateDrug Toxicity - clinical assessmentDrug Toxicity with Specific AntidotesDrug induced Lupus ErythematosusDrug induced liver diseaseDrugsDrugs ListDrugs to Avoid in Acute Renal failureDrugs to avoid ElderlyDrugs to avoid in Liver failureDry and Wet GangreneDual X-ray absorptiometry (DEXA)Duchenne muscular dystrophyDulaglutide GLP-1 agonistDuloxetineDuodenal Atresia (Children)Dupuytrens contractureDysenteryDysphagiaECG - Acute Coronary SyndromeECG - Acute ST Elevation Myocardial InfarctionECG - Atrial fibrillationECG - Atrial flutterECG - BasicsECG - Broad complex tachycardia (possible VT)ECG - Brugada syndromeECG - Causes of a Dominant R wave in V1ECG - Early Repolarisation vs STEMIECG - First degree AV BlockECG - Heart BlockECG - HyperkalaemiaECG - InterpretationECG - Ischaemic Heart DiseaseECG - Left Axis DeviationECG - Left Bundle Branch Block LBBBECG - Left Ventricular HypertrophyECG - Low Voltage ComplexesECG - Narrow complex tachycardiaECG - Normal appearanceECG - Pathological Q wavesECG - QT intervalECG - Right Axis DeviationECG - Right Bundle Branch Block RBBBECG - ST-T T waves changesECG - Supraventricular tachycardia ECG - The QRS complexECG - Tutorial from Queens UniversityECG - Ventricular fibrillationECG - Ventricular tachycardiaECG - Wolff Parkinson White syndrome (WPW)ECG - short PR intervalECG - sinus pauseECG - tall R wave V1ENT Exam - Assessing hearingENT infectionsEbola Virus DiseaseEbstein anomalyEchinocytesEchocardiogramEcstasy toxicityEctopia lentis (subluxation of the lens)Ectopic PregnancyEctropionEculizumabEdoxaban (Lixiana)Edward syndrome (trisomy 18 syndrome)Efavirenz (Sustiva) EFVEhlers-Danlos syndromesEhrlichiosisEikenella corrodensEisenmenger's syndrome (Children)Elbow fractures and InjuriesElectrical injuryEloquent brainEmergency DrugsEmphysemaEmpty sella syndromeEmtricitabine (Emtriva) FTCEnalaprilEnd of Life Care PrescribingEndocarditis and StrokeEndocrinology Lab valuesEndometrial (Uterine) CancerEndometriosisEndoscopic Retrograde Cholangiopancreatography XEndothelinsEnfuvirtideEnoxaparin Sodium (Clexane-Lovenox)EnoximoneEntacaponeEnterococciEnteropathic SpondyloarthritisEnzyme inducers and inhibitorsEosinophilic granulomatosis (Churg Strauss)EpendymomaEpidural HaematomaEpidural abscessEpilepsy - General ManagementEpilepsy - Idiopathic Generalised EpilepsyEpilepsy - Mesial temporal lobe epilepsyEpilepsy - Post TraumaticEpilepsy in PregnancyEpiscleritisEpistaxisEplerenoneEponymous brainstem strokesEpstein-Barr Virus infectionEquivalent doses of OpiatesErb PalsyErgocalciferol (Calciferol)Erlotinib (Tarceva)Erysipelothrix rhusiopathiaeErythema MultiformeErythema NodosumErythrocyte Sedimentation rate (ESR)ErythrocytesErythrodermic PsoriasisErythromycinEscherichia coliEscitalopramEsomeprazoleEssential Thrombocythaemia (ET)Essential TremorEtanerceptEthambutolEthanolEthanol toxicityEthylene glycol toxicityEtomidateEtravirine (intelence) ETREwing sarcomaExenatide (Byetta) GLP1 agonistExercise stress testExploding head syndromeExtradural haematomaExtrapyramidal symptomsExtrinsic Allergic alveolitis (Hypersensitivity)Eye infectionsEzetimibeFabry diseaseFacial NerveFacioscapulohumeral muscular dystrophyFactor V Leiden DeficiencyFaecal CalprotectinFahr syndromeFailure to thrive or Faltering growthFamilial Adenomatous polyposis (FAP)Familial AmyloidosisFamilial HypercholesterolaemiaFamilial Mediterranean Fever (FMF)Familial hypocalciuric hypercalcaemia (FHH)Family Tree (Pedigree)FamotidineFanconi AnaemiaFanconi SyndromeFat embolismFatigue - CausesFatty acidsFebrile seizuresFelodipine (Dihydropyridine)Femoral HerniaFemoral triangleFemur fractures and InuriesFentanyl - FentanilFerritinFerrous Fumarate - Gluconate - SulphateFetal Alcohol SyndromeFetal circulationFever - Pyrexia of unknown origin (FUO PUO)Fever in a travellerFibratesFibrinogenFibromuscular dysplasiaFibromyalgiaFidaxomicinFinasteride (5 alpha-reductase inhibitor)First SeizureFitz-Hugh Curtis SyndromeFlail ChestFlecainide AcetateFlexor sheath infection (flexor tenosynovitis)FlucloxacillinFluconazoleFlucytosineFludrocortisoneFluid balances statusFlumazenil (Annexate - Romazicon)FluoxetineFocal Segmental Glomerulosclerosis (FSGS)Foix-Alajouanine syndromeFolate (Folic) acidFolate deficiencyFolinic acid (Leucovorin)FomepizoleFondaparinuxFood borne diseaseFoscarnet SodiumFosfomycinFosphenytoinFoster Kennedy SyndromeFournier's gangreneFracture TemplateFractured ClavicleFractured Neck of FemurFractured Pubic RamusFractured ScapulaFractured Shaft FemurFractured Tibia and FibulaFractures Shaft HumerusFractures in ChildrenFractures of Upper humerusFragile X syndromeFrailtyFraser guidelines and Gillick CompetenceFree RadicalsFriedreich's AtaxiaFrontotemporal dementiaFull or Complete Blood Count (FBC CBC)FungiFurosemide (Frusemide)Fusidic acidFusobacteria - Tropical ulcerFusobacteriumG protein-coupled receptorsGP Emergency Drugs CarriedGabapentinGalactorrhoeaGalantamineGamete intra-fallopian tube transfer (GIFT)Gamma Glutamyl Transferase (GGT)Gamma hydroxy butyrate (GHB) toxicityGanciclovir - ValganciclovirGardner syndromeGardnerella vaginalisGas GangreneGastric (MALT) LymphomaGastric CancerGastric Outlet obstruction (pyloric stenosis)GastrinomaGastro Intestinal Stromal Tumours (GIST)Gastro-Oesophageal Reflux (Adult GORD)Gastro-Oesophgeal Reflux (Paediatrics GORD)GastroenteritisGastroenterology Exam ListsGastroenterology ExaminationGastroenterology HistoryGastroenterology assessment - JaundiceGastrointestinal anatomy and physiologyGastrointestinal perforationGastrostomy (PEG) tubesGaucher's diseaseGene componentsGenetic DiseasesGentamicinGiardiasisGilbert's syndromeGingival (Gum) hyperplasia-hypertrophyGitelman's syndromeGlasgow Blatchford ScoreGlasgow Coma scaleGlatiramer acetate (Copaxone)GlibenclamideGliclazideGlimepirideGlipizideGlobus PallidusGlomerulonephritisGlossitisGlucagonGlucagonomaGlucose 6 phosphate dehydrogenase deficiencyGlucose Tolerance TestGlutamateGlycated HaemoglobinGlyceryl Trinitrate (GTN)Glycogen storage diseasesGlycolysis_Krebs_Electron_Transport_ChainGlycopyrronium BromideGoitreGolfer's ElbowGolimumab (Simponi)Goodpasture's syndrome (Anti GBM disease)Goserelin (Zoladex)Gradenigo's syndromeGrades of RecommendationGram StainGranuloma annulareGranulomatosis with Polyangitis GPA (Wegener)Graves DiseaseGriseofulvinGrowth Hormone DeficiencyGuillain Barre SyndromeGum hypertrophyGuthrie test New Born blood spotGynaecological History TakingGynaecomastiaHAS-BLED scoreHIV and Post-Exposure Prophylaxis (PEP)HIV and Pre-exposure prophylaxisHIV associated nephropathy (HIVAN)HIV disease AssessmentHTLV-1 Associated myelopathyHaematemesisHaematology Examination - SplenomegalyHaematology Lab valuesHaematuria Mild to SevereHaemodialysisHaemoglobinsHaemolysisHaemolytic AnaemiaHaemolytic Uraemic syndromeHaemolytic disease of the newbornHaemophilia AHaemophilia BHaemophilus aegyptiusHaemophilus ducreyiHaemophilus influenzaeHaemophilus parainfluenzaeHaemopoiesisHaemorrhagic TransformationHaemorrhagic strokeHaemorrhoids (Piles)Hairy Cell LeukaemiaHairy LeukoplakiaHallervorden-Spatz disease (PKAN)HaloperidolHamman-Rich syndromeHand foot and mouth diseaseHand fractures and InjuriesHantavirus infectionsHartmann's solution (Ringer's lactate)Hartnup disease*Hashimoto's (Steroid responsive) EncephalopathyHashimoto's thyroiditisHbA1cHead (Brain) InjuryHead and Neck CancersHeadache - Analgesic overuseHeadache - Assessing Acute and SevereHeadache - Basilar MigraineHeadache - ClusterHeadache - Low CSF pressureHeadache - MigraineHeadache - TensionHeadaches - GeneralHearing aidsHeat StrokeHelicobacter pyloriHelvetica Spotted feverHemicraniectomyHenoch-Schonlein purpuraHeparin - GeneralHeparin - Low Molecular Weight HeparinHeparin - Unfractionated HeparinHeparin-induced thrombocytopenia (HIT)Hepatic EncephalopathyHepatitis AHepatitis BHepatitis CHepatitis DHepatitis EHepatocellular CarcinomaHepatorenal syndromesHereditary ElliptocytosisHereditary HaemochromatosisHereditary Haemorrhagic TelangiectasiaHereditary Spastic ParaparesisHereditary SpherocytosisHereditary angio-oedemaHereditary neuropathy with pressure palsiesHereditary non polyposis coli (Lynch syndrome)Herpes GestationisHerpes SimplexHerpes Simplex Encephalitis (HSV)Herpes VirusesHerpes Zoster Ophthalmicus (HZO) ShinglesHerpes simplex keratitis (HSK)Heyde syndromeHiatus herniaHiccups (Singultus)High Dose Dexamethasone Suppression TestHip pain in childrenHirschsprung disease (congenital megacolon)Hirsuitism XXXHistonesHistoplasmosisHodgkin LymphomaHolt-Oram syndromeHolter monitor (tape) 24-72 hHomocystinuriaHookwormHorner's syndromeHospital acquired Pneumonia (NICE 139)Human albumin solution (HAS)Human prion diseasesHumeral fractures and injuriesHunter's syndrome (MPS-2)Huntington ChoreaHurler's syndrome (MPS-1)Hydatid disease (Echinococcus)Hydatidiform moleHydralazineHydrocortisoneHydrogen BondsHydrops fetalisHydroxocobalaminHydroxocobalamin - Cyanocobalamin (B12)HydroxychloroquineHydroxyurea-HydroxycarbamideHyoscine (Buscopan)Hyper IgM syndromeHyperbaric Oxygen therapyHypercalcaemiaHyperglycaemic Hyperosmolar State (HHS)Hyperinsulinaemic-euglycemic therapy (HIET)HyperkalaemiaHyperkalaemic and Hypokalaemic Periodic ParalysisHypermagnesaemiaHypernatraemiaHyperphosphataemia (High phosphate)HyperprolactinaemiaHypersensitivity reactionsHypertensionHypertension in PregnancyHypertriglyceridaemia (HTG)Hypertrophic cardiomyopathy (HCM - HOCM)Hyperventilation SyndromeHyperviscosity syndromeHypocalcaemiaHypoglycaemiaHypogonadism (Female)Hypogonadism (male)HypokalaemiaHypokalaemic Periodic ParalysisHypomagnesaemiaHyponatraemiaHypoparathyroidismHypophosphataemia (Low phosphate)Hypopituitarism (Pituitary Failure)HypospadiasHypothermiaHypothyroidismHypovolaemic or Haemorrhagic ShockIL-12 receptor deficiencyIV ImmunoglobulinIbandronic acid (Bisphosphonate)IbuprofenIcatibantIdiopathic Intracranial hypertensionIdiopathic Parkinson diseaseIdiopathic Pulmonary FibrosisIgA Nephropathy (Berger's disease)Images - Spot diagosesImatinib mesylateImipenem (Primaxin) with CilastinImmune Reconstitution SyndromeImmune(Idiopathic) Thrombocytopenic Purpura (ITP)Immunoglobulin G4-related disease (IgG4-RD)ImpetigoImplantable cardioverter defibrillator (ICD)Impulse control disordersInclusion Body MyositisIncubation periodsIndapamideIndinavir (IND)Infection screening in Septic patientInfections and their Microbial causeInfectious MononucleosisInfective ConjunctivitisInfective EndocarditisInfertilityInfliximabInfluenzaInguinal HerniaInitial Trauma AssessmentInjury Severity Score (ISS)Insomnia - sleep issuesInsulinInsulinomaInterferon BetaIntermittent ClaudicationInternal CapsuleInternuclear OphthalmoplegiaInterpreting HaematinicsInterstitial KeratitisIntestinal obstruction (Children)Intra Aortic Balloon PumpIntraabdominal abscessIntracerebral Haemorrhage (ICH) ScoreIntracranial HypertensionXIntravenous Iron Replacement (Ferrous)Intraventricular haemorrhage (neonates)Intubation and Mechanical VentilationIntussusception (Adults)Intussusception (Children)Iodine deficiency GoitreIpratropium Bromide (Atrovent)IrbesartanIron SaltsIron deficiency AnaemiaIron toxicityIrritable bowel syndromeIschaemic ColitisIschaemic StrokeIschaemic heart diseaseIsoniazidIsoprenalineIsosorbide DinitrateIsosorbide mononitrateIsotretinoin (Accutane)Ispaghula Husk (Fybogel)IvabradineJansen DiseaseJanus kinase 2Jervell and Lange-Nielsen syndromeJob Syndrome (Hyper IgE syndrome)Jugular Venous Pressure (JVP)Junctional TachycardiaJuvenile DermatomyositisJuvenile Idiopathic arthritis (Stills Disease)Juvenile Myoclonic epilepsy (JME)Kallmann's syndromeKaposi sarcoma (KS)Karnofsky performance status scaleKawasaki diseaseKennedy SyndromeKeratoconusKernicterusKetamineKetoconazoleKlebsiella pneumoniaKlinefelter Syndrome (Children)Klumpke palsyKnee fractures and InjuriesKoebner phenomenonKugelberg Welander syndromeKwashiorkorL-Thyroxine (T4)Labetalol (Trandate)Labyrinthitis - Vestibular NeuronitisLactateLactate dehydrogenase (LDH)Lactic acidosisLactobacillus acidophilusLactose IntoleranceLactuloseLady Windermere syndromeLambert-Eaton syndrome (LEMS)Lamivudine (3TC)LamotrigineLangerhans Cell Histiocytosis XLansoprazoleLanthanumLateral Medullary SyndromeLaxativesLe Fort FracturesLead toxicityLeber hereditary optic neuropathy (LHON)LeflunomideLegal definition of BlindnessLegionella pneumophilaLeishmaniasis (Cutaenous and Visceral)Lemierre's syndromeLenalidomide (Revlimid)Length Dependent PolyneuropathyLennox-Gastaut syndromeLenticulostriate branch occlusionLeprosyLeptinLeptospira interrogansLeptospirosis (Weil's Disease) (Notifiable)Leriche syndrome (aortoiliac occlusive disease)Lesch-Nyhan syndrome (Children)LeukaemiaLeukaemias in GeneralLeukoariosisLeukocytoclastic vasculitisLeukotrienesLevetiracetam (Keppra)LevodopaLevomepromazineLevosimendanLi Fraumeni syndromeLichen PlanusLiddle's syndromeLidocaine(Lignocaine)Lightning strikeLimb girdle dystrophyLimbic EncephalitisLinagliptin (Trajenta)LinezolidLinkageLiothyronine Sodium L-Triodothyronine (T3)Lipid emulsion therapy - 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small intestineMalaria (non falciparum)Malaria FalciparumMale InfertilityMale Urethral CatheterisationMale erectile dysfunctionMalignant AscitesMalignant Hyperpyrexia (Malignant Hyperthermia)Malignant HypertensionMalignant MelanomaMalignant pleural mesotheliomaMallet FingerMallory-Weiss TearMalnutrition Universal Screening ToolManiaMannitolMantle cell lymphomaMarantic EndocarditisMarasmusMaraviroc (Celsentri)Marfan syndromeMarginal Zone LymphomaMassive HaemoptysisMaturity Onset Diabetes of the Young (MODY)McArdles disease (type V)Measles (notifiable)MebeverineMeckel's diverticulumMeconiumMedian NerveMedical Mnemonics Basic SciencesMedical Mnemonics CardiologyMedical Mnemonics EndocrineMedical Mnemonics Mental HealthMedical Mnemonics MiscellaneousMedical Mnemonics NeurologyMedical ProceduresMedical TeethMedullary Sponge kidneyMedulloblastomaMefenamic acidMefloquine (Larium)Megaloblastic anaemiaMelatoninMelioidosisMemantine HydrochlorideMembranous GlomerulonephritisMenetrier diseaseMeniere diseaseMeningiomaMeningitis in the ImmunocompromisedMenopauseMenstrual cycleMental Capacity Act 2005Mental Health Act 1983Mental State ExaminationMercaptopurineMeropenemMesalazine (Aminosalicylate)Mesangiocapillary GlomerulonephritisMesenteric infarctionMetabolic Syndrome XMetabolic acidosisMetabolic alkalosisMetachromic leucodystrophyMetastatic AdenocarcinomaMetastatic bone diseaseMetforminMethaemoglobinaemiaMethanol ToxicityMethodoneMethods to reduce toxin absorptionMethotrexateMethylcelluloseMethylprednisoloneMetoclopramideMetolazoneMetoprololMetronidazole (Flagyl)Metyrapone (Metopirone)MiconazoleMicroangiopathic Haemolytic anaemiaMicrocytic anaemiaMicroscopic PolyangiitisMicroscopic colitisMicrostomiaMidazolamMiddle East Resp Syndrome (MERS) CoronavirusMidodrineMigraine Disability Assessment (MIDAS)Miller-Fisher syndromeMilwaukee shoulder syndromeMini Mental State Examination (MMSE)Minimal Change Disease GlomerulonephritisMinocyclineMinoxidilMirabegronMirizzi syndromeMirtazapineMiscarriageMisoprostolMitochondrial diseasesMitral Regurgitation (Incompetence)Mitral StenosisMitral Stenosis vs Regurgitation - DominanceMitral Valve prolapseMittleschmerzMixed Connective Tissue Disease (MCTD)Mobility aidsModified Duke Criteria for EndocarditisModified Oxford Handicap Scale (MOHS)Modified Rankin ScoreMolluscum contagiosumMonoclonal gammopathy of undetermined significanceMonocular loss of visionMonocytesMonosodium glutamate (MSG) syndromeMontelukastMontreal Cognitive Assessment (MOCA)Moraxella catarrhalisMorphine SulphateMosquito borne diseasesMotor Neuron Disease (MND-ALS)Moyamoya diseaseMucormycosisMultifocal Atrial TachycardiaMultifocal Motor Neuropathy with Conduction blockMultiple Antithrombotics AnticoagulantsMultiple Endocrine Neoplasia type 1 (MEN1)Multiple Endocrine Neoplasia type II (MEN2)Multiple MyelomaMultiple PregnancyMultiple Sclerosis (MS) DemyelinationMultiple System Atrophy (MSA)Mumps (Notifiable)Muscles of the Abdominal RegionMuscles of the BackMuscles of the Head and NeckMuscles of the Lower LimbMuscles of the Pelvis and PerineumMuscles of the Thoracic RegionMuscles of the Upper limbMyasthenia GravisMycobacterium TuberculosisMycophenolate mofetilMycoplasma pneumoniaeMycoplasmasMycosis Fungoides (Sezary Syndrome)Myelodysplastic syndrome (Myelodysplasia)MyelofibrosisMyelofibrosis vs CMLMyelopathyMyeloproliferative disordersMyobacterium avium Complex InfectionMyocardial perfusionMyoclonusMyotonic dystrophy - Dystropica myotonicaMyxoedema comaN-Acetylcysteine (Parvolex)NEWS Reacting to Low Oxygen SaturationsNICE Guidelines LinksNICE Trauma Guidance Summary 2016NSAID toxicityNaloxone (Narcan) Opiate antagonistNaproxenNarcolepsyNasal polypsNasogastric tube insertionNatalizumab (Tysabri)National Early Warning Score NEWS 2 ScoreNeck PainNeck swellings and lumpsNecrotising Enterocolitis (Infants)Necrotising fasciitisNeedlestick injuryNefopamNeisseria gonorrhoeaeNeisseria meningitidisNelson SyndromeNeomycinNeonatal Abstinence Syndrome NASNeonatal JaundiceNeonatal Lupus ErythematosusNeonatal meningitisNeostigmineNephritic syndromeNephroblastoma (Wilm's tumour)Nephrotic syndromeNephrotoxic drugsNerve conduction studiesNerve fibresNeuroanatomy 101Neuroanatomy imagesNeuroblastomaNeurocysticercosisNeuroferrinopathyNeurofibromatosis Type 1Neurofibromatosis Type 2Neuroleptic Malignant SyndromeNeurological - Relative Afferent pupillary defectNeurological - Vision and Eye movementsNeurological Examination - 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IdarucizumabPraziquantelPrazosinPre-Operative AssessmentPreEclampsia, Eclapsmia and HELLPPrednisolonePrednisonePregabalinPremature LabourPremature MenopausePresbyacusisPrescribing InformationPrescribing in PregnancyPressure soresPrevotella (Bacteroides) melaninogenicaPriapismPrimaquinePrimary (Chronic simple) Open angle GlaucomaPrimary Biliary CirrhosisPrimary CNS LymphomaPrimary HyperparathyroidismPrimary Sclerosing CholangitisPrimary ciliary dyskinesiaPrimary hyperaldosteronism (Conn's syndrome)Primary progressive aphasia (Dementia)ProbenicidProchlorperazine (Stemetil)ProcyclidineProgressive Multifocal Leukoencephalopathy (PML)Progressive Supranuclear Palsy (PSP)ProlactinomaPropafenonePropanthelinePropionibacteriumPropofolPropranololPropylthiouracilProstate cancerProsthetic ValvesProtamine SulfateProtein C DeficiencyProtein S DeficiencyProtein losing enteropathyProtein p53Protein synthesisProteusProthrombin 20210A mutationProthrombin Complex Concentrates (PCC)Prothrombin time and CoagulationProthrombotic disordersProton Pump InhibitorsProximal myopathyPrucalopridePsammoma bodiesPseudohypoparathyroidismPseudomonas infection (Pseudomonas aeruginosa)Psoas AbscessPsoriasisPsoriatic arthritisPsychogenic PolydipsiaPubic Lice (Pediculosis Pubis)Pulmonary Alveolar ProteinosisPulmonary Arteriovenous malformationPulmonary EmbolismPulmonary Eosinophilia and CXR changesPulmonary HypertensionPulmonary Hypertension - 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Age over 65SimvastatinSinus BradycardiaSinus Node diseaseSinus TachycardiaSitagliptinSitosterolemiaSjogren's syndromeSkin and soft tissue infectionsSkull AnatomySleep physiologySlipped Upper Femoral Epiphysis (SUFE)Small Bowel IschaemiaSmall Bowel ObstructionSmall vessel diseaseSmallpoxSmokingSnake BitesSneddon SyndromeSodium BicarbonateSodium NitroprussideSodium PhysiologySodium PicosulfateSodium Thiopental - Sodium ThiopentoneSodium Valproate (Epilim Depakote)Sodium Zirconium Cyclosilicate (Lokelma)Soft tissue injuries (sprains, strains)SolifenacinSolitary Pulmonary NoduleSotalol HydrochlorideSpetzler-Martin Grading of AVMSpina BifidaSpinal Cord AnatomySpinal Cord Arteriovenous MalformationsSpinal Cord CompressionSpinal Cord HaematomaSpinal Cord InfarctionSpinal StenosisSpirometrySpironolactoneSpleenSplenic RuptureSpondylolisthesisSpontaneous Bacterial PeritonitisSpontaneous intracranial hypotensionSquamous Cell CarcinomaSt John's WortStaphylococcal InfectionsStaphylococcus aureusStaphylococcus epidermidisStaphylococcus saprophyticusStatinStatus Epilepticus (Epilepsy)Stavudine (Zerit) d4TStevens-Johnson SyndromeStiff Person SyndromeStrabismus (Lazy Eye)Streptobacillus moniliformisStreptococci - anaerobesStreptococcusStreptococcus agalactiaeStreptococcus milleriStreptococcus pneumoniae (Pneumococcus)Streptococcus pyogenesStreptococcus viridansStreptokinaseStreptomycinStridorStroke - Arterial Occlusion and clinical correlateStroke - Epidemiology and risk factorsStroke - General ManagementStroke - ImagingStroke ASPECTS scoringStroke CollateralsStroke Risk FactorsStroke ThrombolysisStrongyloides stercoralis (threadworm)StrontiumSubacute Sclerosing PanencephalitisSubacute ThyroiditisSubarachnoid HaemorrhageSubclavian Steal SyndromeSubclavian vein thrombosisSubdural haematomaSucralfateSudden Cardiac Death (SCD)Sudden Infant Death Syndrome (SIDS)Sudden sensorineural hearing loss (SNHL)SuicideSulfasalazine - SulphasalazineSulphonamide (Sulphamethoxazole)SumatriptanSuperior Mesenteric Artery (SMA) SyndromeSuperior Sagittal Sinus ThrombosisSuperior vena caval obstruction syndromeSupracondylar Femur FracturesSupracondylar Humerus FracturesSupraspinatus tendonitisSupraventricular TachycardiaSurgical CricothyroidotomySurgical prophylaxisSurgical site infectionSusac syndromeSuxamethoniumSydenham's choreaSynchronised DC CardioversionSyncopeSyndrome X (Cardiology)Syndrome of Inappropriate ADH (SIADH) secretionSyndromes with Severe Cognitive IssuesSyphilisSyringobulbiaSyringomyeliaSystemic AmyloidosisSystemic Lupus Erythematosus (SLE)Systemic MastocytosisSystemic SclerosisT cellsTIMI scoreTMN Staging tumoursTNF receptor-associated periodic syndromeTORCH infectionsTURP Hyponatraemia syndromeTabes dorsalisTacrolimusTafamidisTakayasu arteritis (pulseless disease)Takotsubo CardiomyopathyTamoxifenTamsulosin (Flomax)Tanner Stages of Pubertal DevelopmentTardive DyskinesiasTay-Sachs diseaseTazocin (Tazobactam - Piperacillin)TeicoplaninTelomeresTemazepamTemozolomide (Temodal)Template XTemplate two columns listTemporal (Giant Cell GCA) ArteritisTenecteplaseTennis ElbowTensilon testTension PneumothoraxTerbutalineTeriparatideTerlipressinTertiary hyperparathyroidismTesticular CancerTesticular torsionTestingTetrabenazineTetracosactide (Synacthen)TetracyclinesTetralogy of Fallot (Children)Thalamic HaemorrhageThalamic Pain SyndromeThalamic Stroke SyndromeThalidomideTheophyllineTheophylline toxicityThiamineThird Degree (complete) Heart BlockThoracic TraumaThoracic anatomyThoracic outlet syndromeThrombocytosisThrombolysisThrombophilia testingThrombotic Thrombocytopenic purpura (TTP)Thyroglossal Cyst (Children)Thyroid CancerThyroid Function Tests and antbodiesThyroid GlandThyroid Storm - Thyrotoxic crisisThyroid Surgery (Thyroidectomy)Thyroid noduleThyrotoxicosis and HyperthyroidismTiagabineTibia and Fibula fractures and InjuriesTicagrelorTick ParalysisTimololTinea capitisTinidazoleTinzaparin (Innohep)Tiotropium (Spiriva)Titre - 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Paratyphoid fever (Enteric Fever)Tyrosine Kinase receptorsUS vs UK Drug namesUbiquitinUlcerative ColitisUlnar nerveUltrasound - Echo basicsUndifferentiated Inflammatory Arthritis (Children)Unexplained symptomsUpper Gastrointestinal Bleed (GI Bleed)Upper-Lower Motor Neurone signsUrea and ElectrolytesUrethral syndomeUrinary CatheterisationUrinary Incontinence (Stress and Urge)Urinary Tract Infection (UTI Children)Urinary Tract InfectionsUrinary Tract ObstructionUrinary UTI Antibiotic guidanceUrine AnalysisUrothelial tumoursUrticariaUterusVIPomasVTE DVT PE in PregnancyVaginal CarcinomaValaciclovirValsartanVancomycinVariable rate intravenous insulin infusion VRIIIVariant (Prinzmetal) AnginaVaricella-Zoster (Chickenpox Shingles) InfectionVariegate PorphyriaVascular DementiaVasculitis - General Issues and ClassificationVasopressin (AVP) Antidiuretic hormoneVasovagal syncopeVaughan-Williams ClassificationVecuroniumVedolizumab (Entyvio)VenlafaxineVenous Insufficiency and Leg UlcersVenous access Venflons and Central linesVentilator associated pneumonia (VAP)Ventricular FibrillationVentricular Septal defect (VSD) (Children)Ventricular TachycardiaVentricular ectopic beatsVerapamilVertebral artery dissectionVertigoVesicoureteric reflux (VUR) (Children)Vibrio parahaemolyticusVibrio vulnificusVibrio vulnificus Vigabatrin (Sabril)VinblastineVincristineViral MeningitisViral associated cancersVirusesVisual acuityVitamin A deficiency (Children)Vitamin B1 Thiamine deficiencyVitamin B12 deficiencyVitamin B12 excessVitamin C deficiency (Scurvy)Vitamin D (1,25 OH2)Vitamin D (25 OH D)Vitamin D deficiencyVitamin D resistant rickets (Children)Vitamin K (Phytomenadione)Vitamin K deficiencyVitiligoVoltarol (Diclofenac)Von Gierke Disease (Children)Von Hippel LindauVon Willebrand DiseaseWaardenburg's syndrome (Children)Wagner Classification Diabetic foot ulcersWaldenstrom Macroglobulinaemia (WM)Wallerian DegenerationWarfarinWarfarin and BleedingWater PhysiologyWatershed InfarctsWerdnig Hoffman Disease (Children)Wernicke Korsakoff SyndromeWhite Blood Cells - LeukocytesWilliams Syndrome (Children)Wilson diseaseWiskott-Aldrich syndrome (Children)Wolff-Parkinson White syndrome (WPW)Wolfram syndrome (DIDMOAD)Wound healingX linked Agammaglobulinaemia (Bruton)X linked Hypophosphataemic ricketsX-linked IchthyosisX-linked lymphoproliferative disease (Children)Xeroderma pigmentosumYellow FeverYellow Nail SyndromeYersinia enterocoliticaYersinia pestis - Bubonic PlagueYersinia pseudotuberculosisZZAAAZZ_Abnormal charZabramski Classification of CavernomasZidovudine (Retrovir) AZT - ZDVZieve's syndromeZika virusZinc deficiencyZoledronic acidZollinger Ellison syndromeZolpidemZopicloneeGFR

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Haemorrhagic stroke


Introduction
  • Haemorrhagic strokes are more accurately called Spontaneous Intracerebral haemorrhage(SICH) can often be sudden and devastating.
  • They make up approximately 15% of all strokes.
  • One form is Subarachnoid haemorrhage but this tends to be due to aneurysms or vascular anomalies
  • Aneurysmal SAH usually goes to the neurosurgeons initially and will be discussed separately.
  • Mortality is high for those with large bleeds with up to 30-50% of patients dying within 30 days.
  • However many patients with small bleeds can do well and make good recoveries and then the emphasis is on looking for causes that will help prevent further episodes.
  • Note that Traumatic induced ICH is not regarded as stroke.
  • Subdural haemorrhage is "extra-axial" and also not classified as stroke.
Pathological Appearance



Aetiology
  • Haemorrhage can result from vessel rupture at any point in the vascular tree from the main artery coming of the circle of Willis to small penetrating arteries and arterioles, capillary beds and to draining veins.
  • The largest will be the rupture of Berry/Saccular aneurysms, but these tend to cause high-pressure bleeding as seen in the classical SAH.
  • Rupture of smaller intraparenchymal vessels arterioles and smaller vessels can cause intracerebral haemorrhage.
  • Various aetiologies exist from amyloid angiopathy to lipohyalinosis and microaneurysm formation and hypertension.
  • Structural anomalies such as arteriovenous malformations and cavernous angiomas (Cavernomas) can also bleed.
  • Disorders such as hereditary haemorrhagic telangiectasia.
  • Other causes include tumours and some have a tendency to bleed.
  • Coagulopathies cause or exacerbate bleeds and these may be related to clotting defects which may be due to the use of antiplatelet drugs or Warfarin or DOACs or heparins or simply liver failure or haemophilia or thrombocytopenia.
  • Often times risk factors such as a hypertensive bleed on an anticoagulant can appear to exacerbate what may have been a limited haemorrhage as haemostasis is difficult to achieve. Haemorrhage is locally destructive causing tissue damage and haematoma formation and pressure necrosis and even infarction in the surrounding brain.
  • Secondary effects include bleeding into and obstruction of the ventricular system.
  • Venous sinus thrombosis obstruction and resulting back pressure can result in intraparenchymal haemorrhage but this appears to be due to backpressure rather than vessel rupture so paradoxically patients are cautiously anticoagulated.
Epidemiology

Haemorrhagic strokes make up a slightly higher proportion of all stroke cases in those of Afro-Caribbean origins. They also appear to be more prevalent in those from South East Asian and Japan. There may well be underlying racial and genetic differences and incidence of hypertension.

Left Thalamic "Deep" bleed with haemorrhage into the ventricular system. This patient needed close monitoring for the development of obstructive hydrocephalus










Occipital Bleed on Warfarin. C/o Mild headache

Cerebellar Haemorrhage:

Left Basal ganglia bleed

Parietal Bleed
on Warfarin. C/o Mild headacheCerebellar HaemorrhageLeft Basal ganglia bleed


Cavernomas showing the popcorn appearance on T2 and with a rim of blood. It can be seen showing black blood on SWI. Cavernomas do not appear enhanced on angiography.

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Causes

The main causes of haemorrhagic stroke are listed below. They depend very much on the age of the patient. For example, cerebral amyloid angiopathy is largely a disease of the older generation (over the age of 70) and along with hypertension is the commonest cause of bleeds in the elderly. In younger patients, structural lesions are all the more common such as AVM and even berry aneurysms. Other causes of stroke include the ever-increasing use of anticoagulation particularly with Warfarin but also the newer agents such as Dabigatran, Apixaban and Rivaroxaban. So, begin to think of why immediately. The patient on anticoagulants will need an immediate reversal of the coagulopathy as quickly as possible. One of the main differentials when seeing a patient with an unclear history found on the floor with retrograde amnesia and intracerebral haemorrhage is which came first the bleed or the fall. A deep bleed is likely to be hypertensive but a lobar bleed especially with overlying soft tissue swelling on the CT skull or a fracture may suggest the fall came first and the blood is due to a head injury.

Types by Anatomy
  • Lobar (Cortex + subcortical white matter) haemorrhages
  • Deep haemorrhages - putaminal, thalamic, caudate, basal ganglia
  • Brainstem haemorrhage - pontine
  • Cerebellar Haemorrhage
  • Subarachnoid haemorrhage
List of differing causes
Causes of Haemorrhagic strokeMore Information
Hypertension Usually deep bleeds but may also be lobar. Found in the basal ganglia, thalamus, cerebellum, pons
Amyloid angiopathy Usually lobar bleeds
Aneurysmal Usually interlobar bleeds MCA in sylvian fissure, Midline with Anterior communicating
Arteriovenous Malformation Typically lobar bleeds but can also be deep
Anticoagulants/Bleeding disorders Usually lobar bleeds
Drugs Cocaine, Amphetamine
Venous Infarction Headache, seizures
Sickle Cell Disease Can cause both ischaemic and haemorrhagic stroke
Vasculitis Inflammation and disruption of vessel wall. Can be PAN, SLE, WG, Takayasu's disease, Temporal arteritis, Sarcoid, Behcet's disease
Infective endocarditis with septic emboli Causes mycotic aneurysms which can bleed. Careful with anticoagulating patients with active endocarditis
Tumours Can be primary brain tumours or metastases

Bleeding is a dynamic process and may well continue after the initial scan

Bleeding Factors that are important

There is quite a lot of evidence with serial scans that bleeding continues over hours and that haematomas can continue to expand. Any coagulopathy should be corrected. Once a hemispheric bleed reaches a volume of about 60 mls the local compensatory mechanisms fail and there is pressure on the brainstem which leads to coning and death. There is probably more space for haematoma expansion with a less marked rise in ICP in older patients with generalised atrophy. Acute Intracerebral Haemorrhage often causes acute hypertension which can worsen bleeding - careful reduction from very high levels (sustained over 180 mmHg) but not too much or this may lead to cerebral hypoperfusion and further insults. Sometimes small bleeds precede larger bleeds and this is particularly important with subarachnoid haemorrhage where the patient presents with a bleed and sustains a fatal rebleed several days later. The emphasis here is to get the patient to neurosurgery to stabilise the aneurysm with coiling or clipping. Vasospasm which can mimic an ischaemic stroke can also be seen post-SAH. Cerebral AVM can also rebleed. Complications with intracerebral bleeds include raised ICP and hydrocephalus, coning as well as seizures.

Incidence

Out of all strokes only 15% of are due to intracerebral haemorrhage. Only 5% are due to subarachnoid haemorrhage. Prognosis of all haemorrhage is worse than ischaemic stroke with a 30-50% death expectation within 30 days

Clinical
  • As we have discussed elsewhere bleeds have a higher incidence of presenting with a headache or coma in addition to lateralising signs. The neurology due to an enlarging haematoma may slightly cross vascular boundaries which usually restricts and limits infarction.
  • However, all attempts to use clinical signs to differentiate infarction from haemorrhage are not reliable enough to base management on and an early CT is needed in all cases.
  • Those with large bleeds can present with deep coma and blown pupils and will have a very poor prognosis and a small subset will not even get to the hospital or survive to leave the emergency department. Those with SAH will tend to present with an episode of collapse and/or thunderclap headache and be obtunded or comatose.
Clinical findings
  • Deep bleeds (42%)
    • Putaminal bleed (40% of bleeds occur here. Supply from lateral striate arteries): Contralateral hemiparesis and hemisensory loss. Conjugate horizontal eye deviation, homonymous hemianopia and aphasia (dominant), neglect (non dominant)
    • Thalamic bleed (4%): Similar to putaminal. May have vertical gaze palsy, miosis and poorly reactive pupils, convergence paraparesis
    • Caudate bleed: Confusion, disorientation, contralateral hemiparesis
    • Basal ganglia/Internal Capsule: Coma due to raised ICP, Contralateral hemiparesis and hemisensory loss and homonymous hemianopia and aphasia (dominant)
  • Lobar Bleeds(40%)
    • Frontal Lobe (19% of bleeds): headache, abulia, C/L hemiparesis (arm more than leg)
    • Parietal Lobe(5%): C/L hemisensory loss, aphasia (dom), homonymous quad/hemianopia
    • Temporal Lobe(13%): local headache, receptive aphasia (dom), confusion, homonymous quad/hemianopia
    • Occipital Lobe(5%): C/L homonymous hemianopia
  • Cerebellar (8%) - usually unilateral. Life threatening if over 3 cms and needs surgical evacuation
    • Nausea, vomiting, Ataxia, vertigo, diplopia
    • Headache, ataxia, past pointing, nystagmus to affected side
    • Midline lesions present with truncal ataxia
  • Brainstem (6%)
    • Pontine - coma, quadriplegia, decerebration, bilateral miosis, horizontal gaze palsy, locked in
    • Nausea, vomiting, vertigo, diplopia
    • Headache, ataxia, past pointing, nystagmus to affected side
Complications of ICH
Complications
  • Intraventricular extension associated with headache and sudden deterioration and coma.
  • Obstructive Hydrocephalus
  • Cerebral Oedema
  • Partial and Generalised Seizures
  • Rising Intracranial pressure
  • Systemic Hypertension - can worsen bleeding and cerebral autoregulation
Haemorrhagic stroke mimics
  • Head Trauma and secondary bleeding: - look for soft tissue injury. Can be difficult sometimes to work out did patient fall and hit their head and have a bleed or did the bleed come first. The pattern of bleeding tends to be different and does not fit the typical pattern of amyloid or hypertension. There may well be a subarachnoid extension or subdural bleeding. There may be superficial cutaneous haematomas suggesting direct skull trauma. One may see classical contrecoup injuries and bleeding. Any bleeding is made worse by co-existing antithrombotic medications.
  • Tumours with Haemorrhage: - primary or metastatic. If there is suspicion then arrange MRI or CT with contrast once the haematoma has resolved. Metastatic tumours that are more often associated with bleeding include Choriocarcinoma, Melanoma (check skin), Lung cancer, Thyroid carcinoma and Renal cell carcinoma.
  • Ischaemic strokes can have secondary haemorrhage: These can be easily mistaken as primary ICH rather than infarction and haemorrhage. The causes include
    • Haemorrhagic Transformation - seen with embolic strokes that reperfuse and may be exacerbated if thrombolysis or anticoagulated
    • Endocarditis with mycotic aneurysms from cardioembolism and worse if anticoagulated
    • Cerebral Venous thrombosis with secondary back pressure bleeding
    • Sickle Cell disease
    • Cerebral Vasculitis
    • Moyamoya disease

As with ischaemic stroke it is not enough to simply diagnose a haemorrhage without considering the likely pathology behind it, particularly so in the younger patient. The underlying aetiology may be anything from bleeding within a small tumour mimicking stroke to a vascular anomaly or even a venous infarction with haemorrhage requiring anticoagulation. In most cases of those over the age of 70 the diagnosis will be that of longstanding hypertensive disease or amyloid angiopathy or a mixture of both. Hospital post mortems are becoming much less common and so preciseness in the diagnosis in these cases is difficult and various criteria have been set to give a degree of precision about the diagnosis. In recent years advances particularly in imaging have led us to the discovery of 'microhaemorrhages/microbleeds'. Their exact importance and risk to patients is a subject of much research. One of the difficulties is that often the same patients are at risk of both thrombosis and haemorrhage and a weighing up of maximising therapeutic benefit and reducing harm is proving challenging. The last decade has also seen advances in the understanding of those with haemorrhagic stroke who may benefit from surgery. The evidence base continues to grow and clinicians continue to try to use this evidence most effectively for patients. Here we shall discuss the various causes and effects of haemorrhagic stroke.

Investigations

Tests tend to be much fewer and the differential easier than ischaemic strokes. In the older patient with a lobar bleed due to suspected amyloid angiopathy there may be no reason to do any further imaging. In a younger patient it would be vital to get MRI/MRA or CTA or CT angiography if is there was any concern about an underlying vascular anomaly at risk of bleeding again in the future. The usual range of testing is shown below.

Red flags to Investigate for an aetiology
Red flags to investigate with Cross sectional imaging and Angiography
  • Younger patients so amyloid less likely
  • Unexplained - no history of hypertension
  • Recurrent bleeds especially in the same area
  • Lobar bleed
  • Inherited Risks for AVM e.g. Hereditary Haemorrhagic telangiectasia
  • Patients well enough to undergo invasive treatment if needed

Investigations after a Haemorrhagic Stroke
  • Bloods: FBC, CRP, ESR, Glucose, U&E (Hyponatraemia with SAH). LFTs.
  • Coagulation screen and platelets: are vital to exclude coagulopathy or severe thrombocytopenia
  • CT Imaging : very high sensitivity to picking up blood and is the initial investigation of choice. CT shows haematoma in brain substance with possible extension into ventricles. Maybe hydrocephalus and signs of raised ICP. Presence of intraventricular blood is a poor prognostic indicator
  • MRI: Imaging : Almost as good as CT initially but most helpful after the first week when the haematoma has resolved. Old bleeds show a slit-like appearance with signs of haemosiderin. Repeat interval scan at 6 weeks can help exclude an underlying lesion. It is useful now to do the so-called 'black blood' sequences where blood breakdown products appear black. Gradient echo or T2 * (T2 star) sequences are useful.
  • MRA: Shows the circle of Willis and can identify aneurysms and AVM.
  • MRV: Consider if the bleed could possibly be a cerebral venous thrombosis with haemorrhage.
  • CTA: Allows imaging of aneurysms and dissections and vascular malformations.
  • Cerebral angiography (DSA): Reserved for selected cases in tertiary centres for those with SAH or AVM. There is a small probably less than 1% stroke risk associated with the procedure.
  • Echocardiography: CRP and general workup if endocarditis suspected as septic emboli can bleed.
  • Lumbar puncture for red cells and xanthochromia as indicated if SAH suspected
Hypertensive Haemorrhage

The student often sees blood pressure as a cause of acute haemorrhage due to acute rises in blood pressure causing sudden vessel rupture and catastrophic bleeding. In reality, hypertensive bleeds are the result of chronic low-grade damage to usually the deep penetrating vessels over a number of years. These are the same vessels that occlude in the formation of lacunar strokes so it is no wonder that they occupy the same anatomical areas of the brain such as the putamen, basal ganglia, internal capsule, thalamus and pons and cerebellum. Hypertension likely is also a mechanism for the more superficial lobar bleeds though amyloid is also in the differential diagnosis too. The clinical presentation has already been discussed and need not concern us more here. Non-contrast CT head is the imaging of choice and in an older hypertensive patient with a deep bleed, no further imaging is needed unless there are other concerns as to the aetiology.

Coagulopathy

If on warfarin and INR > 1.4 give IV Vitamin K 10 mg stat and Octaplex or FFP. This may require discussion with haematology. Consult with neurosurgeons especially if cerebellar haematoma and/or developing hydrocephalus. Usually, there is a commensurate fall in GCS. IV steroids have no evidence base and may be harmful. Statins and all anticoagulants should be stopped. Always think is this venous infarction with haemorrhage as the patient will then warrant MRV acutely and possible urgent anticoagulation

Intracerebral Haemorrhage (ICH) Score
MeasureScore
GCS3-4 +2
5-12+1
13-150
Age< 80 0
>=80 +1
ICH volume > 30 mlsYes+1
No0
Intraventricular haemorrhageYes+1
No0
Infratentorial origin of bleedYes+1
No0
ScoreMortality
00
113%
226%
372%
497%
5100%
All atypical bleeds that are not classically hypertensive or with an obvious cause need follow up interval scanning to exclude an underlying structural cause. The larger the bleed the longer it will take for the blood to clear.
Management
  • Immediate: The key clinical priorities will be early ABC and airways and breathing support and some patients may require early intubation and ventilation to allow assessment and imaging. For all early CT and treating any coagulopathy, BP control and neurosurgical referral is required. Some may need simply require palliation although the end of life decisions should be carefully made or often delayed in the first 24 hrs. There are ongoing trials such as TICH-2 looking at the administration of the antifibrinolytic drug tranexamic acid (TXA) in patients with spontaneous intracerebral haemorrhage. All patients with SICH should be admitted to a HASU or ITU that provides specialist medical and nursing care and therapy skills. Once the patient is stable usually MR imaging is done at 6-12 weeks to look for causes.
  • Ongoing care: They will need Multidisciplinary stroke care, regular Neurological observations - Temperature, Pulse, BP, GCS, Pupillary responses and the escalation of any worsening so that repeat imaging for further bleeding or hydrocephalus can be performed and intervention initiated as required.
  • Delayed Presentation:When patients present more than 7 days after a stroke and the CT shows a hypodensity and no blood then it is wise to consider an MRI as the best imaging modality as this can give a more accurate determination as to whether this was initially infarct or haemorrhage which has resolved. MRI sequences such as T2* and Gradient echo and SWI will detect the high levels of haemosiderin within a recent bleed.
  • Hypertension:Hypertensive patients should be assessed and have their BP reduced to < 160 mmHg usually with IV antihypertensive agents e.g. Labetalol
  • Neurosurgery: may have a role for some for Haematoma evacuation usually where there is falling GCS. The evidence for surgery in supratentorial bleeds is not strong but selected cases may benefit and cases should be discussed. Always consult with neurosurgeons if there is a cerebellar haematoma that may need evacuation or in those developing hydrocephalus for external ventricular drainage (EVD). Infratentorial bleeds benefit from clot evacuation or shunt insertion for hydrocephalus especially if there are signs of developing coma and haematoma > 3 cm.
  • Coagulopathy: If on warfarin and INR > 1.4 give IV Vitamin K 10 mg stat and Prothrombin complex concentrates or FFP e.g. OCTAPLEX/BERIPLEX (Vitamin K clotting factor replacement). Discuss with haematologists.
  • Thrombocytopenia: All anti-platelet agents or anticoagulation must be stopped, and coagulation normalised. Platelets should be given to raise levels about 50 x 109/L when bleeding time normalises and guidance usually suggests greater than 100 x 109/L although this is not evidence-based. Locally guidelines suggest a target over 80 x 109/L as this helps to ensure that levels never fall below 50 x 109/L. The evidence base for the 50-100 range is without evidence either way and needs more research. Platelet administration is NOT recommended in the setting of ICH on antiplatelets due to data from the PATCH trial where platelets worsened outcomes. Platelets may be harmful in even those not on antiplatelets. We need more trials.
  • VTE prophylaxis: in the short term IPC is the VTE prophylaxis of choice.
  • Steroids: have no evidence base and may be harmful raising blood pressure and causing hyperglycaemia. They should be avoided
  • IV Mannitol:Intravenous mannitol should not be used routinely for treatment of raised intracranial pressure in patients with primary intracerebral haemorrhage. If used it should be as a bridge to surgery or some other definitive procedure.
  • Metal Valves: Stop anticoagulation and switch to aspirin for a week and then consider restarting anticoagulant. Much will depend on size of the bleed, is there a recurring pathological process and other such factors. Evidence suggests that newer metal valves are less thrombogenic depending on the valve type and lower INR levels may be acceptable.
  • Statins: Statins are often stopped as concerns about increased haemorrhage risk which is still being defined. For those at high risk of vascular disease a balance will need to be struck.
  • Hyperglycaemia:Sliding scale if Blood glucose high. Tight control can lead to harmful episodes of subclinical hypoglycaemia.
  • Seizures:Consider IV Phenytoin or Keppra for seizures. See link