Makindo Medical Notes.com Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

@About this App @Contributers @Developer ACTH (Adrenocorticotropic hormone)AFP (Alpha-fetoprotein) Testing AIDS Dementia Complex (HIV)AIDS HIV Infection APGAR Scoring (Children)APTT and Coagulation Abacavir Abatacept Abbreviated Mental Test Score (AMTS)Abciximab Abdominal Aortic Aneurysm Abdominal paracentesis for ascites Abducent Nerve Abetalipoproteinaemia Abnormal Vaginal bleeding Acamprosate Acanthocytosis Acanthosis Nigricans Acarbose Accelerated Idioventricular Rhythm Acetazolamide Acetylcholine Receptor Antibodies Acetylcholinesterase inhibitors Achalasia Achilles Tendon rupture Achondroplasia (Children)Aciclovir Acid maltase deficiency (Pompe disease)Acne Rosacea Acne Vulgaris Acoustic Neuroma (Schwannoma)Acrodermatitis enteropathica (Children)Acromegaly and Giantism Acromio-clavicular joint Actinomyces israeli Action Potential Activated Charcoal Actrapid (Insulin)Acute Abdominal Pain - Acute Peritonitis Acute Acalculous Cholecystitis Acute Anaphylactoid Reactions Acute Anaphylaxis Acute Angle Closure Glaucoma Acute Appendicitis Acute Bacterial Meningitis Acute Bronchitis Acute Cholangitis Acute Cholecystitis Acute Colonic Pseudo-obstruction Acute Coronary Syndrome (ACS) General Acute Coronary Syndrome (ACS) NSTEMI USA Acute Coronary Syndrome (ACS) STEMI Acute Coronary Syndrome (Cardiac Troponins)Acute Coronary Syndrome Grace score Acute Delirium Acute Disc lesions Acute Disseminated Encephalomyelitis Acute Diverticulitis - Diverticular disease Acute Dystonic Reaction Acute Encephalitis Acute Eosinophilic Pneumonia Acute Epiglottitis Acute Exacerbation of COPD Acute Hepatitis Acute Hydrocephalus Acute Hypotension Acute Inflammation Acute Intermittent Porphyria (AIP)Acute Interstitial nephritis Acute Kidney Injury (AKI)Acute Limb Ischaemia Acute Liver Failure Acute Lymphoblastic Leukaemia (ALL)Acute Mastoiditis Acute Monoarthritis Acute Myeloid Leukaemia (AML)Acute Myocarditis Acute Pancreatitis Acute Pelvic Inflammatory Disease Acute Pericarditis Acute Phase reactants Acute Porphyrias Acute Promyelocytic Leukaemia Acute Respiratory Distress Syndrome (Adults)Acute Retroviral Syndrome (HIV)Acute Rhabdomyolysis Acute Rheumatic fever Acute Rotator cuff tear Acute Severe Asthma Acute Severe Colitis Acute Sinusitis Acute Stroke Assessment (ROSIER&NIHSS)Acute Tonsilitis Acute Urinary Retention Acute and Chronic Gout Acute and Chronic Heart Failure Acute on Chronic Liver Disease Decompensation Acutely Ill Patient Adalimumab Addenbrooke's Cognitive Examination-Revised (ACER)Addison Disease (Adrenal Insufficiency)Adefovir Adenosine Adenosine deaminase deficiency Adhesive Capsulitis (Frozen Shoulder)Adjustment - Anxiety disorders Adrenal Antibodies Adrenal Physiology Adrenaline (Epinephrine)Adrenoleukodystrophy Adrenomyeloneuropathy Adult Onset Still's Disease African Trypanosomiasis (Sleeping sickness)Age related macular degeneration Aicardi syndrome Air Embolism Albumin Albumin-Protein Creatinine Ratio (PCR)Alcohol Abuse Alcohol Withdrawal (Delirium Tremens)Alcoholic (Steato)Hepatitis Alcoholic Ketoacidosis Aldosterone Physiology Alendronate (Alendronic acid)Alfacalcidol Alkaline phosphatase (ALP)Alkalinisation of urine Alkaptonuria Allergic Bronchopulmonary Aspergillosis Allogeneic stem cell transplantation Allopurinol Alogliptin (Vipidia)Alopecia Alpha Fetoprotein Alpha Thalassaemia Alpha subunit (ASU) of TSH Alpha-1 Antitrypsin (AAT) deficiency Alport's Syndrome Alteplase Altitude sickness Aluminium and Magnesium Antacids Alveolar Gas Equation Alzheimer disease (Dementia)Amantadine Amenorrhoea American Trypanosomiasis (Chagas Disease)Amiloride Amino acids Aminoglycosides Aminophylline Aminosalicylates Amiodarone Amiodarone and Thyroid disease Amitriptyline Amlodipine Ammonia Encephalopathy Amnestic syndromes Amoebiasis (Entamoeba histolytica)Amoxicillin Amphetamine toxicity Amphotericin B Ampicillin Anaemia of Chronic Disease Anagrelide Anakinra Anal Cancer Andexanet alfa Androgen insensitivity syndrome Aneurysms Angina bullosa haemorrhagica Angiodysplasia Angiomyolipoma Angioneurotic Oedema Angiotensin Converting Enzyme Inhibitors Angiotensin Converting enzyme (ACE)Angular Stomatitis - Cheilitis Anion Gap Ankle and Foot fractures and Injuries Ankle-Brachial pressure Index (ABPI)Ankylosing spondylitis Anorexia Nervosa Antacid medication Antepartum haemorrhage Anterior Horn Cell diseases Anterior circulation Anti Dementia Drugs Anti-Cyclic Citrullinated Peptide (CCP) Antibody Anti-D immunoglobulin Anti-Hu antibodies Anti-OKT3 antibodies Anti-RNP Antibody Anti-Yo antibodies Anti-neutrophilic cytoplasmic antibodies (ANCA)Antibiotics for Abdominal Infections Anticholinergic Burden Anticholinergic syndrome Anticipation Anticoagulation and Antithrombotics Antidiuretic hormone (Vasopressin)Antigen presenting cells Antimicrobial Choices Antimuscarinic drugs Antiphospholipid syndrome Antithrombin III deficiency (AT3)Aorta anatomy Aortic Dissection Aortic Regurgitation (Incompetence)Aortic Sclerosis Aortic Stenosis Aortoenteric fistula Apathetic thyrotoxicosis Apixaban Aplastic anaemia Apomorphine Appendix Cancer Tumours Approach to Assessing Sick Child Approach to child with Acute Gastroenteritis Approach to child with respiratory Distress Arnold Chiari malformation Arrhythmogenic Right ventricular Cardiomyopathy Artemisinins Arterial Blood gas analysis Arterial Pulse assessment Arterial blood gas sampling Arterial vs Venous vs Other Leg Ulcers Arteriovenous malformations Artery of Percheron stroke Artery-to-artery embolic stroke Artesunate Asbestos Related Lung disease Ascites Assessment and Management Aspergilloma Aspergillus fumigatus Aspirin Aspirin Salicylates toxicity Assessing Abdominal Pain Assessing Breathlessness Assessing Chest Pain Assessing Falls Asteatotic eczema Asthma Astigmatism Astrocytomas Asystole Ataxia Telangiectasia Atazanavir Atenolol Atherosclerosis Atopic Eczema or Atopic Dermatitis Atorvastatin Atracurium Atrial Ectopic beats Atrial Fibrillation (Chemical cardioversion)Atrial Natriuretic Peptide (ANP)Atrial fibrillation (AF)Atrial flutter Atrial myxoma Atrial septal defect (ASD)Atrioventricular nodal reentrant tachycardia Atropine Sulfate Autoantibodies Autoimmune Haemolytic anaemia (AIHA)Autoimmune Hepatitis Autonomic neuropathy Autosomal Dominant Autosomal Dominant Polycystic kidney disease Autosomal Recessive Azathioprine Azithromycin B lymphocytes BRCA genes (Familial Breast Cancer)Bacillus anthracis Bacillus cereus poisoning Backpain / Backache Baclofen Bacteria Bacteroides fragilis Balanitis (Adults)Balanitis (Children)Balkan endemic nephropathy (BEN)Balsalazide (Aminosalicylate)Barrett's oesophagus Bartonella Bartters syndrome Basal Cell Carcinoma (BCC)Basic Fracture management Basilar artery thrombosis Becker Muscular dystrophy Beclometasone Beer Potomania Behavioural and Psychological Symptoms of Dementia Behcet's syndrome Bell's palsy Bendroflumethiazide (Bendrofluazide)Benign Paroxysmal Positional Vertigo (BPPV)Benign Prostatic Hyperplasia Benign recurrent intrahepatic cholestasis Benzodiazepine Toxicity Benzodiazepines Benzylpenicillin Sodium (Penicillin G)Berg Balance Scale Beriplex Berylliosis Beta Agonists Beta Blocker toxicity Beta Thalassaemia Beta-2 Microglobulin Beta-lactamases Betahistine (Serc)Bezafibrate Biceps rupture Bilateral adrenalectomy Biliary atresia Bilirubin Biochemical Lab values Bisacodyl Bisoprolol Bisphosphonates Bladder Cancer Bladder Stones Bleeding Bleeding disorders Bleeding due to Drugs Bleomycin Blindness - global causes Blood products - Packed cells blood transfusion Blood Products - Cryoprecipitate Blood Products - Fresh Frozen Plasma Blood Products - Platelets Blood film interpretation Blood gas values Bloody Diarrhoea Blotting Techniques: Gel Electrophoresis Bone Marrow Transplantation Bone disease Lab results Bone metabolism RANK RANKL OPG pathway Bone scintigraphy (Bone scan)Bordetella pertussis - Whooping cough Borrelia burgdorferi Borrelia recurrentis Botulism Brachial neuritis (neuralgic amyotrophy)Brachial plexus anatomy Brachial plexus and associated injury Brain Abscess Brain Anatomy and function Brain MRI Brain Natriuretic Peptide (BNP)Brain Physiology Brain Tumours (Cancer)Brainstem anatomy Branchial cleft cyst Breast Cancer Breast Fibroadenoma Bretylium Broad complex Tachycardia Bromocriptine Bronchial adenoma Bronchiectasis Bronchiolitis Bronchoscopy Brown-Sequard syndrome Brucella Brugada syndrome Budd-Chiari syndrome Budesonide Buerger disease (Thromboangiitis obliterans )Bulbar vs Pseudobulbar palsy Bulimia Nervosa Bullous Pemphigoid Bumetanide Bunions Buprenorphine Bupropion Burkholderia cepacia Burkitt's lymphoma Burns Busulphan (Busulfan)Byssinosis C reactive protein (CRP)CADASIL CARASIL CHADS2 - CHA2DS2-VASc score CMV retinitis CNS fungal Infections CNS infections CSF Rhinorrhoea CT Head Basics (Stroke)CT Pulmonary angiogram (CTPA)CT imaging basics for Stroke CURB 65 score Cabergoline Caecal Volvulus Caisson Disease - Decompression sickness Calcitonin Calcitriol (1,25 Dihydroxycholecalciferol)Calcium Chloride or Gluconate Calcium Physiology Calcium Pyrophosphate Deposition (Pseudogout)Calcium Resonium Calcium channel blockers toxicity Calot's triangle Campylobacter Cancer of Unknown Primar Candesartan Candidiasis Cannabis toxicity Capecitabine Capnocytophaga canimorsus Capnography Capreomycin Captopri Carbamazepine Carbapenemase-producing Enterobacteriaceae Carbimazole Carbon monoxide poisoning Carcinoembryonic antigen (CEA)Carcinoid Heart Disease Carcinoid Tumour Syndrome Carcinoma of the Bile Duct Carcinoma of the Gallbladder Cardiac Amyloid heart disease Cardiac Anatomy and Physiology Cardiac Catheter ablation Cardiac Infections Cardiac MRI Cardiac Resynchronisation Therapy (CRT) Pacemaker Cardiac Valve replacement Cardioembolic stroke Cardiogenic Pulmonary Oedema Cardiogenic shock Cardiology - History Taking Cardiology Exam List Cardiology Examination Cardiology Valves Summary Cardiopulmonary bypass Carmustine Carotid Artery anatomy Carotid Body Tumour Carotid Endarterectomy Carotid Sinus Syncope Carotid Stenting Carotid artery Dissection Carotid sinus massage Carpal tunnel syndrome Carvedilol Case 01 Sudden weakness Case 02 Loss of speech Case 03 Adult male weak legs Case 04 High calcium Case 05 High Potassium and heart failure Case 06 High calcium and weight loss Case 07 Weak eyes Case 08 Weak face Case 09 A cause of Delirium Case 10 Older patient presenting post stroke Case 11 Young patient with acute headache Case 20 Young patient with acute headache Case 21 Hypoglycaemia Case 22 Case 23 Old man with tremor Case 24 Cancer and weak Case 99 (Acute breathlessness)Case Template Cat Scratch Disease Cataract Catheter Related Urinary Tract infection UTI Catheter related Blood stream infection Catheter related UTI Cauda equina syndrome Caudate Nucleus Causes of Airway Obstruction Causes of Avascular Necrosis of Femoral head Causes of Sore throat Causes of Weakness Cavernous angiomas (Cavernomas)Cavernous sinus Cavernous sinus thrombosis Cefaclor Cefalexin Cefotaxime Ceftazidime Ceftriaxone Cefuroxime Celecoxib Cell Response to Injury Cellular Anatomy and Physiology Cellulitis Central Cord Syndrome Central Retinal Vein Occlusion (CRVO)Central Retinal artery Occlusion (CRAO)Central Venous line Insertion Central pontine myelinolysis Cephalosporins Cerebellar Anatomy Physiology Signs Disease Cerebellar Haemorrhage Cerebellar Stroke Cerebral Amyloid angiopathy (CAA)Cerebral Aneurysms Cerebral Angiitis Cerebral Atrophy vs Hydrocephalus Cerebral Cortex Cerebral Metastases Cerebral Palsy Cerebral Perfusion Cerebral Salt Wasting Cerebral Venous Sinus thrombosis Cerebral arteritis Cerebral microbleeds Cervical Cancer screening Cervical Spine injury Cervical cancer Cervical spondylosis Cetirizine Chancroid Charcot Foot Syndrome (CFS)Charcot Marie Tooth (CMT) disease Chediak Higashi syndrome Chest Abdomen anatomy Chest X Ray #1 Chest X Ray Interpretation Chest drain Insertion Chlamydia - Chlamydophila pneumoniae Chlamydia psittaci Chlamydia trachomatis Chlorambucil Chloramphenicol Chlordiazepoxide Chloroquine Chlorphenamine(Chlorpheniramine)Chlorpromazine Cholangiocarcinoma Cholera (Vibrio cholera)Cholestatic Jaundice Cholesteatoma Cholesterol - Lipids Cholinergic crisis-syndrome Chondrocalcinosis Chorea - Ballismus Choreoacanthocytosis Chromosome instability syndromes Chronic Bronchitis Chronic Hepatitis Chronic Inflammation Chronic Inflammatory Demyelinating polyneuropathy Chronic Interstitial Nephritis Chronic Kidney Disease (CKD)Chronic Lymphocytic leukaemia (CLL)Chronic Myeloid Leukaemia (CML)Chronic Obstructive Pulmonary Disease (COPD)Chronic Pancreatitis Chronic Peritonitis Chronic Radiation Enteritis Chronic Urinary Retention Chronic Vision Uni-Bilateral loss (Blindness)Chronic and recurrent Meningitis Chronic liver disease Chronic mucocutaneous candidiasis Chronic stable angina Chylomicrons Ciclosporin Cimetidine Cinacalcet Ciprofloxacin Cirrhosis Cisplatin Citalopram Cladribine Clarithromycin Cleft lip or palate Clindamycin Clopidogrel Clostridium botulinum Clostridium difficile Clostridium perfringens Clostridium tetani - Tetanus Clotrimazole cream Clotting pathways Clozapine Co Careldopa (Sinemet)Co-Amoxiclav (Augmentin)Co-Beneldopa (Madopar)Co-codamol Co-trimoxazole Coagulopathy Coal Worker's Pneumoconiosis Coarctation of the Aorta (CoA aortopathy)Cocaine abuse Cocaine induced chest pain Cocaine toxicity Coccidioidomycosis Codeine Coeliac disease Cogan Syndrome Colchicine Cold Agglutinin Disease (CAD/AIHA)Collagen Colloid cyst in the third ventricle Colloids Colonic (Large bowel) Obstruction Colonoscopy Colorectal cancer Colorectal polyps Colposcopy Coma management Combined Oral contraceptive pill (COCP)Common Peroneal Nerve (CPN)Common variable immunodeficiency Comparing Rheumatoid and Osteoarthritis Complement Comprehensive Geriatric Assessment (CGA)Confirming Death Congenital Acyanotic Heart Disease (Children)Congenital Adrenal hyperplasia Congenital Complete Heart Block Congenital Cyanotic Heart Disease (Children)Congenital Hypothyroidism Congenital Talipes Equinovarus - Clubfoot Constipation Constrictive Pericarditis Contact allergic dermatitis Continuous Positive Airways Pressure (CPAP)Continuous ambulatory peritoneal dialysis Contraception Conus Medullaris syndrome Cor Pulmonale Coronary artery bypass graft surgery Coronavirus SARS-CoV-2 COVID 19 Corticobasal degeneration (Dementia)Corticosteroid-related psychosis Corticosteroids Corynebacterium diphtheriae Cotard delusion Coxiella Burnetii Cranial nerves and examination Craniopharyngioma Creatinine Clearance Cremation forms (UK)Creutzfeldt Jakob disease (Dementia)Crimean-Congo haemorrhagic fever Critical illness neuromuscular weakness Crohn's disease Croup Cryptococcus neoformans infections Cryptogenic Fibrosing Alveolitis Cryptogenic Organising Pneumonia (COP-BOOP)Cryptosporidiosis Crysal arthritis Crystalloids Cushing disease Cushing syndrome Cutaneous Leishmaniasis Cyanide toxicity Cyanosis - Central and Peripheral Cyclizine Cyclo-oxygenase (COX) enzymes Cyclophosphamide Cycloserine Cys leukotriene receptor antagonists Cystic Fibrosis Cystinosis Cystinuria Cytokines Cytomegalovirus infections D Dimer DNA and RNA short notes DNA replication Dabigatran Dalteparin Dandy Walker syndrome Dantrolene Dapagliflozin Darier's Disease Darunavir DeQuervain's thyroiditis Death Certificates (UK)Deep brain stimulation Deep vein thrombosis (DVT)Dehydration Physiology Delayed Puberty Criteria Demeclocycline Dementia with Lewy bodies Dementias Demyelinating Diseases Dengue Fever Denosumab (Prolia)Dental Anatomy Dentatorubral pallidoluysian atrophy Depression Dermatitis Herpetiformis Dermatology terms Dermatomes Dermatomyositis Dermoid cysts Desferrioxamine Desmopressin (DDAVP)Desogestrel (Progestogen Only Pill)Developmental Dislocation (Dysplasia) of the Hip Developmental Milestones Dexamethasone DiGeorge syndrome (thymic aplasia)Diabetes Insipidus (Cranial and Nephrogenic)Diabetes Mellitus Type 1 Diabetes Mellitus Type 1 and DKA (children)Diabetes Mellitus Type 2 Diabetes Mellitus in pregnancy Diabetes on the ward Diabetic Autonomic Neuropathy (DAN)Diabetic Ketoacidosis (DKA) Adults Diabetic Ketoacidosis (DKA) with SGLT2 Inhibitors Diabetic Nephropathy Diabetic Retinopathy Diabetic amyotrophy Diabetic foot Diamond-Blackfan anaemia Diamorphine Diaphragmatic disorders Diarrhoea Diazepam Didanosine (ddI)Diethylstilbestrol Differentials causes of Foot Drop Differentials of ABC Differentials of Generalised lymphadenopathy Differentials of Painful thigh Differentials of XXX Diffuse Oesophageal spasm Diffuse large B-cell lymphoma Diffusion Capacity Digoxin Digoxin Toxicity Dihydrocodeine Dilated cardiomyopathy Diltiazem Diphtheria Dipyridamole Discharges against advice Discoid lupus erythematosus (DLE)Disease template Diseases with associated cancers Dislocation Sternoclaivcular joint Disopyramide Disseminated Intravascular Coagulation (DIC)Distributive Shock Disulfiram (Antabuse)Dobutamine Dog Bites Dog Bites Hand Dominant R wave in V1 Domperidone Donepezil (Aricept)Donovanosis Dopamine Hydrochloride Dopamine agonists Down's syndrome (Trisomy 21)Doxapram Doxazosin (Cardura)Doxepin Doxorubicin (Adriamycin)Doxycycline Driving Drowning Drug Induced Parkinson disease Drug Reaction Eosinophilia Systemic Symptoms DRESS Drug Template Drug Toxicity - clinical assessment Drug Toxicity with Specific Antidotes Drug induced Lupus Erythematosus Drug induced liver disease Drugs Drugs List Drugs to Avoid in Acute Renal failure Drugs to avoid Elderly Drugs to avoid in Liver failure Dry and Wet Gangrene Dual X-ray absorptiometry (DEXA)Duchenne muscular dystrophy Dulaglutide GLP-1 agonist Duloxetine Duodenal Atresia (Children)Dupuytrens contracture Dysentery Dysphagia ECG - Acute Coronary Syndrome ECG - Acute ST Elevation Myocardial Infarction ECG - Atrial fibrillation ECG - Atrial flutter ECG - Basics ECG - Broad complex tachycardia (possible VT)ECG - Brugada syndrome ECG - Causes of a Dominant R wave in V1 ECG - Early Repolarisation vs STEMI ECG - First degree AV Block ECG - Heart Block ECG - Hyperkalaemia ECG - Interpretation ECG - Ischaemic Heart Disease ECG - Left Axis Deviation ECG - Left Bundle Branch Block LBBB ECG - Left Ventricular Hypertrophy ECG - Low Voltage Complexes ECG - Narrow complex tachycardia ECG - Normal appearance ECG - Pathological Q waves ECG - QT interval ECG - Right Axis Deviation ECG - Right Bundle Branch Block RBBB ECG - ST-T T waves changes ECG - Supraventricular tachycardia ECG - The QRS complex ECG - Tutorial from Queens University ECG - Ventricular fibrillation ECG - Ventricular tachycardia ECG - Wolff Parkinson White syndrome (WPW)ECG - short PR interval ECG - sinus pause ECG - tall R wave V1 ENT Exam - Assessing hearing ENT infections Ebola Virus Disease Ebstein anomaly Echinocytes Echocardiogram Ecstasy toxicity Ectopia lentis (subluxation of the lens)Ectopic Pregnancy Ectropion Eculizumab Edoxaban (Lixiana)Edward syndrome (trisomy 18 syndrome)Efavirenz (Sustiva) EFV Ehlers-Danlos syndromes Ehrlichiosis Eikenella corrodens Eisenmenger's syndrome (Children)Elbow fractures and Injuries Electrical injury Eloquent brain Emergency Drugs Emphysema Empty sella syndrome Emtricitabine (Emtriva) FTC Enalapril End of Life Care Prescribing Endocarditis and Stroke Endocrinology Lab values Endometrial (Uterine) Cancer Endometriosis Endoscopic Retrograde Cholangiopancreatography X Endothelins Enfuvirtide Enoxaparin Sodium (Clexane-Lovenox)Enoximone Entacapone Enterococci Enteropathic Spondyloarthritis Enzyme inducers and inhibitors Eosinophilic granulomatosis (Churg Strauss)Ependymoma Epidural Haematoma Epidural abscess Epilepsy - General Management Epilepsy - Idiopathic Generalised Epilepsy Epilepsy - Mesial temporal lobe epilepsy Epilepsy - Post Traumatic Epilepsy in Pregnancy Episcleritis Epistaxis Eplerenone Eponymous brainstem strokes Epstein-Barr Virus infection Equivalent doses of Opiates Erb Palsy Ergocalciferol (Calciferol)Erlotinib (Tarceva)Erysipelothrix rhusiopathiae Erythema Multiforme Erythema Nodosum Erythrocyte Sedimentation rate (ESR)Erythrocytes Erythrodermic Psoriasis Erythromycin Escherichia coli Escitalopram Esomeprazole Essential Thrombocythaemia (ET)Essential Tremor Etanercept Ethambutol Ethanol Ethanol toxicity Ethylene glycol toxicity Etomidate Etravirine (intelence) ETR Ewing sarcoma Exenatide (Byetta) GLP1 agonist Exercise stress test Exploding head syndrome Extradural haematoma Extrapyramidal symptoms Extrinsic Allergic alveolitis (Hypersensitivity)Eye infections Ezetimibe Fabry disease Facial Nerve Facioscapulohumeral muscular dystrophy Factor V Leiden Deficiency Faecal Calprotectin Fahr syndrome Failure to thrive or Faltering growth Familial Adenomatous polyposis (FAP)Familial Amyloidosis Familial Hypercholesterolaemia Familial Mediterranean Fever (FMF)Familial hypocalciuric hypercalcaemia (FHH)Family Tree (Pedigree)Famotidine Fanconi Anaemia Fanconi Syndrome Fat embolism Fatigue - Causes Fatty acids Febrile seizures Felodipine (Dihydropyridine)Femoral Hernia Femoral triangle Femur fractures and Inuries Fentanyl - Fentanil Ferritin Ferrous Fumarate - Gluconate - Sulphate Fetal Alcohol Syndrome Fetal circulation Fever - Pyrexia of unknown origin (FUO PUO)Fever in a traveller Fibrates Fibrinogen Fibromuscular dysplasia Fibromyalgia Fidaxomicin Finasteride (5 alpha-reductase inhibitor)First Seizure Fitz-Hugh Curtis Syndrome Flail Chest Flecainide Acetate Flexor sheath infection (flexor tenosynovitis)Flucloxacillin Fluconazole Flucytosine Fludrocortisone Fluid balances status Flumazenil (Annexate - Romazicon)Fluoxetine Focal Segmental Glomerulosclerosis (FSGS)Foix-Alajouanine syndrome Folate (Folic) acid Folate deficiency Folinic acid (Leucovorin)Fomepizole Fondaparinux Food borne disease Foscarnet Sodium Fosfomycin Fosphenytoin Foster Kennedy Syndrome Fournier's gangrene Fracture Template Fractured Clavicle Fractured Neck of Femur Fractured Pubic Ramus Fractured Scapula Fractured Shaft Femur Fractured Tibia and Fibula Fractures Shaft Humerus Fractures in Children Fractures of Upper humerus Fragile X syndrome Frailty Fraser guidelines and Gillick Competence Free Radicals Friedreich's Ataxia Frontotemporal dementia Full or Complete Blood Count (FBC CBC)Fungi Furosemide (Frusemide)Fusidic acid Fusobacteria - Tropical ulcer Fusobacterium G protein-coupled receptors GP Emergency Drugs Carried Gabapentin Galactorrhoea Galantamine Gamete intra-fallopian tube transfer (GIFT)Gamma Glutamyl Transferase (GGT)Gamma hydroxy butyrate (GHB) toxicity Ganciclovir - Valganciclovir Gardner syndrome Gardnerella vaginalis Gas Gangrene Gastric (MALT) Lymphoma Gastric Cancer Gastric Outlet obstruction (pyloric stenosis)Gastrinoma Gastro Intestinal Stromal Tumours (GIST)Gastro-Oesophageal Reflux (Adult GORD)Gastro-Oesophgeal Reflux (Paediatrics GORD)Gastroenteritis Gastroenterology Exam Lists Gastroenterology Examination Gastroenterology History Gastroenterology assessment - Jaundice Gastrointestinal anatomy and physiology Gastrointestinal perforation Gastrostomy (PEG) tubes Gaucher's disease Gene components Genetic Diseases Gentamicin Giardiasis Gilbert's syndrome Gingival (Gum) hyperplasia-hypertrophy Gitelman's syndrome Glasgow Blatchford Score Glasgow Coma scale Glatiramer acetate (Copaxone)Glibenclamide Gliclazide Glimepiride Glipizide Globus Pallidus Glomerulonephritis Glossitis Glucagon Glucagonoma Glucose 6 phosphate dehydrogenase deficiency Glucose Tolerance Test Glutamate Glycated Haemoglobin Glyceryl Trinitrate (GTN)Glycogen storage diseases Glycolysis_Krebs_Electron_Transport_Chain Glycopyrronium Bromide Goitre Golfer's Elbow Golimumab (Simponi)Goodpasture's syndrome (Anti GBM disease)Goserelin (Zoladex)Gradenigo's syndrome Grades of Recommendation Gram Stain Granuloma annulare Granulomatosis with Polyangitis GPA (Wegener)Graves Disease Griseofulvin Growth Hormone Deficiency Guillain Barre Syndrome Gum hypertrophy Guthrie test New Born blood spot Gynaecological History Taking Gynaecomastia HAS-BLED score HIV and Post-Exposure Prophylaxis (PEP)HIV and Pre-exposure prophylaxis HIV associated nephropathy (HIVAN)HIV disease Assessment HTLV-1 Associated myelopathy Haematemesis Haematology Examination - Splenomegaly Haematology Lab values Haematuria Mild to Severe Haemodialysis Haemoglobins Haemolysis Haemolytic Anaemia Haemolytic Uraemic syndrome Haemolytic disease of the newborn Haemophilia A Haemophilia B Haemophilus aegyptius Haemophilus ducreyi Haemophilus influenzae Haemophilus parainfluenzae Haemopoiesis Haemorrhagic Transformation Haemorrhagic stroke Haemorrhoids (Piles)Hairy Cell Leukaemia Hairy Leukoplakia Hallervorden-Spatz disease (PKAN)Haloperidol Hamman-Rich syndrome Hand foot and mouth disease Hand fractures and Injuries Hantavirus infections Hartmann's solution (Ringer's lactate)Hartnup disease*Hashimoto's (Steroid responsive) Encephalopathy Hashimoto's thyroiditis HbA1c Head (Brain) Injury Head and Neck Cancers Headache - Analgesic overuse Headache - Assessing Acute and Severe Headache - Basilar Migraine Headache - Cluster Headache - Low CSF pressure Headache - Migraine Headache - Tension Headaches - General Hearing aids Heat Stroke Helicobacter pylori Helvetica Spotted fever Hemicraniectomy Henoch-Schonlein purpura Heparin - General Heparin - Low Molecular Weight Heparin Heparin - Unfractionated Heparin Heparin-induced thrombocytopenia (HIT)Hepatic Encephalopathy Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Hepatocellular Carcinoma Hepatorenal syndromes Hereditary Elliptocytosis Hereditary Haemochromatosis Hereditary Haemorrhagic Telangiectasia Hereditary Spastic Paraparesis Hereditary Spherocytosis Hereditary angio-oedema Hereditary neuropathy with pressure palsies Hereditary non polyposis coli (Lynch syndrome)Herpes Gestationis Herpes Simplex Herpes Simplex Encephalitis (HSV)Herpes Viruses Herpes Zoster Ophthalmicus (HZO) Shingles Herpes simplex keratitis (HSK)Heyde syndrome Hiatus hernia Hiccups (Singultus)High Dose Dexamethasone Suppression Test Hip pain in children Hirschsprung disease (congenital megacolon)Hirsuitism XXX Histones Histoplasmosis Hodgkin Lymphoma Holt-Oram syndrome Holter monitor (tape) 24-72 h Homocystinuria Hookworm Horner's syndrome Hospital acquired Pneumonia (NICE 139)Human albumin solution (HAS)Human prion diseases Humeral fractures and injuries Hunter's syndrome (MPS-2)Huntington Chorea Hurler's syndrome (MPS-1)Hydatid disease (Echinococcus)Hydatidiform mole Hydralazine Hydrocortisone Hydrogen Bonds Hydrops fetalis Hydroxocobalamin Hydroxocobalamin - Cyanocobalamin (B12)Hydroxychloroquine Hydroxyurea-Hydroxycarbamide Hyoscine (Buscopan)Hyper IgM syndrome Hyperbaric Oxygen therapy Hypercalcaemia Hyperglycaemic Hyperosmolar State (HHS)Hyperinsulinaemic-euglycemic therapy (HIET)Hyperkalaemia Hyperkalaemic and Hypokalaemic Periodic Paralysis Hypermagnesaemia Hypernatraemia Hyperphosphataemia (High phosphate)Hyperprolactinaemia Hypersensitivity reactions Hypertension Hypertension in Pregnancy Hypertriglyceridaemia (HTG)Hypertrophic cardiomyopathy (HCM - HOCM)Hyperventilation Syndrome Hyperviscosity syndrome Hypocalcaemia Hypoglycaemia Hypogonadism (Female)Hypogonadism (male)Hypokalaemia Hypokalaemic Periodic Paralysis Hypomagnesaemia Hyponatraemia Hypoparathyroidism Hypophosphataemia (Low phosphate)Hypopituitarism (Pituitary Failure)Hypospadias Hypothermia Hypothyroidism Hypovolaemic or Haemorrhagic Shock IL-12 receptor deficiency IV Immunoglobulin Ibandronic acid (Bisphosphonate)Ibuprofen Icatibant Idiopathic Intracranial hypertension Idiopathic Parkinson disease Idiopathic Pulmonary Fibrosis IgA Nephropathy (Berger's disease)Images - Spot diagoses Imatinib mesylate Imipenem (Primaxin) with Cilastin Immune Reconstitution Syndrome Immune(Idiopathic) Thrombocytopenic Purpura (ITP)Immunoglobulin G4-related disease (IgG4-RD)Impetigo Implantable cardioverter defibrillator (ICD)Impulse control disorders Inclusion Body Myositis Incubation periods Indapamide Indinavir (IND)Infection screening in Septic patient Infections and their Microbial cause Infectious Mononucleosis Infective Conjunctivitis Infective Endocarditis Infertility Infliximab Influenza Inguinal Hernia Initial Trauma Assessment Injury Severity Score (ISS)Insomnia - sleep issues Insulin Insulinoma Interferon Beta Intermittent Claudication Internal Capsule Internuclear Ophthalmoplegia Interpreting Haematinics Interstitial Keratitis Intestinal obstruction (Children)Intra Aortic Balloon Pump Intraabdominal abscess Intracerebral Haemorrhage (ICH) Score Intracranial HypertensionX Intravenous Iron Replacement (Ferrous)Intraventricular haemorrhage (neonates)Intubation and Mechanical Ventilation Intussusception (Adults)Intussusception (Children)Iodine deficiency Goitre Ipratropium Bromide (Atrovent)Irbesartan Iron Salts Iron deficiency Anaemia Iron toxicity Irritable bowel syndrome Ischaemic Colitis Ischaemic Stroke Ischaemic heart disease Isoniazid Isoprenaline Isosorbide Dinitrate Isosorbide mononitrate Isotretinoin (Accutane)Ispaghula Husk (Fybogel)Ivabradine Jansen Disease Janus kinase 2 Jervell and Lange-Nielsen syndrome Job Syndrome (Hyper IgE syndrome)Jugular Venous Pressure (JVP)Junctional Tachycardia Juvenile Dermatomyositis Juvenile Idiopathic arthritis (Stills Disease)Juvenile Myoclonic epilepsy (JME)Kallmann's syndrome Kaposi sarcoma (KS)Karnofsky performance status scale Kawasaki disease Kennedy Syndrome Keratoconus Kernicterus Ketamine Ketoconazole Klebsiella pneumonia Klinefelter Syndrome (Children)Klumpke palsy Knee fractures and Injuries Koebner phenomenon Kugelberg Welander syndrome Kwashiorkor L-Thyroxine (T4)Labetalol (Trandate)Labyrinthitis - 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Ventilator associated pneumonia (VAP)

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Most common healthcare-associated infection in intensive care
Significant mortality and morbidity
There is no agreed definition of VAP.

Aetiology

Use of cuffed ET tube or tracheostomy
Intubated and ventilated > 48 hrs
Early VAP < 5 days usually CAP bacteria e.g. Haemophilus and Streptococcus
Late VAP > 5 days often multidrug resistant e.g. Pseudomonas aeruginosa
The main pathogenic factor in the development of VAP is biofilm formation within the tracheal tube (TT) and micro aspiration of secretions

Risk factors

Increasing age (>55 years)
Chronic lung disease
Aspiration/ micro aspiration from being nursed in a supine position
Chest or upper abdominal surgery
Previous antibiotic therapy, especially broad-spectrum antibiotics
Reintubation after unsuccessful extubation, or prolonged intubation
Acute respiratory distress syndrome
Frequent ventilator circuit changes
Polytrauma patient
Prolonged paralysis
Premorbid conditions such as malnutrition, renal failure, and anaemia

Clinical

Fever, purulent respiratory secretions
Rising inflammatory markers, respiratory distress
Worsening respiratory parameters (reduced tidal volume, increased minute ventilation, and hypoxia).

Differentials

Investigations

Bloods; Raised WCC and CRP. Worsening ABG
CXR: usually abnormal. if normal consider another diagnosis

Management

Prevention: avoiding intubation. Semi recumbent positioning of patients, with a 30- to 45-degree head-up approach, reduces the incidence of micro aspiration of gastric contents when compared with patients nursed in a supine position. Avoid H2 blockers and PPI in low-risk patients. Oral hygiene. Sedation breaks.
Management: Oxygenation, IV antibiotics after microbial samples were taken. Early extubation.

References

Ventilator-Associated Pneumonia by Dr Felicity Miller

Revisions

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Makindo