PHYCOLOGY

11 MUSCULOSKELETAL & 12 RHEUMATOLOGY 12.03 With skin problems 15 CHILD HEALTH / PAEDIATRICS 15.12-13 Neurological disorders
ORTHOPAEDIC CONDITIONS • Systemic lupus erythematosus • Epilepsy • Status epilepticus
12.01 • Rheumatoid arthritis • Systemic sclerosis (scleroderma) 15.01 • Paediatric life support • Brain tumours
11.01 Orthopaedic emergencies • Osteoarthritis • Dermatomyositis • Polymyositis • Newborn life support [15.13] • Neural tube defects
• Septic arthritis • Psoriatic arthritis • Sjogren syndrome • Intraosseous infusion • Anaphylaxis • Autism spectrum disorder
• Compartment syndrome
• Spinal cord compression 12.02 With muscular problems 12.04 Vasculitis 15.02-03 Infections 15.14-15 Haemonc disorders
- Cauda equina syndrome • Ankylosing spondylitis • Wegener's • Churg-Strauss • Traffic light assessment of kids • Anaemia • Iron deficiency
• Open fractures • Gout • Pseudogout • Giant cell arteritis • Takayasu arteritis • Meningitis • Encephalitis • Sickle cell disease
• Tendon sheath infection (hand) • Reactive arthritis • Fibromyalgia • Microscopic polyangitis • Hereditary spherocytosis
• Polymyalgia rheumatica • Polyarteritis nodosa [15.03] • Measles • Mumps • Rubella • Henoch-Schonlein purpura
11.02 Upper limb orthopaedic issues • Chronic fatigue syndrome • Henoch-Scholein • Behcet's • Erythema infectiosum • HFMD [15.15] • Immune thrombocytopaenia
• Shoulder • Elbow • Roseola infantum • Chickenpox • Acute lymphoblastic leukaemia
• Fractures: Colles', Smith's, Barton's, • HIV in children • Primary immunodeficiencies
Monteggia's, Galeazzi 13 EAR NOSE THROAT 14 PSYCHIATRY • Severe combined immunodeficiency
15.04 Respiratory disorders
13.01 Ear 14a Substance abuse / overdose
11.03 Hand & foot • Upper respiratory tract infections 15.16-18 Endocrine disorders
• Otalgia • Discharging ear • Cannabis • MDMA/Ecstasy
• Hand • Ganglions - Croup - Epiglottitis • Diabetes mellitus + MODY • DKA




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• Otitis externa • Otitis media • Cocaine • Nitrous oxide
• Foot, incl club foot - Bacterial tracheitis - Diphtheria • Hypothyroidism
• Glue ear • LSD / acid • Opioid misuse
• Lower respiratory tract infections [15.17] • Hyperthyroidism
• Overdose / poisoning
11.04 Hip, including neck of femur - Bronchiolitis - Viral-induced wheeze • Inherited metabolic diseases
13.02 Ear • Hearing loss
fractures - Pneumonia - Whooping cough • Glycogen storage disorders
• Tinnitus • Vertigo 14.01 Mood disorders • Asthma • Cystic fibrosis [02.04] • Phenylalanine ketonuria
• Depression • Suicide
11.05 Knee & ankle issues • Lysosomal storage diseases
13.03 Ear • Childhood deafness • Bipolar disorder 15.05-06 Cardiovascular disorders [15.18] • Precocious puberty
• Deafness in adults • Otosclerosis
09.06 Spinal orthopaedics • Ventricular septal defect (VSD) • Congenital adrenal hyperplasia
Including rib fractures, autonomic • Vestibular schwannoma 14.02 Anxiety & related disorders
• Atrial septal defect (ASD) • Genetic disorders summary
dysreflexia • Benign paroxysmal positional vertigo • Generalised anxiety disorder
• Patent ductus arteriosus
• Meniere's disease • Panic disorders • OCD • PTSD • Coarctation of the aorta 15.19 Developmental disorders
• Vestibular neuronitis • Labyrinthitis • Acute stress disorder • (Others)
09.07 Miscellaneous • Congenital aortic valve stenosis • Developmental milestones
• Dermatomes • Fat embolism • Eisenmenger's syndrome • Speech delay • Cerebral palsy
13.04 Nose 14.03 Psychotic disorders
• Osteomalacia • Osteomyelitis [15.06] • Tetralogy of Fallot (ToF) • Muscular dystrophies (incl Duchenne)
• Rhinosinusitis (acute & chronic) • Features that define psychotic
• Osteochondritis dissecans • Transposition of great arteries (TGA) • Global developmental delay
• Nasal fractures • CSF rhinorrhoea disorders
• Charcot joint • Ebstein's anomaly • Kawasaki disease
• Epistaxis • Nasal cancers • Schizophrenia • Psychosis
• Murmurs and heart sounds in children 15.20-21 Genetic disorders
• Antipsychotics
09.08 Miscellaneous • Down + other trisomies
13.05 Throat
• Joint replacements 15.07-09 GI disorders • Klinefelter • Triple X • Turner
• Sore throat (includes tonsilitis) 14.04 Personality disorders
• Paget's disease of the bone • Abdominal pain • Neuroblastoma [15.21] • Cri du chat • DiGeorge
• Obstructive sleep apnoea • A: Paranoid, schizoid, schizotypal
• Osteoporosis • Coeliac disease • Malnutrition • Williams • Achondroplasia
• Pathological fractures • Stridor – causes • Croup • B: Antisocial, borderline, histrionic, • Diarrhoea & vomiting • Marfan • Noonan • Fragile X
• Acute epiglottitis • Laryngomalacia narcissistic
• Fracture types [15.08] • Appendicitis • Intussusception
• C: Avoidant, dependent, obsessive-
• Pyloric stenosis • Hirschsprung 15.22-23 Neonates
13.06 Throat convulsive
09.09 Malignancies & trauma • Oesophageal atresia • Neonatal sepsis • Seizures
• Dysphonia • Dysphagia
• Osteosarcoma • Chondrosarcoma [15.09] • Congenital diaphragmatic hernia • Respiratory distress • Jaundice
• Head and neck squamous cell 14.05 Eating disorders & miscellaneous
• Ewing's sarcoma • Giant cell tumour • Inguinal hernia • Imperforate anus [15.23] • Necrotising entercolitis
carcinoma (HNSCC) • Bell's palsy psychiatric disorders
• Bone metastases • Trauma surgery • Mid-gut malrotation • Hypoglycaemia • Hypotonia
• Anorexia nervosa • Bulimia nervosa
• Gastroschisis & omphalocele • Minor problems, including skin issues
13.07 Throat • Insomnia • Unexplained symptoms
09.10 Paediatric orthopaedics • Meckel's diverticulum
• Neck lumps • Xerostomia • Electroconvulsive therapy
• Juvenile idiopathic arthritis • Infant feeding problems 15.24 Miscellaneous
• Salivary gland problems
• Transient synovitis of the hip • Non-accidental injury
• Developmental dysplasia • Teeth problems 14.06 Drugs used in psychiatry & 15.10-11 Renal & urological disorders • Screening schedule (perinatal)
• Perthes' • SCFE • Rickets Mental Health Act / Sectioning • UTIs • Nephrotic syndrome • Sudden infant death syndrome
• Paediatric fractures • Acute glomerulonephritis - Brief unexplained resolved event
[15.10] • Phimosis • Cryptorchidism • Vaccination schedule
• Hypospadias • Horseshoe kidney
• Wilms' tumour (nephroblastoma)
• Haemolytic uraemic syndrome

, 14a Substance misuse / Overdose

Cannabis Cocaine Lysergic acid diethylamide (LSD) Overdose / Poisoning Mx

• Aka marijuana, pot, weed, etc • Alkaloid derived from coca plant • Synthetic hallucinogen that has psyche- Benzodiazepines Heparin
• THC is considered the primary • MOA: blocks uptake of dopamine, delic effects – distorts sensory stimuli • Antidote: flumazenil • Protamine sulphate
psychoactive compound, but there are noradrenaline and serotonin and enhances feelings & introspection • Otherwise, supportive Mx
Iron
500+ chemicals in cannabis β-blockers
CNS: seizures, mydriasis (enlarged
pupil), hypertonia, hyperreflexia
CNS: tremors, paresthesias, mydriasis,
hyperreflexia, HA, drowsiness
• If HR<40 or unstable, ☝🏻 atropine ✌🏻 • Desferrioxamine – iron chelating agent

CNS & psych – dependent on individual: glucagon Lead poisoning
• In some individuals: euphoria, relaxa- Psych: agitation, psychosis, Psych: acute reactions ("bad trips"), • Dimecaprol, calcium edetate
tion, sedation, ↑appetite, ↓short-term hallucinations impaired judgment (→injury), euphoria or
Carbon monoxide
memory, ↓concentration, ↓coordination • 100% oxygen
• In others: anxiety, panic attacks, Cardiovascular: ❗️ coronary artery
dysphoria, agitation, psychosis
Cardiovascular: ↑HR, ↑BP, palpitations
• Hyperbaric oxygen
Lithium
• Volume resuscitation (IV fluids)
paranoia, psychosis (incl delusions, spasm (which can cause MI), ↑HR or • Haemodialysis if severe
hallucinations) – esp at higher doses ↓HR, ↑BP, ECG changes (QT prolong- Others: NV, dry mouth, pyrexia
Cyanide
• ± IV sodium bicarbonate
ation, widening), aortic dissection • Hydroxocobalamin (Vitamin B12)
Cardiovascular: ↑HR, ↑BP, chest pain, • Combination of amyl nitrite, sodium
Organophosphates (insecticides)
palpitations, ECG changes Others: ischaemic colitis, hyperthermia,
metabolic acidosis, rhabdomyolysis
Mx: • According to smx
☝🏻
nitrite, and sodium thiosulfate
•☝🏻Atropine ± ?pralidoxime




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Renal: AKI • Agitation: if reassurance fails, benzo
Digoxin
☝🏻
• Psychosis: may require antipsychotics Paracetamol
Muscular: hypertonia, myoclonus, Mx: benzodiazepines • Massive ingestions may require ITU • S/smx: generally unwell, anorexia,
confusion, yellow-green vision,
→ 03.04 (NAC, activated charcoal)
muscle jerking and myalgia • Chest pain: benzos + GTN care (eg intubation & ventilation)
- If MI, do PCI [→01.01] arrythmias, gynaecomastia Salicylates (eg aspirin)
Others: cold extremities, dry mouth, • Toxicity may be precipitated by
• HTN: benzos + sodium nitroprusside
🚩
• S/smx: respiratory alkalosis (2/2
dyspnoea, mydriasis, vomiting and
- DO NOT give β-blockers hypokalaemia (and ↓Mg, ↑Ca, ↑Na, hyperventilation) then metabolic
hypokalaemia, conjunctival injection acidosis), renal failure, MI, hypo-
Opioid misuse acidosis, tinnitus, GI upset/bleeding,
Mx: • Supportive treatment for smx albuminaemia, hypothyroidism seizures, coma
• Psychosocial support for reducing and
controlling use Includes wide range of drugs (morphine,
• Drug-drug interactions: quinidine,
verapamil, diltiazem, spironolactone,
☝🏻 IV bicarbonate (urinary alkalinisation)
- Charcoal if presenting early
• No approved medications Nitrous oxide heroin, codeine, buprenorphine,
methadone, fentanyl, etc)
ciclosporin, thiazides, loop diuretics
• Mx: Digibind, correct potassium levels
✌🏻 Haemodyalisis

• Aka whippets, balloons, laughing gas • MOA: stimulates mu, kappa and delta- and manage arrythmias Tricyclic antidepressants
• MOA: dissociative anaaesthetic, blocks opiod receptors to mediate analgesia ☝🏻 IV bicarbonate – ↓risk of seizures and
the NDMA receptors (↓pain), induces pre- and post-synaptically Ethylene glycol & Methanol
MDMA/Ecstasy euphoria and relaxation + ↑release of •☝🏻 Fomepizole – inhibits alcohol
arrythmias
• If arrythmias develop, DO NOT use
dehydrogenase
• MOA: stimulates the release of
endogenous opioids and dopamine S/smx of opioid misuse
• Pinpoint pupils (miosis), drowsiness,
•✌🏻 Ethanol (if fomepizole not available)
class 1a and 1c antiarrhythmics, avoid
class 3 drugs
dopamine, norepinephrine, serotonin CNS: HA, dizziness, incoordination, ↓RR, rhinorrhea, ± needle track marks • Haemodialysis if refractory to Mx
numbness, tremors Complications Warfarin
CNS: ataxia • Viral infxn 2/2 sharing needles, eg HIV → 10.08 (Vitamin K, PTC, FFP, etc)
Psych: euphoria, altered perceptions,
• Bacterial infxn 2/2 sharing needles, eg
Psych: agitation, anxiety, confusion hallucinations, anxiety, paranoia
infective endocarditis, septic arthritis
Others: hypoxia, hypothermia, ↑HR, ↑BP
Cardiovascular: ↑HR, ↑BP
• VTE • Respi depression, coma, death

Renal: hyponatraemia (2/2 SIADH or Acute Mx Long-term Mx
↑water intake) Long-term effects
•❗️ Vitamin B12 deficiency → subacute
• IV or IM naloxone: 400 mcg, then 800 • ☝🏻
Methadone or buprenorphine
mcg (up to 2 doses at 1min intervals), - Methadone: full agonist of µ-opioid
Others: hyperthermia, rhabdomyolysis combined degeneration of the spinal
cord & anaemia then 2 mg (1 dose), then 4 mg receptor; helps to relieve withdrawal
smx and cravings
• Psychological issues
Mx: supportive treatment - Buprenorphine: partial agonist at µ-
• Direct harm from inhaling gas – lung
• Dantrolene if severe hyperthermia damage, barotrauma, frostbite, etc opioid receptor, antagonist at κ-
receptor; similar effect to metha
Methamphetamine works similarly done and helps ↓ depressive and
dysphoric states
• Compliance monitored by urinalysis
• Detox for 4w in inpatient facility, then
12w in community