01 CARDIOVASCULAR 01.08 03 GASTROINTESTINAL MEDICINE 04 NEUROLOGY 04.13
• Deep vein thrombosis (DVT) & GENERAL SURGERY • Spinal disorders
01.01 • Pulmonary embolism (PE) 04.01 Headaches - Brown-sequard syndrome
• Acute coronary syndrome • Infective endocarditis 03.01 - Subacute combined degeneration
- STEMI, NSTEMI, unstable angina • Pericarditis • Gallbladder disorders 04.02 Neurodegenerative disorders - Friedrich's ataxia
- ECG cardiac territories • Constructive pericarditis - Acute cholecystitis • Dementias • Delirium - Anterior spinal artery occlusion
• Hypertension - Ascending cholangitis - Syringomyelia
- Antihypertensives 01.09 - PSC & PBC 04.03 Neurodegenerative – movement - Tabes dorsalis
• Cardiac tamponade • Liver cancers – hepatocellular disorders, incl Parkinson's, • Neurofibromatosis
01.02 • Antihypertensives (continued) carcinoma & cholangiocarcinoma Huntington's and motor neuron disease • Tuberous sclerosis
• Ischaemic heart disease • Other drugs (adenosine, amiodarone,
• Atrial fibrillation anti-platelets) 03.02 04.04 Infections 04.14
• Adult life support • DLVA rules on cardiovascular disorders • Alcohol-related liver disease • Bacterial & viral meningitis • Restless legs syndrome
• Wilson’s disease • Encephalitis • Abnormal involuntary movements
01.03 01.10 Vascular surgery • Haemochromatosis • Brain & spinal epidural abscesses • DLVA rules for neurological disorders
• Ventricular fibrillation • Peripheral arterial disease • Aphasia DDx
• Ventricular tachycardia • Aortic aneurysm 03.03 04.05 Infections • Wernicke's encephalopathy
• Bradycardia: peri-arrest • Aortic dissection • Hepatitis A, B, C, E • Specific infxns: toxoplasmosis, primary • Charcot-Marie-Tooth syndrome
© quackquackmed.com
• Tachycardia: peri-arrest • Varicose veins • Autoimmune hepatitis CNS lymphoma, cryptococcosis, PML
• Pacemakers • Lower leg ulcers • Non-alcoholic fatty liver disease • Glasgow Coma Scale (GCS) 05 OPHTHALMOLOGY
• Cardiac enzymes • Ankle-brachial pressure index (ABPI) • CSF interpretation table
03.04
05.01 Blindness
01.04 • Paracetamol overdose 04.06 Epilepsy / seizures
• Retinal detachment
• Electrocardiogram (ECG) 02 RESPIRATORY • Disorders of the pancreas • Seizures, incl status epilepticus • Retinal artery & vein occlusion
• Arrhythmias, including Wolff-Parkinson- - Acute & chronic pancreatitis • Psychogenic non-epileptic seizures
• Retinal migraine
White syndrome, Wellen's syndrome, 02.01 - Pancreatic cancer • Anticonvulsants / antiepileptics
• Giant cell arteritis • Optic neuritis
junctional escape rhythm • Asthma • COPD - Neuroendocrine tumours • Papilloedema
• Respiratory failure • Small bowel bacterial overgrowth 04.07 • Vitreous haemorrhage
01.05 syndrome • Syncope
• DDx – loss of colour vision
• Long QT syndrome 02.02 • Brain tumours
• DDx – blurred vision
• Short QT syndrome • Lung cancers 03.05 • IBD – Crohn's & UC • Brain lesions localisation (smx)
• Brugada syndrome • Mesothelioma • Coeliac disease 05.02 Red eye
• Atrial flutter • Bronchiectasis 04.08 Strokes
• Glaucoma – closed-angle
• Shock (÷ different types) • Idiopathic pulmonary fibrosis 03.06 • TIA & ischaemic stroke
• Anterior uveitis
• Appendicitis - Classifications by arteries, smx • Episcleritis & scleritis
01.06 02.03 • Small & large bowel obstructions • Haemorrhagic stroke • Keratitis
• Valve disorders – mitral stenosis, mitral • Pneumonia – CAP + HAP • Hernias
• Common meds in ophthalmology
regurg, aortic stenosis, aortic regurg - In immunocompromised patients 04.09 Brain bleeds • Conjunctivitis (on 05.03)
• Murmurs (DDx) • Tuberculosis 03.07 • Subarachnoid haemorrhage
• Rheumatic fever • Anal fissures & fistulae, haemorrhoids • Subdural & extradural haemorrhage
05.03 External eye problems
• Prosthetic heart valves 02.04 • Colorectal cancer • Cerebral aneurysm
• Blepharitis • Blepharospasm
• Pulses (different types, eg pulsus • Sarcoidosis
• Ectropion & entropion
paradoxus) • Pneumothorax 03.08 04.10 Weakness DDx • Pingucela • Hordeolum / stye
• Heart sounds • Pleural effusions • GORD, gastritis, peptic ulcer disease
• Ophthalmic shingles
• Cystic fibrosis • Oesophageal conditions 04.11 Neuroinflammatory disorders
01.07 • Oxygen therapy • ERCP, TIPS • Multiple sclerosis 05.04 Age-related conditions
• Hypertrophic obstructive • Guillain Barre syndrome • Glaucoma – open-angle
cardiomyopathy (HoCM / HCM) 03.09 – Upper & lower GI bleeding • Chronic inflammatory demyelinating
• Age-related macular degeneration
• Arrhythmogenic right ventricular (poly)neuropathy
• Cataracts
cardiomyopathy (ARVC) 03.10 • Myasthenia gravis • Diabetic neuropathy
• Dilated cardiomyopathy • Irritable bowel syndrome (IBS)
• Orbital & periorbital celluitis
• Chronic heart failure • Diverticular disease 04.12
• Ischaemic bowel disease • CT head – indications 05.05 • Thyroid eye disease
• Abdominal pain DDx • Head injury • Strabismus / squints
• Intracranial pressure – ↑ &↓
• Pupil problems
3a – Primer on anaesthetics
• Tropical eye diseases
• General anaesthesia & airway adjuncts
• Regiona/local anaesthesia
• Post-op nausea & vomiting
, Sudden blindness Causes of sudden, sustained vision loss Transient Vitreous haemorrhage
Retinal detachment vision loss
Painless Painful • 2/2 proliferative diabetic retinopathy
• Anterior ischaemic optic • Acute glaucoma • Amaurosis fugax / >50% (→ 04.04), posterior vitreous
D: detachment of the neuroretina from the neuropathy • Severe corneal pathology TIA Papilloedema detachment or ocular trauma
underlying epithelial pigment layer • Retinal artery occlusion • Severe uveitis (anterior, • Migraine • S/smx: acute/subacute course
• Retinal vein occlusion panuveitis) • Papilloedema D: optic disc swelling that is caused by - painless vision loss / haze
• Macular degeneration (wet) • Endophthalmitis causing transient
R: DM (2/2 traction by the vitreous humour increased intracranial pressure - ± visual field defects if severe
• Retinal detachment • Optic neuritis visual obscuration
causing breaks in retina), myopia (> -8), haemorrhage
↑age, previous surgery for cataracts • Vitreous detachment ↳ 2/2 ↑ICP - red hue in vision
• Severe uveitis A: • space-occupying lesions: neoplastic,
(accelerates posterior vitreous - floaters, dark spots
vascular
© quackquackmed.com
detachment), eye trauma • Ix: fundoscopy (haemorrhage), slit-lamp
• malignant hypertension
• idiopathic intracranial hypertension exam (RBC in anterior vitreous), US (to
S/smx Anterior ischaemic optic Retinal vein occlusion r/o retinal tear or detachment),
• hydrocephalus • hypercapnia
• new onset floaters or flashes neuropathy (AION) fluorescein angiography (to look for
• hypoparathyroidism, hypocalcaemia
- pigment cells enter the vitreous space D: an interruption of the normal venous neovascularisation), orbital CT (if open
• vitamin A toxicity
(floaters) or traction on the retina 90-95% non-arteritic drainage from the retinal tissue globe injury)
(flashes) Retinal artery occlusion • central vein (= CRVO)
• sudden onset, painless and progressive S/smx • almost always bilateral
• one of the vein branches (= BRVO)
• venous engorgement (usually 1st sign)
visual field loss • D: an interruption of the normal • loss of venous pulsation (although
R: ↑age (>65), HTN, cardiovascular
- "curtain falling"; also, shadow progress- arterial supply to the retinal tissue ≡ DDx of loss of colour vision
ing to the centre of the visual field from many normal patients do not have
stroke 2/2 thromboembolism from disease, glaucoma, polycythemia, DM, (non-congenital)
normal pulsation)
hyperlipidaemia, smoking, ↑BMI
the periphery atherosclerosis or arteritis (eg GCA) • Optic neuritis / MS
• if the macula is involved, central visual • blurring of the optic disc margin
• S/smx • Optic nerve ischaemia
• elevation of optic disc
acuity and visual outcomes become much • Glaucoma
worse
- sudden, painless unilateral visual loss S/smx: • sudden, painless, ↓visual acuity, • loss of the optic cup
- relative afferent pupillary defect • ARMD
• peripheral visual fields ↓ - 'cherry red' spot on a pale retina
usually unilaterally • Paton's lines: concentric/radial retinal
• Retina pigmentosa
• central acuity ↓ to hand movements if the • On fundoscopy lines cascading from the optic disc
• Mx: tx underlying conditions • Thyroid eye disease
macula is detached - widespread hyperaemia
• DM (diabetic retinopathy)
• RAPD if the optic nerve is involved
- possible to attempt intra-arterial
thrombolysis but mixed results
↳ in the retina proximal to the occlusion, • Drugs (chloroquine, hydroxychloro-
• On fundoscopy the affected venous system is tortuous quine, phenytoin, sildenafil, digoxin)
• Poor prognosis :(
- red reflex lost and dilated
Optic neuritis
- retinal folds - pale, opaque or wrinkled - severe retinal haemorrhages –
5% arteritic 'stormy sunset' DDx of blurred vision
- if break is small, may appear normal D: inflammation of the optic nerve
- retinal oedema • Refractive error (eg myopia)
Giant cell arteritis → most commonly idiopathic, a primary • Cataracts
Ix: visual acuity, slit-lamp exam demyelinating disease in isolation or 2/2
Mx: - conservative tx (watch and wait) • Retinal detachment
+ US of the eye if media opacity prevents • AION from GCA is primarily due to
- manage co-morbidities, ↓risk
multiple sclerosis • ARMD
visualisation of fundus occlusion of the posterior ciliary
- monitor for complications • Acute angle closure glaucoma
+ CT/MRI if injury suspected artery (branch of ophth artery)
• macular oedema: anti-VEGF injections S/smx • Optic neuritis
• unilat ↓ in visual acuity over h-d
• temp visual loss = amaurosis fugax • Amaurosis fugax
Mx: same-day ref to eye A&E • permanent visual loss is the most • retinal neovascularisation: laser
• posterior vitreous detachment without photocoagulation • poor discrimination of colours, 'red
feared complication of temporal
break/tear: laser tx to ↓risk of retinal desaturation' Ax: • Snellen chart
arteritis and may develop suddenly - Use pinhole occluders (if blurring
detachment • pain worse on eye movement
• diplopia may also result from the improves, then likely cause is
- PVD = vitreous detaches from retina Retinal migraine • RAPD • central scotoma
involvement of any part of the refractive error)
- if separates incompletely, can cause oculomotor system (e.g. CN)
traction and pull on retina → ↑risk of Ix: MRI brain, orbits with contrast • Visual fields • Fundoscopy
D: transient monocular scotoma or loss of
retina detachment • + HA (85%), jaw claudication (65%), vision that is accompanied or followed by a
• pneumatic retinopexy (surgeon positions temporal artery tenderness, PMR headache within 60 minutes of visual Mx: high dose steroids, taper in 4-6w
an air bubble to push the retina back into features (50%), systemic smx symptoms onset
place, then freezes it there) P: if > 3 white-matter lesions, 5-year risk
• vitrectomy – for significant vitreous S/smx: • flashing lights of developing multiple sclerosis is ~50%
traction See also 11.09 for Ocular trauma • scintillating scotoma with fortification
spectrum (expanding zigzag lines)
photo from Wikipedia
05.01 Ophthalmology – Blindness
• Deep vein thrombosis (DVT) & GENERAL SURGERY • Spinal disorders
01.01 • Pulmonary embolism (PE) 04.01 Headaches - Brown-sequard syndrome
• Acute coronary syndrome • Infective endocarditis 03.01 - Subacute combined degeneration
- STEMI, NSTEMI, unstable angina • Pericarditis • Gallbladder disorders 04.02 Neurodegenerative disorders - Friedrich's ataxia
- ECG cardiac territories • Constructive pericarditis - Acute cholecystitis • Dementias • Delirium - Anterior spinal artery occlusion
• Hypertension - Ascending cholangitis - Syringomyelia
- Antihypertensives 01.09 - PSC & PBC 04.03 Neurodegenerative – movement - Tabes dorsalis
• Cardiac tamponade • Liver cancers – hepatocellular disorders, incl Parkinson's, • Neurofibromatosis
01.02 • Antihypertensives (continued) carcinoma & cholangiocarcinoma Huntington's and motor neuron disease • Tuberous sclerosis
• Ischaemic heart disease • Other drugs (adenosine, amiodarone,
• Atrial fibrillation anti-platelets) 03.02 04.04 Infections 04.14
• Adult life support • DLVA rules on cardiovascular disorders • Alcohol-related liver disease • Bacterial & viral meningitis • Restless legs syndrome
• Wilson’s disease • Encephalitis • Abnormal involuntary movements
01.03 01.10 Vascular surgery • Haemochromatosis • Brain & spinal epidural abscesses • DLVA rules for neurological disorders
• Ventricular fibrillation • Peripheral arterial disease • Aphasia DDx
• Ventricular tachycardia • Aortic aneurysm 03.03 04.05 Infections • Wernicke's encephalopathy
• Bradycardia: peri-arrest • Aortic dissection • Hepatitis A, B, C, E • Specific infxns: toxoplasmosis, primary • Charcot-Marie-Tooth syndrome
© quackquackmed.com
• Tachycardia: peri-arrest • Varicose veins • Autoimmune hepatitis CNS lymphoma, cryptococcosis, PML
• Pacemakers • Lower leg ulcers • Non-alcoholic fatty liver disease • Glasgow Coma Scale (GCS) 05 OPHTHALMOLOGY
• Cardiac enzymes • Ankle-brachial pressure index (ABPI) • CSF interpretation table
03.04
05.01 Blindness
01.04 • Paracetamol overdose 04.06 Epilepsy / seizures
• Retinal detachment
• Electrocardiogram (ECG) 02 RESPIRATORY • Disorders of the pancreas • Seizures, incl status epilepticus • Retinal artery & vein occlusion
• Arrhythmias, including Wolff-Parkinson- - Acute & chronic pancreatitis • Psychogenic non-epileptic seizures
• Retinal migraine
White syndrome, Wellen's syndrome, 02.01 - Pancreatic cancer • Anticonvulsants / antiepileptics
• Giant cell arteritis • Optic neuritis
junctional escape rhythm • Asthma • COPD - Neuroendocrine tumours • Papilloedema
• Respiratory failure • Small bowel bacterial overgrowth 04.07 • Vitreous haemorrhage
01.05 syndrome • Syncope
• DDx – loss of colour vision
• Long QT syndrome 02.02 • Brain tumours
• DDx – blurred vision
• Short QT syndrome • Lung cancers 03.05 • IBD – Crohn's & UC • Brain lesions localisation (smx)
• Brugada syndrome • Mesothelioma • Coeliac disease 05.02 Red eye
• Atrial flutter • Bronchiectasis 04.08 Strokes
• Glaucoma – closed-angle
• Shock (÷ different types) • Idiopathic pulmonary fibrosis 03.06 • TIA & ischaemic stroke
• Anterior uveitis
• Appendicitis - Classifications by arteries, smx • Episcleritis & scleritis
01.06 02.03 • Small & large bowel obstructions • Haemorrhagic stroke • Keratitis
• Valve disorders – mitral stenosis, mitral • Pneumonia – CAP + HAP • Hernias
• Common meds in ophthalmology
regurg, aortic stenosis, aortic regurg - In immunocompromised patients 04.09 Brain bleeds • Conjunctivitis (on 05.03)
• Murmurs (DDx) • Tuberculosis 03.07 • Subarachnoid haemorrhage
• Rheumatic fever • Anal fissures & fistulae, haemorrhoids • Subdural & extradural haemorrhage
05.03 External eye problems
• Prosthetic heart valves 02.04 • Colorectal cancer • Cerebral aneurysm
• Blepharitis • Blepharospasm
• Pulses (different types, eg pulsus • Sarcoidosis
• Ectropion & entropion
paradoxus) • Pneumothorax 03.08 04.10 Weakness DDx • Pingucela • Hordeolum / stye
• Heart sounds • Pleural effusions • GORD, gastritis, peptic ulcer disease
• Ophthalmic shingles
• Cystic fibrosis • Oesophageal conditions 04.11 Neuroinflammatory disorders
01.07 • Oxygen therapy • ERCP, TIPS • Multiple sclerosis 05.04 Age-related conditions
• Hypertrophic obstructive • Guillain Barre syndrome • Glaucoma – open-angle
cardiomyopathy (HoCM / HCM) 03.09 – Upper & lower GI bleeding • Chronic inflammatory demyelinating
• Age-related macular degeneration
• Arrhythmogenic right ventricular (poly)neuropathy
• Cataracts
cardiomyopathy (ARVC) 03.10 • Myasthenia gravis • Diabetic neuropathy
• Dilated cardiomyopathy • Irritable bowel syndrome (IBS)
• Orbital & periorbital celluitis
• Chronic heart failure • Diverticular disease 04.12
• Ischaemic bowel disease • CT head – indications 05.05 • Thyroid eye disease
• Abdominal pain DDx • Head injury • Strabismus / squints
• Intracranial pressure – ↑ &↓
• Pupil problems
3a – Primer on anaesthetics
• Tropical eye diseases
• General anaesthesia & airway adjuncts
• Regiona/local anaesthesia
• Post-op nausea & vomiting
, Sudden blindness Causes of sudden, sustained vision loss Transient Vitreous haemorrhage
Retinal detachment vision loss
Painless Painful • 2/2 proliferative diabetic retinopathy
• Anterior ischaemic optic • Acute glaucoma • Amaurosis fugax / >50% (→ 04.04), posterior vitreous
D: detachment of the neuroretina from the neuropathy • Severe corneal pathology TIA Papilloedema detachment or ocular trauma
underlying epithelial pigment layer • Retinal artery occlusion • Severe uveitis (anterior, • Migraine • S/smx: acute/subacute course
• Retinal vein occlusion panuveitis) • Papilloedema D: optic disc swelling that is caused by - painless vision loss / haze
• Macular degeneration (wet) • Endophthalmitis causing transient
R: DM (2/2 traction by the vitreous humour increased intracranial pressure - ± visual field defects if severe
• Retinal detachment • Optic neuritis visual obscuration
causing breaks in retina), myopia (> -8), haemorrhage
↑age, previous surgery for cataracts • Vitreous detachment ↳ 2/2 ↑ICP - red hue in vision
• Severe uveitis A: • space-occupying lesions: neoplastic,
(accelerates posterior vitreous - floaters, dark spots
vascular
© quackquackmed.com
detachment), eye trauma • Ix: fundoscopy (haemorrhage), slit-lamp
• malignant hypertension
• idiopathic intracranial hypertension exam (RBC in anterior vitreous), US (to
S/smx Anterior ischaemic optic Retinal vein occlusion r/o retinal tear or detachment),
• hydrocephalus • hypercapnia
• new onset floaters or flashes neuropathy (AION) fluorescein angiography (to look for
• hypoparathyroidism, hypocalcaemia
- pigment cells enter the vitreous space D: an interruption of the normal venous neovascularisation), orbital CT (if open
• vitamin A toxicity
(floaters) or traction on the retina 90-95% non-arteritic drainage from the retinal tissue globe injury)
(flashes) Retinal artery occlusion • central vein (= CRVO)
• sudden onset, painless and progressive S/smx • almost always bilateral
• one of the vein branches (= BRVO)
• venous engorgement (usually 1st sign)
visual field loss • D: an interruption of the normal • loss of venous pulsation (although
R: ↑age (>65), HTN, cardiovascular
- "curtain falling"; also, shadow progress- arterial supply to the retinal tissue ≡ DDx of loss of colour vision
ing to the centre of the visual field from many normal patients do not have
stroke 2/2 thromboembolism from disease, glaucoma, polycythemia, DM, (non-congenital)
normal pulsation)
hyperlipidaemia, smoking, ↑BMI
the periphery atherosclerosis or arteritis (eg GCA) • Optic neuritis / MS
• if the macula is involved, central visual • blurring of the optic disc margin
• S/smx • Optic nerve ischaemia
• elevation of optic disc
acuity and visual outcomes become much • Glaucoma
worse
- sudden, painless unilateral visual loss S/smx: • sudden, painless, ↓visual acuity, • loss of the optic cup
- relative afferent pupillary defect • ARMD
• peripheral visual fields ↓ - 'cherry red' spot on a pale retina
usually unilaterally • Paton's lines: concentric/radial retinal
• Retina pigmentosa
• central acuity ↓ to hand movements if the • On fundoscopy lines cascading from the optic disc
• Mx: tx underlying conditions • Thyroid eye disease
macula is detached - widespread hyperaemia
• DM (diabetic retinopathy)
• RAPD if the optic nerve is involved
- possible to attempt intra-arterial
thrombolysis but mixed results
↳ in the retina proximal to the occlusion, • Drugs (chloroquine, hydroxychloro-
• On fundoscopy the affected venous system is tortuous quine, phenytoin, sildenafil, digoxin)
• Poor prognosis :(
- red reflex lost and dilated
Optic neuritis
- retinal folds - pale, opaque or wrinkled - severe retinal haemorrhages –
5% arteritic 'stormy sunset' DDx of blurred vision
- if break is small, may appear normal D: inflammation of the optic nerve
- retinal oedema • Refractive error (eg myopia)
Giant cell arteritis → most commonly idiopathic, a primary • Cataracts
Ix: visual acuity, slit-lamp exam demyelinating disease in isolation or 2/2
Mx: - conservative tx (watch and wait) • Retinal detachment
+ US of the eye if media opacity prevents • AION from GCA is primarily due to
- manage co-morbidities, ↓risk
multiple sclerosis • ARMD
visualisation of fundus occlusion of the posterior ciliary
- monitor for complications • Acute angle closure glaucoma
+ CT/MRI if injury suspected artery (branch of ophth artery)
• macular oedema: anti-VEGF injections S/smx • Optic neuritis
• unilat ↓ in visual acuity over h-d
• temp visual loss = amaurosis fugax • Amaurosis fugax
Mx: same-day ref to eye A&E • permanent visual loss is the most • retinal neovascularisation: laser
• posterior vitreous detachment without photocoagulation • poor discrimination of colours, 'red
feared complication of temporal
break/tear: laser tx to ↓risk of retinal desaturation' Ax: • Snellen chart
arteritis and may develop suddenly - Use pinhole occluders (if blurring
detachment • pain worse on eye movement
• diplopia may also result from the improves, then likely cause is
- PVD = vitreous detaches from retina Retinal migraine • RAPD • central scotoma
involvement of any part of the refractive error)
- if separates incompletely, can cause oculomotor system (e.g. CN)
traction and pull on retina → ↑risk of Ix: MRI brain, orbits with contrast • Visual fields • Fundoscopy
D: transient monocular scotoma or loss of
retina detachment • + HA (85%), jaw claudication (65%), vision that is accompanied or followed by a
• pneumatic retinopexy (surgeon positions temporal artery tenderness, PMR headache within 60 minutes of visual Mx: high dose steroids, taper in 4-6w
an air bubble to push the retina back into features (50%), systemic smx symptoms onset
place, then freezes it there) P: if > 3 white-matter lesions, 5-year risk
• vitrectomy – for significant vitreous S/smx: • flashing lights of developing multiple sclerosis is ~50%
traction See also 11.09 for Ocular trauma • scintillating scotoma with fortification
spectrum (expanding zigzag lines)
photo from Wikipedia
05.01 Ophthalmology – Blindness
