Quizzes

Left bundle branch block occurs due to failure of conduction down the left bundle branch, resulting in depolarisation of the left ventricle after the right ventricle.

Sinus arrest is the temporary interruption of sinoatrial node automaticity, that may occur due to intrinsic or extrinsic factors affecting the sinoatrial node.

Alpha thalassaemia is an inherited condition affecting the alpha chains of haemoglobin, resulting in defective haemoglobin synthesis.

Heart failure can be functionally debilitating, though proper management can have a significant positive effect on a patient's mortality risk and quality of life.

Atrial fibrillation is an often insidious condition involving irregular contraction of the ventricles due to fibrillation of the atria. If not properly managed this condition can result in significant complications including cardioembolic stroke.

Hypercalcaemia, or an increased serum calcium concentration >2.60 mmol/L, shortens action potentials which primarily results in early ventricular repolarisation (shortened QT) on ECG.

Left heart failure typically manifests with interstitial and pulmonary oedema, and is most commonly caused by pathology affecting the left ventricular myocardium.

Patients with renal or urological disease may present with a wide variety of symptoms, from alterations in their urine to severe pain or systemic symptoms. Patients with chronic kidney disease pose a wide variety of diagnostic and management issues, which may be further complicated by a history of dialysis or renal transplantation.

Careful history-taking can be used to identify and localise a patient's neurological pathology. By understanding the circumstances and natural history of a neurologic event, it is possible to narrow down the list of likely causes for a patient's presentation.

Haematologic conditions such as leukaemia, lymphoma and the anaemias can be difficult to diagnose. The history is an important first step in this diagnosis, and provides information about the patient's baseline level of function prior to presentation.

A thorough history is valuable in the diagnosis of symptoms such as cough, dyspnoea and chest pain, and can be used to understand a patient's baseline respiratory function.

A thorough history is vital for the diagnosis of patients with issues such as chest pain, heart failure symptoms, palpitations or syncope. The cardiovascular history may also provide important insight into patients' cardiac status, and their risk of future cardiovascular disease in the future.

Gastrointestinal disease can present with a wide variety of symptoms affecting oral intake, the abdomen, bowel motions and the patient's constitution. By taking a thorough history it is possible to narrow down the differential diagnosis and guide clinical examination.

The cranial nerve examination is a complex mix of examination techniques designed to localise pathology to one or more of the twelve cranial nerves. 

Examination of the cardiovascular system is easy to learn but difficult to master. Careful inspection and palpation for peripheral findings, coupled with attentive auscultation of the praecordium, may allow for clinical diagnosis of a patient's cardiac pathology prior to any further investigations.

The urine dipstick is used to assess for a wide variety of renal, urinary tract and systemic pathologies. Using a paper strip containing several reagent-containing squares corresponding to blood, glucose, protein and other analytes, it is possible to gain a significant amount of insight into the cause of a patient's presentation.

The full blood count provides information about a patient's red cells, white cells and platelets. This may be used for several purposing including diagnosing anaemia, monitoring infection or uncovering haematologic disorders.

The arterial blood gas is useful for assessing a patient's oxygenation, and identify acid-base disorders. This section outlines an approach to interpreting ABGs.

X-rays are commonly used in clinical practice to diagnose fractures. Characteristics of the fracture such as the type, deformity and soft tissue / joint involvement are used to guide management.

Haemolysis is the destruction of red blood cells prior to the end of their normal 120-day lifespan, and should be considered in anaemic patients with risk factors or no obvious cause of anaemia. Serum markers may be used to diagnose haemolysis and suggest a cause.

Iron is an important mineral that is involved in red blood cell metabolism and oxygen transport. Iron studies are used to identify iron deficiency or overload states, and are a common test performed as part of the anaemia screen.

The acute phase response is a facet of the innate immune system that occurs in response to infection, trauma or other insults. Certain mediators, known as acute phase reactants, are increased or decreased in the context of acute inflammation. These markers are commonly measured in clinical practice as indicators of acute illness.

Examining urine under the microscopy reveals the presence of cells, crystals, casts and other findings that can suggest the cause of a patient's renal or urinary complaint.

Venipuncture, or phlebotomy, is the process of collecting blood for testing. This section outlines the process for taking blood, with pitfalls and clinical pearls.

Supplemental oxygen is a drug and should be used rationally for specific indications, at the lowest concentration and for the shortest time possible.

The arterial blood gas is useful in acutely unwell patients for assessing acid-base balance and oxygen status. This section outlines the approach for collecting an ABG.

Urinary catheters are used for a wide variety of indications including to relieve urinary retention, measure urine output and collect urine samples.

Intravenous cannulas are inserted every day into hospitalised patients in order to provide IV fluids and medications. IVCs should be inserted using a no-touch technique and assessed regularly in order to avoid complications.

Several manoeuvres and devices can be used to restore patency in patients with a threatened airway. This page outlines the basic interventions that can be provided in these patients.

Apply the tourniquet and feel for a straight, firm, round, elastic, non-pulsatile vein.

Tourniquets are a very useful tool for identifying veins when taking blood or inserting a cannula. However, leaving a tourniquet on for too long can affect the interpretation of blood test results.

Low flow oxygen devices deliver an amount of gas that is less than the patient's total minute ventilation.

Non-invasive ventilation should occur in an appropriate venue with sufficiently trained staff, such as a respiratory ward, HDU or ICU.

Reservoir systems include a reservoir bag, which allows for oxygen to accumulate between breaths. This allows for a higher concentration of oxygen to be inspired.

Invasive ventilation is performed following either intubation or tracheostomy.

High flow devices deliver an amount of gas that is sufficient to meet the patient's total minute ventilation, allowing for delivery of a precise amount of oxygen.

Supplemental oxygen is a drug and should be used rationally for specific indications, at the lowest concentration and for the shortest time possible.

When identifying an artery for insertion of an arterial line, place the index and middle fingers over the desired artery and palpate for the area of maximal impulse.

When looking for an artery, place the index and middle fingers over the desired artery and feel for the area of maximal impulse.

The most common sites for PICC line insertion are the cephalic vein (laterally) or basilic vein (medially) within the antecubital fossa or just above.

24 - paediatrics, fragile veins

Airway manoeuvres are used to relieve upper airway obstruction, and maintain a patent airway.

Airway adjuncts are used to relieve upper airway obstruction.

Avoid burns, infections, oedema or moles when assessing for a site to inject.

Left anterior fascicular block occurs due to failure of conduction down the left anterior fascicle.

Myelodysplasia refers to the presence of morphologically and functionally abnormal blood cells. 

Digoxin is a cardiac glycoside which can be associated with significant toxicity. Certain ECG findings are characteristic.

Nonthyroidal illness (also known as sick euthyroid syndrome) is an adaptive response of the thyroid to acute of chronic illness.

Metabolic acidosis is a process in which an external agent or internal process is causing excessive acidity in a way that is metabolic (i.e. non-respiratory).

Atelectasis refers to alveolar volume loss resulting in collapse of a portion of the lung.

When the right bundle branch and the left bundle branch (or both left-sided fascicles) are blocked, complete heart block occurs. However, several patterns suggest 'incomplete' or 'impending' trifascicular block.

Hypertrophic Cardiomyopathy (HCM) is a disorder that  causes left ventricular hypertrophy (particularly of the interventricular septum), which may be obstructive or non-obstructive.

Ventricular fibrillation is a chaotic ventricular rhythm that is not compatible with haemodynamic stability.

Focal atrial tachycardia is a rapid atrial rhythm originating from a single atrial focus.

Marfan syndrome occurs due to one of many mutations in the gene encoding the extracellular matrix protein fibrillin 1.

Vitamin B12, also known as cobalamin, is an important cofactor in the homocysteine metabolism, haemoglobin synthesis and myelination.

Most hepatitis A assays measure both IgM and IgG levels.

Respiratory acidosis is a process by which reduced effective ventilation results in carbon dioxide retention.

Vitamin B12, also known as cobalamin, is an important cofactor in the homocysteine metabolism, haemoglobin synthesis and myelination.

Hypernatraemia is a serum sodium concentration >145mmol/L. This may be caused by losing water, gaining salt or by redistribution of water within the body.

Down syndrome occurs as a result of trisomy 21, or three copies of chromosome 21.

AV reentrant tachycardias occur when an atrial impulse is conducted through an accessory pathway - either retrogradely following AV conduction (orthodromic) or anterogradely (antidromic).

Atrioventricular (AV) block occurs due to delayed conduction of an impulse between the atria or ventricles, due to intrinsic or extrinsic causes.

Peptic ulcer disease is a common condition where ulcers may form in the stomach or duodenum. This may be as a result of Helicobacter pylori infection, medications, stress or dietary factors.

Hypokalaemia, or a reduced serum potassium concentration of <3.5mmol/L, is associated with hyperpolarisation of cardiac myocytes. If severe, hypokalaemia causes abnormal ventricular automaticity which may result in ventricular arrhythmias.

Multiple myeloma is a plasma cell neoplasm: a condition involving clonal expansion of plasma cells that secrete paraprotein or free light chains.

Hypothyroidism refers to underactivity of the thyroid, with reduced circulating thyroid hormones. This is usually accompanied by typical signs and symptoms of hypothyroidism.

Left posterior fascicular block occurs due to failure of conduction down the left posterior fascicle.

A patent ductus arteriosus is the persistence post birth of a blood vessel connecting the pulmonary artery and the aorta.

Pulmonary embolism is the complete or partial obstruction of the pulmonary arterial system due to an embolus, most commonly as a complication of lower limb deep venous thrombosis.

Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited disorder in which there is fibro-fatty replacement of the right ventricular myocardium. The condition is the second most common of sudden cardiac death in young people.

Right heart failure typically manifests with peripheral overload - resulting in findings such as a raised JVP, peripheral oedema, pleural effusions and ascites.

Atrial flutter is most commonly due to a right atrial macro-reentrant circuit, and has significant crossover with atrial fibrillation in its pathogenesis.

Gastroesophageal reflux disease is a condition in which there is incompetence of the lower oesophageal sphincter, resulting in reflux of gastric acid.

Tuberculosis is the disease caused by the bacteria Mycobacterium tuberculosis, and may affect almost any organ in the body resulting in a wide range of clinical presentations.

Several hereditary conditions are associated with a prolonged QT interval, which increases the risk of life-threatening arrhythmia.

Brugada syndrome is an inherited condition that strongly predisposes to sudden cardiac death. The condition is autosomal dominant in inheritance and involves a loss of function mutation in sodium channels, predominantly affecting the right ventricle.

Pulmonary hypertension refers to a heterogeneous and functionally limiting group of disorders that result in increased pressure within the pulmonary arteries.

Monomorphic VT is a focal or reentrant ventricular rhythm that requires rapid assessment and management, due to its risk of haemodynamic instability and collapse.

Turner syndrome occurs secondary to monosomy X, where all or part of an X chromosome is missing, or due to duplication of the long arm of one X chromosome.

Sinus tachycardia originates from the sinus node and is a physiologic response that occurs due to changes in autonomic regulation - either sympathetic activation or reduction in parasympathetic tone.

Thyrotoxicosis refers to hyperactivity of the thyroid gland, with increased circulating thyroid hormones. This tends to be accompanied by typical signs and symptoms of thyrotoxicosis such as those listed below.

Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac pre-excitation syndrome that occurs due to the presence of an accessory conduction pathway.

Multifocal atrial tachycardia is an irregular rhythm that occurs due to multiple atrial ectopic foci.

Bifascicular block occurs when there is failure of conduction down the right bundle branch as well as either the left anterior or left posterior fascicle.

AV nodal reentrant tachcardia (AVNRT) is the most common type of paroxysmal supraventricular tachycardia (pSVT), and occurs due to a reentrant loop within the AV node.

Chronic obstructive pulmonary disease is a severely functionally limiting condition primarily affecting previous tobacco smokers. Management is targeted to the severity of the disease, and underpinned by smoking cessation.

Beta thalassaemia is an inherited defect in beta globin chains of haemoglobin, resulting in defective haemoglobin synthesis.

Chronic liver disease is a common condition most often caused by alcohol, fatty liver disease or viral hepatitis. This condition can be difficult to diagnose, and the examination is crucial for identifying evidence of portal hypertension, oestrogen excess encephalopathy and other complications of cirrhosis.

Hypophosphataemia refers to a reduced serum phosphate concentration of <0.8 mmol/L. This may occur in the context of reduced intake, compartmental shift or increased excretion of phosphate.

Sinus bradycardia is initiated by the sinus node, and occurs in the setting of reduced automaticity due to either intrinsic or extrinsic causes.

Sinoatrial exit block is a delay in conduction between the sinoatrial node and atrial myocardium.

Hyponatraemia is an imbalance between sodium and water balance in the body, producing a reduced serum sodium concentration of <135 mmol/L.

Sickle cell anaemia is an inherited disorder affecting haemoglobin synthesis, resulting in 'sickling' of red blood cells and resultant complications.

Iron deficiency may occur due to poor intake, poor absorption or loss of iron. The most common complication of iron deficiency is anaemia, which presents as a microcytic, hypochromic anaemia.

Right bundle branch block occurs due to failure of conduction down the right bundle, resulting in slowed right ventricular depolarisation.

Folate, also known as vitamin B9, is an important coenzyme in DNA and amino acid metabolism pathways.

Hypocalcaemia, or a reduced serum calcium concentration >2.15 mmol/L, prolongs action potentials which primarily results in delayed ventricular repolarisation (prolonged QT) on ECG.

Catacholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited disorder that occurs due to mutations in the ryanodine receptor, affecting calcium release from the sarcoplasmic reticulum.

The anaemia of chronic disease is a common condition that is associated with chronic infection, inflammation or malignancy where patients develop a non-specific anaemia.

Sick sinus syndrome (SSS) occurs when the sinus node is not functioning correctly, due to either intrinsic or extrinsic causes.

Transfusion of blood products is often a life-saving intervention, however blood products are associated with multiple infective and non-infective complications that patients should be monitored for.

There are many varied means for achieving contraception, each of which is associated with a risk of unintended pregnancy. This section lists the efficacy of possible contraceptive methods, both for correct and consistent use as well as the use typically seen.

Monoclonal antibodies are named based on standard nomenclature that describes the target and species of origin of the antibody.

Opioids are a group of natural, semi-synthetic and synthetic medications that are used for pain relief. Though opioids can be useful in certain situations, they are associated with adverse effects and a significant risk of dependence.

The patient's past medical history provides the medical context that underpins their current presentation. By understanding the natural history and course of their existing medical conditions, it is possible to predict their risk of complications and narrow down the differential diagnosis of their presenting complaint.

Smoking tobacco places patients at risk of multiple respiratory, cardiovascular and other complications. By understanding our patients' smoking history and overall exposure to tobacco it is possible to estimate this risk and guide them in attempting to quit smoking.

The patient's medication history is a very important aspect of their medical history. Documenting a comprehensive list of a patient's medications allows for correct charting of medications as well of the identification of potential drug interactions or adverse effects.

Alcohol abuse, binging and dependence is very common in the community, and can result in significant acute and chronic complications. A tactful history will aid in understanding the patient's pattern of alcohol intake and their attitude toward alcohol.

Renal transplantation is a complex field and requires a detailed understanding of the patient's physical, psychological and social factors. This page contains basic questions to ask in order to better understand the history of a patient who has had a renal transplant.

An allogeneic stem cell transplant involves depleting a patient's bone marrow using chemotherapy, and then transfusing another (matched) patient's stem cells. This serves purposes of both replacing their haematopoietic cells with normal cells, and providing some degree of graft-vs-disease effect.

An autologous stem cell transplant refers to the process of mobilising and collecting a patient's stem cells, providing chemotherapy to deplete the bone marrow, and then retransfusing their stem cells. This process is less complex and has less potential side effects than an allogeneic stem cell transplant.

Learning clinical medicine can be a daunting task - whether you're just starting out in medical school or getting onto the wards. However, there is now a wide range of clinical medicine apps that can help you to nail down core concepts efficiently and effectively. Apps focused on clinical medicine may offer a variety of features such as guides to history and examination, diagnostic support, interactive clinical cases, and point-of-care tools. With so many options available, it can be difficult to know which apps are most useful.

Flashcards have long been a popular and effective study tool for medical students. Using flashcards as part of your study routine improves retention of medical concepts, particularly if you use spaced repetition to maximise your recall.

Note-taking is a key part of the study process. We use notes to collect, categorise, synthesize and review the large amount of information that we learn in medical school. 

The medical sciences - anatomy, physiology, pathology, pharmacology and many more - are core aspects of medical education that you’ll jump right into when starting medical school. These topics provide a foundation for understanding how the human body works, how diseases affect it and how drugs can interact with human physiology.

Clinical medicine refers to the aspects of medicine that deal directly with the patient - history, examination, investigations, management and prognosis. Clinical medicine is a vital aspect of your medical education, and requires a deep theoretical understanding as well as practical experience. As medical education moves more and more online, a large number of video resources and platforms have become available that focus on clinical medicine. Such videos allow us the opportunity to learn from expert clinicians and educators, and can fast-track learning - particularly if you identify as a ‘visual’ learner.

Let’s be honest - medical school is a busy, challenging and stressful time. Long study sessions are required to cram a massive amount of information into your brain. You’ll have exams and clinical placements to deal with, not to mention the need to find your niche and work toward a residency program. You will likely be expected to perform research during this time as well. It can be difficult to remain calm and maintain a social life - it’s no surprise that medical medical students struggle with burnout and mental health issues.

Navigating the medical world requires not just knowledge, but also the ability to make informed decisions based on complex medical data. There is a vast array of evidence-based formulae, clinical checklists and tools that have been developed and validated to assist us in medical decision-making, to facilitate the best possibleoutcomes for our patients.

Medical school is a busy time with a demanding workload, and it's often challenging to stay organised, manage your time effectively and maintain productivity. Fortunately, there is a massive number of productivity apps that you can leverage to optimise your study time, boost your efficiency, pass exams and keep up with extracurricular activities! 

ECG interpretation is an essential skill for medical students and doctors - these seeminly simple traces are crucial for diagnosing and managing a wide range of cardiac condition. However, ECG interpretation can be challenging - particularly if you’re looking at ECG traces for the first time. It is important to develop a consistent method for approaching ECGs so you don’t miss anything.

Learning is a constant process during medical school, and we will take in a massive amount of information over a few short years. Before diving in and trying to absorb everything, it is useful to have an understanding of how we learn. This can then guide your note-taking, studying and overall approach to university.

We learn a plethora of information during our time at medical school, and we need to make it stick - both for exams, and for our clinical practice in the future. There are several methods for improving your memory and ensuring that you recall information when required.

Studying is a key part of the medical school experience - whether it is alone or in a group. You'll be spending plenty of long days or nights in the books, on your laptop or with a plethora of study tools.

During your time in medical school, you will learn many practical skills that will complement your medical knowledge. Skills such as blood-taking, cannulation, urinary catheterisation and suturing are vital to your everyday job as a junior doctor, and as such it is important to have experience with these procedures before you are unleashed on the wards. 

The amount that you’ll learn in your years of medical school is staggering. Anatomy, physiology, histology, pathology, pharmacology - and that’s before even starting on clinical medicine! You are likely under pressure to master complex concepts in a short amount of time, and it can be challenging to retain everything you’ve learned. Luckily, there are a variety of study tools available to help you remember everything. A key tool for medical students is the humble flashcard.

The patient's body habitus provides insight into a patient's diet and metabolic status as well as their overall risk of cardiovascular and non-cardiovascular complications in the future. While static measures such as body habitus and waist-hip ratio can estimate future risk, unexpected change in weight may suggest active disease.

Power assessment is a key part of the motor examination, and can be used to identify focal or global weakness.

Capillary refill time is a marker of perfusion, and prolonged refill time suggests poor perfusion of the area being examined.

Diabetics often exhibit onycholysis of the nails, and poor diabetic control can lead to increased infection risk and paronychias.

Ulcers, or non-healing open wounds, may occur in the lower limb in the context of arterial disease, venous disease or peripheral neuropathy.

The patient's level of consciousness is an assessment of their wakefulness and responsiveness to external stimuli.

The patient's ability to perform fine motor tasks is an indicator of their ability to perform functional tasks such as writing and cooking.

The biceps, triceps and supinator reflexes are the major motor reflexes of the upper limb. The strength of the reflex, elicited by tapping on the appropriate tendon, can aid in localising a patient's weakness to the upper motor neuron or lower motor neuron.

Assessment of tone is the first part of the motor assessment, and is a good starting point and screening tool in that abnormal tone can immediately suggest an upper motor neuron lesion or Parkinsonism.

Peripheral polyneuropathy presents with motor, sensory or mixed deficits affecting multiple (usually symmetrical) nerve distributions, without a clear pattern of involvement affecting a nerve root or peripheral nerve distribution.

Neurological causes of weakness may be delineated into upper motor neuron (brain, brainstem or spinal cord) or lower motor neuron (nerve root, plexus or peripheral nerve) causes. These two broad groups manifest with specific findings elicitable on examination.

Power assessment is a key part of the motor examination, and can be used to identify focal or global weakness.

Patients with myaesthenic syndromes exhibit muscle fatigability, or the inability to maintain contraction of muscles over time.

Cerebellar pathology produces a specific set of clinical findings that can be readily elicited on clinical examination. Patients with lesions within the cerebellum typically present with a wide-based, unsteady gait with dyscoordination and nystagmus.

Peripheral mononeuropathy is a type of peripheral neuropathy affecting a single peripheral nerve.

Mononeuritis multiplex (also known as mononeuropathy multiplex and multiple mononeuropathy) is a peripheral neuropathy that affects two or more peripheral nerves.

Sensation is a key aspect of the nervous system, and includes many different modalities. By thoroughly assessing the pattern of sensory loss it is possible to characterise and localise a central or peripheral nervous lesion.

Cerebellar pathology produces a specific set of clinical findings that can be readily elicited on clinical examination. Patients with lesions within the cerebellum typically present with a wide-based, unsteady gait with dyscoordination and nystagmus.

Proximal weakness is most commonly a manifestation of muscular pathology, though may also occur in certain neurologic conditions.

Asterixis, also known as hepatic flap or uraemic flap, is an important sign of metabolic encephalopathy that occurs due to dysregulation of the diencephalic motor centers in the brain that regulate innervation of muscles responsible for maintaining position.

In the context of the gastrointestinal examination, it is important to inspect for jaundice as well as bronzing of the skin, as these signs may suggest the presence of liver disease or haemochromatosis.

The patient's body habitus provides insight into a patient's diet and metabolic status as well as their overall risk of cardiovascular and non-cardiovascular complications in the future. While static measures such as body habitus and waist-hip ratio can estimate future risk, unexpected change in weight may suggest active disease.

Examination of the supraclavicular lymph nodes is of particular importance in the gastrointestinal exam, as enlargement of Virchow's node (the left supraclavicular node) may occur due to embolisation of a GI tumour.

Examination of the lips may provide valuable insights into a patient's nutritional and immune status. Localised pathology may also be picked up by examining the lips.

During the gastrointestinal examination, inspection of the hands is important as it may reveal signs of chronic liver disease or anaemia.

Examination of the skin of the abdomen can reveal significant clues regarding the presence of portal hypertension, previous abdominal distension and previous abdominal procedures.

Palpation of the liver can be used to assess the liver span and consistency, as well as for tenderness over the liver or gallbladder.

During the gastrointestinal examination, inspection of the skin can reveal skin changes that can point toward a specific GI or hepatobiliary pathology.

During the gastrointestinal examination the flanks are often ignored in favour of the abdomen, however there is valuable information to be gained from inspecting and palpating the flanks routinely.

Peritonism refers to inflammation of the peritoneum, which suggests acute abdominal pathology that should be rapidly diagnosed and treated.

There are several pathognomonic and diagnostic signs to be found on inspection of the eyes.

Patients with hepatic encephalopathy in the setting of acute or chronic liver disease may be confused or have a reduced level of consciousness.

Auscultation for the character of the bowel sounds may reveal evidence of hyperactive or underactive bowels.

Consent - ask for the patient's consent to perform a digital rectal examination. Explain what to expect.

Nail signs such as leukonychia and koilonychia are useful external signs of gastrointestinal or hepatobiliary pathology.

The patient's breath may reveal information about their oral hygiene, or suggest the presence of metabolic disease.

Ask the patient to indicate where on the abdomen is painful. Superficially palpate the nine segments of the abdomen to elicit tenderness and assess for masses. If no tenderness is present, palpate more deeply.

Ascites (fluid within the peritoneal cavity) may be caused by many conditions - particularly cirrhosis, heart failure and hypoalbuminaemia. Ascites can be difficult to diagnose on examination, however shifting dullness and the fluid wave can assist in assessing for abdominal fluid.

Appendicitis is an emergency that should be rapidly diagnosed and treated, however this is often difficult clinically - especially in female patients. Signs such as tenderness in McBurney's point as well as the Rosving sign can suggest acute appendicitis.

It is possible to identify an abdominal aortic aneurysm by clinical examination; the aneurysm may be visible on inspection or become apparent on palpation.

The arms can provide a lot of information regarding a patient's liver disease; spider naevi and Bier spots are signs of chronic liver disease, purpura may suggest an underlying coagulopathy and scratch marks suggest an obstructive cause of liver disease.

Inspection of the chest during the gastrointestinal exam can reveal disease specific rashes, as well as signs of cirrhosis such as spider naevi and loss of normal chest hair distribution.

The kidneys are often missed during examination of the abdomen, though the presence of ballotable or tender kidneys can provide a significant amount of information about the cause of their presentation.

Chronic liver disease is a common condition most often caused by alcohol, fatty liver disease or viral hepatitis. This condition can be difficult to diagnose, and the examination is crucial for identifying evidence of portal hypertension, oestrogen excess encephalopathy and other complications of cirrhosis.

Inspecting the patient's skin for evidence of pallor, plethora or jaundice provide information regarding the presence of anaemia, polycythaemia or haemolysis.

The nails can reveal signs suggestive of haematologic disease. While pallor of the nail bed is a sign of anaemia, koilonychia suggests potential iron deficiency.

The axillary lymph nodes drain from the neck, chest wall, breast and upper limbs. Enlargement of these lymph nodes can suggest pathology affecting these regions or a systemic process that is infective, inflammatory or malignant.

Splenomegaly is present if the spleen is palpable. This may be a sign of portal hypertension due to liver, vascular or pulmonary disease; splenomegaly also occurs with certain infections and haematologic malignancies.

Lymphadenopathy refers to enlargement of the lymph nodes, which is often painful. It is important to carefully assess for lymph node enlargement, as this suggests infective, inflammatory or malignant pathology.

Assessing a patient's gait can be a useful screening tool for identifying pathology affecting mobility. Impairment of gait may be due to pain, weakness, deformity or joint instability.

The term nystagmus is used mainly to refer to jerk nystagmus, abnormal rhythmic eye movements that may be a sign of cerebellar disease.

Cerebellar pathology produces a specific set of clinical findings that can be readily elicited on clinical examination. Patients with lesions within the cerebellum typically present with a wide-based, unsteady gait with dyscoordination and nystagmus.

The finger-nose test is used to assess coordinated, target-driven movement of the upper limb; this is lost in the context of cerebellar pathology.

Ataxic dysarthria is also know as 'scanning speech' or 'drunken speech'.

Agrammatism is the incorrect use of grammar.

Repetition of simple sounds is useful for identifying weakness of the muscles involved in articulation

Also known as Wernicke's dysphasia.

Also known as Broca's dysphasia.

Listen to each of the cardiac areas for normal / pathologic heart sounds, a pericardial rub and for the presence of a murmur.

Blood pressure is a measure of the arterial pressure during systole and diastole; this may also be used to calculate the mean arterial pressure. Low blood pressure can result in poor organ perfusion, which high blood pressure puts patients at risk of cardiac, cerebrovascular, retinal and renal complications.

Human body temperature is a balance of heat production and heat dissipation, and tends to vary very little within an individual. Temperature is regulated by the hypothalamus, which drives thermoregulatory processes that include vasoconstriction / vasodilation, sweating and shivering.

Decreased skin turgor is a sign of dehydration.

The respiratory rate is an important vital sign that is an early marker of deterioration.

Auscultate the abdomen for bowel sounds. First listen in one quadrant and if an abnormality is discovered then listen in each of the three other quadrants.

Palpate the radial pulse for at least thirty seconds and determine whether the beats fall in time or are irregular.

Look for swelling of the lower limbs; apply pressure to the anterior aspect of the tibia for fifteen seconds and then release to assess for pitting oedema.

The oxygen saturation is a reflection of the percentage of haemoglobin that is bound to oxygen.

The Glasgow Coma Scale (GCS) is a 15-point scale indicating level of consciousness.

The heart rate is an invaluable vital sign that is commonly used as part of the assessment of a patient's haemodynamic state.

The blood sugar should be tested in every acutely unwell person, mainly because hypoglycaemia is an underdiagnosed cause of reduced consciousness, and can mimic stroke symptoms.

There are multiple clinical signs that suggest hypoperfusion, or shock.

The presence of respiratory distress indicates that the patient has significant pathology (respiratory or otherwise) that requires immediate assessment and management.

Human body temperature is a balance of heat production and heat dissipation, and tends to vary very little within an individual. Temperature is regulated by the hypothalamus, which drives thermoregulatory processes that include vasoconstriction / vasodilation, sweating and shivering.

The oxygen saturation is a reflection of the percentage of haemoglobin that is bound to oxygen.

Blood pressure is a measure of the arterial pressure during systole and diastole; this may also be used to calculate the mean arterial pressure. Low blood pressure can result in poor organ perfusion, which high blood pressure puts patients at risk of cardiac, cerebrovascular, retinal and renal complications.

The heart rate is an invaluable vital sign that is commonly used as part of the assessment of a patient's haemodynamic state.

The residual volume is the volume left in the lungs after a maximal expiration.

While spirometric values such as FEV₁ and FVC can be suggestive of restrictive lung disease,  a reduced total lung capacity (TLC) of 80% predicted is diagnostic.

Lung volumes are measures of the amount of gas present within the lungs during each phase of the respiratory cycle. These volumes can be used clinically to diagnose respiratory disease.

The volume-time graph is a graphical representation of spirometry results.

Flow-volume loops are produced by asking the patient to breath out then in as forcefully as possible, and may reveal a characteristic pattern suggestive of restrictive, obstructive or other pulmonary disease.

Diffusing Capacity of Lung for Carbon Monoxide (DLCO) is a measure of the efficiency of lung gas transfer. This test is used to further characterise a respiratory defect following spirometry and lung volume testing, to provide evidence supporting a specific respiratory pathology.

The total lung capacity refers to the volume of air within the lungs after a maximal inspiration.

The functional residual capacity (FRC) is the volume left in the lungs after passive expiration, i.e. without use of accessory muscles.

Correct spirometry technique is vital for collecting an accurate sample, and poor compliance with the test may result in a false positive or false negative result.

Coagulation testing is useful for assessing patients' ability to clot; for investigating the cause of a patient's coagulopathy; and for therapeutic monitoring of certain anticoagulant medications. The classical coagulation profile includes the prothrombin time and activated partial thromboplastin time, though other tests may be performed as required.

The thrombin time (TT) is not routinely performed as part of a coagulation screen.

Fibrin D-dimer is a measurement of cross-linked fibrin degradation products, generally indicative of clot formation with active clot breakdown.

The prothrombin time (PT) and international normalised ratio (INR) are measures of the extrinsic coagulation pathway. 

Mixing studies are used to determine the cause of prolonged PT/INR and/or APTT.

Analysis of cerebrospinal fluid is used to identify infections affecting the central nervous system. CSF testing (particularly of proteins) also be used in the diagnosis of demyelinating diseases such as Guillain-Barre syndrome and multiple sclerosis.

The colour and consistency of a patient's urine can provide significant information regarding the cause of their urinary complaint. 

The urine specific gravity is a measure of the amount of solute compared to water. Pure water has a specific gravity of 1.000.

Urine pH is a measure of the acid content in urine. This often reflects the acidity of serum, however there are certain cases (e.g. renal tubular acidosis) in which the urine pH does not match the serum pH.

There are many ways in which a urine sample can be collected. The method of collection depends on the type of test performed, and certain patient factors.

Leukocyte esterase (LE) is an enzyme produced by white blood cells. If leukocyte esterase is present in urine then this is indicative of an increase in leukocytes in urine, also known as pyuria. 

First degree sinoatrial exit block is due to delayed transmission of an impulse from the sinoatrial node, and is not detectable on ECG.

Type II second degree AV block occurs when there is an intermittently missed QRS complex due to failure of conduction through the AV node.

Also known as Wenkebach SA exit block.

Type I second degree AV block occurs when there is progressively delayed AV transmission eventually resulting in a missed QRS complex.

Sinoatrial exit block is a delay in conduction between the sinoatrial node and atrial myocardium.

Atrioventricular (AV) block occurs due to delayed conduction of an impulse between the atria or ventricles, due to intrinsic or extrinsic causes.

In advanced or 'high-grade' second degree heart block, multiple beats are blocked and it is difficult to distinguish between Mobitz type I and II.

Complete atrioventricular block represents complete failure of conduction between the atria and ventricles.

First degree AV block indicates delayed conduction between the atria and the ventricles.

In third degree sinoatrial exit block, there is complete failure of transmission to the atria - this is indistinguishable from sinus arrest on ECG.

Type II second degree sinoatrial exit block occurs when there is an intermittently missed P wave due to failure of conduction to the atrial myocardium.

Reticulocytes are non-nucleated immature red blood cells. They are not normally present in the circulation in high numbers, though may be seen if the bone marrow is producing large numbers of red cells.

Neutrophils are the most prevalent white blood cells in circulation. They are a type of polymorphonuclear (PMN) leukocyte, with 3-5 nuclear lobes and fine granules within the cytoplasm.

Eosinophils are granulocytes with a bilobed nucleus, blue cytoplasm and orange-red cytoplasmic granules

Anaemia is a very common condition that may occur in the context of reduced red blood cell production, increased red blood cell destruction, or red blood cell loss.

Beta thalassaemia is an inherited defect in beta globin chains of haemoglobin, resulting in defective haemoglobin synthesis.

The mean cell volume (MCV) is a measure of the average volume of a red blood cell.

Lymphocytes are small leukocytes with a large nucleus, though they may be larger with a low nuclear : cytoplasmic ratio if they are reactive.

Red cell distribution width (RDW) is the amount of variation in red blood cell size. Cells may be relatively uniform in size and have a low RDW, or have a wide range of sizes and have a high RDW.

Platelets are very small non-nucleated cells that derive from fragmentation of megakaryocytes. They play an important role in clot formation and haemostasis.

Reflects the number of circulating red blood cells.

Alpha thalassaemia is an inherited condition affecting the alpha chains of haemoglobin, resulting in defective haemoglobin synthesis.

Leukocytes represent a variety of cells derived from myeloid and lymphoid lineages that perform a variety of immune functions.

Basophils are relatively uncommon white blood cells. Morphologically they are granulocytes with large bluish (basophilic) granules. 

Haemoglobin is a tetrameric protein found within red blood cells, composed of a haem (iron-containing) molecule, two alpha and two beta globin subunits.

Monocytes are large leukocytes of myeloid origin with blue-grey ground glass cytoplasm and horseshoe-shaped nucleus.

The haematocrit, also known as the packed cell volume (PCV), is the volume of red blood cells as a percentage of total blood volume.

The anaemia of chronic disease is a common condition that is associated with chronic infection, inflammation or malignancy where patients develop a non-specific anaemia.

Sickle cell anaemia is an inherited disorder affecting haemoglobin synthesis, resulting in 'sickling' of red blood cells and resultant complications.

The PaO₂ on an arterial blood is only relevant for assessing for hypoxia when the patient is on room air.  If they are receiving supplemental oxygen this will artificially increase the PaO₂ which may appear normal.

The bicarbonate level is significantly influenced by acid-base buffering system, and can by affected by the presence of a respiratory process. The base excess is an indicator of a metabolic process that is independent of this buffering system.

The serum pH is a measure of the acidity of alkalinity of the blood, based on an inverse log of the hydrogen ion concentration. This can be used in conjunction with the HCO₃ and PaCO₂ to determine whether there is an acid-base disorder present.

Serum lactate is an important marker of prognosis and resolution in many critical illnesses.

Metabolic acidosis is a process in which an external agent or internal process is causing excessive acidity in a way that is metabolic (i.e. non-respiratory).

Left heart failure typically manifests with interstitial and pulmonary oedema, and is most commonly caused by pathology affecting the left ventricular myocardium.

When auscultating the heart, systematically listen to each of the cardiac regions for a heart sounds, murmurs or a rub. If added heart sounds or a murmur are noted, determine which area the extra sound is loudest in, and then perform manoeuvres to further isolate the added sound.

In the context of the cardiovascular examination, inspecting the mouth can reveal information about the patient's dentition, reveal evidence of hypoxia or suggest the presence of a hereditary or congenital disorder.

Skin changes and overall poor skin condition of the lower limb may occur due to soft tissue disease; arterial, venous or lymphatic insufficiency; loss of afferent nerve supply or simply poor self-care.

Palpating the praecordium for palpable heaves and thrills may provide valuable clues regarding the patient's cardiac pathology.

The main priorities in auscultating the lung fields during the cardiovascular examination are to assess for evidence of pulmonary oedema or a pleural effusion.

Listening for cardiac murmurs in different positions as well as in inspiration and expiration can be used to narrow down the potential cause for the murmur.

Right heart failure typically manifests with peripheral overload - resulting in findings such as a raised JVP, peripheral oedema, pleural effusions and ascites.

Aortic stenosis manifests as an ejection (mid) systolic murmur best heard over the base of the heart, associated with narrowed pulse pressure and reduced intensity of S2.

Blood pressure is a measure of the arterial pressure during systole and diastole; this may also be used to calculate the mean arterial pressure. Low blood pressure can result in poor organ perfusion, which high blood pressure puts patients at risk of cardiac, cerebrovascular, retinal and renal complications.

Oedema or swelling of the lower limb occurs due to fluid accumulation, and may be either pitting or non-pitting.

In the context of the cardiovascular examination, inspection of the skin can provide important information about the patient's peripheral perfusion and oxygenation.

Aortic regurgitation manifests as a descrescendo diastolic murmur, heard loudest on sitting forward on expiration.

Mitral regurgitation examines as a pan-systolic murmur best heard over the apex with a volume-loaded heart, soft S1 and present S3 with or without evidence of left ventricular failure.

Right ventricular failure may manifest as hepatomegaly, splenomegaly and ascites; demonstrating these findings can help to clinch the clinical diagnosis. An important target for palpation in the cardiovascular examination is also the abdominal aorta, as an undiagnosed aneurysm may be fatal in the future.

Scars on the chest can suggest past surgery, trauma, burns or healed skin conditions.

There are several pathognomonic and diagnostic signs to be found on inspection of the eyes.

Whether a delay occurs between two radial arteries or between the radial artery and femoral artery depends on whether the lesion is proximal or distal to the branching of the left subclavian.

Palpation of the rate and rhythm of the radial pulse is a useful screening tool for the presence of cardiac arrhythmias.

Down syndrome occurs as a result of trisomy 21, or three copies of chromosome 21.

Hypertrophic Cardiomyopathy (HCM) is a disorder that  causes left ventricular hypertrophy (particularly of the interventricular septum), which may be obstructive or non-obstructive.

Pulmonary hypertension refers to a heterogeneous and functionally limiting group of disorders that result in increased pressure within the pulmonary arteries.

Mitral stenosis manifests as a low-pitched, mid-diastolic murmur best heard in the apex in the left lateral position.

Turner syndrome occurs secondary to monosomy X, where all or part of an X chromosome is missing, or due to duplication of the long arm of one X chromosome.

When performing a cardiovascular examination, always ask to perform fundoscopy. This may reveal signs of diabetic or hypertensive nephropathy.

Pulmonary stenosis manifests as an ejection systolic murmur heard loudest over the pulmonary area on inspiration, and may be associated with a split S2 and S4.

The second heart sound (S2) indicates closure of the aortic (A2) and pulmonary (P2) valves.

A patent ductus arteriosus is the persistence post birth of a blood vessel connecting the pulmonary artery and the aorta.

Tricuspid regurgitation manifests as a pan-systolic murmur best heard at the left lower sternal edge on inspiration.

Dynamic manoeuvres are useful for distinguishing between hypertrophic cardiomyopathy and aortic stenosis in the presence of a systolic murmur.

The waist circumference and waist-hip ratio are markers of central obesity, with evidence to support their use in estimating cardiovascular risk.

Postural hypotension may be present in a patient with Parkinson's disease, as they may develop autonomic neuropathy.

The mask-like facies seen in Parkinsonism is also referred to as hypomimia, and occurs as a manifestation of bradykinesia and hypokinesia.

Cerebellar pathology produces a specific set of clinical findings that can be readily elicited on clinical examination. Patients with lesions within the cerebellum typically present with a wide-based, unsteady gait with dyscoordination and nystagmus.

Patients with myaesthenic syndromes exhibit muscle fatigability, or the inability to maintain contraction of muscles over time.

The patellar and ankle reflexes are the major motor reflexes of the lower limb. The strength of the reflex, elicited by tapping on the appropriate tendon, can aid in localising a patient's weakness to the upper motor neuron or lower motor neuron.

Peripheral mononeuropathy is a type of peripheral neuropathy affecting a single peripheral nerve.

Pain sensation is conveyed via the spinothalamic pathway, and mapping of this can be used to determine the distribution of a patient's sensory loss.

Power assessment is a key part of the motor examination, and can be used to identify focal or global weakness.

Assessment of tone is the first part of the motor assessment, and is a good starting point and screening tool in that abnormal tone can immediately suggest an upper motor neuron lesion or Parkinsonism.

Assessing a patient's gait can be a useful screening tool for identifying pathology affecting mobility. Impairment of gait may be due to pain, weakness, deformity or joint instability.

Mononeuritis multiplex (also known as mononeuropathy multiplex and multiple mononeuropathy) is a peripheral neuropathy that affects two or more peripheral nerves.

Proprioception is the sense of position and movement of the body in the absence of vision.

Soft touch is transmitted via multiple sensory pathways, and can be used as a screening tool to assess for sensory loss.

Cerebellar pathology produces a specific set of clinical findings that can be readily elicited on clinical examination. Patients with lesions within the cerebellum typically present with a wide-based, unsteady gait with dyscoordination and nystagmus.

Mixed upper and motor neuron signs can occur rarely, and there are few conditions which are able to cause both. The major differential would be the presence of two separate pathologies.

Proximal weakness is most commonly a manifestation of muscular pathology, though may also occur in certain neurologic conditions.

Distal weakness is more commonly a manifestation of neuropathy, though may also occur in certain muscular conditions.

Peripheral polyneuropathy presents with motor, sensory or mixed deficits affecting multiple (usually symmetrical) nerve distributions, without a clear pattern of involvement affecting a nerve root or peripheral nerve distribution.

Assessing a patient's gait can be a useful screening tool for identifying pathology affecting mobility. Impairment of gait may be due to pain, weakness, deformity or joint instability.

Assessing a patient's gait can be a useful screening tool for identifying pathology affecting mobility. Impairment of gait may be due to pain, weakness, deformity or joint instability.

Language assessment is a crucial element of the mental status examination, providing insight into a patient's cognitive and communicative abilities. Key aspects of evaluating language include comprehension, word repetition, object naming, reading, and writing.

Listen to the patient speak on order to assess for a potential speech disorder. Listen to the rate of speech, volume, quantity, fluency and tonality.

The patient's level of arousal is an assessment of how awake and active they are. Patients may be hyperactive or display psychomotor agitation, or conversely show evidence of psychomotor retardation or even stupor.

Thought content refers to the subject matter, themes, and ideas that an individual expresses during a mental status examination or clinical interview. Assessing thought content is essential for understanding the individual's current mental state, identifying potential psychiatric conditions, and formulating an appropriate treatment plan.

Attention and concentration are essential cognitive functions that enable individuals to focus on tasks and process information. Key components of assessment include distractibility and digit span.

Hallucinations are abnormal sensory symptoms that may manifest as visual, auditory, tactile or extraordinary disturbances. Hallucinations may be caused by organic disease or psychiatric disorders.

Assessing a patient's gait can be a useful screening tool for identifying pathology affecting mobility. Impairment of gait may be due to pain, weakness, deformity or joint instability.

The oropharynx performs both respiratory and digestive functions, and allows for passage of air into the lower airways. Oropharyngeal examination can reveal pathology of the mucosa or tonsils.

Tactile fremitus is an assessment of the low-frequency vibration of a patient's chest, which is used as an indirect measure of the amount of air and density of tissue present within the lungs.

Breath sounds are normally heard on auscultating the chest, and their intensity and character can be used to assess for the presence of pulmonary pathology.

There are several pathognomonic and diagnostic signs to be found on inspection of the eyes.

Watch the patient's pattern of breathing, taking into account the rate, regularity and depth of respiration. Specific patterns of breathing may suggest an underlying pathology.

Chest wall deformities may be an external sign of an underlying disease, or may themselves cause significant restrictive pulmonary disease.

Vocal resonance is an assessment of the density of lung tissue, performed by auscultating the chest and asking the patient to speak. Increased vocal resonance suggests increased density, while reduced vocal resonance suggests an increase in the amount of air present.

The nasal cavity warms, filters and adds moisture to inhaled air. By inspecting the nasal cavity it may be possible to assess for obstruction impeding respiration, inflammation or other pathology.

Carefully inspect the patient's fingers, looking for discolouration of the nail beds and distal digits.

Chest percussion is used to assess the resonance of the lungs as a surrogate for the amount of air in the alveoli.

The character of a patient's cough suggest of the cause of their respiratory illness.

The oxygen saturation is a reflection of the percentage of haemoglobin that is bound to oxygen.

Adventitious sounds are abnormal sounds heard on the chest in inspiration or expiration, in addition to the normal breath sounds.

Several clinical signs allow for the clinical suspicion of chronic obstructive pulmonary disease, which can then be confirmed with pulmonary function testing.

Skin changes and overall poor skin condition of the lower limb may occur due to soft tissue disease; arterial, venous or lymphatic insufficiency; loss of afferent nerve supply or simply poor self-care.

In diabetics, always ask to perform fundoscopy. This may provide valuable information regarding the presence of diabetic retinopathy.

Inspection of the colour of the lower limbs in diabetics can suggest the presence of arterial insufficiency, venous insufficiency or infection.

Folate, also known as vitamin B9, is an important coenzyme in DNA and amino acid metabolism pathways.

Vitamin B12, also known as cobalamin, is an important cofactor in the homocysteine metabolism, haemoglobin synthesis and myelination.

A copper-containing protein produced by the liver that binds ~90% of plasma copper.

Lactate dehydrogenase (LDH) is an enzyme present in the cytoplasm of most cells that catalyses the conversion of lactate to pyruvate.

AST and ALT are enzymes that are commonly used in conjunction to identify active hepatocellular injury.

Bilirubin is a breakdown product of haem that is conjugated in hepatocytes with glucuronic acid and then excreted in bile.

A nitrogen-containing compound that is normally cleared by the liver.

Alkaline phosphatase (ALP) is an enzyme normally found in liver, bone, intestine, late placenta and kidney. Its elevation is often used to diagnose cholestatic liver dysfunction, though it may also be elevated in bone disease as well as certain other conditions.

AST and ALT are enzymes that are commonly used in conjunction to identify active hepatocellular injury.

Gamma glutamyl transferase (GGT) is an enzyme found in hepatocytes and biliary epithelial cells, and is a sensitive yet non-specific marker of hepatocyte damage.

Albumin is a group of serum proteins produced by the liver that maintain oncotic pressure and transport certain hydrophobic compounds.

The Weber classification is used to class lateral malleolar fractures, based on the location of the fibular fracture - below, at the level of or above the distal tibiofibular joint. The Weber classification indicates the stability of the fracture, and is used to guide treatment.

Monoclonal antibodies are named based on standard nomenclature that describes the target and species of origin of the antibody.

Taking notes is a key part of many students' learning process. If done correctly, they allow you to filter, process and actively learn information, and are a very useful tool when studying. Notes can be returned to multiple times or turned into questions, flashcards or other learning tools.

Patients with asthma are at risk of exacerbations, which may cause significant morbidity or mortality. By understanding the natural history of their airways disease it is possible to create a management plan that prevents complications in the future.

Smoking tobacco places patients at risk of multiple respiratory, cardiovascular and other complications. By understanding our patients' smoking history and overall exposure to tobacco it is possible to estimate this risk and guide them in attempting to quit smoking.

Tuberculosis is the disease caused by the bacteria Mycobacterium tuberculosis, and may affect almost any organ in the body resulting in a wide range of clinical presentations. In patients with a history of tuberculosis, it is important to understand the risk factors, natural history and past treatment of disease.

Chronic obstructive pulmonary disease is a severely functionally limiting condition primarily affecting previous tobacco smokers. Management is targeted to the severity of the disease, and underpinned by smoking cessation.

Heart failure can be functionally debilitating, though proper management can have a significant positive effect on a patient's mortality risk and quality of life.

Smoking tobacco places patients at risk of multiple respiratory, cardiovascular and other complications. By understanding our patients' smoking history and overall exposure to tobacco it is possible to estimate this risk and guide them in attempting to quit smoking.

Alcohol abuse, binging and dependence is very common in the community, and can result in significant acute and chronic complications.

Patients with stable ischaemic heart disease are at great risk of cardiovascular death in the future. By taking a thorough history and understanding the natural history of their disease it is possible to estimate this risk, and identify ways to prevent future complications.

Atrial fibrillation is an often insidious condition involving irregular contraction of the ventricles due to fibrillation of the atria. If not properly managed this condition can result in significant complications including cardioembolic stroke.

Dyspnoea, or shortness of beath, refers to the feeling of 'not getting enough air' or 'air hunger'. Thi may herald cardiorespiratory disease, though may also occur in the context of many other acute and chronic conditions.

Diabetes is a common disease, and is often poorly controlled. When assessing a patient with diabetes it is important to get an idea of how long they have had diabetes, what microvascular and macrovascular complications they have had, how good their control is, and whether they have had any hypoglycaemic episodes.

Inflammatory bowel disease (IBD) is a heterogeneous autoimmune condition that encompasses Crohn's disease and ulcerative colitis. Flares of IBD should be diagnosed and treated promptly.

Smoking tobacco places patients at risk of multiple respiratory, cardiovascular and other complications. By understanding our patients' smoking history and overall exposure to tobacco it is possible to estimate this risk and guide them in attempting to quit smoking.

A detailed travel history can help to define a patient's risk of certain infectious diseases. A patient presenting with fevers after recent travel to a developing country may have a much wider range of potential infections than a patient who resides in a developed country and has not recently travelled.

Gastroesophageal reflux disease is a condition in which there is incompetence of the lower oesophageal sphincter, resulting in reflux of gastric acid.

Alcohol abuse, binging and dependence is very common in the community, and can result in significant acute and chronic complications.

Peptic ulcer disease is a common condition where ulcers may form in the stomach or duodenum. This may be as a result of Helicobacter pylori infection, medications, stress or dietary factors.

Scleroderma is also known as systemic sclerosis.

The term nystagmus is used mainly to refer to jerk nystagmus, abnormal rhythmic eye movements that may occur due to peripheral nervous system, central nervous system or vestibular pathology.

Pseudobulbar palsy is a neurologic syndrome that occurs due to an upper motor neuron lesion affecting cranial nerves IX, X and XII.

The glabellar reflex is a primitive reflex - normally present in infants and absent in adults. In patients with frontal lobe damage or or Parkinsonism, 'frontal release' signs such as glabellar, grasp, suck, snout and palmomental reflexes will be present.