Our Medical Articles

Abdominal Pain

When you are on call you will often get a bleep about a patient in abdominal pain. Abdominal pain can be a bit of a...

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Abdominal X-rays

The advantages of AXRs are far less radiation to patients & that they’re logistically easy to organise out of hours. Unlike CTs they do not...

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Acute Asthma

1. You are unlikely to be expected to make decisions about long term asthma management, therefore, focus your efforts on learning how to deal with...

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Acute COPD exacerbation

As an FY1, you are unlikely to be expected to make decisions about long term COPD management therefore focus your efforts on learning how to...

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Acute Kidney Injury

AKI is very common affecting around 20% of inpatients & it is important to recognise promptly and correctly to avoid complications. In this article, we...

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Acute Stroke

Whilst on call or in A&E you may be asked to assess somebody who is suspected to have had a stroke. This is a very...

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Acutely Swollen Joint

There are three joint pain calls you might receive whilst you’re on call or on the wards. We have split them into three articles (with...

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Alcohol Withdrawal

Suddenly stopping alcohol intake in patients who have been drinking heavily for prolonged periods is dangerous and can lead to severe withdrawal. Delirium tremens can...

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Anaemia

Perhaps the most common blood test you will review daily will be the FBC (full blood count). You will commonly see a low haemoglobin &...

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Anticoagulation

For new doctors, prescribing anticoagulants can be daunting. A few simple rules can make this easier. Ensure you use your local guidelines in the first...

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Applying to Geriatric Medicine

Within Geriatric Medicine you are always working as part of a multidisciplinary team and have lots of close interactions with other allied health professionals. In...

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Arthralgia

There are three joint pain calls you might receive whilst you’re on call or on the wards. We have split them into three articles (with...

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Ascitic Tap and Drain

Ascitic aspiration (tap) is routinely performed for every patient admitted with ascites to identify the underlying cause. The most urgent reason to do it would...

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Atrial Fibrillation

AF is the most common sustained cardiac arrhythmia you will encounter. In this article, we focus on the management of it. Identification of atrial fibrillation...

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Back Pain

In this article, we cover the assessment and management of back pain. This article forms part of a series on different types of joint pain...

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Chest Pain

As a junior doctor, you will also often assess patients complaining of chest pain in the acute admissions setting and on the wards. Reviewing a...

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Chronic Pancreatitis

Chronic pancreatitis is characterised by repeated pancreatic inflammation. This leads to the destruction of pancreatic tissue leading to irreversible loss of both endocrine and exocrine...

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CNS Infections

A CNS infection is one that involves the central nervous system in some way. This includes the meninges, cerebellum, ventricular system and spinal cord, among...

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Common Skin Issues

Dermatology is a vast topic that junior doctors often find daunting. Do read our article on describing skin lesions. Fortunately, there are only a handful...

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Constipation

Constipation is one of the most common complaints in hospital, especially on the geriatric wards.Failure to treat constipation can lead to longer hospital stays and...

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Deep Vein Thrombosis

A deep vein thrombosis (DVT) is a condition in which a blood clot (thrombosis) forms within a deep vein and can be provoked or unprovoked...

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Delirium

Acute confusion, otherwise known as delirium, is very common in hospitals – 20-30% on medical wards and between 10% and 50% of those that have...

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Dementia

As an FY1 in hospital, you will come across lots of patients with dementia. They often have multiple problems requiring longer hospital stays, higher morbidity...

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Describing Skin Lesions

It is quite common for you to need to describe rashes for documentation purposes, to senior colleagues or to refer to various specialties including dermatology....

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Diabetic Foot Ulcers

Introduction: Diabetic foot ulcerations are a significant complication of diabetes and often precede minor (below the ankle) or major (above or below the knee) amputation....

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Dialysis Patients

There is an increasing prevalence of end-stage kidney disease and it is therefore likely that you will be involved in the care of dialysis patients....

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Diarrhoea

Diarrhoea is a very common complaint and may be the reason for a patient’s admission, or develop as a new problem during an inpatient stay....

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Discharge Planning

It is important for junior doctors to understand what the discharge planning process involves so you can have an active role in multidisciplinary team meetings....

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DKA and HHS

You’ve found a patient is hyperglycaemic & either they are ketotic or have significant hyperglycaemia (>30mmol/L) and so you suspect DKA or HHS respectively. Diabetic Ketoacidosis (DKA)...

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Falls

As an F1, you will quite frequently get bleeped to review a patient who has had a fall on the ward, particularly if you are...

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Fever in the Returning Traveller

COVID-19 aside, international travel is easier and more prevalent than ever before, and illness associated with travel is common. Although most infections contracted overseas are...

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Fluid Balance

Almost every patient admitted to hospital receives IV fluids at some point in their journey. However, the body manages this, without the need for careful...

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Frailty Syndromes

What is frailty? In simple terms, frail patients lack physiological reserves, and it takes more for them to bounce back after an insult. Contrary to...

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Haematuria

You will regularly see patients with blood in their urine, most often picked up incidentally on a urine drip. Your initial assessment should aim to...

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Headache

Acute headache is a common complaint that you’ll see whilst on the wards or in the acute take. Although most causes of headache are completely...

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Heart Failure

Heart Failure is not a diagnosis in itself, rather a collection of symptoms that require investigation to find the underlying cause. Heart failure syndrome is...

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HIV

Human Immunodeficiency Virus (HIV) is a species of lentivirus that can infect humans and subsequently causes Acquired Immunodeficiency Syndrome (AIDS). At the end of 2018,...

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Hypercalcaemia

Serum calcium concentration is tightly regulated between 2.1-2.6mmol/L. Severe hypercalcaemia is a life-threatening electrolyte emergency requiring prompt recognition and urgent treatment.  Do check out our...

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Hyperglycaemia

Hyperglycaemia is something you will encounter frequently. In this article, we focus on how to approach hyperglycaemia and identify diabetic emergencies. If your patient is...

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Hypernatraemia

Hypernatraemia is defined as a sodium above 145 mmol/L with severe being more than 150 mmol/L. Usually, hypernatraemia is a “not enough water” problem –...

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Hypertension in Hospital

As a junior doctor, you will often be called about patients with raised blood pressure (BP) in secondary care. This differs from chronic hypertension in...

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Hypocalcaemia

Acute hypocalcaemia that is severe (<1.9 mmol/L) or symptomatic can be life-threatening and necessitates urgent treatment. It is often initially picked up when a patient...

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Hypoglycaemia

In this article, we provide a quick overview of how to treat and investigate the cause of patients with hypoglycaemia. Definition In diabetics, <4 mmol/L...

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Hyponatraemia

Hyponatraemia (serum Sodium <135 mmol/L) is one of the most common electrolyte abnormalities you will see and so a systematic approach to identifying the underlying...

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Hypophosphataemia

The UK Medicines Information group have provided excellent guidance on how to replace phosphate. Clinical features Generally asymptomatic if mild Can cause many systemic features...

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Hypoxia

As an FY1, you will be called to review hypoxic ward patients. Here we discuss common causes of generalised hypoxia and not focal hypoxia/ischaemia such...

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Infective Endocarditis

Infective endocarditis (IE) is relatively rare in the UK. However, delays in diagnosis and treatment can lead to serious complications, and be fatal. Thus, it...

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Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) refers to a relapsing and remitting inflammatory disorder of the gastrointestinal (GI) tract, which may be accompanied by extra-GI manifestations. ContentsWhat...

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Interpreting Blood Films

A blood film looks at our three cell types (erythrocytes, leukocytes & platelets) under a microscope to identify any abnormalities to give visual clues regarding...

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Interpreting CSF Results

Understanding how to do an LP and interpret the results is an essential skill for most doctors, particularly those planning on a hospital-based specialty. You...

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Jaundice & Deranged LFTs

As the FY1, you will see patients with liver dysfunction either on the take or deranged LFTs when you are reviewing bloods. A focused approach...

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Lumbar Puncture

A lumbar puncture uses a fine needle inserted between the vertebrae in the lower back to take samples of CSF from the subarachnoid space. The...

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Managing patients with CKD

In whichever specialty you work, you will encounter large numbers of patients with chronic kidney disease and this will impact many components of their care....

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Medications in Diabetes

In this article, we’ll cover the treatments used in Diabetes Mellitus. We’ll look at key things you need to know about each therapy, when you...

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Microbiology Discussions

A lot of your time as an FY1 will be spent on the phone to various other specialities. You’ll come across patients with infections in...

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Nasogastric Tubes

NG tubes are passed from the nose to the stomach. Depending on the material, they can stay between 2 to 6 weeks. However, they quite...

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Nausea & Vomiting

You will frequently get calls regarding nausea & vomiting: many patients present with it or develop it because of their diagnosis or treatment. You must...

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Neutropenic Sepsis

Please read an overview of the management of sepsis before reading this article. ContentsDefinitionHigh-risk patientsSigns and symptomsInvestigations and ManagementConfirming the diagnosisScoring systemsFollow upReferences Definition Neutropenic...

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Non-Invasive Ventilation

Non-invasive ventilation is a way of providing ventilatory support to patients in respiratory failure without using an invasive airway device (e.g. ET tube or tracheostomy...

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Notifiable Diseases

As a junior doctor, it is your statutory duty as a medical professional to alert the local public health team to a new or suspected...

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Nutrition

Nutrition is an important aspect of a patient’s health and is overlooked during medical school as you are learning exciting pathophysiology of weird and wonderful...

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Opiate overdose & toxicity

You will likely encounter an opiate overdose due to the prevalence of opiates for recreational use, in those who have chronic pain or mental health...

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Orthogeriatrics

Fragility fractures in the elderly As a junior doctor on call, in geriatrics or in orthopaedics – you will frequently look after frail and elderly...

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Palliative Care

Dying is a natural process and unfortunately, something that we all come across in our daily jobs, including whilst on call. Despite this, very little...

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Palpitations

Palpitations can be described as the sensation of an abnormally received heartbeat. It can be rapid, irregular, forceful or just an unusual awareness. Palpitations are...

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Pancreatitis

Pancreatitis is a condition characterised by the inflammation of the pancreas. These patients are usually managed conservatively. Your aim is to try to find out...

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Paracetamol Overdose

As an FY1, you will encounter these either during clerking shifts or you may look after them on the ward. As it is quite common,...

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Parkinson’s Disease

In this article, we will present several common scenarios involving Parkinson’s disease (PD) that F1 doctors might face on the ward or on call. We...

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PEG Tubes

PEG tubes are used as long term feeding options (and medication administration) for those in whom NG tubes are unsuitable or too short term. Indications...

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Pneumonia

In this article, we will focus on more practical concerns when managing a patient with pneumonia for junior doctors. Covid-19 is not discussed here.  History...

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Pneumothorax

A pneumothorax is defined as the abnormal collection of air between the visceral and parietal space of the lung i.e. the pleural space. It typically...

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Prescribing analgesia

When assessing pain, ensure you begin by taking a history to characterise the pain as neuropathic pain, inflammatory pain and oncological pain all respond to...

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Pulmonary embolism

A pulmonary embolism (PE) is a blocked blood vessel in your lungs, most often due to a blood clot. It is common and can be...

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Pulmonary Oedema

RCEM has published some clear and comprehensive information which is well worth a read. Below we include a very quick summary as a refresher. Causes: Impaired...

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Reduced GCS

As a doctor, you will frequently be called for a drowsy patient. They can vary from confused to completely unconscious. The Glasgow Coma Scale can...

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Refeeding Syndrome

Defined as a collection of electrolyte abnormalities associated with a massive intracellular shift of electrolytes. Associated with aggressive nutritional rehabilitation of malnourished patients in e.g....

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Seizures

Scenario: You are bleeped by one of the staff nurses to review a patient on the orthopaedic ward who is “jerking in her bed”. She...

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Sepsis

Sepsis is an infection with evidence of organ dysfunction. Septic shock is when a patient with sepsis is hypotensive despite appropriate fluid resuscitation. ContentsIntroductionHigh-risk criteriaSepsis...

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Sickle Cell Disease

Sickle cell diseases are a disorder of haemoglobin affecting red blood cells. This autosomal recessive, single gene defect results in the formation of HbS (sickle...

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Stomas

The word stoma comes from Greek to mean “an opening”. There are many types which are formed for a variety of reasons, but here we...

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Sudden Visual Loss

Loss of vision can be a scary symptom for patients to experience, and a scary presentation for doctors to manage! You will not be expected...

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Superior Vena Cava Syndrome

SVC syndrome is an oncological emergency. There is obstruction of the superior vena cava resulting in stagnating blood and a high risk of thrombosis. Due...

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Suturing

Sutures are placed to aid with wound healing following a traumatic laceration or surgical incision and to promote haemostasis. In this article, we will look...

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Syncope

From the Greek: Syn: together & kopein: to cut - referring to a block in blood supply from the body to the brain, most often...

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Thyroid Disease

As a junior, you will frequently see patients who potentially have thyroid dysfunction. The problem is these patients often present with quite generalised symptoms and...

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Transfusion

In this article, we will go through the three most common scenarios you will encounter. These are: (1) Does this patient need a transfusion? (2)...

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Understanding Types of Homes

Patients may live or be discharged to a wide variety of social care settings and understanding these is important for any foundation doctor. This can...

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Upper GI bleed

These patients have the potential to become haemodynamically unstable extremely quickly; try to avoid delays in reviewing them. In-hospital mortality is around 10%. If they...

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Urinary Tract Infections

Urinary tract infections (UTIs) in adults are extremely common in both primary and secondary care and it is inevitable that you will be diagnosing and...

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Vertigo

Vertigo is described as an “abnormal sensation of motion. It can occur in the absence of motion or when motion is sensed inaccurately”1 Assessing a...

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