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Medical Topics

Transient Loss of Consciousness

Transient loss of consciousness is ( TLoC ) is defined as an apparent loss of consciousness with an abrupt onset , a short duration and a spontaneous and complete recovery (Gert van Dikl et al 2009 )

Consciousness is defined as the ability to maintain awareness of the self and of the environment Syncope is the form of TLoC which is caused by cerebral hypoperfusion characterized by a rapid onset ,

Dyspepsia – assessment

Dyspepsia origin from Greek word dyspeptos : dys- bad , pepsis -digestion A definition proposed by Crean et al more than two decades ago is still considered one of the most comprehensive and it describes dyspepsia as an ” episodic recurrent or persistent abdominal pain or discomfort or any other symptoms referable to the upper alimentary tract ,

Inguinal hernia

Inguinal hernia is a bulge of the peritoneum through a congenital or acquired defect in the muscular and fascial structures of the abdominal wall ( Conze et al. 2001 )

A hernia is described as a protrusion of a sac of peritonium , often containing intestine or other
 abdominal contents from its proper cavity through a weakness in the abdominal wall.

Falls assessment

A fall is defined as an event which causes a person to, unintentionally, rest on the ground or lower level , and is not a result of a major intrinsic event ( such as stroke ) or overwhelming hazard.

How common –Falls and fall-related injuries -happen more often with advancing age Falls are not inevitable part of ageing Over 1/3rd of people over age 65 fall each year and the proportion increases to 50 % by age 80 Each year abut 30% to 40 % of people aged 65 yrs and older who live in the community fall Falls are neither purely accidental nor inevitable –>


Polycythemia is an abnormal increase in red blood cell mass. Causes of polycythemia include a true increase in RBCs -Primary bone marrow problem or Secondary to other disorder ie a physiologic response to hypoxia or to a deranged and increased erythropoetin production.

Primary bone marrow problem –Polycythemia vera ( PV) Exon 12 mutations.

Low Back Pain

Pain in lumbosacral area of the back between the bottom of the
 ribs and the top of legs.

How common –One of the most common health problems among all populations of the world Most people would experience back pain at some point of their lives – 70 to 85 % of adults will experience LBP at some point on their life Most cases are managed in primary care ( up to 65 % ) and subsequently they become the sole provider for these patients Estimated point prevalence is 18 % ( ie 18 % experience LBP at any given time ) Incidence is highest in 3 rd decade and overall prevalence increases with age until 60-65 yrs and then declines gradually Men and women are affected equally but in the age group >

Hormone Replacement Therapy ( HRT )

Hormone replacement therapy is the replacement of female sex 
hormones oestrogen and progesterone in women to control
 symptoms of the menopause 

( definition from the )

HRT usage

About a million women in UK use treatment for menopausal symptoms An estimated 1.5 million women – around 80 % of those going through menopause experience some symptoms HRT is highly successful in treating common symptoms of menopause in the short term ( short-term is up to 5 yrs ) HRT is also been shown to reduce risk of CV disease ,

Menopause-diagnosis and management

Menopause –A biological stage in a woman’s life that occurs when she stops menstruating and reaches the end of her natural reproductive life 
( NICE 2019 )

Perimenopause –Also called climacteric ( Greek- rung of ladder ) NICE – time in which a woman has irregular cycles of ovulation and menstruation leading up to menopause and continuing until 12 months after her final period It is the time when endocrinological ,


CBTi is the preferred treatment for both acute and chronic insomnia and is backed by evidence , both short and long term Pharmacological treatment can be considered as an adjunctive therapy to CBTi / other behavioral therapies in the comprehensive management of insomnia for both acute and chronic insomnia In the acute phase of CBTi adding a medication to alleviate insomnia may have a slightly better effect compared to CBT-i alone

Decide which agent based on predominant symptom pattern what is the goal of the treatment previous treatment trials/ response patient preference ,


DSM V describes insomnia as longstanding ( more than 3 months ) subjective difficulty initiating sleep , maintaining sleep or waking too early , accompanied by distress about the experience of daytime fatigue and its impact on day time functioning. The difficulty occurs atleast
 3 nights / week , despite adequate opportunity for sleep.

How common –Insomnia is common affecting up to 1 in 3 adults in the UK,