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Cardiovascular

Abdominal pain in kids

Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB)

Acanthosis Nigricans

Actinic Cheilitis

Acute Kidney Injury (AKI)

Acute Swollen Joint with Fever

Acute Vision Loss

Acute and Progressive Vision Loss

Adjustment Disorder and Anxiety

Adjustment Disorder with Depressed Mood

Age related macular degeneration

Alcohol Cessation

Allergic rhinitis

Angular Cheilitis

Ankylosing Spondylitis (AS)

Anorexia Nervosa

Anticholinergics and TCAs

Antidepressants

Antimetabolite drugs

Antiphospholipid syndrome

Anxiety Disorders

Aortic Dissection

Atrial Fibrillation

Behavioural / learning disorders

Behavioural disturbances

Bell’s palsy and Ramsey Hunt syndrome

Beta-Human Chorionic Gonadotropin (β-hCG)

Biologic agents

Bipolar Disorder

Bleeding disorders

Bronchiectasis (Updated)

CA-125 (Cancer Antigen 125)

CVD Risk Assessment

Calluses and Corns

Candida (Candidiasis as an STI)

Carpal tunnel syndrome and de quervains tenosynovitis

Cervical spondylosis

Chickenpox (Varicella)

Chronic Cough in Children

Chronic Fatigue Syndrome (CFS)

Chronic Kidney Disease (CKD)

Chronic Rhinosinusitis

Chronic Stridor

Clavicular fracture

Colorectal Cancer Screening Recommendations

Congestive Cardiac Failure

Connective Tissue Diseases

Contact Dermatitis

Cutaneous Drug Eruptions

Dacrocystitis, dacyrostenosis, dacyrocystocoele

Deep Vein Thrombosis (DVT)

Depression and Delirium

Dermal melanocystosis (mongolian spot)

Developmental Dysplasia of the Hip (DDH)

Diabetes Insipidus (DI) vs Primary Polydipsia

Diabetic Neuropathy

Dizziness / syncope

Duchenne muscular dystrophy

Dupuytrens / trigger finger

Dyspnoea (Shortness of Breath)

Male Sexual Dysfunction (ED, Low Libido, Premature Ejaculation)

Differentials

Psychological: Depression, anxiety, stress.
Social: Relationship issues, SSRIs, antihypertensives, substance use.
Neurological: Diabetic neuropathy, pelvic trauma/surgery.
Endocrine: Hypogonadism, hyperthyroidism, hyperprolactinaemia.
Cardiovascular: PVD, hypertension, obesity (CVD marker).
Respiratory: OSA.
Genital: Peyronie’s disease.

History

Symptoms: ED, low libido, premature ejaculation.
Erections: Morning erections/masturbation (suggest psychogenic if present).
Mood: Depression, anxiety.
Substance Use: Alcohol, drugs.
Meds: SSRIs, antihypertensives.
Endocrine: Polyuria, gynaecomastia.
CVD/OSA: Hypertension, snoring.
Trauma: Pelvic injury, surgery.
Genital: Penile deformity.

Examination

Obesity (BMI>30)
Small testicular size / gynaecomastia
Penile plaques
Visual field defects
Femoral pulse

Investigations

Routine: FBC, UEC, lipids, fasting glucose.
Hormonal: Morning testosterone ± LH if abnormal.
Other: TSH, prolactin (low libido, gynaecomastia).
Cardio: Assess fitness (e.g., 20 steps in 15 seconds).

Management

Erectile Dysfunction (ED)

Non-Pharm: Counselling, lifestyle changes.
Pharm:
- First-line: Sildenafil 50 mg PO (1 hr pre-activity). Avoid with nitrates.
- Second-line: Intracavernosal alprostadil.
- Alternative: Vacuum device.

Premature Ejaculation (PE)

Non-Pharm: Topical anaesthetic (glans + shaft) or thick condoms.
Pharm:
- First-line: Dapoxetine 30 mg PO (3 hrs pre-activity).
- Alternative: Paroxetine 20 mg (on-demand or regular).

Low Libido

Treat underlying issues: Depression, hypogonadism, substance use.
Optimise lifestyle: Reduce weight, alcohol, stress.

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Key Notes

ED: Early CVD marker—assess broader CVD risks.
Low testosterone is rare (<4%): Test only when clinically indicated.
Premature ejaculation often improves with psychological and relationship support.

Lithium

Side Effects

Short-Term

CNS: Sedation, confusion, unsteadiness, tremors, dysarthria, seizures (in toxicity)
Neuromuscular: Rigidity, hyperreflexia
GI: Nausea, vomiting, diarrhoea
Cardiovascular: QTc prolongation, possible hypovolaemia (especially from nephrogenic diabetes insipidus)
Dermatological: Psoriasis flares or exacerbation

Long-Term

Chronic lithium toxicity
Nephrogenic Diabetes Insipidus (NDI)
Hypothyroidism
Hyperparathyroidism (hypercalcaemia)
Weight Gain

Toxicity

Toxic Doses/Levels

Acute: Ingestion >5 g or serum level >5 mmol/L
Chronic: Serum level >1.5 mmol/L raises toxicity risk

Risk Factors

Dehydration (reduces lithium clearance)
Medications that decrease renal clearance: ACE inhibitors, ARBs, NSAIDs, diuretics
Hypothyroidism, CKD

Key Investigations

Serum Lithium Levels: 6-hourly if suspected toxicity
Renal Function: Check creatinine, urea
Serum Sodium: Assess for hypernatraemia (NDI)
ECG: Possible QTc prolongation or arrhythmias

Monitoring on Treatment

Lithium Levels: Every 3–6 months; target range ~0.6–1.0 mmol/L (1.2 mmol/L if manic)
Renal Function & Electrolytes: Regular checks (UEC, CMP)
Thyroid Function Tests (TFTs): 6–12 monthly

Management of Toxicity

Acute Toxicity

Stop Lithium Immediately
Hydration: IV 0.9% sodium chloride to promote lithium excretion
Monitoring: ECG, serial serum lithium levels, renal function
Haemodialysis (with toxicologist advice) if:
- Serum lithium >4 mmol/L + renal impairment
- Serum lithium >5 mmol/L
- Severe neurological toxicity (seizures, coma)

Decontamination

Activated Charcoal: Not effective (lithium not adsorbed)
Whole-Bowel Irrigation: Consider if >50 g ingested <4 hrs earlier (toxicologist guidance)

Haemodialysis

Continue until serum lithium <1 mmol/L and clinical improvement

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