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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)

Myasthenia Gravis (MG)

History

Fluctuating weakness (worsens throughout the day)
Ptosis (difficulty opening eyes)
Dysphagia
Diplopia
Weakness worsens with stress
Breathlessness
Associated with autoimmune diseases (e.g. thyroid disease)

Examination

Asymmetrical ptosis
Hoarse voice
Limb weakness/wasting
Dropped head sign
Monitor vital capacity (risk of respiratory failure)

Investigations

ACh receptor antibodies (first-line)
MuSK antibodies (if AChR negative)
Electromyography (if seronegative)
CT/MRI chest (thymoma, ~10% cases)
MRI brain (exclude differentials)
Ice pack test (supports ocular MG)

Management

Neurology referral
CT chest (exclude thymoma, consider thymectomy)
Cholinesterase inhibitors (pyridostigmine)
IV immunoglobulin/plasmapheresis (myasthenic crisis)
Immunosuppressants (e.g. steroids) if pyridostigmine insufficient

Myasthenia Gravis (MG)

History

Fluctuating weakness: Tends to worsen throughout the day or with repeated muscle use
Ptosis (droopy eyelids), often asymmetrical
Diplopia (double vision)
Dysphagia, difficulty chewing or swallowing
Weakness exacerbated by stress, infection, or prolonged activity
Breathlessness if respiratory muscles are involved
Associated with autoimmune diseases (e.g. thyroid disease, rheumatoid arthritis)

Examination

Asymmetrical Ptosis: May improve briefly after rest (or ice pack test)
Hoarse Voice: Bulbar involvement affecting speech
Limb Weakness/Wasting: Proximal muscle groups often affected
Dropped Head Sign: Neck extensor weakness
Monitor Vital Capacity: Risk of respiratory compromise or myasthenic crisis

Investigations

Acetylcholine Receptor (AChR) Antibodies: First-line serological test
MuSK Antibodies: If AChR-negative (5–10% of MG are MuSK-positive)
Electromyography (EMG): Particularly repetitive nerve stimulation, single-fibre EMG if seronegative
CT/MRI Chest: Check for thymoma (~10% of MG cases) or thymic hyperplasia
MRI Brain: Exclude differential diagnoses (e.g. multiple sclerosis, stroke)
Ice Pack Test: Improvement in ocular muscle function after applying ice suggests ocular MG

Management

Neurology Referral
- Essential for diagnosis confirmation and ongoing therapy
- Consider thymectomy if thymoma or in certain MG subtypes
Medications
- Cholinesterase Inhibitors: Pyridostigmine helps symptomatic relief of muscle weakness
- Immunosuppressants: (e.g. corticosteroids, azathioprine) if pyridostigmine is insufficient or for long-term control
- IV Immunoglobulin/Plasmapheresis: For severe exacerbations or myasthenic crisis
Supportive Measures
- Monitor respiratory function (vital capacity, ABGs if needed)
- Plan for potential myasthenic crisis requiring ICU care if severe bulbar or respiratory compromise
- Lifestyle advice: Adequate rest, avoid triggers (infections, certain medications)

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