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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)

Neuroleptic Malignant Syndrome (NMS)

Key Features

Rare, life-threatening reaction to dopamine antagonists or dopaminergic drug withdrawal
Classic Tetrad:
1. Extrapyramidal: Lead-pipe rigidity, bradykinesia, dystonia, tremor, dysphagia
2. Hyperthermia: >39°C
3. Autonomic Instability: Tachycardia, hypertension, labile BP, tachypnoea, sweating
4. CNS: Confusion, mutism, altered mental state, incontinence, coma

Investigations

↑ Creatine kinase (>3x ULN), leukocytosis, ↓ serum iron
EEG: Diffuse slowing

Causative Drugs

Dopamine Antagonists

1st Gen: Haloperidol, chlorpromazine, droperidol
2nd Gen: Risperidone, olanzapine, quetiapine, clozapine

Dopaminergic Drug Withdrawal

Levodopa, bromocriptine

DSM-5 Diagnostic Criteria

Major Criteria (All Required):

Dopamine antagonist exposure or dopaminergic drug withdrawal
Severe muscle rigidity
Hyperthermia (>38°C)

Other Criteria (≥2):

Tachycardia, labile BP, or sweating
↑ CK or leukocytosis
Dysphagia, tremor
Altered mental status, mutism

____________________________________

Management

Immediate Interventions

Stop causative agent (e.g., antipsychotics, anticholinergics, lithium)
Supportive care:
- Airway management if required (e.g., intubation)
- IV fluids for hypotension and cooling measures

Pharmacological Treatment

First-Line: Bromocriptine 2.5 mg PO/NG every 8 hrs (↑ to 5 mg every 4 hrs)
Second-Line: Dantrolene for refractory cases (toxicologist consultation)
Adjunct: Diazepam for agitation

____________________________________

Additional Notes

Hyperthermia severity correlates with mortality → urgent cooling essential
Differentiate from serotonin syndrome (hyperreflexia vs. rigidity)
Therapy duration: 5–10 days for severe cases

Neuroleptic Malignant Syndrome (NMS)

Key Features

Rare, life-threatening reaction to dopamine antagonists or abrupt withdrawal of dopaminergic agents
Classic Tetrad:
1. Extrapyramidal: Marked “lead-pipe” rigidity, bradykinesia, dystonia, tremor, dysphagia
2. Hyperthermia: Often >39°C
3. Autonomic Instability: Tachycardia, hypertension or labile BP, tachypnoea, diaphoresis
4. CNS Changes: Confusion, mutism, altered mental status, up to coma/incontinence

Investigations

↑ Creatine Kinase (often >3× ULN), reflects severe muscle injury
Leukocytosis
↓ Serum Iron (seen in some cases)
EEG: Diffuse slowing (non-specific)

Causative Drugs

Dopamine Antagonists

1st Generation: Haloperidol, chlorpromazine, droperidol
2nd Generation: Risperidone, olanzapine, quetiapine, clozapine

Dopaminergic Drug Withdrawal

Levodopa, bromocriptine, or other dopaminergic therapy

DSM-5 Diagnostic Criteria

Major Criteria (All Required)

Exposure to a dopamine antagonist OR dopaminergic drug withdrawal
Severe Muscle Rigidity
Hyperthermia >38°C

Other Criteria (≥2)

Tachycardia, labile BP, or sweating
↑ CK or leukocytosis
Dysphagia, tremor
Altered mental status, mutism

Management

Immediate Interventions

Stop Causative Agent (antipsychotics, dopaminergic antagonists)
Supportive Care:
- Ensure airway management; consider intubation if indicated
- IV fluids for hypotension, active cooling measures for hyperthermia

Pharmacological Treatment

First-Line: Bromocriptine (dopamine agonist)
- 2.5 mg PO/NG every 8 hrs, can increase to 5 mg every 4 hrs if needed
Second-Line: Dantrolene for refractory cases (consult toxicologist)
Adjunct: Diazepam for agitation or sedation

Notes

Hyperthermia severity correlates with mortality → urgent cooling is essential
Distinguish from serotonin syndrome (the latter features hyperreflexia/clonus vs. NMS with rigidity and bradyreflexia)
Treatment duration can be 5–10 days for severe cases
Re-challenge with antipsychotics requires caution and specialist guidance

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