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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)

Spirometry

Withholding Bronchodilators

SABA: 4 hrs
SAMA: 12 hrs
ICS/LABA (bd): 24 hrs
LAMA/LABA (od): 36 hrs
Combo: Follow longer time
Ensures accurate baseline for obstruction assessment

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Procedure

Pre-test: Salbutamol 100 mcg x4 (via spacer), 30 secs apart, wait 10 mins
Perform pre- and post-bronchodilator tests
At least 3 acceptable blows, <5% variability (best 2 efforts)
Avoid poor technique (coughing, submaximal effort, abrupt stop)

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Ventilatory Defects

Obstructive:
- FEV₁/FVC <0.7 or LLN (concave loop)
- E.g. Asthma, COPD, overlap
Restrictive:
- FVC <0.8 or LLN; FEV₁/FVC normal/increased
- E.g. Interstitial lung disease, obesity
Mixed:
- Low FEV₁/FVC + Low FVC → Needs lung volume testing

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Reversibility

Adults: ≥12% + 200 mL improvement in FEV₁ or FVC post-bronchodilator
Children: ≥12% alone sufficient

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Severity (Post-Bronchodilator FEV₁)

Mild: >80%
Moderate: 50–80%
Severe: 30–50%
Very Severe: <30%

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Key Notes

COPD: Post-FEV₁/FVC <0.7, FEV₁ <80% predicted confirms
Asthma: ≥12% FEV₁ improvement supports diagnosis
Pre vs. post helps differentiate asthma vs. COPD
Repeat spirometry if unclear or to monitor treatment response

Spirometry: Key Points

Withholding Bronchodilators

SABA (Short-Acting β₂-Agonist): 4 hours
SAMA (Short-Acting Muscarinic Antagonist): 12 hours
ICS/LABA (twice daily): 24 hours
LAMA/LABA (once daily): 36 hours
Combination: Follow the longer recommended time

(Ensures accurate baseline for obstruction assessment.)

Procedure

Pre-Test Bronchodilator Administration
- Salbutamol 100 mcg ×4 puffs via spacer, 30 sec between puffs
- Wait 10 minutes before post-bronchodilator measurement
Perform Pre- and Post-Bronchodilator Tests
- At least 3 acceptable blows; best 2 efforts should have <5% variability.
- Avoid common errors (coughing, submaximal effort, abrupt stop).

Ventilatory Defects

Obstructive Pattern

FEV₁/FVC <0.7 or lower limit of normal (LLN)
Flow-volume loop → concave in expiration
Examples: Asthma, COPD, or overlap.

Restrictive Pattern

FVC <0.8 or LLN, with normal or increased FEV₁/FVC
Examples: ILD, obesity, chest wall deformities.

Mixed Defect

Low FEV₁/FVC + Low FVC → needs lung volume testing to confirm.

Reversibility Test

Definition

Adults: ≥12% and ≥200 mL improvement in FEV₁ or FVC post-bronchodilator indicates significant reversibility.
Children: ≥12% improvement alone is sufficient.

(Supports asthma diagnosis if present.)

Severity (Based on Post-Bronchodilator FEV₁ % Predicted)

Mild: >80%
Moderate: 50–80%
Severe: 30–50%
Very Severe: <30%

Key Notes

COPD Diagnosis: Post-bronchodilator FEV₁/FVC <0.7 and FEV₁ <80% predicted.
Asthma: Reversibility of ≥12% in FEV₁ or FVC.
Pre vs Post results help differentiate asthma vs COPD.
Repeat spirometry if results are unclear or to monitor treatment response over time.

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