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Medications and Surgery

Warfarin Dosing and Management

Neuroleptic Malignant Syndrome (NMS)

Depression and Delirium

Acute and Progressive Vision Loss

Acute Vision Loss

Smoking Cessation

Neutropenia and Normocytic Anaemia

Hereditary Thrombophilia

Thyroid Radionucleotide Scan

Postpartum Thyroiditis

Diabetes Insipidus (DI) vs Primary Polydipsia

Orbital Fracture

Pulmonary Embolism

Troponin Testing

Beta-Human Chorionic Gonadotropin (β-hCG)

CA-125 (Cancer Antigen 125)

Abnormal/Dysfunctional Uterine Bleeding (AUB/DUB)

First Trimester Bleeding and Ectopic Pregnancy

Hormone Replacement Therapy (HRT)

Hyperemesis Gravidarum (HG)

Menorrhagia (Heavy Menstrual Bleeding - HMB)

Premenstrual Syndrome (PMS) / Premenstrual Dysphoric Disorder (PMDD)

Premature Ovarian Failure

Candida (Candidiasis as an STI)

Turner Syndrome

Urinary Tract Infections (UTI)

Chronic Kidney Disease (CKD)

Nephritic Syndrome

Nephrotic Syndrome

Acute Kidney Injury (AKI)

Chronic Fatigue Syndrome (CFS)

Connective Tissue Diseases

Inflammatory Joint

Osteoarthritis (OA)

Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA)

Rheumatic Fever (RF)

Rheumatoid Arthritis (RA)

Spondyloarthritides (SpA)

Viral Arthritis

Ankylosing Spondylitis (AS)

Bronchiectasis (Updated)

Chronic Cough in Children

Deep Vein Thrombosis (DVT)

Dyspnoea (Shortness of Breath)

Epstein-Barr Virus (EBV)

Interstitial Lung Disease (ILD)

Legionella Pneumonia (Legionnaires’ Disease)

Obstructive Sleep Apnoea (OSA)

PERC Criteria (Pulmonary Embolism Rule-Out Criteria)

Pertussis (Whooping Cough)

Pleural Effusion

Stridor and Croup

Thrombophlebitis

Alcohol Cessation

Anorexia Nervosa

Adjustment Disorder and Anxiety

Anxiety Disorders

Bipolar Disorder

Adjustment Disorder with Depressed Mood

Eating Disorders

Gambling Disorder

Innocent Murmur

Definition

Non-pathological heart murmur in healthy children, unrelated to structural heart disease

Symptoms

Asymptomatic with no cyanosis, syncope, failure to thrive, or dyspnoea

Diagnosis: 7 S’s

Sensitive: Changes with position or respiration (softer when standing)
Short: Brief systolic murmur
Single: No extra heart sounds (e.g., clicks, gallops)
Small: Localised with no radiation
Soft: Low intensity (grade 1–3/6)
Sweet: Soft, blowing quality
Systolic: Ejection murmur with no diastolic component

Negative Indicators

Cyanosis, tachypnoea, tachycardia, oedema, or fatigue
Abnormal growth or weight gain
Heaves, thrills, diastolic murmur, or other abnormal findings
Rare in infants <1 year, requiring evaluation for congenital heart disease

Management

Reassurance: Educate parents on the benign nature of the murmur
Follow-up: Routine reviews to monitor for any changes

When to Refer

Concerning signs such as failure to thrive, cyanosis, syncope, or exertional symptoms
Persistent murmur despite positional changes
Features not fitting the 7 S’s
Referral to a paediatric cardiologist for echocardiography

Innocent Murmur

Definition

Harmless heart murmur found in healthy children with no underlying structural heart disease
Also known as a functional or physiologic murmur
Most confidently diagnosed in children over 1 year of age

Symptoms

Typically asymptomatic with no cyanosis, syncope, failure to thrive, or dyspnoea
Detected incidentally during routine cardiovascular examination

Diagnosis

Based on the "7 S’s":
- Sensitive: Murmur intensity changes with position or respiration (softer when standing)
- Short: Brief, confined to early or mid-systole
- Single: No additional heart sounds such as clicks or gallops
- Small: Localised with no radiation to other areas
- Soft: Low intensity, usually grade 1–3/6
- Sweet: Soft, blowing or musical quality
- Systolic: Present only during systole with no diastolic component
Absence of abnormal findings on general and systemic examination
Evaluate cautiously in infants under 1 year due to higher risk of congenital heart disease

Management

Provide reassurance that the murmur is benign and expected to resolve with growth
Routine follow-up during regular health checks to monitor for any new symptoms or changes
No specific treatment required for an innocent murmur

When to Refer

If there are signs such as failure to thrive, cyanosis, syncope, or exertional dyspnoea
If the murmur persists without variation on positional changes or exhibits features inconsistent with the 7 S’s
Referral to a paediatric cardiologist for echocardiography if any risk factors or abnormal findings are present

Notes

Innocent murmurs are common in children and generally have no long-term consequences
A comprehensive history and physical examination are essential to rule out pathological murmurs
Parental education is crucial to alleviate concerns and encourage routine monitoring

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