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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)

Parkinson’s Disease

History

Tremor (resting, hands)
Difficulty rising from chair
Stiffness (arms, legs)
Constipation
Loss of smell
Falls
Non-motor symptoms (fatigue, depression, REM sleep behaviour disorder) may precede motor signs

Examination

Resting "pill-rolling" tremor
Shuffling gait, loss of arm swing
Stooped posture
Masked facies
Cogwheel rigidity
Bradykinesia
Power, reflexes, sensation usually normal
Postural instability develops later

Investigations

Clinical diagnosis (based on response to levodopa)
DaTScan (dopamine transporter scan) for atypical cases

Management

Neurology referral for confirmation
Patient education (chronic nature of disease)
Levodopa + carbidopa (first-line)
Dopamine agonists (pramipexole, ropinirole) or anticholinergics (consider in younger or tremor-dominant cases)
Physiotherapy (mobility)
Psychology (CBT), Parkinson’s support group
Speech therapy
Manage comorbidities (dementia, depression, anxiety)
Falls prevention, regular exercise
Avoid metoclopramide & prochlorperazine, use domperidone 10 mg TDS (max 7 days) for nausea

Note: Parkinsonism (Parkinson-plus syndromes) does not improve with levodopa/carbidopa.

Parkinson’s Disease

History

Tremor: Resting, often “pill-rolling” in the hands
Mobility Issues: Difficulty rising from a chair, stiffness in arms/legs, slower movements
Constipation: Common non-motor feature
Loss of Smell (anosmia)
Falls (postural instability in later disease)
Non-Motor Symptoms: Fatigue, depression, REM sleep behaviour disorder (may precede motor signs)

Examination

Resting Tremor: Pill-rolling type, reduces with intentional movement
Shuffling Gait: Reduced arm swing, stooped posture
Rigidity: “Cogwheel” or “lead-pipe” in arms/legs
Bradykinesia: Slowness of movements, reduced facial expression (masked facies)
Power, Reflexes, Sensation: Typically normal
Postural Instability: Tends to occur in later disease stages

Investigations

Primarily a clinical diagnosis.
Response to Levodopa can support diagnosis.
DaTScan (dopamine transporter scan) sometimes used in atypical or uncertain presentations.

Management

Neurology Referral
- For confirmation of diagnosis and tailoring therapy.
Patient Education
- Chronic, progressive nature of disease.
- Discuss realistic goals, importance of exercise, and support services.
Pharmacotherapy
- Levodopa + Carbidopa (first-line)
- Dopamine Agonists (pramipexole, ropinirole) or Anticholinergics (e.g. benztropine) in younger patients or tremor-dominant disease to delay levodopa side effects.
- Manage side effects (dyskinesias, motor fluctuations) as disease progresses.
Allied Health and Support
- Physiotherapy: Improves mobility, gait training, reduces falls.
- Psychology or counselling: CBT for depression or anxiety, connect with Parkinson’s support groups.
- Speech Therapy: If dysarthria, swallowing issues.
- Occupational Therapy: Home safety, assistive devices, falls prevention.
Comorbidities & Lifestyle
- Screen for dementia, depression, anxiety (common in Parkinson’s).
- Falls prevention strategies, regular exercise.
- Avoid dopamine-blocking medications (e.g. typical antipsychotics, metoclopramide, prochlorperazine) that worsen symptoms.
- If antiemetic needed → use domperidone (10 mg TDS, max 7 days) as it doesn’t cross BBB significantly.

Note

Parkinson-plus syndromes (e.g. progressive supranuclear palsy) do not improve well with levodopa/carbidopa, often have additional features atypical for PD (vertical gaze palsy, early falls, etc.)

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