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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)

Testicular Pain

Differentials

Testicular torsion (surgical emergency)
Epididymitis
Testicular trauma
Testicular cancer
Hydrocele
Varicocele
Inguinal hernia
Prostatitis

History

Trauma to testes
Dysuria or urethral discharge
Systemic symptoms (fever, malaise)
Recent sexual activity
Swelling or tenderness of scrotum
Abdominal pain
Recent surgeries
Family history of testicular cancer

Examination

Fever
Prehn’s sign:
- Positive in epididymitis (pain relief with scrotal elevation)
- Negative in torsion
Cremasteric reflex:
- Absent in torsion
- Present in epididymitis
Other findings:
- High-riding testes (torsion)
- Testicular swelling
- Transillumination (hydrocele)
- Tender epididymis
- "Bag of worms" sensation (varicocele)
- Inguinal masses or prostate tenderness

Investigations

Urine MCS and PCR for chlamydia/gonorrhoea
Doppler ultrasound: Differentiate torsion (reduced blood flow) from epididymitis (increased blood flow)
Tumour markers (AFP, β-hCG): If cancer suspected
FBC: Assess for infection

Key Notes

Varicocele: Manage conservatively unless testicular atrophy or reduced sperm quality; consider surgical ligation or embolisation in <21 years
Torsion: Requires detorsion within 6 hours for salvage
Epididymitis: Antibiotics targeting likely pathogens (e.g., STI or UTI)
Torsion = negative phrens and absence of cremasteric reflex
Epididymitis = positive phrens and presence of cremasteric reflex

Testicular Pain

Differentials

Testicular Torsion (surgical emergency)
Epididymitis / Epididymo-orchitis
Testicular Trauma
Testicular Cancer
Hydrocele
Varicocele
Inguinal Hernia
Prostatitis (may refer pain to testicles)

History

Trauma to the groin or testicles
Dysuria, Urethral Discharge → suspect infection (epididymitis)
Systemic Symptoms: Fever, malaise (infection vs. torsion)
Sexual Activity: STIs risk factor for epididymitis
Swelling/Tenderness of scrotum onset (acute vs. chronic)
Abdominal Pain referral
Recent Surgery (hernia repair, etc.)
Family History: Testicular cancer

Examination

Vital Signs: Fever might suggest infection (epididymitis).
Prehn’s Sign (pain relief with scrotal elevation):
- Positive in epididymitis (pain improves)
- Negative in torsion
Cremasteric Reflex (stroking inner thigh → testicle rises):
- Absent in torsion
- Present in epididymitis
Other Findings:
- High-riding Testis, “horizontal lie” (torsion)
- Transillumination → Hydrocele (fluid lights up), not typical in solid masses
- “Bag of Worms” sensation → Varicocele
- Inguinal Mass → Hernia
- Prostate Tenderness on DRE → Prostatitis

Investigations

Urine MCS + PCR for chlamydia/gonorrhoea (if infection suspected)
Doppler Ultrasound: Key to differentiate
- Torsion → reduced or absent blood flow
- Epididymitis → increased blood flow (hyperaemia)
Tumour Markers: AFP, β-hCG if testicular cancer suspected
FBC: Look for infection or elevated WBC

Key Notes by Condition

1. Testicular Torsion

Urgent surgical exploration; 6-hour window for salvage
Typical exam: Negative Prehn’s sign, absent cremasteric reflex, acute onset severe pain
Doppler US shows decreased blood flow

2. Epididymitis

Infective cause (chlamydia/gonorrhoea in younger men, UTI in older)
Positive Prehn’s sign, present cremasteric reflex, gradual onset
Antibiotics based on likely pathogen (e.g. ceftriaxone + doxycycline if STI)

3. Varicocele

“Bag of worms,” often on left side, worsens with Valsalva
Manage conservatively unless testicular atrophy or fertility issues. Surgical/embolisation in some.

4. Hydrocele

Typically transilluminates, usually painless.
Conservative management unless large or symptomatic.

5. Testicular Cancer

Painless mass, heaviness in scrotum.
Check US + tumour markers (AFP, β-hCG, LDH).

6. Hernia

Groin swelling, can extend into scrotum.
Check cough impulse, reduce if possible.

Management

Torsion

Emergency referral for surgical detorsion ± orchiopexy within 6 hours.

Epididymitis

Antibiotics targeting likely organism (STI or UTI).
Analgesia, scrotal support, rest.

Varicocele

Observation unless painful, testicular atrophy, or fertility concerns.

Hydrocele

Watchful waiting if mild; consider surgical aspiration/repair if large/symptomatic.

Testicular Cancer

Urgent US imaging, tumour markers, referral to urology.

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