One Liners Flashcards by A D

HIV patient, CD4 <200, pneumonia with ground-glass opacities on CXR

Pneumocystis jirovecii

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HIV patient, multiple ring-enhancing brain lesions on CT

Toxoplasmosis

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HIV patient, single large brain lesion with EBV DNA in CSF

CNS lymphoma

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HIV patient, painful vesicular rash along dermatome

Shingles (VZV reactivation)

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HIV patient, fluffy white retinal lesions, visual loss

CMV retinitis

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HIV patient, meningitis, India ink positive CSF

Cryptococcus neoformans

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Traveller’s diarrhoea, rice-water stools, severe dehydration

Cholera (Vibrio cholerae)

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Diarrhoea after poultry, Guillain-Barré syndrome risk

Campylobacter

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Bloody diarrhoea, HUS, child

E. coli O157:H7

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Diarrhoea after antibiotics, pseudomembranes

Clostridioides difficile

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Steatorrhoea after camping trip, foul-smelling stools

Giardia lamblia

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Liver abscess, anchovy paste aspirate

Entamoeba histolytica

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Diarrhoea + pneumonia + hyponatraemia

Legionella pneumophila

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Pneumonia, rusty sputum, lobar consolidation

Streptococcus pneumoniae

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Pneumonia, alcoholic, currant jelly sputum

Klebsiella pneumoniae

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Pneumonia, young adult, dry cough, erythema multiforme

Mycoplasma pneumoniae

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Pneumonia + bird exposure

Psittacosis (Chlamydophila psittaci)

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Pneumonia + sheep farmer

Q fever (Coxiella burnetii)

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Pneumonia + cave/bat droppings

Histoplasmosis

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TB + meningitis in child

Miliary tuberculosis

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Painful rapidly spreading cellulitis, crepitus, systemic toxicity

Necrotising fasciitis (Group A Strep, Clostridia)

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Fever, sore throat, sandpaper rash, strawberry tongue

Scarlet fever (Strep pyogenes)

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Rose-coloured spots on trunk after fever

Typhoid fever (Salmonella typhi)

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Erythema migrans bull’s-eye rash after tick bite

Lyme disease (Borrelia burgdorferi)

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Painless chancre at genital site

Primary syphilis

Maculopapular rash on palms and soles

Secondary syphilis

Gummas + tabes dorsalis

Tertiary syphilis

Meningitis + purpuric rash

Neisseria meningitidis

Meningitis in neonate, gram-positive rods

Listeria monocytogenes

Meningitis in alcoholic/diabetic, sinus infection, black nasal eschar

Mucormycosis

Dog bite, hydrophobia, encephalitis

Rabies virus

Locked-in syndrome after poorly cooked shellfish

Botulism (Clostridium botulinum toxin)

Periodic fever every 48h

Plasmodium vivax/ovale malaria

Severe malaria, irregular fever spikes, cerebral involvement

Plasmodium falciparum

Freshwater swimmer, haematuria, bladder cancer risk

Schistosoma haematobium

Elephantiasis, lymphatic obstruction

Filariasis (Wuchereria bancrofti)

Hookworm infection, iron-deficiency anaemia

Ancylostoma duodenale

Chagas disease, dilated cardiomyopathy + megaoesophagus

Trypanosoma cruzi

Black fever, hepatosplenomegaly, pancytopenia

Leishmaniasis (Leishmania donovani)

Migrating skin rash, tropical travel

Strongyloides (larva currens)

Hydatid cyst, liver, daughter cysts

Echinococcus granulosus

Exposure to unpasteurised milk + undulating fever

Brucellosis

Goat farmer, pneumonia + hepatitis

Q fever (Coxiella burnetii)

Shepherd, pneumonia, wool exposure

Anthrax (Bacillus anthracis)

Dog bite, cellulitis + sepsis

Capnocytophaga canimorsus / Pasteurella multocida

Cat scratch + lymphadenopathy

Bartonella henselae

Rat bite fever

Streptobacillus moniliformis

Wide pulse pressure, collapsing water hammer pulse

Aortic regurgitation

Ejection systolic murmur radiating to carotids

Aortic stenosis

Mid-diastolic murmur with opening snap

Mitral stenosis

Early diastolic murmur

Aortic regurgitation

Irregularly irregular pulse

Atrial fibrillation

Young woman, hypertension, abdominal bruit

Fibromuscular dysplasia (renal artery stenosis)

Prolonged QT interval

Risk of torsades (drugs/electrolyte abnormalities)

Kussmaul’s sign (↑ JVP on inspiration with prominent y descent) + pericardial knock

Constrictive pericarditis

Syncope on exertion + harsh murmur

Severe aortic stenosis

Radiofemoral delay

Coarctation of the aorta

Cannon A waves in JVP

Complete heart block

Fixed, wide split S2

Atrial septal defect

Ejection systolic murmur, young athlete, sudden death

Hypertrophic cardiomyopathy

Janeway lesions, Osler nodes, Roth spots

Infective endocarditis

Beck’s triad: hypotension, muffled heart sounds, raised JVP

Cardiac tamponade

Delta wave on ECG

Wolff-Parkinson-White syndrome

Sawtooth flutter waves on ECG

Atrial flutter

Bilateral hilar lymphadenopathy + erythema nodosum

Sarcoidosis

Farmer, dyspnoea, crackles

Hypersensitivity pneumonitis (Farmer’s lung)

Clubbing + foul-smelling sputum

Bronchiectasis

Superior vena cava obstruction, facial swelling

Small cell lung cancer

Tall thin young man, sudden chest pain

Primary spontaneous pneumothorax

Pleural plaques, lower lobe fibrosis

Asbestosis

Upper lobe cavitating lesion + haemoptysis

Tuberculosis

Honeycomb lung on CT

Idiopathic pulmonary fibrosis

Flu-like illness, bird exposure

Psittacosis (Chlamydophila psittaci)

Asthma + eosinophilia + bronchiectasis

Allergic bronchopulmonary aspergillosis

Recurrent chest infections + infertility + dextrocardia

Kartagener’s syndrome

Pink puffer

Emphysema-dominant COPD

Blue bloater

Chronic bronchitis COPD

Upper lobe cavitation + haemoptysis in HIV patient

TB reactivation

Increased DLCO on lung function

Asthma

Decreased DLCO on lung function

Pulmonary fibrosis, emphysema

Pruritus + ↑ ALP + antimitochondrial antibody

Primary biliary cholangitis

Beaded bile ducts on ERCP + UC

Primary sclerosing cholangitis

Anti-TTG antibody + villous atrophy

Coeliac disease

Painless jaundice, palpable non-tender gallbladder (Courvoisier sign)

Pancreatic cancer

RUQ pain + fever + jaundice (Charcot’s triad)

Ascending cholangitis

Spider naevi + palmar erythema + gynaecomastia

Cirrhosis

Oesophageal varices + splenomegaly

Portal hypertension

Kayser-Fleischer rings

Wilson’s disease

Elevated ferritin + bronze skin + diabetes

Haemochromatosis

Anti-smooth muscle antibody

Autoimmune hepatitis

Pernicious anaemia + gastric cancer risk

Atrophic gastritis

Skip lesions, transmural inflammation

Crohn’s disease

Continuous mucosal involvement, bloody diarrhoea

Ulcerative colitis

Gallstones + haemolysis

Pigment stones

Fat female forty fertile

Gallstones

String sign on barium swallow

Crohn’s disease

Lead pipe colon on barium enema

Ulcerative colitis

Haematuria + hearing loss + eye problems

Alport syndrome

Nephrotic syndrome + Hepatitis B

Membranous GN

Crescentic GN on biopsy

RPGN

Pulmonary haemorrhage + renal failure

Goodpasture’s syndrome

Recurrent UTIs + staghorn calculi

Proteus (struvite stones)

Hypokalaemia + hypertension + metabolic alkalosis

Conn’s syndrome

Hyponatraemia + small cell lung cancer

SIADH

Polyuria + polydipsia + hypernatraemia

Diabetes insipidus

Flank pain + haematuria + mass

Renal cell carcinoma

Bilateral enlarged kidneys + haematuria + hypertension

Polycystic kidney disease

Periorbital oedema + proteinuria

Nephrotic syndrome

Anaemia + small kidneys

Chronic kidney disease

Oliguria + muddy brown casts

Acute tubular necrosis

Metabolic acidosis + normal anion gap

Renal tubular acidosis

Raised creatinine after ACE inhibitor

Bilateral renal artery stenosis

Exophthalmos + pretibial myxoedema

Graves’ disease

Painful thyroid + raised ESR

Subacute thyroiditis

Thyroid nodule + ↑ calcitonin

Medullary thyroid cancer

Hypertension + hypokalaemia

Conn’s syndrome

Hyperpigmentation + hyponatraemia + hyperkalaemia

Addison’s disease

Headache + sweating + palpitations

Phaeochromocytoma

Acromegalic features + diabetes

GH-secreting pituitary adenoma

Bitemporal hemianopia

Pituitary macroadenoma

Short stature + webbed neck + streak ovaries

Turner’s syndrome

Tall stature + small testes + gynaecomastia

Klinefelter’s syndrome

Cafe-au-lait spots + neurofibromas

Neurofibromatosis type 1

Bilateral vestibular schwannomas

Neurofibromatosis type 2

Angiofibromas + ash leaf spots + seizures

Tuberous sclerosis

Haemangioblastoma + renal cysts/carcinoma

Von Hippel-Lindau disease

MEN2 + medullary thyroid carcinoma

RET mutation

Recurrent oral/genital ulcers

Behçet’s

Young man, back pain improves with exercise

Ankylosing spondylitis

Chalky tophus

Gout

Chondrocalcinosis on X-ray

Pseudogout

Heliotrope rash + proximal weakness

Dermatomyositis

Sclerodactyly + Raynaud’s + oesophageal dysmotility

Systemic sclerosis

Urethritis + arthritis + conjunctivitis

Reactive arthritis

Pain + morning stiffness in shoulders/hips

Polymyalgia rheumatica

Jaw claudication + temporal headache + ↑ ESR

Giant cell arteritis

Granulomas, c-ANCA + haemoptysis

Granulomatosis with polyangiitis (Wegener’s)

p-ANCA + renal disease + asthma

Churg-Strauss (EGPA)

Cryoglobulins + Hepatitis C

Mixed cryoglobulinaemia

Livedo reticularis + recurrent miscarriage

Antiphospholipid syndrome

Bloody diarrhoea + arthritis + PSC

Ulcerative colitis (extraintestinal)

Resting pill-rolling tremor

Parkinson’s disease

Ptosis + diplopia worse on fatigue

Myasthenia gravis

Weakness improves with use

Lambert-Eaton syndrome

Ascending paralysis post-infection

Guillain-Barré

Scanning speech + intention tremor + nystagmus

Multiple sclerosis

Charcot’s triad: dysarthria, ataxia, nystagmus

MS cerebellar involvement

Floppy baby, tongue fasciculations

Spinal muscular atrophy

Foot drop, high-stepping gait

Peroneal nerve palsy

Bilateral ptosis + ophthalmoplegia + proximal weakness

Mitochondrial myopathy (Kearns-Sayre)

Winging of scapula

Long thoracic nerve palsy

Hemisection of cord: ipsilateral weakness + contralateral pain loss

Brown-Séquard syndrome

Sudden thunderclap headache

Subarachnoid haemorrhage

Bitemporal hemianopia

Pituitary tumour

Intention tremor + dysmetria

Cerebellar lesion

Chorea + dementia + caudate atrophy

Huntington’s disease

Ring-enhancing lesion on CT brain in HIV

Toxoplasmosis

Bloody diarrhoea after camping

Entamoeba histolytica

Periodic fever spikes every 48h

Plasmodium vivax/ovale

Freshwater swimmer + haematuria

Schistosomiasis

Periorbital oedema after pork

Trichinellosis

Dog tapeworm, liver cyst with daughter cysts

Echinococcus

Diarrhoea after antibiotics, pseudomembranes

Clostridioides difficile

Flu-like illness, unpasteurised milk

Brucellosis

Rose spots + relative bradycardia

Typhoid fever

Tick bite + erythema migrans rash

Lyme disease

Hydrophobia + encephalitis

Rabies

Maculopapular rash starting on wrists/ankles

Rocky Mountain spotted fever

Smear: smudge cells

CLL

Smear: Auer rods

AML (esp. APML)

Smear: Rouleaux formation

Myeloma

Smear: target cells

Thalassaemia, liver disease, hyposplenism

Pancytopenia + hairy cells on smear

Hairy cell leukaemia

Reed-Sternberg cells

Hodgkin’s lymphoma

Bone pain + anaemia + renal failure + hypercalcaemia

Myeloma

Massive splenomegaly + tear drop cells

Myelofibrosis

High haematocrit + pruritus after hot bath

Polycythaemia vera

Child, abdominal mass + starry sky appearance

Burkitt lymphoma

Cold agglutinins + haemolysis

Mycoplasma infection, CLL

Warm agglutinins

Autoimmune haemolytic anaemia (IgG)

Microangiopathic haemolysis + thrombocytopenia + neuro signs

TTP

Bleeding + low platelets + giant platelets

Bernard-Soulier syndrome

Recurrent epistaxis + telangiectasia

Hereditary haemorrhagic telangiectasia

Drug → pulmonary fibrosis

Amiodarone, methotrexate, bleomycin

Drug → gingival hyperplasia

Phenytoin, ciclosporin

Drug → blue-grey skin discolouration

Amiodarone

Drug → haemorrhagic cystitis

Cyclophosphamide

Drug → hypertrichosis + gum hypertrophy

Ciclosporin

Drug → ototoxicity + nephrotoxicity

Aminoglycosides

Drug → lactic acidosis

Metformin

Drug → red/orange urine

Rifampicin

Drug → Achilles tendon rupture

Fluoroquinolones

Drug → torsades de pointes

Sotalol, macrolides, haloperidol

Drug → cold extremities, bronchospasm

Beta-blockers

Drug → grey baby syndrome

Chloramphenicol

Drug → orange tears/secretions

Rifabutin

Drug → drug-induced lupus

Hydralazine, procainamide, isoniazid

Drug → aplastic anaemia

Chloramphenicol

Drug → SIADH

Carbamazepine, SSRIs

Study design: rare disease

Case-control study

Study design: new treatment efficacy

Randomised controlled trial

Study design: prevalence snapshot

Cross-sectional study

Severe painful red eye, halos around lights, ciliary flush, fixed mid-dilated pupil, sudden vision loss

Acute angle-closure glaucoma

Head injury, brief LOC, lucid interval, then rapid deterioration

Extradural

Ophthalmoplegia + Ataxia + Areflexia, preserved power, post-infectious

Miller�Fisher syndrome (GBS variant)

Pregnant woman with Sj�gren�s _ fetal congenital heart block risk

anti-Ro (SSA) antibody

Crescent formation on renal biopsy

Rapidly progressive glomerulonephritis (RPGN)

Linear IgG deposition along GBM on immunofluorescence

Goodpasture’s syndrome

Granular (‘starry sky’) deposits of IgG & C3 on immunofluorescence

Post-streptococcal glomerulonephritis

Spike and dome appearance on silver stain

Membranous nephropathy

Tram-track double contour appearance

Membranoproliferative glomerulonephritis (MPGN)

Subepithelial humps

Post-streptococcal glomerulonephritis

Nephrotic syndrome in a child, responsive to steroids

Minimal change disease

Nephrotic syndrome in HIV patient

Focal segmental glomerulosclerosis (FSGS)

Associated with Hepatitis B

Membranous nephropathy

Associated with Hepatitis C

Membranoproliferative GN / cryoglobulinaemia

HIV + heroin user + nephrotic syndrome

Focal segmental glomerulosclerosis (FSGS)

Diabetic with Kimmelstiel-Wilson nodules

Diabetic nephropathy

Young male + hearing loss + haematuria

Alport syndrome

Asymptomatic haematuria in child, post-URI

IgA nephropathy (Berger’s disease)

Palpable purpura + abdominal pain + arthralgia + haematuria

Henoch-Schönlein purpura (IgA vasculitis)

Anti-GBM antibodies + pulmonary haemorrhage + renal failure

Goodpasture’s syndrome

ANCA-associated small-vessel vasculitis + kidney involvement

GPA / MPA (rapidly progressive GN)

Nephrotic syndrome + hypercoagulability (renal vein thrombosis)

Membranous nephropathy

Gross haematuria after sore throat (1–2 days)

IgA nephropathy

Haematuria after sore throat (1–2 weeks)

Post-streptococcal GN

Cola-coloured urine, periorbital oedema, hypertension

Post-streptococcal GN

Kidney biopsy: apple-green birefringence with Congo red stain

Amyloidosis

Fever + rash + eosinophilia + AKI after antibiotics

Acute interstitial nephritis

Papillary necrosis + analgesic abuse

Analgesic nephropathy

Papillary necrosis + sickle cell disease

Sickle cell nephropathy

Oliguria + raised creatinine after contrast

Contrast-induced nephropathy

Hypertension + young woman + recurrent strokes + renal artery bruit

Fibromuscular dysplasia

Sudden-onset flank pain + haematuria + absent kidney function on one side

Renal artery/vein thrombosis

Bilateral enlarged kidneys + hypertension + haematuria

Autosomal dominant polycystic kidney disease (ADPKD)

Berry aneurysm + polycystic kidneys

ADPKD

Haematuria + flank pain + palpable mass

Renal cell carcinoma

Polycythaemia + renal mass

Renal cell carcinoma (↑EPO)

Child with flank mass + haematuria

Wilms tumour (nephroblastoma)

Haematuria + smoker + painless mass at bladder base

Transitional cell carcinoma

Haematuria + flank pain + renal colic

Nephrolithiasis

Hexagonal crystals in urine

Cystinuria

Envelope-shaped crystals in urine

Calcium oxalate stones

Coffin-lid crystals in urine

Struvite stones (infection, Proteus)

Radiolucent renal stones

Uric acid stones

Dialysis patient with carpal tunnel syndrome

β2-microglobulin amyloidosis

CKD + bone pain + hypocalcaemia + hyperphosphataemia

Secondary hyperparathyroidism

CKD + normal/high calcium + very high PTH

Tertiary hyperparathyroidism

Renal failure + pericarditis + encephalopathy

Indications for dialysis

Renal transplant patient + graft dysfunction + hypertension

Chronic allograft nephropathy

Renal transplant + fever + rising creatinine + tenderness

Acute rejection

SLE with high specificity antibody

Anti‑dsDNA

SLE highly specific, renal disease activity marker

Anti‑dsDNA

SLE highly specific (Smith antigen)

Anti‑Sm

Photosensitive rash + oral ulcers + arthritis → screening antibody

ANA

Drug‑induced lupus (hydralazine, procainamide, isoniazid)

Anti‑histone

SLE with congenital heart block risk in fetus

Anti‑Ro/SSA

SLE with neonatal lupus/rash risk

Anti‑Ro/SSA

SLE with sicca features (overlap with Sjögren’s)

Anti‑Ro/SSA and Anti‑La/SSB

Mixed connective tissue disease (U1 RNP)

Anti‑U1‑RNP

Antiphospholipid syndrome screening

Lupus anticoagulant

Antiphospholipid syndrome thrombosis/recurrent miscarriage

Anticardiolipin antibodies

Antiphospholipid syndrome − anti‑β2 glycoprotein I

Anti‑β2‑glycoprotein I

Sicca symptoms (dry eyes/mouth) key antibody

Anti‑Ro/SSA

Sjögren’s second key antibody

Anti‑La/SSB

Positive Schirmer test, parotid enlargement

Anti‑Ro/SSA ± Anti‑La/SSB

Limited cutaneous (CREST) scleroderma

Anti‑centromere

Diffuse cutaneous systemic sclerosis (topoisomerase I)

Anti‑Scl‑70 (anti‑topoisomerase I)

Scleroderma renal crisis risk (RNA polymerase III)

Anti‑RNA polymerase III

Polymyositis/Dermatomyositis hallmark antibody

Anti‑Jo‑1 (anti‑histidyl‑tRNA synthetase)

Dermatomyositis with anti‑Mi‑2

Anti‑Mi‑2

Antisynthetase syndrome (ILD + mechanics hands)

Anti‑Jo‑1 / Anti‑PL‑7 / Anti‑PL‑12

Immune‑mediated necrotising myopathy (statin‑associated)

Anti‑HMG‑CoA reductase

Dermatomyositis with malignancy risk (TIF‑1γ)

Anti‑TIF1‑γ (p155/140)

Dermatomyositis, severe ILD (MDA5)

Anti‑MDA5

SRP myopathy (acute severe proximal weakness)

Anti‑SRP

Granulomatosis with polyangiitis (Wegener’s)

c‑ANCA (PR3)

Microscopic polyangiitis

p‑ANCA (MPO)

Eosinophilic granulomatosis with polyangiitis (Churg‑Strauss)

p‑ANCA (MPO)

Renal‑pulmonary syndrome with linear IF on biopsy

Anti‑GBM (Goodpasture’s)

Polyarteritis nodosa (HBV‑associated) serology

HBsAg / HBV markers (no specific autoantibody)

Henoch–Schönlein purpura (IgA vasculitis)

Raised IgA / IgA immune complexes

Cryoglobulinaemic vasculitis (often HCV)

Mixed cryoglobulins (IgM RF)

Behçet disease immunology

HLA‑B51 association (no specific autoantibody)

Kawasaki disease immunology

No specific autoantibody (clinical dx)

Giant cell arteritis/PMR

↑ESR/CRP (no disease‑specific autoantibody)

Rheumatoid arthritis most specific antibody

Anti‑CCP (ACPA)

Rheumatoid arthritis common but less specific antibody

Rheumatoid factor (IgM against Fc of IgG)

Felty syndrome (RA + splenomegaly + neutropenia)

RF / Anti‑CCP (clinical dx)

Ankylosing spondylitis genetic marker

HLA‑B27

Reactive arthritis genetics

HLA‑B27

Psoriatic arthritis genetics

HLA‑B27 (subset)

Primary biliary cholangitis (PBC)

Anti‑mitochondrial antibody (AMA‑M2)

Autoimmune hepatitis type 1

ANA / Anti‑smooth muscle (SMA)

Autoimmune hepatitis type 2 (younger pts)

Anti‑LKM‑1

Autoimmune hepatitis (soluble liver antigen)

Anti‑SLA/LP

Primary sclerosing cholangitis

p‑ANCA (atypical)

Coeliac disease screening antibody

Anti‑tissue transglutaminase (tTG) IgA

Coeliac disease confirmatory/alternate antibody

Anti‑endomysial (EMA) IgA

Coeliac with IgA deficiency – which test?

tTG IgG / DGP IgG

Inflammatory bowel disease (UC) atypical ANCA

p‑ANCA (atypical)

Autoimmune pancreatitis (IgG4‑related)

Elevated IgG4 / IgG4‑positive plasma cells

Graves disease

TSH receptor‑stimulating antibodies (TRAb)

Hashimoto thyroiditis

Anti‑TPO ± Anti‑thyroglobulin

Type 1 diabetes mellitus

GAD65 antibodies ± IA‑2 / ZnT8

Addison disease (primary adrenal insufficiency)

21‑hydroxylase antibodies

Pernicious anaemia

Intrinsic factor antibodies (± parietal cell Ab)

Autoimmune hypoparathyroidism (APS‑1)

AIRE mutation; anti‑IFN‑ω (research)

Myasthenia gravis (most common)

Anti‑AChR

Myasthenia gravis (seronegative subset)

Anti‑MuSK

Lambert–Eaton myasthenic syndrome

Anti‑VGCC (P/Q type)

Paraneoplastic cerebellar degeneration (gynecologic/breast)

Anti‑Yo

Paraneoplastic encephalitis (testicular)

Anti‑Ma2 (Ta)

Paraneoplastic sensory neuronopathy (SCLC)

Anti‑Hu

NMDA receptor encephalitis (ovarian teratoma)

Anti‑NMDA‑R

Goodpasture syndrome

Anti‑GBM

ANCA small‑vessel vasculitis with renal involvement

PR3‑ANCA (c‑ANCA) / MPO‑ANCA (p‑ANCA)

Dermatitis herpetiformis

Anti‑endomysial / Anti‑tTG (coeliac‑linked)

SLE subacute cutaneous form

Anti‑Ro/SSA

Linear IgA bullous dermatosis

Linear IgA (basement membrane)

Pemphigus vulgaris

Anti‑desmoglein‑3 (± Dsg1)

Bullous pemphigoid

Anti‑BP180 (type XVII collagen) / BP230

Cold agglutinin disease

Cold IgM autoantibodies (anti‑I)

Warm autoimmune haemolytic anaemia

Warm IgG autoantibodies

Immune thrombocytopenia (ITP)

Anti‑platelet glycoprotein antibodies

ANCA‑negative pauci‑immune GN clue

Serology negative; biopsy diagnosis

Neonatal lupus & congenital heart block risk

Maternal Anti‑Ro/SSA (± Anti‑La/SSB)

CREST with pulmonary hypertension risk marker

Anti‑centromere

Rapidly progressive GN + pulmonary haemorrhage

Anti‑GBM or ANCA

ILD with mechanics hands

Antisynthetase antibodies (Anti‑Jo‑1/PL‑7/PL‑12)

Statin exposure + severe proximal weakness

Anti‑HMG‑CoA reductase

RA with high specificity test

Anti‑CCP (ACPA)

APS causing false‑positive VDRL/RPR

Anticardiolipin / Lupus anticoagulant

Sudden monocular vision loss + pale, swollen optic disc + headache/malaise in elderly

Arteritic AION (Giant cell arteritis)

Sudden monocular vision loss + painless + swollen optic disc in vascular risk patient

Non-arteritic AION

Progressive central vision loss + central scotoma + drusen

Age-related macular degeneration (dry)

Sudden central vision loss + haemorrhages / exudates + retinal thickening

Age-related macular degeneration (wet, neovascular)

Acute, painful vision loss + red eye + halo around lights + mid-dilated pupil + ciliary flush

Acute angle-closure glaucoma

Sudden vision loss + cherry-red spot on fovea + pale retina

Central retinal artery occlusion

Sudden vision loss + retinal haemorrhages + cotton wool spots + dilated veins

Central retinal vein occlusion

Painless, transient monocular vision loss ('curtain coming down')

Amaurosis fugax (TIA/embolic)

Painful vision loss + photophobia + red eye + decreased corneal sensation

Herpes simplex keratitis

Gradual, bilateral peripheral visual field loss + cupped optic discs

Chronic open-angle glaucoma

Bilateral progressive loss of central vision in elderly

Macular degeneration (dry)

Bilateral vision loss in diabetic

Diabetic retinopathy (non-proliferative / proliferative)

Loss of night vision + peripheral field constriction + waxy optic disc pallor

Retinitis pigmentosa

Bilateral painless vision loss + pale optic discs + microaneurysms

Ischaemic optic neuropathy (non-arteritic, chronic)

Flame-shaped haemorrhages + cotton wool spots + AV nicking

Hypertensive retinopathy

Dot-blot haemorrhages + microaneurysms + exudates

Diabetic retinopathy

'Blood and thunder' retina

Central retinal vein occlusion

Cherry-red spot on macula

CRAO or Tay-Sachs

Silver wiring of arterioles

Chronic hypertensive retinopathy

Macular star (hard exudates radiating from fovea)

Malignant hypertension

Dendritic ulcer on fluorescein staining

Herpes simplex keratitis

Corneal opacity + interstitial keratitis + vascularisation

Syphilitic interstitial keratitis

Painless white corneal ulcer in immunocompromised

Fungal keratitis (Candida, Aspergillus)

Red eye + discharge + contact lens wearer

Pseudomonas keratitis

Unilateral red eye + photophobia + small pupil + anterior chamber cells/flare

Anterior uveitis

Bilateral uveitis + sacroiliitis + HLA-B27

HLA-B27 associated uveitis

Granulomatous uveitis + mutton-fat keratic precipitates

Sarcoidosis

Red eye + hypopyon

Endophthalmitis

Bitemporal hemianopia

Pituitary adenoma (optic chiasm compression)

Left homonymous hemianopia

Contralateral occipital lobe lesion / stroke

Right superior quadrantanopia ('pie in the sky')

Left temporal lobe lesion (Meyer's loop)

Right inferior quadrantanopia ('pie on the floor')

Left parietal lobe lesion

Internuclear ophthalmoplegia (impaired adduction + nystagmus on abduction)

MLF lesion, commonly MS

Optic neuritis (young adult + painful eye movement)

MS, idiopathic, post-viral

Sudden proptosis + pain + diplopia + fever

Orbital cellulitis

Painless proptosis + slowly progressive

Thyroid eye disease (Graves orbitopathy)

Eyelid droop + ptosis + diplopia, diurnal fluctuation

Myasthenia gravis

Eyelid lesion with central ulceration + rolled border

Basal cell carcinoma

White pupillary reflex (leukocoria) in child

Retinoblastoma

Crossed eyes in early childhood

Strabismus (esotropia / exotropia)

Infant with cataracts + microphthalmia

Congenital rubella syndrome

Blue sclera + high myopia + fractures

Osteogenesis imperfecta

Sudden monocular painful red eye + corneal oedema + mid-dilated pupil

Acute angle-closure glaucoma

Bilateral papilloedema + headache + vomiting

Raised intracranial pressure

'Salt and pepper' fundus + night blindness

Vitamin A deficiency

Copper / Kayser-Fleischer rings

Wilson disease

Sudden-onset pleuritic chest pain + dyspnoea + risk factor for VTE

Pulmonary embolism

Pleuritic chest pain + unilateral decreased breath sounds + hyperresonance

Pneumothorax

SOB, productive cough, fever + lobar consolidation on CXR

Community-acquired pneumonia (Streptococcus pneumoniae)

SOB, fever, bilateral patchy infiltrates in immunocompromised

Pneumocystis jirovecii pneumonia

Young adult, episodic wheeze, cough, dyspnoea, atopy

Asthma

Middle-aged smoker, chronic productive cough >3 months for ≥2 years

Chronic bronchitis (COPD)

Dyspnoea + decreased FEV1/FVC ratio + smoking history

COPD

Pink puffer: dyspnoea, cachexia, hyperinflated lungs

Emphysema-dominant COPD

Blue bloater: hypoxia, cyanosis, peripheral oedema, productive cough

Chronic bronchitis-dominant COPD

Acute deterioration in COPD patient with increased dyspnoea, sputum, purulence

COPD exacerbation

Subacute night sweats, weight loss, cough, upper lobe cavitation

Pulmonary tuberculosis

Persistent dry cough + reticulonodular infiltrates, occupational exposure to dusts

Interstitial lung disease

Honeycombing on HRCT + bibasal fibrosis + clubbing

Idiopathic pulmonary fibrosis

Acute onset fever, pleuritic chest pain, CXR: patchy infiltrates + cough after aspiration

Aspiration pneumonia

Fever, productive cough, cavitating lesions on CXR, history of alcohol abuse

Klebsiella pneumonia

Acute dyspnoea + wheeze + reduced peak flow + triggers (exercise, allergen)

Acute asthma exacerbation

Recurrent sinopulmonary infections + bronchiectasis on HRCT + situs inversus

Kartagener syndrome

Chronic cough + thick purulent sputum + HRCT showing tram-track and signet ring signs

Bronchiectasis

Hypoxia + polycythaemia + daytime somnolence + obesity

Obesity hypoventilation syndrome

Loud snoring + daytime sleepiness + witnessed apnoeas

Obstructive sleep apnoea

Cough + haemoptysis + smoker + upper lobe mass on CXR

Lung cancer (squamous cell carcinoma)

Cough + weight loss + centrally located hilar mass + paraneoplastic hypercalcaemia

Squamous cell carcinoma of lung

Peripheral nodule + non-smoker + adenocarcinoma on biopsy

Adenocarcinoma of lung

Centrally located mass + lambert-eaton syndrome + SIADH

Small cell lung carcinoma

Large effusion + dullness to percussion + reduced breath sounds + transudate

Heart failure (pleural effusion)

Large effusion + exudative + low glucose + high LDH + pleuritic pain

Parapneumonic effusion / empyema

Dyspnoea + chest pain + mediastinal shift on CXR

Tension pneumothorax

Exertional dyspnoea + inspiratory crackles + reduced lung volumes

Restrictive lung disease

Persistent dry cough + occupational exposure to asbestos + pleural plaques

Asbestosis

Progressive dyspnoea + autoimmune disease + basal fibrosis

Connective tissue disease-associated ILD

Acute respiratory distress after fluid overload or sepsis + bilateral infiltrates

Acute respiratory distress syndrome (ARDS)

CXR: patchy opacities + ground-glass appearance in immunocompromised

Pneumocystis jirovecii pneumonia

Chronic dyspnoea + eosinophilia + migratory infiltrates on CXR

Chronic eosinophilic pneumonia

Fever + cough + dyspnoea + bird exposure

Hypersensitivity pneumonitis (extrinsic allergic alveolitis)

Apical cavitary lesions in a patient with history of TB

Reactivation tuberculosis

Sudden-onset cough + inspiratory stridor + choking history

Foreign body aspiration

Progressive dyspnoea + occupational silica exposure + upper lobe nodules

Silicosis

Acute jaundice + encephalopathy + coagulopathy + very high AST/ALT

Acute liver failure

Chronic hepatitis B + ground-glass hepatocytes on biopsy

Hepatitis B

Chronic hepatitis C + mixed cryoglobulinaemia + palmar erythema

Hepatitis C

Alcoholic patient + AST:ALT >2:1 + macrocytosis

Alcoholic hepatitis

Fatigue + pruritus + antimitochondrial antibodies + cholestatic LFTs

Primary biliary cholangitis

Middle-aged male + cholestatic LFTs + onion-skin bile duct fibrosis on biopsy

Primary sclerosing cholangitis

Acute RUQ pain + fever + jaundice (Charcot's triad)

Ascending cholangitis

Acute epigastric pain radiating to the back + elevated amylase/lipase

Acute pancreatitis

Gallstone + biliary colic + RUQ pain after fatty meals

Cholelithiasis

Chronic diarrhoea + steatorrhoea + weight loss + villous atrophy on biopsy

Coeliac disease

Diarrhoea + crampy abdominal pain + bloody stool + crypt abscesses on biopsy

Ulcerative colitis

Skip lesions + transmural inflammation + cobblestone appearance on imaging

Crohn's disease

Fever + RUQ pain + leukocytosis + Murphy's sign

Acute cholecystitis

Melena + epigastric pain + NSAID use

Peptic ulcer disease (gastric/duodenal)

Hematochezia + diverticula on colonoscopy

Diverticular bleeding

Recurrent painless jaundice + pruritus + cholestatic LFTs + elderly patient

Cholangiocarcinoma

Weight loss + early satiety + epigastric pain + upper GI mass

Gastric adenocarcinoma

Chronic liver disease + esophageal varices + splenomegaly

Portal hypertension

Ascites + low SAAG (<1.1) + high protein

Exudative ascites (malignancy, infection)

Ascites + high SAAG (≥1.1) + low protein

Portal hypertension-related ascites (cirrhosis)

Sudden onset severe epigastric pain + rigid abdomen + free air under diaphragm on CXR

Perforated peptic ulcer

Diabetic patient + chronic diarrhoea + macrocytic anemia + steatorrhoea

Exocrine pancreatic insufficiency

Chronic diarrhoea + anti-Saccharomyces cerevisiae antibodies + terminal ileum involvement

Crohn's disease

Painless jaundice + weight loss + Courvoisier sign

Pancreatic cancer (head)

Chronic alcohol + hepatomegaly + spider nevi + palmar erythema

Cirrhosis

History of variceal bleed + encephalopathy + asterixis

Decompensated cirrhosis

Diarrhoea + crampy pain + relief with defecation + no alarm features

Irritable bowel syndrome

Jaundice + pruritus + cholestatic LFTs + AMA negative + ANA positive

Autoimmune hepatitis (cholestatic variant)

Fatigue + dark urine + elevated ALT > AST + autoantibodies + female

Autoimmune hepatitis

Severe colicky abdominal pain + biliary colic + radiates to right scapula

Gallstone disease

Steatorrhoea + weight loss + low fecal elastase

Pancreatic insufficiency

Alcoholic patient + elevated GGT + AST>ALT

Alcoholic liver disease

Chronic diarrhoea + positive anti-TTG antibodies + villous atrophy

Coeliac disease

Recurrent variceal bleeding + prophylaxis with non-selective beta-blockers

Portal hypertension management

Recurrent sinopulmonary infections + low IgG, IgA, IgM + normal T cells

Common variable immunodeficiency

X-linked recurrent bacterial infections + absent B cells + low immunoglobulins

X-linked agammaglobulinemia (Bruton's)

Severe viral and fungal infections + chronic diarrhoea + failure to thrive + low T cells

Severe combined immunodeficiency (SCID)

Neutropenia + recurrent bacterial infections + delayed umbilical cord separation

Leukocyte adhesion deficiency

Chronic granulomatous disease + recurrent catalase-positive infections + abnormal nitroblue tetrazolium test

Chronic granulomatous disease

Recurrent Neisseria infections + low terminal complement components (C5-C9)

Terminal complement deficiency

Recurrent respiratory infections + eczema + thrombocytopenia

Wiskott-Aldrich syndrome

Young adult + chronic mucocutaneous candidiasis + endocrine autoimmunity

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED)

HIV patient + CD4 count <200 + opportunistic infections

Advanced HIV/AIDS

Immediate hypersensitivity reaction + IgE + mast cell degranulation

Type I hypersensitivity

Cytotoxic antibody-mediated reaction + IgG or IgM + complement activation

Type II hypersensitivity

Immune complex mediated + deposition in tissues + complement activation

Type III hypersensitivity

T cell-mediated delayed reaction + sensitized T cells

Type IV hypersensitivity

Autoantibodies to TSH receptor + hyperthyroidism

Graves disease

Anti-mitochondrial antibodies + cholestatic LFTs + female

Primary biliary cholangitis

Anti-dsDNA + low complement + malar rash + nephritis

Systemic lupus erythematosus

Anti-centromere antibodies + CREST syndrome

Limited scleroderma

Anti-Scl-70 (topoisomerase I) antibodies + diffuse skin thickening

Diffuse systemic sclerosis

Anti-Jo-1 antibodies + interstitial lung disease + myositis

Polymyositis / Dermatomyositis

Anti-Ro/SSA + neonatal lupus / congenital heart block

Sjögren's syndrome

Recurrent sinopulmonary infections + IgG subclass deficiency

Selective IgG subclass deficiency

Defective oxidative burst in neutrophils + positive nitroblue tetrazolium

Chronic granulomatous disease

Recurrent pyogenic infections + absent neutrophil chemotaxis

Leukocyte adhesion deficiency

Serum sickness + fever, rash, arthralgia after drugs or antiserum

Type III hypersensitivity

Contact dermatitis + poison ivy + T-cell mediated

Type IV hypersensitivity

Immediate urticaria + anaphylaxis after peanuts

Type I hypersensitivity

Hashimoto thyroiditis + anti-thyroid peroxidase antibodies + hypothyroidism

Autoimmune thyroiditis

Recurrent bacterial infections + absent B cells + X-linked inheritance

Bruton's agammaglobulinemia

Recurrent sinopulmonary infections + normal B cells + low IgG/IgA/IgM

Common variable immunodeficiency

DiGeorge syndrome + absent thymus + tetany + recurrent viral infections

T-cell immunodeficiency

CREST syndrome + progressive breathlessness + basal crackles + lower-zone shadowing on CXR

Scleroderma-associated pulmonary fibrosis (interstitial lung disease)

Injecting drug user + injection-site abscess + fever + pansystolic murmur

Staphylococcus aureus (right-sided infective endocarditis)

Healthcare worker needlestick from HIV-positive, HCV-negative, HBV-vaccinated patient not on ART

Start HIV post-exposure prophylaxis with 28 days of Tenofovir/Emtricitabine + Raltegravir; no HBV or HCV prophylaxis needed

# e Immunocompromised (chemotherapy) patient + non-immune + recent high-risk exposure to chickenpox

Give varicella-zoster immunoglobulin (VZIG) as soon as possible

Traveller to Mexico + watery diarrhoea + cramping abdominal pain + mild fever + mucus but no blood

Enterotoxigenic Escherichia coli (ETEC)

Traveller to Southeast Asia + profuse watery 'rice-water' diarrhoea + severe dehydration

Vibrio cholerae

Traveller to Africa + watery diarrhoea + abdominal cramps + vomiting + incubation 1–2 days

Enterotoxigenic Escherichia coli (ETEC)

Traveller to India + bloody diarrhoea + fever + abdominal pain

Shigella spp.

Traveller to South America + fever + bloody diarrhoea + abdominal cramps + diarrhea persisting >1 week

Campylobacter jejuni

Traveller to sub-Saharan Africa + prolonged diarrhoea (>2 weeks) + malabsorption + weight loss

Giardia lamblia

Traveller to Mexico + diarrhoea + low-grade fever + mucousy stools + abdominal cramps

Enteropathogenic Escherichia coli (EPEC)

Traveller to developing country + acute diarrhoea after consuming undercooked beef + haemolytic uraemic syndrome risk

Enterohemorrhagic E. coli (EHEC, O157:H7)

Traveler returning from Asia + fever + rose spots + relative bradycardia + hepatosplenomegaly

Salmonella Typhi (typhoid fever)

Traveller returning from Asia + high fever + abdominal pain + diarrhoea + constipation + leukopenia

Salmonella Typhi

Traveller + diarrhoea + bloating + greasy stools + chronic infection in immunocompromised

Giardia lamblia

Traveller + dysentery + tenesmus + fever + lower abdominal cramps + rectal involvement

Shigella spp.

Traveller to rural area + fever + hepatomegaly + right upper quadrant pain + jaundice

Hepatitis A virus

Traveller to Southeast Asia + jaundice + dark urine + nausea + pruritus + elevated ALT > AST

Hepatitis E virus

Patient immunocompromised + chronic diarrhoea + oocysts in stool + acid-fast stain positive

Cryptosporidium parvum

Traveller returning from rural Africa + watery diarrhoea + blood and mucus + abdominal cramps

Entamoeba histolytica

Traveler with foodborne diarrhoea + vomiting + onset 6–24h after ingestion of poultry or eggs

Salmonella non-typhi

Traveler + diarrhoea after ingestion of canned foods + neurological symptoms + blurred vision

Clostridium botulinum

Traveller + sudden-onset watery diarrhoea after buffet meal + incubation 1–6 hours

Staphylococcus aureus enterotoxin

Traveler + diarrhoea + fever + incubation 12–36h after undercooked seafood

Vibrio parahaemolyticus

Traveller + diarrhoea + systemic symptoms + incubation 1–7 days + travel to Asia or Africa

Campylobacter jejuni

Traveller + fever + right upper quadrant pain + liver abscess + history of dysentery

Entamoeba histolytica

Traveler with seafood ingestion + rapidly onset vomiting + diarrhoea + self-limiting

Bacillus cereus (emetic type)

Traveler + diarrhoea + severe abdominal cramps + temperature normal + bloody stools

EHEC (Enterohemorrhagic E. coli)

Traveler + persistent diarrhoea + immunocompromised + oocysts in stool (modified acid-fast)

Cryptosporidium

Traveler + watery diarrhoea + severe dehydration + history of drinking unfiltered water

Vibrio cholerae

Traveler + diarrhoea + incubation 1–3 days + cramping + low-grade fever + exposure to food/water

EPEC / ETEC

Traveler + bloody diarrhoea + fever + mucous + small bowel invasion + traveler’s dysentery

Shigella / Campylobacter

Traveler + persistent diarrhoea + flatulence + weight loss + malabsorption + fat-soluble vitamin deficiency

Giardia lamblia

Traveler + diarrhoea + jaundice + recent travel to endemic area + incubation 15–50 days

Hepatitis A virus

Sudden-onset left arm weakness + facial droop + slurred speech + right MCA territory infarct on CT

Right middle cerebral artery stroke

Sudden-onset confusion + ataxia + dysarthria + left-sided intention tremor + vertebrobasilar infarct

Posterior circulation stroke

Transient right-sided weakness lasting 20 minutes + no CT changes

Transient ischemic attack (TIA)

Sudden-onset severe headache + nausea + photophobia + neck stiffness + subarachnoid blood on CT

Subarachnoid hemorrhage

Acute unilateral severe headache + ipsilateral lacrimation + nasal congestion + restlessness

Cluster headache

Unilateral throbbing headache + nausea + photophobia + aura

Migraine with aura

Progressive resting tremor + bradykinesia + cogwheel rigidity + masked facies

Parkinson’s disease

Rapid-onset asymmetric flinging movements of one side + subthalamic nucleus lesion

Hemiballismus

Slow, writhing movements of hands and face + Huntington’s disease

Chorea

Sudden shock-like movements of face triggered by touch

Trigeminal neuralgia

Progressive muscle weakness + fatigability + ptosis + diplopia worse at end of day

Myasthenia gravis

Rapidly progressive weakness + areflexia + history of infection 2 weeks prior

Guillain-Barré syndrome (acute inflammatory demyelinating polyneuropathy)

Distal symmetric sensory loss + stocking-glove pattern + diabetes

Diabetic peripheral neuropathy

Progressive distal weakness + hammer toes + absent reflexes + pes cavus + family history

Charcot-Marie-Tooth disease

Proximal muscle weakness + elevated CK + heliotrope rash + Gottron's papules

Dermatomyositis

Acute flaccid paralysis in a child + asymmetric + fever + CSF lymphocytosis

Poliomyelitis

Brief generalized tonic-clonic seizure + post-ictal confusion + no prior history

First unprovoked seizure

Focal seizure with impaired awareness + automatisms + temporal lobe lesion on MRI

Temporal lobe epilepsy

Child with brief sudden jerks of extremities on awakening + EEG shows generalized spike-wave

Juvenile myoclonic epilepsy

Progressive cognitive decline + myoclonus + periodic sharp waves on EEG + CSF 14-3-3 positive

Creutzfeldt-Jakob disease

Progressive memory loss + personality change + frontal lobe atrophy on MRI

Frontotemporal dementia

Acute confusion + visual hallucinations + fluctuating attention in elderly

Delirium / Lewy body dementia

Bilateral lower limb weakness + UMN signs + thoracic sensory level + MRI cord lesion

Transverse myelitis

Progressive lower limb spasticity + urinary urgency + sensory level + MRI spinal cord lesions

Multiple sclerosis (spinal demyelination)

Ascending numbness + weakness + recent campylobacter infection + CSF shows high protein, normal WCC

Guillain-Barré syndrome

Progressive upper limb weakness + fatigable + ptosis + positive edrophonium test

Myasthenia gravis

Intention tremor + dysdiadochokinesia + wide-based gait + alcohol excess

Cerebellar degeneration

Rapid-onset diplopia + ptosis + ophthalmoplegia + antitoxin exposure

Botulism

Acute-onset flaccid paralysis + recent gastroenteritis + albuminocytologic dissociation

Guillain-Barré syndrome

Peripheral facial nerve palsy + inability to close eye + drooping mouth + no other neurological deficit

Bell's palsy (CN VII)

Acute vertigo + nausea + horizontal nystagmus + normal MRI

Peripheral vestibular neuronitis

Progressive sensory ataxia + positive Romberg + loss of vibration/proprioception + low B12

Subacute combined degeneration (B12 deficiency)

Fever + headache + photophobia + neck stiffness + CSF neutrophilic pleocytosis

Bacterial meningitis

Fever + headache + rash + CSF lymphocytic pleocytosis

Viral meningitis

Immunocompromised patient + headache + confusion + ring-enhancing lesions on MRI

Toxoplasmosis (CNS)

Progressive spastic paraparesis + urinary urgency + sensory level + HIV positive

HIV-associated vacuolar myelopathy

Acute-onset diplopia + ptosis + dysphagia + descending paralysis + toxin exposure

Botulism

Sudden-onset unilateral weakness + slurred speech + hyperdense MCA branch on CT

Ischemic stroke (MCA territory)

Bilateral leg weakness + UMN signs + thoracic sensory level + longitudinally extensive cord lesion

Neuromyelitis optica (NMO)

Gradual memory loss + personality changes + frontal lobe atrophy on MRI + negative 14-3-3 protein

Frontotemporal dementia

Unilateral severe periorbital pain + lacrimation + nasal congestion + restlessness

Cluster headache

Child with brief sudden jerks of extremities on awakening + generalized spike-wave on EEG

Juvenile myoclonic epilepsy

Progressive asymmetric distal weakness + pes cavus + hammer toes + absent reflexes + family history

Charcot-Marie-Tooth disease

Acute lower limb flaccid paralysis + recent campylobacter gastroenteritis + albuminocytologic dissociation

Guillain-Barré syndrome

Acute confusion + visual hallucinations + fluctuating attention + elderly patient

Delirium (consider Lewy body dementia in chronic cases)

Progressive upper limb weakness + fatigable + ptosis + positive edrophonium test

Myasthenia gravis

Sudden-onset lower facial droop + spared forehead + upper motor neuron lesion

Central facial palsy

Sudden-onset lower facial droop + involvement of forehead + lower motor neuron lesion

Peripheral facial palsy (Bell's palsy)

Acute hemiplegia + gaze deviation + aphasia + CT confirms MCA infarct

Middle cerebral artery stroke

Acute hemiplegia + leg weakness > arm weakness + frontal lobe involvement

Anterior cerebral artery stroke

Contralateral homonymous hemianopia + occipital lobe lesion

Posterior cerebral artery stroke

Ataxia + vertigo + ipsilateral limb incoordination + dysmetria + cerebellar infarct

Cerebellar stroke

Acute-onset back pain + asymmetric weakness + sensory loss + MRI spinal cord lesion

Spinal cord infarct

Gradual tremor + postural instability + bradykinesia + poor levodopa response

Parkinson-plus syndrome (PSP, MSA, CBD)

Acute-onset severe headache + CT normal + LP shows xanthochromia

Subarachnoid hemorrhage (aneurysmal rupture)

Progressive distal weakness + areflexia + pes cavus + family history

Charcot-Marie-Tooth disease

Acute-onset unilateral facial droop + forehead spared

Central facial palsy (UMN)

Acute-onset unilateral facial droop + forehead involved

Peripheral facial palsy (LMN)

Acute flaccid paralysis + respiratory involvement + autonomic dysfunction

Guillain-Barré syndrome (severe form)

Progressive asymmetric upper limb weakness + fasciculations + muscle wasting + preserved sensation

Amyotrophic lateral sclerosis (ALS)

Acute-onset vertigo + hearing loss + tinnitus + horizontal-rotatory nystagmus

Labyrinthitis

Progressive spastic paraparesis + lower limb weakness + Babinski positive + sensory level

Spinal cord compression

Acute-onset headache + fever + neck stiffness + photophobia + purulent CSF

Bacterial meningitis

Gradual cognitive decline + early memory loss + amyloid plaques + neurofibrillary tangles

Alzheimer's disease

Acute-onset diplopia + ptosis + ophthalmoplegia + ingestion of canned food

Botulism

Patient with pH 7.24 + HCO3 12 + PCO2 3.9 + tachypnoea

High-anion-gap metabolic acidosis (lactic acidosis) with respiratory compensation

Patient with pH 7.50 + HCO3 32 + PCO2 48

Primary metabolic alkalosis with partial respiratory compensation

Patient with pH 7.30 + PCO2 60 + HCO3 28

Primary respiratory acidosis with renal compensation

Patient with pH 7.50 + PCO2 28 + HCO3 22

Primary respiratory alkalosis with renal compensation

Unconscious patient in shock + pH 7.10 + HCO3 10 + PCO2 20

Severe high-anion-gap metabolic acidosis (lactic acidosis)

Diabetic patient with Kussmaul breathing + pH 7.15 + HCO3 8

Diabetic ketoacidosis (high-anion-gap metabolic acidosis)

Patient with pH 7.22 + HCO3 15 + Cl 100 + Na 140

High-anion-gap metabolic acidosis

Patient with pH 7.35 + HCO3 15 + PCO2 30

Compensated metabolic acidosis

Patient with pH 7.50 + HCO3 34 + hypokalemia + vomiting

Metabolic alkalosis due to vomiting

Patient with pH 7.10 + PCO2 55 + HCO3 20 + COPD history

Acute-on-chronic respiratory acidosis

Patient with pH 7.52 + PCO2 28 + HCO3 20

Primary respiratory alkalosis (hyperventilation syndrome)

Patient with metabolic acidosis + increased anion gap + ingestion history

High-anion-gap metabolic acidosis (MUDPILES)

Patient with metabolic acidosis + normal anion gap + diarrhea

Normal-anion-gap (hyperchloremic) metabolic acidosis

Patient with severe dehydration + metabolic alkalosis + high urine chloride

Saline-responsive metabolic alkalosis (contraction alkalosis)

Patient with metabolic alkalosis + hypokalemia + hypertension + low renin

Primary hyperaldosteronism (Conn's syndrome)

Patient with metabolic alkalosis + hypokalemia + hypertension + high renin

Secondary hyperaldosteronism

Patient with acute respiratory acidosis + PCO2 rise without HCO3 change

Acute respiratory acidosis (renal compensation not yet started)

Patient with chronic respiratory acidosis + PCO2 60 + HCO3 32 + pH 7.36

Chronic respiratory acidosis with renal compensation

Patient with hyponatremia + hypovolemia + low urine sodium

Hypovolemic hyponatremia (extrarenal loss)

Patient with hyponatremia + hypervolemia + edema + liver disease

Hypervolemic hyponatremia

Patient with hyponatremia + euvolemic + urine osmolality high + SIADH

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Patient with hypernatremia + dehydration + low urine osmolality

Central diabetes insipidus

Patient with hypernatremia + polyuria + high urine sodium

Nephrogenic diabetes insipidus

Patient with hypokalemia + metabolic alkalosis + vomiting

Chloride-responsive metabolic alkalosis

Patient with hypokalemia + hypertension + metabolic alkalosis

Mineralocorticoid excess

Patient with hyperkalemia + metabolic acidosis + ECG peaked T waves

Acute hyperkalemia

Patient with metabolic acidosis + anion gap 28 + history of methanol ingestion

Methanol poisoning (high-anion-gap metabolic acidosis)

Patient with metabolic acidosis + anion gap 30 + ethylene glycol ingestion

Ethylene glycol poisoning

Patient with metabolic acidosis + anion gap + salicylate ingestion

Salicylate toxicity

Patient with pH 7.40 + HCO3 normal + PCO2 normal + mild lactate 3

Compensated metabolic acidosis (early lactic acidosis)

Patient with hypokalemia + alkalosis + vomiting + urine chloride < 20

Chloride-responsive metabolic alkalosis

Patient with hypokalemia + hypertension + metabolic alkalosis + urine chloride > 20

Chloride-resistant metabolic alkalosis (hyperaldosteronism)

Patient with metabolic acidosis + normal anion gap + urinary bicarbonate wasting

Renal tubular acidosis (type 1 or 2)

Patient with pH 7.18 + PCO2 80 + HCO3 28 + COPD exacerbation

Acute-on-chronic respiratory acidosis

Patient with rapid breathing + pH 7.48 + PCO2 25 + HCO3 22

Respiratory alkalosis due to hyperventilation

Patient with chronic respiratory alkalosis + compensatory low HCO3

Chronic hyperventilation (renal compensation)

Patient with metabolic acidosis + high anion gap + diabetic + ketones

Diabetic ketoacidosis

Patient with metabolic acidosis + high anion gap + uremia + creatinine 600

Uremic metabolic acidosis

Patient with pH 7.60 + low potassium + high bicarbonate + vomiting

Severe metabolic alkalosis

Patient with hyperchloremia + normal anion gap metabolic acidosis + diarrhea

GI bicarbonate loss

Patient with metabolic acidosis + normal anion gap + renal tubular acidosis + urine pH > 5.5

Distal (type 1) renal tubular acidosis

Patient with metabolic acidosis + normal anion gap + renal tubular acidosis + urine pH < 5.5

Proximal (type 2) renal tubular acidosis

Patient with metabolic alkalosis + vomiting + low urine chloride

Chloride-responsive metabolic alkalosis

Patient with metabolic alkalosis + mineralocorticoid excess + hypertension

Chloride-resistant metabolic alkalosis

Patient with hyperkalemia + metabolic acidosis + ECG changes + kidney failure

Acute kidney injury causing hyperkalemic metabolic acidosis

Patient with hypokalemia + metabolic alkalosis + vomiting or NG suction

Extrarenal chloride loss

Patient with hyponatremia + euvolemia + normal renal function + high urine osmolality

SIADH

Patient with metabolic acidosis + anion gap + ingestion history of antifreeze

Ethylene glycol poisoning

Patient with metabolic acidosis + normal anion gap + diarrhea + low bicarbonate

GI bicarbonate loss

Patient with metabolic alkalosis + hypokalemia + hypertension + low renin

Primary hyperaldosteronism

Patient with metabolic alkalosis + vomiting + high urine chloride + refractory hypokalemia

Secondary hyperaldosteronism

Patient with hypernatremia + dehydration + decreased urine output

Hypovolemic hypernatremia

Short female with webbed neck, widely spaced nipples, and streak ovaries

Turner syndrome (45,X)

Tall male, gynecomastia, small testes, infertility, learning difficulties

Klinefelter syndrome (47,XXY)

Obese child with hypogonadism, hypotonia, and learning disability

Prader–Willi syndrome

Child with inappropriate laughter (‘happy puppet’), seizures, ataxia, developmental delay

Angelman syndrome

Neonate with clenched fists, rocker-bottom feet, micrognathia, congenital heart defects

Edwards syndrome (trisomy 18)

Neonate with cleft lip/palate, polydactyly, microphthalmia, scalp defects

Patau syndrome (trisomy 13)

Infant with high-pitched cat-like cry, microcephaly, wide-set eyes, intellectual disability

Cri-du-chat syndrome (5p deletion)

Male child with macro-orchidism, long face, large ears, intellectual disability, autism features

Fragile X syndrome

Child with progressive cerebellar ataxia, telangiectasia, recurrent infections

Ataxia-telangiectasia

Teen with photosensitivity, skin freckling, early skin cancers

Xeroderma pigmentosum

Young child with café-au-lait spots, axillary freckling, Lisch nodules, optic gliomas

Neurofibromatosis type 1

Child with bilateral vestibular schwannomas, cataracts, meningiomas

Neurofibromatosis type 2

Male with renal cell carcinoma, pheochromocytoma, retinal/cerebellar haemangioblastomas

von Hippel–Lindau syndrome

Child with hypocalcaemia, recurrent infections, abnormal facies, conotruncal heart defects

DiGeorge syndrome (22q11 deletion)

Short child with learning difficulties, elfin facies, hypercalcaemia, friendly personality

Williams syndrome

Child with coarse facial features, corneal clouding, hepatosplenomegaly, developmental regression

Hurler syndrome (MPS I)

Child with aggressive behaviour, no corneal clouding, hepatosplenomegaly

Hunter syndrome (MPS II, X-linked recessive)

Teenager with hepatosplenomegaly, bone pain, Erlenmeyer flask deformity of femur

Gaucher disease

Infant with cherry-red spot on macula, developmental regression, no hepatosplenomegaly

Tay–Sachs disease

Child with cherry-red spot, hepatosplenomegaly, neurodegeneration

Niemann–Pick disease

Teen with renal angiomyolipomas, seizures, adenoma sebaceum (facial angiofibromas)

Tuberous sclerosis

Child with cerebellar haemangioblastomas, cysts in pancreas/kidney, pheochromocytomas

von Hippel–Lindau syndrome

Child with port-wine stain (V1 distribution), seizures, hemiplegia, intellectual disability

Sturge–Weber syndrome

Young man with recurrent haemarthroses, prolonged bleeding after trauma

Haemophilia A (factor VIII deficiency)

Young woman with thrombocytopenia, eczema, recurrent infections

Wiskott–Aldrich syndrome

Teen with recurrent respiratory infections, bronchiectasis, situs inversus

Kartagener’s syndrome (primary ciliary dyskinesia)

Infant with meconium ileus, recurrent chest infections, male infertility

Cystic fibrosis (CFTR mutation)

Child with hypoglycaemia, lactic acidosis, doll-like face, hepatomegaly

von Gierke disease (glycogen storage disease I)

Child with exercise intolerance, painful muscle cramps, myoglobinuria after exercise

McArdle disease (glycogen storage disease V)

Neonate with cataracts, hepatomegaly, failure to thrive, E. coli sepsis

Galactosaemia

Young boy with progressive muscle weakness, calf pseudohypertrophy, Gowers sign

Duchenne muscular dystrophy (dystrophin mutation)

Teen boy with milder muscle weakness than Duchenne, later onset

Becker muscular dystrophy

Child with short stature, multiple bone exostoses, early arthritis

Hereditary multiple exostoses

Teen with recurrent fractures, blue sclerae, hearing loss

Osteogenesis imperfecta

Child with brittle hair, developmental delay, hypotonia, poor copper absorption

Menkes disease

Teen with tremor, dysarthria, psychiatric symptoms, Kayser–Fleischer rings

Wilson’s disease (ATP7B mutation)

Young woman with easy bruising, hyperextensible skin, joint hypermobility

Ehlers–Danlos syndrome

Child with lens subluxation, tall stature, aortic aneurysm

Marfan syndrome

Young woman with silvery scaly plaques on extensor surfaces and scalp, nail pitting

Psoriasis vulgaris

Child with itchy flexural rash, worse at night, history of asthma and hay fever

Atopic eczema

Young adult with vesicles and crusting around the mouth, honey-coloured lesions

Impetigo (Staph. aureus or Strep. pyogenes)

Middle-aged woman with flaccid blisters and oral mucosal involvement, Nikolsky positive

Pemphigus vulgaris

Elderly man with tense, pruritic bullae, Nikolsky negative

Bullous pemphigoid

Child with intensely itchy burrows in web spaces of hands, family affected

Scabies

Patient with grouped vesicles on an erythematous base, recurrent on lips

Herpes simplex

Elderly patient with painful vesicular rash in dermatomal distribution

Herpes zoster (shingles)

Teen with comedones, papules, pustules on face and back

Acne vulgaris

Child with annular scaly lesion with central clearing, well-demarcated edge

Tinea corporis (ringworm)

Teen athlete with itchy scaly rash in groin

Tinea cruris

Runner with macerated, itchy rash between toes

Tinea pedis (athlete’s foot)

Young child with patchy hair loss, scaly scalp

Tinea capitis

Patient with hypopigmented patches on trunk that do not tan in summer

Pityriasis versicolor (Malassezia furfur)

Child with sudden eruption of oval, salmon-pink scaly lesions, 'herald patch' then Christmas tree distribution

Pityriasis rosea

Middle-aged man with silvery scale on extensor elbows, arthritis, nail pitting

Psoriatic arthritis

Obese woman with velvety, hyperpigmented skin in axillae and neck folds

Acanthosis nigricans (may indicate insulin resistance or malignancy)

Elderly man with pearly papule, rolled edge, central ulcer, sun-exposed skin

Basal cell carcinoma

Farmer with scaly, crusted lesion on lower lip or ear, risk of metastasis

Squamous cell carcinoma of skin

Fair-skinned young adult with pigmented changing mole (ABCDE features)

Malignant melanoma

Man with greasy yellow scales on scalp and nasolabial folds, worse in Parkinson’s

Seborrhoeic dermatitis

Elderly patient with thick, hyperkeratotic, scaly lesion on sun-exposed area, premalignant

Actinic keratosis

Child with fever, malaise, then vesicular rash in crops at different stages

Varicella (chickenpox)

Teenager with slapped-cheek rash, then lacy rash on trunk and limbs

Parvovirus B19 (erythema infectiosum, Fifth disease)

Infant with high fever, then sudden blanching maculopapular rash on trunk

Roseola infantum (HHV-6/7, Sixth disease)

Child with painful oral ulcers and vesicular rash on hands, feet, buttocks

Hand, foot and mouth disease (Coxsackie A virus)

Teen with painful grouped vesicles on erythematous base, recurrent genital ulcers

Genital herpes (HSV-2)

Adult with target lesions after HSV infection or drugs, may involve palms and mucosa

Erythema multiforme

Middle-aged man with recurrent oral ulcers, genital ulcers, uveitis

Behçet’s disease

Patient with erythematous malar rash, photosensitive, sparing nasolabial folds + nephritis

Systemic lupus erythematosus (SLE)

Young adult with palpable purpura on buttocks, abdominal pain, arthralgia, renal involvement

Henoch–Schönlein purpura (IgA vasculitis)

Child with sandpaper rash, strawberry tongue, sore throat

Scarlet fever (Strep. pyogenes)

Teen with urticaria, wheals, angioedema, resolves within 24h

Allergic urticaria

Middle-aged man with well-demarcated erythematous plaques with central clearing and advancing edge, satellite pustules in skin folds

Candidiasis (intertrigo)

Patient with itchy, purple, polygonal, flat-topped papules on wrists and oral mucosa

Lichen planus

Young woman with erythematous nodules on shins, painful, history of IBD or sarcoid

Erythema nodosum

Patient with hyperpigmented, leathery skin due to repeated scratching and rubbing

Lichen simplex chronicus

Infant with salmon patch on nape of neck or glabella, fades with age

Naevus simplex (‘stork bite’)

Child with raised red strawberry-like lesion, grows rapidly then involutes

Infantile haemangioma

Patient with congenital port-wine stain in trigeminal V1 distribution, seizures, glaucoma

Sturge–Weber syndrome

Teen with café-au-lait spots, axillary freckling, neurofibromas

Neurofibromatosis type 1

Young adult with ash-leaf hypopigmented macules, facial angiofibromas, seizures

Tuberous sclerosis

CSF: Opening pressure high, cloudy, neutrophils ↑, protein ↑, glucose ↓

Bacterial meningitis

CSF: Lymphocytes ↑, protein mildly ↑, glucose normal, clear appearance

Viral meningitis

CSF: Lymphocytes ↑, very high protein, glucose very low, Ziehl–Neelsen stain may show AFB

Tuberculous meningitis

CSF: Lymphocytes ↑, protein ↑, glucose low, India ink stain positive

Cryptococcal meningitis (esp. HIV)

CSF: Lymphocytes ↑, protein ↑, oligoclonal bands, normal glucose

Multiple sclerosis

CSF: Protein very high (>1 g/L), very few or no cells (‘albuminocytologic dissociation’), glucose normal

Guillain–Barré syndrome

CSF: Xanthochromia present, red cells throughout samples 1–3

Subarachnoid haemorrhage

CSF: RBCs fall between tube 1 and tube 3, no xanthochromia

Traumatic lumbar puncture

CSF: Neutrophils ↑, protein ↑, glucose low, Gram negative diplococci seen

Meningococcal meningitis

CSF: Neutrophils ↑, protein ↑, glucose low, Gram positive diplococci seen

Pneumococcal meningitis

CSF: Opening pressure ↑, clear fluid, WCC normal, protein normal, glucose normal

Idiopathic intracranial hypertension

CSF: Prion protein detection, 14-3-3 protein, nonspecific mild protein rise

CJD (Creutzfeldt–Jakob disease)

CSF: Positive VDRL, lymphocytes ↑, protein ↑, glucose ↓

Neurosyphilis

CSF: Eosinophils present, lymphocytes ↑, protein ↑, may suggest parasitic infection

Parasitic meningitis

CSF: Clear, lymphocytes ↑, protein normal or mildly ↑, glucose normal, EBV PCR positive

Viral encephalitis (e.g. HSV, EBV)

CSF: Mild pleocytosis, RBCs ↑, temporal lobe involvement on MRI

Herpes simplex encephalitis

CSF: Oligoclonal bands in CSF only (not serum)

Multiple sclerosis

CSF: Lymphocytes ↑, protein ↑, glucose low, positive fungal culture (Candida, Aspergillus)

Fungal meningitis (non-cryptococcal)

CSF: High protein, low glucose, lymphocytic pleocytosis, immunocompromised host

Listeria monocytogenes meningitis

CSF: No white cells, markedly high protein, glucose normal

Froin’s syndrome (blockage of CSF flow, e.g. spinal tumour)

Photosensitive rash, arthritis, nephritis. Which antibody is most specific?

SLE – Anti-dsDNA (also Anti-Smith)

Dry eyes, dry mouth, positive Schirmer’s test. Which antibody?

Sjögren’s syndrome – Anti-Ro (SSA), Anti-La (SSB)

Diffuse skin tightening, Raynaud’s, dysphagia. Which antibody?

Systemic sclerosis (diffuse) – Anti-Scl-70 (topoisomerase I)

CREST features. Which antibody?

Limited systemic sclerosis – Anti-centromere

Proximal muscle weakness, heliotrope rash, raised CK. Which antibody?

Dermatomyositis/Polymyositis – Anti-Jo-1

Fatigue, pruritus, jaundice, cholestatic LFTs. Which antibody?

Primary biliary cholangitis – Anti-mitochondrial (AMA)

Cholestatic picture, IBD association, p-ANCA positive. Which condition?

Primary sclerosing cholangitis – p-ANCA

Hepatitis with raised transaminases, positive anti-smooth muscle. Diagnosis?

Autoimmune hepatitis type 1 – Anti-smooth muscle

Hepatitis with raised transaminases, positive anti-LKM-1. Diagnosis?

Autoimmune hepatitis type 2 – Anti-LKM-1

Hemoptysis and renal failure. Which antibody?

Goodpasture’s syndrome – Anti-GBM

Sinusitis, hematuria, cavitating lung lesions. Which antibody?

Granulomatosis with polyangiitis – c-ANCA (PR3)

Asthma, eosinophilia, neuropathy. Which antibody?

EGPA – p-ANCA (MPO)

Rapidly progressive glomerulonephritis with p-ANCA. Which condition?

Microscopic polyangiitis – p-ANCA (MPO)

Symmetrical polyarthritis, raised ESR. Which specific antibody?

Rheumatoid arthritis – Anti-CCP

Recurrent miscarriages, livedo reticularis, prolonged APTT. Which antibody?

Antiphospholipid syndrome – Anti-cardiolipin / Lupus anticoagulant / Anti-β2GP1

Chronic diarrhea, villous atrophy, positive antibody. Which condition?

Celiac disease – Anti-tTG, Anti-endomysial

Inflammatory back pain, sacroiliitis. Which HLA?

Ankylosing spondylitis – HLA-B27

Overlap features of lupus, systemic sclerosis, and polymyositis. Which antibody?

Mixed connective tissue disease – Anti-U1 RNP

Polymyositis with interstitial lung disease. Which antibody?

Anti-synthetase syndrome – Anti-Jo-1 (also Anti-PL-7, Anti-PL-12)

Neonatal lupus / congenital heart block risk. Which maternal antibody?

Anti-Ro (SSA)

Scleroderma renal crisis. Which antibody?

Anti-RNA polymerase III

Drug-induced lupus (hydralazine, procainamide, isoniazid). Which antibody?

Drug-induced lupus – Anti-histone

Hashimoto’s thyroiditis. Which antibodies?

Anti-TPO, Anti-thyroglobulin

Graves’ disease. Which antibody drives the condition?

TSH receptor antibody (TRAb, thyroid-stimulating immunoglobulin)

Myasthenia gravis. Which antibody?

Anti-acetylcholine receptor antibody (Anti-AChR)

Lambert-Eaton syndrome. Which antibody?

Anti-VGCC (voltage-gated calcium channel)

Inflammatory bowel disease (UC). Which autoantibody is often present?

p-ANCA

Inflammatory bowel disease (Crohn’s). Which autoantibody can be seen?

ASCA (anti-Saccharomyces cerevisiae antibody)

Paraneoplastic cerebellar degeneration. Which antibody?

Anti-Yo (anti-Purkinje cell)

Paraneoplastic small-cell lung cancer with encephalitis. Which antibody?

Anti-Hu

Stiff person syndrome. Which antibody?

Anti-GAD (glutamic acid decarboxylase)

Agitation, dilated pupils, hypertension, tachycardia, chest pain, arrhythmias

Cocaine intoxication

Miosis, respiratory depression, coma

Opioid (e.g. heroin) overdose

Agitation, sweating, dilated pupils, tachycardia, hyperthermia, hyponatremia (esp. after clubbing)

Amphetamine/MDMA intoxication

Euphoria, red eyes, increased appetite, anxiety/paranoia

Cannabis intoxication

Hallucinations, dilated pupils, anxiety/panic

LSD/psychedelic intoxication

Ataxia, slurred speech, disinhibition, hypoglycemia

Alcohol intoxication

Delirium, tremors, seizures, confusion after alcohol cessation

Alcohol withdrawal

Right upper quadrant pain, jaundice, hepatic necrosis after overdose

Paracetamol overdose

Tinnitus, hyperventilation (resp alkalosis), metabolic acidosis, hyperthermia

Aspirin overdose

Dry mouth, dilated pupils, urinary retention, arrhythmias, seizures

TCA overdose

Fever, clonus, agitation, dilated pupils (esp. after antidepressants)

Serotonin syndrome (SSRI overdose)

Sedation, ataxia, respiratory depression, hypotension (esp. with alcohol)

Benzodiazepine overdose

Bradycardia, hypotension, hypoglycemia, bronchospasm

Beta-blocker overdose

Hypotension, bradycardia, hyperglycemia (after antihypertensive ingestion)

Calcium channel blocker overdose

Vomiting, abdominal pain, metabolic acidosis, shock, hepatic failure (esp. child)

Iron overdose

Nausea, vomiting, yellow-green vision, arrhythmias

Digoxin toxicity

Ataxia, coarse tremor, polyuria, seizures, renal failure

Lithium toxicity

Headache, confusion, collapse, cherry-red skin

Carbon monoxide poisoning

Seizures, lactic acidosis, bitter almond odor

Cyanide poisoning

Salivation, lacrimation, urination, diarrhea, bronchorrhea, pinpoint pupils

Organophosphate poisoning

Cyanosis not improving with O₂, chocolate-brown blood

Methemoglobinemia (nitrates, dapsone, benzocaine)

Drug overdose: dry mouth, dilated pupils, confusion, urinary retention, seizures, wide QRS arrhythmias

TCA (e.g. amitriptyline) overdose → Treat with IV sodium bicarbonate

Drug overdose: nausea, vomiting, tremor, seizures, hypokalaemia, tachyarrhythmias

Theophylline toxicity → Treat with activated charcoal, beta-blockers for arrhythmias

Drug overdose: bradycardia, hypotension, hypoglycaemia, bronchospasm

Beta-blocker (e.g. bisoprolol, propranolol) overdose → Treat with IV glucagon, atropine, pacing if needed

Drug overdose: hypotension, bradycardia, hyperglycaemia, metabolic acidosis

Calcium channel blocker overdose → Treat with IV calcium, high-dose insulin, vasopressors

Drug overdose: vomiting, abdominal pain, metabolic acidosis, shock, hepatic failure

Iron overdose → Treat with IV desferrioxamine

Drug overdose: nausea, vomiting, yellow-green vision, confusion, arrhythmias

Digoxin toxicity → Treat with digoxin-specific antibody fragments

Drug overdose: ataxia, coarse tremor, polyuria, seizures, renal impairment

Lithium toxicity → Treat with IV fluids, haemodialysis if severe

Drug overdose: tinnitus, hyperventilation, mixed respiratory alkalosis + metabolic acidosis, hyperthermia

Aspirin (salicylate) overdose → Treat with IV bicarbonate, haemodialysis if severe

Drug overdose: right upper quadrant pain, jaundice, hepatic necrosis

Paracetamol overdose → Treat with IV N-acetylcysteine

Drug overdose: sedation, ataxia, respiratory depression, hypotension

Benzodiazepine overdose → Treat with Flumazenil (rarely, seizure risk)

Drug overdose: palpitations, tremor, heat intolerance, anxiety, diarrhea

Levothyroxine overdose → Treat supportively, beta-blockers for symptoms

Drug overdose: easy bruising, bleeding gums, prolonged INR

Warfarin overdose → Treat with vitamin K, fresh frozen plasma if severe

Drug overdose: lactic acidosis, GI upset, fatigue

Metformin overdose → Supportive care, haemodialysis if severe

Drug overdose: hypoglycaemia, confusion, sweating, palpitations

Insulin or sulfonylurea overdose → IV glucose, glucagon if severe

Drug overdose: agitation, dilated pupils, hypertension, tachycardia, chest pain, arrhythmias

Cocaine overdose

Drug overdose: miosis, respiratory depression, coma

Opioid overdose → Naloxone

Drug overdose: agitation, sweating, dilated pupils, tachycardia, hyperthermia, hyponatremia

Amphetamine/MDMA overdose

Drug overdose: euphoria, red eyes, increased appetite, anxiety/paranoia

Cannabis overdose

Drug overdose: hallucinations, dilated pupils, anxiety/panic

LSD/psychedelic overdose

Drug overdose: salivation, lacrimation, urination, diarrhea, bronchorrhea, pinpoint pupils

Organophosphate poisoning → Atropine + pralidoxime

Drug overdose: cyanosis not improving with O₂, chocolate-brown blood

Methemoglobinemia → Methylene blue

Drug overdose: seizures, lactic acidosis, bitter almond odor

Cyanide poisoning → Hydroxocobalamin or sodium thiosulfate

Drug overdose: headache, confusion, collapse, cherry-red skin

Carbon monoxide poisoning → 100% O₂ or hyperbaric O₂

Question

Answer

FVC ↓, FEV1 ↓, FEV1/FVC normal or ↑, TLC ↓, DLCO ↓

Restrictive lung disease (e.g. pulmonary fibrosis)

FVC ↑, FEV1 ↑, FEV1/FVC ↓, TLC ↑, RV ↑

Obstructive lung disease (e.g. COPD, asthma)

FEV1 ↓, FEV1/FVC ↓, reversibility after bronchodilator >12%

Asthma

DLCO ↓, RV ↑, TLC ↑, FEV1/FVC ↓

Emphysema

Chest X-ray: lobar consolidation, air bronchograms, opacity in single lobe

Lobar pneumonia

Chest X-ray: bilateral interstitial infiltrates, honeycombing, basal predominance

Idiopathic pulmonary fibrosis

CT scan: tree-in-bud appearance, bronchiectasis, upper lobe predominance

Post-infectious or cystic fibrosis bronchiectasis

ABG: PaO2 ↓, PaCO2 ↑, pH normal or slightly acidotic

Type 2 respiratory failure (COPD exacerbation)

ABG: PaO2 ↓, PaCO2 normal or ↓, pH normal

Type 1 respiratory failure (pulmonary embolism, pneumonia)

ECG: sinus tachycardia, S1Q3T3 pattern, right heart strain

Pulmonary embolism

Echocardiogram: dilated RV, tricuspid regurgitation, elevated pulmonary artery pressure

Pulmonary hypertension / cor pulmonale

ECG: LVH with strain pattern, LBBB

Chronic hypertension or aortic stenosis

ECG: ST elevation in V1–V4, Q waves, reciprocal changes

Anterior STEMI

ECG: ST elevation in II, III, aVF, reciprocal changes

Inferior STEMI

ECG: prolonged PR interval, QRS widening, T-wave inversion, bradycardia

TCA overdose

Lung function: FEV1/FVC ↓, TLC normal or ↑, FEV1 improves with bronchodilator

Reversible airway obstruction (asthma)

FVC ↓, FEV1 ↓, FEV1/FVC normal, TLC ↓, restrictive pattern, history of connective tissue disease

Secondary interstitial lung disease (e.g. scleroderma)

Pulse oximetry: SpO2 ↓, normal PaCO2, dyspnoea

Hypoxemia (pulmonary embolism, V/Q mismatch)

Chest X-ray: hyperinflated lungs, flattened diaphragms, increased retrosternal space

COPD / emphysema

CT pulmonary angiogram: filling defect in pulmonary artery, right heart strain

Pulmonary embolism

CFTR gene mutation, thick sticky mucus, recurrent lung infections, pancreatic insufficiency

Cystic fibrosis

Hemizygous mutation in HFE gene, bronze skin, diabetes, cirrhosis, high ferritin

Hereditary haemochromatosis

FMR1 trinucleotide repeat expansion, intellectual disability, large ears, macroorchidism

Fragile X syndrome

Mutation in HBB gene, chronic haemolytic anaemia, target cells on blood smear

Beta-thalassemia

Mutation in HBB gene, sickle-shaped RBCs, vaso-occlusive crises

Sickle cell disease

Deficiency of phenylalanine hydroxylase, fair skin, musty body odour, intellectual disability if untreated

Phenylketonuria (PKU)

Deficiency of alpha-1 antitrypsin, early-onset emphysema, liver disease

Alpha-1 antitrypsin deficiency

Mutation in LDL receptor gene, tendon xanthomas, premature coronary artery disease

Familial hypercholesterolemia

Mutation in PAH gene, phenylalanine accumulation, intellectual disability

Classic phenylketonuria

Mutation in OTC gene, hyperammonemia, vomiting, lethargy in neonates

Ornithine transcarbamylase deficiency (urea cycle disorder)

Deficiency of glucocerebrosidase, hepatosplenomegaly, bone pain, pancytopenia

Gaucher disease

Deficiency of sphingomyelinase, cherry-red macula, neurodegeneration

Niemann-Pick disease

Deficiency of hexosaminidase A, neurodegeneration, cherry-red macula, onion-skin lysosomes

Tay-Sachs disease

Mutation in G6PD gene, hemolysis triggered by oxidative stress, jaundice

G6PD deficiency

Deficiency of homogentisate oxidase, dark urine, ochronosis, arthritis

Alkaptonuria

Deficiency of glucose-6-phosphate dehydrogenase, X-linked recessive, favism

G6PD deficiency

Mutation in MECP2 gene, regression of skills after 6–18 months, hand-wringing movements

Rett syndrome

Defect in uroporphyrinogen decarboxylase, photosensitivity, dark urine, abdominal pain

Porphyria cutanea tarda

Mutation in PKD1 or PKD2 gene, bilateral renal cysts, hypertension, progressive renal failure

Autosomal dominant polycystic kidney disease

Mutation in TSC1 or TSC2 gene, facial angiofibromas, seizures, renal angiomyolipomas

Tuberous sclerosis complex

Painless lower GI bleeding in a child or young adult, often with melena or bright red stool; may mimic appendicitis if inflamed

Meckel's diverticulum (true diverticulum from persistent vitelline duct; may contain ectopic gastric or pancreatic tissue) ## Footnote Rule of 2s: 2% of population, 2 feet from ileocecal valve, 2 inches long, commonly presents before age 2. Ectopic tissue: Gastric mucosa → ulceration and bleeding. Diagnosis: Technetium-99m pertechnetate scan (“Meckel scan”).

Weak wrist extension, loss of finger extension, numbness over dorsum of hand, radial deviation of wrist when flexing

Radial nerve lesion (mid-humerus fracture)

Weak elbow flexion, wrist flexion, and supination; sensory loss over lateral forearm and thumb

Musculocutaneous nerve lesion

Wrist drop, loss of triceps reflex, numbness over dorsal forearm and hand

Radial nerve lesion at spiral groove

Weak finger abduction and adduction, ulnar deviation of hand, numbness in little finger and medial half of ring finger

Ulnar nerve lesion at elbow

Weak thumb opposition, thenar wasting, numbness over lateral palm and palmar surface of first three fingers

Median nerve lesion at carpal tunnel

Difficulty abducting shoulder, weak shoulder flexion, numbness over lateral shoulder

Axillary nerve lesion (surgical neck of humerus fracture)

Weak hip flexion and knee extension, sensory loss over anterior thigh and medial leg

Femoral nerve lesion

Weak knee flexion and plantarflexion, numbness over posterior thigh and leg, foot drop

Sciatic nerve lesion

Foot drop, weak dorsiflexion, sensory loss over dorsum of foot and lateral leg

Common peroneal (fibular) nerve lesion at fibular head

Inability to dorsiflex toes, sensory loss on dorsum of foot

Deep peroneal nerve lesion

Claw hand, weakness in interossei, sensory loss in medial two fingers, difficulty with fine finger movements

Ulnar nerve lesion at wrist

Weak plantarflexion, inversion, sensory loss over lateral foot

Tibial nerve lesion

Weak shoulder abduction, winged scapula, sensory loss over medial scapula border

Long thoracic nerve lesion (serratus anterior)

Wrist flexion and abduction weak, sensory loss over lateral forearm, hand numbness (median nerve distribution)

Pronator teres syndrome (median nerve entrapment)

Weak forearm pronation, flexion of elbow, numbness over lateral forearm

Median nerve lesion at elbow

Loss of biceps reflex, weakness of elbow flexion, sensory loss over lateral forearm

C5 nerve root lesion

Loss of triceps reflex, weakness of elbow extension, numbness over middle finger

C7 nerve root lesion

Loss of knee jerk reflex, weakness of knee extension, sensory loss over anterior thigh

L3/L4 nerve root lesion

Loss of ankle jerk reflex, weakness of plantarflexion, sensory loss over lateral foot and sole

S1 nerve root lesion

Difficulty shrugging shoulders, weakness turning head, atrophy of trapezius

Spinal accessory nerve lesion

Chronic leg induration, reddish-brown pigmentation, history of venous ulcers

Lipodermatosclerosis → Hypodermis fibrosis

Acute onset fever, chills, flank pain, hypotension, hemoglobinuria during or within minutes of transfusion

Acute haemolytic transfusion reaction (incompatible ABO)

Fever and mild chills without hemolysis during or shortly after transfusion

Febrile non-haemolytic transfusion reaction (most common; cytokine-mediated or anti-WBC antibodies)

Itching, urticaria, erythema during or shortly after transfusion, no fever

Allergic (mild) transfusion reaction; usually IgE mediated

Severe bronchospasm, hypotension, angioedema during transfusion

Anaphylactic transfusion reaction; often in IgA-deficient patients

Fever, jaundice, malaise, mild drop in hemoglobin 3–14 days after transfusion; positive DAT, reticulocytosis

Delayed haemolytic transfusion reaction (DHTR); anamnestic antibody response

Progressive dyspnea, hypoxia, pulmonary infiltrates within 6 hours of transfusion

Transfusion-related acute lung injury (TRALI); donor anti-HLA or anti-granulocyte antibodies

Fluid overload, dyspnea, hypertension during or soon after transfusion

Transfusion-associated circulatory overload (TACO); consider diuretics

Low-grade fever, malaise, mild hemolysis, positive DAT 7–21 days post-transfusion

Delayed serologic transfusion reaction; usually clinically mild

Dark urine, jaundice, hemoglobinuria, hypotension during transfusion; ABO mismatch suspected

Acute intravascular haemolysis

Post-transfusion hepatitis, jaundice, elevated LFTs weeks later

Transfusion-transmitted viral infection (HBV, HCV, rarely HIV)

Fever, hypotension, rash, eosinophilia, renal dysfunction, 7–21 days post-transfusion

Transfusion-associated graft-versus-host disease (TA-GVHD); rare but fatal

Fever, hypotension, urticaria during transfusion in patient with anti-IgA antibodies

Anaphylactic transfusion reaction in IgA deficiency

Reticulocytosis, mild anemia, positive DAT in patient with previous transfusions

Anamnestic response causing delayed haemolytic transfusion reaction

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