Post-op hypotension in a patient on steroids → suspect hypoadrenal state.
Mitral stenosis: diastolic murmur, signs of pulmonary congestion, history of limited medical access.
Pericarditis: sharp chest pain, worse when supine, relieved when leaning forward; diffuse ST elevation.
STEMI: central pain radiating to shoulders + ECG ST elevation.
NSTEMI: chest pain without ST elevation but elevated troponin.
Aortic dissection: sudden tearing chest pain, pulse deficits.
Use of adrenaline with lignocaine: appropriate in wounds near major structures (e.g. anterior wrist), but avoid in digits, devitalised tissues, or elderly frail skin.
Guillain-Barré Syndrome: ascending weakness, areflexia, raised CSF protein with no cells. Risk of respiratory failure.
Myasthenia Gravis: fatigable weakness, dysphagia, diplopia, normal endoscopy.
Multiple Sclerosis: optic neuritis, MRI: periventricular ovoid lesions, CSF: oligoclonal bands.
Essential tremor: bilateral, better with alcohol, family history.
Psychogenic tremor: inconsistent, distractible, entrainment.
Neuroleptic Malignant Syndrome: rigidity, fever, high CK, long-term antipsychotics.
Wernicke-Korsakoff: thiamine deficiency → confusion, ataxia, nystagmus (Wernicke) ± memory loss (Korsakoff).
Spontaneous pneumothorax: young, thin male, sudden chest pain, hyperresonant.
Foreign body aspiration in child: wheeze, sudden onset → bronchoscopy.
Tuberculosis: upper lobe consolidation, immigrant, weight loss.
Pulmonary embolism: SOB, tachycardia, possible pleuritic chest pain.
Bronchopneumonia: post-op fever, crepitations, usually >48 hrs post-op.
Epiglottitis: soft stridor, tripod posture, drooling → call senior urgently.
Post-thyroidectomy neck swelling → open wound immediately to relieve hematoma.
Anaphylaxis post-op: hypotension + urticaria/scratching/flushing → IM adrenaline.
Opioid overdose: pinpoint pupils, low RR → Naloxone.
CO poisoning: normal SpO2, cherry-pink appearance → 100% oxygen.
DKA: high glucose, ketones, acidotic → IV fluids + insulin + K⁺.
Hypoglycaemia conscious → oral glucose (e.g. jelly beans).
Hypoglycaemia fasting for surgery → IV 10% glucose.
T2DM not controlled with lifestyle → Start Metformin.
Pernicious anaemia: macrocytic anaemia + hypersegmented neutrophils + low B12.
Hereditary spherocytosis: splenomegaly, positive osmotic fragility test.
CML: high WCC, left shift, splenomegaly.
Sickle cell disease: recurrent bone pain, need for vaccination.
Variceal bleeding: cirrhosis signs, massive haematemesis → octreotide, endoscopy.
C. difficile colitis: post-antibiotics, fever, bloody diarrhoea, toxic megacolon on X-ray.
Salmonella enteritis: traveller’s diarrhoea with blood, fever.
Giardia: post-travel bloating, flatulence, chronic diarrhoea.
Pancreatitis: epigastric pain radiating to back, nausea, vomiting.
Mallory-Weiss tear: haematemesis after retching (less likely if no prior vomiting).
Clostridium difficile → suspect in any bloody diarrhoea post-antibiotics.
Polycystic kidney disease: haematuria, high BP, family history of brain bleed.
IgA nephropathy: microscopic haematuria, post-infection, young male.
Bladder cancer: painless haematuria, smoking/chemical exposure.
Intussusception: red currant jelly stool, colicky pain, sausage-shaped mass.
Transient synovitis: hip pain post-viral illness, afebrile, well.
Perthes disease: painless limp, reduced ROM, sclerotic femoral head.
Pyloric stenosis: projectile vomiting, hungry baby, weight loss.
Congenital adrenal hyperplasia: vomiting, undescended testes, salt-wasting.
Post-op oliguria: first check fluid balance chart.
Epididymo-orchitis: painful, swollen testis, febrile.
Appendicectomy + fever + mucous diarrhoea (day 10) → pelvic abscess.
Scaphoid fracture suspicion: immobilise and re-Xray in 10–14 days.
Ectopic pregnancy: hypotension, pain, positive β-hCG → resus + urgent gynae.
Mastitis: breastfeeding mother, tender quadrant → start flucloxacillin.
Endometriosis: dysmenorrhoea, retroverted uterus, pain persists through bleeding.
Non-accidental injury: retinal haemorrhages, bruising, full fontanelle → mandatory report.
Fever on day 2 post-laparoscopy: suspect atelectasis or IV site infection.
Benztropine: for acute dystonia from antiemetics (e.g. metoclopramide).
Diazepam: for alcohol withdrawal.
Flumazenil: for benzodiazepine overdose (use with caution).
Digoxin overdose: needs cardiac monitoring.
Clozapine + SOB: concern for cardiomyopathy → echo.
Polymyositis: proximal muscle weakness + ↑CK + ↑ANA.
Fibromyalgia: widespread pain, normal bloods, tender points.
Polymyalgia Rheumatica: elderly, shoulder stiffness, ESR↑, responds to steroids.
Branchial cyst: fluctuant lateral neck mass.
Foreign body in child’s nose: recurrent unilateral epistaxis, foul discharge.
Penetrating eye trauma (metal work): irregular pupil → CT orbit + ophthalmology.
Pre-arrest signs in epiglottitis → call for help.
Tension haematoma post thyroidectomy → release sutures urgently.
DKA management: fluid first, then insulin, then K⁺.
Septic hypotension (e.g. pyelonephritis) → CSL bolus 500mL.
CO poisoning → high-flow oxygen even with normal SpO₂.