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If X, think Y

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Biochem
Cardiology
Dermatology
Endocrinology
ENT
Gastro
Haematology
Immunology
Multi system disease
Musculo-skeletal
Neurology
Obs & Gynae
Opthalmology
Paeds
Psych
Renal
Respiratory
Rheumatology
T&O
Urology
Vascular

If X
Biochem
Ca2+ ↔, phosphate ↔, ALP ↔
Ca2+ ↔/↓, phosphate ↓, ALP ↑
Ca2+ ↔, phosphate ↔, ALP ↑
PTH ↑, Ca ↑, phosphate ↓, ALP ↑
PTH ↑, Ca ↔, phosphate (↑ CKD) (↓ vit D def), ALP ↑
PTH ↑, Ca ↑, phosphate ↓, ALP ↑
PTH ↑, Ca ↓, phosphate ↑, ALP ↑
PTH ↔/↑, Ca ↓
hepatocellular Ca
testicular Ca
choriocarcinoma
breast Ca
ovarian Ca
pancreatic Ca
colorectal Ca

multiple myeloma
twitching face, numb lips

Cardiology
boot shaped heart
globular shaped heart
pleuritic chest pain eased by sitting up or leaning forward
widened mediastinum post RTA
atypical chest pain in a diabetic
recent MI, weeks later feverish, sharp chest pain
recent MI, now hypotension, ↑JVP on inspiration
continuous machine like murmur
chest pain 30 min after eating
tingling sensation, then collapse
murmur radiates to axilae
giant a wave
canon a wave
large v waves
absent a waves
absent femoral pulse
blowing continuous sys and dia murmur, below clavicles, disappears on lying flat

Dermatology
golden/yellow crusted lesion
dark brown, greasy, stuck on appearance
multiple painful, soft, mobile lumps
purple, flat, well demarcated, on face
purple, flat, well demarcated, on face, now has new onset seizures
target lesions
small papules or domes, with dimpled centre
anterolateral leg ulcer in diabetic, initially red nodule, now flat brown/yellow waxy
baby, new rapidly growing bright red rash on face
dark velvety rash in aprmpits, neck
dark velvety rash in aprmpits, neck, weight loss, GI symptoms

brown.diabetic. white line on surface (Whickhams striae). now rapid hair loss blisters which burst easily tense blisters which are deeper . depressed rash on legs hypothyroid. painful red lesions on shins lesion in site of previous trauma brown macules. now hair loss immunosuppression therapy. intensely itchy. lacy rash on shins well demarcated erythema. flat topped. then necrotic IBD. diarrhoea white lesions on tongue. now big red round rashes post transplant skin Ca TB. well demarcated. on lower leg red spots in ring pattern fingertip lesion. white lacework pattern in mouth red patches over knuckles white spots on vulva / penis tick bite. purple (violaceous). now rash oral & perianal. purple lesion crohns. blistering rash on extensors baby started weaning. deep bluish. pearly edge pink/brown flat lesion. painless. scaly. short broken hairs remain male pattern baldness acute systemic illness. central necrotic plug everted edge rolled. can't wipe off lesion grew rapidly over 6/52. bleeds easliy transplant patient. herald patch irregularly shaped. ulcer on shins. on cheek lump with punctum pigmented lips & mouth coeliac disease. now painful disfiguring lesions on face circular patches of hair loss asymmetrical hair loss. rubbery skin lesions which tingle when pressed pin point bleeding when plaque scraped off pressure applied to edge of lesion causes epidermis to separate from dermis known eczema.e. now blistering of palms and soles skin lesion on shoulder/upper arm i. rapid grown.

now skin pigmentation tight shirt collar. big doughy hands heavy pregnancy bleeding. occurs post stress or alcohol cushing disease. medullary thyroid. low BM ENT painless. low TSH lethargy. marfinoid flushing. high T4. foul smelling discharge from ear exposure to cold weather. wt loss. wt gain. phaeochromycytoma Ca as MEN type 2 plus mucosal neuromas in GI tract. bronchospam. hypo Na+. transilluminates. INC BP. thyroid peroxidase autoantibodies any systemic infection. low T4 and low TSH pituitary. fever bulging eye. hyper Na+. pancreatic islet cell Ca parathyroid. regurgitation and neck lump neck swelling between upper and middle 3rd of SCM neck swelling with pain & swelling on eating Gastro bronzed/tanned skin high ferritn & LFTs and jaundice young. liver change green/brown eye pigmentation . parathyroid. high T4. anterior triangle neck lump halitosis. vertigo soft. now dizzy. irregular subcutaneous nodule in pinna tinnitus. INC micuration hyper K+. thirst. peri-oral tingling post thyroidectomy congenital adrenal hyperplasia painful goitre. fluctuant.Endocrinology phaeochromocytoma hypo K+. diarrhoea bipolar patient with lethargy. INC pigmentation confusion. wt gain. changed behaviour. diarrhoea.

jaundice post alcohol + stress. dysphagia. splenomegaly BBQ then food poisoning symptoms after 12 hours painful glossitis. Lt lower lobe atelectasis. pleural effusion alcoholic. itchy lump in abdomen. surgical emphysema haematemesis post head injury haemetemesis post burn abdo pain 30 min after eating abdo pain worse with eating abdo pain eased by eating jew. dementia Haematology reed Sternberg cells target cells auer rods heinz bodies signet ring cells recurrent nose bleeds. vomiting. history of surgery young man. impaired relaxation of LOS trauma. now jaundice. raised Lt hemidiaphragm. abdo pain . bloods = isolatde raised bilirubin dysphagia solids + liquids. repeated sudden onset swelling and bruising around joints burr cells biopsy is congo red +ve philadephia chromosome present in 95% afebrile. telangiectasia on lips + tongue young. new onset limp high HbA2 and HbF on electrophoresis worsening school performance.freckled lips and bowel symptoms multiple peptic ulcers wt loss. dark velvety skin in axilla and neck known UC.

saddle nose . now infective endocarditis bowel pathology. sun tan like rash holiday to south america/africa. now infective endocarditis IV drug user. sun tan like rash holiday in east africa. holiday to south America 6/52 post transplant. non-immune hydrops baby with periostitis. fingers + wrist addisons disease autoimmune hepatitis churg-strauss syndrome coeliac disease limited cutaneous systemic sclerosis diffuse systemic sclerosis pernicious anaemia primary biliary cirrhosis sjorens syndrome antiphospholipid syndrome SLE wegners granuloma 1o sclerosing cholangitis sterile pyuria dermatomyositis clue cells difficulty swallowing. now fever. jaundice. bradycardia chorioretinitis. calcification on CT head stillborn. now fever. post swimming in dirty water holiday to south east asia. now fever. tram lines on CT head retinitis. now infective endocarditis fever. now rash. constipation then diarrhoea. now infective endocarditis genitourinary pathology. diarrhoea prosthetic heart valve.Immunology anaphylaxis reaction post transfusion reaction glomerulonephritis immune reaction contact dermatitis / transplant painless genital ulcer itch worse at night.

opthalmoplegia walking on cotton wool. wt loss adult onset hayfever & asthma. numbness back pain eased on leaning forward vomit blood post head injury ascending paralysis post infection amyloid plaques. haemoptysis. falls over. apathy crescent shaped bleed on CT loss of facial movements. -ve for herpes simplex nose bleeds. then drowsy. nystagmus. painful to sleep on Neurology confusion. back pain Japanese lady. with sensation intact tired with repetitive movement dry mouth. behavior change. now can't abduct arm. falls. recent general malaise. foot drop ringing. fever. difficulty standing. leg ulcers recurrent oral & anal ulcers.Multisystem disease monoclonal pretein in urine. disinhibition. big calfs minor injury. sudden onset shoulder pain young boy. neurofibrillary tangles in brain forgetful. lucid interval. blurred vision. absent reflexes. nose deformity tender temporal skin Musculoskeletal 60y. deafness dizzy when turn head vesicles in ear . but muscle weakness improves with use sudden severe headache. known polycystic kidney disease head trauma. dizziness. incontinent stepwise detorioration of cognitive function antisocial. biconvex CT headache with lacrimation high arched foot. absent peripheral pulses.

proprioception intact hyperextension of neck. sensory loss other leg loss of pain+temp. weak extraocular muscles melanin deposits in sclera cataracts. painful PV bleeding pregnant.sudden onset dizziness motor loss one leg. PV bleed. gram -ve diplococcus pregnant. epicanthal folds . PV bleed. itch USS shows snowstorm appearance clue cells. cervical excitation Ophthalmology nodules in eye lids and conjunctiva. shoulder tip pain. optic atrophy blue sclera. gait impaired pupils accomodate but dont react to light dizzy. strabismus. patient denies loss poor vision. glare of head lights both eyes fail to adduct misty cornea tremor eased by alcohol weak shoulder abduction and external rotation erb's palsy guttering between extensor tendon of hand foot drop loss thumb adduction (froment's sign) dementia with fluctuating consciousness and halucinations Obs & Gynae white discharge. painless PV bleeding pregnant. PV bleeding pregnant. exaggerated pregnancy syptoms. fetal bradycardia pregnant. keratoconus CMV retinitis lens dislocated inferiorly grey/white bands across cornea. visual loss. fishy smell strawberry cervix. frothy discharge.

metabolic alkalosis stridor.brushfileds spots angiod streaks decreased corneal sensation and tears orbital tumour. parotid enlargement lanugo hair dilated pupils. proteinuria 3+. drooling distended abdo. facial + ankle swelling. facial + ankle swelling. insect crawling on skin iron overdose propranolol overdose benzodiazepine overdose carbon monoxide poisoning aspirin overdose antimuscarinic overdose Renal young child. proteinuria. albumin = 17 young adult. hypo K+. anti-glomerulo basement membrane antibody +ve haematuria 2 days post URTi . albumin = 17 haemoptysis. harsh pansystolic murmur. proteinuria 3+. ejection sytolic. continuous machine like murmur newborn. wide fixed and split 2nd HS. sweaty tremor nuckle calluses. glioma cherry red spot on macula Paeds hypochloraemic. loudest pulmonary area Psych post op becomes anxious. radiating all over but loudest at LLSE newborn. tachycardiac. mass in flank does not cross midline projectile vomiting overlapping fingers newborn.

red eyes. aminoaciduria. medial deviation of ureters glycosuria. low Na. calculi symptoms renal symptoms. hearing loss. blood slightly precipitates in cold temp cotton mill quarry workers. SOB . now dry cough.bright line above meniscus arthritis. cold pale fingers child. respiratory symptoms holiday.2 weeks post tonsillitis / cellulitis. pitting + lifting nails arthritis. seizures dry cough. now dry eyes + mouth difficulty swallowing. dysuria bone symptoms. eye lesions varicocele. splenomegaly RA. hearing loss RA. phosphaturia Respiratory HIV. generalised pink rash. oedema. Xray . bilateral hydronephrosis. previous coal worker. dark urine recurrent UTI. proteinuria. haematuria painful renal angle 'tram track' appearance under microscope Hodgkins disease Kimmelstiel-Wilson lesions dilated collecting ducts hyperparathyroid thrombocytopenia. ARF intracerebral aneurysm or haemorrhagic stroke enlarged kidney's. swollen knees acute knee pain. target lesions. now cough. painful red eye RA. fever. painless red eyes RA. stonemasons Rheumatology diagnosed with RA.

acute hip pain. hip pain. now numb over upper lateral arm post motorcycle RTA. swelling. loss sensation sole foot fell onto arm. knee pain. fixed flexion fractured humerus and unable to extend wrist unable to straighten finger tip unable to flex finger at DIP unable to flex finger at PIP claw hand bulge in upper arm in flexion at elbow lady. nil else young. loss sensation on dorsum hand anterior shoulder dislocation. loss ankle jerk. shooting pain in toes in walking. tender at metatarsal heads arm adducted. externally rotated prepubescent child. calcification young boy. periosteal elevation. now loan to groin pain Vascular groin lump with fluid thrill and varicies in leg . gradual onset. pain in hip young girl. arm limp. internally rotated arm abducted. knee pain climbing stairs finger pain. Xray = collapsed femoral head hit knee against dashboard.T&O fat boy. pronated panda / raccoon eyes Urology recurrent UTIs. knee pain post exercise young girl. now unable to flex toes. extended. medially rotated. unable to extend at MCP.

1 04 .Version log Version & Date 0.2015 .-03 .

Think Y osteoporosis osteomalacia pagets disease 1o hyperparathyroidism 2o  hyperparathyroidism 3o  hyperparathyroidism hypoparathyroidism pseudohypoparathyroidism α-fetoprotein α-fetoprotein. B-HCG B-HCG CA 15-3 CA 125 Ca 19-9 CEA .

monoclonal IgA (paraprotein) hypo Ca2+ tetralogy of fallot cardiac tamponade percarditis ruptured aorta MI Dressler's syndrome pericardial effusion PDA oesophageal spasm hyperventilation MR (Radiates) tricuspid stenosis 3o heart block TR atrial fibrillation coarctation of the aorta venous hum impetigo seborrhoeic warts (keratosis) dercum's disease deep capillary naevus (port wine stain) sturge-weber syndrome erythema multiforme molluscum contagiosum (pox virus) necrobiosis lopoidica cavernous haemangioma (strawberry naevus) acanthosis nigricans GI malignancy .

diabetic dermopathy erythema ab igne erysipelas epidermal cyst (sebacous cyst) peutz jegures dermatitis herpetiformis acrodermatitis ateropathica leukoplakia keratoacanthoma SCC BCC aka Rodent ulcer Bowens disease granuloma annulare pyogenic granuloma kaposis sarcoma pyoderma gangrenosum erythema nodosum marjolins ulcer neurofibromatosis type 1 Auspitz sign Nikolsky sign pompholyx pityriasis rosea lichen planus dermatomyositis lichen slerosis erythema chronicum migrans SCC lupus vulgaris (aka tuberculosis luposa) alopecia areata trichotillomania androgenetic alopecia telogen effluvium anagen effluvium pemphigus vulgaris bullous pemphigoid .

hence. raised 17-hydroxy progeserone de quervains thyroiditis graves disease hypothyroidism 2o to lithium hashimotos thyroiditis sick euthyroid syndrome MEN type 1 MEN type 2 (aka 2a) MEN tyoe 3 (aka 2b) carcinoid syndrome.24hr VMA conn's syndrome adrenal insufficiency / Addisons hypo Ca2+ 21-hydroxylase deficiency. 24hr 5 hydroxyindole acetic acid nelson's syndrome acromegaly sheehan's syndrome cholesteotoma chondrodermatitis nodularis chronica helicis meniere's dosease cystic hygroma pharyngeal pouch branchial cyst salivary calculi haemochromatosis haemochromatosis wilsons disease wilsons disease .

land at NY. drive down route 95 to philadelphia) leukaemia thalassaemia trait lead poisoning .Peutz-Jeghers syndrome zollinger-ellison syndrome gastric Ca cholangiocarcinoma incisional hernia gilberts syndrome oesophageal achalasia (Rx = Heller's myotomy) splenic injury boerhaave's syndrome cushings ulcer curling ulcer mesenteric ischaemia gastric ulcer duodenal ulcer gauchers disease salmonella pellagra = niacin (B3) deficiency hodgkins disease thalassaemia AML G6PD deficiency carcinoma hereditary haemorrhagic telangiectasia haemophilia uraemia amyloidosis CML (cross the middle of the atlantic.

anti-smooth muscle pANCA anti-endomysial. anti-tissue transglutaminase. anti-intrinsic factor anti-mitochondrial anti-Ro. anti-La anticardiolipin ds DNA & antinuclear antibody cANCA ANCA TB anti-Jo bacterial vaginosis chagas disease graft-versus-host disease staph epidermis staph aureus strep bovis enterococcus faecalis leptospirosis dengue fever yellow fever typhoid fever taxoplasmosis CMV parovirus syphyllis .Type I (allergy) Type II (bad blood) Type III (clumps) Type IV (delayed) syphylis (treponema pallidum) scabies anti-21-hydroxylase anti-nuclear. anti-gliadin anti-centromere antibodies (ACA) scl-70 (anti-topoisomerase) anti-parietal cell.

multiple myeloma takayasu's arteritis churg-strauss syndrome bechets disease wegners granuloma giant cell/temporal arteritis polymyalgia rheumatica muscular dystrophy adhesive capsulitis wernicke's encephalopathy vit B1 deficiency spinal stenosis cushings ulcer guillian barre syndrome alzheimers disease normal pressure hydrocephalus vascular dementia picks disease subdural haemorrhage bells palsy myasthenia gravis lambert-eaton syndrome subarachnoid haemorrhage extradural haematoma cluster headache charcot marie tooth disease meniers disease BPPV ramsy hint syndrome .

labrinthytis brown sequard syndrome syringomyelia posterior cord compression argyll robertson pupil cortical blindness cataracts multiple sclerosis (internuclear ophthalmoplegia) acute closed angle glaucoma benign essential tremor suprascapular nerve C5. C6 ulnar damage common peroneal nerve ulnar nerve dementia with lewy bodies candida albicans hydatidiform mole bacterial vaginosis (gardnerella) trichomonas gonorrhoea placenta praevia placental abruption hydatiform mole vasa praevia  ectopic amyloidosis alkaptonuria alports syndrome AIDs/HIV homocystinuria hyperparathyroidism ehlers'danlos syndrome .

down's syndrome pseudoxanthoma elasticum riley-day syndrome neurofibromatosis central retinal artery occlusion pyloric stenosis epiglotitis nephroblastoma pyloric stenosis edwards syndrome PDA VSD ASD alcohol withdrawal bullimia anorexia cocaine desferrioxamine atropine flumazenil oxygen sodium bicarbonate phyostigmine minimal change glomerulonephritis membranous glomerulonephritis goodpasture's syndrome IgA nephropathy aka Berger's disease .

post streptococcal glomerulonephritis aka proliferative glomerulonephritis proteus UTI infection alports syndrome renal Ca pyelonephritis membranoproliferative glomerulonephritis aka mesangiocapillary glomerulonephritis minimal change glomerulonephritis diabetic nephropathy medullary sponge kidney nephrocalcinosis haemolytic-uraemic syndrome polycystic kidney disease retroperitoneal fibrosis falconi syndrome pneumocystis jioveci legionella pneumophilia mycoplasma pneumoniae byssinosis silicosis sjogrens syndrome limited cutaneous sclerosis (CREST syndrome) still's disease pseudogout psoriatic arthritis reiter syndrome pagets disease episcleritis scleritis felty's syndrome caplan syndrome .

slipped upper femoral epiphysis osgood schlater chondromalacia infective tenosynovitis radial nerve damage extensor tendon injury (mallet finger) flexor digitorium profundus damage flexor digitorium superficialis damage ulnar damage rupture long head of bicep (popeye sign) mortons neuroma posterior shoulder dislocation anterior shoulder dislocation irritable hip (transient synovitis) osteosarcoma perthe's disease tibial nerve damage radial nerve damage axillary nerve damage brachial plexus damage (aka erb's palsy akak waiters tip) basal skull # Mg2+ ammonium phosphate stone saphena varix .

Changes .