General Medicine Diagnostic Features

By: Muhammad Awais, Moeed Naqvi

(ERRORS AND OMISSIONS ACCEPTED)

RESPIRATORY DISEASE:
1. Pleural effusion: Pleural rub, Pain on inspiration, Coughing, Curved shadow on X-Ray
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2. Asthma: Any precipitating factor i.e. pollens, cold weather, exercise, early morning and
night time symptoms, chest tightness, wheezing, cough, relieved by bronchodilators, FEV1
is decreased
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3. COPD: Cough and sputum for most days for at least 3 months in each of 2 consecutive
years, Smoking history, age above 40, breathlessness, sputum, Crackles heard, cor
pulmonale (pitting edema)
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4. Bronchiectasis: Cough daily persistent, excess amount of sputum, Halitosis, CT shows

dilated bronchi, Pleuritic pain, clubbing
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5. Cystic Fibrosis: Lungs normal at birth, Bronchiectasis like features, Infertility in male,
delayed puberty, malabsorption and steatorrhea, nasal polyps
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6. Pneumonia: Old age, Smokers, Fever, Rigors, Appetite lost, Rusty sputum, upper abdominal
tenderness, bronchial breathing, x ray shows consolidation
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7. Tuberculosis: Poor socioeconomic status, Many persons living at a small place, fever, night
sweats, anorexia, weight loss, dry cough, X ray shows millet seeds appearance, Cavitation in
X ray, Anemia, Evening rise of temperature, matted lymph nodes
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8. Bronchogenic carcinoma: Smoking, cough, hemoptysis, Bronchial obstruction, severe

cavitation in x ray, Mediastinal spread, clubbing, seizures
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9. Pneumothorax: Sudden onset of unilateral pleuritic chest pain and breathlessness,

resonant percussion note, tracheal displacement away from the effected side (Tension
Pneumothorax)
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10. Sarcoidosis: Lymphopenia, Deranged LFTs, Serum ACE, erythema nodosum, x ray shows
sarcoid, cobblestone appearance of bronchial mucosa, cough, breathlessness, Skin sarcoid
(lupus pernio), Arthralgia, Uveitis
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 Central Nervous System (CNS)
1. Meningitis: Fever, Headache, Confusion, Vomiting, Leukocytosis, NECK STIFFNESS/RIGIDITY,
Kerning’s and Brudzinki signs POSITIVE, Glucose Content Low < 40mg/dl

2. Viral Meningitis: Fever Headache Neck Stiffness "Glucose Content Normal

3. T.B Meningitis: Fever Headache Stiff Neck, Confusion, Family History of TB, "NERVE PALSIES
- Abducent/ oculomotor" Lymphocytes Predominant - COBWEB/SPIDERWEB
4. Brain Abscess: Headache, Fever, Confusion, and Discharge from Ear - CT scan Shows "Single
or Multiple Low Density Areas with Ring Appearance"
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5. Stroke: Age 40-60, H/O of Diabetes or HT, Loss of Consciousness, Vertigo, WEAKNESS OF
ONE SIDE OF BODY EITHER LEFT OR RIGHT In Balancing and Sensory Loss of Affected Side,
Aphasia, Diplopia
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6. Trigeminal Neuralgia: Episodic Electric Shock like Sharp Pain after Eating, Drinking, Shaving,
Washing of Face, over Jaw Lasting Seconds.
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7. Bell’s Palsy: Loss of Wrinkling, Inability to close Eye, UPWARD ROTATION OF EYE BALL IN
EFFORT TO CLOSE THE AFFECTED EYE, Taste Impairment, Facial Weakness
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8. Parkinsonism: Mask like Face, Flexed Posture, Short Step walk, Resting Tremors,
Hypokinesia, Small Hand Writing, Monotonous Speech - Cogwheel + Lead Pipe Rigidity
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9. Multiple Sclerosis: Difficult Walking, Symptoms are Present from certain weeks + were also
Present some years Back (Relapsing and Remitting Course) Diplopia (Abducent nerve),
Plantar UP GOING. MRI shows MULTIPLE AREAS OF DEMYELINATION/Plaques
10. Migraine: Unilateral, Females, Vomiting, Chocolate/Cheese/Alcohol, Episodic History of
Flashing or Sparkling Lights + Visual Defects
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11. Alzheimer’s: Names Forget, Altered Motor Activity, Aggression, Depression, Dementia -
MRI shows Atrophy of Certain brain Areas
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12. Gillian- Barre Syndrome: H/O of Diarrhea or Infection, Weakness Involving Legs then arms
(Ascending paralysis), absent reflex in all four limbs/Fingers/Ankles/toes - Sensory loss
13. Myasthenia Gravis: Diplopia, Ptosis, Dysphagia, Weakness of Limbs (Unable to do
Combing of Hairs) TENSILON TEST +ve
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Cardiovascular System (CVS)

1. Left Heart Failure: Dyspnea, Fatigue, Cough, Nocturnal, Pleural effusion, THIRD HEART
SOUND (MCQ) (S3-Gallop Rhythm), loud P2, Cardiomegaly
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2. Right Heart Failure: Cough, Dyspnea, PAIN IN RIGHT HYPOCONDRIUM, PEDAL EDEMA,
Raised JVP, Hepatomegaly
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3. Congestive Cardiac Failure: Combination of LHF and RHF

^FRAMINGHAM CRITERIA MUST DO
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4. Angina Pectoris: Chest Pain, Dyspnea, Nausea, Radiating, Fainting, ECG shows ST Segment
DEPRESSION - Relieved by Sublingual Nitroglycerine
MCQ: Only Angina type Showing ST Elevation is Prinzmetal
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5. Myocardial Infarction: Sternal Pain Radiating but Severe than angina and lasting more than
30 minutes, Ischemia, Cold Sweats, Pallor, Tachycardia, Cold Peripheries, Third Heart Sound.
ECG show ST ELEVATION and T-wave Inversion , Raised Cardiac Enzymes
Not Relieved by Nitroglycerine, Muscluar Damage to Heart.
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6. Rheumatic Fever: Age 5-17 (must note this), Fever, Anorexia, Joints Warm + Painful
involving Ankles Elbow Wrists (Polyarthritis) Chest Pain, Murmur, Prolonged PR Interval,
Raised ESR, ASO Titer, Leukocytosis
^Must Read Ducket Jones Criteria from Book
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7. Infective Endocarditis: H/O of Dental Treatment (Drug Abusers too), Fever, Malaisa,
Weight Loss, Clubbing, Spleenomegaly, Heamturia, Skin Lesion (Petachiae, Olser Nodules)
Retinal Spots, Any Murmur of New kind (Diastolic, Pan-Systolic) +ve EEG
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^Must Read DUKE Criteria

8. Mitral Stenosis: "Localized or Normal" Apex beat at 5th Intercostal Space (mcq) + Mid
Diastolic Murmur, Opening Snap
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9. Mitral Regurgitation: "Displaced Apex Beat”, Pan-Systolic Murmur, Soft S1 n S3
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10. Aortic Stenosis: Apex Beat "Localized/Normal. Ejection CLICK, Systolic Murmur, Slow
Rising Pulse
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11. Aortic Regurgitation: "Displaced" Apex Beat, Mid Diastolic or Ejection Systolic Murmur,
Collapsing/Bounding/Water-Hammer Pulse
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12. Pericarditis: Retrosternal Chest Pain Radiating to neck and Shoulder, Pain Aggravated by
Change of Posture and Swallowing and Deep Respiration, Friction Rub, Scratchy Sound Over
Pericardium
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13. CPR: 30:2... ABCD Primary + Secondary - Read from Book

DIABETES MELLITUS
1. Type 1 DM: Age below 40, Weight Loss, Polyuria, Polydipsia, Thirst, Vision Blurring, Tetany.
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2. Type 2 DM: Age above 40, Obese, Symptoms from years, Polyuria, Polydipsia, Lack of
Energy, and Vision Blurring
- Oral Hypoglycemic Drugs are contraindicated in Pregnancy
3. Hypoglycemia: Imbalance Between Diet cause it, Person Can Collapse, Pallor, Hunger,
Confusion, Speech Difficulty, Sweating, Cannot Concentrate. Blood Sugar Level - Less than
63mg/dl
4. DKA: Drowsiness, Confusion, Thirsty, Abdominal Pain, Rapid Weak Pulse, Hypothermia,
Acidotic/Acetone/Fruity Smell in Breath, pH < 7.3 Bicarb < 15 meq/L, Ketonuria,
Hyperglycemia > 250mg/dl Hypokalemia
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5. Hyperosmolar Non Ketotic COMA: Dehydration, Nausea, Blood Sugar Level > 600mg/dl pH
normal, BiCarb > 15, no Ketonuria
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6. Diabetic Neuropathy: Paranesthesia Feet and Hands, Dull pain, GLOVE and Stock type
Impairment of sensation, Dec vibration, Muscle Weakness.
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7. Diabetic Foot: Paranesthesia, Pain in Calf Muscles, ULCER or Wound on Foot,
Hyperglycemia
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8. Diabetic Nephropathy: Microalbuminuria (Mcq), HT, Periorbital Puffiness and EDEMA of

Feet, Heavy Proteinuria, Raised Urea and Creatinine Level
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9. Diabetic Retinopathy: Dot Blot Hemorrhage, Cotton Wool Spots, Bright Yellow Color Hard
Exudates, Fibrosis, Defect in Vision
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10. Gestational Diabetes: Pregnant Lady, Weight Loss, Hyperglycemia

RENAL DISEASES:
1. Nephrotic syndrome: Proteinuria greater than 3.5g/24hrs, Hypo albuminuria, Edema more
in morning, Hypotension/Hypertension both may occur
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2. Nephritic syndrome: Hematuria, Edema, Hypertension, Oliguria

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3. Acute Kidney Failure: Acute onset of symptoms, History of drugs, diabetes, liver disease,
sepsis, blood loss, raised urea and creatinine, Edema, hypotension and tachycardia, pulmonary
edema
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4. Chronic Kidney Failure: Chronic abnormal values of urea and creatinine, nocturia,
Kassmaul’s breathing, Pruritus, anorexia, weight loss, hiccups, restless leg syndrome,
hypocalcemia, hyperphosphatemia
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5. Adult polycystic disease: Vague discomfort in loin or abdomen, hypertension, hematuria,

berry aneurysms, cystic lesions on X-rays, ultrasound or MRI
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6. Renal Stone Disease: Pain in loin radiating to anterior abdominal wall, hematuria,
presence of stones in x ray, ultrasound
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7. Urinary tract Infection: More in females, Pain during micturition, Suprapubic pain during
and after vomiting, cloudy urine with unpleasant smell, urinary urgency
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8. Pyelonephritis: Fever, rigors, loin pain, tenderness at lumbar region, hypotension, may
present with symptoms of UTI