General Medicine Diagnostic Features

GENERAL MEDICINE DIAGNOSTIC FEATURES BY MUHAMMAD AWAIS AND MOEED NAQVI

General Medicine Diagnostic Features By: Muhammad Awais (SMDC)

Moeed Naqvi (IDC) (ERRORS AND OMISSIONS ACCEPTED)

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"

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

6. Trigeminal Neuralgia: Episodic Electric Shock like Sharp Pain after

Eating, Drinking, Shaving, Washing of Face, over Jaw Lasting Seconds.

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

8. Parkinsonism: Mask like Face, Flexed Posture, Short Step walk,

Resting Tremors, Hypokinesia, Small Hand Writing, Monotonous Speech

- Cogwheel + Lead Pipe Rigidity

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

11. Alzheimer’s: Names Forget, Altered Motor Activity, Aggression,

Depression, Dementia - MRI shows Atrophy of Certain brain Areas

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

Cardiovascular System (CVS)

1. Left Heart Failure: Dyspnea, Fatigue, Cough, Nocturnal, Pleural

effusion, THIRD HEART SOUND (MCQ) (S3-Gallop Rhythm), loud P2,

Cardiomegaly


2. Right Heart Failure: Cough, Dyspnea, PAIN IN RIGHT

HYPOCONDRIUM, PEDAL EDEMA, Raised JVP, Hepatomegaly

3. Congestive Cardiac Failure: Combination of LHF and RHF

^FRAMINGHAM CRITERIA MUST DO

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

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.

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

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

^Must Read DUKE Criteria


8. Mitral Stenosis: "Localized or Normal" Apex beat at 5th Intercostal

Space (mcq) + Mid Diastolic Murmur, Opening Snap

9. Mitral Regurgitation: "Displaced Apex Beat”, Pan-Systolic Murmur,

Soft S1 n S3

10. Aortic Stenosis: Apex Beat "Localized/Normal. Ejection CLICK,

Systolic Murmur, Slow Rising Pulse

11. Aortic Regurgitation: "Displaced" Apex Beat, Mid Diastolic or

Ejection Systolic Murmur, Collapsing/Bounding/Water-Hammer Pulse

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

13. CPR: 30:2... ABCD Primary + Secondary - Read from Book

Endocrine System

1. Acromegaly: Headache, Visual Disturbances, Broad Nose, Teeth

Separation or Dental Space, Protrusion of Lower Jaw (Proganthism) My

Shoe Size Has been Increased + Bi Temporal Hemianopia

2. Cushing Syndrome: Muscle Weakness, HT, Bone Pains, Plethora

Face, Central Obesity, Moon like Face, Pink/Red Marks on Abdomen,

Hirsutism.

3. Hypothyroidism: Dry Skin, Weight GAIN, Tiredness/Sleepy Cold

Intolerance, Fatigue, Bradycardia, Hoarseness of Voice, Puffiness,

Delayed Ankle Jerk, Carpal Tunnel Syndrome, TSH Inc., T3 T4 Low.


4. Hyperthyroidism: Palpitations, Irritability, Insomnia, Weight LOSS,

Tachycardia, Heat intolerance, Hyperreflexia, Warm Hands,

Exophthalmos, Proptosis (Graves’ Disease) TSH Dec., T3 T4 HIGH

5. Thyroid Storm/Crisis: Thyrotoxicosis Emergency due to Radioiodine

Therapy: All HIGH, Hyperpyrexia, Sever Tachycardia, Breathing Rate >

16, Extreme Restlessness, Vomiting, Diarrhea

6. Hypoparathyroidism: H/O of Thyroid Surgery, Carpopedal Spasms,

Paranesthesia of Hands and Feet’s, Trousseaus and Chvosteks Signs +Ve

7. Hyperparathyroidism: Abdominal Pain, Moans, Groans, Recurrent

Renal Calculi/Stones... PTH and Calcium Serum Raised, low Phosphate

DIABETES MELLITUS

1. Type 1 DM: Age below 40, Weight Loss, Polyuria, Polydipsia, Thirst,

Vision Blurring, Tetany.

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

5. Hyperosmolar Non Ketotic COMA: Dehydration, Nausea, Blood

Sugar Level > 600mg/dl pH normal, BiCarb > 15, no Ketonuria

6. Diabetic Neuropathy: Paranesthesia Feet and Hands, Dull pain,

GLOVE and Stock type Impairment of sensation, Dec vibration, Muscle

Weakness.

7. Diabetic Foot: Paranesthesia, Pain in Calf Muscles, ULCER or Wound

on Foot, Hyperglycemia

8. Diabetic Nephropathy: Microalbuminuria (Mcq), HT, Periorbital

Puffiness and EDEMA of Feet, Heavy Proteinuria, Raised Urea and

Creatinine Level

9. Diabetic Retinopathy: Dot Blot Hemorrhage, Cotton Wool Spots,

Bright Yellow Color Hard Exudates, Fibrosis, Defect in Vision

10. Gestational Diabetes: Pregnant Lady, Weight Loss, Hyperglycemia

LIVER DISORDERS

1. Hepatitis A: Nausea, Fever, Vomiting, Anorexia, High/Dark Colored

Urine + Pale Stool - Symptoms from 1-5 Days

*Learn the Viral Markers - Antigens and Mode of Spread of Hepatitis

Infections Acute and Chronic Both A+B+C

2. Alcoholic Liver Disease: Prolonged History of Alcohol, Fatty Liver,

Jaundice, Fever, Ascites, Ankle Edema, Mallari Bodies,


Hepatosplenomegaly

3. Cirrhosis of Liver: Palmar erythema, Spider Nevi, Gynecomastia,

Bruising, Purpura, Clubbing, Jaundice, Breast Atrophy, Ascites, GI Bleed,

Purpura,

4. Hepatic Encephalopathy: Mood Changes, Sleep Disturbances,

Dysarthria, Confusion, Sweet Breath, Flapping Tremors, Less Previous

Memory, Elevated AMMONIA LEVEL

*Causes of HE is UQ Must Do from Book

5. Primary Biliary Cirrhosis: Pruritus, Clubbing, Jaundice Bile

Accumulation, Bone Pain, Cholesterol in Skin, Very High Alkaline

Phosphates Level + Anti Mitochondrial Antibodies (AMA) Present 6. Hemochromatosis: Excess IRON in form of HEMOSIDERIN, Bronze

Pigmentation of Skin, Arthritis,

7. Wilson's Disease: CNS Involvement "Difficult Walking + Speaking +

Eating" Family History of Disease, Dirty Green Brown Ring inside

Cornea (Keizer Fleisher Ring) due to Very High Copper Content in Body,

Low Ceruloplasmin

^ Learn Causes of Jaundice

8. Liver Abscess: Pain, Fever, febrile, VISIBLE ENLARGED Bulging LIVER,

PUNCH test +ve, Entamoeba + E.coli

9. Hepatocellular Carcinoma: Pain in Right Hypochondria, Bloody

Ascites, Irregular tender enlarged liver, Metastasis evident + Raised

Alpha Fetoprotein.


BLOOD DISORDERS:

1. Iron Deficiency Anemia: Female, Poor socioeconomic status, Spoon

shaped nails, Multiple pregnancies, Menorrhagia, Low MCV, Low MCH,

Low Hb Level, Microcytic hypochromic RBCs, Serum ferritin low,

Serum iron low.

2. Megaloblastic anemia: Poor socioeconomic status, Low Hb, Raised

MCV, Raised MCH, Serum Ferritin normal, Macrocytic hyper chromic

cells, Folate or B12 deficiency, Gastrectomy, Paresthesia’s and

neurological signs(in case of B12 deficiency)

3. Pernicious anemia: Features of megaloblastic anemia + Intrinsic

factor deficiency

4. Hemolytic anemia: Cause of bleed internal or external, Low Hb, Inc.

Reticulocytes, Inc. Unconjugated bilirubin, Dec heptoglobin, Inc. LDH

5. Sickle cell anemia: Features of hemolytic anemia + Sickle shaped

cells

6. Hereditary spherocytosis: Features of hemolytic anemia +

spherocytosis, direct coombe’s test positive

7. Thalassemia Minor: Male, Mild anemia, Iron therapy fails for

microcytic cells, Normal iron/ferritin levels

8. Thalassemia Major: Severe anemia, Iron level increased, both

parents have thalassemia minor

9. Acute Lymphoblastic Leukemia: Age less than 15, Blast cells more


than or equal to 20%, Lymphoblastic cells seen, severe leukocytosis

10. Acute Myeloid Leukemia: Age more than 15, Blast cells more than

or equal to 20%, Myeloblastic cells, Auer rods in cytoplasm, severe

leukocytosis

11. Chronic Myeloid leukemia: Philadelphia chromosome, massive

splenomegaly, Myeloblast less than 10%, Myleocytes are raised,

severe leukocytosis, More mature cells are seen

12. Chronic lymphocytic leukemia: Mature lymphocytosis,

Anemia/Thrombocytopenia seen, direct coombe’s test positive

13. Hodgkin’s Lymphoma: Rubbery lymph nodes, Owl eyed shaped

cells/Reed-Sternberg cells, Chest x-ray and CT shows mediastinal mass,

rare involvement of extra nodal sites

14. Non-Hodgkin’s Lymphoma: Lymphadenopathy, Involvement of

extra nodal sites, No Reed Sternberg cells

15. Multiple Myeloma: Malignant plasma cells increased, M-Protein in

serum, skeletal lytic lesions, and coin shaped radiolucency in skull

16. Polycythemia Rubra Vera: Excess of all blood cells, Epistaxis,

Pruritus, Blackouts, bone marrow hyperplasia

17. Idiopathic thrombocytopenia purpura: Easy bruising, Menorrhagia,

Signs of CT disease, HIV, Drugs, Increased size of megakaryocytes, Inc.

PT

18. Hemophilia A: Males, Factor VIII deficient, Spontaneous bleeding,

bleeding into large joints, X Linked, Inc. APTT


19. Hemophilia B: Factor IX deficient, less common than Hemophilia A,

Same features of hemophilia A

20. Von Willebrand disease: Easy bruising, epistaxis, deficient von

willebrand factor

21. Disseminated intravascular coagulation: Multiple clots in the body,

Platelets consumed, D Dimers raised, Factor VIII and X decreased,

History of sepsis, trauma, toxicity by drugs

RENAL DISEASES:

1. Nephrotic syndrome: Proteinuria greater than 3.5g/24hrs, Hypo

albuminuria, Edema more in morning, Hypotension/Hypertension both

may occur

2. Nephritic syndrome: Hematuria, Edema, Hypertension, Oliguria

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

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

5. Adult polycystic disease: Vague discomfort in loin or abdomen,

hypertension, hematuria, berry aneurysms, cystic lesions on X-rays,


ultrasound or MRI

6. Renal Stone Disease: Pain in loin radiating to anterior abdominal

wall, hematuria, presence of stones in x ray, ultrasound

7. Urinary tract Infection: More in females, Pain during micturition,

Suprapubic pain during and after vomiting, cloudy urine with

unpleasant smell, urinary urgency

8. Pyelonephritis: Fever, rigors, loin pain, tenderness at lumbar region,

hypotension, may present with symptoms of UTI

GASTROINTESTINAL DISEASES:

1. GERD: Heart burn, Regurgitation, water brash, wake up at night due

to choking, overweight patient, Use of acidic drinks and spices,

hoarseness (acid laryngitis)

2. Peptic ulcer disease: Epigastric pain, NSAIDs history, Pain on eating

is gastric ulcer, Pain after eating or empty stomach is duodenal ulcer,

Urease breath test is positive

3. Coeliac disease: Wheat products sensitivity, watery diarrhea, short

stature, malabsorption symptoms such as vitamin deficiencies and

weight loss, oral ulceration, anti endomysial antibodies positive

4. Ulcerative colitis: Rectal bleeding, bloody mucus diarrhea,

associated with stress, non-smokers, pANCA positive, Tenesmus

5. Crohn’s Disease: Abdominal pain, watery diarrhea, weight loss,

abdominal tenderness, Ashkenazi Jews, smokers, ASCA positive,


Tenesmus

6. Irritable bowel syndrome: Associated with stress, Gets periods of

diarrhea and constipation, abdominal bloating, colicky cramping

nature of abdominal discomfort

INFECTIOUS DISEASES:

1. Measles: Respiratory droplets, Koplik spots, conjunctivitis, rash first

on face then to body, complicates to pneumonia, hepatitis, otitis

media, and encephalitis

2. Chicken pox: Rash most dense on trunk and goes to limbs, rash

progresses from pustules to crustations, fever, after every 2-4 days

new lesions appears

3. Shingles: Previous history of chicken pox, immune compromised

status, burning sensation on trunk region

4. Dengue fever: Mosquito bite, Nearby fresh water collection,

Mosquito shows white stripes, Platelet count decreased, if less than 1

lac platelet then called dengue hemorrhagic fever, break bone fever,

capillary refill time greater than 2 sec

5. Scarlet fever: History of pharyngitis or tonsillitis, strawberry tongue,

high grade fever, diffuse erythematous rash that blanches on pressure

6. Leptospirosis: Photophobia, Uveitis, Pericarditis, ARDS, Myositis,

Bruises, Conjunctivitis, Tropical climate

7. Typhoid fever: Fecal-oral route, Peyer’s patches, Rose spots on


trunk, High grade fever, Rigors, Myalgia, bradycardia, typhodot positive,

Step ladder fever

8. Bacillary dysentery: Bloody and purulent diarrhea, abdominal pain,

Tenesmus, tenderness over colon, fever, dehydration, weakness,

Unhygienic food

9. Malaria: Indus river or African area, Presence of mosquito bite on

skin, High grade fever, headache, Jaundice and anemia, black urine,

urea creatinine abnormal, hypoglycemia, no sign of neck rigidity,

relapsing fever, alternate days

10. Amoebiasis: Bloody diarrhea, anemia, abdominal pain, enlarged

tender liver, abnormal LFTs, Abscess in liver

11. Ascariasis: Abdominal pain, malnutrition, intestinal obstruction,

contaminated food

RESPIRATORY DISEASE:

1. Pleural effusion: Pleural rub, Pain on inspiration, Coughing, Curved

shadow on X-Ray

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

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)


4. Bronchiectasis: Cough daily persistent, excess amount of sputum,

Halitosis, CT shows dilated bronchi, Pleuritic pain, clubbing

5. Cystic Fibrosis: Lungs normal at birth, Bronchiectasis like features,

Infertility in male, delayed puberty, malabsorption and steatorrhea,

nasal polyps

6. Pneumonia: Old age, Smokers, Fever, Rigors, Appetite lost, Rusty

sputum, upper abdominal tenderness, bronchial breathing, x ray shows

consolidation

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

8. Bronchogenic carcinoma: Smoking, cough, hemoptysis, Bronchial

obstruction, severe cavitation in x ray, Mediastinal spread, clubbing,

seizures

9. Pneumothorax: Sudden onset of unilateral pleuritic chest pain and

breathlessness, resonant percussion note, tracheal displacement away

from the effected side (Tension Pneumothorax)

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

DO PRAY FOR US AND YOUR FELLOWS AND ALL BDS

POINT TEAM IT WONT TAKE MORE THAN A MINUTE

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General Medicine Diagnostic Features