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Paces Clues
for
Station 5

3rd edition
Seizures  Look for spot
diagnosis of Tuberous
sclerosis,
Neurofibramatosis
 Risk factors of
seizures e.g lack of
sleep, missed meals,
binge alcohol, infection, ,
drug interaction, trauma,
electrolyte/metabolic
disturbance e.g
hypoglycaemia,
hyponatremia,
hypomagnesemia,
Hypocalcemia
 Rule out SOL e.g
tumour/abscess
 Stroke
  Meningoencephalitis

Headache chronic  Watch out for spot

diagnosis of
Acromegaly, Cushing,
Neurofibromatosis,
Tuberous sclerosis
 Any SOL of brain e.g
tumour, abscess
 Others
Tension,Medication
overuse induced,
Migraine
 Idiopathic intracranial
hypetension

Headache Chronic + visual  SOL e.g tumors (rule out

symptoms acromegaly, cushing
disease, non functioning
pit tumors & other brain
tumors)
 Idiopathic intracranial htn
Glaucoma
 Multiple sclerosis -visual,
weakness, imbalance
 Migraine
 GCA in elderly

Headache chronic with focal  SOL e.g tumour, abscess

weakness  Stroke
 If transient weakness
also consider hemiplegic
migraine
 Multiple Sclerosis
Headache acute  GCA in elderly
 SAH
 Meningitis
 Cerebral venous sinus
thrombosis
 Acute episode of
migraine or cluster
headache
 ICH
 Arterial dissection
 Pit apoplexy

Headache Acute + visual  Giant cell arteritis in

disturbances elderly
 Migraine
 SAH/Stroke/TIA
 CRAO, CRVO
 SOL (Hematoma due to
trauma, Pituitary bleed
due to rapidly enlarging
tumor)
 MS
 Epilepsy
 Glaucoma
 Vasculitis of different
sorts

 SAH
Headache Acute + seizures  Stroke
 Trauma with epidural
bleed
 Cerebral venous sinus
thrombosis
 SOL (Hematoma due to
trauma, Pituitary bleed
due to rapidly enlarging
tumor),
 Meningitis/Encephalitis
 Cerebral Malaria
Headache episodic  Migraine
 Cluster
 Pheochromocytoma/MEN
 Panic attacks

Headache facial  GCA in elderly

 Trigeminal neuralgia
 Post herpetic
 Sinusitis, toothache

Headache,Hypertension,  Acromegaly/MEN
Palpitations, Sweating  Pheochromocytoma/MEN
 Neurofibromatois with
Pheochromocytoma
 Menopause
 SAH/ Stroke/TIA
 Malignant HTN
 Pre-Eclempsia/Eclempsia
 Cocaine/Amphetamine
 Cardiac
 Panic attacks

Morning Headaches  Raised intracranial

pressure e.g SOL or
idiopathic intracranial
hypertension
 Obstructive sleep apnea
 CO poisoning
Visual problems

Dry Gritty Eyes  Thyroid eye disease

 Rheumatological diseases
e.g RA, Sjogren,
spondyloarthropathies
 Sarcoidosis
 IBD

Diplopia Double Vision  Graves opthalmopathy

 Myasthenia Gravis
 Multiple Sclerosis
 Miller fischer
 Cranial nerves 3,4,6
 Wernike’s
 Mononeuritis multiplex

Tunnel Vision, night vision  Retinitis pigmentosa

colour vision affected

Acute unilateral loss of vision  Amaurosis fugax

 CRAO
 CRVO
 BRVO
 Diabetic maculopathy
 GCA
 Migraine
 Glaucoma

Bumping into objects,  Bitemporal hemianopia

difficulty looking on sides, e.g Acromegaly
accident  Homonymous
hemianopia
 Tunneled vision
Red painful eye with
photophobia
Colour vision reduced
Slowly progressive painless
in diabetic
Papilloedema
Uncontrolled Hypertension
 Ankylosing spondylitis
 Sereonegative arthritis
 Sarcoidosis
 Other vascultitides
 Other rheumatological
diseases
 IBD
 Optic atrophy e.g due to
MS, ethambutol
 Retinitis pigmentosa
 Retinal pigmentation-
HCQ
 Diabetic retinopathy
 Maculopathy
 Cataract
 Osmolar changes in lens
 Retinitis pigmentosa with
DM as a part of
syndrome
 Idiopathic intracranial htn
 SOL
 Accelerated HTN
 Acromegaly
 Cushing
 Pheochromocytoma /
MEN
 Neurofibromatosis
 Tuberous sclerosis
 RAS
 GN
 ADPKD
 Systemic sclerosis
 Coarctation
  Drugs (Steroids, anabolic
steroids, OCPs,
cyclosporin,
recreational,)

Diarhea acute  Flare or first presentation

of IBD
 Food poisoning
 Traveller diarhea
 Drug induced e.g C.diff

Diarhea chronic  Malabsorption e.g

Systemic sclerosis,
Coeliac, Chronic
pancreatitis
 Infections e.g TB, HIV
 IBD
 Spondyloatrhropathies
 Ca Colon
 Thyrotoxicosis
 Autonomic neuropathy-
DM, Carcinoid
 Previous abdominal
surgery
 Radiation
 Microscopic colitis

Dizziness  Addison
(autoimmune,hiv, tb)
 Hypoglycemia
 Anemia
 Autonomic neuropathy
 Drug induced e.g
antihypertensives
Difficulty in walking  Rheumatological
conditions e.g RA,
Ankylosing spondylitis,
Osteoarthritis
 Proximal myopathy
 Neuro causes e.g spastic
paraparesis, Cerebellar
synd, Sensori / motor
periph neuropathy
 Parkinson
 Connective tissue
conditions like Marfan
Ehlers danlos
 Vision problems

Back pain chronic  Ankylosing spondylitis &

sacroilitis due to other
spondyloarthropathies
 Osteoporotic fractures e.g
on steroids
 Multiple myeloma
 Ca prostate with Mets
 Spinal claudication/stenosis
 Cord compression e.g by
SOL
 Pott disease
 Osteomyelitis
 Neurofibromatosis has also
come with this presentation
of back pain

Painful hands  RA
 Psoriatic Arthritis
 SLE
 Systemic sclerosis
 Raynaud
 Osteoarthritis
 Carpal tunnel syndrome
 Raynaud
Lesions on shins  Erythema nodosum
(Painful)
 Pyoderma gangrenosum
(Painful)
 necrobiosis lipoidica
 Pretibial myxedema

Painful Shins  Pyoderma gangrenosum

e.g with IBD
 Sarcoidosis with erythema
nodosum – causes
Infections- Streptococcal,
fingal, TB, Leprosy,
Malignancy, Drugs - OCP,
sulphonylurea,
sulphonamide, penicillin

Tremors of hands  Parkinson disease (resting)

 Essential tremors
(Postural)
 Cerebellar syndrome
(Intention tremor)
 Wilson's disease (young,
liver disease, family hx)
 Thyrotoxicosis
 Pheochromocytoma
 Anxiety/Panic attacks
 Drugs including
recreational drugs, Lithium
toxicity, Salbutamol,
Cyclosporin
 Alcohol
 Caffeine excess

Uncontrolled Diabetes  Cushing

 Acromegaly
 Poor life style
Falls  Without loss of
consciousness - Proximal
myopathy, Chronic
rheumatological diseases,
connective tissue disorders
e.g ehlor danlos,
Osteoporosis, Tripping due
to carpets, steps , Visual
Problems, Balance problems
- cerebellar, Parkinson
disease, Parkinson Plus
with postural drop, -
sensory peripheral
neurpathy
 With dizziness- Postural
hypotension e.g Addison,
due to drugsACE, Beta, Ca
blockers), Autonomic
neuropathy.
 With loss of
consciousness : syncope
seizures, hypoglycemia
(insulin)

Tingling numbness in hands  Raynaud - primary or

secondary
 Carpal tunnel syndrome due
to Acromegaly,
Hypothyroid, Arthritis,
Repeated use of hands i.e
occupational, other ddx of
CTS, drugs
 Hypocalcemia
 Cervical rib
Raynaud  Connective tissue :
Systemic sclerosis,
dermatomyositos, mctd,
other rheumatological
 Myeloproliferative
 Cryoglobulinemia
 hep B
 cervical rib
 drugs e.g beta blockers,
cocaine
 trauma
 vibrating tools

Weight gain  Cushing

 PCOS
 Pregnancy
 Hypothyroid
 Acromegaly
 Drugs- insulin,
sulphonyluria, OCPs,
steroids, Antidepressents,
anti psychotics,
antiepileptics, nicotine
withdrawl

Acne  Cushing
 PCOS
 drugs like steroids, ocp,
anabolic steroids,
testosterone, ciclosporin,
anti epileptics

Increased hair growth  Cushing

 PCOS
 drugs e.g ciclosporin
Menstrual  Acromegaly
irregularities/Infertitily  Prolactinoma
 Hypopituitarism
 Hypothyroid
 Hyperthyroid
 PCOS
 Cushing

Palpitations  Thyrotoxicosis
 Pheochromocytoma
 Cardiac e.g AF, SVT,
Hypoglycemia
 Anxiety
 Anemia
 Drugs - B2 agonist,
theophyline, thyroxine,
Amiodarone
 Caffeine

Palpitations + sweating +  Endo : Pheochromocytoma,

light headness Thyrotoxicosis,
Hypoglycemia, Menopause
 Cardio : Arrythmias
 Vasovagal
 Others Anxiety, Caffeine,
Alcohol withdrawl, drug
withdrawl

TIA causes in young  Antiphospholipid

syndrome
 Behcet
 Hereditary
thrombophilias
 Vasculits
 Atrial fibrillation with
mitral valve disease
 Infective endocarditis
with septic emboli
  PNH
 Familial e.g familial
hyperlipidemia, Cadasil
syndrome
 ASD
 Patent foramen ovale

TIA causes in elderly  Atrial fibrillation

 Cardiac risk factors
 Malignancy
 vasculitis
 Infective Endocarditis

Pulmonary embolism/DVT in  APL synd

young  Behcet
 PNH
 Thrombophilia
 OCPs
 Post op, prolonged
immobilization
 Long flight

Pulmonary embolism in  Myeloproliferative

elderly disease
 Malignancy
 Post op, prolonged
immobilization
 Long flight

Pericarditis  SLE
 Viral
 Bacterial
 TB
Pleuritic Chest pain  PE
 Pneomothorax
 Pericarditis (improves on
leaning forward)
 Pl Effusion
 Pneumonia
 Musculoskeletal

Chest pain Tearing radiating  Aortic dissection

to back

Chest pain acute retrosternal  Acs

+ vomiting  GERD
 Oesophageal
rupture/Oesophageal tear
and haematoma

Chest Pain acute causes  ACS

 PE
 Pneumothorax
 Pericarditis
 Myocarditis
 Aortic dissection
 Functional

Chest Pain chronic causes  Angina

 Mitral valve prolapse
 GERD (remeber systemic
sclerosis)
 Aortic stenosis
 Pericarditis
 Pleuritic pain causes
 Musculoskeletal causes
 Pheochromocytoma
 Anxiety
 Cocaine
Weight loss with preserved  Thyrotoxicosis
appetite  Malabsorption
 Dm
 Pheochromocytoma
 Addison
 Laxatives

Weight loss with loss of  Malignancy

appetite  Congestive heart failure
 Chronic resp diseases
 CKD
 CLD
 HIV
 TB
 Depression

Fatigue, Tiredness  Myasthenia

 OSA
 Hypothyroidism
 Acromegaly
 Cushing
 Addison
 Hypopituitarism
 Hypercalcemia
 Chronic fatigue syndrome
 Depression
 Chronic conditions e.g CHF,
CKD,CLD, COPD etc
 Anemia

Dysphagia  Systemic sclerosis

 Thyroid with retrosternal
extension
 Oesophageal cancer
 Benign strcitures
 Achlasia
 Neurological causes
especially Myasthenia
SOB acute  PE
 Pulmonary edema
 Pneumothorax
 Pneumonia

SOB chronic  ILD due to RA/MTX

 Systemic sclerosis
 Sarcoidosis
 Thyroid
 Anemia
 Congestive heart failure
 Chronic respiratory diseases
 TB
 Ca lung
 Neurological causes
 Anxiety

Mononeuritis multiplex  Vasculitis

 Behcet
 Connective tissue disorders
e.g RA etc
 DM
 Malignancy
 Sarcoidosis
 Amyloidosis

Hoarsness of voice  URTI

 GERD
 Hypothyroidism
 Laryngitis
 Malignancy
 Post surgical trauma
 Steroids
 Occupational e.g singer
Jerky movements of legs at  Restless leg syndrome
night  Seizures

Leg cramps & aches after  Hypocalcemia due to

thyroid surgery Hypoparathyroidism post
thyroidectomy

Purpura/Red spots on  Thrombocytopenia causes

skin/bruising e.g ITP
 Vasculitis (palpable
purpura)
 HHT
 Coagulation disorders
 Over anticoagulation

Ulcers/discharge at  Rule out Raynaud

fingertips

Lower limb bilateral swelling  Nephrotic

 CLD
 CHF
 CKD
 Corpulmonale
 Pretibial myxedema,
Hypothyroidism

Swelling and discolouration  Consider Pretibial

of lower limbs myxedema

Unilateral swelling of lower  DVT including behcet, APL

limb syndrome
 Ruptured baker cyst
 Septic arthtiris
 Cellulitis
Calf pain  DVT
 Ruptured baker cyst
 Septic Arthritis
 Burger disease

Dysuria  Behcet
 Reactive arthritis

Secondary osteoarthritis  Hemochromotosis

 Acromegaly

Impotence  Diabetic autonomic

neuropathy
 Vascular insufficiency e.g
post MI
 Hypopituitarism
 Acromegaly
 Anxiety, depression
 Beta blockers


Rash itchy  Dermatitis herpetitsformis

 Lichen planus
 Dermatitis (contact, atopic)
Urticaria
 Infections (scabies, shingles
, impetigo)
 insect bites
 drug eruptions

Hypopigmentation  Vitiligo (sensations intact

within lesion)
 Ashleaf macules in tuberous
sclerosis
 Tinea versicolor (e.g
diabetic)
 Leprosy (sensations
 impaired within lesion)

Hyperpigmentation Localized : Pityriasis versicolor,

cafe au lait spots in
Neurofibromatosis,
pemphigus,
Generalised ; Addison, Peutz
jeghers, Primary &
Hemochromotosis, Drug
induced e.g amiodarone induced
photosensitivity, Minocycline,
Tanning e.g occupational outdoor
work in sunlight

Abdomen acute, vomit –  Porphyrias

 DKA
 Flare of IBD
 Intestinal obstruction

Jaundice recurrent  Gilbert

 Hemolysis
 Gall stones

Jaundice acute  Ac hepatitis

 Budd chiari
 Hemolyisis
 Gilbert
 Gallstones

Jaundice chronic  CLD (viral hep B,C,

hemochromotosis,Wilson,
autoimmune
hepatitis,Primary billary
cirrhosis,Primary sclerosing
cholangitis, Alcoholic
hepatitis, NASH)
 Pancreatic/billary
malignancy
 Drugs e.g ATT, statins
Swelling in one foot  Charcot joint
 Osteomyelitis/Septic
arthritis Gout

Muscle pain tenderness with  dermatomyositis/

or without skin rash polymyositis
 Statin induced


Fatigue/tiredness/multiple
aching points
 FIBROMYALGIA
 Chronic fatigue syndrome
 Rule out connective tissue
disorders
 Hypothyroidism
 In elderly r/o PMR

Recurrent fracture with  PAGETS DISEASE

hearing impairment  OSTEOGENESIS
IMPERFECTA

Weakness of one arm  Stroke

 Radiculopathy
 Neuralgic amyotrophy

Cough  Asthma, COPD

 Pneumonia, Bronchitis
 Ca lung
 LVF
 Post nasal drip
 GERD
 TB
 Sarcoidosis
 Churg Straus
 Aspiration pneumonia in
chronic neuro cases
 Foreign body
 Drugs ACE, aspirin,nsaids,
 nitrates, calcium channel
blockers

Hemoptysis  PE
 Infections (Pneumonia,
abscess, TB, Bronchiectasis,
ABPA)
 Ca lung/mets
 Good pasture
 Vasculitis e.g Wegener
 HHT
 Pulm edema
 bleeding disordera
 Over anticoagulation

Cough with hemoptysis and  Vasculitis

blurred vision

Wheeze  Bronchial asthma

 Churg Straus
 Bronchopulmonary
aspergillosis
 GERD
 Post nasal drip
 Drug induced
bronchospasm e.g Beta
blocker , nsaids

Hemoptyis + hematuria  Vasculitis

 Goodpasture
 Bleeding disorder

Black out/Collapse  Seizure

 Cardiogenic
 Vasovagal
 Postural drop
 Hypoglycaemia
  Paget
Hearing problems  Osteogenesis imperfecta
 Neurofibramotosis type 2
with acoustic neuroma CPA
tumour
 Alport
 Behcet
 Wegener
 drug induced - gentamycin
frusemide

Tall stature Marfan

Kline filter
Kallman
Homocystinuria

Short stature Down

Tuner
Coeliac
Cystic fibrosis/bronchiectasis
Bardet biedl syndrome
Familial

Shoulder pain with anemia Sickle cell

Malena/Hematemesis  Drug induced gastric ulcers

e.g NSAIDS use in RA
 Mallory weis tear
 HHT
 Osophageal varices
 Elderly r/o upper GI
malignancy
Monoarthritis  Septic arthritis
 Gout (Risk factors-Alcohal,
CKD,diuretics
 Hemarthrosis (underlying
bleeding disorder, over
anticoagulation, trauma)
 Flare of RA or Psoriatic
arthritis
 R/O cellulitis & ruptured
baker cyst

Symmetrical Polyarthritis  RA
 SLE
 Psoriais
 Viral

Asymmetric polyarthritis  Sero negative arthritis

 Gout
 Pseudogout
 Behcet
 Rheumatic fever

Epistaxis  HHT
 Vasculitis
 Platelet disorders
 Von willebrand disease
 Coagulation disorders
 Methotrexate toxicity
 Felty

Bilateral Ptosis  Myasthenia

 Myotonic dystrophy

Rash following streptococcal  Guttate psoriasis

infection
Abdominal pain, vomit,  Addison
dizziness with postural drop

post renal transplant  diabetic retinopathy,

diminished vision in a  cataract(steroids,
diabetic - differentials ciclosporin), CMV retinitis
 CRAO, CRVO e.g if htn, dm

Known Renal transplant,  fistula induced swelling

presents with arm swelling  subclavian vein thrombosis
on the side of AV fistula  svc obstruction
 compartment syndrome

If vitiligo  always look for other

autoimmune diseases

Cervical lymphedenopathy  TB
 Sarcoidosis
 Lymphoproliferative
 HIV
 Amyloidosis

Vertigo  MS
 Benign positional vertigo
 CPA tumor
 post infection
 drug induced

Back pain acute  Pathological fracture due to

osteoporosis/mets
 disc prolapse
 discitis
 osteomyelitis
 Cord compression (Abscess,
trauma, hematoma)
Confusion in elderly  Transient global amnesia
 TIA
 Subdural hematoma
 Hypoglycemia
 Hyponatremia,
Hypernatremia
 Hypercalcemia
 Infections eg uti,
pneumonia

Acute transient episode of  Hypo or hyperkalemic

paraparesis periodic paralysis
 other electrolyte/metabolic
disturbances
 Hyperkalemia recovers
within one hour &
hypokalemia can recover
within few hs
 Thyrotoxic periodic paralysis

Oral ulcers + rash  SLE

 Behcet
 Crohns
 Coeliac
 Pemphigus

Menorhagia  VWB disease

 HHT
 ITP
 Hypothyroid

Recurrent  Ehlor danlos

dislocations/double joints  Psuedoxanthoma elasticum
Gynaecomestia  CLD
 Malignancy
 Puberty
 Klinefilter
 Hyperprolatinoma
 Drug induced e.g
spironolactone, cimitidine,
digoxin, ketaconozole,
anabolic steroids, gnrh
analogues in prostate
cancer

Acute abdomen  DKA

 AIP
 Hered angioedema
 Ac Pancreatitis (epigastric
pain radiating to back e
increased triglycerides)
 Billary colic (e.g k/c sickle
cell)
 Renal colic
 Other surgical causes


Contact dermatitis New occupation recently e.g

detergent industry

Microcytic Iron deficiency  Coeliac

anemia  NSAIDS - UGI bleed sec to
ulcers
 Elderly – GI malignancy
 Heyde's syndrome
 HHT
 Von williebrand disease

Macrocytic anemia
 Megaloblastic - pernicious,
malabsorption, vegetarian,
poor oral intake,
gastrectomy, ileal resection,
 bact overgrowth, alcohol,
myeloproliferative,
cytotoxics, methotrexate,
Hemolytic anemia, fish
tapeworm
 Non megaloblastic -
hypothyroid, liver disease,
alcohol

Yellow nail syndrome Bronchiectasis

Recurrent hypoglycemia  Addison

 CAH
 Hypopituitarism
 Factitious
 In diabetic – gastric
autonomic neuropathy
causing diarhea and
decreased absorption.
Associated coeliac disease
causing malabsorption
 Decreased insulin
requirement e.g diabetic
nephropathy
 Insulinoma
 CLD, dumping syndrome
(post gastrectomy)
 Erratic lifestyle
 Sulfonylurea
 Alcohol

 Autonomic neuropathy e.g

Hypoglycemic unawareness poorly controlled DM
in diabetic  Too strict glycemic control
over long period causing
brain desenitization to
hypos
 Beta blockers, opoids,
antidepressents masking
effect
Brachial plexopathy
Common are :
 Erb’s palsy C5/C6(waitor’s
tip hand)
 Klumpke’s palsy T8/T1 with
claw hand/horner
 Look for sensory loss in
relevant dermatomes

Scars in hand  Carpal tunnel release scar

release
 digital sympathectomy
 Trauma

Wrist pain  Carpal tunnel syndrome

 Trauma

Important drugs side effects  Biologics e.g infliximab

for St 5 (Reactivation TB, other
infections, hypersensitvty,
pancytopenia)
 Carbimazole
(Neutropenia)
 Methotrexate
(Pancytopenia, Infections,
hepatic toxicity, ILD)
 ATT (peripheral
neuropathy, optic atrophy,
hepatotoxicity)
 Amiodarone (Lung
fibrosis, hypo/hyper
thyroid, photosensitivity)
 Lithium (Diabetes insipidus
- confusion with
hypernatremia, renal
failure,)
 Warfain & other
anticoagulants
 ACE inhibitors (postural
 drop, dry coug)
 Beta blockers
(hypoglycemic
unawareness, postural drop,
impotence, fatigue)
 Thiazides (Gout ,
hypercalcemia)
 Hydroxychlroroquine
(excerbates psoriasis,
retinal pigmentation)
 NSAIDs (UGI bleed,
interstitial nephritis)
 Steroids (DM, Cataract,
iotrogenic cushing, UGI
bleed)
 Cyclophosphamide
(Haemorgic cystitis, renal
toxicity)
 Colchicine (dose related
Diarhea)
 Metformin (dyspepsia,
contraindicated in advanced
renal failure, metabolic
acidosis)
 Aspirin
 Gentamycin given with
frusemide (hearing loss)
 Interferons (Flu like,
depression)
 Cocaine (vasospatic
angina, raynaud)
 Esctacy (hyponatremia,
seizures)
 Digoxin – GI symptoms,
visual symptoms
 Ticagrelor -
breathlessness
Drug interactions
 Methotrexate &
trimethoprim
 Theophyline &
Clarithromycin
 Interactions of warfarin, Li ,
Amiodarone, Statins

Excess Alcohol longterm  Poor diabetes control

complications  Pancreatitis
 Alcoholic hepatitis
 Liver cirrhosis
 increased risk of
cardiovascular disease &
stroke
 Gastritis
 Thiamine deficiency,
Dementia
 Peripheral Neuropathy
 Cerebellar syndrome
 increased risk of
osteoporosis

Excess alcohol short term  Alcohol intoxication with

complications behaviour problems
 Seizures
 Driving issues
 Legal issues with authorities
 Hypoglycaemia
 delirium tremens on
withdrwal,

Important Occupations  Mining industry- asbestoes

exposure - mesothioloma,
interst pneumonitis
 Vibrating tools
 Exposure to chemicals,
fumes (Occupational
Asthma, Interstitial
 pneumonitis)
 Rubber dye industry anyline
- ca bladder
 Contact dermatitis - access
to chemicals
 HIV high risk occupations -
prostitutes, barbars,
Buesiness man, sales
representative frequent
flyer to africa, thialand
 Alcohol - Works in Bar with
easy access to alcohol

HIV high risk behaviours  Buesiness man/sales

representative frequent
flyer to africa, Thailand.
Sexual contact with
prostitutes without
protection
 IVDU sharing needles
 past transfusion

Hematuria Painless GN
ADPKD
Goodpasture
Vasculitis (wegener, MP, PAN,
HSP, Lupus neph)
Cancer-kidney,bladder,prostate
BPH
Infections- UTI, Infective
endocarditis, TB
Rhabdomyolyisis
Bleeding disorders,
Anticoagulants
hemorrhagic cystitis -
cyclophosphamide
Trauma e.g catheterization
Hematuria microscopic  GN (post streptococcal, IgA
nephropathy, Anti GBM)
 Alport
 ADPKD
 Vasculitis
 Infective endocarditis
 good pasture
 Renal stones
 Infections e.g TB
 Bleeding disorder,
 Anticoagulants

Flushing  Polycythemia
 Carcinoid
 Cushing
 Angioedema
 Superior vena cava
obstruction
 Mastocytosis
 Menopause
 Rosacea
 Vasodilators
 Mital stenosis
 Drugs side effects
antidepressents,
metronidazole

Epileptic pt presenting with  Rule out Phenytoin toxicity

cerebellar signs &
generalized lymphedenpathy

HIV pt presents with  Rule out HIV adrenalitis

hypotension &
hypoglycaemia

Exertional dyspnea in HIV  Rule out PCP

Oncology emergencies  Hypercalcemia
 SVC obstruction
 PE
 Pneumothorax
 Tumor lysis syndrome

Renal stones risk factors  Hyperparathyroid leading to

hypercalcemia
 Malignancy
 Hyperuricemia e.g gout,
chemo leading to uric acid
stones
 Crohns predisposes to
calcium oxalate stones

Scaly plaque  Psoriasis

 Discoid eczema
 Tinea
 Lichen Planus

Guttate Psoraisis Differentials would include

 Pityriasis Rosea
 Maculopapular drug
eruption
 Viral exanthem
 sec syphilis

Aids defining skin  Mucosal candidiasis

manifestations  Chronic herpes simplex > 1
month
 large facial molluscms
 Kaposi sarcoma
Photosensitivity  SLE
 Discoid lupus
 drug induced lupus
Dermatomyositis
 Rosacea
 Porphyrias
 Allergic reaction to drug

Blistering lesions  Pemphigus vulgaris

 Bullous pemphigoid
 Dermatitis herpetiformis
 Erythema multiforme
 SJ syndrome, TENS
 Drug induced

Pruritis - Local causes  Urticaria

 Eczema
 Dermatitis herpetiformis
 Lichen planus
 Infections (scabies, Viral,
fungal, bacterial)
 insect bite
 Drugs

Pruritis - systemic causes  Cholestasis - PBC, PSC,

Obst jaundice
 Uremia
 Polycythemia Rubra vera,
Myeloproliferativedisorders
 Lymphoproliferative
disorders
 Hypothyroidism
 Psychogenic
Polyuria  DM
 DI Nephrogenc (CKD,
hyper Ca , hypo K, Li,
Amphotericine,
Ofloxacin,
demeclocycline,
foscarnet)
 DI Cranial (Post
surgical, Radiotherapy,
trauma, pit
tumors/mets, abscess,
TBM, inflamatory-
sarcoidosis,
histiocytosis)
 DI Psychogenic
 CKD
 Diuretics

Proximal Myopathy  Endo : cushing, acromegaly,

hypo hyper thyroid, DM
 Osteomalacia
 Rheumatological -
polymyosisitis,
dermatomyositis, MCTD,
PMR
 Neuro : MG, muscular
dystrophy
 Electrolyte imbalance
hypokalemia, hypocalcemia
 Drugs steroids, statins,
fibrates, Zidovudine,
Penicillamine

Proximal Myopathy with DM  Cushing

 Acromegaly
 Thyroid – hypo/hyper
 Diabetic amyotrophy
Muscle pain/discomfort  Inflammatory myositis
 Diabetic Amyotrophy
 Hypothyroidism
 Statins

Neck lump  Thyroid (graves, mng, ,

hashimoto, subac
thyroiditis, adenoma,
cancer)
 Thyroglossal cyst
 Lymphedenopathy
(reactive, tb, hiv,
lymphoproliferstive, mets,
Sarcoidosis)
 4- Vascular - carotid body
tumor
 Salivary gland (parotitis,
cancer, sarcoidosis,
alcoholic hepatitis)

Lower GI bleed  Local - anal fissue,

haemorrhoids
 Colitis - IBD, Infective,
Ischemic, Radiation,
 Diverticulitis
 Ca colon
 HHT
 Rapid Upper GI bleed
 Bleeding disorders
 Over anticoagulation
Numbness Tingling Strange  Peripheral neuropathy
creeping sensations in legs (for exam- DM, HIV,
connective tissue vasculitis
Hypothyroidism, uremia, ,
Isoniazid, Nitrofurantoin,
alcohol, B12 def e.g in
vegtarian)
 Restless Leg syndrome
 Spinal stenosis
 Spinal cord compression
 Vascular claudication/PVD
 Transient (Epilepsy, Restless
synd. TIA, Anxiety
somatization , migraine,
MS, hypoglycemia)
 Mononuritis multiplex

Peripheral Neuropathy  Acute (GBS, Porphyria,

Toxins)
 Chronic (DM, B12 def,
Herediatary like charcot ,
CKD, Hypothyroid,
connective tissue,
Paraneoplastic,
Amyloidosis, CIDP,
Drugs)

Difficulty swallowing  Watch out for spot

Dysphagia diagnosis of Systemic
Sclerosis
 Painful ; fungal,
bisphosphanates, GERD,
nsaids
 Acute : foreign body -
Chronic : 1) Mechanical ;
strictures benign
malignant, cpmpression
by goiter lymph nodes 2)
Motility disorders ;
 achalasia, systemic
sclerosis,
dermatomyositis,
polymyositis
3)Neurological mnd,
stroke, MG, Parkinson

Hypercalcemia  Hyperparathyroidism with

or without MEN
 Multiple myeloma
 Mets
 Sarcoidosis
 Dietary
 Drugs

Sleep disorders  OSA

 Cental (Brainstem
lesions, degenerative
brain conditions)
 Narcolepsy

Increased seizure frequency  Poor Compliance

 Vomiting & diarhea
 Pregnancy
 Lack of sleep
 Missed meals
 Any acute illness
 Progession of etiology e.g
in SOL
 Drug interactions enzyme
inducers - Alcohol,
rifampicin, alcohol,
sulphonyluria. Drugs that
reduce threshold - Li,
macrolides, quinolones,
flucloxacilin,
Antidepressents,
Imipramine. Recreational
Amphetamines, esctacy,
cocaine
Chorea  Huntington
 Wilson
 Basal ganglia stroke
 Levodopa induced
dyskinesia
 Neuroleptics
 Sydenham’s chorea

Nephrotic syndrome  Primary glomerular

(Minimal change GN,
Focal segmental GN,
Membranous GN)
 Secondary ; DM, SLE,
Malaria, Amyloidosis,
Drugs nsaids (interstial
nephritis), Captopril,
Gold, penicilamine
(Membranous)

Nephrotic syndrome in RA  Amyloidosis

 Vasculitis e RA
 Drug induced

Cavitating Lung lesions  TB

 Ca Lung
 Wegener
 SLE
 PE
 Abscess
 Fungal

 Alopecia Areata
Alopecia diffuse non scarring  Telogen Effluvium,
Hypothyroid
 Malnutrition
 Fe deficiency
 Chronic disease
 Drugs
Flushing + Diarhrea  Carcinoid
 Mastocytosis

Drugs causing Anaphylaxis  Penicilin, cephalosporin,

IgE mediated NM blocking agents in
anesthesia, therapeutic
antibodies

Drugs causing Anaphylaxis  Radiograph contrast

non IgE mediated media, ACE, Aspirin,
nsaids

Secondary Amenorhea  Pregnancy

 Lactation
 Menopause
 Endo ;
 PCOS
 Cushing
 Premature ovarian failure
 Congenital adrenal
hyperplasia
 Pituitary tumor or
infiltration
 Hyperprolactenemia
 Hypopituitrism
 Post surgery suppression
of hypo-pit axis
 Hyperthyroidism
 Addison
 Ovarian or adrenal
malignancy
 Anorexia nervosa

Epilepsy with decreased  Consider Tuberous

vision sclerosis with retinal
hamartomas on
fundoscopy
Hypertension with skin
lesions
Diminished vision in a
diabetic , post renal
transplant , differentials -
Facial Swelling (generalised)
Swollen Hands
Dropping objects/Clumsiness
due to weakness of hands
Neurofibramotosis and
associated condition e.g
 Pheochromocytoma
 Renal artery stenosis
 Coarctation of Aorta
 Diabetic retinopathy
 Cataract(steroids)
 CMV retinitis
 CRVO
 BRVO
 Angioedema
 Superior venacaval
obstruction
 Nephrotic syndrome
 subcutaneous
emphysema
 Carpal Tunnel syndrome
 Rheumatological
conditions
 Enlarged hands in
Acromegaly
 Causes of distal
weakness e.g Carpal
tunnel syndrome ,
Myotonic dystrophy,
MND, inclusion body
myositis