Internal one summary

Infectious gastroenteritis — clue/test/treat?

Acute watery diarrhea → clinical diagnosis; stool tests if indicated → oral rehydration or IV fluids for severe dehydration

⚡ Bowel obstruction — clue/test/treat?

Vomiting + distension + obstipation → CT abdomen/pelvis → NPO + IV fluids ± NG tube; urgent surgery if strangulation or peritonitis

⚡ Mesenteric ischemia — clue/test/treat?

Pain out of proportion ± AF → urgent CT angiography → resuscitation + antibiotics + heparin when appropriate + revascularization; laparotomy if peritonitis

Diverticulitis — clue/test/treat?

LLQ pain + fever → CT when indicated → fluids + analgesia ± selective antibiotics; drain appropriate abscesses

⭐ Appendicitis — clue/test/treat?

Periumbilical pain migrating to RLQ → US or CT → appendectomy + perioperative antibiotics; selected uncomplicated cases may receive antibiotics

NSAID peptic ulcer — clue/test/treat?

Epigastric pain + NSAID use → EGD if indicated + H. pylori testing → stop NSAID + PPI; endoscopic hemostasis if bleeding

Lactose malabsorption — clue/test/treat?

Bloating + diarrhea after dairy → hydrogen breath test if needed → reduce lactose ± lactase replacement

Chronic pancreatitis malabsorption — clue/test/treat?

Greasy stools + weight loss → low fecal elastase → pancreatic enzyme replacement + nutrition

⭐ Achalasia — clue/test/treat?

Solids AND liquids dysphagia from onset → manometry after excluding obstruction by EGD → POEM or pneumatic dilation or Heller myotomy

⭐ Esophageal cancer — clue/test/treat?

Progressive solids-to-liquids dysphagia + weight loss → EGD + biopsy → stage-based surgery and/or chemoradiotherapy

Barrett esophagus — clue/test/treat?

Long-standing GERD → EGD + biopsy confirms intestinal metaplasia → PPI + surveillance; endoscopic eradication for indicated dysplasia

⭐ Acute cholecystitis — clue/test/treat?

RUQ pain + fever + Murphy sign → RUQ ultrasound → fluids + analgesia + antibiotics when indicated + early laparoscopic cholecystectomy

Pancreatic head cancer — clue/test/treat?

Painless jaundice + pale stools + dark urine → pancreatic-protocol CT ± EUS → Whipple if resectable; stage-based cancer treatment

⚡ Perforated ulcer — clue/test/treat?

Sudden severe pain + rigid abdomen → CT showing free air if stable → NPO + IV fluids + IV antibiotics + PPI + urgent surgery

Gilbert syndrome — clue/test/treat?

Mild intermittent jaundice during fasting or stress → isolated unconjugated bilirubin rise with normal liver enzymes → reassurance

Hepatocellular carcinoma — clue/test/treat?

Cirrhosis + liver lesion → multiphasic CT/MRI with arterial enhancement and washout → resection or ablation or transplant if eligible

Primary sclerosing cholangitis — clue/test/treat?

Ulcerative colitis + pruritus + high ALP → MRCP showing beading → manage complications + surveillance; transplant if advanced

⚡ Portal hypertension — clue/test/treat?

Cirrhosis + varices/ascites → ultrasound and endoscopy as indicated → NSBB for eligible patients; variceal bleed needs resuscitation + octreotide + antibiotics + banding

⭐ Celiac disease — clue/test/treat?

Chronic diarrhea + iron deficiency → anti-tTG IgA + total IgA ± duodenal biopsy while eating gluten → lifelong gluten-free diet

⭐ Crohn disease — clue/test/treat?

Skip lesions + transmural inflammation + fistulas → ileocolonoscopy + biopsy → induction steroids when appropriate; biologics for moderate-severe disease

⚡ Ulcerative colitis — clue/test/treat?

Bloody diarrhea + continuous inflammation from rectum → colonoscopy + biopsy; exclude infection → mesalamine if mild; severe attack needs admission + IV steroids

⭐ Acute pancreatitis — clue/test/treat?

Epigastric pain radiating to back → lipase at least 3 times upper limit + ultrasound for gallstones → goal-directed IV fluids + analgesia + early feeding

⚡ Acute cholangitis — clue/test/treat?

Fever + RUQ pain + jaundice → LFTs + ultrasound ± MRCP → IV antibiotics + fluids + timely ERCP drainage; urgent if severe

⚡ Upper GI bleeding — clue/test/treat?

Hematemesis or melena → CBC + type/crossmatch + EGD after stabilization → resuscitation + endoscopic hemostasis; ulcer PPI or variceal vasoactive drug + antibiotics + banding

⭐ Cirrhosis — clue/test/treat?

Ascites + jaundice + spider angiomas → ultrasound + liver synthetic-function tests → treat cause + complications; ascites spironolactone ± furosemide; encephalopathy lactulose; fever with ascites requires paracentesis

⭐ Lung cancer types — clue/test/treat?

Adenocarcinoma often peripheral; squamous often central; small-cell aggressive → CT + biopsy → stage-specific surgery or radiotherapy or systemic treatment

Paraneoplastic syndromes — clue/test/treat?

Small-cell causes SIADH/ACTH/Lambert-Eaton; squamous causes PTHrP hypercalcemia → syndrome-directed labs → treat malignancy + syndrome

Lung cancer manifestations — clue/test/treat?

Pancoast causes shoulder pain/Horner; SVC obstruction causes facial swelling → contrast chest CT ± biopsy → oncologic care; airway compromise is emergency

Primary spontaneous pneumothorax — clue/test/treat?

Sudden unilateral pleuritic pain in young person → CXR → observe if stable/minimally symptomatic; aspirate or drain if indicated

Secondary spontaneous pneumothorax — clue/test/treat?

COPD + acute pleuritic pain/dyspnea → CXR → oxygen if hypoxemic + pleural drainage when indicated; emergency decompression if tension

⚡ Tension pneumothorax — clue/test/treat?

Hypotension + unilateral absent breath sounds → CLINICAL diagnosis without waiting for X-ray → immediate chest decompression then chest tube

⭐ Pleural effusion — clue/test/treat?

Dull percussion + reduced breath sounds → ultrasound-guided thoracentesis with Light criteria if indicated → treat cause ± drainage

⭐ Empyema — clue/test/treat?

Pneumonia + infected pleural fluid/pus → thoracentesis showing pus or low pH → IV antibiotics + chest tube drainage

Asbestosis — clue/test/treat?

Asbestos exposure + basal interstitial fibrosis → HRCT ± PFT → avoid exposure + supportive care

⭐ Sarcoidosis — clue/test/treat?

Bilateral hilar lymphadenopathy ± erythema nodosum → chest imaging ± biopsy showing noncaseating granulomas → observe if mild; steroids if significant organ disease

Hypersensitivity pneumonitis — clue/test/treat?

Bird or mold exposure + cough/dyspnea → exposure history + HRCT → remove antigen ± corticosteroids

Obesity-related restriction — clue/test/treat?

Severe obesity + restricted chest-wall expansion → PFT showing low TLC → weight loss + assess obesity hypoventilation

Chylothorax — clue/test/treat?

Milky pleural fluid → pleural triglycerides above 110 mg/dL support diagnosis → low-fat/MCT diet + treat cause ± drain

⭐ COPD — clue/test/treat?

Smoking/exposure + chronic dyspnea → post-bronchodilator FEV1/FVC below 0.70 → smoking cessation + inhaled bronchodilators often LABA/LAMA; exacerbation may need systemic steroids

⚡ Asthma — clue/test/treat?

Episodic wheeze + trigger variability → spirometry with variable airflow limitation → ICS-containing therapy; severe attack needs inhaled bronchodilators + systemic steroids ± oxygen

⭐ Community-acquired pneumonia — clue/test/treat?

Fever + productive cough + crackles → chest X-ray with consolidation → suitable outpatient amoxicillin; hospitalized regimen often ceftriaxone + azithromycin

⚡ Sepsis / septic shock — clue/test/treat?

Infection + organ dysfunction ± hypotension/poor perfusion → cultures + lactate + organ tests without delaying care → prompt IV antibiotics + reassessed fluids + source control; norepinephrine if shock persists

Pneumonia complications — clue/test/treat?

Persistent fever or worsening hypoxemia after pneumonia → CXR/US/CT ± pleural tap → empyema drainage; abscess antibiotics; ARDS lung-protective ventilation; sepsis protocol

Pneumococcal pneumonia — clue/test/treat?

Lobar pneumonia ± rusty sputum → CXR ± Gram-positive lancet diplococci → appropriate beta-lactam antibiotic according to severity

⚡ Pulmonary embolism — clue/test/treat?

Sudden dyspnea + pleuritic pain + tachycardia → Wells/clinical probability then D-dimer if appropriate then CTPA → anticoagulation; shock warrants urgent reperfusion consideration

⭐ Tuberculosis — clue/test/treat?

Chronic cough + night sweats + weight loss → sputum Xpert MTB/RIF + culture → airborne isolation + multidrug therapy; classic susceptible TB regimen 2HRZE/4HR

⚡ ARDS — clue/test/treat?

Sepsis/pneumonia + bilateral opacities + severe hypoxemia → chest imaging + oxygenation assessment → treat cause + tidal volume about 6 mL/kg predicted body weight; prone if severe

⚡ Acute respiratory failure — clue/test/treat?

Type 1 low oxygen; type 2 high carbon dioxide → ABG → oxygen/ventilation + cause treatment; acidotic hypercapnic COPD often NIV; intubate if unsafe or failing

⚡ STEMI — clue/test/treat?

Ischemic chest pain + persistent ST elevation → immediate ECG; do not wait for troponin → urgent PCI + antiplatelet/antithrombotic therapy

⭐ NSTEMI — clue/test/treat?

Ischemic pain + rise/fall in troponin without persistent ST elevation → serial ECG + high-sensitivity troponin → antithrombotics + statin + risk-guided angiography

Unstable angina — clue/test/treat?

Rest or crescendo ischemic chest pain without infarction-related troponin rise → serial ECG/troponin → NSTE-ACS therapy + risk-guided assessment

Stable angina — clue/test/treat?

Predictable exertional pain relieved by rest → coronary CTA or stress imaging when indicated → beta-blocker/CCB ± nitrate + risk reduction

⭐ Acute pericarditis — clue/test/treat?

Sharp positional pain improves leaning forward → ECG with diffuse ST elevation/PR depression ± echo → NSAID/aspirin + colchicine if suitable

⚡ Cardiac tamponade — clue/test/treat?

Hypotension + raised JVP + muffled heart sounds → urgent bedside echocardiogram → emergency pericardial drainage if hemodynamically compromised

⚡ Aortic dissection — clue/test/treat?

Sudden severe tearing chest/back pain ± pulse deficit → CT angiography when stable → IV beta-blockade/impulse control; type A needs emergency surgery

Myocarditis — clue/test/treat?

Recent viral illness + chest pain/arrhythmia → ECG + troponin + echo ± cardiac MRI → supportive care + HF/arrhythmia treatment; exercise restriction

⚡ Atrial fibrillation — clue/test/treat?

Irregularly irregular rhythm with no organized P waves → ECG → stable rate/rhythm management + assess anticoagulation; unstable due to AF needs synchronized cardioversion

Atrial flutter — clue/test/treat?

Sawtooth flutter waves → ECG → rate control ± ablation + stroke-risk assessment; unstable needs synchronized cardioversion

⚡ SVT — clue/test/treat?

Sudden regular narrow-complex tachycardia → ECG → stable vagal maneuvers then adenosine when appropriate; unstable synchronized cardioversion

⚡ Monomorphic VT with pulse — clue/test/treat?

Regular wide-complex tachycardia with pulse → ECG + stability check → unstable synchronized cardioversion; stable expert-guided IV antiarrhythmic

⚡ VF / pulseless VT — clue/test/treat?

Unresponsive + pulseless + shockable rhythm → immediate rhythm assessment → CPR + unsynchronized defibrillation + advanced life support

⚡ Torsades de pointes — clue/test/treat?

Polymorphic twisting VT with prolonged QT → ECG + K/Mg → IV magnesium + correct triggers; sustained polymorphic VT requires unsynchronized shock

⚡ Complete heart block — clue/test/treat?

P waves unrelated to QRS complexes → ECG → unstable immediate pacing; permanent pacemaker usually if nonreversible

Mobitz I — clue/test/treat?

PR lengthens progressively then QRS drops → ECG → observe if asymptomatic; manage symptomatic bradycardia

Mobitz II — clue/test/treat?

Constant PR with intermittent dropped QRS → ECG → urgent pacing assessment; permanent pacemaker if nonreversible

Symptomatic bradycardia — clue/test/treat?

Slow heart rate + hypotension or syncope → ECG + assess perfusion → atropine; if ineffective pacing or dopamine/epinephrine infusion

⚡ Hyperkalemia — clue/test/treat?

Peaked T waves ± widened QRS → ECG + serum K → IV calcium for dangerous ECG changes then insulin/dextrose then remove potassium

Hypokalemia — clue/test/treat?

Flat T waves + U waves → serum potassium + magnesium + ECG → K replacement ± Mg correction

⚡ Acute pulmonary edema — clue/test/treat?

Severe dyspnea + crackles + orthopnea → CXR or lung US ± echo → oxygen if hypoxemic + NIV if needed + IV loop diuretic if congested; nitrates if BP allows

⭐ HFrEF — clue/test/treat?

EF at or below 40% + heart failure symptoms → echocardiogram + BNP → ARNI/ACEi/ARB + evidence-based beta-blocker + MRA + SGLT2 inhibitor; diuretics for congestion

HFpEF — clue/test/treat?

Heart failure symptoms + EF at least 50% + objective filling-pressure evidence → echo + BNP → SGLT2 inhibitor + diuretics if congested + manage comorbidities

Right-sided heart failure — clue/test/treat?

Raised JVP + leg edema + ascites → echocardiogram → treat underlying cause + diuretics

⚡ Cardiogenic shock — clue/test/treat?

Hypotension + cold extremities + poor perfusion → ECG + urgent echo + lactate → correct cause such as urgent PCI + norepinephrine if needed ± inotrope

⚡ Hypertensive emergency — clue/test/treat?

Severely high BP + acute target-organ damage → ECG + creatinine + focused organ evaluation → titrated IV antihypertensives with condition-specific BP targets

⭐ Aortic stenosis — clue/test/treat?

Systolic murmur radiates to carotids + syncope/angina/dyspnea → echocardiography → valve replacement via TAVR/SAVR when severe and indicated

Aortic regurgitation — clue/test/treat?

Early diastolic murmur + bounding pulses → echocardiography → valve surgery when severe and indicated; acute severe AR requires urgent assessment

Mitral stenosis — clue/test/treat?

Opening snap + diastolic rumble → echocardiography → balloon mitral commissurotomy if suitable

⭐ Mitral regurgitation — clue/test/treat?

Holosystolic murmur radiates to axilla → echocardiography → valve repair/replacement when indicated; acute severe MR needs urgent intervention

Tricuspid regurgitation — clue/test/treat?

Holosystolic murmur louder on inspiration → echocardiography → treat cause + diuretics ± valve procedure

⭐ Infective endocarditis — clue/test/treat?

Fever + new murmur ± embolic signs → 3 blood-culture sets + echocardiography → targeted prolonged IV antibiotics ± valve surgery

Rheumatic fever — clue/test/treat?

Recent strep throat + migratory arthritis/carditis → Jones criteria + preceding strep evidence → penicillin eradication/prophylaxis + anti-inflammatory therapy

Hypertrophic cardiomyopathy — clue/test/treat?

Exertional syncope + murmur louder with Valsalva → echocardiography → beta-blocker when appropriate + sudden-death risk assessment ± ICD

Dilated cardiomyopathy — clue/test/treat?

Dilated LV + low EF → echocardiography → HFrEF four-pillar drugs + treat underlying cause