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
GENERAL MEDICINE DIAGNOSTIC FEATURES BY MUHAMMAD AWAIS AND MOEED NAQVI
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
GENERAL MEDICINE DIAGNOSTIC FEATURES BY MUHAMMAD AWAIS AND MOEED NAQVI
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
GENERAL MEDICINE DIAGNOSTIC FEATURES BY MUHAMMAD AWAIS AND MOEED NAQVI
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.
GENERAL MEDICINE DIAGNOSTIC FEATURES BY MUHAMMAD AWAIS AND MOEED NAQVI
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
GENERAL MEDICINE DIAGNOSTIC FEATURES BY MUHAMMAD AWAIS AND MOEED NAQVI
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,
GENERAL MEDICINE DIAGNOSTIC FEATURES BY MUHAMMAD AWAIS AND MOEED NAQVI
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.
GENERAL MEDICINE DIAGNOSTIC FEATURES BY MUHAMMAD AWAIS AND MOEED NAQVI
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
GENERAL MEDICINE DIAGNOSTIC FEATURES BY MUHAMMAD AWAIS AND MOEED NAQVI
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
GENERAL MEDICINE DIAGNOSTIC FEATURES BY MUHAMMAD AWAIS AND MOEED NAQVI
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,
GENERAL MEDICINE DIAGNOSTIC FEATURES BY MUHAMMAD AWAIS AND MOEED NAQVI
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,
GENERAL MEDICINE DIAGNOSTIC FEATURES BY MUHAMMAD AWAIS AND MOEED NAQVI
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
GENERAL MEDICINE DIAGNOSTIC FEATURES BY MUHAMMAD AWAIS AND MOEED NAQVI
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)
GENERAL MEDICINE DIAGNOSTIC FEATURES BY MUHAMMAD AWAIS AND MOEED NAQVI
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