If X, think Y

Version 0.1

Biochem
Cardiology
Dermatology
Endocrinology
ENT
Gastro
Haematology
Immunology
Multi system disease
Musculo-skeletal
Neurology
Obs & Gynae
Opthalmology
Paeds
Psych
Renal
Respiratory
Rheumatology
T&O
Urology
Vascular

If X
Biochem
Ca2+ , phosphate , ALP
Ca2+ /, phosphate , ALP
Ca2+ , phosphate , ALP
PTH , Ca , phosphate , ALP
PTH , Ca , phosphate ( CKD) ( vit D def), ALP
PTH , Ca , phosphate , ALP
PTH , Ca , phosphate , ALP
PTH /, Ca
hepatocellular Ca
testicular Ca
choriocarcinoma
breast Ca
ovarian Ca
pancreatic Ca
colorectal Ca

multiple myeloma
twitching face, numb lips

Cardiology
boot shaped heart
globular shaped heart
pleuritic chest pain eased by sitting up or leaning forward
widened mediastinum post RTA
atypical chest pain in a diabetic
recent MI, weeks later feverish, sharp chest pain
recent MI, now hypotension, JVP on inspiration
continuous machine like murmur
chest pain 30 min after eating
tingling sensation, then collapse
murmur radiates to axilae
giant a wave
canon a wave
large v waves
absent a waves
absent femoral pulse
blowing continuous sys and dia murmur, below clavicles, disappears on lying flat

Dermatology
golden/yellow crusted lesion
dark brown, greasy, stuck on appearance
multiple painful, soft, mobile lumps
purple, flat, well demarcated, on face
purple, flat, well demarcated, on face, now has new onset seizures
target lesions
small papules or domes, with dimpled centre
anterolateral leg ulcer in diabetic, initially red nodule, now flat brown/yellow waxy
baby, new rapidly growing bright red rash on face
dark velvety rash in aprmpits, neck
dark velvety rash in aprmpits, neck, weight loss, GI symptoms

diabetic, depressed rash on legs

hypothyroid, brown, lacy rash on shins
well demarcated erythema, on cheek
lump with punctum
pigmented lips & mouth
coeliac disease, intensely itchy, blistering rash on extensors
baby started weaning, now rash oral & perianal, diarrhoea
white lesions on tongue, can't wipe off
lesion grew rapidly over 6/52, central necrotic plug
everted edge
rolled, pearly edge
pink/brown flat lesion, scaly, on lower leg
red spots in ring pattern
fingertip lesion, rapid grown, bleeds easliy
transplant patient, painless, purple lesion
crohns, deep bluish, well demarcated, ulcer on shins, then necrotic
IBD, painful red lesions on shins
lesion in site of previous trauma
brown macules, rubbery skin lesions which tingle when pressed
pin point bleeding when plaque scraped off
pressure applied to edge of lesion causes epidermis to separate from dermis
known eczema, now blistering of palms and soles
skin lesion on shoulder/upper arm i.e. herald patch
irregularly shaped, flat topped, purple (violaceous), white line on surface (Whickhams
striae), white lacework pattern in mouth
red patches over knuckles
white spots on vulva / penis
tick bite, now big red round rashes
post transplant skin Ca
TB, now painful disfiguring lesions on face
circular patches of hair loss
asymmetrical hair loss, short broken hairs remain
male pattern baldness
acute systemic illness, now hair loss
immunosuppression therapy, now rapid hair loss
blisters which burst easily
tense blisters which are deeper

Endocrinology
phaeochromocytoma
hypo K+, hyper Na+, INC BP, thirst, INC micuration
hyper K+, hypo Na+, INC pigmentation
confusion, peri-oral tingling post thyroidectomy
congenital adrenal hyperplasia
painful goitre, high T4, fever
bulging eye, wt loss, diarrhoea
bipolar patient with lethargy, wt gain, high T4, low TSH
lethargy, wt gain, thyroid peroxidase autoantibodies
any systemic infection, low T4 and low TSH
pituitary, parathyroid, pancreatic islet cell Ca
parathyroid, medullary thyroid, phaeochromycytoma Ca
as MEN type 2 plus mucosal neuromas in GI tract, marfinoid
flushing, diarrhoea, bronchospam, occurs post stress or alcohol
cushing disease, now skin pigmentation
tight shirt collar, big doughy hands
heavy pregnancy bleeding, now dizzy, low BM

ENT
painless, foul smelling discharge from ear
exposure to cold weather, irregular subcutaneous nodule in pinna
tinnitus, vertigo
soft, fluctuant, transilluminates, anterior triangle neck lump
halitosis, regurgitation and neck lump
neck swelling between upper and middle 3rd of SCM
neck swelling with pain & swelling on eating

Gastro
bronzed/tanned skin
high ferritn & LFTs and jaundice
young, changed behaviour, liver change
green/brown eye pigmentation

freckled lips and bowel symptoms

multiple peptic ulcers
wt loss, dysphagia, dark velvety skin in axilla and neck
known UC, now jaundice, itchy
lump in abdomen, history of surgery
young man, jaundice post alcohol + stress, bloods = isolatde raised bilirubin
dysphagia solids + liquids, impaired relaxation of LOS
trauma, raised Lt hemidiaphragm, Lt lower lobe atelectasis, pleural effusion
alcoholic, vomiting, surgical emphysema
haematemesis post head injury
haemetemesis post burn
abdo pain 30 min after eating
abdo pain worse with eating
abdo pain eased by eating
jew, splenomegaly
BBQ then food poisoning symptoms after 12 hours
painful glossitis, dementia

Haematology
reed Sternberg cells
target cells
auer rods
heinz bodies
signet ring cells
recurrent nose bleeds, telangiectasia on lips + tongue
young, repeated sudden onset swelling and bruising around joints
burr cells
biopsy is congo red +ve
philadephia chromosome present in 95%
afebrile, new onset limp
high HbA2 and HbF on electrophoresis
worsening school performance, abdo pain

Immunology
anaphylaxis reaction
post transfusion reaction
glomerulonephritis immune reaction
contact dermatitis / transplant
painless genital ulcer
itch worse at night, fingers + wrist
addisons disease
autoimmune hepatitis
churg-strauss syndrome
coeliac disease
limited cutaneous systemic sclerosis
diffuse systemic sclerosis
pernicious anaemia
primary biliary cirrhosis
sjorens syndrome
antiphospholipid syndrome
SLE
wegners granuloma
1o sclerosing cholangitis
sterile pyuria
dermatomyositis
clue cells
difficulty swallowing, holiday to south America
6/52 post transplant, now rash, diarrhoea
prosthetic heart valve, now infective endocarditis
IV drug user, now infective endocarditis
bowel pathology, now infective endocarditis
genitourinary pathology, now infective endocarditis
fever, jaundice, post swimming in dirty water
holiday to south east asia, now fever, sun tan like rash
holiday to south america/africa, now fever, sun tan like rash
holiday in east africa, now fever, constipation then diarrhoea, bradycardia
chorioretinitis, tram lines on CT head
retinitis, calcification on CT head
stillborn, non-immune hydrops
baby with periostitis, saddle nose

Multisystem disease
monoclonal pretein in urine, back pain
Japanese lady, absent peripheral pulses, recent general malaise, fever, wt loss
adult onset hayfever & asthma, leg ulcers
recurrent oral & anal ulcers, -ve for herpes simplex
nose bleeds, haemoptysis, nose deformity
tender temporal skin

Musculoskeletal
60y, sudden onset shoulder pain
young boy, difficulty standing, big calfs
minor injury, now can't abduct arm, painful to sleep on

Neurology
confusion, falls, nystagmus, opthalmoplegia
walking on cotton wool, numbness
back pain eased on leaning forward
vomit blood post head injury
ascending paralysis post infection
amyloid plaques, neurofibrillary tangles in brain
forgetful, falls over, incontinent
stepwise detorioration of cognitive function
antisocial, disinhibition, behavior change, apathy
crescent shaped bleed on CT
loss of facial movements, with sensation intact
tired with repetitive movement
dry mouth, blurred vision, absent reflexes, but muscle weakness improves with use
sudden severe headache, known polycystic kidney disease
head trauma, lucid interval, then drowsy, biconvex CT
headache with lacrimation
high arched foot, foot drop
ringing, dizziness, deafness
dizzy when turn head
vesicles in ear

sudden onset dizziness

motor loss one leg, sensory loss other leg
loss of pain+temp, proprioception intact
hyperextension of neck, gait impaired
pupils accomodate but dont react to light
dizzy, visual loss, patient denies loss
poor vision, glare of head lights
both eyes fail to adduct
misty cornea
tremor eased by alcohol
weak shoulder abduction and external rotation
erb's palsy
guttering between extensor tendon of hand
foot drop
loss thumb adduction (froment's sign)
dementia with fluctuating consciousness and halucinations

Obs & Gynae

white discharge, itch
USS shows snowstorm appearance
clue cells, fishy smell
strawberry cervix, frothy discharge,
gram -ve diplococcus
pregnant, painless PV bleeding
pregnant, painful PV bleeding
pregnant, exaggerated pregnancy syptoms, PV bleeding
pregnant, PV bleed, fetal bradycardia
pregnant, PV bleed, shoulder tip pain, cervical excitation

Ophthalmology
nodules in eye lids and conjunctiva, weak extraocular muscles
melanin deposits in sclera
cataracts, keratoconus
CMV retinitis
lens dislocated inferiorly
grey/white bands across cornea, optic atrophy
blue sclera, strabismus, epicanthal folds

brushfileds spots
angiod streaks
decreased corneal sensation and tears
orbital tumour, glioma
cherry red spot on macula

Paeds
hypochloraemic, hypo K+, metabolic alkalosis
stridor, drooling
distended abdo, mass in flank does not cross midline
projectile vomiting
overlapping fingers
newborn, continuous machine like murmur
newborn, harsh pansystolic murmur, radiating all over but loudest at LLSE
newborn, ejection sytolic, wide fixed and split 2nd HS, loudest pulmonary area

Psych
post op becomes anxious, tachycardiac, sweaty tremor
nuckle calluses, parotid enlargement
lanugo hair
dilated pupils, insect crawling on skin
iron overdose
propranolol overdose
benzodiazepine overdose
carbon monoxide poisoning
aspirin overdose
antimuscarinic overdose

Renal
young child, facial + ankle swelling, proteinuria 3+, albumin = 17
young adult, facial + ankle swelling, proteinuria 3+, albumin = 17
haemoptysis, proteinuria, anti-glomerulo basement membrane antibody +ve
haematuria 2 days post URTi

2 weeks post tonsillitis / cellulitis, oedema, proteinuria, dark urine

recurrent UTI, calculi symptoms
renal symptoms, hearing loss, eye lesions
varicocele, haematuria
painful renal angle
'tram track' appearance under microscope
Hodgkins disease
Kimmelstiel-Wilson lesions
dilated collecting ducts
hyperparathyroid
thrombocytopenia, fever, ARF
intracerebral aneurysm or haemorrhagic stroke
enlarged kidney's, bilateral hydronephrosis, medial deviation of ureters
glycosuria, aminoaciduria, phosphaturia

Respiratory
HIV, respiratory symptoms
holiday, now dry cough, low Na, seizures
dry cough, target lesions, blood slightly precipitates in cold temp
cotton mill
quarry workers, stonemasons

Rheumatology
diagnosed with RA, now dry eyes + mouth
difficulty swallowing, cold pale fingers
child, generalised pink rash, swollen knees
acute knee pain, Xray - bright line above meniscus
arthritis, pitting + lifting nails
arthritis, red eyes, dysuria
bone symptoms, hearing loss
RA, painless red eyes
RA, painful red eye
RA, splenomegaly
RA, previous coal worker, now cough, SOB

T&O
fat boy, pain in hip
young girl, knee pain post exercise
young girl, knee pain climbing stairs
finger pain, swelling, fixed flexion
fractured humerus and unable to extend wrist
unable to straighten finger tip
unable to flex finger at DIP
unable to flex finger at PIP
claw hand
bulge in upper arm in flexion at elbow
lady, shooting pain in toes in walking, tender at metatarsal heads
arm adducted, internally rotated
arm abducted, externally rotated
prepubescent child, acute hip pain, nil else
young, knee pain, periosteal elevation, calcification
young boy, hip pain, gradual onset, Xray = collapsed femoral head
hit knee against dashboard, now unable to flex toes, loss ankle jerk, loss sensation sole
foot
fell onto arm, unable to extend at MCP, loss sensation on dorsum hand
anterior shoulder dislocation, now numb over upper lateral arm
post motorcycle RTA, arm limp, extended, medially rotated, pronated
panda / raccoon eyes

Urology
recurrent UTIs, now loan to groin pain

Vascular
groin lump with fluid thrill and varicies in leg

Version log
Version & Date
0.1
04 - -03 - 2015

Think Y
osteoporosis
osteomalacia
pagets disease
1o hyperparathyroidism
2o hyperparathyroidism
3o hyperparathyroidism
hypoparathyroidism
pseudohypoparathyroidism
-fetoprotein
-fetoprotein, B-HCG
B-HCG
CA 15-3
CA 125
Ca 19-9
CEA

monoclonal IgA (paraprotein)

hypo Ca2+

tetralogy of fallot
cardiac tamponade
percarditis
ruptured aorta
MI
Dressler's syndrome
pericardial effusion
PDA
oesophageal spasm
hyperventilation
MR(Radiates)
tricuspid stenosis
3o heart block
TR
atrial fibrillation
coarctation of the aorta
venous hum

impetigo
seborrhoeic warts (keratosis)
dercum's disease
deep capillary naevus (port wine stain)
sturge-weber syndrome
erythema multiforme
molluscum contagiosum (pox virus)
necrobiosis lopoidica
cavernous haemangioma (strawberry naevus)
acanthosis nigricans
GI malignancy

diabetic dermopathy
erythema ab igne
erysipelas
epidermal cyst (sebacous cyst)
peutz jegures
dermatitis herpetiformis
acrodermatitis ateropathica
leukoplakia
keratoacanthoma
SCC
BCC aka Rodent ulcer
Bowens disease
granuloma annulare
pyogenic granuloma
kaposis sarcoma
pyoderma gangrenosum
erythema nodosum
marjolins ulcer
neurofibromatosis type 1
Auspitz sign
Nikolsky sign
pompholyx
pityriasis rosea
lichen planus
dermatomyositis
lichen slerosis
erythema chronicum migrans
SCC
lupus vulgaris (aka tuberculosis luposa)
alopecia areata
trichotillomania
androgenetic alopecia
telogen effluvium
anagen effluvium
pemphigus vulgaris
bullous pemphigoid

24hr VMA
conn's syndrome
adrenal insufficiency / Addisons
hypo Ca2+
21-hydroxylase deficiency, hence, raised 17-hydroxy progeserone
de quervains thyroiditis
graves disease
hypothyroidism 2o to lithium
hashimotos thyroiditis
sick euthyroid syndrome
MEN type 1
MEN type 2 (aka 2a)
MEN tyoe 3 (aka 2b)
carcinoid syndrome, 24hr 5 hydroxyindole acetic acid
nelson's syndrome
acromegaly
sheehan's syndrome

cholesteotoma
chondrodermatitis nodularis chronica helicis
meniere's dosease
cystic hygroma
pharyngeal pouch
branchial cyst
salivary calculi

haemochromatosis
haemochromatosis
wilsons disease
wilsons disease

Peutz-Jeghers syndrome
zollinger-ellison syndrome
gastric Ca
cholangiocarcinoma
incisional hernia
gilberts syndrome
oesophageal achalasia (Rx = Heller's myotomy)
splenic injury
boerhaave's syndrome
cushings ulcer
curling ulcer
mesenteric ischaemia
gastric ulcer
duodenal ulcer
gauchers disease
salmonella
pellagra = niacin (B3) deficiency

hodgkins disease
thalassaemia
AML
G6PD deficiency
carcinoma
hereditary haemorrhagic telangiectasia
haemophilia
uraemia
amyloidosis
CML (cross themiddle of the atlantic, land at NY, drive down route 95 to
philadelphia)
leukaemia
thalassaemia trait
lead poisoning

Type I (allergy)
Type II (bad blood)
Type III (clumps)
Type IV (delayed)
syphylis (treponema pallidum)
scabies
anti-21-hydroxylase
anti-nuclear, anti-smooth muscle
pANCA
anti-endomysial, anti-tissue transglutaminase, anti-gliadin
anti-centromere antibodies (ACA)
scl-70 (anti-topoisomerase)
anti-parietal cell, anti-intrinsic factor
anti-mitochondrial
anti-Ro, anti-La
anticardiolipin
ds DNA & antinuclear antibody
cANCA
ANCA
TB
anti-Jo
bacterial vaginosis
chagas disease
graft-versus-host disease
staph epidermis
staph aureus
strep bovis
enterococcus faecalis
leptospirosis
dengue fever
yellow fever
typhoid fever
taxoplasmosis
CMV
parovirus
syphyllis

multiple myeloma
takayasu's arteritis
churg-strauss syndrome
bechets disease
wegners granuloma
giant cell/temporal arteritis

polymyalgia rheumatica
muscular dystrophy
adhesive capsulitis

wernicke's encephalopathy
vit B1 deficiency
spinal stenosis
cushings ulcer
guillian barre syndrome
alzheimers disease
normal pressure hydrocephalus
vascular dementia
picks disease
subdural haemorrhage
bells palsy
myasthenia gravis
lambert-eaton syndrome
subarachnoid haemorrhage
extradural haematoma
cluster headache
charcot marie tooth disease
meniers disease
BPPV
ramsy hint syndrome

labrinthytis
brown sequard syndrome
syringomyelia
posterior cord compression
argyll robertson pupil
cortical blindness
cataracts
multiple sclerosis (internuclear ophthalmoplegia)
acute closed angleglaucoma
benign essential tremor
suprascapular nerve
C5, C6
ulnar damage
common peroneal nerve
ulnar nerve
dementia with lewy bodies

candidaalbicans
hydatidiform mole
bacterial vaginosis (gardnerella)
trichomonas
gonorrhoea
placenta praevia
placental abruption
hydatiform mole
vasa praevia
ectopic

amyloidosis
alkaptonuria
alports syndrome
AIDs/HIV
homocystinuria
hyperparathyroidism
ehlers'danlos syndrome

down's syndrome
pseudoxanthoma elasticum
riley-day syndrome
neurofibromatosis
central retinal arteryocclusion

pyloric stenosis
epiglotitis
nephroblastoma
pyloric stenosis
edwards syndrome
PDA
VSD
ASD

alcohol withdrawal
bullimia
anorexia
cocaine
desferrioxamine
atropine
flumazenil
oxygen
sodium bicarbonate
phyostigmine

minimal change glomerulonephritis

membranous glomerulonephritis
goodpasture's syndrome
IgA nephropathy aka Berger's disease

post streptococcal glomerulonephritis aka proliferative glomerulonephritis

proteus UTI infection
alports syndrome
renal Ca
pyelonephritis
membranoproliferative glomerulonephritis aka mesangiocapillary
glomerulonephritis
minimal change glomerulonephritis
diabetic nephropathy
medullary sponge kidney
nephrocalcinosis
haemolytic-uraemic syndrome
polycystic kidney disease
retroperitoneal fibrosis
falconi syndrome

pneumocystis jioveci
legionella pneumophilia
mycoplasma pneumoniae
byssinosis
silicosis

sjogrens syndrome
limited cutaneous sclerosis (CREST syndrome)
still's disease
pseudogout
psoriatic arthritis
reiter syndrome
pagets disease
episcleritis
scleritis
felty's syndrome
caplan syndrome

slipped upper femoral epiphysis

osgood schlater
chondromalacia
infective tenosynovitis
radial nerve damage
extensor tendon injury (mallet finger)
flexor digitorium profundus damage
flexor digitorium superficialis damage
ulnar damage
rupture long head of bicep (popeye sign)
mortons neuroma
posterior shoulder dislocation
anterior shoulder dislocation
irritable hip (transient synovitis)
osteosarcoma
perthe's disease
tibial nerve damage
radial nerve damage
axillary nerve damage
brachial plexus damage (aka erb's palsy akak waiters tip)
basal skull #

Mg2+ ammonium phosphate stone

saphena varix

Changes