I want you to read the file it has situational tasks. I want you to give me just a simple disease wise leading syndromes(with symptoms ), diagnostic measures, treatment (both therapeutic and surgical )

I want you to read the file it has situational tasks. I want you to give me just a 1.simple disease wise leading syndromes(with symptoms ), diagnostic measures, treatment (both therapeutic and surgical ). 2. A table with medicine groups and examples alongside the disease. 3. Preliminary diagnosis with reasons that include the leading syndrome name only. As u will describe them in no. 1

I want you to read the files it has situational tasks. I want you to give me just a 1.simple disease wise leading syndromes(with symptoms ), diagnostic measures, treatment (both therapeutic and surgical ). 2. A table with medicine groups and examples alongside the disease. 3. Preliminary diagnosis with reasons that include the leading syndrome name only. As u will describe them in no. 1. Make it concise, short last min revision worthy . Take reference from books like baileys , and other internal medicine, surgery and paediatric books

Reading File

Now let me extract text from all 4 PDFs in parallel:

Running Command

cd /home/daytona/workspace/attachments/1f45a4e1-9c7a-4589-bb1b-6f50202f40d3 && python3 -c " import pdfplumber, os files = [ 'S1 2(1) (1).pdf', 'Therapy No.1 (1).pdf', 'GOSS Exam Paediatrics(1) (1).pdf', 'GOSS Exam Surgery (Hos.1) Editted 1(1) (1).pdf' ] for f in files: print(f'\\n========== {f} ==========') try: with pdfplumber.open(f) as pdf: for i, page in enumerate(pdf.pages): text = page.extract_text() if text: print(f'--- Page {i+1} ---') print(text) except Exception as e: print(f'Error: {e}') " 2>&1 | head -500

Running Command

cd /home/daytona/workspace/attachments/1f45a4e1-9c7a-4589-bb1b-6f50202f40d3 && python3 -c " import pdfplumber files = [ 'S1 2(1) (1).pdf', 'Therapy No.1 (1).pdf', 'GOSS Exam Paediatrics(1) (1).pdf', 'GOSS Exam Surgery (Hos.1) Editted 1(1) (1).pdf' ] for f in files: print(f'\n========== {f} ==========') try: with pdfplumber.open(f) as pdf: for i, page in enumerate(pdf.pages): text = page.extract_text() if text: print(f'--- Page {i+1} ---') print(text) except Exception as e: print(f'Error: {e}') " 2>&1 | tail -n +500 | head -600

Running Command

cd /home/daytona/workspace/attachments/1f45a4e1-9c7a-4589-bb1b-6f50202f40d3 && python3 -c " import pdfplumber files = [ 'Therapy No.1 (1).pdf', 'GOSS Exam Paediatrics(1) (1).pdf', 'GOSS Exam Surgery (Hos.1) Editted 1(1) (1).pdf' ] for f in files: print(f'\n========== {f} ==========') try: with pdfplumber.open(f) as pdf: print(f'Total pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages): text = page.extract_text() if text: print(f'--- Page {i+1} ---') print(text[:3000]) except Exception as e: print(f'Error: {e}') " 2>&1 | head -800

Running Command

cd /home/daytona/workspace/attachments/1f45a4e1-9c7a-4589-bb1b-6f50202f40d3 && python3 -c " import pdfplumber files = [ 'Therapy No.1 (1).pdf', 'GOSS Exam Paediatrics(1) (1).pdf', 'GOSS Exam Surgery (Hos.1) Editted 1(1) (1).pdf' ] for f in files: print(f'\n========== {f} ==========') try: with pdfplumber.open(f) as pdf: print(f'Total pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages[26:60]): text = page.extract_text() if text: print(f'--- Page {i+27} ---') print(text[:2500]) except Exception as e: print(f'Error: {e}') " 2>&1 | head -800

Running Command

cd /home/daytona/workspace/attachments/1f45a4e1-9c7a-4589-bb1b-6f50202f40d3 && python3 -c " import pdfplumber # Get remaining therapy pages and paediatrics + surgery files files = [ ('Therapy No.1 (1).pdf', 51, 100), ('GOSS Exam Paediatrics(1) (1).pdf', 0, 50), ('GOSS Exam Surgery (Hos.1) Editted 1(1) (1).pdf', 0, 50), ] for f, start, end in files: print(f'\n========== {f} (pages {start+1}-{end}) ==========') try: with pdfplumber.open(f) as pdf: print(f'Total pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages[start:end]): text = page.extract_text() if text: print(f'--- Page {i+start+1} ---') print(text[:2000]) except Exception as e: print(f'Error: {e}') " 2>&1 | head -900

Running Command

cd /home/daytona/workspace/attachments/1f45a4e1-9c7a-4589-bb1b-6f50202f40d3 && python3 -c " import pdfplumber # Get paediatrics and surgery files files = [ ('GOSS Exam Paediatrics(1) (1).pdf', 0, 60), ('GOSS Exam Surgery (Hos.1) Editted 1(1) (1).pdf', 0, 60), ] for f, start, end in files: print(f'\n========== {f} ==========') try: with pdfplumber.open(f) as pdf: print(f'Total pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages[start:end]): text = page.extract_text() if text: print(f'--- Page {i+start+1} ---') print(text[:2500]) except Exception as e: print(f'Error: {e}') " 2>&1 | head -900

I now have enough content from all four files to compile the comprehensive answer. Let me now produce the full structured output.

Running Command

cd /home/daytona/workspace/attachments/1f45a4e1-9c7a-4589-bb1b-6f50202f40d3 && python3 -c " import pdfplumber # Get Surgery file f = 'GOSS Exam Surgery (Hos.1) Editted 1(1) (1).pdf' with pdfplumber.open(f) as pdf: print(f'Total pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages[:40]): text = page.extract_text() if text: print(f'--- Page {i+1} ---') print(text[:2500]) " 2>&1 | head -600

I now have comprehensive content from all four files. Let me compile the full structured answer document.Here is the complete compiled answer covering all diseases from all four files:

DISEASE-WISE EXAM REVISION GUIDE

(Surgery · Therapy · Paediatrics)

═══════════════════════════════════════

SURGERY CASES

═══════════════════════════════════════

1. CHRONIC PANCREATITIS

Leading Syndrome

Exocrine insufficiency + Pain syndrome

Constant epigastric pain radiating to the back, not food-related
Weight loss, diarrhea (steatorrhea, creatorrhea)
Type 2 DM (endocrine insufficiency - late sign)
Elevated bilirubin (ductal obstruction)

Diagnosis

Lab: Serum amylase (often normal in chronic), blood glucose, LFT (AST/ALT/ALP), stool for steatorrhea/creatorrhea, fecal elastase, secretin stimulation test (gold standard) Imaging: Abdominal X-ray (calcifications), USS (duct dilatation, cysts), CECT (calcifications, fibrosis, ductal stones), ERCP/MRCP (ductal anatomy, strictures)

Treatment

Conservative	Surgical
Low-fat diet, alcohol cessation	Pancreatic duct decompression (drainage)
Analgesics/NSAIDs, tramadol, opioids	Frey's procedure (head coring + ductal drainage to Roux-loop)
Enzyme replacement (Pancreatin/Creon)	Beger's procedure (head resection + anastomosis)
PPI (Omeprazole 20-40mg), H2 blockers	Whipple's (Pancreaticoduodenectomy)
Octreotide (reduce secretion)	Total/partial pancreatectomy
Insulin (if diabetic)	Pancreaticojejunostomy

Medicine Table

Group	Examples
Enzyme supplements	Pancreatin, Creon, Fistal
PPI	Omeprazole, Lansoprazole
H2 blockers	Ranitidine, Famotidine
Octreotide/Somatostatin analogues	Octreotide (Sandostatin)
Analgesics	NSAIDs, Tramadol, Morphine
Antidiabetics	Insulin

Preliminary Diagnosis

Chronic pancreatitis - based on the exocrine insufficiency syndrome (steatorrhea, creatorrhea, weight loss) + pain syndrome (constant epigastric pain with back radiation) + history of acute/necrotizing pancreatitis + DM.

2. PANCREATIC PSEUDOCYST

Leading Syndrome

Abdominal mass syndrome

Left hypochondrium pain (dull, constant)
Palpable painless, immobile epigastric mass
Weight sensation in epigastrium
History of acute pancreatitis (6 months prior)

Diagnosis

Lab: Serum amylase (persistently elevated), CEA in cyst fluid (low = pseudocyst), amylase in cyst fluid (high = pseudocyst) Imaging: USS (size, location), CT (differentiates pseudocyst from cystic neoplasm), Endoscopic USS + aspiration (fluid cytology), ERCP/MRCP (ductal communication)

Treatment

Conservative	Surgical
Bowel rest, NPO	External drainage (US/CT-guided percutaneous)
TPN (parenteral nutrition)	Endoscopic transenteric drainage (cystogastrostomy, cystoduodenostomy)
Antibiotics if infected	Internal drainage (cystogastrostomy, cystojejunostomy)
Watch-and-wait (many resolve spontaneously)	Distal pancreatectomy + splenectomy (if cyst in tail)
	Pancreaticoduodenectomy (if cyst in head)

Medicine Table

Group	Examples
Antibiotics (if infected)	Meropenem, Piperacillin-Tazobactam
TPN solutions	Glucose, Amino acids, Lipids

Preliminary Diagnosis

Pancreatic pseudocyst - based on the abdominal mass syndrome (painless, immobile epigastric mass) + prior acute pancreatitis history + persistent elevated amylase.

3. INSULINOMA (Endocrine Pancreatic Tumor)

Leading Syndrome

Hypoglycemic syndrome (Whipple's triad)

Tremor, weakness, constant hunger
Symptoms during fasting (neuroglycopenic)
Hypoglycemia on blood test
Insulin:glucose ratio >0.3 on 72-hour fast

Diagnosis

Lab: Blood glucose (<40mg%), insulin level (>7µU/ml), C-peptide (>1.2µg/ml), proinsulin:insulin ratio (>20% = malignant if >40%), 72-hour supervised fast, insulin provocation test (tolbutamide/calcium gluconate) Imaging: USS pancreas, CT/MRI (localize tumor), Endoscopic USS, Visceral angiography, Octreotide scan, Transhepatic portal vein sampling, Intraoperative sonography

Treatment

Conservative	Surgical
Diazoxide (blocks insulin release)	Tumor enucleation (laparoscopic)
Octreotide (reduces insulin secretion)	Distal pancreatectomy (tail tumors)
Calcium channel blockers (Verapamil)	Whipple's procedure (head tumors, multiple)
Beta-blockers, Phenytoin, Steroids	90% curable with surgery
Streptozotocin (liver metastases)

Medicine Table

Group	Examples
Diazoxide	Diazoxide
Somatostatin analogues	Octreotide
Calcium channel blockers	Verapamil
Cytotoxic (metastatic)	Streptozotocin

Preliminary Diagnosis

Insulinoma - based on hypoglycemic syndrome (Whipple's triad) + insulin:glucose ratio 0.4-0.7 (>0.3 = diagnostic) + persistent hypoglycemia on 72-hour fast.

4. ZOLLINGER-ELLISON SYNDROME (Gastrinoma)

Leading Syndrome

Acid hypersecretion syndrome + GI bleeding syndrome

Recurrent deep peptic ulcers (postbulbar duodenal)
Pyrosis, severe epigastric pain, diarrhea (NG suction resolves it)
Hematemesis and melena
BAO >15 mEq/hr; BAO:MAO ratio >0.6

Diagnosis

Lab: CBC (anemia), elevated CRP, fasting serum gastrin (>1000 pg/ml = diagnostic), secretin stimulation test, calcium stimulation test, gastric pH (<2) Imaging: CT abdomen, Upper GI endoscopy + biopsy, Somatostatin receptor scintigraphy (octreotide scan), Endoscopic USS

Treatment

Conservative	Surgical
PPI (first-line, high-dose): Omeprazole, Lansoprazole, Pantoprazole	Resection of pancreatic tissue containing tumor
Octreotide (somatostatin analogue)	Liver tumor debulking
Chemotherapy (tumor control)	Embolization / Radiofrequency ablation

Medicine Table

Group	Examples
PPI	Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole
Somatostatin analogues	Octreotide
Chemotherapy	Streptozotocin, 5-FU

Preliminary Diagnosis

Zollinger-Ellison Syndrome (Gastrinoma) - based on acid hypersecretion syndrome (BAO >23 mEq/hr, BAO:MAO=0.74) + recurrent postbulbar ulcers + diarrhea relieved by NG suction.

5. PERIAMPULLARY / PANCREATIC CARCINOMA

Leading Syndrome

Obstructive jaundice syndrome + Anemia + Cancer syndrome

Constant epigastric pain radiating to back (not food-related)
Progressive weight loss (>15 kg), weakness
Dark urine, jaundice (obstructive: elevated conjugated bilirubin)
Anemia (Hb 76g/l)

Diagnosis

Lab: CBC (anemia), LFT (raised total + conjugated bilirubin, ALP, ALT, AST), CA 19-9 (tumor marker), serum amylase/lipase, FBS Imaging: CT (gold standard for staging), TUS/EUS, MRI, ERCP, PET scan

Treatment

Conservative	Surgical (Curative)
Oral morphine (pain)	Whipple's (pancreaticoduodenectomy)
Enzyme replacement	Pylorus-preserving pancreaticoduodenectomy
Chemotherapy (Gemcitabine)	Palliative:
	Stent (ERCP/PTC) for jaundice
	Cholecysto/Choledocojejunostomy
	Gastrojejunostomy (duodenal obstruction)
	Coeliac nerve block (pain)

Medicine Table

Group	Examples
Opioid analgesics	Morphine, Pethidine
Chemotherapy	Gemcitabine
Enzyme supplements	Creon, Pancreatin

Preliminary Diagnosis

Periampullary/Pancreatic carcinoma - based on obstructive jaundice syndrome (dark urine, elevated conjugated bilirubin) + cancer syndrome (severe weight loss >15kg, progressive constant pain) + anemia.

6. CHOLEDOCHOLITHIASIS + ACUTE PANCREATITIS

Leading Syndrome

Obstructive jaundice + Acute abdominal pain syndrome

Epigastric pain radiating to back
Jaundice (sometimes)
Vomiting, elevated amylase
History of chronic cholecystitis

Diagnosis

Lab: CBC (leukocytosis, left shift), amylase/lipase/trypsin (elevated), serum bilirubin, LFT (ALT/AST) Imaging: USS/CT (stone, gallbladder wall thickness, CBD dilatation), FGDS (exclude papilla stenosis, tumor, PU), ERCP (biliary obstruction - contraindicated in acute pancreatitis)

Treatment

Conservative	Surgical
NPO + IV fluids	ERCP sphincterotomy + stone extraction/lithotripsy
Analgesics (Pethidine), antispasmodics	Stent insertion (CBD)
Antibiotics	Choledochotomy + stone extraction + T-tube (Kehr's)
Antiemetics	Laparoscopic/open CBD exploration
	Cholecystectomy

Medicine Table

Group	Examples
Analgesics	Pethidine, NSAIDs
Antibiotics	Ceftriaxone, Piperacillin-Tazobactam
Antispasmodics	No-spa (Drotaverine)
Antiemetics	Metoclopramide

Preliminary Diagnosis

Choledocholithiasis complicated by acute pancreatitis - based on acute abdominal pain syndrome (epigastric pain with back radiation, elevated amylase) + obstructive jaundice syndrome + history of chronic cholecystitis.

7. CANCER OF THE ESOPHAGUS

Leading Syndrome

Dysphagia + Cancer syndrome

Progressive dysphagia (solids → liquids)
Retrosternal pain, weight loss
Increased salivation, regurgitation
Endoscopy: constriction, hilly mucosa, ulceration, contact bleeding
Barium: irregular narrowing

Diagnosis

Lab: CBC (anemia), LFT (metastasis to liver), biopsy (HER2 protein) Imaging: OGD + biopsy (definitive), Barium swallow, CT chest, PET scan, Bronchoscopy (tracheal/bronchial spread), Esophageal manometry

Treatment

Conservative	Surgical
Neoadjuvant chemotherapy + radiotherapy	Radical esophagectomy (Ivor-Lewis/transhiatal)
Immunotherapy (Nivolumab)	Stent placement (palliative)
Esophageal dilatation	Multimodal (surgery + chemo/radio for nodal involvement)
Anticholinergics (Scopolamine - hypersalivation)

Medicine Table

Group	Examples
Chemotherapy	5-FU, Cisplatin, Paclitaxel
Immunotherapy	Nivolumab
Anticholinergics	Scopolamine

Preliminary Diagnosis

Carcinoma of the esophagus (middle/lower third) - based on dysphagia syndrome (progressive solid food dysphagia) + cancer syndrome (weight loss, regurgitation) + endoscopy showing ulcerated, crumbling stricture.

8. ACHALASIA OF THE ESOPHAGUS

Leading Syndrome

Dysphagia syndrome (motility disorder)

Dysphagia (solids AND liquids)
Regurgitation of undigested food
Retrosternal pain/heaviness after meals
Weight loss
Barium: "Bird's beak" / "Rat-tail" narrowing at LES

Diagnosis

Lab: CBC (hypochromic anemia from nutritional deficiency) Imaging: Barium swallow (bird's beak), Chest X-ray (air-fluid level, dilated esophagus), CT (megaesophagus), Esophageal manometry (GOLD STANDARD - absent peristalsis + hypertensive unrelaxed LES), OGD (exclude malignancy)

Treatment

Conservative	Surgical
Nitrates (Isosorbide dinitrate) - reduce LES pressure	Laparoscopic Heller Myotomy + Dor fundoplication (standard)
CCB (Nifedipine) - reduce LES pressure	POEM (Per Oral Endoscopic Myotomy)
Botulinum toxin injection (endoscopic)	Nissen fundoplication (anti-reflux)
Pneumatic balloon dilatation	Resection (megaesophagus/sigmoid esophagus)

Medicine Table

Group	Examples
Nitrates (spasmolytics)	Isosorbide dinitrate
CCB	Nifedipine
Botulinum toxin	Botox injection

Preliminary Diagnosis

Achalasia of the esophagus (Stage 3) - based on dysphagia syndrome (solid + liquid dysphagia) + barium showing constriction at lower esophagus with absent peristalsis + manometry (absent peristalsis, high LES pressure).

9. ESOPHAGEAL DIVERTICULUM (Epiphrenic)

Leading Syndrome

Dysphagia + Regurgitation syndrome

Retrosternal pain/heaviness after meals
Dysphagia, regurgitation of food
Halitosis (unpleasant mouth smell)
Barium: "clubbing" protrusion above diaphragm

Diagnosis

Lab: No specific labs Imaging: OGD/Esophagoscopy, Barium swallow X-ray (protrusion of esophageal wall), 24-hour pH test (GERD), Esophageal manometry

Treatment

Conservative	Surgical
Diet change (smaller meals, slow eating, stay upright post-meal)	Cricopharyngeal myotomy (small diverticula)
Water intake	Diverticulopexy + cricopharyngeal myotomy (large)
	Endoscopic diverticulotomy (Dohlman procedure)
	Diverticulectomy (resection)

Preliminary Diagnosis

Esophageal epiphrenic diverticulum - based on dysphagia + regurgitation syndrome (retrosternal heaviness, halitosis, food regurgitation) + barium showing clubbing protrusion above diaphragm.

10. HIATAL HERNIA

Leading Syndrome

GERD syndrome + Reflux syndrome

Retrosternal burning pain, heartburn
Worse lying down and bending forward
Worse after meals
Regurgitation
Barium: stomach plicas above diaphragm, obtuse Giss angle

Diagnosis

Lab: CBC (anemia if bleeding), FBS, biochemical tests Imaging: Barium swallow (gold standard - shows gastroesophageal reflux, stomach above diaphragm), FEGS/OGD (esophagitis, reflux), CT scan

Treatment

Conservative	Surgical
Antacids	Laparoscopic Nissen fundoplication (sliding hernia - gold standard)
H2 blockers (Ranitidine)	Hiatus repair
PPI (Omeprazole)	Collis-Nissen gastroplasty (paraesophageal hernia)
Lifestyle changes (small meals, avoid bending/lying after eating)

Medicine Table

Group	Examples
PPI	Omeprazole, Pantoprazole
H2 blockers	Ranitidine, Famotidine
Antacids	Mg(OH)2, Alginate-antacid (Gaviscon)

Preliminary Diagnosis

Hiatal hernia - based on GERD/reflux syndrome (retrosternal pain, heartburn, worse lying flat/bending forward) + barium showing stomach above diaphragm with gastroesophageal reflux.

11. GI BLEEDING (Acute Peptic Ulcer - Hemorrhagic)

Leading Syndrome

GI Bleeding (Hemorrhagic) + Hypovolemic Shock syndrome

Black stools (melena), hematemesis
Weakness, dizziness, syncope
Tachycardia (100-106 bpm), hypotension (90-100/60 mmHg)
Pale skin, cold sweat
Hb 86g/l, RBC 2.8x10¹²

Diagnosis

Lab: CBC (anemia), urea breath test (H. pylori), biopsy, fecal antigen test, serology; AST/ALT/urea/creatinine Imaging: FGDS/OGD (gold standard - identifies source + allows hemostasis), Double-contrast barium meal

Treatment

Conservative	Surgical
NPO, complete rest, cold pack to abdomen	Endoscopic hemostasis (electrocoagulation, laser photocoagulation, glue, hemostatic drugs)
IV fluids + blood transfusion (packed RBCs), plasma	Angiographic embolization of gastroduodenal artery
Hemostatics: IV aminocaproic acid, Vicasol, Ca chloride	Oversewing of bleeding vessel
PPI: IV Omeprazole, Ranitidine/Famotidine IV
Aminocaproic acid + Contrycal/Trasylol + Adrenalin (cold) orally

Medicine Table

Group	Examples
PPI	IV Omeprazole, Pantoprazole
H2 blockers	Ranitidine, Famotidine (IV)
Hemostatics	Aminocaproic acid, Etamsylate (Vicasol), Tranexamic acid
Blood products	Packed RBCs, Plasma, Albumin

Preliminary Diagnosis

Gastrointestinal bleeding (Hemorrhagic syndrome) - based on GI bleeding syndrome (melena, hematemesis) + hypovolemic shock syndrome (tachycardia, hypotension, syncope, Hb drop) + history of NSAID use or peptic ulcer.

12. CHRONIC ARTERIAL INSUFFICIENCY (Leriche's Syndrome / PAD)

Leading Syndrome

Chronic limb ischemia syndrome (Fontaine IV)

Intermittent claudication (leg/buttock/lumbar pain after 50-100m walking)
Impotence (Leriche's)
Absent hair, ivory-black skin of lower extremities
Absent pulses on all lower extremity arteries
Positive ischemic functional tests

Diagnosis

Lab: CBC (platelets, thrombocytosis), cholesterol/triglycerides, glucose (diabetes screening), APTT/PT-INR Imaging: Duplex USS, Digital subtraction angiography, Aortography (Seldinger/Dos-Santos), CT/MR angiogram, Ankle-Brachial Index (ABI)

Treatment

Conservative	Surgical
Analgesics	Thromboembolectomy (direct/indirect Fogarty)
Anticoagulants (Heparin → Warfarin)	Bypass (allograft/synthetic material)
Thrombolytics (Streptokinase)	Aortobifemoral bypass
Antiplatelets: Aspirin + Clopidogrel (dual)	Endovascular thrombolysis
Statins (Rosuvastatin/Atorvastatin)	Fasciotomy (prevent necrosis)
	Amputation (if gangrene/necrosis)

Medicine Table

Group	Examples
Antiplatelets	Aspirin, Clopidogrel
Anticoagulants (direct)	Heparin, Fraxiparine
Anticoagulants (indirect)	Warfarin
Thrombolytics	Streptokinase, Urokinase, TPA
Statins	Rosuvastatin, Atorvastatin

Preliminary Diagnosis

Chronic arterial insufficiency (Leriche's Syndrome) - based on chronic limb ischemia syndrome (claudication, absent pulses, skin changes, impotence) + Fontaine stage IV signs.

13. ACUTE ARTERIAL INSUFFICIENCY (Embolism)

Leading Syndrome

Acute limb ischemia syndrome (6 Ps)

Acute sudden pain in limb
Pallor (pale, cold limb)
Pulselessness (absent pulses distally)
Paresthesia, numbness (loss of sensation)
Paralysis (absent active movements)
Source: mitral stenosis → cardiac embolism / atrial fibrillation

Diagnosis

Lab: CBC (platelets, thrombocytosis), APTT/PT-INR, D-dimer, coagulogram Imaging: Duplex USS, Digital subtraction angiography (Seldinger), MRI

Treatment

Conservative	Surgical
Anticoagulants: Heparin (direct) → Warfarin (indirect)	Indirect embolectomy (Fogarty catheter)
Thrombolytics (Streptokinase, Urokinase)	Direct embolectomy (arteriotomy at occlusion)
Spasmolytics (Papaverine, Carbocholine)	Bypass (allograft/synthetic)
Analgesics	Endovascular thrombolysis (antegrade/retrograde)
Antiplatelets (Aspirin, Clopidogrel 75-300mg)	Fasciotomy (compartment syndrome prevention)
	Amputation (if necrosis/gangrene)

Medicine Table

Group	Examples
Anticoagulants	Heparin, Fraxiparine, Warfarin
Thrombolytics	Streptokinase, Urokinase, TPA
Spasmolytics	Papaverine, Carbocholine
Antiplatelets	Aspirin, Clopidogrel

Preliminary Diagnosis

Acute arterial insufficiency - embolism (left/right femoral/iliac artery) - based on acute limb ischemia syndrome (sudden onset cold, pale, pulseless, numb, paralyzed limb) + cardiac source (mitral stenosis, atrial fibrillation).

14. ACUTE AORTIC DISSECTION

Leading Syndrome

Tearing chest pain + Vascular catastrophe syndrome

Sudden severe tearing/distending chest pain with neck radiation
Pulsation feeling
Severe hypotension (70/30 mmHg), tachycardia (128 bpm)
Pale skin, neck vein distension, muffled heart tones (pericardial tamponade)
History of essential hypertension

Diagnosis

Lab: CBC, ESR, CRP, urea, creatinine, electrolytes, Troponin (negative - helps exclude MI) Imaging: CXR (calcium sign - >10mm separation of intimal calcification), Echocardiography (LVH), TEE, CT angiography, MRI (gold standard), Aortogram

Treatment

Conservative	Surgical
Beta-blockers: Esmolol/Propranolol/Labetalol (target HR <65, BP reduction 20%)	Replacement with Dacron tube graft
CCB (if beta-blocker contraindicated): Verapamil, Diltiazem	Bentall procedure (aorta + aortic valve replacement)
Vasodilators: Sodium nitroprusside	David procedure (aorta replacement + valve reimplantation)
ACEI/ARB: Enalapril/Telmisartan	Stent-graft insertion

Medicine Table

Group	Examples
Beta-blockers	Esmolol, Propranolol, Labetalol
CCB	Verapamil, Diltiazem
ACEI	Enalapril
ARB	Telmisartan
Vasodilators	Sodium nitroprusside

Preliminary Diagnosis

Acute ascending aortic dissection with pericardial tamponade - based on tearing chest pain syndrome (sudden severe chest pain with neck radiation) + severe hemodynamic collapse + muffled heart tones + history of hypertension.

15. VARICOSE VEINS + CHRONIC VENOUS INSUFFICIENCY (CVI)

Leading Syndrome

Chronic venous insufficiency syndrome

Varicose (dilated, tortuous) veins of lower extremities
Transient leg edema
Skin pigmentation, dermatosclerosis (medial calf)
Trophic ulcer (non-healing, malleolus area)
CVI Grade II

Diagnosis

Lab: CBC, APTT, PT/INR Imaging: Duplex scan (venous mapping, patency of deep veins), MR venography (pelvic/abdominal veins), Phlebography/Contrast venography

Treatment

Conservative	Surgical
Compression stockings	Crossectomy (Troyanov-Trendelenburg procedure)
Sclerotherapy / Laser sclerotherapy	Endoscopic dissection of communicating veins
Exercise, leg elevation	Stripping of saphenous vein

Medicine Table

Group	Examples
Venotonics	Diosmin (Detralex), Troxerutin
Anticoagulants (DVT prevention)	Heparin, LMWH
Sclerosant	Sodium tetradecyl sulfate

Preliminary Diagnosis

Varicose disease CVI Grade II - based on chronic venous insufficiency syndrome (varicose veins, edema, pigmentation, dermatosclerosis) + trophic ulcer (in post-thrombophlebitic variant).

16. ILIOFEMORAL PHLEBOTHROMBOSIS (DVT)

Leading Syndrome

Acute deep vein thrombosis syndrome

Severe pain and edema of entire lower extremity
Fever (38°C)
Hyperemia, shiny, tense skin
Circumference difference: shin +4cm, thigh +6cm
Painful on touch

Diagnosis

Lab: D-dimer (ELISA/latex agglutination), CBC, APTT, PT-INR Imaging: Duplex USS (gold standard), Phlebography, MRI/CT

Treatment

Conservative	Surgical
Heparin (direct anticoagulant) → Warfarin	IVC filter (vena cava filter - prevent PE)
Thrombolytics (Streptokinase, Urokinase)	Thrombectomy (clot removal, endovenous)
Leg elevation, compression
Analgesics

Medicine Table

Group	Examples
Anticoagulants	Heparin, LMWH (Fraxiparine), Warfarin
Thrombolytics	Streptokinase, Urokinase
NSAIDs	Diclofenac

Preliminary Diagnosis

Iliofemoral phlebothrombosis - based on acute DVT syndrome (sudden onset severe swelling, pain, redness, tense skin of entire lower extremity) + fever + asymmetric limb circumference.

17. ACUTE THROMBOPHLEBITIS (Varicose)

Leading Syndrome

Superficial thrombophlebitis syndrome

Pain along dilated vein, medial calf
Cord-like, rosary-bead thickened vein (painful on palpation)
Hyperemia, skin infiltration around vein
Low-grade fever (37.8°C)
No limb edema (differentiates from DVT)

Diagnosis

Lab: (minimal workup) Imaging: Duplex USS (rule out deep vein involvement)

Treatment

Conservative	Surgical
Leg elevation, compression bandages	Crossectomy (Troyanov-Trendelenburg) if extending to saphenofemoral junction
Anti-inflammatory drugs (topical Diclofenac)
Anticoagulants (if extending to DVT)

Preliminary Diagnosis

Acute varicose thrombophlebitis - based on superficial thrombophlebitis syndrome (cord-like tender vein, local hyperemia, infiltration) + background varicose disease + no limb edema.

18. LUNG ABSCESS (Acute)

Leading Syndrome

Pulmonary suppuration syndrome

Cough with copious (70ml/day) purulent, foul-smelling sputum
Chest pain, breathlessness
Fever (38.6°C), weakness, night sweats
CXR: cavity with air-fluid level (upper or lower lobe)
Amphoric breathing on auscultation

Diagnosis

Lab: CBC (neutrophil leukocytosis), CRP elevated, sputum culture + sensitivity, blood culture Imaging: CXR, CT chest, Bronchoscopy (FBS), Sputum microscopy

Treatment

Conservative	Surgical
Clindamycin 600mg IV TID (first-line) → oral 300mg QID	Transthoracic tube drainage (Monaldi technique)
IV Penicillin G 2-10 million U/day → oral Penicillin V	Thoracostomy
Penicillin + Metronidazole 500mg QID (oral, alternative)	Lobectomy/Pulmonectomy (chronic/failed conservative)
Antibiotic per sensitivity (Gram-negative or S.aureus)
Postural drainage

Medicine Table

Group	Examples
Antibiotics (anaerobic)	Clindamycin, Metronidazole
Penicillins	Penicillin G/V
Aminoglycosides (Gram-neg)	Amikacin

Preliminary Diagnosis

Acute lung abscess (upper/lower lobe) - based on pulmonary suppuration syndrome (copious foul purulent sputum, fever, amphoric breathing) + CXR cavity with air-fluid level.

19. LUNG GANGRENE

Leading Syndrome

Pulmonary gangrene syndrome

Massive pulmonary hemorrhage
Copious purulent, bloody, three-layered sputum (on standing)
Cough, breathlessness, severe toxemia
Multiple cavities on CXR
Diffuse dark patches in lung

Diagnosis

Lab: Sputum for culture, sensitivity, cytology; diagnostic puncture/biopsy Imaging: CXR (multiple cavities, dark patchy), CT chest (with/without contrast), bronchoscopy, bronchoalveolar lavage, MRI, thoracoscopy

Treatment

Conservative	Surgical
Complex antibiotic therapy (per sensitivity)	Lung resection (lobectomy) - definitive for gangrene
Drainage + complex lavage of abscess cavities	Pulmonectomy (after 7-10 days intensive prep)
Correction of homeostasis and immunodeficiency	Transthoracic drainage (various methods)
IV Hemodesis, Reopolyglucine, glucose, Ringer's
Immunoprotectors: Levamisole, Thymosinum

Preliminary Diagnosis

Lung gangrene - based on pulmonary gangrene syndrome (massive hemoptysis, three-layered sputum, multiple cavities) + severe toxemia.

20. CHRONIC LUNG ABSCESS

Leading Syndrome

Chronic pulmonary suppuration syndrome

Persistent cough with 30-50ml purulent sputum/day
Hemoptysis (blood-tinged sputum)
Repeated exacerbations of inflammatory process
Breathlessness on mild exertion
History of prior acute abscess

Diagnosis

Lab: CBC, sputum culture/sensitivity Imaging: CXR, CT chest, bronchoscopy, BAL, transthoracic needle aspiration, MRI

Treatment

Conservative	Surgical
Antibiotics (per sensitivity)	Lobectomy (absolute indication: repeated pulmonary hemorrhage)
Postural drainage	Pulmonectomy (extensive disease)
Physiotherapy

Preliminary Diagnosis

Chronic lung abscess - based on chronic pulmonary suppuration syndrome (persistent purulent sputum >months, hemoptysis, repeated exacerbations) + prior acute abscess history.

21. PERIPHERAL / CENTRAL LUNG CANCER

Leading Syndrome

Peripheral: Chest pain + Horner's/Pancoast + intoxication syndrome Central: Bronchial obstruction syndrome (dry cough → hemoptysis, atelectasis, post-obstructive pneumonia, intoxication)

Dry cough, hemoptysis, chest pain
Breathlessness, rapid fatigability, weight loss, fever
Elevated ESR

Diagnosis

Lab: Sputum cytology, ESR Imaging: CXR (round shadow with fuzzy edges - peripheral; atelectasis - central), CT chest, Bronchoscopy + biopsy + BAL (central), Percutaneous needle biopsy (peripheral), PET scan, Endobronchial sonography

Treatment

Conservative	Surgical
Chemotherapy + Radiotherapy (combined)	Surgical resection (lobectomy/lobe resection)
Immunotherapy	Interstitial radiation therapy
Stage-based adjuvant therapy

Medicine Table

Group	Examples
Chemotherapy	Cisplatin, Carboplatin, Paclitaxel
Immunotherapy	Pembrolizumab, Nivolumab

Preliminary Diagnosis

Peripheral/Central lung cancer - based on bronchial obstruction syndrome (central: dry cough, hemoptysis, atelectasis) or chest pain + intoxication syndrome (peripheral: chest pain, weight loss, round shadow).

═══════════════════════════════════════

THERAPY CASES

═══════════════════════════════════════

22. ACUTE LEUKEMIA (AML/ALL)

Leading Syndromes

Hemorrhagic + Anemic + Hyperplastic + Intoxication

Gum bleeding, epistaxis, petechiae/ecchymoses (hemorrhagic)
Pallor, weakness, dizziness (anemic)
Hepatosplenomegaly, lymphadenopathy (hyperplastic)
Fever, diaphoresis (intoxication)
Blast cells >20% on CBC; leukemic hiatus; eosinophil-basophil dissociation

Diagnosis

Lab: CBC (pancytopenia, >20% blasts, leukemic hiatus), coagulogram (PT/PTT), LFT, RFT, CXR Definitive: Bone marrow aspiration/biopsy, immunophenotyping, cytogenetics, cytochemistry

Treatment

Conservative (Chemotherapy)	Surgical
AML: 7+3 (Cytarabine 7 days + Daunorubicin 3 days)	Bone marrow transplant (allogenic)
ALL: GALB/RACOP (Cyclophosphamide, Daunorubicin, Vincristine, Prednisolone, L-Asparaginase)
Supportive: Antibiotics, Blood transfusion

Medicine Table

Group	Examples
Anthracyclines	Daunorubicin
Antimetabolites	Cytarabine, Methotrexate
Alkylating agents	Cyclophosphamide
Vinca alkaloids	Vincristine
Corticosteroids	Prednisolone
Asparaginase	L-Asparaginase

Preliminary Diagnosis

Acute Leukemia (AML/ALL) - based on hemorrhagic syndrome (gum bleeding, epistaxis, skin hemorrhages) + hyperplastic syndrome (hepatosplenomegaly, lymphadenopathy) + anemic syndrome + >38% blasts on CBC.

23. IRON DEFICIENCY ANEMIA (IDA)

Leading Syndromes

Anemic + Sideropenic

Weakness, dizziness, palpitations, dyspnea, pale skin (anemic)
Angular stomatitis, dysphagia, voice hoarseness, pica (chalk/toothpaste/kerosene craving), koilonychia, blue sclerae (sideropenic)
CBC: Hb ↓, MCV ↓ (<80), MCH ↓, MCHC ↓, RDW ↑, serum iron ↓

Diagnosis

Lab: CBC (microcytic hypochromic anemia), serum iron (↓), ferritin (↓), TIBC (↑), transferrin saturation (↓), peripheral smear (hypochromic microcytes), fecal occult blood Other: Barium swallow (if Plummer-Vinson), USS (uterine myoma), gynecology review

Treatment

Conservative	Surgical
Oral iron: Ferrous sulphate (1st line)	Treat underlying cause (e.g. myomectomy for uterine myoma)
Vitamin C (enhances iron absorption)
IV iron (Iron sucrose, Ferric gluconate) - if oral not tolerated
Blood transfusion (severe anemia)

Medicine Table

Group	Examples
Oral iron	Ferrous sulphate, Ferrous gluconate
IV iron	Iron sucrose, Ferric gluconate
Adjuvant	Vitamin C

Preliminary Diagnosis

Iron Deficiency Anemia (Stage II/III) - based on anemic syndrome (Hb ↓, pallor, weakness) + sideropenic syndrome (angular stomatitis, pica, koilonychia, dysphagia, blue sclerae) + MCV/MCH/MCHC all low + serum iron low.

24. VITAMIN B12 DEFICIENCY ANEMIA

Leading Syndromes

Anemic + Neurological + GIT (Glossitis)

Weakness, palpitations, jaundice (lemon-yellow), dyspnea (anemic)
Paresthesias, numbness, cold lower extremities, polyneuropathy (neurological)
Glossitis (raspberry/beefy tongue, papillary atrophy), hepatomegaly (GIT)
CBC: Hb ↓, MCV ↑ (>100), Jolly bodies, Kebot rings, hypersegmented neutrophils, pancytopenia

Diagnosis

Lab: CBC (macrocytic hyperchromic anemia, pancytopenia), serum B12 (↓), methylmalonic acid (↑), homocysteine (↑), LDH (↑), indirect bilirubin (↑), anti-intrinsic factor antibodies (Schilling test), bone marrow (megaloblastic erythropoiesis), gastroscopy (atrophic gastritis)

Treatment

Conservative	Surgical
IM Cyanocobalamin 500mcg twice/day x 4 weeks	Treat underlying cause (if tumor)
If CNS: 1000mcg/day x 10 days → 1000mcg every 10 days
Maintenance: 500mcg once weekly (lifelong if pernicious anemia)
Folate supplementation if co-deficient

Medicine Table

Group	Examples
Vitamin B12	Cyanocobalamin, Hydroxocobalamin, Methylcobalamin (IM)
Folate	Folic acid

Preliminary Diagnosis

Vitamin B12 Deficiency Anemia - based on anemic syndrome (Hb ↓, macrocytic hyperchromic) + neurological syndrome (paresthesias, numbness) + GIT syndrome (glossitis, atrophic tongue) + Jolly bodies/Kebot rings on smear + atrophic gastritis on gastroscopy.

25. GOUT (Acute Gouty Arthritis)

Leading Syndromes

Joint + Inflammatory + Metabolic (hyperuricemia)

Sudden onset excruciating pain in 1st MTP joint (big toe), at night, after food/alcohol
Swelling, hyperemia, hot skin over joint, exquisite tenderness (even light touch)
Fever, leukocytosis, elevated ESR
Tophi on auricle (whitish nodules)
Uric acid >420 μmol/L
Urate crystals on joint aspiration (needle-shaped, negatively birefringent)

Diagnosis

Lab: CBC (leukocytosis, elevated ESR), uric acid (↑), CRP (↑), lipid profile, urinalysis (urates) Imaging: X-ray foot (punched-out erosions with overhanging rim), USS joint (double contour sign), renal USS (urate stones), joint aspiration (gold standard - urate crystals)

Treatment

Conservative (Acute)	Conservative (Long-term/Inter-ictal)	Surgical
NSAIDs: Indomethacin 25-50mg TID (5-10 days)	Allopurinol 100-300mg/day (xanthine oxidase inhibitor)	None usually
Colchicine 1.2mg then 0.6mg 1hr later	Probenecid (uricosuric)
Corticosteroids if NSAID/colchicine contraindicated: Prednisolone 40mg/day, intraarticular Triamcinolone	Diet: reduce purines, alcohol, hydration
	ACE inhibitors + CCB/diuretics (for hypertension)

Medicine Table

Group	Examples
NSAIDs	Indomethacin, Naproxen
Colchicine	Colchicine
Corticosteroids	Prednisolone, Triamcinolone (intraarticular)
Xanthine oxidase inhibitors	Allopurinol, Febuxostat
Uricosurics	Probenecid, Sulfinpyrazone
Uricases	Pegloticase, Rasburicase

Preliminary Diagnosis

Acute gouty arthritis (Podagra) - based on joint syndrome (sudden, nocturnal, exquisite pain at 1st MTP, hyperemia, swelling) + inflammatory syndrome (fever, leukocytosis, elevated ESR) + hyperuricemia + tophi.

26. OSTEOARTHRITIS (OA)

Leading Syndrome

Joint syndrome (degenerative)

Pain on movement/walking, worse at end of day, worse going downstairs
Crepitus in joints
Deformity: varus/valgus, Heberden (DIP) / Bouchard (PIP) nodes
Limited range of motion
X-ray: joint space narrowing, subchondral sclerosis, osteophytes

Diagnosis

Lab: CBC, ESR, CRP (mildly elevated or normal), RF (negative - helps exclude RA), joint aspiration (no urate crystals), anti-nuclear antibody (exclude SLE/RA) Imaging: X-ray (narrowed space, osteophytes, sclerosis), USS joint (synovial membrane thickness), MRI (cartilage assessment)

Treatment

Conservative	Surgical
Weight loss, exercise (swimming), walking aids	Total knee/joint replacement
Physiotherapy (ultrasound, PEMF)	Osteotomy
NSAIDs: Diclofenac 50-100mg, Meloxicam 7.5-15mg	Osteophyte removal, chondroplasty
Analgesic: Acetaminophen 325-650mg QID
Tramadol (if severe, NSAID-refractory)
Intraarticular Corticosteroids: Methylprednisolone 40mg / Triamcinolone 20-40mg
Chondroprotectives: Chondroitin sulfate 500mg BD, Glucosamine sulfate 1500mg/day
Intraarticular Hyaluronate

Medicine Table

Group	Examples
NSAIDs (non-selective)	Diclofenac, Ibuprofen, Naproxen
NSAIDs (COX-2 selective)	Meloxicam, Nimesulide, Celecoxib
Analgesics	Acetaminophen, Tramadol
Intraarticular corticosteroids	Methylprednisolone, Triamcinolone
Chondroprotectives	Chondroitin sulfate, Glucosamine sulfate
Intraarticular HA	Hyaluronate (Alflutop, Synvisc)

Preliminary Diagnosis

Osteoarthritis (nodular form, Stage 3-4) - based on joint syndrome (pain on movement, crepitus, deformity, limited ROM, Heberden/Bouchard nodes) + X-ray stage (osteophytes, subchondral sclerosis, joint space narrowing).

27. RHEUMATOID ARTHRITIS (RA)

Leading Syndromes

Joint + Constitutional + Inflammatory

Symmetrical small joint swelling (MCP, PIP - hands and wrists)
Morning stiffness >1 hour (early) or >4 hours (late)
Rheumatoid nodules over PIP joints
Elevated RF (>20 IU/mL), elevated anti-CCP (>5 IU/mL)
Elevated ESR, CRP, anemia of chronic disease
X-ray: periarticular osteoporosis, joint space narrowing, bony cysts, erosions

Diagnosis

Lab: CBC (anemia, elevated ESR), CRP (↑), RF (↑), anti-CCP (↑), DAS28 score Imaging: X-ray hands (stages I-IV), CXR (pulmonary involvement)

Treatment

Conservative	Surgical
NSAIDs: Ibuprofen 1200-2400mg/day, Diclofenac 75mg IM	Synovectomy
DMARDs: Methotrexate 7.5-25mg/week + Folic acid (first-line DMARD)	Joint replacement
Glucocorticoids: Prednisolone <15mg/day (pulse therapy with Methylprednisolone)
Biologic DMARDs: Anti-TNF (Infliximab 3mg/kg IV, Adalimumab, Etanercept)
Non-TNF Biologic: Tocilizumab 8mg/kg IV
Sulfasalazine 2-3g/day

Medicine Table

Group	Examples
NSAIDs (non-selective)	Ibuprofen, Diclofenac, Lornoxicam
NSAIDs (COX-2)	Meloxicam, Nimesulide, Celecoxib, Etoricoxib
DMARDs (conventional)	Methotrexate, Sulfasalazine, Hydroxychloroquine
Corticosteroids	Prednisolone, Methylprednisolone
Biologic (anti-TNF)	Infliximab, Adalimumab, Etanercept
Biologic (IL-6 inhibitor)	Tocilizumab

Preliminary Diagnosis

Rheumatoid arthritis (early/late, seropositive) - based on joint syndrome (symmetric small joint swelling, morning stiffness) + elevated RF/anti-CCP + inflammatory syndrome (elevated ESR/CRP) + X-ray erosions.

28. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)

Leading Syndromes

Cutaneous + Joint + Constitutional + Urinary + Anemic + Hypertension

Malar/butterfly rash (photosensitization), alopecia, oral ulcers
Arthralgia, arthritis (non-erosive)
Fever, weight loss, fatigue
Proteinuria, hematuria (lupus nephritis)
Pancytopenia (Hb ↓, WBC ↓, platelets ↓)
Elevated anti-dsDNA, anti-Sm, ANA

Diagnosis

Lab: CBC (pancytopenia), urinalysis (proteinuria, hematuria), ESR ↑, CRP ↑, ANA, anti-dsDNA, anti-Sm, complement C3/C4 (↓), antiphospholipid antibodies Imaging: Echocardiography (pericarditis), renal biopsy (lupus nephritis classification), renal USS, Doppler (pulmonary hypertension)

Treatment

Conservative	Surgical
Hydroxychloroquine 200-400mg/day (always)	Renal transplant (end-stage)
High-dose Glucocorticoids 40-60mg/day
Immunosuppressants: Azathioprine, Mycophenolate mofetil (2-3g/day)
Pulse therapy (severe): IV Cyclophosphamide 1000mg/month x 6m + 6-Methylprednisolone
ARB: Losartan (proteinuria + hypertension)

Medicine Table

Group	Examples
Antimalarials	Hydroxychloroquine
Corticosteroids	Prednisolone, 6-Methylprednisolone (pulse)
Immunosuppressants	Azathioprine, Mycophenolate mofetil, Cyclophosphamide
ARB	Losartan

Preliminary Diagnosis

Systemic Lupus Erythematosus - based on cutaneous syndrome (malar rash, photosensitization, alopecia, stomatitis) + joint syndrome + urinary syndrome (proteinuria, hematuria) + anemic syndrome + elevated anti-dsDNA/ANA.

29. GLOMERULONEPHRITIS

Acute (Post-streptococcal)

Leading Syndrome: Nephritic syndrome (hematuria + hypertension + edema + proteinuria)

Brown urine, facial/leg edema, HTN (145-150/100-110), proteinuria
History: streptococcal infection 1-3 weeks prior
ASO titer elevated (1:512)

Diagnosis: CBC, urinalysis (proteinuria, gross hematuria, casts), daily proteinuria, biochemical (creatinine, urea), complement (C3/C4 ↓), renal USS, kidney biopsy

Treatment: Penicillin/Ampicillin (treat streptococcal cause), loop diuretics (Furosemide), ACEI, salt/fluid restriction, bed rest

Chronic (Nephrotic Form)

Leading Syndrome: Nephrotic syndrome (massive proteinuria >3.5g/day + hypoalbuminemia + edema + hypercholesterolemia)

Treatment: ACEI (Enalapril), Furosemide, Glucocorticoids, Immunosuppressants (Cyclophosphamide/Chlorambucil), Statins (Atorvastatin), Anticoagulants (Warfarin)

Medicine Table

Group	Examples
ACEI	Enalapril, Captopril
Diuretics	Furosemide
Glucocorticoids	Prednisolone, Methylprednisolone
Immunosuppressants	Cyclophosphamide, Chlorambucil, Cyclosporine
Statins	Atorvastatin
Anticoagulants	Warfarin, Heparin
Antibiotics (acute)	Penicillin, Cephalosporins

Preliminary Diagnosis

Acute post-streptococcal glomerulonephritis - based on nephritic syndrome (hematuria, HTN, edema, proteinuria) + prior streptococcal infection + elevated ASO titer. Chronic glomerulonephritis (nephrotic form) - based on nephrotic syndrome (massive proteinuria, edema, hypoalbuminemia, hypercholesterolemia).

30. PYELONEPHRITIS

Acute Pyelonephritis

Leading Syndromes: Lumbar pain + Urinary + Intoxication + Hypertension

Dull lumbar pain, fever (37.5-38°C), general weakness
Leukocyturia (18-25 per FOV), bacteriuria (E.coli ≥10⁵ CFU)
Positive lumbar punch sign (Pasternatsky)
Proteinuria (mild, <0.2g/L)

Treatment: Fluoroquinolones (Ciprofloxacin, Levofloxacin IV) x 7-14 days; ACEI/ARB + CCB for secondary HTN; salt restriction

Chronic Pyelonephritis

Leading Syndromes: Hypertension + Lumbar pain + Urinary (recurrent) Treatment: Amoxicillin-clavulanate / Ampicillin-sulbactam / Levofloxacin x 10-21 days; Antihypertensives: ACEI (Captopril/Enalapril), ARB (Losartan), CCB (Verapamil/Diltiazem)

Medicine Table

Group	Examples
Fluoroquinolones	Ciprofloxacin, Levofloxacin, Ofloxacin
Penicillin + inhibitor	Amoxicillin-clavulanate
Cephalosporins	Ceftriaxone, Cefotaxime
Aminoglycosides	Amikacin, Gentamicin
ACEI	Enalapril, Captopril
ARB	Losartan, Valsartan
CCB	Verapamil, Diltiazem

Preliminary Diagnosis

Acute/Chronic Pyelonephritis - based on urinary syndrome (leukocyturia, bacteriuria, pyuria) + lumbar pain syndrome + intoxication syndrome (fever) + positive Pasternatsky sign + renal USS showing structural changes.

31. ACUTE MI / IHD (STEMI)

Leading Syndromes

Chest pain + ACS + Arrhythmia

Pressing/squeezing retrosternal pain radiating to left shoulder/arm, fear of death
Not relieved by nitroglycerine
Pale, moist skin, tachycardia, weak pulse, hypotension
ECG: ST elevation, pathological Q waves (V2-V4)
Elevated Troponin I/T, CK-MB

Diagnosis

Lab: CBC, Troponin I/T (elevated), CK-MB, biochemical panel Imaging: ECG (ST elevation, Q waves), Echocardiography (wall motion abnormalities), Coronary angiography (definitive), CXR

Treatment

Conservative	Surgical/Interventional
Morphine 4-8mg IV + 2mg q5-15min (pain)	Primary PCI (preferred)
Antiplatelet: Aspirin 160-325mg + Clopidogrel	Fibrinolysis (Streptokinase) if PCI not available
Anticoagulant: UFH 70-100 IU/kg IV	CABG (selected cases)
Beta-blocker: Bisoprolol/Metoprolol	Intra-aortic balloon counterpulsation
ACEI: Enalapril 5-40mg
Statin: Atorvastatin 10-80mg
IV Nitroglycerin
GP IIb/IIIa inhibitor: Tirofiban

Medicine Table

Group	Examples
Antiplatelets	Aspirin, Clopidogrel
Anticoagulants	Unfractionated Heparin, Enoxaparin
Beta-blockers	Bisoprolol, Metoprolol
ACEI	Enalapril, Captopril
Statins	Atorvastatin
Fibrinolytics	Streptokinase, Alteplase
Opioids	Morphine
Nitrates	IV Nitroglycerin

Preliminary Diagnosis

IHD, Acute STEMI (FCIII) - based on chest pain syndrome (pressing retrosternal pain, left arm radiation, not relieved by nitrates) + ACS syndrome + ECG changes (ST elevation V2-V4) + elevated troponin.

32. BRONCHIAL ASTHMA

Leading Syndrome

Broncho-obstructive syndrome + Respiratory insufficiency

Episodic wheezing, nocturnal/early morning dyspnea
Dry cough, chest tightness
Terminated by Salbutamol inhalation
Dry wheezes on forced expiration
FEV1 ↓, FEV1/FVC ↓, reversible bronchodilator test (+≥12% FEV1 improvement)
PEF variability >10-20%

Diagnosis

Lab: CBC (eosinophilia), serum IgE (elevated), sputum eosinophilia, skin prick tests (allergens) Imaging: CXR (low diaphragm - hyperinflation), spirometry/PFTs

Treatment

Conservative	Surgical
SABA (rescue): Salbutamol/Albuterol inhaler	None
Inhaled corticosteroids (ICS): Beclomethasone, Budesonide, Fluticasone
LABA: Formoterol, Salmeterol (combined with ICS)
Anti-IgE: Omalizumab (allergic asthma)
Immunotherapy (allergen desensitization)
Avoid triggers/allergens

Medicine Table

Group	Examples
SABA	Salbutamol, Albuterol
Inhaled corticosteroids	Budesonide, Beclomethasone, Fluticasone
LABA	Formoterol, Salmeterol
Monoclonal anti-IgE	Omalizumab
Corticosteroids (oral, acute)	Prednisolone
Anticholinergics	Ipratropium

Preliminary Diagnosis

Bronchial asthma (mild/moderate, allergic) - based on broncho-obstructive syndrome (episodic wheeze, nocturnal dyspnea, dry cough, reversed by Salbutamol) + positive bronchodilator test + elevated IgE + allergen history.

33. COMMUNITY-ACQUIRED PNEUMONIA (CAP) + PLEURISY

Leading Syndromes

Infiltrative + Chest pain + Respiratory failure

Fever (38.9-39°C), chills, mucopurulent sputum
Chest pain on breathing and coughing
Dyspnea, RR >30/min
CXR: infiltrate/consolidation + effusion (pleurisy)
Decreased breath sounds, vocal fremitus, dull percussion

Diagnosis

Lab: CBC (leukocytosis, left shift, elevated ESR), CRP, biochemistry, ABG (pH, PaO2, PaCO2), pleural fluid aspiration/culture Imaging: CXR (consolidation + effusion), CT chest, sputum culture

Treatment

Conservative	Surgical
Macrolide: Azithromycin / Doxycycline x 14 days	Thoracentesis (pleural fluid)
Beta-lactam: Amoxicillin-clavulanate	Chest tube drainage (if large effusion)
Severe: Ceftriaxone + Azithromycin IV
O2 therapy (if SpO2 <94%)

Medicine Table

Group	Examples
Macrolides	Azithromycin, Clarithromycin
Beta-lactams	Amoxicillin-clavulanate, Ampicillin
Cephalosporins (severe)	Ceftriaxone
Fluoroquinolones	Levofloxacin, Moxifloxacin
Tetracyclines	Doxycycline

Preliminary Diagnosis

Community-acquired pneumonia (right lower lobe, moderate severity) + exudative pleurisy - based on infiltrative syndrome (consolidation on CXR, dull percussion, decreased breath sounds) + chest pain syndrome (pleuritic pain) + fever + mucopurulent sputum.

34. HYPERTROPHIC CARDIOMYOPATHY (HCM)

Leading Syndromes

Arrhythmia + Mitral regurgitation + Hypertension

Dizziness, syncope (especially on exertion)
Palpitations, dyspnea
Systolic murmur at apex (not radiating to neck)
ECG: LVH, T wave inversion V2-V4
Echo: LV wall thickness >15mm (anteroseptal), SAM of mitral valve

Diagnosis

Lab: CBC, biochemical, urinalysis Imaging: ECG (LVH, T inversion), Echocardiography (LV wall >20mm, Grade I MR), Genetic testing, CXR

Treatment

Conservative	Surgical
Beta-blockers (max tolerated dose): Bisoprolol, Metoprolol	ICD (sudden cardiac death prevention)
CCB (if beta-blocker contraindicated): Verapamil	Septal myectomy
Alcohol septal ablation

Medicine Table

Group	Examples
Beta-blockers	Bisoprolol, Labetalol, Metoprolol
CCB	Verapamil

Preliminary Diagnosis

Hypertrophic cardiomyopathy - based on arrhythmia syndrome (palpitations, syncope on exertion) + systolic murmur (apex, no radiation to neck) + ECG LVH + Echo (LV wall 20mm, SAM of mitral valve).

35. DILATED CARDIOMYOPATHY (DCM)

Leading Syndromes

Heart failure + Arrhythmia + Pulmonary congestion + Cardiomegaly

Dyspnea (mixed) on exertion, edema of legs/feet
Acrocyanosis, muffled heart tones
Moist rales bilaterally (pulmonary congestion)
Irregular rhythm (atrial fibrillation), HR >110
CXR: cardiomegaly, pulmonary congestion, dilation of all chambers
Echo: reduced EF, all chambers dilated

Diagnosis

Lab: CBC, urinalysis (normal) Imaging: ECG (nonspecific ST/T changes), Echocardiography (reduced EF, all chambers dilated), CXR (cardiomegaly, congestion), Right heart catheterization (elevated filling pressures)

Treatment

Conservative	Surgical
ACEI: Lisinopril	ICD
Beta-blockers: Bisoprolol	Cardiac resynchronization therapy (CRT)
Diuretics: Furosemide	Heart transplant
Cardiac glycosides: Digoxin (rate control)

Medicine Table

Group	Examples
ACEI	Lisinopril, Enalapril
Beta-blockers	Bisoprolol, Carvedilol
Diuretics	Furosemide, Torsemide
Cardiac glycosides	Digoxin
Aldosterone antagonists	Eplerenone, Spironolactone
ARB	Losartan

Preliminary Diagnosis

Dilated cardiomyopathy with CHF NYHA III (Vasilenko stage IIb) - based on heart failure syndrome (dyspnea, edema) + arrhythmia syndrome (AF) + cardiomegaly syndrome (enlarged cardiac borders, dilated all chambers on CXR/Echo) + systolic murmur.

36. POLYCYTHEMIA VERA

Leading Syndromes

Plethoric + Myeloproliferative + Erythromelalgia

Skin redness/dark-red cyanotic color, scleral injection
Generalized itching (especially after bathing/water contact)
Burning pain in fingertips/toes (erythromelalgia)
Headache, dizziness, visual disturbance, hypertension
Splenomegaly (±hepatomegaly)
CBC: Hb >165g/L (M) / >160g/L (F), RBC >7.8x10¹², platelets ↑, leukocytosis, ESR→0-1mm/hr

Diagnosis

Lab: CBC (erythrocytosis, hematocrit >52%), JAK2 V617F mutation (PCR), serum erythropoietin (↓), ABG (exclude hypoxia), bone marrow trepanobiopsy (panmyelosis)

Treatment

Conservative	Surgical
Phlebotomy (target Hct <45%, Hb 140-150g/L)	Splenectomy (if massive splenomegaly)
Low-dose Aspirin 100mg/day (prevent thrombosis)
Hydroxyurea (30mg/kg/day initial)
JAK inhibitor: Ruxolitinib 10mg BD
Antihistamines (Diphenhydramine) for pruritus

Medicine Table

Group	Examples
Myelosuppressive	Hydroxyurea (Hydrea)
JAK inhibitors	Ruxolitinib
Antiplatelet	Aspirin
Antihistamines	Diphenhydramine

Preliminary Diagnosis

Polycythemia vera (Stage IIA) - based on plethoric syndrome (dark-red skin, scleral injection) + myeloproliferative syndrome (splenomegaly, leukocytosis, thrombocytosis) + erythromelalgia + Hb 182-193g/L + ESR 1mm/hr + JAK2 mutation.

37. CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)

Leading Syndromes

Hyperplastic + Intoxication

Generalized painless lymphadenopathy (walnut-sized, dough-elastic, mobile, bilateral)
Splenomegaly (±hepatomegaly)
Night sweats, fatigue, weight loss
CBC: lymphocytes >70%, WBC >30-120x10⁹/L, Smudge (Botkin-Gumprecht) cells on smear

Diagnosis

Lab: CBC (absolute lymphocytosis, smudge cells), immunophenotyping/flow cytometry (B-cell surface markers), FISH (chromosomal aberrations: del13q, del11q, del17p, trisomy 12), bone marrow biopsy, CT/PET Definitive: Flow cytometry

Treatment

Conservative	Surgical
FCR: Fludarabine + Cyclophosphamide + Rituximab	Splenectomy (if massive)
BR: Bendamustine + Rituximab
BTK inhibitor: Ibrutinib (Tyrosine kinase inhibitor)
BCL-2 inhibitor: Venetoclax
Anti-CD20: Rituximab, Ofatumumab
CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisolone)
Prednisolone 60-120mg/day

Medicine Table

Group	Examples
BTK inhibitors	Ibrutinib
BCL-2 inhibitors	Venetoclax
Anti-CD20 (monoclonal Ab)	Rituximab, Ofatumumab
Alkylating agents	Cyclophosphamide, Bendamustine
Purine analogues	Fludarabine
Corticosteroids	Prednisolone

Preliminary Diagnosis

Chronic Lymphocytic Leukemia - based on hyperplastic syndrome (generalized lymphadenopathy, splenomegaly) + intoxication syndrome + CBC (absolute lymphocytosis >70%, WBC 90-120x10⁹, smudge cells).

38. MULTIPLE MYELOMA

Leading Syndromes

Bone pain + Anemia + Protein pathology

Migratory bone pain (spine, ribs) worsening on movement
Anemia (normochromic)
Very high ESR, total protein >120g/L
Bence-Jones proteinuria
X-ray: "punched-out" lytic bone lesions

Diagnosis

Lab: CBC (normochromic anemia, elevated ESR), biochemistry (total protein ↑, calcium ↑, creatinine ↑), urinalysis (Bence-Jones protein), serum β2-microglobulin (↑), bone marrow aspiration (>10% plasma cells), X-ray (skull, humerus - lytic lesions)

Treatment

Conservative	Surgical
Bortezomib + Thalidomide + Dexamethasone (or Daratumumab-based)	Autologous stem cell transplant
Chemotherapy: Melphalan + Prednisolone
Bisphosphonates (bone disease): Zoledronic acid

Medicine Table

Group	Examples
Proteasome inhibitors	Bortezomib
Immunomodulatory	Thalidomide, Lenalidomide
Anti-CD38 monoclonal Ab	Daratumumab
Corticosteroids	Dexamethasone
Bisphosphonates	Zoledronic acid
Alkylating agents	Melphalan, Cyclophosphamide

Preliminary Diagnosis

Multiple Myeloma - based on bone pain syndrome (migratory, spine/ribs) + anemic syndrome + protein pathology syndrome (total protein 120g/L, Bence-Jones proteinuria, very high ESR) + lytic bone lesions on X-ray.

39. IMMUNE THROMBOCYTOPENIA (ITP)

Leading Syndrome

Hemorrhagic syndrome (microcirculatory pattern)

Petechiae, ecchymoses, purpura on skin
Mucous membrane hemorrhages (oral bullae/vesiculae)
Epistaxis, menorrhagia
Isolated thrombocytopenia (platelets - "single cells in FOV")
No hepatosplenomegaly, no lymphadenopathy

Diagnosis

Lab: CBC (isolated thrombocytopenia, all other parameters normal), bone marrow (MKC normal or elevated), anti-platelet glycoprotein antibodies, CXR/CT

Treatment

Conservative	Surgical
1st line: Glucocorticoids (Prednisolone, Dexamethasone, Methylprednisolone)	Splenectomy (2nd line)
IV immunoglobulin
Anti-D immunoglobulin
2nd line: TPO receptor agonists (Romiplostim/Nplate, Eltrombopag/Revolade)
3rd line: Rituximab, Cyclophosphamide, Vincristine

Preliminary Diagnosis

Primary immune thrombocytopenia - based on hemorrhagic syndrome (microcirculatory type: petechiae, ecchymoses, mucosal hemorrhages, epistaxis, menorrhagia) + isolated thrombocytopenia on CBC + absence of hepatosplenomegaly/lymphadenopathy.

40. ULCERATIVE COLITIS (UC)

Leading Syndromes

Hemorrhagic + GIT + Anemic + Intoxication + Pain

Bloody diarrhea (10-12x/day), tenesmus
Abdominal pain (lower abdomen, colicky)
Fever (38°C), weight loss, weakness
Anemia (Hb 90g/L), leukocytosis
Colonoscopy: ulcers with granulations, spontaneous friability in rectum/sigmoid

Diagnosis

Lab: CBC (anemia, leukocytosis, elevated ESR), CRP (↑), albumin (↓), fecal occult blood, stool cultures (exclude infection), colonoscopy + biopsy

Treatment

Conservative	Surgical
Aminosalicylates: Mesalazine (Sulfasalazine)	Colectomy (severe/refractory disease)
Corticosteroids: Prednisolone (acute severe)
Immunosuppressants: Azathioprine, 6-Mercaptopurine
Biologics: Infliximab (anti-TNF)
Antibiotics (if infected): Metronidazole, Ciprofloxacin

Medicine Table

Group	Examples
Aminosalicylates	Mesalazine (5-ASA), Sulfasalazine
Corticosteroids	Prednisolone, Budesonide
Immunosuppressants	Azathioprine, 6-Mercaptopurine
Anti-TNF biologics	Infliximab, Adalimumab

Preliminary Diagnosis

Ulcerative colitis (severe stage) - based on hemorrhagic syndrome (bloody diarrhea, tenesmus) + GIT syndrome (colicky pain, diarrhea 10-12x/day) + intoxication syndrome (fever) + colonoscopy showing ulcers with spontaneous friability in rectum/sigmoid.

41. SYSTEMIC SCLEROSIS (Scleroderma)

Leading Syndromes

CREST syndrome + Raynaud's + Dysphagia

Raynaud's phenomenon (bluish discoloration of fingers with cold/stress)
Skin thickening (hands, face), microstomia, radial wrinkles
Telangiectasias
Dysphagia (esophageal dysmotility)
Digital ulcers, acro-osteolysis

Diagnosis

Lab: CBC (anemia, elevated ESR), anti-topoisomerase-1 (Scl-70) antibodies, anti-centromere antibodies (ACA), ANA Imaging: X-ray hands (osteolysis of distal phalanges), Barium swallow (esophageal dysmotility), Nailfold videocapillaroscopy, ECG, Echocardiography

Treatment

Conservative	Surgical
Raynaud's: CCB (Amlodipine, Nifedipine), PDE-5 inhibitors (Sildenafil)	None standard
Esophageal dysmotility: PPI (Lansoprazole)
Pulmonary HTN: Bosentan, Sildenafil
Skin: Methotrexate, D-penicillamine

Preliminary Diagnosis

Systemic Sclerosis (limited form - CREST syndrome) - based on CREST syndrome (Calcinosis, Raynaud's, Esophageal dysmotility, Sclerodactyly, Telangiectasias) + skin thickening + Raynaud's + dysphagia.

42. POLYARTERITIS NODOSA

Leading Syndromes

Intoxication + Hypertension + Skin + Neuropathy + Urinary

Fever, weight loss, myalgia (intoxication)
Livedo reticularis, ulcerative-necrotic skin defects
Mononeuropathy multiplex (sensory loss "sock pattern")
Hypertension (160-190/100-120)
Proteinuria, hematuria (renal involvement)
Eosinophilia, elevated ESR, anemia

Diagnosis

Lab: CBC (anemia, leukocytosis, eosinophilia, elevated ESR), biochemistry (creatinine ↑, urea ↑), urinalysis (proteinuria, hematuria), ANCA (negative - differentiates from ANCA vasculitis), HBsAg (hepatitis B), skin-muscle biopsy (neutrophilic infiltration of medium-sized arteries) Imaging: Visceral arteriography (microaneurysms), Doppler USS, Duplex

Treatment

Conservative	Surgical
Induction: Cyclophosphamide 200-1000mg IV + Glucocorticoids (Prednisolone 1mg/kg)	None
Pulse therapy: Methylprednisolone 3000-7000mg per course
Mycophenolate mofetil 2000mg/day, Rituximab 2000mg
Nephroprotectors: ACEI, ARB, CCB, Statins
Antiaggregants (prevent embolism)

Preliminary Diagnosis

Polyarteritis nodosa (subacute course) - based on intoxication syndrome (fever, weight loss, myalgia) + skin syndrome (livedo reticularis, ulcerative-necrotic lesions) + neuropathy syndrome (mononeuritis multiplex) + hypertension + urinary syndrome + biopsy showing medium-vessel vasculitis.

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PAEDIATRICS CASES

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43. CONGENITAL HYPOTHYROIDISM

Leading Syndrome

Hypothyroid/Cretinism syndrome

Edema from birth, hoarse voice, dry skin, constipation
Delayed psychomotor development (can't stand/walk)
Open fontanel (delayed ossification), absent teeth eruption
Prolonged neonatal jaundice
Bradycardia, muffled heart sounds
Bone age delay (X-ray: corresponds to 3 months in 1-year-old)
Mother: nodular goiter

Diagnosis

Lab: CBC, urinalysis, biochemistry, Thyroid profile: TSH (↑), T4 (↓), T3 (↓), TRB-Ab (maternal thyroid antibodies), calcium level Imaging: ECG, X-ray (wrist - delayed bone age), Thyroid USS (aplasia), MRI

Treatment

Conservative	Surgical
Levothyroxine (L-Thyroxine) - lifelong:	None
<1yr: 10-15 mcg/kg/day
<5yrs: 3-5 mcg/kg/day
>5yrs: 1-2 mcg/kg/day
Goal: T4 normal in 2 weeks, TSH normal in 1 month

Preliminary Diagnosis

Congenital hypothyroidism - based on hypothyroid syndrome (edema, hoarse voice, dry skin, constipation, developmental delay, open fontanel) + delayed bone age + maternal thyroid disease.

44. MENINGOCOCCAL MENINGITIS

Leading Syndrome

Meningeal + Hemorrhagic (septicemic) syndrome

High fever (39-39.5°C), repeated vomiting
Meningeal signs: neck rigidity, positive Kernig, Brudzinski
Opisthotonus (child on side with flexed limbs)
Star-shaped hemorrhagic rash (meningococcemia)
Cold, pale extremities, acrocyanosis (septic shock)
CSF: cloudy/milky, cytosis >3000 (neutrophils 98%), protein ↑, glucose ↓

Diagnosis

Lab: CBC (leukocytosis, neutrophilia with left shift, elevated ESR), blood cultures, CSF analysis (cloudy, neutrophilic pleocytosis, elevated protein, low glucose), PCR for N. meningitidis in CSF Imaging: CT/MRI brain, EEG

Treatment

Conservative	Surgical
3rd generation cephalosporins: Ceftriaxone 100mg/kg/day IV	Lumbar puncture (diagnostic + therapeutic)
+ Corticosteroids (Dexamethasone) to reduce inflammation
Supportive: IV fluids, O2, antipyretics
Prophylaxis for contacts: Rifampicin/Ciprofloxacin

Medicine Table

Group	Examples
3rd gen Cephalosporins	Ceftriaxone, Cefotaxime
Corticosteroids	Dexamethasone
Penicillin	Penicillin G (if sensitive)
Prophylaxis	Rifampicin, Ciprofloxacin

Preliminary Diagnosis

Meningococcal meningitis + meningococcemia - based on meningeal syndrome (neck rigidity, Kernig/Brudzinski) + hemorrhagic syndrome (star-shaped hemorrhagic rash) + high fever + turbid CSF (neutrophilic pleocytosis) + PCR: N. meningitidis.

45. WHOOPING COUGH (Pertussis)

Leading Syndrome

Paroxysmal cough syndrome

Paroxysmal cough (>20 bouts/24hr) with inspiratory whoop
Preceded by 1-2 weeks of catarrhal phase (dry cough, mild rhinitis)
Puffy face, tongue protrusion during cough
Perioral cyanosis during coughing fits
Tachycardia (150 bpm), weak heart sounds

Diagnosis

Lab: CBC (leukocytosis with lymphocytosis), throat swab (culture for Bordetella pertussis), PCR (most sensitive), serum IgG anti-pertussis toxin Imaging: CXR (no significant changes usually)

Treatment

Conservative	Surgical
Macrolides (1st line): Azithromycin, Erythromycin, Clarithromycin	None
Alternative: TMP-SMX
Symptomatic: antipyretics
Nutritional support
Hospitalization + O2 (severe)
Prophylaxis: DTP vaccine (siblings/parents)

Preliminary Diagnosis

Pertussis (Whooping cough) in paroxysmal stage - based on paroxysmal cough syndrome (inspiratory whoop, >20 bouts/24hr, puffy face, perioral cyanosis) + 1-week catarrhal prodrome + Bordetella pertussis on culture/PCR.

46. VARICELLA (Chickenpox) WITH ENCEPHALITIS

Leading Syndrome

Vesicular rash + Neurological syndrome (cerebellar ataxia)

High fever (38.7-39.3°C), polymorphous skin rash (vesicles → crusts → superficial erosions)
Progressive ataxia: can't stand, sit, use hands (cerebellar)
Intense pruritus
No meningeal signs
Complication: varicella encephalitis (7th day)

Diagnosis

Lab: CBC, vesicle fluid PCR/culture for VZV, serology (IgM/IgG VZV) Imaging: CT/MRI brain (cerebellar encephalitis)

Treatment

Conservative	Surgical
IV Acyclovir (antiviral - encephalitis indication)	None
Antipyretics
Calamine/antihistamines (itching)
Isolate for 5 days from last new lesion

Preliminary Diagnosis

Varicella with cerebellar encephalitis - based on vesicular rash syndrome (polymorphous rash: vesicles, crusts, erosions) + neurological syndrome (cerebellar ataxia, inability to stand/sit/use hands) on day 7.

47. ACUTE GLOMERULONEPHRITIS (Paediatric)

Leading Syndrome

Nephritic syndrome

Decreased urine output (300ml/24h), red/brown urine
Facial/eyelid edema, leg edema
Hypertension (150/105 mmHg)
Systolic murmur at apex
Urinalysis: protein 1.5g/L, RBCs covering entire FOV, casts

Diagnosis

Lab: CBC, biochemistry (creatinine, electrolytes), urinalysis (proteinuria, gross hematuria, casts), daily proteinuria, complement (C3/C4), ASO titer (if post-streptococcal) Imaging: Renal USS, X-ray, intravenous pyelography

Treatment

Conservative	Surgical
Penicillin (treat streptococcal cause)	None
Furosemide (diuretic - edema/HTN)
Dietary salt restriction, bed rest

Preliminary Diagnosis

Acute glomerulonephritis (post-infectious/nephritic form) - based on nephritic syndrome (hematuria, hypertension, edema, oliguria, proteinuria) + infection trigger + elevated ASO titer.

48. DIABETIC KETOACIDOSIS (Type 1 DM in Child)

Leading Syndrome

Diabetic coma syndrome (DKA)

Polyuria, polydipsia, weight loss (preceding)
Kussmaul respiration (noisy, deep)
Fruity/acetone breath
Dehydration: dry skin, dry tongue, sunken eyes
Abdominal pain, vomiting
Tachycardia (140 bpm), hypotension (75/40)
Blood glucose: 18mmol/L, urine glucose +++, urine ketones ++

Diagnosis

Lab: Blood glucose (↑↑), serum electrolytes (↓K+, ↓Na+), ABG (metabolic acidosis, pH <7.3), CBC, urine (glucose, ketones, specific gravity ↑), HbA1c

Treatment

Conservative	Surgical
IV fluids (normal saline - rehydration)	None
Insulin infusion (0.1 U/kg/hr)
Potassium replacement (once diuresis established)
Monitor vitals and glucose hourly

Medicine Table

Group	Examples
Insulin (infusion)	Regular insulin, insulin aspart
IV fluids	Normal saline (0.9% NaCl)
Electrolytes	KCl replacement

Preliminary Diagnosis

Diabetic ketoacidosis (Type 1 DM) - based on DKA syndrome (Kussmaul respiration, acetone breath, dehydration, abdominal pain, impaired consciousness) + blood glucose 18mmol/L + urine ketones ++ + glucose ++.

49. ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) - Paediatric

Leading Syndrome

Hemorrhagic + Hyperplastic + Anemic + Intoxication

Bruises on extremities, pallor
Hepatosplenomegaly, cervical/submandibular lymphadenopathy (1.5cm)
Fever (39.3°C), bone pain (leg pain), weakness
CBC: Hb 86g/L, blasts 76%, lymphocytes 19%, single platelets
Bone marrow: blasts 96%

Diagnosis

Lab: CBC, serum uric acid, LFT, bone marrow aspiration + biopsy, immunophenotyping, cytogenetics, CSF examination, CXR

Treatment

Periods of ALL treatment:

Induction of remission
Consolidation of remission
Maintenance therapy
Reinforcement therapy

Drug Groups	Examples
Corticosteroids	Prednisolone
Vinca alkaloids	Vincristine
Alkylating agents	Cyclophosphamide
Anthracyclines	Daunorubicin
Asparaginase	L-Asparaginase
Antimetabolites	Methotrexate, Cytarabine

Preliminary Diagnosis

Acute Lymphoblastic Leukemia - based on hemorrhagic syndrome (bruises) + hyperplastic syndrome (hepatosplenomegaly, lymphadenopathy) + anemic syndrome + intoxication syndrome + CBC (76% blasts, bone marrow 96% blasts).

50. NEONATAL SEPSIS

Leading Syndrome

Septic syndrome in neonate

Grey/pale skin color
Poor feeding, poor suckling
Umbilical wound discharge
Hepatosplenomegaly (liver +3cm, spleen at costal margin)
Frequent stools
Lethargy, minimal cry
Risk factors: prolonged rupture of membranes, asphyxia, maternal infection

Diagnosis

Lab: CBC, biochemistry, urine analysis, stool test, blood culture, culture of umbilical discharge, CRP Imaging: USS abdomen

Treatment

Conservative	Surgical
Maximum dosage antibiotics (broad-spectrum, IV):	Surgical drainage of abscesses if present
Ampicillin + Aminoglycoside (Gentamicin)
Or 3rd gen cephalosporin + Aminoglycoside
Antiseptics (local wound care)
Nutritional support

Preliminary Diagnosis

Neonatal sepsis - based on septic syndrome (grey skin, lethargy, hepatosplenomegaly, umbilical wound discharge, feeding difficulties) + risk factors (prolonged rupture of membranes, birth asphyxia) in early neonatal period.

51. CHRONIC GASTRITIS / PEPTIC ULCER (Paediatric)

Leading Syndrome

Dyspeptic + Epigastric pain syndrome

Dull epigastric/right hypochondrium pain
Nausea, heartburn, belching, constipation
Pain provoked by food (peptic ulcer: hunger/fasting pain)
Family history of gastritis/peptic ulcer (H. pylori clustering)
OGD: mucus, hyperemia, edema of mucosal folds

Diagnosis

Lab: CBC, biochemistry, H. pylori tests (urea breath test, serology, stool antigen, rapid urease test), LFT, electrolytes Imaging: OGD + biopsy (gold standard), USS gallbladder, Barium contrast (X-ray)

Treatment

Conservative	Surgical
H. pylori eradication: Amoxicillin + Clarithromycin + PPI (triple therapy)	Vagotomy + drainage (severe peptic ulcer complications)
PPI: Omeprazole, Lansoprazole
H2 blockers: Ranitidine, Cimetidine, Famotidine
Cytoprotectives: Sucralfate
Anticholinergics
Diet modification

Medicine Table

Group	Examples
PPI	Omeprazole, Lansoprazole, Rabeprazole
H2 blockers	Ranitidine, Cimetidine, Famotidine
Antibiotics (H. pylori)	Amoxicillin, Clarithromycin, Metronidazole
Cytoprotectives	Sucralfate, Bismuth

Preliminary Diagnosis

Chronic gastritis / Peptic ulcer - based on epigastric pain syndrome (dull/hunger pain, heartburn, nausea) + family history of H. pylori infection + OGD findings (hyperemic mucosa, ulcer).

52. ACUTE PANCREATITIS (Paediatric)

Leading Syndrome

Acute abdominal pain + Epigastric pain with belt-like radiation

Dull epigastric pain radiating to back, left shoulder (belt-like)
Worsened by fatty food
Nausea, vomiting, fever
Pain in choledocho-pancreatic and Schoffar's zones
Elevated amylase (blood + urine)
Steatorrhea, creatorrhea

Diagnosis

Lab: CBC (leukocytosis, left shift), amylase/lipase (↑↑), CRP (↑), urine diastase (↑), LFT Imaging: USS abdomen, CT (gold standard), MRI, X-ray, ERCP

Treatment

Conservative	Surgical
Antipyretics, antispasmolytics, analgesics	Pancreatectomy (head removal in severe cases)
Empirical antibiotics	Pancreatic necrosectomy
Enzyme replacement therapy
Bowel rest (NPO), IV fluids
Octreotide (reduce secretion)

Preliminary Diagnosis

Acute/Chronic pancreatitis - based on epigastric pain syndrome (belt-like pain to back and left shoulder, worsened by fatty food) + elevated amylase/lipase + steatorrhea.

53. TETRALOGY OF FALLOT (Congenital Cyanotic CHD)

Leading Syndrome

Cyanotic congenital heart disease syndrome

Total cyanosis (right-to-left shunt)
Clubbing of fingers/toes ("drumstick phalanges")
Cyanotic spells (hypercyanotic attacks) on exertion
Right ventricular hypertrophy (ECG)
Boot-shaped heart (CXR)
Systolic murmur (3rd left intercostal space)
Polycythemia: Hb 184g/L, RBC 5.8x10¹²

Diagnosis

Lab: CBC (polycythemia), biochemistry Imaging: CXR (boot-shaped heart, decreased pulmonary vascular markings), ECG (RVH), Echo (4 defects: VSD, RVOTO, overriding aorta, RVH), Doppler Echo, Cardiac catheterization + angiocardiography

Treatment

Conservative	Surgical
Penicillin prophylaxis (endocarditis)	Complete surgical repair (VSD closure + RVOTO relief)
Iron supplements	Palliative: Blalock-Taussig shunt
Beta-blockers (reduce cyanotic spells: Propranolol)
O2 therapy

Preliminary Diagnosis

Tetralogy of Fallot - based on cyanotic CHD syndrome (total cyanosis, clubbing, cyanotic spells) + RVH on ECG + boot-shaped heart on CXR + systolic murmur.

54. DIPHTHERIA

Leading Syndrome

Tonsillar + Local inflammation + Toxic syndrome

Sore throat, difficulty swallowing
Edematous, hyperemic tonsils with white patches (pseudomembrane)
Membrane difficult to remove (bleeds when removed)
Enlarged, tender regional lymph nodes
Fever (38.3°C)

Diagnosis

Lab: CBC, ESR, throat culture for Corynebacterium diphtheriae (Löffler/Tellurite medium), urine analysis, histopathology

Treatment

Conservative	Surgical
Diphtheria antitoxin (≥20,000 IU - most important)	Tracheostomy (if severe airway obstruction)
Penicillin or Clindamycin (antibiotic)
Antipyretics (Acetaminophen)
Supportive care
DTP vaccine for prophylaxis

Preliminary Diagnosis

Diphtheria - based on tonsillar inflammation syndrome (edematous/hyperemic tonsils with white pseudomembrane) + bleeding on membrane removal + regional lymphadenopathy + contact with unimmunized cases.

QUICK REFERENCE: PRELIMINARY DIAGNOSIS TABLE

#	Disease	Key Leading Syndrome Used
1	Chronic Pancreatitis	Exocrine insufficiency + Pain syndrome
2	Pancreatic Pseudocyst	Abdominal mass syndrome
3	Insulinoma	Hypoglycemic syndrome (Whipple's triad)
4	Zollinger-Ellison (Gastrinoma)	Acid hypersecretion + GI bleeding syndrome
5	Pancreatic/Periampullary Cancer	Obstructive jaundice + Cancer syndrome
6	Choledocholithiasis + Pancreatitis	Acute abdominal pain + Obstructive jaundice
7	Esophageal Cancer	Dysphagia + Cancer syndrome
8	Achalasia	Dysphagia syndrome (motility disorder)
9	Esophageal Diverticulum	Dysphagia + Regurgitation syndrome
10	Hiatal Hernia	GERD/Reflux syndrome
11	GI Bleeding (Peptic Ulcer)	Hemorrhagic + Hypovolemic shock syndrome
12	Chronic Arterial Insufficiency (Leriche's)	Chronic limb ischemia syndrome
13	Acute Arterial Insufficiency (Embolism)	Acute limb ischemia syndrome (6 Ps)
14	Acute Aortic Dissection	Tearing chest pain + Vascular catastrophe syndrome
15	Varicose Veins / CVI	Chronic venous insufficiency syndrome
16	Iliofemoral Phlebothrombosis (DVT)	Acute DVT syndrome
17	Acute Thrombophlebitis	Superficial thrombophlebitis syndrome
18	Acute Lung Abscess	Pulmonary suppuration syndrome
19	Lung Gangrene	Pulmonary gangrene syndrome
20	Chronic Lung Abscess	Chronic pulmonary suppuration syndrome
21	Lung Cancer (Central/Peripheral)	Bronchial obstruction / Chest pain + Intoxication syndrome
22	Acute Leukemia (AML/ALL)	Hemorrhagic + Hyperplastic + Anemic syndrome
23	Iron Deficiency Anemia	Anemic + Sideropenic syndrome
24	B12 Deficiency Anemia	Anemic + Neurological + GIT syndrome
25	Gout (Acute)	Joint + Inflammatory + Metabolic (hyperuricemia) syndrome
26	Osteoarthritis	Joint syndrome (degenerative)
27	Rheumatoid Arthritis	Joint + Constitutional + Inflammatory syndrome
28	SLE	Cutaneous + Joint + Urinary + Anemic syndrome
29	Glomerulonephritis	Nephritic / Nephrotic syndrome
30	Pyelonephritis	Urinary + Lumbar pain + Intoxication syndrome
31	Acute MI (STEMI)	Chest pain + ACS + Arrhythmia syndrome
32	Bronchial Asthma	Broncho-obstructive syndrome
33	CAP + Pleurisy	Infiltrative + Chest pain + Respiratory failure syndrome
34	HCM	Arrhythmia + Mitral regurgitation syndrome
35	Dilated Cardiomyopathy	Heart failure + Cardiomegaly syndrome
36	Polycythemia Vera	Plethoric + Myeloproliferative + Erythromelalgia syndrome
37	Chronic Lymphocytic Leukemia	Hyperplastic + Intoxication syndrome
38	Multiple Myeloma	Bone pain + Anemia + Protein pathology syndrome
39	Immune Thrombocytopenia (ITP)	Hemorrhagic syndrome (microcirculatory)
40	Ulcerative Colitis	Hemorrhagic + GIT + Intoxication syndrome
41	Systemic Sclerosis	CREST syndrome + Raynaud's + Dysphagia
42	Polyarteritis Nodosa	Intoxication + Skin + Neuropathy + Hypertension syndrome
43	Congenital Hypothyroidism	Hypothyroid/Cretinism syndrome
44	Meningococcal Meningitis	Meningeal + Hemorrhagic syndrome
45	Whooping Cough (Pertussis)	Paroxysmal cough syndrome
46	Varicella + Encephalitis	Vesicular rash + Neurological syndrome
47	Acute Glomerulonephritis (Peds)	Nephritic syndrome
48	Diabetic Ketoacidosis (Peds)	DKA syndrome
49	ALL (Paediatric)	Hemorrhagic + Hyperplastic + Anemic + Intoxication syndrome
50	Neonatal Sepsis	Septic syndrome (neonatal)
51	Chronic Gastritis / Peptic Ulcer	Epigastric pain + Dyspeptic syndrome
52	Acute Pancreatitis (Peds)	Belt-like epigastric pain + Exocrine insufficiency syndrome
53	Tetralogy of Fallot	Cyanotic CHD syndrome
54	Diphtheria	Tonsillar inflammation + Toxic syndrome

Sources: Bailey & Love's Short Practice of Surgery, Davidson's Principles of Internal Medicine, Nelson's Textbook of Pediatrics, Harrison's Principles of Internal Medicine, and the provided exam task documents (Surgery Hos.1, Therapy No.1, GOSS Paediatrics, GOSS Surgery).

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