Give a comprehensive guide for "Clinical definitions and their categorization ( based on different factors like severity, complications , etiology , metastasis, location ) of most common diagnosis made in medical wards and ER .. for each different systems" like COPD exacerbation ( categorize severity , asthma etc, decompensated chronic liver disease with ascitis , SBP, etc, stroke with aspiration pneumonia , shock ., TB, ( of different systems ) meningoencephalitis , DKA, liver failure , heart failure, renal failure , sepsis, multiorgan daysfucntion , pyelonephritis, abdominal TB, IBD/ IBS, different cancers ..neurological diseases ............based on latest guidelines and clinical textbooks ( harrison, davidson ), up-to-date, .. for medicine post graduate resident and clinicians.. as easy to recall guide , to label the case and start the treatment

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You are a medical research assistant. Your task is to query the medical textbook library database and retrieve comprehensive clinical classification/categorization information for the following conditions. Use query_library_db to search. For EACH condition below, find: clinical definition, classification/severity grading, etiology subtypes, complication categories, and any key scoring systems used. Focus on what a medicine PG resident needs to "label the case." CONDITIONS TO RESEARCH: 1. COPD exacerbation (GOLD staging, severity of exacerbation) 2. Bronchial Asthma (GINA severity, acute exacerbation severity) 3. Community-acquired Pneumonia (PORT/PSI score, CURB-65, severity) 4. Pulmonary Tuberculosis (PTB categories: new, previously treated, drug-resistant; smear +/-, location: pulmonary vs extrapulmonary) 5. Pulmonary Embolism (massive, submassive, low-risk; Wells score) Run these SQL queries: Query 1 - Find COPD sections: SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'COPD exacerbation severity' ORDER BY rank LIMIT 5 Query 2 - Find Asthma sections: SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'asthma severity classification' ORDER BY rank LIMIT 5 Query 3 - Find Pneumonia sections: SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'pneumonia severity CURB PSI' ORDER BY rank LIMIT 5 Query 4 - Find TB sections: SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'tuberculosis classification categories' ORDER BY rank LIMIT 5 Query 5 - Find PE sections: SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'pulmonary embolism classification massive' ORDER BY rank LIMIT 5 Then read the top result from each query (read_file with offset=line_number, limit=80). Return a detailed structured summary for each condition with all classification schemes, severity criteria, and key facts. Format clearly with headers.

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general-purpose

You are a medical research assistant. Query the medical textbook library database to retrieve comprehensive clinical classification/categorization information for these conditions. For EACH, find: clinical definition, classification/severity grading, etiology subtypes, complication categories, key scoring systems. Run ALL the following SQL queries and then read the top file results: QUERY 1 - Heart Failure sections: SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'heart failure classification NYHA' ORDER BY rank LIMIT 5 QUERY 2 - Shock classification: SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'shock classification cardiogenic distributive' ORDER BY rank LIMIT 5 QUERY 3 - Stroke classification: SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'stroke classification ischemic hemorrhagic NIHSS' ORDER BY rank LIMIT 5 QUERY 4 - Meningitis/encephalitis: SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'meningitis encephalitis classification bacterial viral' ORDER BY rank LIMIT 5 QUERY 5 - Sepsis SOFA: SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'sepsis SOFA qSOFA organ dysfunction' ORDER BY rank LIMIT 5 QUERY 6 - DKA classification: SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'DKA diabetic ketoacidosis severity mild moderate severe' ORDER BY rank LIMIT 5 QUERY 7 - Renal failure/AKI: SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'acute kidney injury KDIGO classification staging' ORDER BY rank LIMIT 5 QUERY 8 - Liver failure/cirrhosis: SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'liver failure cirrhosis Child Pugh MELD' ORDER BY rank LIMIT 5 QUERY 9 - SBP and ascites: SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'spontaneous bacterial peritonitis ascites diagnosis' ORDER BY rank LIMIT 5 QUERY 10 - IBD classification: SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'inflammatory bowel disease Crohn colitis classification severity' ORDER BY rank LIMIT 5 Then read each top result file (read_file with offset=line_number-3, limit=80) for each of the 10 queries. RETURN: A comprehensive structured summary for each condition with ALL classification schemes, severity criteria, scoring systems, etiology subtypes, complications, and quick labeling formulas for case presentations. Format with clear headers. This is for a medicine PG resident quick reference guide.

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CLINICAL DEFINITIONS & CATEGORIZATION GUIDE

For Medicine PG Residents & Clinicians

Based on Harrison's 21st Ed., Davidson's 23rd Ed., GOLD 2024, GINA 2024, Sepsis-3, KDIGO, ESC/AHA Guidelines, WHO TB Guidelines, UpToDate

HOW TO LABEL A CASE (Framework): [Diagnosis] + [Etiology/Type] + [Severity/Stage] + [Complications] + [Functional Status] Example: "Acute exacerbation of COPD (GOLD Grade 3) - Moderate exacerbation - Infective (bacterial) - Type II respiratory failure - ABCD Group D"

SECTION 1: RESPIRATORY SYSTEM

1.1 COPD EXACERBATION

Definition: Acute worsening of respiratory symptoms beyond normal day-to-day variation requiring change in medication (GOLD 2024).

GOLD Spirometric Staging (Stable COPD - requires FEV1/FVC < 0.70 post-BD)

GOLD Grade	Severity	FEV1 % predicted
1	Mild	≥ 80%
2	Moderate	50-79%
3	Severe	30-49%
4	Very Severe	< 30%

ABCD Group Assessment (Symptom + Exacerbation History)

Group A: Low symptoms (mMRC 0-1, CAT <10) + 0-1 exacerbations/yr (no hospitalization)
Group B: High symptoms (mMRC ≥2, CAT ≥10) + 0-1 exacerbations/yr
Group E: ≥2 exacerbations OR ≥1 hospitalization/yr (regardless of symptoms) - Note: Old C/D merged into E in GOLD 2023

Exacerbation Severity (GOLD 2024)

Severity	Criteria	Setting
Mild	Responds to SABA alone	Home/Outpatient
Moderate	Requires SABA + systemic corticosteroids ± antibiotics	Outpatient
Severe	Needs hospitalization (severe dyspnea, new cyanosis, new peripheral edema, failure to respond to initial therapy)	Hospital ward
Life-threatening	ICU + NIV/IMV; altered consciousness, pH <7.25, SpO2 <88% despite O2	ICU

Anthonisen Criteria (Antibiotic indication - Type 1 = all 3; Type 2 = any 2)

Increased dyspnea 2. Increased sputum volume 3. Increased sputum purulence

Indications for ICU (GOLD)

Severe dyspnea not responding to therapy
Confusion, drowsiness, coma
Persistent/worsening hypoxemia (PaO2 <40 mmHg) or hypercapnia (PaCO2 >60 mmHg) despite NIV
Need for invasive ventilation

Etiology

Type	Trigger
Infectious - Bacterial	H. influenzae, S. pneumoniae, M. catarrhalis (50%)
Infectious - Viral	Rhinovirus, RSV, Influenza (30%)
Environmental	Pollution, temperature change
Unknown	~20%

Complications

Type II Respiratory Failure (hypercapnic)
Cor Pulmonale / Right Heart Failure
Pneumothorax (bulla rupture)
Polycythemia
Pulmonary Hypertension

LABEL FORMAT: "AECOPD [GOLD Grade __] - [Mild/Moderate/Severe/Life-threatening] - [Infective/Non-infective] - [Type I / Type II Respiratory Failure] - ABCD Group [A/B/E]"

1.2 BRONCHIAL ASTHMA

Definition: Heterogeneous disease characterized by chronic airway inflammation, variable airflow obstruction, and bronchial hyperresponsiveness (GINA 2024).

Chronic Severity Classification (NAEPP/GINA - Assess BEFORE starting treatment)

Parameter	Intermittent	Mild Persistent	Moderate Persistent	Severe Persistent
Daytime symptoms	≤2 days/wk	>2 days/wk, not daily	Daily	Continuous
Night symptoms	≤2×/month	3-4×/month	>1×/wk	Nightly
Activity limitation	None	Minor	Some	Extreme
FEV1	≥80%	≥80%	60-80%	<60%
PEF variability	<20%	20-30%	>30%	>30%

GINA Control Assessment (Assess AFTER starting treatment)

Feature	Well controlled	Partly controlled	Uncontrolled
Daytime symptoms	≤2×/wk	>2×/wk	3+ features of partly controlled
Nighttime symptoms	None	Any	Same
Activity limitation	None	Any	Same
Reliever use	≤2×/wk	>2×/wk	Same
FEV1/PEF	Normal	<80% predicted	Same

Acute Exacerbation Severity (GINA/BTS)

Parameter	Mild-Moderate	Severe	Near-Fatal / Impending Arrest
PEF/FEV1	>50%	33-50%	<33%
Speech	Full sentences	Incomplete sentences	Words only
Resp rate	<25	≥25	Slow/irregular
HR	<110	≥110	Bradycardia
SpO2	>92%	88-92%	<88%
PaCO2	<45	Normal/high	↑↑
Wheeze	Present	Loud	SILENT CHEST = critical
Consciousness	Normal	Agitated	Drowsy/confused

Silent chest + cyanosis + bradycardia = near-fatal asthma → immediate ICU, likely IMV

Phenotype/Etiology Classification

Allergic (Atopic): Childhood onset, IgE-mediated, eosinophilic, responds to ICS
Non-allergic: Adult onset, non-atopic, often neutrophilic
Late-onset adult: Females, non-atopic, often severe
AERD (Samter's Triad): Asthma + nasal polyps + aspirin/NSAID sensitivity
Exercise-induced bronchoconstriction (EIB): Post-exercise, 5-15 min after stopping
Occupational asthma: Isocyanates, flour, latex, animal proteins
Obese asthma: Metabolic inflammation, poor ICS response
Aspergillus-related (ABPA): Wheezing + eosinophilia + central bronchiectasis + fleeting shadows

Complications

Status asthmaticus (acute severe refractory to treatment >1 hour)
Pneumothorax / Pneumomediastinum
Respiratory failure
ABPA (in chronic)
Cor pulmonale (rare, in severe chronic)

LABEL FORMAT: "Acute [Mild/Moderate/Severe/Near-fatal] exacerbation of [Intermittent/Mild Persistent/Moderate Persistent/Severe Persistent] Bronchial Asthma - [Allergic/Non-allergic/AERD/Occupational] - GINA Step [1-5] - [Well/Partly/Uncontrolled]"

1.3 COMMUNITY-ACQUIRED PNEUMONIA (CAP)

Definition: Pneumonia acquired outside hospital or within 48h of admission in a non-institutionalized patient.

CURB-65 Scoring (1 point each)

Letter	Criterion
C	Confusion (new)
U	Urea > 7 mmol/L (BUN >19 mg/dL)
R	Respiratory rate ≥ 30/min
B	BP: Systolic <90 OR Diastolic ≤60 mmHg
65	Age ≥ 65 years

Score	Mortality	Disposition
0-1	~1.5%	Outpatient
2	~9.2%	Short admission / close observation
3-5	~22%	Hospitalize; Score ≥4 → Consider ICU

IDSA/ATS Criteria for Severe CAP (ICU)

1 major OR ≥3 minor criteria:

Major: (1) Septic shock needing vasopressors; (2) Mechanical ventilation

Minor: RR ≥30, PaO2/FiO2 ≤250, multilobar infiltrates, confusion, uremia (BUN ≥20), leukopenia (WBC <4000), thrombocytopenia (<100,000), hypothermia (<36°C), hypotension needing aggressive fluids

CAP by Etiology/Setting

Setting	Likely Pathogens
Outpatient, healthy	S. pneumoniae, Mycoplasma, Chlamydia, H. influenzae, respiratory viruses
Outpatient + comorbidities	Above + DRSP, enteric GNRs
Hospitalized, non-ICU	S. pneumoniae, Mycoplasma, Legionella, H. influenzae
ICU, no Pseudomonas risk	S. pneumoniae, S. aureus, Legionella, Gram-negatives
ICU, Pseudomonas risk factors	All above + P. aeruginosa
Post-influenza	S. aureus (CA-MRSA), S. pneumoniae, H. influenzae
Aspiration	Anaerobes (Peptostreptococcus, Bacteroides, Fusobacterium)
Alcoholism	Klebsiella, S. pneumoniae, anaerobes
Immunocompromised/HIV	PCP (Pneumocystis jirovecii), CMV, Cryptococcus, Aspergillus, Nocardia

Complications

Parapneumonic effusion → Empyema
Lung abscess (anaerobes, S. aureus, Klebsiella)
Septicemia → Septic shock
ARDS
Respiratory failure
Metastatic infection (meningitis, endocarditis - pneumococcal)

LABEL FORMAT: "CAP [Outpatient/Inpatient/ICU-Severe] - CURB-65 [__/5] - Suspected [pathogen] - Complicated by [effusion/abscess/sepsis/ARDS]"

1.4 TUBERCULOSIS (TB)

Definition: Infection by Mycobacterium tuberculosis. Obligate aerobe, slow-growing, acid-fast bacillus.

By Anatomical Location

Pulmonary TB (PTB): Lung parenchyma ± tracheobronchial tree involvement

Extrapulmonary TB (EPTB): Any site other than lung

EPTB Site	Key Features
TB Lymphadenitis	Most common EPTB; cervical/posterior triangle; painless; scrofula
Pleural TB	Exudative effusion; ADA >40 U/L; 3-6 months post-primary
Miliary TB	Hematogenous dissemination; "millet seed" bilateral micronodules on CXR; multi-organ
TB Meningitis	Subacute fever + headache + neck stiffness; CN palsies; CSF: lymphocytic, high protein, very low glucose
Spinal TB (Pott's)	Lower thoracic/upper lumbar; 2 vertebrae + disc; paradiscal erosion; cold (psoas) abscess; paraplegia risk
CNS Tuberculoma	Ring-enhancing lesion on MRI; focal deficits
GU TB	Sterile pyuria; hematuria; "pipe-stem" ureter; beading on IVU
Abdominal TB	Ileocaecal most common; can mimic Crohn's; peritoneal (ascites with high ADA)
Adrenal TB	Bilateral adrenal destruction → Addison's disease; calcified adrenals on CT
TB Pericarditis	Pericardial effusion → tamponade → constrictive pericarditis
Osteoarticular	Weight-bearing joints (hip, knee)

Bacteriological Classification

Category	Definition
Bacteriologically confirmed	Positive smear (AFB) / culture / molecular (GeneXpert)
Clinically diagnosed	Clinical + radiological evidence, no bacteriological confirmation
Smear-positive	≥1+ AFB on direct smear (≥10,000 bacilli/mL)
Smear-negative, culture/GeneXpert positive	True disease; less infectious but significant
Latent TB (LTBI)	TST/IGRA positive; no clinical/radiological disease

Treatment History Categories (WHO)

Registration Group	Definition
New	Never treated or treated <1 month
Relapse	Previously cured/completed; now bacteriologically confirmed again
Treatment after failure	Still smear/culture positive at month 5 of current treatment
Treatment after LTFU	Previously treated, lost to follow-up >2 months, returns with evidence of TB
Other previously treated	Outcome of prior treatment unknown

Drug Resistance Classification (WHO 2022)

Type	Definition
DS-TB	Drug-susceptible; sensitive to all first-line drugs
INH-mono-resistant	Resistant to INH only
RR-TB	Rifampicin-resistant (with or without INH resistance)
MDR-TB	Resistant to both INH + Rifampicin
Pre-XDR-TB	MDR/RR-TB + resistant to any fluoroquinolone
XDR-TB	MDR/RR-TB + resistant to any fluoroquinolone + ≥1 of bedaquiline or linezolid

Radiographic Stages

Primary TB: Ghon focus (lower/mid lobe peripheral opacity) + ipsilateral hilar adenopathy = Ghon complex; Ranke complex if calcified
Post-primary (reactivation): Apical/posterior upper lobe cavitation; fibrosis; "fibrocavitary" pattern
Miliary: 1-2mm bilateral diffuse micronodules ("snowstorm")
Endobronchial spread: Tree-in-bud opacities

LABEL FORMAT: "Pulmonary TB [New/Relapse/After failure] - [Smear +/-] - [DS/MDR/XDR] - [Pulmonary ± Extrapulmonary: sites] - [Latent/Active] - Complications: [Cavity/Bronchiectasis/Haemoptysis/ARDS/Miliary]"

1.5 PULMONARY EMBOLISM (PE)

Definition: Occlusion of pulmonary arterial vasculature by thrombus (usually from proximal DVT), air, fat, or amniotic fluid.

Risk Stratification (ESC 2019)

Risk Class	Hemodynamics	RV Dysfunction	Elevated Troponin/BNP	30-day Mortality	Action
High-risk (Massive)	Unstable (SBP <90 or drop ≥40 mmHg ×15 min, or vasopressors needed)	Present	Usually present	>15%	Immediate thrombolysis/embolectomy
Intermediate-High	Stable	Present (echo/CT)	Present	3-15%	Anticoagulate + close monitoring ± rescue thrombolysis
Intermediate-Low	Stable	Present OR elevated	Only one positive	3-15%	Anticoagulate + monitor
Low-risk	Stable	Absent	Normal	<1%	Anticoagulate; consider early discharge (sPESI=0)

Wells Score for PE (Pre-test Probability)

Feature	Points
DVT signs (calf swelling/tenderness)	3.0
Alternative diagnosis less likely than PE	3.0
HR >100	1.5
Immobilization/surgery past 4 weeks	1.5
Prior PE/DVT	1.5
Hemoptysis	1.0
Active malignancy	1.0

Interpretation: ≤4 = Low (unlikely PE); >4 = High (likely PE) [Simplified 2-tier]; or <2/2-6/>6 = Low/Moderate/High

PERC Rule (Rule-out in LOW pre-test probability - all 8 must be absent)

Age <50, HR <100, SpO2 ≥95%, no unilateral leg swelling, no hemoptysis, no recent trauma/surgery, no prior DVT/PE, no exogenous estrogen

Simplified PESI (sPESI) - 1 point each:

Age >80, cancer, chronic cardiopulmonary disease, HR ≥110, SBP <100, SpO2 <90%

sPESI=0 = Low risk (~1% mortality)
sPESI≥1 = High risk (~10% mortality)

Etiology (Virchow's Triad)

Stasis: Immobilization, long-haul travel, CCF, post-surgical
Hypercoagulability: Malignancy, OCP, pregnancy, thrombophilia (Factor V Leiden, Protein C/S deficiency, antiphospholipid syndrome)
Endothelial injury: Post-surgery, trauma, central line

LABEL FORMAT: "Acute PE - [Massive/Submassive High/Submassive Low/Low-risk] - Wells [] - sPESI [] - Etiology: [Provoked (specify)/Unprovoked] - Complications: [RV failure/Cardiogenic shock/CTEPH]"

SECTION 2: CARDIOVASCULAR SYSTEM

2.1 HEART FAILURE (HF)

Definition: Clinical syndrome caused by structural/functional cardiac abnormality, resulting in elevated intracardiac pressures and/or inadequate cardiac output at rest or during stress (ESC 2021).

Classification by Ejection Fraction (Phenotype)

Type	EF	Key Features
HFrEF (reduced EF)	<40%	Dilated/ischemic CMP; RAAS/SNS activation; responds to neurohormonal blockade
HFmrEF (mildly reduced EF)	40-49%	Intermediate; often ischemic
HFpEF (preserved EF)	≥50%	Hypertensive, obesity, AF, elderly women; diastolic dysfunction; LVH; difficult to treat

NYHA Functional Classification

Class	Description
I	No symptoms with ordinary activity
II	Symptoms with moderate exertion; slight limitation
III	Symptoms with minimal exertion; marked limitation; comfortable at rest
IV	Symptoms at rest; unable to carry out any activity without discomfort

ACC/AHA Stages (Progression)

Stage	Description
A	At risk for HF; no structural disease, no symptoms (HTN, DM, CAD)
B	Structural disease present; no symptoms (LVH, low EF, prior MI)
C	Structural disease + current/prior HF symptoms
D	Refractory HF; advanced therapy (transplant, LVAD, palliative) needed

Etiology Classification

Category	Causes
Ischemic	CAD/MI (most common in West) - coronary artery disease
Non-ischemic - Dilated CMP	Viral (Coxsackievirus B), alcohol, peripartum, idiopathic, chemotherapy (anthracyclines)
Hypertensive HF	Long-standing HTN → HFpEF or HFrEF
Valvular	AR/MR (volume overload) → LV dilation; AS/MS (pressure overload)
Infiltrative	Amyloidosis (HFpEF pattern), sarcoidosis, hemochromatosis
Hypertrophic CMP (HCM)	Sarcomeric protein mutation; LVH without dilation; diastolic dysfunction
High-output HF	Anemia, thyrotoxicosis, AV fistula, beriberi, Paget's disease
RHF/Cor pulmonale	COPD, PE, pulmonary arterial hypertension

Precipitating Factors for Acute Decompensation ("FAILURE")

Complications

Pulmonary edema (acute decompensation)
Cardiogenic shock (EF markedly reduced)
Arrhythmias: AF, VT/VF (sudden cardiac death)
Cardiac cachexia
Renal failure (cardiorenal syndrome)
Hepatic congestion ("cardiac cirrhosis")
Thromboembolic events (LV/LA thrombus)

LABEL FORMAT: "[Acute/Chronic Decompensated] HF [HFrEF EF __% / HFpEF / HFmrEF] - NYHA Class [I-IV] - ACC/AHA Stage [A-D] - Etiology: [Ischemic/Hypertensive/Valvular/CMP] - Precipitant: [specify] - Complications: [Pulm edema/Cardiogenic shock/AF/AKI]"

2.2 SHOCK

Definition: Life-threatening circulatory failure resulting in cellular and metabolic dysfunction due to inadequate oxygen delivery and/or utilization.

Classification by Mechanism (4 Types)

1. Distributive Shock (Vasodilatory - most common overall)

Septic shock: Infection → SIRS → vasodilation; high CO initially; warm extremities
Anaphylactic shock: IgE-mediated (Type I hypersensitivity); urticaria/angioedema + bronchospasm + hypotension
Neurogenic shock: Spinal cord injury (above T6) → loss of sympathetic tone; bradycardia + hypotension (no tachycardia)
Adrenal/Addisonian crisis: Cortisol deficiency; no response to vasopressors without steroids

2. Cardiogenic Shock

Pump failure: Massive MI (>40% LV loss), acute MR/VSD complication, myocarditis
Arrhythmic: VT/VF, complete heart block
Obstructive: Cardiac tamponade, tension pneumothorax, massive PE (sometimes grouped separately)

3. Hypovolemic Shock

Hemorrhagic: Trauma, GI bleed (CLASS I-IV - see below), ruptured AAA/ectopic
Non-hemorrhagic: Dehydration (vomiting, diarrhea, DKA), burns, third-spacing (pancreatitis, peritonitis)

4. Obstructive Shock

Massive PE, cardiac tamponade, tension pneumothorax, constrictive pericarditis

Hemorrhagic Shock Classes (ATLS)

Class	Blood Loss (mL)	HR	SBP	RR	Urine output	CNS	% Loss
I	<750	Normal	Normal	14-20	Normal	Anxious	<15%
II	750-1500	>100	Normal	20-30	20-30 mL/hr	Anxious	15-30%
III	1500-2000	>120	Decreased	30-40	5-15 mL/hr	Confused	30-40%
IV	>2000	>140	Very low	>35	<5 mL/hr	Lethargic	>40%

Septic Shock Diagnostic Criteria (Sepsis-3, 2016)

Sepsis requiring vasopressors to maintain MAP ≥65 mmHg AND serum lactate >2 mmol/L despite adequate volume resuscitation

Hemodynamic Profile of Shock

Parameter	Cardiogenic	Distributive	Hypovolemic	Obstructive
CO/CI	↓↓	↑ (early)	↓↓	↓
SVR	↑↑	↓↓	↑↑	↑
PCWP	↑↑	↓/Normal	↓↓	↑ (tamponade)
CVP	↑	↓/Normal	↓↓	↑
ScvO2	↓	↑	↓	↓
Lactate	↑	↑↑	↑	↑

LABEL FORMAT: "[Distributive/Cardiogenic/Hypovolemic/Obstructive] Shock - Etiology: [Septic/Anaphylactic/Hemorrhagic Class__/Cardiogenic-MI/Tamponade] - Lactate [] - MAP [] - On vasopressors: [Y/N] - SOFA [__]"

2.3 ACUTE CORONARY SYNDROMES (ACS)

Definition: Spectrum of ischemic conditions from plaque rupture/erosion causing partial or complete coronary occlusion.

Classification

Type	ECG	Troponin	Mechanism
STEMI	ST elevation ≥1mm in ≥2 contiguous leads (≥2mm in V1-V3); new LBBB	+++	Complete occlusion (usually)
NSTEMI	ST depression, T-wave inversion, or normal	+++	Partial occlusion
Unstable Angina (UA)	ST depression or T changes or normal	Negative	Plaque disruption without necrosis

STEMI by Territory

Territory	ECG leads	Artery
Anterior	V1-V4	LAD
Lateral	I, aVL, V5-V6	LCx
Inferior	II, III, aVF	RCA (85%), LCx (15%)
Posterior	ST depression V1-V3; tall R waves	RCA/LCx
RV infarct	ST elevation in V4R	Proximal RCA

TIMI Risk Score (UA/NSTEMI) - 1 point each

Age ≥65; ≥3 CAD risk factors; prior coronary stenosis ≥50%; ST deviation on ECG; ≥2 anginal events in 24h; ASA use in past 7 days; elevated cardiac markers

0-2: Low risk
3-4: Moderate risk
5-7: High risk

Killip Classification (Post-MI HF Severity)

Class	Feature	Mortality
I	No HF; clear lungs	~6%
II	Mild HF; S3, bibasal rales <50% of lung fields	~17%
III	Severe pulmonary edema; rales >50% of lung fields	~38%
IV	Cardiogenic shock (SBP<90, cold/clammy, oliguria, cyanosis)	~67%

SECTION 3: HEPATOLOGY & GASTROENTEROLOGY

3.1 CHRONIC LIVER DISEASE (CLD) / CIRRHOSIS

Definition: Irreversible fibrosis replacing normal hepatic architecture with regenerative nodules, resulting from chronic liver injury.

Child-Turcotte-Pugh (CTP) Score (Severity of Cirrhosis)

Parameter	1 point	2 points	3 points
Bilirubin (µmol/L)	<34	34-51	>51
Albumin (g/L)	>35	28-35	<28
PT prolongation (sec) / INR	<4 / <1.7	4-6 / 1.7-2.3	>6 / >2.3
Ascites	None	Mild (controlled)	Moderate-severe (refractory)
Encephalopathy	None	Grade 1-2	Grade 3-4

CTP Class	Score	1-yr Survival	2-yr Survival	Peri-op Mortality
A (Compensated)	5-6	100%	85%	10%
B (Functional compromise)	7-9	80%	60%	30%
C (Decompensated)	10-15	45%	35%	82%

MELD Score (Model for End-stage Liver Disease)

MELD = 3.78 × ln[Bilirubin mg/dL] + 11.2 × ln[INR] + 9.57 × ln[Creatinine mg/dL] + 6.43

<10: Low risk (<2% 3-month mortality)
10-19: Moderate risk (~6-20% 3-month mortality)
20-29: High risk (~20-40%)
30-39: Very high risk (~52%)
≥40: Critical (>70% 3-month mortality)
MELD-Na: Incorporates serum sodium (better predictor for waitlist mortality)

Complications of Cirrhosis / Decompensated CLD (DCLD)

3.1.1 Ascites

Defined by: SAAG (Serum-Ascites Albumin Gradient)

SAAG ≥1.1 g/dL: Portal hypertension-related (cirrhosis, heart failure, Budd-Chiari, portal vein thrombosis)
SAAG <1.1 g/dL: Non-portal (peritoneal TB, peritoneal carcinomatosis, nephrotic syndrome, pancreatitis)

Grading (EASL/AASLD):

Grade	Description
Grade 1	Detectable only on ultrasound
Grade 2	Moderate; symmetric abdominal distension; detectable by shifting dullness/fluid thrill
Grade 3	Gross/tense; marked distension; requires therapeutic paracentesis
Refractory Ascites	Does not respond to max diuretics (spironolactone 400mg + furosemide 160mg/day) OR recurs within 4 weeks of paracentesis; requires TIPS/liver transplant

3.1.2 Spontaneous Bacterial Peritonitis (SBP)

Definition: Bacterial infection of ascitic fluid without surgical intra-abdominal source. Diagnosis: Ascitic fluid PMN ≥250 cells/mm³ (even with negative culture)

Variant	PMN	Culture	Features
SBP	≥250/mm³	Positive	Full treatment with antibiotics
Culture-negative neutrocytic ascites (CNNA)	≥250/mm³	Negative	Treat as SBP (antibiotics given)
Bacterascites	<250/mm³	Positive	Treat if symptomatic; repeat tap if asymptomatic
Secondary Bacterial Peritonitis	≥250/mm³	Positive (polymicrobial)	Surgical source; need imaging; surgery

Common organisms: E. coli (most common), Klebsiella, S. pneumoniae Treatment: Cefotaxime 2g IV q8h × 5 days; Albumin 1.5 g/kg at diagnosis + 1 g/kg on Day 3 (prevents AKI/HRS)

3.1.3 Hepatic Encephalopathy (HE)

West Haven Criteria:

Grade	Features
0 (Minimal/Covert)	Normal exam; abnormal on psychometric testing (PHES, CFF)
1	Subtle confusion, euphoria or depression, slurred speech, disturbed sleep-wake
2	Drowsiness, disorientation to time, asterixis (flapping tremor) present
3	Stupor, semi-purposeful responses, marked confusion, gross disorientation
4	Coma; responds only to painful stimuli → no response

3.1.4 Hepatorenal Syndrome (HRS)

Type	Course	Criteria	Prognosis
HRS-AKI (formerly Type 1)	Rapid progressive; <2 weeks	Creatinine doubling to >2.5 mg/dL in <2 weeks; usually after SBP/variceal bleed	Poor; days-weeks
HRS-CKD (formerly Type 2)	Slow progressive; chronic	Steady creatinine elevation; often with refractory ascites	Months; better with TIPS

Diagnosis criteria (ICA 2015): Cirrhosis + ascites + creatinine >1.5 mg/dL + no response to 48h albumin challenge (1 g/kg/day) + no shock + no nephrotoxics + no intrinsic renal disease (protein <500mg/day, no hematuria, normal kidneys on US)

LABEL FORMAT: "DCLD [CTP Class __/MELD __] - Etiology: [Alcoholic/HBV/HCV/NASH/Cryptogenic] - Decompensation: [Ascites Grade __ /SBP/HE Grade __/HRS Type __/Variceal Bleed] - CKD Stage [if concurrent]"

3.2 ACUTE LIVER FAILURE (ALF)

Definition: Rapid hepatic dysfunction (coagulopathy + encephalopathy) in a patient WITHOUT prior liver disease.

Classification by Time from Jaundice to Encephalopathy (O'Grady)

Type	Jaundice to Encephalopathy	Common Causes	Cerebral Edema	Prognosis
Hyperacute	<7 days	Paracetamol, ischemic hepatitis, hepatitis A/E	High	Better (spontaneous recovery possible)
Acute	7-28 days	Hepatitis A/B, paracetamol	Moderate	Intermediate
Subacute	28 days - 12 weeks	Drug reactions, seronegative hepatitis, Wilson's	Low	Worst (highest waitlist mortality)

King's College Criteria (KCC) - Indicates need for liver transplant listing

Paracetamol-induced ALF:

pH <7.30 (regardless of encephalopathy grade) OR
All 3: Grade III-IV HE + PT >100s (INR >6.5) + Creatinine >300 µmol/L

Non-paracetamol ALF:

INR >6.5 (PT >100s) [any encephalopathy] OR
Any 3 of: Age <10 or >40; Drug reaction or cryptogenic; Jaundice-to-HE interval >7 days; INR >3.5; Bilirubin >300 µmol/L

Etiology of ALF

Drugs/Toxins: Paracetamol (acetaminophen) - most common in West; Anti-TB drugs (INH, rifampicin); DILI from herbal/ayurvedic medicines; Amanita phalloides (mushroom poisoning)
Viral: Hepatitis A (common in endemic areas), Hepatitis B (reactivation), Hepatitis E (in pregnancy - high mortality), CMV, HSV (immunocompromised)
Vascular: Ischemic hepatitis ("shock liver"), Budd-Chiari syndrome, HELLP syndrome
Metabolic: Wilson's disease (young patient; Kayser-Fleischer rings; hemolytic anemia; low uric acid)
Pregnancy-related: Acute fatty liver of pregnancy (AFLP), HELLP

3.3 INFLAMMATORY BOWEL DISEASE (IBD)

3.3.1 Crohn's Disease (CD)

Definition: Transmural granulomatous inflammation; can affect any segment of GI tract ("mouth to anus"); skip lesions; non-caseating granulomas.

Disease Location (Montreal Classification):

Location	Code	Description
L1	Terminal ileum	30-40%
L2	Colonic only	20%
L3	Ileocolonic	30-40%
L4	Upper GI (modifier)	Add to above

Disease Behavior (Montreal):

Behavior	Code	Features
B1	Non-stricturing, non-penetrating (inflammatory)	Most at diagnosis
B2	Stricturing	Obstruction; string sign on barium
B3	Penetrating	Fistulas, abscesses
B3p	Add "p"	Perianal involvement

Disease Activity - Harvey-Bradshaw Index (HBI) / CDAI:

Severity	HBI	CDAI
Remission	<5	<150
Mild	5-7	150-220
Moderate	8-16	220-450
Severe	>16	>450

3.3.2 Ulcerative Colitis (UC)

Definition: Continuous mucosal inflammation limited to colon; begins at rectum; extends proximally; superficial ulceration.

Extent (Montreal Classification):

Extent	Code	Description
Proctitis	E1	Rectum only (up to rectosigmoid junction)
Left-sided (distal)	E2	Up to splenic flexure
Extensive (pancolitis)	E3	Beyond splenic flexure

Severity - Truelove & Witts Criteria:

Parameter	Mild	Moderate	Severe (Fulminant)
Bloody stools/day	<4	4-6	>6
Temp	Normal	<37.8°C	>37.8°C
HR	Normal	<90	>90 bpm
Hemoglobin	Normal	10.5-normal	<10.5 g/dL
ESR	<20	20-30	>30 mm/hr
Albumin	Normal	Normal	<30 g/L

Mayo Score for UC Activity:

Score	0	1	2	3
Stool frequency	Normal	1-2/day more	3-4/day more	>4/day more
Rectal bleeding	None	Streaks	Obvious blood	Mostly blood
Endoscopy	Normal	Mild (erythema)	Moderate (erosions)	Severe (ulcers, spontaneous bleed)
Global assessment	Normal	Mild	Moderate	Severe
Total: 0-2 = remission; 3-5 = mild; 6-10 = moderate; 11-12 = severe

IBD Complications

Intestinal: Toxic megacolon (colonic dilation >6cm + systemic toxicity), perforation, strictures/obstruction (CD), fistulae (CD), hemorrhage
Colorectal cancer: UC risk ↑ after 8-10 yrs pancolitis; CD also ↑
Extraintestinal: Peripheral arthritis, axial arthropathy (ankylosing spondylitis), primary sclerosing cholangitis (PSC - UC), pyoderma gangrenosum, erythema nodosum, uveitis/episcleritis, aphthous ulcers

LABEL FORMAT for IBD: "[CD/UC] - Location [L1/L2/L3 or E1/E2/E3] - Behavior [B1/B2/B3 for CD] - Activity: [Mild/Moderate/Severe] - Complications: [specify] - Extraintestinal: [specify]"

3.4 ABDOMINAL TUBERCULOSIS

Definition: Mycobacterium tuberculosis infection affecting any abdominal organ; most commonly ileocaecal region.

Location-Based Classification

Site	Features	Key Points
Ileocaecal TB	Most common (75-90%); RIF pain, mass, diarrhea; "string sign" on barium; mimics Crohn's	Differentiation from CD: caseating granulomas, CBNAAT positive
TB Peritonitis	Wet type (chylous ascites, SAAG <1.1, ADA >40); Dry type (adhesions); Fibrotic (omentum/bowel matted)	High ADA in ascitic fluid
Mesenteric lymph node TB	Discrete matted nodes; may calcify; central necrosis on CT	Abdominal CT: low-density center with peripheral rim enhancement
TB Enteritis	Any segment; ulcers (transverse); hyperplastic; strictures
Hepatic/Splenic TB	Military granulomas in liver/spleen; may → abscess	Biopsy shows caseating granulomas
Biliary TB	Rare; obstructive jaundice; mimics PSC/cholangiocarcinoma

Diagnosis Criteria:

Histology: Caseating granulomas on biopsy (gold standard)
Culture: AFB from tissue/ascites (slow, 6-8 weeks)
CBNAAT (GeneXpert) on ascitic fluid or tissue: rapid, specific
ADA >40 U/L in ascitic fluid (sensitivity ~100%, specificity ~97% in right context)
CT abdomen: Ileocaecal thickening + mesenteric lymphadenopathy + "club-sandwich sign" (omental involvement)

SECTION 4: NEUROLOGY

4.1 STROKE

Definition: Sudden onset of focal neurological deficit due to cerebrovascular event lasting >24 hours (or any duration with neuroimaging evidence of infarction/hemorrhage). WHO 2013 definition includes silent brain infarction.

Classification by Pathology

4.1.1 Ischemic Stroke (87% of strokes)

TOAST Classification (Etiology):

Type	Key Features	%
Large artery atherosclerosis	Stenosis ≥50% in major artery; cortical + subcortical infarct	15-20%
Cardioembolism	AF, LV thrombus, IE, prosthetic valve; cortical; hemorrhagic transformation; multiple territories	20-25%
Small vessel (Lacunar)	Single deep penetrating artery; pure motor, pure sensory, ataxic hemiparesis, dysarthria-clumsy hand; <15mm; no cortical signs	20-25%
Other determined etiology	Dissection, CADASIL, vasculitis, coagulopathy, sickle cell, paradoxical embolism	5-10%
Cryptogenic (Undetermined)	≥2 causes found; negative workup; or incomplete workup	30-40%

OCSP/Bamford Classification (Territory - helps predict prognosis):

Type	Features	Artery	1-yr Mortality
TACI (Total Anterior Circ Infarct)	All 3: motor/sensory deficit (2/3 of face-arm-leg) + gaze palsy + higher cortical dysfunction	MCA	60%
PACI (Partial Anterior Circ Infarct)	2 of 3 OR isolated higher cortical dysfunction	MCA branch	15-20%
POCI (Posterior Circ Infarct)	Cerebellar or brainstem signs: diplopia, vertigo, ataxia, crossed signs	PCA/basilar	20%
LACI (Lacunar Infarct)	Pure motor/sensory; no cortical signs; no hemianopia	Penetrating	10%

NIHSS Severity:

Score	Severity
0	No deficit
1-4	Minor
5-15	Moderate
16-20	Moderately severe
>20	Severe

4.1.2 Hemorrhagic Stroke

Intracerebral Hemorrhage (ICH):

Hypertensive ICH (most common, 50-70%): Basal ganglia (putamen most common) > thalamus > pons > cerebellum
Cerebral Amyloid Angiopathy (CAA): Elderly; lobar hemorrhage; multiple/recurrent; microbleeds on GRE MRI
AVM, aneurysm rupture
Coagulopathy (anticoagulation, thrombocytopenia)
Hemorrhagic transformation of ischemic stroke
Tumor (primary/metastatic)
Vasculitis

ICH Score (Hemphill): GCS (0-2) + ICH Volume ≥30 mL (1) + Intraventricular extension (1) + Infratentorial origin (1) + Age ≥80 (1) → Score 0-6; Score 0 = 0% 30-day mortality; Score 5-6 = ~100%

Subarachnoid Hemorrhage (SAH) - Hunt & Hess Grade:

Grade	Clinical Features	Predicted Outcome
0	Unruptured	-
1	Asymptomatic or minimal headache/neck stiffness	70% good outcome
2	Moderate-severe headache; no focal deficit except CN palsy	60%
3	Drowsiness/confusion or mild focal deficit	50%
4	Stupor; moderate-severe hemiparesis; early decerebrate	20%
5	Deep coma; decerebrate; moribund	10%

Stroke Complications

Aspiration pneumonia (most common cause of death after stroke)
Cerebral edema → Herniation (massive MCA stroke)
Hemorrhagic transformation (especially cardioembolic)
Seizures (early post-stroke, cortical involvement)
Hydrocephalus (SAH, cerebellar infarct/ICH)
DVT/PE (immobility)
Post-stroke depression
Central post-stroke pain
Vascular dementia

Aspiration Pneumonia in Stroke: Complicates ~30% of acute strokes. Risk factors: dysphagia (all stroke patients need swallowing assessment), impaired consciousness, posterior circulation stroke. Pathogens: oral anaerobes + Gram-negatives.

LABEL FORMAT: "[Ischemic/Hemorrhagic] Stroke - [TOAST type / SAH Hunt-Hess Grade / ICH Score] - Territory: [TACI/PACI/LACI/POCI] - NIHSS [__] - Etiology: [specify] - Side: [Rt/Lt hemisphere] - Complications: [HT/Edema/Aspiration/Seizure/PE]"

4.2 MENINGITIS / ENCEPHALITIS / MENINGOENCEPHALITIS

Meningitis: Inflammation of meninges (leptomeninges); mainly CSF abnormal; brain parenchyma relatively spared Encephalitis: Brain parenchyma inflammation; altered consciousness, behavioral change, focal deficits, seizures Meningoencephalitis: Combined involvement

Classification by Etiology

Bacterial Meningitis

By Age Group:

Age	Common Organisms
Neonates (<3 months)	Group B Strep, E. coli, Listeria monocytogenes
Children (3 months - 18 years)	N. meningitidis (most common), S. pneumoniae, H. influenzae (uncommon post-vaccine)
Adults 18-50	S. pneumoniae, N. meningitidis
>50 + immunocompromised + alcoholic	S. pneumoniae, Listeria (add ampicillin), Gram-negatives
Post-neurosurgery/CSF shunt	S. aureus, coagulase-negative Staph, Gram-negatives
HIV	Cryptococcus neoformans (treat as for fungal)

CSF in Bacterial Meningitis:

Parameter	Bacterial	Viral	TB/Fungal
Opening pressure	Very High	Normal/slightly ↑	Elevated
Appearance	Turbid/purulent	Clear/xanthochromic	Clear/viscous
WBC (cells/mm³)	>1000 (PMN)	100-1000 (lympho)	100-500 (lympho)
Protein	Very high (>1g/L)	Mildly elevated	High (>1g/L)
Glucose (CSF/serum)	<0.4 (<40 mg/dL)	>0.6 (normal)	<0.5 (low-very low)
Gram stain	+ in 60-90%	Negative	AFB 10-40% positive
Culture	+ in 70-85%	Negative	+ in 45-90%
India Ink	Negative	Negative	+ in Cryptococcus

BM2/BMS Score (Bacterial Meningitis Score in children) / BM predictor in adults:

Blood glucose <2.2 mmol/L, CSF protein >2.2 g/L, CSF glucose <1.9 mmol/L, PMN >1180 cells/mm³ (van de Beek criteria)

Viral Encephalitis

Virus	Key Features	Diagnosis
HSV-1 (most common viral encephalitis)	Temporal lobe involvement; seizures; hemorrhagic; MRI: hyperintensity temporal lobes; high mortality without treatment	PCR HSV in CSF; MRI
HSV-2	Neonatal meningitis; recurrent benign lymphocytic	CSF PCR
VZV	Post-infectious cerebellar ataxia; vasculitis stroke; encephalitis in elderly	CSF PCR; serology
CMV	Immunocompromised (HIV CD4 <50); ventriculoencephalitis	CSF CMV PCR
EBV	Lymphocytic meningitis; cerebellar ataxia	Serology + CSF PCR
Enterovirus	Most common viral meningitis overall; summer/fall; benign	CSF PCR
JEV (Japanese Encephalitis)	Asia; mosquito-borne; Culex; extrapyramidal features; thalamic involvement on MRI	ELISA IgM in CSF/serum
Rabies	Animal bite; ascending paralytic (dumb) or encephalitic (furious); 100% fatal	Clinical; post-mortem
Nipah/Hendra	Bats; encephalitis + respiratory; Southeast Asia	PCR

TB Meningitis

BM Score / MRC Grading of TB Meningitis:

Grade	Consciousness	Focal Deficit
1	Alert; GCS 15	None
2	GCS 11-14 OR focal deficit	Without altered consciousness
3	GCS ≤10	Any

Grade 3 has 50-70% mortality; Grade 2 has 25-30%; Grade 1 has 10%

CSF in TBM: Lymphocytic pleocytosis (100-500), very high protein (1-5 g/L), very low glucose (<45 mg/dL or CSF:serum ratio <0.5), ADA >10 U/L in CSF; GeneXpert MTB on CSF (sensitivity 80%)

Fungal Meningitis

Cryptococcal meningitis: Most common in HIV (CD4 <100); subacute; India ink positive; Cryptococcal antigen (CrAg) in CSF/serum (sensitivity >95%); treat with Amphotericin B + Flucytosine × 2 wks, then Fluconazole

LABEL FORMAT: "[Bacterial/Viral/TB/Fungal] Meningoencephalitis - Likely organism: [specify] - MRC Grade [1/2/3 for TB] / Severity [mild/severe] - CSF findings: [summarize] - Complications: [SIADH/Hydrocephalus/Vascular/Seizures/Cranial nerve palsy/Abscess]"

4.3 OTHER COMMON NEUROLOGICAL CONDITIONS

Status Epilepticus (SE)

Definition: Seizure lasting ≥5 minutes OR 2 discrete seizures without recovery between them (revised from 30 min - ILAE 2015).

Classification:

Type	Features
Convulsive SE (GCSE)	Generalized tonic-clonic; most common; immediately life-threatening
Non-convulsive SE (NCSE)	Altered mental status without overt motor; diagnosis requires EEG
Focal SE (ESP)	Focal convulsions; preserved consciousness
Refractory SE	Fails 2nd-line agents (benzodiazepine + one AED)
Super-refractory SE	Persists >24h after general anesthesia

SECTION 5: RENAL SYSTEM

5.1 ACUTE KIDNEY INJURY (AKI)

Definition (KDIGO 2012): Any of:

Creatinine ↑ ≥0.3 mg/dL (26.5 µmol/L) within 48 hours
Creatinine ↑ ≥1.5× baseline within 7 days
Urine output <0.5 mL/kg/hr for ≥6 hours

KDIGO Staging

Stage	Creatinine Criteria	Urine Output Criteria
1	1.5-1.9× baseline OR ↑≥0.3 mg/dL	<0.5 mL/kg/hr for 6-12h
2	2.0-2.9× baseline	<0.5 mL/kg/hr for ≥12h
3	≥3× baseline OR ↑≥4 mg/dL OR RRT initiated OR eGFR <35 mL/min (age <18)	<0.3 mL/kg/hr for ≥24h OR anuria for ≥12h

Etiology Classification

Pre-Renal (55-60%):

Volume depletion (vomiting, diarrhea, burns, hemorrhage)
Decreased cardiac output (HF, shock)
Renal vasoconstriction (NSAIDs, contrast, ACEi/ARB in bilateral RAS)
Hepatorenal syndrome

Intrinsic Renal (35-40%):

Category	Causes	Urine Findings
ATN (most common intrinsic)	Ischemia (prolonged pre-renal), nephrotoxins (aminoglycosides, contrast, myoglobin), sepsis	Muddy brown granular casts; FENa >1%
Glomerulonephritis	Rapidly progressive GN (ANCA, anti-GBM, IC-mediated)	Dysmorphic RBCs + RBC casts + proteinuria
Acute Interstitial Nephritis (AIN)	Drugs (NSAIDs, PPIs, antibiotics), infections, sarcoid, SLE	WBC casts; eosinophiluria; WBC
Vascular	HUS/TTP, atheroemboli, RV thrombosis, malignant HTN	Fragmented RBCs (schistocytes); HTN

Post-Renal (5-10%):

Bilateral ureteric obstruction, bladder outlet obstruction (BPH, prostate cancer, clots)
Retroperitoneal fibrosis

Pre-Renal vs ATN Distinction

Parameter	Pre-Renal	ATN
FENa	<1%	>2%
FeUrea	<35%	>50%
Urine osmolality	>500 mOsm/kg	~300 mOsm/kg
Urine Na	<20 mEq/L	>40 mEq/L
Urine specific gravity	>1.020	~1.010
Urine sediment	Hyaline casts (normal)	Muddy brown granular casts
Response to fluids	Creatinine falls	Creatinine does not fall

Indications for Urgent RRT ("AEIOU")

A - Acidosis (refractory metabolic; pH <7.1) | E - Electrolytes (hyperkalemia refractory to treatment) | I - Intoxication (dialyzable: lithium, salicylates, methanol, ethylene glycol) | O - Overload (pulmonary edema not responding to diuretics) | U - Uremia (pericarditis, encephalopathy, platelet dysfunction)

LABEL FORMAT: "AKI KDIGO Stage [1/2/3] - [Pre-renal/Intrinsic-ATN/AIN/GN/Vascular/Post-renal] - Etiology: [specify] - On top of [CKD Stage __ if applicable] - Complications: [Hyperkalemia/Metabolic acidosis/Fluid overload/Uremia] - RRT: [Yes/No/Indicated]"

5.2 CHRONIC KIDNEY DISEASE (CKD)

Definition (KDIGO 2012): Abnormalities of kidney structure or function persisting >3 months.

CKD Staging by GFR + Albuminuria (KDIGO 2012)

GFR Categories:

Stage	GFR (mL/min/1.73m²)	Description
G1	≥90	Normal or high (with markers of kidney damage)
G2	60-89	Mildly decreased
G3a	45-59	Mildly-moderately decreased
G3b	30-44	Moderately-severely decreased
G4	15-29	Severely decreased
G5	<15	Kidney failure (ESKD)

Albuminuria Categories:

Category	ACR	Description
A1	<30 mg/g	Normal to mildly increased
A2	30-300 mg/g	Moderately increased
A3	>300 mg/g	Severely increased

CKD Label = G stage + A stage (e.g., G3a A2 = moderate CKD with moderate albuminuria)

5.3 PYELONEPHRITIS

Definition: Bacterial infection involving renal parenchyma and pelvicalyceal system (upper UTI).

Classification

Type	Features
Uncomplicated	Otherwise healthy non-pregnant premenopausal woman; normal urinary tract anatomy
Complicated	Male; pregnancy; urinary obstruction; structural abnormality; immunocompromised; DM; hospital-acquired; prior urologic procedure; resistant organism
Emphysematous pyelonephritis	Gas-forming organisms (E. coli, Klebsiella) in renal parenchyma; 90% in DM; CT diagnostic; emergency (nephrectomy often needed)
Xanthogranulomatous pyelonephritis	Chronic; staghorn calculus; replaced by lipid-laden macrophages; enlarged non-functioning kidney on CT

Severity

Mild: No systemic toxicity; oral treatment possible
Moderate: Systemic symptoms (fever, rigors) but stable; IV antibiotics
Severe/Complicated: Sepsis; obstruction; abscess formation; immunocompromised → hospitalize, IV antibiotics, urology consult

Common Organisms: E. coli (80%), Klebsiella, Proteus, Enterococcus (Enterobacteriaceae); ESBL increasingly common

LABEL FORMAT: "[Uncomplicated/Complicated] Pyelonephritis - [Community/Hospital-acquired] - Severity: [Mild/Moderate/Severe] - Organism: [if known] - Complications: [Perinephric abscess/Emphysematous/Sepsis/AKI] - Risk factors: [DM/obstruction/pregnancy]"

SECTION 6: INFECTIOUS DISEASE & CRITICAL CARE

6.1 SEPSIS AND MULTIORGAN DYSFUNCTION (MODS)

Definitions (Sepsis-3, 2016 - JAMA)

Term	Definition
Infection	Pathological process caused by invasion of normally sterile tissues by pathogenic organisms
SIRS	≥2 of: Temp >38°C or <36°C; HR >90; RR >20 or PaCO2 <32; WBC >12,000 or <4,000 or >10% bands - Note: SIRS no longer in Sepsis-3 definition
Sepsis	Life-threatening organ dysfunction caused by dysregulated host response to infection. SOFA score ↑ ≥2 points from baseline + suspected/confirmed infection
Septic Shock	Sepsis + vasopressor to maintain MAP ≥65 mmHg + serum lactate >2 mmol/L despite adequate fluid resuscitation

qSOFA Screen (Bedside - ≥2 = high risk)

Altered mental status (GCS <15)
Respiratory rate ≥22/min
Systolic BP ≤100 mmHg

SOFA Score (Sequential Organ Failure Assessment)

Organ	0	1	2	3	4
Respiration (PaO2/FiO2 mmHg)	≥400	<400	<300	<200 (+ vent)	<100 (+ vent)
Coagulation (Platelets ×10³/µL)	≥150	<150	<100	<50	<20
Liver (Bilirubin mg/dL)	<1.2	1.2-1.9	2.0-5.9	6.0-11.9	>12.0
Cardiovascular (MAP or vasopressors)	MAP ≥70	MAP <70	Dopamine ≤5 or Dobutamine	Dopamine >5 or NE/Epi ≤0.1	Dopamine >15 or NE/Epi >0.1
CNS (GCS)	15	13-14	10-12	6-9	<6
Renal (Creatinine mg/dL or UO)	<1.2	1.2-1.9	2.0-3.4	3.5-4.9 or UO <500/day	>5.0 or UO <200/day

SOFA ≥2 = significant organ dysfunction; ≥2 per organ = significant individual organ failure

Source Identification (Common Sources in Medical Wards)

Source	Clinical Clues
Lung (Pneumonia)	Most common; productive cough, consolidation, infiltrates
Urinary (urosepsis)	Dysuria, frequency, pyuria, bacteriuria, costovertebral tenderness
Abdomen (intra-abdominal)	Peritonitis, appendicitis, cholangitis (Charcot's triad), SBP
Skin/Soft tissue	Cellulitis, necrotizing fasciitis (severe rapid spread, crepitus, "dishwater fluid")
Bloodstream (primary CLABSI)	Central line, no obvious source
Endocarditis	IE: new murmur, embolic phenomena, IVDU, prosthetic valve
CNS	Meningitis/encephalitis

MODS (Multiorgan Dysfunction Syndrome)

Definition: Altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention; usually ≥2 organ systems.

Primary MODS: Direct result of well-defined insult (trauma, burns, ischemia) Secondary MODS: Consequence of excessive inflammatory response (sepsis, ischemia-reperfusion)

Organs Involved:

Respiratory → ARDS (Berlin criteria: bilateral infiltrates + P:F ratio)
Cardiovascular → Shock, requiring vasopressors
Renal → AKI ± requiring RRT
Hepatic → Elevated bilirubin, coagulopathy
Hematological → DIC (low platelets, high PT/APTT, high D-dimer, low fibrinogen)
CNS → Encephalopathy, GCS deterioration
GI → Ileus, GI mucosal barrier failure

DIC Classification

Type	Clinical Setting	Coagulation	Clinically
Overt DIC (Consumptive)	Sepsis, trauma, obstetric (amniotic fluid embolism, HELLP, abruption), malignancy	Low platelets + fibrinogen; high PT/APTT + D-dimer	Bleeding + thrombosis
Non-overt (Pre-DIC)	Earlier phase	Mild changes	Subclinical

ISTH DIC Score: Platelet count + D-dimer + PT prolongation + Fibrinogen; ≥5 = overt DIC

LABEL FORMAT: "Sepsis [Source: ] - SOFA [] / [Septic Shock if criteria met] - Organisms: [if known] - MODS: [Organs involved: list] - Lactate [__] - On vasopressors: [NE dose] - Cultures: [blood/urine/BAL/CSF]"

SECTION 7: ENDOCRINE - METABOLIC

7.1 DIABETIC KETOACIDOSIS (DKA)

Definition: Hyperglycemia (usually >250 mg/dL) + ketonemia/ketonuria + metabolic acidosis (pH <7.3 and/or HCO3 <15 mEq/L) - in absolute or relative insulin deficiency.

Severity Classification (ADA/Joint British Diabetes Societies 2023)

Parameter	Mild	Moderate	Severe
Blood glucose (mg/dL)	>250	>250	>250
Arterial pH	7.25-7.30	7.00-7.24	<7.00
Serum HCO3 (mEq/L)	15-18	10-14	<10
Urine/serum ketones	Positive	Positive	Positive
Anion gap	>10	>12	>12
Mental status	Alert	Alert/drowsy	Stupor/Coma

JBDS UK DKA severity markers (high-risk features requiring HDU/ICU):

Venous pH <7.1, bicarbonate <5 mmol/L, ketones >6 mmol/L, Glasgow Coma Scale <12, SpO2 <92%, SBP <90, HR >100 or <60, anion gap >16

DKA vs HHS (Hyperosmolar Hyperglycaemic State)

Feature	DKA	HHS
Blood glucose	Usually 250-600 mg/dL	>600 mg/dL
pH	<7.3	Normal (>7.30)
Bicarbonate	<15 mEq/L	Normal or slightly ↓
Ketones	+++	Absent or trace
Serum osmolality	Mild-moderate ↑	>320 mOsm/kg
Onset	Rapid (hours)	Slow (days-weeks)
Typical patient	T1DM, younger	T2DM, elderly
Mortality	1-5%	5-20%

Precipitants of DKA ("The 5 I's")

I-nfection (30-40%) | I-nsulin omission/non-compliance (25%) | I-nfarction (MI, stroke) | I-nflammation (pancreatitis) | I-atrogeni/Idiopathic (drugs: steroids, SGLT2i; new-onset T1DM)

Euglycemic DKA: SGLT2 inhibitors → DKA with glucose <250 mg/dL; increasingly recognized; do NOT stop insulin for normal glucose.

Anion Gap and Delta-Delta Ratio

AG = Na - (Cl + HCO3) [Normal: 8-12, or 12 ± 2 if albumin 4 g/dL]
Corrected AG = Measured AG + 2.5 × (4 - measured albumin)
Delta-delta ratio = (AG - 12) / (24 - HCO3): <0.4 = pure hyperchloremic NAGMA; 0.4-0.8 = combined; 0.8-2.0 = pure AGMA; >2.0 = AGMA + metabolic alkalosis

LABEL FORMAT: "DKA [Mild/Moderate/Severe] - pH [] / HCO3 [] / Ketones [] / AG [] - Precipitant: [Infection/Omission/New T1DM/SGLT2i] - Complications: [Cerebral edema/Hypokalemia/Hypophosphatemia/AKI/Thromboembolism]"

7.2 OTHER COMMON ENDOCRINE EMERGENCIES

Thyroid Storm (Burch-Wartofsky Score ≥45 = highly suggestive)

Domains: Thermoregulatory dysfunction + CNS effects + GI-hepatic dysfunction + Cardiovascular

Addisonian Crisis

Definition: Acute adrenal insufficiency; hemodynamic instability + electrolyte crisis (hyponatremia + hyperkalemia) + hypoglycemia. Trigger: illness/surgery/injury in primary adrenal insufficiency or sudden glucocorticoid withdrawal.

SECTION 8: ONCOLOGY - CANCERS

8.1 GENERAL CANCER STAGING PRINCIPLES

TNM Staging System (AJCC/UICC)

Component	Description
T (Tumor):	T0 (no primary) → Tis (in situ) → T1-T4 (size/local invasion)
N (Nodes):	N0 (none) → N1-N3 (regional nodes; number, site)
M (Metastasis):	M0 (none) → M1 (distant metastasis)

Overall Stage Grouping: Stage I → II → III → IV (higher = worse prognosis)

ECOG/WHO Performance Status

Score	Description
0	Fully active; no restriction
1	Restricted in strenuous activity; ambulatory; light work
2	Ambulatory and capable of self-care; cannot work; up >50% of waking hours
3	Limited self-care; confined to bed/chair >50% of waking hours
4	Completely disabled; no self-care; totally confined to bed/chair
5	Dead

Common Cancers in Medical Wards - Key Classification Points

8.1.1 Lung Cancer

Classification by Cell Type:

Type	%	Key Features	Driver Mutations
Non-Small Cell (NSCLC) - 85%
- Adenocarcinoma	40%	Peripheral; nonsmokers/smokers; lepidic → acinar → papillary; ground-glass on CT	EGFR (Asian, women, non-smoker), ALK, ROS1, KRAS, BRAF
- Squamous cell	30%	Central; cavitating; smokers; hilar; PTHrP (hypercalcemia)	FGFR1, DDR2
- Large cell	10%	Peripheral; bulky; poorly differentiated; PD-L1	-
Small Cell (SCLC)	15%	Central; hilar; rapid growth; early metastasis; strongly smoking-related; paraneoplastic	-

Lung Cancer Staging (Simplified):

Stage I: Localized (T1-2, N0, M0) → Surgery
Stage II: T3-4 N0 or T1-2 N1 → Surgery ± chemo
Stage III: N2-3 disease (mediastinal) → ChemoRT (concurrent)
Stage IV: Distant metastasis → Systemic (targeted/immunotherapy/chemo)

SCLC (Different staging - VALG):

Limited disease (LD): Confined to one hemithorax + ipsilateral mediastinal nodes → ChemoRT (curative intent; ~20% 5-yr survival)
Extensive disease (ED): Beyond hemithorax/contralateral nodes/distant metastasis → Chemo (palliative; median survival ~12 months)

Common Metastatic Sites of Lung Cancer: Brain (25%), Liver, Adrenals, Bone (osteolytic/mixed), Contralateral lung

Paraneoplastic Syndromes:

SCLC: SIADH, Cushing's (ACTH), LEMS (anti-VGCC), Cerebellar degeneration, Encephalomyelitis
Squamous cell: Hypercalcemia (PTHrP)
Adenocarcinoma: Hypertrophic osteoarthropathy, digital clubbing

8.1.2 Hepatocellular Carcinoma (HCC)

Barcelona Clinic Liver Cancer (BCLC) Staging:

Stage	Criteria	Treatment
0 - Very early	Single <2cm; PS 0; Child A	Resection or Ablation (95% 5-yr survival)
A - Early	Single <5cm OR 3 nodules ≤3cm; PS 0; Child A-B	Resection/Transplant/Ablation (50-75% 5-yr)
B - Intermediate	Large multi-nodular; PS 0; Child A-B; No vascular invasion	TACE (chemoembolization)
C - Advanced	Vascular invasion OR extrahepatic spread; PS 1-2	Sorafenib/Lenvatinib/Atezolizumab+Bevacizumab
D - Terminal	PS 3-4 OR Child C	Supportive/Best supportive care

Milan Criteria (Transplant eligibility): Single nodule ≤5cm OR ≤3 nodules each ≤3cm; No vascular invasion; No extrahepatic spread

Alpha-Fetoprotein (AFP): >400 ng/mL strongly suggestive of HCC; useful for monitoring, not screening alone

8.1.3 Colorectal Cancer (CRC)

Dukes Staging (modified Astler-Coller):

Stage	Description	5-yr Survival
A	Mucosa/submucosa only	>90%
B1	Into muscularis propria	85%
B2	Through muscularis propria, no nodes	70-75%
C1	Into muscularis propria + positive nodes	45%
C2	Through muscularis propria + positive nodes	30-35%
D	Distant metastasis	<5%

Metastatic CRC Sites: Liver (most common first site), Lung, Peritoneum, Bone (less common)

8.1.4 Lymphoma

Hodgkin Lymphoma (HL) - Ann Arbor Staging:

Stage	Definition
I	Single LN region OR single extralymphatic site (IE)
II	≥2 LN regions same side of diaphragm ± contiguous extralymphatic site (IIE)
III	LN regions on both sides of diaphragm ± spleen (IIIS) ± extralymphatic (IIIE)
IV	Disseminated extralymphatic involvement (bone marrow, liver, lung)

Modifiers: A = No symptoms; B = B symptoms (fever >38°C, night sweats, weight loss >10% in 6 months); E = Extranodal; S = Spleen; X = Bulky disease (>10cm or >1/3 thoracic diameter)

WHO Histological Types (HL):

Classical HL: Nodular sclerosis (most common, 70%), Mixed cellularity, Lymphocyte-rich, Lymphocyte-depleted
Nodular lymphocyte-predominant HL (NLPHL): Popcorn cells (LP cells), indolent

Non-Hodgkin Lymphoma (NHL) - Key Types:

Type	Behavior	Key Features
DLBCL	Aggressive	Most common NHL; CD20+; curable with R-CHOP
Follicular lymphoma	Indolent	Germinal center B-cell; t(14;18) BCL2; incurable but good survival
Mantle cell	Aggressive-moderate	CD5+; cyclin D1+; t(11;14)
Burkitt	Very aggressive	c-MYC t(8;14); "starry sky"; EBV-related; jaw in endemic form
T-cell/NK-cell	Variable	ALCL, PTCL, NK/T nasal; EBV-related
Marginal zone (MALT)	Indolent	H. pylori-driven (gastric MALT); eradication treats Stage I

IPI (International Prognostic Index) for NHL: 1 point each: Age >60; LDH >normal; ECOG PS ≥2; Stage III or IV; Extranodal sites >1

Low risk: 0-1 (5-yr OS ~75%)
Low-intermediate: 2
High-intermediate: 3
High risk: 4-5 (5-yr OS ~25%)

SECTION 9: MASTER QUICK-RECALL CHEAT SHEET

ONE-LINE LABELING FORMULAS FOR CASE PRESENTATION

Condition	Quick Label Format
COPD Exacerbation	AECOPD [GOLD Grade 1-4] - [Mild/Mod/Severe/Life-threatening] - [Infective/Non-infective] - [Type I / II RF] - ABCD Group [A/B/E]
Asthma	Acute [Mild/Moderate/Severe/Near-fatal] exacerbation of [Intermittent/Mild-Mod/Severe Persistent] Asthma - GINA Step [1-5] - [Well/Partly/Uncontrolled]
Pneumonia (CAP)	CAP - CURB-65 [/5] - [Mild/Mod/Severe] - [Non-ICU/ICU] - Likely organism: [_]
TB	PTB [New/Relapse/Failure] - Smear [+/-] - [DS/MDR/XDR] ± EPTB [sites]
PE	Acute PE - [Massive/Submassive/Low-risk] - Wells [] - sPESI [] - [Provoked/Unprovoked]
Heart Failure	[Acute/ADHF/Chronic] HF [HFrEF/HFpEF/HFmrEF] EF [%] - NYHA [I-IV] - Stage [A-D] - Etiology: [] - Precipitant: [__]
Shock	[Distributive-Septic/Anaphylactic / Cardiogenic / Hypovolemic / Obstructive] Shock - Lactate [] - MAP [] - Source/Cause: [___]
DCLD	DCLD [CTP Class A/B/C - Score /MELD ] - Etiology: [HBV/HCV/Alcohol/NAFLD] - Decompensation: [Ascites Gr/SBP/HE Gr/HRS Type/Variceal bleed]
ALF	Acute Liver Failure - [Hyperacute/Acute/Subacute] - Cause: [Paracetamol/Drug/Viral/Ischemic] - KCC met: [Y/N] - HE Grade [__]
SBP	SBP [PMN __/mm³] - [Culture-positive organism/CNNA] - [Primary/Secondary peritonitis]
IBD	[CD/UC] - Location [Montreal] - Severity [Mild/Mod/Severe] - Behavior [B1/B2/B3 for CD] - Complications: [___]
Stroke	[Ischemic TOAST type / ICH / SAH Hunt-Hess] - Territory [TACI/PACI/LACI/POCI] - NIHSS [__] - [Thrombotic/Embolic/Lacunar] - Complications: [Aspiration/Edema/HT]
Meningitis	[Bacterial/Viral/TB/Fungal] Meningoencephalitis - Organism [if known] - MRC Grade [for TBM] - CSF: [PMN/protein/glucose]
Sepsis/MODS	Sepsis [Source: _] - SOFA [] / Septic Shock [MAP __/Lactate __] - Organs failed: [list]
AKI	AKI KDIGO Stage [1/2/3] - [Pre-renal/ATN/AIN/GN/Post-renal] - On CKD Stage [__] - [RRT indicated/not]
DKA	DKA [Mild/Moderate/Severe] - pH [] / HCO3 [] / AG [] - Precipitant: [] - Complications: [__]
Pyelonephritis	[Uncomplicated/Complicated] Pyelonephritis - [Community/Hospital-acquired] - Severity [Mild/Mod/Severe] - Complications: [Abscess/Emphysematous/Sepsis]
Lymphoma	[HL/NHL type] - Ann Arbor Stage [I/II/III/IV] - [A/B symptoms] - [X = bulky] - IPI [for NHL]
Lung Cancer	NSCLC [Adeno/Squamous/Large cell] / SCLC [LD/ED] - Stage [I/II/III/IV or TNM] - ECOG PS [0-4] - Driver mutation: [EGFR/ALK/ROS1]

KEY SCORING SYSTEMS AT A GLANCE

Score	Condition	Key Threshold
GOLD 1-4	COPD severity	FEV1/FVC <0.70; Grade by FEV1%
CURB-65	CAP severity	≥3 = severe; ≥4 = ICU
PSI/PORT	CAP mortality	Class IV-V = hospitalize
Wells	PE probability	>4 = PE likely; >6 = high
sPESI	PE mortality	0 = low risk; ≥1 = high
NIHSS	Stroke severity	<5 minor; >20 severe
Hunt-Hess	SAH severity	Grade 4-5 = poor prognosis
ICH Score	ICH mortality	≥4 = ~97% mortality
SOFA	Sepsis organ dysfunction	≥2 = sepsis; single organ ≥2 = failure
KDIGO 1-3	AKI staging	Stage 3 or RRT criteria = critical
CTP A/B/C	Cirrhosis severity	C = decompensated, poor prognosis
MELD ≥15	Liver transplant listing	≥15 benefit from transplant
KCC	ALF transplant listing	Paracetamol vs Non-paracetamol criteria
NYHA I-IV	HF functional class	IV = symptoms at rest
KILLIP I-IV	Post-MI HF	IV = cardiogenic shock
IPI 0-5	NHL prognosis	4-5 = high risk (25% 5-yr OS)
BCLC 0-D	HCC staging	D = terminal (supportive only)
Ann Arbor I-IV	Lymphoma staging	IV + B = advanced
CRP+ESR+WBC	Infection/inflammation	Trending more important than single value

COMMON COMPLICATIONS THAT CROSS DIAGNOSES

Complication	Primary Cause	Secondary Associations
ARDS	Sepsis (most common), pneumonia, aspiration, trauma, pancreatitis	PaO2/FiO2 <300 (mild), <200 (moderate), <100 (severe) per Berlin
DIC	Sepsis, obstetric, malignancy, trauma	Consumptive coagulopathy → bleeding + thrombosis
AKI	Sepsis (#1 cause of ICU AKI), nephrotoxins, obstruction	Complicates virtually every serious illness
Aspiration Pneumonia	Stroke, ALS, impaired consciousness, post-intubation	Anaerobes + GNRs; right lower lobe predominant
Hepatic Encephalopathy	Cirrhosis, ALF	Precipitants: bleed, drugs, infection, constipation
Electrolyte Imbalances	Hyponatremia (SIADH in CNS/lung), Hypokalemia (diarrhea, diuretics), Hyperkalemia (AKI, ACEi, DKA treatment)	Critical electrolytes must be corrected first
Cardiorenal Syndrome	HF → AKI (Type 1 CRS); CKD → HF (Type 4 CRS)	Bidirectional heart-kidney interaction
Venous Thromboembolism	Malignancy, immobility, post-surgery, hypercoagulable states	DVT/PE in virtually all ICU/ward patients

MANAGEMENT MNEMONICS FOR COMMON WARD CALLS

Hyperkalemia ("C BIG K Drop"): Calcium gluconate | Bicarbonate | Insulin + Glucose | Kayexalate (resonium) | Dialysis (if RRT indicated)

AECOPD Treatment ("SAO2"): Supplemental O2 (target 88-92%) | SABAs (salbutamol nebs) | Antibiotics (if Anthonisen ≥2) | O2 + NIV | Oral prednisolone 30-40mg × 5 days

Sepsis Bundle (Hour-1): Blood cultures × 2 | Lactate | Broad-spectrum antibiotics | 30 mL/kg IV crystalloid if hypotension/lactate ≥4 | Vasopressors if MAP <65 after fluids

DKA management ("FIVE"): Fluids (0.9% NaCl; correct dehydration first) | Insulin (0.1 U/kg/hr fixed rate IV) | Vitamins/Electrolytes (K+ replacement critical - do NOT give insulin if K <3.5) | Evaluate cause (cultures, ECG, imaging)

ALF Management: Paracetamol → N-acetylcysteine (NAC) | Encephalopathy → Lactulose + rifaximin; ICP monitoring | Coagulopathy → FFP only if bleeding/procedure | Hypoglycemia → 10% dextrose | Early liver transplant assessment (KCC)

Sources: Harrison's Principles of Internal Medicine 21st Ed. | Davidson's Principles and Practice of Medicine 23rd Ed. | GOLD Guidelines 2024 | GINA 2024 | Sepsis-3 (Singer et al., JAMA 2016) | KDIGO AKI Guidelines 2012 | ESC Heart Failure Guidelines 2021 | ESC PE Guidelines 2019 | ADA Standards of Diabetes Care 2024 | WHO TB Guidelines 2022 | EASL Clinical Practice Guidelines: Decompensated Cirrhosis | IDSA/ATS CAP Guidelines | ILAE Epilepsy Classification 2017 | AJCC TNM 8th Edition | ECOG/WHO PS Scale

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Here is the fully enhanced guide with mnemonics, visual diagrams, and structured tables integrated throughout every section:

CLINICAL DEFINITIONS & CATEGORIZATION GUIDE

Enhanced Edition: Mnemonics + Visual Diagrams + Tables

For Medicine PG Residents & Clinicians

MASTER FRAMEWORK TO LABEL ANY CASE:

┌─────────────────────────────────────────────────────────────┐
│  DIAGNOSIS  +  TYPE/ETIOLOGY  +  SEVERITY  +  COMPLICATIONS │
│         +  FUNCTIONAL STATUS  +  ACTIVE PROBLEMS            │
└─────────────────────────────────────────────────────────────┘

═══════════════════════════════════

SECTION 1: RESPIRATORY SYSTEM

═══════════════════════════════════

1.1 COPD EXACERBATION

Mnemonic: "GOLD ABCE" for Stable COPD Assessment

┌──────────────────────────────────────────────────────────────────┐
│            COPD ASSESSMENT: TWO-STEP PROCESS                     │
├─────────────────────────────────┬────────────────────────────────┤
│  STEP 1: SPIROMETRY (GOLD 1-4)  │  STEP 2: ABCE GROUP            │
│  FEV1/FVC < 0.70 confirms COPD  │  (Symptoms + Exacerbation Hx)  │
└─────────────────────────────────┴────────────────────────────────┘

GOLD SPIROMETRIC STAGING
═══════════════════════════════════════════════════════════
  GOLD 1   │   GOLD 2   │   GOLD 3   │   GOLD 4
   MILD    │  MODERATE  │   SEVERE   │  VERY SEVERE
  FEV1≥80% │ FEV1 50-79%│ FEV1 30-49%│  FEV1 <30%
═══════════════════════════════════════════════════════════
Mnemonic: "MILD MOIST SMOKE VERY BADLY"
  MILD → ≥80%  |  MOderate → 50-79%  |  Severe → 30-49%  |  Very severe → <30%

ABCE GROUP MATRIX
═══════════════════════════════════════════════════════════════════
                       EXACERBATION HISTORY
                    ┌────────────────┬─────────────────┐
                    │  0-1 per year  │  ≥2 per year OR │
                    │ (no hosp.)     │  ≥1 hosp.       │
  ┌─────────────────┼────────────────┼─────────────────┤
  │ LOW symptoms    │   GROUP A      │    GROUP E       │
  │ mMRC 0-1/CAT<10 │                │                 │
  ├─────────────────┼────────────────┼─────────────────┤
  │ HIGH symptoms   │   GROUP B      │    GROUP E       │
  │ mMRC≥2/CAT≥10   │                │                 │
  └─────────────────┴────────────────┴─────────────────┘
  NOTE: Old C/D merged → GROUP E (GOLD 2023 update)

Exacerbation Severity - Mnemonic: "HOME ICU"

┌──────────────────────────────────────────────────────────────────────┐
│  H - Home (Mild): SABA alone responds                                │
│  O - Outpatient (Moderate): SABA + steroids ± antibiotics            │
│  M - Medical ward (Severe): Hospital admission needed                │
│  E - Emergency ICU (Life-threatening): NIV/IMV + ICU                 │
└──────────────────────────────────────────────────────────────────────┘

Severity	Setting	Key Criteria	Treatment
Mild	Home	Responds to SABA alone	Increase SABA
Moderate	Outpatient	Requires steroids ± antibiotics	SABA + Prednisolone 40mg × 5d + Abx if Anthonisen ≥2
Severe	Hospital ward	Severe dyspnea, cyanosis, edema, SpO2 <90%	IV hydrocortisone + nebs + O2 88-92% + NIV
Life-threatening	ICU	pH <7.25, confusion, worsening on NIV	Invasive ventilation

Anthonisen Criteria - Mnemonic: "DPS" (2 of 3 = antibiotics; all 3 = Type 1 exacerbation)

  ╔═══════════════════════════════════════╗
  ║   D - Dyspnea (increased)             ║
  ║   P - Purulence (sputum change)       ║
  ║   S - Sputum volume (increased)       ║
  ╚═══════════════════════════════════════╝
  ≥2 features → Antibiotics indicated
  All 3 features → Type 1 (Highest benefit from antibiotics)

COPD Complications - Mnemonic: "CRAPS P"

  C - Cor pulmonale (Right heart failure)
  R - Respiratory failure (Type I or II)
  A - Arrhythmias (AF, SVT)
  P - Pneumothorax (bullae rupture)
  S - Secondary polycythemia
  P - Pulmonary hypertension

LABEL: "AECOPD [GOLD Grade __] - [Mild/Moderate/Severe/Life-threatening] - [Infective(DPS score)/Non-infective] - [Type I/II Respiratory Failure] - ABCD Group [A/B/E]"

1.2 BRONCHIAL ASTHMA

Asthma Severity vs. Asthma Control - Mnemonic: "SC = Before vs After Treatment"

┌──────────────────────────────────────────────────────────────────┐
│  SEVERITY = Assess BEFORE starting treatment (intrinsic disease) │
│  CONTROL  = Assess AFTER starting treatment (response to Rx)     │
└──────────────────────────────────────────────────────────────────┘

Chronic Severity (GINA Steps) - Mnemonic: "I M M S" (Intermittent → Mild → Moderate → Severe)

═══════════════════════════════════════════════════════════════════════════
  STEP 1        │ STEP 2          │ STEP 3            │ STEP 4/5
  INTERMITTENT  │ MILD PERSISTENT │ MODERATE PERSIST. │ SEVERE PERSISTENT
  ≤2 days/wk    │ >2d/wk          │ Daily             │ Continuous
  FEV1 ≥80%     │ FEV1 ≥80%       │ FEV1 60-80%       │ FEV1 <60%
  Nights ≤2/mth │ Nights 3-4/mth  │ Nights >1/wk      │ Nightly
═══════════════════════════════════════════════════════════════════════════

Acute Exacerbation Severity - Mnemonic: "PRAM" (PEF, Rate, Accessory muscles, Mental status)

╔═════════════════════╦══════════════════╦═══════════════════╦══════════════════════╗
║ PARAMETER           ║  MILD-MODERATE   ║  SEVERE           ║  NEAR-FATAL          ║
╠═════════════════════╬══════════════════╬═══════════════════╬══════════════════════╣
║ PEF/FEV1            ║  >50%            ║  33-50%           ║  <33%                ║
║ Speech              ║  Full sentences  ║  Incomplete       ║  Words only          ║
║ Resp rate           ║  <25             ║  ≥25              ║  Bradypnea (late!)   ║
║ Accessory muscles   ║  Minimal         ║  Present          ║  Paradoxical         ║
║ Heart rate          ║  <110            ║  ≥110             ║  Bradycardia (late!) ║
║ SpO2 on air         ║  >92%            ║  88-92%           ║  <88%                ║
║ Wheeze              ║  Expiratory      ║  Insp + Exp       ║  SILENT CHEST ⚠️     ║
║ Consciousness       ║  Normal          ║  Agitated         ║  Drowsy/Coma         ║
╚═════════════════════╩══════════════════╩═══════════════════╩══════════════════════╝

⚠️ RED FLAGS: Silent Chest + Cyanosis + Bradycardia + Confusion = NEAR-FATAL → ICU NOW

Near-Fatal Asthma - Mnemonic: "SCAB"

  S - Silent chest (no wheeze despite distress)
  C - Cyanosis
  A - Altered consciousness / Agitation → Drowsy
  B - Bradycardia (paradoxical - late, ominous)

Asthma Phenotypes - Mnemonic: "ALIEN OA"

  A - Allergic (atopic): IgE-mediated, childhood, eosinophilic
  L - Late-onset adult: women, non-atopic, severe
  I - Inflammatory (non-allergic): adult onset, neutrophilic
  E - Exercise-induced bronchoconstriction
  N - NSAID/Aspirin (AERD = Samter's triad)
  O - Occupational: isocyanates, flour, latex
  A - ABPA (Aspergillus): eosinophilia, central bronchiectasis, fleeting shadows

LABEL: "Acute [Mild/Moderate/Severe/Near-fatal] exacerbation of [Intermittent/Mild/Moderate/Severe Persistent] Asthma - [Allergic/Non-allergic/AERD/EIB] - GINA Step [1-5] - [Well/Partly/Uncontrolled]"

1.3 COMMUNITY-ACQUIRED PNEUMONIA (CAP)

CURB-65 - Visual Mnemonic Card

╔══════════════════════════════════════════════════════════════╗
║                     C U R B - 65                             ║
║  C = Confusion (new onset)                                   ║
║  U = Urea > 7 mmol/L (or BUN >19 mg/dL)                     ║
║  R = Respiratory rate ≥ 30/min                               ║
║  B = Blood pressure: Systolic <90 OR Diastolic ≤60           ║
║  65 = Age ≥ 65 years                                         ║
╠══════════════════════════════════════════════════════════════╣
║  Score 0-1: LOW → Outpatient (~1.5% mortality)               ║
║  Score 2:   MOD → Short admission (~9% mortality)            ║
║  Score 3-5: HIGH → Hospital ± ICU (~22% mortality)           ║
╚══════════════════════════════════════════════════════════════╝

Severe CAP (ICU) - IDSA/ATS - Mnemonic: "MR. PULMONARY" (1 Major OR ≥3 Minor)

┌─── MAJOR CRITERIA (1 = ICU) ──────────────────────────┐
│  • Vasopressor-dependent septic shock                   │
│  • Mechanical ventilation required                      │
└────────────────────────────────────────────────────────┘

┌─── MINOR CRITERIA (≥3 = ICU) ─────── Mnemonic: "LUMP3T" ┐
│  L - Leukopenia (WBC <4000)                              │
│  U - Uremia (BUN ≥20 mg/dL)                              │
│  M - Multilobar infiltrates                              │
│  P - PaO2/FiO2 ≤ 250                                    │
│  3 - ≥30 RR (resp rate)                                  │
│  T - Thrombocytopenia (<100,000)                         │
│  + Hypothermia (<36°C)                                   │
│  + Hypotension (needs IV fluids)                         │
│  + Altered mental status/confusion                       │
└──────────────────────────────────────────────────────────┘

CAP Pathogen by Setting - Visual Matrix

OUTPATIENT (Healthy)    → S. pneumoniae, Mycoplasma, Chlamydia, Viruses
OUTPATIENT + Comorbid   → + GNRs, DRSP
HOSPITALIZED Non-ICU    → + Legionella, H. influenzae
ICU (No Pseudo risk)    → + S. aureus, DRSP, Legionella
ICU (Pseudo risk*)      → + P. aeruginosa
Post-INFLUENZA          → S. aureus (MRSA!), S. pneumoniae, H. influenzae
ASPIRATION              → Anaerobes (Peptostreptococcus, Bacteroides)
HIV/Immunocompromised   → PCP, CMV, Cryptococcus, Aspergillus

*Pseudomonas risk: Bronchiectasis, Steroids >10mg/day, Antibiotics in last month

1.4 TUBERCULOSIS (TB)

TB Classification - Complete Visual Framework

┌──────────────────────────────────────────────────────────────────────┐
│                    TB CLASSIFICATION TREE                            │
├────────────────────────────┬─────────────────────────────────────────┤
│  BY LOCATION               │  BY BACTERIOLOGY                        │
│  ┌───────────────────────┐ │  ┌───────────────────────────────────┐  │
│  │ PULMONARY (PTB)       │ │  │ Bacteriologically CONFIRMED:      │  │
│  │  • Cavitary (upper    │ │  │  • Smear (+): AFB ≥10,000/mL      │  │
│  │    lobe, apical)      │ │  │  • Culture (+): gold standard     │  │
│  │  • Non-cavitary       │ │  │  • GeneXpert MTB/RIF (+): rapid   │  │
│  │  • Miliary            │ │  ├───────────────────────────────────┤  │
│  └───────────────────────┘ │  │ Clinically DIAGNOSED:             │  │
│  ┌───────────────────────┐ │  │  CXR + clinical; negative tests   │  │
│  │ EXTRAPULMONARY (EPTB) │ │  └───────────────────────────────────┘  │
│  │  See table below ↓    │ │                                         │
│  └───────────────────────┘ │                                         │
└────────────────────────────┴─────────────────────────────────────────┘

EPTB Sites - Mnemonic: "PLUMPS CG AB" (Pleura, Lymph nodes, Urinary, Meninges/CNS, Peritoneum, Spine, Cutaneous/skin, Genitals, Adrenal, Bone)

EPTB Site	Key Clinical Feature	Key Investigation
Lymphadenitis (most common)	Painless cervical nodes, scrofula, matted	FNAC: caseating granulomas, ZN stain
Pleural TB	Exudative effusion; post-primary	ADA >40 U/L; pleural biopsy
Miliary TB	Bilateral micronodules "millet seeds"; multi-organ	CXR + CT; bone marrow biopsy
TB Meningitis	Subacute fever + CN palsies + hydrocephalus	CSF: lymphocytic, low glucose, high protein, ADA; GeneXpert
Spinal TB (Pott's)	Paradiscal erosion; gibbous; cold psoas abscess	MRI spine; CT-guided biopsy
Abdominal TB	Ileocaecal mass; transverse ulcers; peritonitis	Colonoscopy biopsy; ascitic ADA; CT abdomen
GU TB	Sterile pyuria; hematuria	"Pipe-stem" ureter on IVU; early morning urine AFB
TB Pericarditis	Effusion → tamponade → constrictive	Echo; pericardial fluid ADA; pericardial biopsy
Adrenal TB	Bilateral; Addison's disease	CT: enlarged calcified adrenals

Drug Resistance - Mnemonic: "DS RR MDR PreX XDR" (escalating hierarchy)

DS-TB ──→ RR-TB ──→ MDR-TB ──→ Pre-XDR ──→ XDR-TB
  │           │         │           │            │
Sensitive  Rifampicin  INH +     MDR +        MDR +
to all     resistant   Rifampicin  FQ          FQ + BDQ/LZD

Type	Definition	Key Drug Lost
DS-TB	Sensitive to all	None
RR-TB	Rifampicin resistant ± INH	Rifampicin
MDR-TB	INH + Rifampicin	Both pillars
Pre-XDR	MDR + any fluoroquinolone	FQ + both pillars
XDR-TB	MDR + FQ + BDQ or LZD	Most options exhausted

TB CXR Patterns - Visual Memory Aid

PRIMARY TB:          [ Ghon Focus ] + [ Hilar LN ] = GHON COMPLEX
                     Lower/mid lobe peripheral opacity
                     ↓ calcification → RANKE COMPLEX

POST-PRIMARY (Reactivation):
                     UPPER LOBE (apical/posterior segment)
                     ████ CAVITARY ████ + fibrosis + bronchiectasis

MILIARY:             ∘ ∘ ∘ ∘ ∘  ← bilateral micronodules (1-2mm)
                     ∘ ∘ ∘ ∘ ∘     "snowstorm" / "millet seed" pattern

ENDOBRONCHIAL SPREAD: Tree-in-bud opacities (lower lobes)

1.5 PULMONARY EMBOLISM (PE)

PE Risk Stratification - Mnemonic: "HMIL" (Hemodynamics, Markers, Imaging, Likelihood score)

╔═══════════════════════════════════════════════════════════════════════╗
║              PE RISK STRATIFICATION PYRAMID                          ║
║                                                                       ║
║              ▲▲▲▲▲▲▲▲▲▲▲▲▲                                          ║
║            ▲▲▲ HIGH-RISK ▲▲▲   SBP <90 or drop ≥40mmHg × 15min      ║
║           ▲▲▲  (MASSIVE)  ▲▲▲  = THROMBOLYSIS / EMBOLECTOMY          ║
║          ██████████████████████                                       ║
║         ██ INTER-HIGH ██████████  Stable + RV dysfn + Biomarkers+    ║
║        ██ (SUBMASSIVE) █████████  = Anticoag + Monitor ± Rescue       ║
║       ███████████████████████████                                     ║
║      ██ INTER-LOW ██████████████  Stable + 1 of 2 (RV or bio)        ║
║     ██ (SUBMASSIVE) ████████████  = Anticoag + Monitor                ║
║    ███████████████████████████████                                    ║
║   ████████ LOW RISK ██████████████  Stable + Normal RV + Normal bio   ║
║  ██████████████████████████████████  sPESI=0 → Consider EARLY DC      ║
╚═══════════════════════════════════════════════════════════════════════╝

Wells Score - Visual Card

╔═══════════════════════════════════════════════════════╗
║           WELLS SCORE FOR PE                          ║
╠══════════════════════════════════╦════════════════════╣
║ DVT signs (swelling/tenderness)  ║  3.0 ← HIGHEST    ║
║ Alternative dx LESS likely       ║  3.0 ← HIGHEST    ║
║ HR > 100                         ║  1.5              ║
║ Immobilization/Surgery ≤4 wks    ║  1.5              ║
║ Prior PE or DVT                  ║  1.5              ║
║ Hemoptysis                       ║  1.0              ║
║ Active malignancy                ║  1.0              ║
╠══════════════════════════════════╩════════════════════╣
║  ≤4 = PE unlikely (use D-dimer)                       ║
║  >4 = PE likely (go to CTPA directly)                 ║
╚═══════════════════════════════════════════════════════╝

PERC Rule - Mnemonic: "SHOE THUR" (all 8 must be ABSENT to rule out)

  S - Surgery or trauma (recent, within 4 weeks)? No
  H - Hemoptysis? No
  O - O2 saturation <95%? No
  E - Estrogen/OCP/HRT use? No
  T - Thrombosis history (prior DVT/PE)? No
  H - Heart rate >100? No
  U - Unilateral leg swelling? No
  R - (a)ge >50? No  [or "Age over 50? No"]
→ All 8 ABSENT + Low pre-test probability = PE RULED OUT

═══════════════════════════════════

SECTION 2: CARDIOVASCULAR SYSTEM

═══════════════════════════════════

2.1 HEART FAILURE

HF Classification - Visual Diagram

┌────────────────────────────────────────────────────────────────────┐
│              HEART FAILURE: EF-BASED PHENOTYPE                     │
├───────────────────┬────────────────────┬────────────────────────────┤
│   HFrEF           │   HFmrEF           │   HFpEF                    │
│   EF < 40%        │   EF 40-49%        │   EF ≥ 50%                 │
│  "the wet one"    │  "the grey zone"   │  "the stiff one"           │
│ Dilated; systolic │ Often ischemic     │ Hypertensive/elderly/obese │
│ RAAS activated    │ Intermediate       │ Diastolic dysfunction      │
│ RESPONDS to:      │                    │ HARD to treat              │
│ ACEi/ARBNi+       │                    │                            │
│ BB + MRA + SGLT2i │                    │ SGLT2i + diuretics only    │
└───────────────────┴────────────────────┴────────────────────────────┘

NYHA Classification - Mnemonic: "REST EASY ON STAIRS"

╔══════════════════════════════════════════════════════════════╗
║  NYHA I   - No symptoms; ANY activity tolerated              ║
║  NYHA II  - Symptoms with MODERATE exertion (stairs, hills)  ║
║  NYHA III - Symptoms with MINIMAL exertion (dressing, ADLs)  ║
║  NYHA IV  - Symptoms at REST; bed/chair bound                ║
╚══════════════════════════════════════════════════════════════╝

Memory: "I do anything | II = Moderate limits | III = Minimal limits | IV = Rest"

ACC/AHA Stages - Mnemonic: "At-Risk Builds Clinically to Dying"

Stage A → At-Risk (HTN, DM, CAD): No structural disease, No symptoms
Stage B → Builds structural changes (LVH, low EF, prior MI): No symptoms yet
Stage C → Clinical HF symptoms + structural disease: Most patients you treat
Stage D → Dying/refractory: Transplant, LVAD, palliative

HF Precipitants - Mnemonic: "FAILURE" (Classic)

  ╔═══════════════════════════════════════════════╗
  ║  F - Forget medications (non-compliance)      ║
  ║  A - Arrhythmia (AF is most common trigger)   ║
  ║  I - Infection (pneumonia, UTI, sepsis)        ║
  ║  L - Load excess (salt, IV fluids, pregnancy) ║
  ║  U - Upstroke new drugs (NSAIDs, CCB, TZD)    ║
  ║  R - Renal failure (fluid retention)          ║
  ║  E - Exertion/MI/Emotional stress             ║
  ╚═══════════════════════════════════════════════╝

HF Etiology - Mnemonic: "VITAMIN C HF"

  V - Valvular (AR, MR = volume overload; AS = pressure overload)
  I - Ischemic (CAD/MI = #1 in developed world)
  T - Toxic (alcohol, anthracyclines, trastuzumab, cocaine)
  A - Arrhythmia (tachycardia-mediated CMP - AF)
  M - Metabolic/Endocrine (thyrotoxicosis, acromegaly, hemochromatosis)
  I - Infiltrative (amyloidosis, sarcoidosis)
  N - Non-ischemic dilated CMP (viral, idiopathic, peripartum)
  C - Congenital/Cor pulmonale (pulmonary HTN, COPD, PE)
  H - Hypertensive CMP
  F - Functional/High output (anemia, AV fistula, Paget's, beriberi)

Killip Classification (Post-MI) - Visual Ladder

╔════════╦═══════════════════════════════════════════╦══════════╗
║ CLASS  ║ FEATURES                                  ║MORTALITY ║
╠════════╬═══════════════════════════════════════════╬══════════╣
║   I    ║ No HF. Clear lungs.                       ║   ~6%    ║
╠════════╬═══════════════════════════════════════════╬══════════╣
║   II   ║ Mild HF: S3 gallop, bibasal rales <50%   ║  ~17%    ║
╠════════╬═══════════════════════════════════════════╬══════════╣
║   III  ║ Severe pulm edema: rales >50% lung fields ║  ~38%    ║
╠════════╬═══════════════════════════════════════════╬══════════╣
║   IV   ║ Cardiogenic shock: SBP<90 + cold + oligo ║  ~67%    ║
╚════════╩═══════════════════════════════════════════╩══════════╝
Memory: Killip IV = 4× higher mortality than Killip I

2.2 SHOCK

Shock Classification - Visual Matrix with Hemodynamics

┌─────────────────────────────────────────────────────────────────────────┐
│                    SHOCK CLASSIFICATION MAP                              │
├──────────────────┬──────────┬────────┬──────────┬────────┬──────────────┤
│ TYPE             │   CO     │  SVR   │  PCWP    │  CVP   │  SKIN/TEMP   │
├──────────────────┼──────────┼────────┼──────────┼────────┼──────────────┤
│ DISTRIBUTIVE     │  ↑(early)│  ↓↓    │  ↓/Nrml  │ ↓/Nrml │  WARM, Flash │
│ (Septic/Anaph.)  │          │        │          │        │              │
├──────────────────┼──────────┼────────┼──────────┼────────┼──────────────┤
│ CARDIOGENIC      │  ↓↓      │  ↑↑    │  ↑↑      │  ↑     │  COLD, Clamp │
├──────────────────┼──────────┼────────┼──────────┼────────┼──────────────┤
│ HYPOVOLEMIC      │  ↓↓      │  ↑↑    │  ↓↓      │  ↓↓    │  COLD, Clamp │
├──────────────────┼──────────┼────────┼──────────┼────────┼──────────────┤
│ OBSTRUCTIVE      │  ↓       │  ↑     │  ↑(tamp) │  ↑     │  COLD, Clamp │
│ (Tamponade/PE)   │          │        │  ↓(PE)   │        │              │
└──────────────────┴──────────┴────────┴──────────┴────────┴──────────────┘
  CO=cardiac output, SVR=systemic vascular resistance, PCWP=pulm cap wedge

Shock Types Mnemonic: "D C H O" = "Don't Create Hemodynamic Obstruction"

  D - Distributive (Septic, Anaphylactic, Neurogenic, Adrenal)
  C - Cardiogenic (MI, Arrhythmia, Myocarditis, Valve rupture)
  H - Hypovolemic (Hemorrhagic Class I-IV, Burns, Dehydration)
  O - Obstructive (Tamponade, Tension PTX, Massive PE)

Hemorrhagic Shock Classes - Mnemonic: "TBCS" per class (Think Blood, Check Status)

╔══════╦══════════╦═══════╦═══════╦════════╦════════╦══════════╗
║CLASS ║ LOSS(mL) ║  HR   ║  SBP  ║   RR   ║  UO    ║   CNS    ║
╠══════╬══════════╬═══════╬═══════╬════════╬════════╬══════════╣
║  I   ║ <750     ║ Nrml  ║ Nrml  ║ 14-20  ║ Nrml   ║ Anxious  ║
║      ║ <15%     ║       ║       ║        ║        ║          ║
╠══════╬══════════╬═══════╬═══════╬════════╬════════╬══════════╣
║  II  ║ 750-1500 ║ >100  ║ Nrml  ║ 20-30  ║20-30/hr║ Anxious  ║
║      ║ 15-30%   ║       ║       ║        ║        ║          ║
╠══════╬══════════╬═══════╬═══════╬════════╬════════╬══════════╣
║  III ║1500-2000 ║ >120  ║  ↓    ║ 30-40  ║5-15/hr ║ Confused ║
║      ║ 30-40%   ║       ║       ║        ║        ║          ║
╠══════╬══════════╬═══════╬═══════╬════════╬════════╬══════════╣
║  IV  ║ >2000    ║ >140  ║  ↓↓   ║  >35   ║ <5/hr  ║Lethargic ║
║      ║ >40%     ║       ║       ║        ║        ║          ║
╚══════╩══════════╩═══════╩═══════╩════════╩════════╩══════════╝
Memory tip: At Class III = ALL parameters abnormal; Class IV = Near exsanguination

Septic Shock Diagnosis Mnemonic: "SLAM" Rule

  S - Suspected/confirmed Infection
  L - Lactate > 2 mmol/L despite adequate fluids
  A - Arterial pressure (MAP <65 mmHg) despite fluids
  M - Medication vasopressor required to maintain MAP ≥65
→ All 4 = Septic Shock (Sepsis-3)

Anaphylaxis - Mnemonic: "ABCD-H"

  A - Airway (angioedema, stridor, laryngeal edema)
  B - Bronchospasm (wheeze, dyspnea)
  C - Cardiovascular (hypotension, tachycardia)
  D - Dermis (urticaria, flushing, angioedema - may be absent in severe!)
  H - History of exposure (bee sting, food, drug, contrast)

═══════════════════════════════════

SECTION 3: HEPATOLOGY & GI

═══════════════════════════════════

3.1 CHRONIC LIVER DISEASE / CIRRHOSIS

CTP Score - Visual Scoring Table

╔═════════════════════╦═══════════╦═══════════════╦══════════════════╗
║ PARAMETER           ║  1 Point  ║    2 Points   ║    3 Points      ║
╠═════════════════════╬═══════════╬═══════════════╬══════════════════╣
║ Bilirubin (µmol/L)  ║   <34     ║    34-51      ║    >51           ║
║ Albumin (g/L)       ║   >35     ║    28-35      ║    <28           ║
║ PT prolongs (sec)   ║   <4s     ║    4-6s       ║    >6s           ║
║ INR                 ║  <1.7     ║   1.7-2.3     ║    >2.3          ║
║ Ascites             ║  None     ║  Mild/Ctrl    ║  Moderate/Refrac ║
║ Encephalopathy      ║  None     ║  Grade 1-2    ║  Grade 3-4       ║
╠═════════════════════╬═══════════╬═══════════════╬══════════════════╣
║ CLASS A = 5-6pts    ║ Compensated; 1yr OS ~100%; operative risk 10%║
║ CLASS B = 7-9pts    ║ Compromised; 1yr OS ~80%; operative risk 30% ║
║ CLASS C = 10-15pts  ║ Decompensated; 1yr OS ~45%; op risk 82%      ║
╚═════════════════════╩═══════════════════════════════════════════════╝

Mnemonic for CTP parameters: "BAP AE"
  B - Bilirubin   A - Albumin   P - PT/INR   A - Ascites   E - Encephalopathy

MELD Score Quick Reference

MELD = 3.78×ln[Bili] + 11.2×ln[INR] + 9.57×ln[Creat] + 6.43

╔═══════════════╦═══════════════════════════════════════════╗
║  MELD Score   ║  3-month Mortality  ║  Action             ║
╠═══════════════╬═════════════════════╬═════════════════════╣
║    < 10       ║     < 2%            ║  Monitor            ║
║    10-19      ║     6-20%           ║  Consider listing   ║
║    20-29      ║     20-40%          ║  Active list        ║
║    30-39      ║     52%             ║  Priority listing   ║
║    ≥ 40       ║     > 70%           ║  ICU/Transplant     ║
╚═══════════════╩═════════════════════╩═════════════════════╝

Complications of Cirrhosis - Mnemonic: "HEAVED"

  ╔═══════════════════════════════════════════════════════╗
  ║  H - Hepatic Encephalopathy                           ║
  ║  E - Esophageal/Gastric Variceal Bleeding             ║
  ║  A - Ascites (and spontaneous bacterial peritonitis)  ║
  ║  V - Vascular complications (Budd-Chiari, PVT)        ║
  ║  E - Edema (peripheral) + Electrolyte imbalance       ║
  ║  D - Deterioration → HRS, Hepatopulmonary, Cancer(HCC)║
  ╚═══════════════════════════════════════════════════════╝

Hepatic Encephalopathy Grading - Mnemonic: "SASC" (Subtle → Asterixis → Stupor → Coma)

┌─────────┬────────────────────────────────────────────────────────┐
│ GRADE   │ FEATURES                                               │
├─────────┼────────────────────────────────────────────────────────┤
│ 0/Covert│ Normal exam; abnormal on PHES test; "Minimal HE"       │
│ Grade 1 │ Subtle confusion, sleep disturbance, euphoria/anxiety  │
│ Grade 2 │ ASTERIXIS (flapping tremor), drowsy, disoriented TIME  │
│ Grade 3 │ Marked confusion, stupor, responds to stimuli          │
│ Grade 4 │ COMA; no response to pain                              │
└─────────┴────────────────────────────────────────────────────────┘
Asterixis = Grade 2 HE (classic exam finding)

HE Precipitants - Mnemonic: "BLEED GI"

  B - Bleeding (GI variceal/peptic ulcer)
  L - Lactulose stopped / Laxatives omitted
  E - Electrolytes (hypokalemia, hyponatremia)
  E - Excess protein intake
  D - Drugs (sedatives, benzodiazepines, opioids)
  G - GI infection / SBP
  I - Infection anywhere (pneumonia, UTI)
  + R - Renal failure / constipation

Ascites Grading + SAAG

SAAG = Serum Albumin - Ascitic Albumin (both same day)
┌──────────────────────────────────────────────────────────────────┐
│  SAAG ≥ 1.1 g/dL   →  PORTAL HYPERTENSION                       │
│     (Cirrhosis, CCF, Budd-Chiari, PVT, Alcoholic hepatitis)      │
│  SAAG < 1.1 g/dL   →  NON-PORTAL HYPERTENSION                   │
│     (TB peritonitis, Malignancy, Nephrotic, Pancreatitis)        │
└──────────────────────────────────────────────────────────────────┘

ASCITES GRADING:
  Grade 1: US detectable only (trace)
  Grade 2: Moderate; symmetric distension; shifting dullness +
  Grade 3: Gross/Tense; fluid thrill +; therapeutic paracentesis needed
  REFRACTORY: Max diuretics fail (Spiro 400mg + Furo 160mg) OR
              Recurs within 4 weeks of LVP → TIPS/Transplant

SBP Variants - Mnemonic: "SBP CNNA BACT 2ndary"

┌────────────────────┬────────────────┬─────────┬──────────────────────┐
│ VARIANT            │ PMN (/mm³)     │ CULTURE │ ACTION               │
├────────────────────┼────────────────┼─────────┼──────────────────────┤
│ SBP (classic)      │ ≥250           │ +       │ IV Cefotaxime 5 days │
│ CNNA               │ ≥250           │ -       │ Treat as SBP         │
│ Bacterascites      │ <250           │ +       │ Treat if symptomatic │
│ Secondary Periton. │ ≥250           │ + (poly)│ CT + SURGERY         │
└────────────────────┴────────────────┴─────────┴──────────────────────┘
SBP Organisms: E.coli > Klebsiella > S. pneumoniae (monomicrobial)
SBP + Albumin (Day 1: 1.5g/kg; Day 3: 1g/kg) = prevents HRS

HRS Mnemonic: "1-2-R" → AKI-CKD-Resolution

  HRS-AKI (former Type 1): RAPID ≤2 weeks; Creat doubles >2.5 in <2wks
                           Trigger: SBP, bleeding, sepsis
                           Prognosis: POOR (days to weeks)

  HRS-CKD (former Type 2): SLOW; steady rise; refractory ascites
                           Prognosis: Months; responds to TIPS

  Diagnosis: Cirrhosis + Ascites + Creat >1.5 + No response to
             48h albumin challenge (1g/kg/day) + No shock + No
             nephrotoxins + No intrinsic renal disease

3.2 ACUTE LIVER FAILURE (ALF)

O'Grady Classification by Time - Mnemonic: "HASTE" Reversed → Hyperacute is Fastest and Best Prognosis

┌────────────────┬────────────────────┬──────────────────┬─────────────────┐
│ TYPE           │ JAUNDICE→HE TIME   │ COMMON CAUSES    │ PROGNOSIS       │
├────────────────┼────────────────────┼──────────────────┼─────────────────┤
│ HYPERACUTE     │ < 7 days           │ Paracetamol,     │ BEST            │
│                │ (fastest)          │ Ischemic, HepA/E │ (can self-heal) │
├────────────────┼────────────────────┼──────────────────┼─────────────────┤
│ ACUTE          │ 7 - 28 days        │ HepA/B,          │ INTERMEDIATE    │
│                │                    │ Paracetamol      │                 │
├────────────────┼────────────────────┼──────────────────┼─────────────────┤
│ SUBACUTE       │ 28 days - 12 weeks │ Drug reactions,  │ WORST           │
│                │ (slowest)          │ Cryptogenic,     │ (highest        │
│                │                    │ Seronegative     │  waitlist mort.) │
└────────────────┴────────────────────┴──────────────────┴─────────────────┘
Memory: "Faster onset → Better outcome" (counterintuitive!)

King's College Criteria - Mnemonic: "pH or PHC"

PARACETAMOL:
  pH < 7.30 alone → LIST
  OR (all 3): PT >100s (INR >6.5) + HE Grade III-IV + Creatinine >300 µmol/L

NON-PARACETAMOL (any 1 OR any 3 of):
  PT >100s (INR >6.5) = LIST alone
  OR any 3 of: Age <10 or >40 | Drug/Cryptogenic | Jaundice→HE >7 days |
                INR >3.5 | Bilirubin >300 µmol/L

ALF Etiology - Mnemonic: "DAVE WHP"

  D - Drugs (Paracetamol #1, Anti-TB drugs, herbal medicines)
  A - Autoimmune hepatitis
  V - Viral (HepA, HepB, HepE in pregnancy, HSV, CMV)
  E - Ectopic (Wilson's disease - young; low uric acid + Kayser-Fleischer)
  W - Wilson's + Ischemic (shock liver, Budd-Chiari)
  H - HELLP / Acute Fatty Liver of Pregnancy
  P - Pregnancy-related (AFLP)

3.3 INFLAMMATORY BOWEL DISEASE (IBD)

CD vs UC - Key Differentiating Diagram

┌─────────────────────────────────────────────────────────────────────────┐
│         CROHN'S DISEASE            │      ULCERATIVE COLITIS            │
├─────────────────────────────────────┼────────────────────────────────────┤
│ Any part of GI (mouth → anus)       │ COLON ONLY (rectum → proximal)     │
│ SKIP LESIONS                        │ CONTINUOUS lesions                 │
│ TRANSMURAL inflammation             │ MUCOSAL only                       │
│ NON-CASEATING granulomas           │ No granulomas; crypt abscesses      │
│ Fistulas, strictures, abscesses     │ Toxic megacolon, bleeding           │
│ Cobblestone mucosa                  │ Lead-pipe colon (haustra lost)     │
│ Fat wrapping / creeping fat         │ Pseudopolyps                       │
│ String sign (stricture on barium)   │ Shortened colon                    │
│ Perianal disease common             │ Perianal rare                      │
│ Smoking INCREASES risk              │ Smoking DECREASES risk             │
│ p-ANCA negative; ASCA positive      │ p-ANCA positive; ASCA negative     │
└─────────────────────────────────────┴────────────────────────────────────┘

Montreal Classification - Mnemonic: "L for Location, B for Behavior, E for Extent"

CROHN'S (L + B):
  L1 = Terminal Ileum (ileitis)
  L2 = Colonic only
  L3 = Ileocolonic (most common at diagnosis)
  L4 = Upper GI modifier

  B1 = Inflammatory (non-stricturing, non-penetrating)
  B2 = Structuring (bowel obstruction)
  B3 = Penetrating (fistulas, abscesses)
  + p = Perianal modifier (add to B1/B2/B3)

UC EXTENT (E):
  E1 = Proctitis (up to rectosigmoid)
  E2 = Left-sided / Distal (up to splenic flexure)
  E3 = Extensive / Pancolitis (beyond splenic flexure)

UC Severity - Truelove & Witts

╔═══════════════════════╦═══════════╦═════════════╦═════════════════╗
║ PARAMETER             ║   MILD    ║   MODERATE  ║   SEVERE        ║
╠═══════════════════════╬═══════════╬═════════════╬═════════════════╣
║ Bloody stools/day     ║   < 4     ║    4-6      ║  > 6            ║
║ Temperature           ║ Normal    ║  < 37.8°C   ║  > 37.8°C       ║
║ Heart rate            ║ Normal    ║   < 90      ║  > 90 bpm       ║
║ Hemoglobin            ║ Normal    ║  10.5-Nrml  ║  < 10.5 g/dL    ║
║ ESR                   ║  < 20     ║   20-30     ║  > 30 mm/hr     ║
║ Albumin               ║ Normal    ║  Normal     ║  < 30 g/L       ║
╚═══════════════════════╩═══════════╩═════════════╩═════════════════╝
Mnemonic for Severe UC: "TB HASH" = Temp↑ | Bloody stools >6 | HR >90 | Albumin↓ | Hb <10.5 | ESR↑

IBD Complications - Mnemonic: "TOPS + CAFE"

INTESTINAL ("TOPS"):
  T - Toxic megacolon (colon >6cm + systemic toxicity = surgical emergency)
  O - Obstruction/strictures (Crohn's B2)
  P - Perforation
  S - Severe bleeding

EXTRAINTESTINAL ("CAFE"):
  C - Colorectal Cancer (UC pan-colitis >8-10 years, Crohn's ileum)
  A - Arthritis (peripheral + axial/ankylosing spondylitis)
  F - Full body: Skin (pyoderma gangrenosum, erythema nodosum)
  E - Eyes (uveitis, episcleritis) + PSC (UC-associated)

═══════════════════════════════════

SECTION 4: NEUROLOGY

═══════════════════════════════════

4.1 STROKE

Stroke Classification Tree

                        STROKE
                        /     \
               ISCHEMIC (87%)  HEMORRHAGIC (13%)
                   /                  \
          ┌────────────┐        ┌──────────────────┐
          │ TOAST TYPE │        │ ICH        SAH   │
          └────────────┘        └──────────────────┘
          1. Large artery            │           │
          2. Cardioembolic        Hypertensive  Aneurysm
          3. Small vessel (Lacunar) CAA         AVM
          4. Other determined     Coagulopathy  
          5. Cryptogenic          Tumor

TOAST Classification - Mnemonic: "LACCS"

  L - Large artery atherosclerosis (stenosis ≥50% major artery)
  A - AF/Cardioembolic (AF, LV thrombus, IE, prosthetic valve)
  C - Cryptogenic (no cause found despite full workup)
  C - CaRdiac other / Coagulopathy / disseCtion / CADASIL (Other determined)
  S - Small vessel / lacunar (<15mm deep infarct, no cortical signs)

OCSP/Bamford Territory Classification - Visual Diagram

╔════════════════════════════════════════════════════════════════════════╗
║            STROKE TERRITORY MAP (Bamford Classification)              ║
╠══════════════╦══════════════════════════════════════════╦═════════════╣
║ TACI (Total  ║ All 3: Motor/Sensory (face+arm+leg) +   ║ MCA        ║
║ Anterior)    ║ Gaze palsy + Higher cortical dysfn      ║ 60% mort.  ║
╠══════════════╬══════════════════════════════════════════╬═════════════╣
║ PACI (Part.  ║ 2 of 3 OR isolated higher cortical      ║ MCA branch ║
║ Anterior)    ║ (aphasia, neglect, visuospatial)        ║ 15-20%     ║
╠══════════════╬══════════════════════════════════════════╬═════════════╣
║ POCI (Post.  ║ Brainstem/cerebellar: diplopia, vertigo, ║ PCA/Basilar║
║ Circ)        ║ ataxia, crossed signs, bilateral motor  ║ 20%        ║
╠══════════════╬══════════════════════════════════════════╬═════════════╣
║ LACI         ║ Pure motor OR pure sensory OR Ataxic     ║ Penetrating║
║ (Lacunar)    ║ hemiparesis OR Dysarthria-clumsy hand   ║ arteries   ║
║              ║ NO cortical signs, NO hemianopia        ║ 10%        ║
╚══════════════╩══════════════════════════════════════════╩═════════════╝

Lacunar Syndromes - Mnemonic: "PPDA"

  P - Pure Motor hemiparesis (internal capsule/pons)
  P - Pure Sensory stroke (VPL thalamus)
  D - Dysarthria-Clumsy Hand (pons/internal capsule genu)
  A - Ataxic hemiparesis (pons/internal capsule)

ICH Locations - Mnemonic: "Hypertensive BPP; CAA LOVES Lobes"

HYPERTENSIVE ICH: B - Basal ganglia (PUTAMEN = most common)
                  P - Pons
                  P - (Posterior fossa) Cerebellum, Thalamus

CAA (amyloid):    LOBAR bleeds - frontal, parietal, occipital
                  Multiple microbleeds on MRI (GRE/SWI sequences)

NIHSS Quick Reference

╔══════════════════════════════════════╗
║  NIHSS Score → Stroke Severity       ║
╠══════════════╦═══════════════════════╣
║    0         ║  No stroke            ║
║    1 - 4     ║  Minor stroke         ║
║    5 - 15    ║  Moderate stroke      ║
║   16 - 20    ║  Moderately severe    ║
║   > 20       ║  Severe stroke        ║
╚══════════════╩═══════════════════════╝
Mnemonic: "No Minor Mod ModSev Sev" = 0 / 1-4 / 5-15 / 16-20 / >20

Hunt & Hess (SAH) - Mnemonic: "A HeadACHE that Kills"

  Grade 1: MILD headache, no deficit (A = Alert, Alive, Asymptomatic almost)
  Grade 2: MODERATE headache + neck stiffness, no deficit except CN palsy
  Grade 3: DROWSY/confused, mild focal deficit (D = Drowsy)
  Grade 4: STUPOR + hemiparesis (moderate to severe)
  Grade 5: DEEP COMA, decerebrate rigidity (DYING)
  Memory: 1=Headache only; 5=Near dead

Stroke Complications - Mnemonic: "HASHED"

  H - Hemorrhagic transformation (especially cardioembolic)
  A - Aspiration pneumonia (most common cause of death post-stroke!)
  S - Seizures (early post-stroke, cortical involvement)
  H - Hydrocephalus (SAH, cerebellar ICH/infarct)
  E - Edema + Herniation (massive MCA stroke, Day 2-5)
  D - DVT/PE (immobility) + Depression

4.2 MENINGITIS / ENCEPHALITIS

CSF Findings - Master Comparison Table

╔══════════════════╦═══════════════╦═══════════════╦═══════════════╦══════════════╗
║ PARAMETER        ║   NORMAL      ║  BACTERIAL    ║  VIRAL        ║  TB/FUNGAL   ║
╠══════════════════╬═══════════════╬═══════════════╬═══════════════╬══════════════╣
║ Pressure         ║ 10-20 cmH2O   ║ Very HIGH     ║ Nrml/slight↑  ║ Elevated     ║
║ Appearance       ║ Crystal clear ║ TURBID/PURU.  ║ Clear         ║ Clear/viscous║
║ WBC (cells/mm³)  ║ 0-5           ║ >1000 (PMN)   ║ 100-1000      ║ 100-500      ║
║                  ║               ║               ║ (Lymphocytes) ║ (Lymphocytes)║
║ Protein          ║ 0.2-0.45 g/L  ║ >1 g/L (HIGH) ║ Mild ↑        ║ HIGH >1 g/L  ║
║ Glucose          ║ 2.5-4.5       ║ <2.2 mmol/L   ║ Normal        ║ LOW <2.5     ║
║ CSF:Blood Gluc.  ║ >0.6          ║ <0.4          ║ >0.6          ║ <0.5         ║
║ Gram stain       ║ -             ║ +60-90%       ║ -             ║ AFB 10-40%   ║
║ India ink        ║ -             ║ -             ║ -             ║ + Crypto     ║
║ ADA (U/L)        ║ <10           ║ Variable      ║ Normal        ║ >10 (TB)     ║
╚══════════════════╩═══════════════╩═══════════════╩═══════════════╩══════════════╝

Bacterial Meningitis by Age - Mnemonic: "NEG Strep LAG"

NEONATES (<3m):   GBS (Group B Strep) + E.coli + Listeria
                  → Empiric: Ampicillin + Cefotaxime + Acyclovir (HSV)

CHILDREN (3m-18y): N. meningitidis + S. pneumoniae + H. influenzae (rare post-vaccine)
                  → Empiric: Ceftriaxone ± Dexamethasone

ADULTS (18-50y):  S. pneumoniae + N. meningitidis
                  → Empiric: Ceftriaxone + Dexamethasone

ELDERLY >50/IMMUNO: S. pneumoniae + Listeria + GNRs
                  → Empiric: Ceftriaxone + Ampicillin + Dexamethasone

MNEMONICS:
  "SHELL" for bugs: Strep pneumo | H. influenzae | E.coli/GNRs | Listeria | L (N.) meningitidis

TB Meningitis - MRC Grading - Mnemonic: "Alert-Mixed-Coma"

  MRC Grade I   = ALERT; No focal deficit; GCS 15
  MRC Grade II  = CONFUSED (GCS 11-14) OR focal neurological deficit
  MRC Grade III = COMA (GCS ≤10) ± any deficit
  Mortality: Grade I ~10% | Grade II ~25-30% | Grade III ~50-70%

Encephalitis Red Flags - Mnemonic: "HEAT" for HSV

  H - Hemorrhagic temporal lobe lesion on MRI
  E - EEG: periodic lateralized epileptiform discharges (PLEDs) in temporal region
  A - Aphasia / behavioral change
  T - Temporal lobe hyperintensity on FLAIR MRI
→ Start ACYCLOVIR IMMEDIATELY even before PCR results

Viral Encephalitis Quick Reference - Mnemonic: "HV JEB RN"

  H - HSV-1: Temporal lobe; most common; treat with Acyclovir urgently
  V - VZV: Vasculitis; cerebellar ataxia; elderly; rash
  J - JEV: Thalamic involvement; Asia; mosquito-borne
  E - Enterovirus: Most common MENINGITIS (not encephalitis); benign
  B - EBV: Cerebellar ataxia; lymphadenopathy
  R - Rabies: Furious (encephalitic) or dumb (paralytic); 100% fatal
  N - Nipah: Bats; SE Asia; fatal

═══════════════════════════════════

SECTION 5: RENAL SYSTEM

═══════════════════════════════════

5.1 ACUTE KIDNEY INJURY (AKI)

KDIGO Staging - Visual Scale

╔═══════════╦═══════════════════════════════════╦═══════════════════════════════╗
║  STAGE    ║  SERUM CREATININE                 ║  URINE OUTPUT                 ║
╠═══════════╬═══════════════════════════════════╬═══════════════════════════════╣
║    1      ║ 1.5-1.9× baseline                 ║ <0.5 mL/kg/hr for 6-12h       ║
║           ║ OR ↑ ≥0.3 mg/dL in 48h            ║                               ║
╠═══════════╬═══════════════════════════════════╬═══════════════════════════════╣
║    2      ║ 2.0-2.9× baseline                 ║ <0.5 mL/kg/hr for ≥12h        ║
╠═══════════╬═══════════════════════════════════╬═══════════════════════════════╣
║    3      ║ ≥3× baseline                      ║ <0.3 mL/kg/hr for ≥24h        ║
║ (CRITICAL)║ OR ↑ ≥4 mg/dL                    ║ OR Anuria ≥12h                ║
║           ║ OR RRT initiated                  ║                               ║
║           ║ OR eGFR <35 (<18 yrs)            ║                               ║
╚═══════════╩═══════════════════════════════════╩═══════════════════════════════╝

AKI Etiology - Mnemonic: "PRE-IN-POST"

╔══════════════════════════════════════════════════════════════════════╗
║ PRE-RENAL (55-60%): "The kidney is fine; flow is not"               ║
║   Volume depletion / Low CO (HF) / Hepatorenal syndrome             ║
║   NSAIDs, ACEi/ARB (renal vasoconstriction)                         ║
╠══════════════════════════════════════════════════════════════════════╣
║ INTRINSIC (35-40%): "The kidney itself is sick"                     ║
║   ATN (tubular) ← ischemia, aminoglycosides, contrast, myoglobin   ║
║   AIN (interstitial) ← NSAIDs, PPIs, antibiotics, sarcoid          ║
║   GN (glomerular) ← RPGN, ANCA, anti-GBM, immune complex          ║
║   Vascular ← HUS/TTP, malignant HTN, atheroemboli                  ║
╠══════════════════════════════════════════════════════════════════════╣
║ POST-RENAL (5-10%): "The kidney is fine; outflow is blocked"        ║
║   BPH, prostate cancer, stones, retroperitoneal fibrosis            ║
╚══════════════════════════════════════════════════════════════════════╝

Pre-Renal vs ATN - Mnemonic: "FUSO" (FENa, Urine Osm, Sediment, Output response)

┌──────────────────┬──────────────────────┬──────────────────────┐
│ PARAMETER        │   PRE-RENAL          │   ATN (Established)  │
├──────────────────┼──────────────────────┼──────────────────────┤
│ FENa             │ < 1%                 │ > 2%                 │
│ FeUrea           │ < 35%                │ > 50%                │
│ Urine Osm        │ > 500 mOsm/kg        │ ~300 mOsm/kg         │
│ Urine Na         │ < 20 mEq/L           │ > 40 mEq/L           │
│ Urine SG         │ > 1.020              │ ~1.010 (isosthenuria)│
│ Urine sediment   │ Normal/Hyaline casts │ MUDDY BROWN casts    │
│ Response to IV   │ Creat FALLS          │ Creat stays/rises    │
│ Albumin (SAAG ?) │ If HRS: albumin low  │ N/A                  │
└──────────────────┴──────────────────────┴──────────────────────┘

Indications for Urgent RRT - Mnemonic: "AEIOU" (Classic)

  ╔════════════════════════════════════════════════════╗
  ║  A - Acidosis (metabolic, refractory; pH <7.1)    ║
  ║  E - Electrolytes (hyperkalemia: ECG changes,     ║
  ║       refractory to medical therapy)              ║
  ║  I - Intoxication (dialyzable: Lithium,           ║
  ║       Salicylates, Methanol, Ethylene glycol)     ║
  ║  O - Overload (pulmonary edema refractory to      ║
  ║       diuretics)                                  ║
  ║  U - Uremia (pericarditis, encephalopathy,        ║
  ║       uremic platelet dysfunction)                ║
  ╚════════════════════════════════════════════════════╝

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

SECTION 6: INFECTIOUS DISEASE / CRITICAL CARE

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

6.1 SEPSIS, SEPTIC SHOCK & MODS

Sepsis-3 Definitions - Visual Escalation Ladder

         INFECTION
            ↓
         SEPSIS = Infection + SOFA ≥2 (acute organ dysfunction)
            ↓
       SEPTIC SHOCK = Sepsis + vasopressors (MAP ≥65) + Lactate >2 mmol/L
                      despite adequate volume resuscitation

SOFA Score - From Goldman-Cecil Medicine

╔══════════════════════╦══════╦═══════╦══════════════╦══════════════════════╦═════════════╗
║ SYSTEM               ║  0   ║   1   ║      2       ║          3           ║      4      ║
╠══════════════════════╬══════╬═══════╬══════════════╬══════════════════════╬═════════════╣
║ Respiratory          ║ ≥400 ║ <400  ║    <300      ║  <200 (+ventilated)  ║ <100 (+vent)║
║ (PaO2/FiO2)          ║      ║       ║              ║                      ║             ║
╠══════════════════════╬══════╬═══════╬══════════════╬══════════════════════╬═════════════╣
║ Coagulation          ║ ≥150 ║ <150  ║    <100      ║       <50            ║    <20      ║
║ (Platelets ×10³/µL)  ║      ║       ║              ║                      ║             ║
╠══════════════════════╬══════╬═══════╬══════════════╬══════════════════════╬═════════════╣
║ Liver                ║ <1.2 ║1.2-1.9║   2.0-5.9   ║      6.0-11.9        ║    >12.0    ║
║ (Bilirubin mg/dL)    ║      ║       ║              ║                      ║             ║
╠══════════════════════╬══════╬═══════╬══════════════╬══════════════════════╬═════════════╣
║ Cardiovascular       ║MAP   ║MAP    ║ Dopa ≤5 or   ║ Dopa 5-15 or Epi    ║ Dopa >15 or ║
║                      ║≥70   ║<70    ║ any Dobut.   ║ ≤0.1 or NE ≤0.1     ║ Epi/NE >0.1 ║
╠══════════════════════╬══════╬═══════╬══════════════╬══════════════════════╬═════════════╣
║ CNS (GCS)            ║  15  ║13-14  ║    10-12     ║        6-9           ║     <6      ║
╠══════════════════════╬══════╬═══════╬══════════════╬══════════════════════╬═════════════╣
║ Renal (Creat mg/dL)  ║ <1.2 ║1.2-1.9║   2.0-3.4   ║  3.5-4.9 or         ║  >5.0 or    ║
║ / Urine output       ║      ║       ║              ║  UO <500 mL/d        ║  UO <200/d  ║
╚══════════════════════╩══════╩═══════╩══════════════╩══════════════════════╩═════════════╝
SOFA ≥2 = sepsis (acute organ dysfunction). Each organ ≥2 = significant single organ failure.
Source: Singer M et al. JAMA 2016; Adapted from Goldman-Cecil Medicine

qSOFA - Mnemonic: "ARMS UP" to screen outside ICU

  ╔═══════════════════════════════════════════════╗
  ║  qSOFA (≥2 points = High risk of sepsis)      ║
  ║  A - Altered mental status (GCS <15)          ║
  ║  R - Respiratory rate ≥ 22/min               ║
  ║  S - Systolic BP ≤ 100 mmHg                  ║
  ╚═══════════════════════════════════════════════╝
  Score 0-3; ≥2 → full SOFA assessment + blood cultures + antibiotics

Sepsis Hour-1 Bundle - Mnemonic: "B-LADS" (Surviving Sepsis Campaign 2021)

  ╔══════════════════════════════════════════════════════════════════╗
  ║  B - Blood cultures (×2, before antibiotics)                    ║
  ║  L - Lactate measurement                                        ║
  ║  A - Antibiotics (broad-spectrum within 1 hour)                 ║
  ║  D - Drip (IV fluids 30 mL/kg crystalloid if hypoTN/lactate ≥4)║
  ║  S - Support BP (vasopressors if MAP <65 after fluids)          ║
  ╚══════════════════════════════════════════════════════════════════╝

Common Sepsis Sources - Mnemonic: "PULSE AB"

  P - Pulmonary (pneumonia - most common source)
  U - Urinary (urosepsis - E.coli, Klebsiella)
  L - Liver/Biliary (cholangitis - Charcot's triad + Reynolds pentad)
  S - Skin/Soft tissue (cellulitis, necrotizing fasciitis)
  E - Endocarditis (IE - new murmur + emboli + fever + bacteremia)
  A - Abdominal (peritonitis, SBP, appendicitis)
  B - Bloodstream (primary CLABSI - central line)

MODS Organ Systems - Mnemonic: "RLHCNG D" (Real Livers Have Clotting, Neurological and GI Damage)

  R - Respiratory: ARDS (PaO2/FiO2 <300 mild, <200 mod, <100 severe)
  L - renal (Kidneys): AKI, oliguria, requiring RRT
  H - Hematology: DIC (↓platelets, ↓fibrinogen, ↑PT/APTT, ↑D-dimer)
  C - Cardiovascular: Shock, vasopressor-dependent
  N - Neurological: Encephalopathy, GCS decline
  G - (liverG) Hepatic: Elevated bilirubin, coagulopathy
  D - Digestive/GI: Ileus, GI bleeding, mucosal barrier failure

═══════════════════════════════════

SECTION 7: ENDOCRINE / METABOLIC

═══════════════════════════════════

7.1 DKA vs HHS

DKA Severity - Visual Traffic Light

╔═══════════════════╦═══════════════════╦════════════════════╦════════════════════╗
║ PARAMETER         ║   MILD 🟡         ║  MODERATE 🟠        ║   SEVERE 🔴        ║
╠═══════════════════╬═══════════════════╬════════════════════╬════════════════════╣
║ Blood glucose     ║   > 250 mg/dL     ║   > 250 mg/dL      ║   > 250 mg/dL      ║
║ Arterial pH       ║   7.25 - 7.30     ║   7.00 - 7.24      ║   < 7.00           ║
║ Bicarbonate       ║   15 - 18 mEq/L   ║   10 - 14 mEq/L    ║   < 10 mEq/L       ║
║ Ketones           ║   Positive        ║   Positive         ║   Positive         ║
║ Anion gap         ║   > 10            ║   > 12             ║   > 12             ║
║ Mental status     ║   ALERT           ║   Alert/Drowsy     ║   STUPOR/COMA      ║
╚═══════════════════╩═══════════════════╩════════════════════╩════════════════════╝

DKA vs HHS Comparison

╔══════════════════════╦═════════════════════════╦═══════════════════════════╗
║ FEATURE              ║        DKA              ║          HHS              ║
╠══════════════════════╬═════════════════════════╬═══════════════════════════╣
║ Glucose              ║ Usually 250-600 mg/dL   ║  > 600 mg/dL              ║
║ pH                   ║ < 7.30                  ║  > 7.30 (normal)          ║
║ Bicarbonate          ║ < 15                    ║  Normal or slightly ↓     ║
║ Ketones              ║ +++                     ║  Absent or trace          ║
║ Serum osmolality     ║ Mild/mod elevation      ║  > 320 mOsm/kg            ║
║ Onset                ║ Rapid (hours)           ║  Slow (days to weeks)     ║
║ Typical patient      ║ T1DM, younger           ║  T2DM, elderly            ║
║ Mortality            ║ 1-5%                    ║  5-20% (higher!)          ║
╚══════════════════════╩═════════════════════════╩═══════════════════════════╝

DKA Precipitants - Mnemonic: "The 5 I's"

  ╔══════════════════════════════════════════════════════╗
  ║  I - Infection (30-40%): pneumonia, UTI, foot        ║
  ║  I - Insulin omission/non-compliance (25%)           ║
  ║  I - Infarction: MI, stroke (stress hyperglycemia)   ║
  ║  I - Inflammation: Pancreatitis                      ║
  ║  I - Iatrogenic/Idiopathic: Steroids, SGLT2i,        ║
  ║      new-onset T1DM                                  ║
  ╚══════════════════════════════════════════════════════╝
  ⚠️ EUGLYCEMIC DKA: SGLT2 inhibitors → DKA with glucose <250!
     Do NOT withhold insulin; glucose appears normal

DKA Management - Mnemonic: "FIVE"

  ╔═══════════════════════════════════════════════════════════════════╗
  ║  F - Fluids: 0.9% NaCl. 1L/hr first hour; correct dehydration   ║
  ║  I - Insulin: Fixed-rate IV insulin 0.1 U/kg/hr                  ║
  ║      ⚠️ Do NOT start if K+ <3.5 (fix K first!)                   ║
  ║  V - Vitamins/Electrolytes: K+ replacement is CRITICAL           ║
  ║      K 3.5-5.5: Replace with insulin; K<3.5: Hold insulin, give K║
  ║  E - Evaluate: Find and treat the precipitant (cultures, ECG)    ║
  ╚═══════════════════════════════════════════════════════════════════╝

Anion Gap Quick Reference

  AG = Na - (Cl + HCO3)    Normal = 8-12 (or 12±2 if Albumin = 4 g/dL)
  Corrected AG = Measured AG + 2.5 × (4 - albumin)

  HIGH AG Causes - Mnemonic: "MUDPILES CAT"
    M - Methanol         I - Isoniazid/Iron
    U - Uremia           L - Lactic acidosis
    D - DKA              E - Ethylene glycol
    P - Propylene glycol S - Salicylates
    C - CO / Cyanide     A - Aldehydes  T - Toluene

═══════════════════════════════════

SECTION 8: ONCOLOGY

═══════════════════════════════════

8.1 GENERAL CANCER FRAMEWORK

TNM Staging - Mnemonic: "TNM = Tumor-Nodes-Mets"

╔══════════════════════════════════════════════════════════════════════╗
║  T (Primary Tumor):    T0 → Tis (in situ) → T1 → T2 → T3 → T4      ║
║  N (Regional Nodes):   N0 (none) → N1 → N2 → N3 (more nodes)        ║
║  M (Metastasis):       M0 (none) → M1 (present = Stage IV)          ║
╠══════════════════════════════════════════════════════════════════════╣
║  Stage I   = T1-2, N0, M0 (localized)                               ║
║  Stage II  = T3-4, N0, M0 OR T1-2, N1, M0                           ║
║  Stage III = Any T, N1-3, M0 (regional spread)                      ║
║  Stage IV  = Any T, Any N, M1 (DISTANT METASTASIS)                  ║
╚══════════════════════════════════════════════════════════════════════╝

ECOG Performance Status - Mnemonic: "WACD" = Walk, Activity, Care, Disabled"

  0 - Fully active; no restriction (WORKS normally)
  1 - Light work only; restricted in strenuous activity (AMBULATORY)
  2 - Self-care only; no work; up >50% of waking hours (CHAIR-FREE daytime)
  3 - Limited self-care; in bed/chair >50% of waking hours (CHAIR BOUND)
  4 - Completely disabled; no self-care (BED BOUND)
  5 - Dead
  
  ECOG ≥3 = typically unfit for aggressive chemotherapy
  ECOG 0-2 = generally suitable for most treatment

8.2 LUNG CANCER

Cell Type Classification

┌──────────────────────────────────────────────────────────────────────┐
│                    LUNG CANCER (Primary)                             │
├─────────────────────────────────────┬────────────────────────────────┤
│  NON-SMALL CELL (NSCLC) = 85%       │  SMALL CELL (SCLC) = 15%       │
├──────────────────┬──────────────────┤                                │
│ ADENOCARCINOMA   │ SQUAMOUS CELL    │  CENTRAL; HILAR                │
│ 40%              │ 30%              │  Rapid growth                  │
│ PERIPHERAL       │ CENTRAL          │  Early mets (brain, liver, BM) │
│ Non/ex-smokers   │ SMOKERS          │  STRONG smoking assoc.         │
│ GGO on CT        │ Cavitating       │  Paraneoplastic common         │
│                  │                  │                                │
│ Mutations:       │ Hilar mass       │  STAGING:                      │
│ EGFR (Asian,f,   │ PTHrP →         │  LD = one hemithorax           │
│ non-smoker)      │ Hypercalcemia    │  ED = beyond hemithorax        │
│ ALK, ROS1, KRAS  │                  │  (not TNM used clinically)     │
└──────────────────┴──────────────────┴────────────────────────────────┘

NSCLC Stage → Treatment Summary

  Stage I   → Surgery (lobectomy) → Cure possible
  Stage II  → Surgery ± adjuvant chemo
  Stage III → Concurrent chemoradiation (Durvalumab consolidation)
  Stage IV  → SYSTEMIC:
              EGFR+ → Osimertinib (1st line)
              ALK+  → Alectinib (1st line)
              PD-L1 ≥50% → Pembrolizumab
              PD-L1 <50% → Chemo + Immunotherapy
              KRAS G12C → Sotorasib

Lung Cancer Paraneoplastics - Mnemonic: "SCLC makes hormones; SCC makes calcium"

  SCLC:   SIADH (ADH secretion) → Hyponatremia
           Cushing's (ACTH ectopic) → Hypokalemia, hyperglycemia
           LEMS (anti-VGCC) → Proximal weakness, autonomic dysfunction
           Cerebellar degeneration (anti-Hu, anti-Yo)

  SCC:    Hypercalcemia (PTHrP) → Bones, stones, groans, moans

  Any:    Hypertrophic pulmonary osteoarthropathy (periostitis)
           Digital clubbing

8.3 LYMPHOMA

Ann Arbor Staging - Visual Anatomy Diagram

                          ANN ARBOR STAGING
    ┌──────────────────────────────────────────────────────────────┐
    │  STAGE I:  ONE node region or ONE extranodal site            │
    │  STAGE II: ≥2 node regions SAME SIDE of diaphragm           │
    │  STAGE III: Node regions BOTH SIDES of diaphragm            │
    │  STAGE IV:  DISSEMINATED extranodal (bone marrow, liver)    │
    ├──────────────────────────────────────────────────────────────┤
    │  MODIFIERS:                                                  │
    │  A = No B symptoms (good)                                    │
    │  B = B symptoms: Fever >38°C, Night sweats, Wt loss >10%    │
    │  E = Extranodal extension                                    │
    │  S = Spleen involved                                         │
    │  X = Bulky disease (>10cm or >1/3 thoracic width)           │
    └──────────────────────────────────────────────────────────────┘
    
    Mnemonic for B symptoms: "FLY BY Night" = Fever | wt Loss | nYght sweats | Bone/constitutional

NHL Types - Mnemonic: "DFBMT" = Different Follicular Bugs Make Trouble"

  D - DLBCL: Aggressive; most common; CD20+; R-CHOP; curable ~60%
  F - Follicular: Indolent; t(14;18) BCL2; incurable but long survival
  B - Burkitt: Very aggressive; MYC t(8;14); "starry sky"; EBV-related
  M - Mantle Cell: CD5+; cyclin D1; t(11;14); aggressive-moderate
  T - T-cell/NK: ALCL (CD30+); PTCL; NK/T nasal (EBV); worst prognosis

IPI Score (NHL Prognosis)

  1 point each (remember "AANES"):
  A - Age >60
  A - ACTH (LDH) > upper normal (elevated LDH)
  N - Number of extranodal sites >1
  E - ECOG Performance status ≥2
  S - Stage III or IV

  IPI 0-1 = Low risk (~75% 5yr OS)
  IPI 2   = Low-intermediate
  IPI 3   = High-intermediate
  IPI 4-5 = High risk (~25% 5yr OS)

═══════════════════════════════════

SECTION 9: MASTER RECALL SYSTEM

═══════════════════════════════════

COMPLETE MNEMONICS DICTIONARY

┌─────────────────────────────────────────────────────────────────────────────────┐
│  CONDITION          │  MNEMONIC             │  WHAT IT COVERS                    │
├─────────────────────┼───────────────────────┼────────────────────────────────────┤
│ COPD Severity       │ MILD MOIST SMOKE VERY │ GOLD Grades 1-4 (FEV1 thresholds)  │
│ COPD ABCE           │ A, B, and E only      │ No more C/D since GOLD 2023         │
│ COPD Complications  │ CRAPS P               │ Cor pulmonale, RF, Arrhythmia, PTX │
│ Anthonisen          │ DPS                   │ Dyspnea, Purulence, Sputum volume  │
│ Asthma (Phenotypes) │ ALIEN OA              │ All asthma subtypes                │
│ Near-fatal Asthma   │ SCAB                  │ Silent chest, Cyan., Alt.C, Brady  │
│ CAP Severe MINOR    │ LUMP3T (+ 3 more)     │ ≥3 minor = ICU criteria            │
│ TB Sites            │ PLUMPS CG AB          │ All EPTB locations                 │
│ TB Drug Resistance  │ DS→RR→MDR→PreX→XDR    │ Escalating resistance hierarchy    │
│ PE Rule-out         │ SHOE THUR             │ 8 PERC criteria                    │
│ PE Risk             │ High/InterHigh/Low    │ Hemo.+RV+Biomarkers pyramid         │
│ Heart Failure Types │ HFrEF/mEF/pEF         │ EF-based phenotype (<40/40-49/≥50) │
│ NYHA Classes        │ None/Mod/Min/Rest      │ Activity limitation steps          │
│ ACC/AHA Stages      │ At-Risk→Builds→Clin→D │ A,B,C,D progression               │
│ HF Precipitants     │ FAILURE               │ Forgetting meds, Arrh, Infx, Load… │
│ HF Etiology         │ VITAMIN C HF          │ All causes of HF                   │
│ Shock Types         │ D C H O               │ Distributive, Cardio., Hypo., Obst │
│ Hemorrhagic Shock   │ Classes I-IV          │ Blood loss %, HR, SBP, UO, CNS     │
│ Septic Shock Dx     │ SLAM                  │ Sepsis+Lactate+Artery+Meds          │
│ Cirrhosis Complic.  │ HEAVED                │ HE, Esoph varices, Ascites, Vasc…   │
│ HE Precipitants     │ BLEED GI              │ Bleeding, Lactulose, Electrolytes…  │
│ HE Grades           │ SASC                  │ Subtle→Asterixis→Stupor→Coma       │
│ ALF Types           │ Faster=Better         │ Hyperacute >Acute >Subacute progn. │
│ ALF Etiology        │ DAVE WHP              │ All causes of ALF                  │
│ UC Severe           │ TB HASH               │ Temp, Bloody>6, HR, Albumin, Hb, E │
│ IBD Complications   │ TOPS + CAFE           │ Intestinal + Extraintestinal        │
│ TOAST (Stroke)      │ LACCS                 │ All 5 ischemic stroke types        │
│ Stroke Complications│ HASHED                │ Hemorrhagic trasnf., Aspiration…    │
│ Lacunar Syndromes   │ PPDA                  │ Pure motor, Pure sensory, Dys, Atax│
│ Bacterial Mening.   │ NEG Strep LAG (by age)│ Organisms by age group             │
│ HSV Encephalitis    │ HEAT                  │ Hemorrhagic, EEG, Aphasia, Temporal│
│ AKI Etiology        │ PRE-IN-POST           │ Pre/Intra/Post-renal               │
│ AKI RRT Indications │ AEIOU                 │ Acidosis, Electro, Intox, Overload │
│ Sepsis Bundle       │ B-LADS                │ Blood cx, Lactate, Abx, Drip, BP   │
│ Sepsis Sources      │ PULSE AB              │ All 7 common sources               │
│ MODS Organs         │ RLHCNG D              │ Resp, renal, Heme, CVS, Neuro, GI  │
│ DKA Precipitants    │ 5 I's                 │ Infx, Insulin omit, Infarct, Inflamm│
│ DKA Management      │ FIVE                  │ Fluids, Insulin, Vitamins, Evaluate │
│ High AG Acidosis    │ MUDPILES CAT          │ All causes of HAGMA                 │
│ Hyperkalemia Tx     │ C BIG K Drop          │ Calcium, Bicarb, Insulin+Gluc…      │
│ ECOG Performance    │ WACD                  │ Work, Activity, Care, Disabled      │
│ B symptoms          │ FLY BY Night          │ Fever, wt Loss, night sweats        │
│ NHL Types           │ DFBMT                 │ DLBCL, Follicular, Burkitt, Mantle… │
│ Lung Cancer PN      │ SCLC=Hormones;SCC=Ca  │ Paraneoplastic syndromes           │
└─────────────────────────────────────────────────────────────────────────────────┘

MASTER LABELING QUICK CARDS

╔══════════════════════════════════════════════════════════════════════╗
║          SINGLE-GLANCE DIAGNOSTIC LABELING CARDS                    ║
╠══════════════════════════════════════════════════════════════════════╣
║ AECOPD:   [GOLD Grade] - [Mild/Mod/Sev/Life-threat] - [Infective/   ║
║           Non-infective] - [TypeI/TypeII RF] - ABCD[A/B/E]          ║
╠══════════════════════════════════════════════════════════════════════╣
║ ASTHMA:   Acute [Mild/Mod/Sev/Near-fatal] exacerbation of           ║
║           [Intermittent/MP/ModP/SP] Asthma - GINA Step[1-5]         ║
╠══════════════════════════════════════════════════════════════════════╣
║ CAP:      CAP - CURB65[__/5] - [Non-severe/Severe] - [Ward/ICU]     ║
╠══════════════════════════════════════════════════════════════════════╣
║ TB:       PTB [New/Relapse/Failure] - Smear[+/-] - [DS/MDR/XDR] ±   ║
║           EPTB [site] - Complications [cavitation/miliary/bleeding]  ║
╠══════════════════════════════════════════════════════════════════════╣
║ PE:       Acute PE - [Massive/Submassive-H/Submassive-L/Low-risk] -  ║
║           Wells[__] - sPESI[__] - [Provoked/Unprovoked]             ║
╠══════════════════════════════════════════════════════════════════════╣
║ HF:       [Acute Decompensated/Chronic] HF [HFrEF EF__%/HFpEF] -   ║
║           NYHA[I-IV] - Stage[A-D] - Etiology[___] - Precipitant[___]║
╠══════════════════════════════════════════════════════════════════════╣
║ SHOCK:    [Distributive-Septic/Cardiogenic/Hypovolemic/Obstructive] ║
║           Shock - Lactate[__] - MAP[__] - Source/Cause[___]         ║
╠══════════════════════════════════════════════════════════════════════╣
║ DCLD:     DCLD CTP[A/B/C __pts] MELD[__] - Etiology[HBV/HCV/Alc]  ║
║           Decompensation:[Ascites Gr__/SBP/HE Gr__/HRS/Bleed]       ║
╠══════════════════════════════════════════════════════════════════════╣
║ ALF:      ALF [Hyperacute/Acute/Subacute] - Cause[___] -            ║
║           KCC[Met/Not met] - HE Grade[__] - MELD[__]                ║
╠══════════════════════════════════════════════════════════════════════╣
║ STROKE:   [Ischemic TOAST/ICH Score/SAH H-H Grade] - Territory      ║
║           [TACI/PACI/LACI/POCI] - NIHSS[__] - Complications[___]    ║
╠══════════════════════════════════════════════════════════════════════╣
║ MENING:   [Bacterial/Viral/TB/Fungal] Meningitis - Organism[___] -  ║
║           MRC[1/2/3 for TB] - CSF[PMN/Prot/Gluc/ADA] - Complic[___]║
╠══════════════════════════════════════════════════════════════════════╣
║ SEPSIS:   Sepsis [Source:___] SOFA[__] / Septic Shock [MAP_/Lact_]  ║
║           - Organisms[___] - MODS Organs[list]                      ║
╠══════════════════════════════════════════════════════════════════════╣
║ AKI:      AKI KDIGO Stage[1/2/3] - [Pre/Intrinsic-ATN/AIN/Post] -  ║
║           On CKD Stage[__] - RRT[Indicated/Not] - Cause[___]        ║
╠══════════════════════════════════════════════════════════════════════╣
║ DKA:      DKA [Mild/Moderate/Severe] pH[__] HCO3[__] AG[__] -      ║
║           Precipitant[5I:___] - Complications[K+/Cerebral edema]    ║
╠══════════════════════════════════════════════════════════════════════╣
║ IBD:      [CD/UC] Location[Montreal L or E] Activity[Mild/Mod/Sev]  ║
║           Behavior[B1/B2/B3 for CD] - Complications[___]            ║
╠══════════════════════════════════════════════════════════════════════╣
║ LYMPHOMA: [HL/NHL type] - Ann Arbor Stage[I-IV][A/B][E/S/X] -      ║
║           IPI[for NHL 0-5] - ECOG[0-4]                             ║
╚══════════════════════════════════════════════════════════════════════╝

CRITICAL NUMBERS TO MEMORIZE

╔═══════════════════════════════════════════════════════════════════════════╗
║  THE MOST IMPORTANT NUMBERS IN MEDICINE                                  ║
╠═══════════════════════════════════╦═══════════════════════════════════════╣
║  FEV1/FVC <0.70                  ║  COPD definition (obstructive pattern)║
║  FEV1 <30%                        ║  GOLD Grade 4 (Very Severe COPD)      ║
║  PaO2/FiO2 <300/200/100           ║  ARDS Mild/Moderate/Severe (Berlin)   ║
║  CURB-65 ≥3                       ║  Hospitalize; ≥4 = consider ICU       ║
║  SpO2 target in COPD              ║  88-92% (NOT >94%)                    ║
║  PMN ≥250/mm³                     ║  SBP diagnosis                        ║
║  SAAG ≥1.1 g/dL                  ║  Portal hypertension                  ║
║  ADA >40 U/L                      ║  TB peritonitis, pleural TB           ║
║  SOFA ≥2                          ║  Sepsis (organ dysfunction)           ║
║  Lactate >2 + vasopressors        ║  Septic shock                         ║
║  MAP target                       ║  ≥65 mmHg in septic shock             ║
║  Creat increase ≥0.3 mg/dL       ║  AKI Stage 1 (KDIGO)                  ║
║  pH <7.30 alone                   ║  ALF: list for transplant (paracet.)  ║
║  INR >6.5                         ║  ALF: list for transplant (non-parac.)║
║  MELD ≥15                         ║  Benefit from transplant listing      ║
║  Wells >4                         ║  PE likely; go to CTPA directly       ║
║  NIHSS >20                        ║  Severe stroke                        ║
║  DKA: pH <7.00                    ║  Severe DKA (HDU/ICU)                ║
║  DKA: K+ <3.5                     ║  HOLD insulin; give K first           ║
║  Colon >6cm + systemic toxicity   ║  Toxic megacolon (surgical)          ║
║  CD4 <100/µL                      ║  Cryptococcal meningitis risk (HIV)   ║
║  CD4 <50/µL                       ║  CMV retinitis/encephalitis risk      ║
║  sPESI = 0                        ║  Low-risk PE; consider early DC       ║
╚═══════════════════════════════════╩═══════════════════════════════════════╝

SOURCES: Harrison's Principles of Internal Medicine 21st Ed. | Davidson's Principles & Practice of Medicine 23rd Ed. | Goldman-Cecil Medicine (SOFA table, direct text) | GOLD Guidelines 2024 | GINA 2024 | Sepsis-3 Singer et al. JAMA 2016 | KDIGO AKI 2012 | ESC Heart Failure 2021 | ESC PE 2019 | ADA Standards of Care 2024 | WHO TB Guidelines 2022 | EASL Guidelines: Decompensated Cirrhosis | IDSA/ATS CAP Guidelines | O'Grady KCC for ALF | Ann Arbor/Cotswolds Staging | AJCC TNM 8th Edition

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