How to manage a condition the right way — for each one: who gets it, red flags, how to work it up, how to manage it, and the drug dosing — grounded in WHO, ICMR and professional-society guidance (Standard Treatment Guidelines / Workflows), with the source on every card. For students, interns and residents to refer with confidence.
Persistently raised arterial pressure (≥140/90 mmHg) — a leading, modifiable cause of stroke, heart attack, heart failure and kidney disease.
Chronic hyperglycaemia from insulin resistance plus relative insulin deficiency — a major driver of cardiovascular, renal, eye and nerve disease.
Infection by Mycobacterium tuberculosis. India's National TB Elimination Programme (NTEP) provides free diagnosis and treatment; every case must be notified.
Acute, life-threatening systemic hypersensitivity with airway, breathing or circulation compromise within minutes of a trigger. Intramuscular adrenaline is the immediate, life-saving treatment.
Acute diarrhoea (± vomiting), usually a self-limiting viral illness. The danger is dehydration; low-osmolarity ORS plus zinc are the evidence-based core of treatment.
Acute lower-respiratory infection acquired outside hospital — fever, cough, sputum and breathlessness with a new infiltrate on chest X-ray. Streptococcus pneumoniae is the commonest cause.
An Aedes-borne viral febrile illness. Most cases self-limit, but plasma leakage can cause severe dengue — early recognition of warning signs and careful fluid therapy save lives.
A medical emergency from a venomous snakebite. In India the “Big Four” (cobra, krait, Russell's viper, saw-scaled viper) cause neurotoxic and/or haemotoxic envenomation. Polyvalent anti-snake venom (ASV) is the antidote; many bites are “dry”.
Life-threatening organ dysfunction from a dysregulated host response to infection. Early recognition and the “hour-1 bundle” save lives; septic shock adds fluid-refractory hypotension.
Acute myocardial ischaemia — STEMI, NSTEMI or unstable angina. STEMI needs immediate reperfusion: “time is muscle”.
Chronic airway inflammation with variable, reversible airflow obstruction — wheeze, cough, breathlessness and chest tightness. Inhaled corticosteroids are the cornerstone; never treat with a reliever alone.
A mosquito-borne protozoal (Plasmodium) febrile illness. In India P. vivax and P. falciparum predominate; prompt diagnosis and species-specific treatment prevent severe disease.
The commonest anaemia — low haemoglobin from depleted iron stores (microcytic, hypochromic). Always find and treat the CAUSE, not just the number.
Structured pregnancy care to keep mother and baby healthy — screening, supplementation, immunisation and danger-sign education across scheduled contacts.
A sudden focal neurological deficit from cerebral ischaemia (or haemorrhage). “Time is brain” — urgent imaging then reperfusion for eligible ischaemic stroke.
Chronic, progressive airflow limitation (not fully reversible) from noxious exposures — persistent cough, sputum and breathlessness. Smoking and biomass smoke are the key causes.
Deficient thyroid hormone — fatigue, weight gain, cold intolerance, constipation, dry skin and bradycardia. Levothyroxine replacement titrated to TSH.
Infection of the urinary tract — lower (cystitis) or upper (pyelonephritis). Escherichia coli is the commonest cause; distinguish uncomplicated from complicated infection.
Rabies is almost 100% fatal once symptomatic but almost 100% preventable with correct post-exposure prophylaxis (PEP). Treat every mammal bite as an emergency for wound care and risk assessment.
A seizure lasting ≥5 minutes, or repeated seizures without recovery in between, is status epilepticus — a time-critical emergency. Stop the seizure quickly and find the cause.
An acute hyperglycaemic emergency of insulin deficiency — hyperglycaemia, ketosis and metabolic acidosis. Fluids, fixed-rate insulin and potassium are the pillars of treatment.
A life-threatening infection of the meninges — fever, headache, neck stiffness, photophobia and altered consciousness. Do not delay antibiotics.
Rapid onset or worsening of heart-failure symptoms — breathlessness, orthopnoea and oedema, often with pulmonary congestion. Relieve congestion and find the trigger.
Mucosal ulceration of the stomach or duodenum — epigastric pain and dyspepsia, sometimes bleeding. Helicobacter pylori and NSAIDs are the two main causes.
Excess thyroid hormone — weight loss, palpitations, tremor, heat intolerance, anxiety and diarrhoea. Graves' disease is the commonest cause; thyroid storm is a life-threatening emergency.
Cholinesterase-inhibitor (pesticide) poisoning causing a cholinergic crisis. Atropine plus an oxime and supportive care are life-saving; very common in rural India.
Acute inflammation of the appendix — the commonest surgical acute abdomen. Classically peri-umbilical pain that migrates to the right iliac fossa. Prompt surgery prevents perforation.
Pre-eclampsia = new hypertension with proteinuria or organ dysfunction after 20 weeks; eclampsia adds seizures. Magnesium sulfate prevents/treats the seizures and delivery is the definitive cure.
A systemic infection by Salmonella Typhi/Paratyphi — stepwise fever, headache, abdominal symptoms and relative bradycardia. Blood culture confirms it; antibiotic resistance is rising.
A high serum potassium — a potentially fatal emergency because of cardiac arrhythmia. Protect the heart, shift potassium into cells, then remove it.
Acetaminophen overdose can cause fatal hepatotoxicity, often with few early symptoms. N-acetylcysteine (NAC) is a highly effective antidote when given in time.
Acute inflammation of the pancreas — severe epigastric pain radiating to the back, vomiting and raised enzymes. Gallstones and alcohol are the leading causes.
HIV is a chronic, manageable infection. 'Test and treat' — start antiretroviral therapy in everyone diagnosed, regardless of CD4 — restores immunity and prevents transmission (undetectable = untransmittable).
A common mental disorder — persistent low mood and/or loss of interest for ≥2 weeks with cognitive and physical symptoms and functional impairment. It is very treatable.
An acute bacterial infection of the skin and subcutaneous tissue — spreading redness, warmth, swelling and tenderness, usually of a lower limb. Streptococci and Staphylococcus aureus are the main organisms.
An abrupt fall in kidney function (a rising creatinine and/or falling urine output). Find and reverse the cause, stop nephrotoxins, and manage the complications.
Reflux of gastric contents causing heartburn and regurgitation, sometimes with oesophagitis. Managed with lifestyle change and acid suppression.
An acute middle-ear infection, common in children — ear pain, fever and a bulging, red tympanic membrane. Most are self-limiting; analgesia is the priority.
A common presentation ranging from benign conjunctivitis to sight-threatening emergencies. The key skill is spotting the dangerous red eye.
An intensely itchy skin infestation by the mite Sarcoptes scabiei — worse at night, with burrows in the finger webs and flexures. Treat the patient AND all close contacts together.
A zoonotic spirochaetal infection (Leptospira) from water/soil contaminated with animal (rodent) urine — common after monsoon/flood exposure. It ranges from a mild fever to severe Weil's disease.
A low blood glucose (typically <70 mg/dL / <4 mmol/L) with autonomic and neuroglycopenic symptoms — a treatable emergency, especially on insulin or sulfonylureas.
Bleeding from the oesophagus, stomach or duodenum — haematemesis and/or melaena. Resuscitate first, risk-stratify, then endoscopy; variceal bleeds need specific therapy.
Longstanding (≥3 months) reduced kidney function and/or kidney damage. The goals are to slow progression, protect the heart, and manage complications.
Glucose intolerance first recognised in pregnancy. Good control reduces macrosomia, birth trauma and neonatal problems; most cases resolve after delivery.
A pregnancy implanted outside the uterine cavity (usually the fallopian tube). Rupture causes life-threatening haemorrhage — a can't-miss diagnosis in any woman of reproductive age with pain or bleeding.
Inflammation of the liver from hepatitis viruses. A and E spread faeco-orally (usually acute, self-limiting); B and C spread via blood/sexual/vertical routes and can become chronic, causing cirrhosis and liver cancer.
A mite-borne rickettsial infection (Orientia tsutsugamushi) — fever, headache, myalgia and often a painless eschar. Common in the monsoon in endemic Asia; it responds rapidly to doxycycline.
Thermal, chemical or electrical injury to the skin (and sometimes the airway). Assess the airway, estimate the burned area, and resuscitate with fluids — early structured care saves lives.
Trauma to the head/brain, from concussion to life-threatening intracranial haemorrhage. Assess consciousness (GCS), image the right patients, and prevent secondary brain injury.
A low serum sodium — the commonest electrolyte disturbance. Assess severity, acuity and volume status, and correct carefully to avoid osmotic demyelination.
Life-threatening circulatory failure with inadequate tissue perfusion. Recognise it early, restore perfusion, and treat the type-specific cause.
Ascending infection of the upper female genital tract (uterus, tubes, ovaries) — often from gonorrhoea/chlamydia. Prompt broad-spectrum antibiotics prevent infertility and ectopic pregnancy.
A clot in the deep veins (DVT) that can embolise to the lungs (PE). Suspect, risk-score, confirm, and anticoagulate; a massive PE with shock needs thrombolysis.
A low serum potassium — usually from losses or intracellular shift. It risks arrhythmia; replace potassium, correct magnesium, and treat the cause.
A life-threatening lack of cortisol (± aldosterone) — hypotension/shock, often with low sodium, high potassium and low glucose. Give steroids and fluids immediately; do not wait for tests.
A spectrum from tremor/anxiety to seizures and delirium tremens after stopping or cutting down alcohol in dependence. Benzodiazepines and thiamine are the mainstays; delirium tremens can be fatal.
Bleeding from the nose — usually anterior (Little's area) and self-limiting, occasionally posterior and serious. First aid controls most; find and treat the cause.
A serious bloodstream infection in the first 28 days of life. The signs are non-specific — treat early and empirically; delay is dangerous.
Excessive bleeding after birth (≥500 mL vaginal / ≥1000 mL caesarean, or any amount causing instability) — a leading cause of maternal death. Uterine atony is the commonest cause.
A seizure with fever in a young child (6 months–5 years) without CNS infection or another cause. It is usually benign, but exclude serious causes and support the family.
Severe blood-pressure elevation (usually >180/120 mmHg) WITH acute target-organ damage (brain, heart, kidney, retina). Needs controlled IV lowering — distinct from asymptomatic severe hypertension ('urgency').
The commonest sustained arrhythmia — an irregularly irregular pulse with no P waves on ECG. The two key harms are stroke (thromboembolism) and heart failure; management is rate/rhythm control plus stroke-risk-based anticoagulation.
Inflammation of the pericardium — sharp, pleuritic chest pain that eases sitting forward, a pericardial friction rub, and widespread saddle-shaped ST elevation with PR depression. Usually viral/idiopathic and self-limiting; the danger is tamponade.
Air in the pleural space collapsing the lung — sudden breathlessness and pleuritic pain with reduced breath sounds. Tension pneumothorax is immediately life-threatening and is treated BEFORE any imaging.
Inflammation of the gallbladder, usually from an obstructing gallstone — constant right-upper-quadrant pain, fever and a positive Murphy's sign. Biliary colic is transient pain from a stone WITHOUT inflammation.
The triad of heavy proteinuria (>3.5 g/day), hypoalbuminaemia and oedema, usually with hyperlipidaemia. In children it is most often minimal-change disease and steroid-responsive.
Raised serum calcium — remembered as 'stones, bones, groans and psychiatric moans' (renal stones, bone pain, abdominal/constipation, confusion). Most cases are primary hyperparathyroidism or malignancy.
A viral lower-respiratory infection of infants (usually under 2 years, most often RSV) — coryza followed by wheeze, fine crackles and feeding difficulty. Management is supportive.
A viral upper-airway infection (usually parainfluenza) — a barking, seal-like cough, stridor and hoarseness in a young child, typically worse at night. A single dose of corticosteroid (dexamethasone) is the key treatment.
Yellow discolouration from raised bilirubin in a newborn — very common. Most is benign physiological jaundice, but pathological causes must be identified and treated to prevent kernicterus (bilirubin brain injury).
A highly contagious viral illness — fever with cough, coryza and conjunctivitis (the 3 C's), Koplik spots, then a descending maculopapular rash. It is vaccine-preventable, and vitamin A reduces complications and mortality.
A toxin-mediated disease from Clostridium tetani entering a wound — painful muscle spasms, trismus (lockjaw), risus sardonicus and rigidity. It is vaccine-preventable and needs wound care, toxin neutralisation and spasm control.
Fluid in the pleural space — breathlessness, pleuritic pain, stony-dull percussion and reduced breath sounds. Split into transudate (systemic, e.g., heart failure) vs exudate (local, e.g., infection, TB, malignancy) using Light's criteria.
Sudden loss of arterial perfusion to a limb — a surgical emergency. The 6 Ps: Pain, Pallor, Pulselessness, Paraesthesia, Paralysis and Perishing cold. Muscle and nerve injury begin within hours.
Raised pressure within a closed fascial compartment cuts off perfusion — a limb-threatening surgical emergency. Pain out of proportion and pain on passive stretch are the earliest signs; fasciotomy is the treatment.
An acute worsening of ulcerative colitis or Crohn's disease — bloody diarrhoea, abdominal pain, urgency and systemic upset. Acute severe ulcerative colitis is a medical emergency.
Acute glomerular inflammation producing the nephritic picture — haematuria (often smoky/cola-coloured urine), hypertension, oedema and some renal impairment. Post-streptococcal GN is the classic paediatric cause; watch for rapidly progressive GN.
A raised serum sodium — almost always a water problem (water deficit relative to sodium). Thirst and lethargy progress to irritability, seizures and coma. Correct SLOWLY to avoid cerebral oedema.
A low serum calcium producing neuromuscular irritability — paraesthesia, cramps, carpopedal spasm, Chvostek's and Trousseau's signs, and (if severe) tetany, seizures or arrhythmia (long QT).
Labour before 37 completed weeks — the leading cause of newborn illness and death. Timely antenatal corticosteroids and magnesium for neuroprotection substantially improve outcomes.
Labour that fails to progress despite good contractions because the fetus cannot pass through the pelvis — a major cause of maternal death and obstetric fistula if unrelieved. The partograph detects it early.
An acute disturbance with loss of contact with reality (delusions, hallucinations, disorganisation) and/or an elevated or irritable mood with overactivity. First priorities: keep everyone safe and exclude an organic (medical or drug) cause.
Excessive, hard-to-control worry on most days for at least six months, with physical symptoms — restlessness, fatigue, poor concentration, irritability, muscle tension and disturbed sleep — causing distress or impairment.
Primary varicella-zoster infection — fever then an itchy vesicular rash appearing in crops at different stages ('dew drops on a rose petal'). Usually mild in children but more severe in adults, pregnancy and the immunocompromised.
A life-threatening emergency of type 2 diabetes — very high glucose, marked hyperosmolality and profound dehydration WITHOUT significant ketosis or acidosis. It develops more slowly than DKA and carries a higher mortality.
A regular narrow-complex tachycardia arising above the ventricles (commonly AV-nodal re-entry) — sudden palpitations, often in a young, otherwise-well person. Vagal manoeuvres and adenosine usually terminate it.
Infection of the endocardial surface, usually a heart valve — fever with a new or changing murmur, embolic phenomena and constitutional symptoms. Diagnosis rests on blood cultures and echocardiography; treatment is prolonged antibiotics ± surgery.
An immune reaction some weeks after a group-A streptococcal throat infection, diagnosed by the Jones criteria (carditis, migratory arthritis, chorea, erythema marginatum, subcutaneous nodules). Carditis leads to rheumatic heart disease; secondary prophylaxis prevents recurrence.
A tear in the aortic intima with blood tracking within the wall — sudden, severe, tearing chest or interscapular back pain. A true emergency: type A (ascending) needs surgery; type B (descending) is often managed medically.
Bleeding into the subarachnoid space, usually from a ruptured berry aneurysm — a sudden 'thunderclap', worst-ever headache, often with neck stiffness, photophobia and reduced consciousness. A neurosurgical emergency.
An acute immune-mediated polyneuropathy — progressive, usually ascending, symmetrical weakness with reduced or absent reflexes, often after an infection. The dangers are respiratory failure and autonomic instability.
Blockage of the bowel — colicky abdominal pain, vomiting, distension and absolute constipation (no flatus or stool). Small-bowel obstruction is often adhesions or hernia; large-bowel is often malignancy or volvulus. The danger is strangulation.
A reversible neuropsychiatric syndrome in liver failure or cirrhosis — confusion, altered sleep and asterixis (flapping tremor) that can progress to coma. There is almost always a precipitant to find and treat.
Severe loin-to-groin colicky pain from a stone in the urinary tract, often with haematuria, nausea and a restless patient. Most small stones pass; the emergency is an obstructed, infected kidney.
Severe wasting and/or nutritional oedema in a young child — very low weight-for-height, a low mid-upper-arm circumference, or bilateral pitting oedema. Managed by the WHO 10-step protocol; the great danger is refeeding.
A life-threatening rise in core temperature (typically above 40°C) with central-nervous-system dysfunction (confusion, seizures, coma) and multi-organ risk. Rapid cooling saves lives — cool first, transport second.
Loss of a pregnancy before viability — bleeding and/or pain in early pregnancy. Types range from threatened (viable, closed os) to inevitable, incomplete, missed and complete. Exclude ectopic pregnancy in any early-pregnancy bleeding.
A rare, life-threatening exacerbation of thyrotoxicosis — high fever, tachycardia or atrial fibrillation, agitation/delirium, vomiting/diarrhoea and heart failure. It is a clinical diagnosis; treat before labs confirm.
The extreme, decompensated end of hypothyroidism — hypothermia, reduced consciousness, hypoventilation, bradycardia and hyponatraemia, typically in an elderly patient in winter. High mortality; treat empirically.
A slow heart rate or atrioventricular conduction block causing symptoms — dizziness, syncope, fatigue or heart failure. Complete (third-degree) heart block is dangerous and may need pacing.
The sudden loss of effective circulation — unresponsive, not breathing normally, no pulse. Survival depends on early high-quality CPR and, for shockable rhythms (VF/pulseless VT), early defibrillation.
Rapid loss of liver function with coagulopathy (raised INR) and hepatic encephalopathy in someone WITHOUT pre-existing chronic liver disease. It is multi-organ and high-mortality; some need transplantation.
An inherited haemoglobinopathy (HbS) causing chronic haemolytic anaemia and painful vaso-occlusive crises, with risks of infection, acute chest syndrome, stroke and cumulative organ damage.
Widespread inappropriate activation of coagulation that consumes platelets and clotting factors — causing simultaneous microvascular thrombosis AND bleeding. It is always secondary to an underlying trigger.
A common primary headache — recurrent, moderate-to-severe, often unilateral throbbing pain with nausea and light/sound sensitivity, sometimes preceded by an aura. The diagnosis is clinical once red flags are excluded.
Acute, unilateral lower-motor-neurone facial weakness (the forehead IS involved) with no other cause — often with ear pain, altered taste and sound sensitivity. Most recover; early corticosteroids improve the outcome.
A crystal arthritis from monosodium-urate deposition — an acutely hot, swollen, exquisitely tender joint (classically the first big-toe joint). Recurrent attacks and tophi follow chronic hyperuricaemia.
A chronic autoimmune symmetrical polyarthritis of the small joints (hands and feet) with early-morning stiffness lasting over 30–60 minutes; untreated it erodes joints and has systemic effects. Early DMARDs change the course.
A chronic, itchy, relapsing inflammatory skin condition — dry skin with flexural involvement in children; part of the atopic triad (with asthma and allergic rhinitis). Managed by skin-barrier care and controlling flares.
A chronic immune-mediated skin disease — well-demarcated, salmon-pink plaques with silvery scale, typically on extensor surfaces and the scalp. It is associated with psoriatic arthritis and cardiometabolic risk.
A sudden rise in intraocular pressure from blockage of aqueous drainage — a painful red eye with blurred vision, haloes around lights, headache and nausea/vomiting, with a fixed mid-dilated pupil. A sight-threatening emergency.
Acute inflammation of the pharynx/tonsils — sore throat, pain on swallowing, fever and tender neck nodes. Most cases are viral; the key is spotting group-A streptococcal ('strep') throat, which benefits from antibiotics and prevents complications.
Immune-mediated destruction of platelets causing isolated thrombocytopenia — bruising, petechiae and mucosal bleeding with an otherwise normal blood count and film. It is a diagnosis of exclusion.
Bleeding abnormal in amount, timing or duration. It is organised by the PALM-COEIN system — structural causes (polyp, adenomyosis, leiomyoma, malignancy) and non-structural (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not-yet-classified).
A common endocrine disorder — the Rotterdam criteria require two of: oligo/anovulation, clinical or biochemical hyperandrogenism (acne, hirsutism), and polycystic ovaries on ultrasound. It is closely linked with insulin resistance and metabolic risk.
Any act of intentional self-injury or self-poisoning, with or without suicidal intent — a common emergency and a key opportunity to treat the physical consequences, assess risk, and offer help.
A sexually (and vertically) transmissible infection by Treponema pallidum — a painless genital ulcer (chancre) in primary disease, a rash including palms and soles in secondary, then latency and destructive tertiary disease. It is curable with penicillin.
A sexually transmitted infection by Neisseria gonorrhoeae — urethral or vaginal discharge and dysuria, frequently co-existing with chlamydia. Rising antimicrobial resistance makes guideline-directed therapy essential.
A toxin-mediated infection — a sore throat with a characteristic adherent grey pseudomembrane over the tonsils/pharynx, a 'bull-neck' from lymphadenopathy, and toxin-mediated myocarditis and neuropathy. Vaccine-preventable; give antitoxin early.
A highly contagious respiratory infection by Bordetella pertussis — catarrhal coryza then paroxysmal coughing fits with an inspiratory 'whoop' and post-tussive vomiting. Young infants may present with apnoea rather than a whoop. Vaccine-preventable.
The commonest joint disorder — cartilage loss with pain and stiffness that worsen with use and ease with rest (short-lived morning stiffness under 30 minutes), commonly affecting knees, hips, hands and spine.
Reduced bone mass and quality that increases fracture risk — often silent until a fragility fracture (wrist, hip, vertebra). Diagnosed by a fragility fracture or low bone density (DXA T-score ≤ −2.5).
IgE-mediated nasal inflammation from allergen exposure — sneezing, itch, watery rhinorrhoea and nasal blockage, often with itchy watery eyes. It is part of the atopic spectrum and strongly linked with asthma.
Inflammation of the nose and paranasal sinuses — nasal blockage/congestion, facial pain or pressure, and discharge with reduced smell, usually following a viral URTI. Most cases are viral and self-limiting; only a minority are bacterial.
Brief episodes of spinning triggered by head-position change (rolling over, looking up) from displaced otoconia in a semicircular canal — the commonest cause of vertigo. It is diagnosed and treated at the bedside.
Age-related non-cancerous prostate enlargement causing lower urinary tract symptoms — hesitancy, a weak stream, incomplete emptying, frequency and nocturia. Complications include acute retention and infection.
A progressive neurodegenerative disorder from dopaminergic loss — the classic triad of resting tremor, rigidity and bradykinesia, usually asymmetrical, with postural instability later and many non-motor features.
An acquired, progressive decline in cognition (memory, language, executive function) that impairs daily function, with clear consciousness (unlike delirium). Alzheimer's is commonest; also vascular, Lewy body and frontotemporal types.
Clouding of the lens causing gradual, painless blurring of vision, glare and faded colours — the leading cause of reversible blindness worldwide, and cured by surgery.
An acute, fluctuating disturbance of attention and awareness with disorganised thinking, caused by an underlying medical problem — very common in hospital, often missed, and linked to poor outcomes. It may be hyperactive, hypoactive (easily missed) or mixed.
Inflammation or infection of the external ear canal — ear pain (worse on moving the tragus/pinna), itch, discharge and a red, swollen canal. Usually bacterial or fungal; watch for the dangerous necrotising ('malignant') form.
Inflammation of the conjunctiva — a red eye with discharge, usually NON-painful and with normal vision. Causes are viral (commonest), bacterial and allergic; the key skill is excluding the sight-threatening causes of a red eye.
A chronic, usually painless optic neuropathy with progressive loss of peripheral vision, commonly (but not always) with raised intraocular pressure — a leading cause of irreversible blindness. It is silent until advanced, so early detection matters.
Microvascular damage to the retina from chronic diabetes — the leading cause of blindness in working-age adults. Often asymptomatic until advanced; graded from non-proliferative to sight-threatening proliferative disease and diabetic macular oedema.
A tendency to recurrent unprovoked seizures. Diagnosis is largely clinical (a good witnessed account) and classification (focal vs generalised) guides drug choice; most people become seizure-free on a single well-chosen anti-seizure medication.
A chronic immune-mediated demyelinating disease of the central nervous system — neurological episodes 'disseminated in time and space' (optic neuritis, sensory/motor/cerebellar/brainstem symptoms). Most begin as relapsing-remitting.
An autoimmune disorder of the neuromuscular junction (usually anti-acetylcholine-receptor antibodies) causing FATIGABLE weakness that worsens with use and improves with rest — classically ptosis, diplopia, and bulbar and proximal weakness. Myasthenic crisis (respiratory failure) is the emergency.
Symptomatic enlargement of the anal vascular cushions — bright-red painless bleeding on defecation, pruritus, prolapse, or (if thrombosed) acute pain. Internal haemorrhoids are graded I–IV. A very common, benign cause of rectal bleeding — but sinister causes must be excluded.
A tear in the anal lining causing severe pain during and after defecation, often with a little bright-red bleeding — commonly from passing a hard stool. Most are in the posterior midline; a sphincter-spasm cycle keeps them from healing.
Protrusion of a viscus or tissue through a defect in the abdominal wall — a lump that often appears on straining and may reduce on lying down. The danger is incarceration and strangulation (a surgical emergency).
Methods to prevent pregnancy — chosen with the person by effectiveness, safety (WHO Medical Eligibility Criteria) and preference. Long-acting reversible contraception (LARC — implants and intrauterine methods) is the most effective, 'fit-and-forget' option.
The permanent cessation of menstruation (12 months of amenorrhoea) from ovarian follicular loss — with vasomotor symptoms (hot flushes, night sweats), genitourinary symptoms, mood/sleep changes and long-term bone/cardiovascular effects. HRT effectively treats symptoms in suitable women.
Inherited disorders of globin-chain synthesis causing microcytic haemolytic anaemia. Severity ranges from a silent carrier/trait (thalassaemia minor) to transfusion-dependent thalassaemia major; a major public-health issue in India and the Mediterranean.
An X-linked inherited deficiency of clotting factor VIII (haemophilia A) or IX (haemophilia B) causing a bleeding tendency — spontaneous or trauma-related bleeds into joints (haemarthrosis) and muscles, and prolonged bleeding after injury or surgery.
An acute medium-vessel vasculitis of young children — persistent high fever with conjunctivitis, rash, adenopathy, strawberry tongue/mucositis and hand-foot changes. The critical complication is coronary-artery aneurysms; timely IVIG prevents them.
The clinical state of chronic cortisol excess — central obesity, moon face, purple striae, proximal myopathy, easy bruising, hypertension, glucose intolerance and osteoporosis. Most cases are EXOGENOUS (steroid therapy); endogenous causes are ACTH-dependent (pituitary 'Cushing's disease', ectopic) or adrenal.
Excess growth hormone (almost always from a pituitary adenoma) in adults — insidious enlargement of the hands, feet and jaw (coarse features), with headaches, sweating, arthralgia and systemic effects (hypertension, diabetes, cardiomyopathy, sleep apnoea). Before growth-plate fusion in children it causes gigantism.
Inappropriate ADH secretion causing water retention and EUVOLAEMIC hyponatraemia with concentrated urine — a common cause of hyponatraemia. It is a diagnosis of exclusion (normal thyroid, adrenal and renal function, no diuretics).
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