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Approach to presentations

Students meet symptoms before they meet diagnoses. Every presentation runs the same eight-step frame: immediate threats, history, exam, representation, differential, investigations, interpretation, next steps.

29 presentations
Eight steps each

DyspneaFirst threat: Hypoxia needing oxygen now (SpO2, work of breathing, mentation)

Chest painFirst threat: ACS: the ECG within 10 minutes of arrival

Acute kidney injuryFirst threat: Hyperkalemia with ECG changes

Confusion / altered mental statusFirst threat: Hypoglycemia: glucose at the bedside, immediately

GI bleedingFirst threat: Hemodynamic instability: two large-bore IVs before any diagnostics

Fever in the hospitalFirst threat: Septic shock physiology

SyncopeFirst threat: Arrhythmic syncope: no warning, during exertion, or while supine

PalpitationsFirst threat: Sustained VT or rapid pre-excited AF

JaundiceFirst threat: Ascending cholangitis: fever, rigors, RUQ pain with jaundice

Peripheral edemaFirst threat: Unilateral swelling is DVT until reasoned otherwise

Acute joint painFirst threat: Septic arthritis: the hot joint that destroys cartilage in days

Unintentional weight lossFirst threat: Occult malignancy, especially GI, pancreatic, and lymphoma

AnaphylaxisFirst threat: Airway edema: voice change, tongue swelling, stridor

Falls in the older patientFirst threat: Head injury on anticoagulation: scan generously

Polyuria & polydipsiaFirst threat: New diabetes tipping into DKA or hyperosmolar state

Shock & hypotensionFirst threat: All of it: shock is the threat; the question is which engine failure

HeadacheFirst threat: Thunderclap onset (peak within a minute): subarachnoid hemorrhage until excluded

First seizureFirst threat: Ongoing or recurring seizure at 5 minutes: status epilepticus, benzodiazepine now

Focal weaknessFirst threat: Sudden focal deficit is a stroke code: time of onset (or last seen well) decides therapy eligibility

Acute abdominal painFirst threat: Peritonitis (rigid, silent abdomen) or free air: surgical review now, not after imaging

HemoptysisFirst threat: Massive hemoptysis (over ~100 mL or any airway compromise): the threat is asphyxiation, not exsanguination

Back pain with red flagsFirst threat: Cauda equina: saddle anesthesia, retention with overflow, bilateral leg symptoms: MRI within hours, not days

Acute diarrheaFirst threat: Shock and profound dehydration, most dangerous at the extremes of age

DysuriaFirst threat: Fever, flank pain, or rigors on top of dysuria: pyelonephritis, and with shock, urosepsis

Bruising and bleedingFirst threat: Bleeding into a closed space: head, airway and neck, retroperitoneum: image and correct in parallel

HypoglycemiaFirst threat: Neuroglycopenia (confusion, seizure, coma) is brain injury in progress: glucose now, by any working route

AnemiaFirst threat: Active bleeding with hemodynamic change: the falling hemoglobin with a rising heart rate

ThrombocytopeniaFirst threat: Thrombotic thrombocytopenic purpura: fragments on the film with thrombocytopenia is plasma exchange tonight

Rash on the wardFirst threat: A non-blanching rash with fever: meningococcal sepsis until proven otherwise