CARDIOVASCULAR SYSTEM (CVS)

Pattern: Myocardial Infarction (Inferior Wall)
- Presentation: Middle-aged male with retrosternal chest pain, sweating, and vomiting.
- Key Clue: ECG shows ST elevation in leads II, III, and aVF. Bradycardia is often present (RCA supply to SA/AV node).
- Diagnosis/Step: Inferior Wall MI. Avoid Nitrates if RV infarction is suspected; treat with Aspirin/PCI.
Pattern: Cardiac Tamponade
- Presentation: Patient with chest trauma or malignancy presents with hypotension, distended neck veins, and muffled heart sounds (Beck’s Triad).
- Key Clue: Pulsus Paradoxus (BP drop >10mmHg on inspiration) or Electrical Alternans on ECG.
- Diagnosis/Step: Cardiac Tamponade —->Immediate Pericardiocentesis.
Pattern: Constrictive Pericarditis
- Presentation: Patient with history of TB presents with ascites, pedal edema, and dyspnea.
- Key Clue: Kussmaul’s Sign (JVP rises on inspiration) or Pericardial Knock (S3). X-ray may show pericardial calcification.
- Diagnosis/Step: Constrictive Pericarditis,.

RESPIRATORY SYSTEM

Pattern: Tension Pneumothorax
- Presentation: Trauma patient or COPD patient with sudden onset severe breathlessness and hypotension.
- Key Clue: Trachea deviated to opposite side, hyper-resonant percussion note, absent breath sounds on affected side.
- Diagnosis/Step: Tension Pneumothorax —->Needle Decompression (Immediate) before Chest X-ray,.
Pattern: Pleural Effusion
- Presentation: Patient with gradual breathlessness, stony dullness on percussion, and decreased breath sounds.
- Key Clue: X-ray shows homogeneous opacity with a curved upper margin (Meniscus sign).
- Diagnosis/Step: Pleural Effusion —->Diagnostic Thoracocentesis,.
Pattern: Fat Embolism Syndrome
- Presentation: Young patient with long bone fracture (femur) develops sudden breathlessness and confusion 24-72 hours post-injury.
- Key Clue: Petechial rash on chest/axilla + Hypoxia + Confusion.
- Diagnosis/Step: Fat Embolism Syndrome —->Supportive care (Oxygen/Ventilation),.

Pattern: Acute Pancreatitis
- Presentation: Alcoholic male or female with gallstones presents with severe epigastric pain radiating to the back.
- Key Clue: Pain relieved by bending forward; Elevated Serum Amylase/Lipase.
- Diagnosis/Step: Acute Pancreatitis —->IV Fluids & Analgesia (Contrast CT is gold standard),,.
Pattern: Perforation Peritonitis
- Presentation: History of NSAID use or peptic ulcer, presents with sudden severe abdominal pain and a rigid, “board-like” abdomen.
- Key Clue: Chest X-ray shows free gas under the diaphragm.
- Diagnosis/Step: Hollow Viscus Perforation —->Exploratory Laparotomy,,.
Pattern: Intussusception
- Presentation: Infant (6-9 months) with excessive crying, drawing legs to chest, and vomiting.
- Key Clue: “Red Currant Jelly” stools or sausage-shaped mass. USG shows “Target sign”.
- Diagnosis/Step: Intussusception —->Pneumatic/Hydrostatic Reduction,.
Pattern: Hypertrophic Pyloric Stenosis (CHPS)
- Presentation: 3-6 week old first-born male with non-bilious projectile vomiting immediately after feeding.
- Key Clue: Palpable “Olive-shaped mass” in epigastrium. Metabolic Alkalosis.
- Diagnosis/Step: CHPS —->Pyloromyotomy (Ramstedt’s),,.

Pattern: Extradural Hemorrhage (EDH)
- Presentation: Young male hit by cricket ball/trauma to temporal region. Brief loss of consciousness —->Lucid Interval (normalcy) —->rapid deterioration.
- Key Clue: NCCT Brain shows Biconvex (Lens-shaped) hyperdensity limited by suture lines.
- Diagnosis/Step: EDH —->Craniotomy/Evacuation,,.
Pattern: Subarachnoid Hemorrhage (SAH)
- Presentation: Sudden onset “Thunderclap headache” (worst headache of life), neck stiffness, or collapse.
- Key Clue: NCCT shows hyperdensity in Sylvian fissure/cisterns (Star shape).
- Diagnosis/Step: Ruptured Berry Aneurysm (SAH),.
Pattern: Cryptococcal Meningitis
- Presentation: HIV positive patient (low CD4) with chronic headache and neck stiffness.
- Key Clue: CSF India Ink staining shows encapsulated yeast cells.
- Diagnosis/Step: Cryptococcal Meningitis —->Amphotericin B,.

Pattern: Pheochromocytoma
- Presentation: Young patient with episodic headaches, sweating, and palpitations. Found to have severe hypertension.
- Key Clue: Triad of Headache, Sweating, Palpitations. Elevated Urinary VMA/Metanephrines.
- Diagnosis/Step: Pheochromocytoma —->Alpha-blockers (Phenoxybenzamine) before Beta-blockers,,.
Pattern: Hypocalcemia (Tetany)
- Presentation: Patient post-thyroidectomy complains of tingling around mouth and muscle cramps.
- Key Clue: Chvostek’s sign (facial twitch) or Trousseau’s sign (carpopedal spasm) positive.
- Diagnosis/Step: Hypocalcemia —->IV Calcium Gluconate,,.
Pattern: Graves’ Disease
- Presentation: Weight loss despite good appetite, heat intolerance, palpitations, tremors.
- Key Clue: Exophthalmos (proptosis) or Pretibial Myxedema. Low TSH, High T3/T4.
- Diagnosis/Step: Graves’ Disease (Thyrotoxicosis).

Pattern: Ectopic Pregnancy
- Presentation: Female of reproductive age with amenorrhea (6-8 weeks), sudden lower abdominal pain, and spotting.
- Key Clue: Adnexal tenderness/mass + Empty uterus on USG + Beta-hCG levels lower than expected.
- Diagnosis/Step: Ectopic Pregnancy,,.
Pattern: Placenta Previa
- Presentation: Pregnant woman (3rd trimester) with sudden onset painless, causeless bright red vaginal bleeding.
- Key Clue: Uterus is soft/relaxed. NO Per-Vaginal (PV) exam allowed.
- Diagnosis/Step: Placenta Previa —->USG for localization,.
Pattern: Molar Pregnancy
- Presentation: Amenorrhea with uterine size greater than period of gestation, hyperemesis (excessive vomiting).
- Key Clue: USG shows “Snowstorm appearance”. Extremely high Beta-hCG.
- Diagnosis/Step: Hydatidiform Mole —->Suction Evacuation,.

Pattern: Ureteric Colic
- Presentation: Sudden onset severe loin pain radiating to groin/testicle. Patient is restless (cannot find comfortable position).
- Key Clue: Hematuria on urinalysis.
- Diagnosis/Step: Ureteric Calculus —->NCCT KUB (Gold standard).
Pattern: Bladder Cancer
- Presentation: Elderly male (smoker or dye factory worker) with painless, profuse hematuria.
- Key Clue: Cystoscopy shows growth.
- Diagnosis/Step: Transitional Cell Carcinoma (TCC),.