Lymphadenopathy

Associated systemic disease — bilateral hilar lymphadenopathy (sarcoidosis), IBD symptoms, recent streptococcal infectio

AIDS-defining illness, very low CD4, seroconversion illness, needle-stick/exposure (PEP within 72h)

Mediastinal mass with SVC obstruction, or airway/cord compression → oncological emergency

Don't give blind/empirical antibiotics or steroids before a diagnosis (unless septic) — they obscure the picture

Cardiac sarcoid (arrhythmia/heart block), neurosarcoidosis, or sight-threatening uveitis → urgent specialist treatment

Neutropenic sepsis, bleeding from thrombocytopenia/DIC, or tumour lysis syndrome → emergencies

≥30 with an unexplained breast lump → suspected-cancer pathway (2-week-wait); ≥50 with unilateral nipple changes (discha

Always exclude HIV and syphilis co-infection; fluctuant buboes may need aspiration

Any white pupillary reflex (leukocoria) → urgent ophthalmology; persistent unexplained bruising/pallor/bone pain; a chil

CLL with rapidly enlarging node/systemic symptoms → Richter transformation

Systemic illness, rapid spread, periocular involvement (risk to sight) → same-day admission, IV aciclovir, ophthalmology

Haemodynamic instability, hypothermia, high-output failure, secondary sepsis — admit

Hoarseness, fixed/hard nodule, rapid growth, cervical nodes, or stridor → suspected cancer pathway / urgent

AIDS-defining illness (PCP, cryptococcal meningitis, cerebral toxoplasmosis, CMV retinitis) → urgent specialist treatmen

Significant mucosal/GI bleeding; suspected intracranial bleed (severe headache/neuro signs) — rare but serious

SPLENOMEGALY → risk of splenic rupture (avoid contact sport for ~4–6 weeks); rarely airway compromise from massive tonsi

Macrophage activation syndrome in systemic JIA (cytopenias, very high ferritin, coagulopathy) → emergency

Coronary artery aneurysms — the feared complication; incomplete Kawasaki in infants

Haemoptysis/persistent cough/weight loss in a smoker → urgent 2-week-wait referral + urgent CXR (NICE NG12)

Measles in pregnancy/immunosuppressed, or with encephalitis/pneumonia → severe; rubella exposure in a pregnant woman → u

Do not miss appendicitis — if in doubt, observe/image/operate

Any persistent penile lesion/ulcer → biopsy (don't dismiss as infection/balanitis)

TB meningitis / disseminated (miliary) TB → urgent treatment; airborne isolation for suspected active pulmonary TB

Exposure in pregnancy → congenital rubella syndrome (deafness, cataracts, congenital heart disease — PDA)

Neurosyphilis (ocular/auditory/neurological), congenital syphilis, cardiovascular involvement

Rapidly enlarging hard mass + stridor/hoarseness in the elderly → anaplastic — urgent airway/oncology

Cerebral toxoplasmosis in HIV → urgent treatment; the key differential is primary CNS lymphoma (both ring-enhancing)

Lyme carditis (heart block) or neuroborreliosis → specialist treatment (IV ceftriaxone)

Pain out of proportion, rapid spread, crepitus, dusky/necrotic skin, systemic toxicity → necrotising fasciitis (surgical