MLA Domain 5 · Presentation
Nausea
30 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.
classic presentation · 7
Generalised peritonitis (perforation) → emergency
Reduced consciousness, neurological signs, cardiac ischaemia, pregnancy → consider hyperbaric oxygen
Aura + COCP (stroke risk → COCP is UKMEC 4); thunderclap or new focal/systemic features → exclude secondary causes (see
Twin-to-twin transfusion syndrome (monochorionic); preterm labour; growth discordance
Syncope on EXERTION, while supine, or with palpitations; abnormal ECG; family history of sudden death; structural heart
New pattern, red-flag features (see panel) → exclude secondary causes; medication-overuse if frequent analgesia
Acute liver FAILURE (coagulopathy, encephalopathy) — fulminant hepatitis (esp. B, E in pregnancy) → specialist/transplan
recognised feature · 23
Painful red eye + haloes + nausea + fixed mid-dilated pupil = AACG — sight-threatening, refer immediately
Sepsis, gangrene/perforation, empyema → urgent surgery
Ongoing pain, haemodynamic instability, arrhythmia, acute heart failure → high-risk, urgent cardiology
Hypoglycaemia, coagulopathy, encephalopathy → fulminant hepatic failure; maternal and fetal emergency
Severe pancreatitis (Glasgow ≥3 / persistent organ failure) → HDU/ITU, high mortality
Addisonian CRISIS: hypotension/shock, vomiting, hyponatraemia, hypoglycaemia, often triggered by illness/surgery → emerg
Delirium tremens and withdrawal seizures are medical emergencies; suspected Wernicke’s → immediate parenteral thiamine
New seizure in an adult, progressive focal deficit, raised-ICP features → urgent imaging; impending herniation
A rapid fall in eGFR, accelerated hypertension, or visible haematuria → investigate for a treatable cause (GN, obstructi
Refractory hyperkalaemia/acidosis/fluid overload or uraemic pericarditis/encephalopathy → urgent dialysis (AEIOU)
Fever + RUQ pain + raised inflammatory markers → cholecystitis (inflammation), not simple colic
Fulminant hepatic failure (acute); cirrhosis/HCC (chronic); pregnancy (vertical transmission)
Severe (>3.5 mmol/L) or symptomatic (confusion, dehydration, arrhythmia) → emergency IV fluids + bisphosphonate
Acute abdomen with an adnexal mass — emergency; delay risks ovarian loss
Papilloedema + focal neurology → urgent neuroimaging for a space-occupying lesion/haemorrhage
Late presentation, staggered overdose, hepatic encephalopathy, raised INR/lactate, acidosis (pH <7.3) → liver-unit crite
Pain starting years after menarche, deep dyspareunia, menorrhagia, or an abnormal examination → suspect a SECONDARY caus
OBSTRUCTED + infected kidney (pyonephrosis) — stone/obstruction with infection → EMERGENCY decompression (nephrostomy/st
Severe acidosis, very high levels, altered consciousness, seizures, renal failure → haemodialysis
Acute severe symptomatic hyponatraemia (seizures, reduced GCS) → hypertonic saline in a controlled setting
Reduced GCS, focal deficit, rebleeding (highest risk first 12h), hydrocephalus, vasospasm (delayed ischaemia)
Severe/rapid hyponatraemia with seizures/coma → hypertonic saline (specialist; avoid overcorrection → osmotic demyelinat
It is a CLINICAL diagnosis → immediate surgical exploration; do NOT delay for an ultrasound — the testis infarcts within