MLA Domain 5 · Presentation

Ptosis

12 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 · 2

Carotid & cervical artery dissection

Stroke/TIA from dissection → urgent stroke pathway; thrombolysis decisions need imaging confirmation

Noonan syndrome

Significant cardiac disease (pulmonary stenosis/HCM); bleeding tendency before surgery

recognised feature · 8

Cerebral venous sinus thrombosis

Seizures, reduced GCS, venous haemorrhagic infarction, pregnancy/postpartum

Cluster headache

First presentation needs imaging to exclude a secondary cause; very high pain/suicidality risk in clusters

Graves disease

Dysthyroid optic neuropathy (reduced colour vision/acuity, RAPD) → urgent (sight-threatening — see ophthalmology)

Hyperthyroidism / thyrotoxicosis

Thyroid storm (fever, agitation, tachyarrhythmia, delirium, often precipitated by illness/surgery) → emergency

Myasthenia gravis

Myasthenic CRISIS — respiratory muscle weakness (monitor FVC), bulbar weakness with aspiration; certain drugs trigger it

Orbital cellulitis

Reduced vision/colour, RAPD, or proptosis = optic-nerve threat — emergency

Preseptal (periorbital) cellulitis

ANY of: proptosis, painful/restricted eye movements, reduced acuity/colour vision, RAPD, marked systemic illness → ORBIT

Thyroid eye disease (Graves orbitopathy)

Reduced colour vision, an RAPD, or reduced acuity → compressive (dysthyroid) OPTIC NEUROPATHY — urgent (sight-threatenin

differential of the above · 2

Migraine

Aura + COCP (stroke risk → COCP is UKMEC 4); thunderclap or new focal/systemic features → exclude secondary causes (see

Turner syndrome

Coarctation of the aorta / bicuspid aortic valve; aortic dissection risk; renal anomalies