MLA Domain 5 · Presentation
Weight gain
17 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 · 5
Severe malnutrition/failure to thrive; do NOT start a gluten-free diet before testing (false negatives)
Rapid onset + weight loss + hypokalaemia + pigmentation → ectopic ACTH (often small-cell lung cancer) — investigate for
Pseudomonas colonisation, haemoptysis, distal intestinal obstruction syndrome, CF-related diabetes
Myxoedema coma (hypothermia, bradycardia, reduced consciousness, hyponatraemia) → emergency
Heart failure in infancy (large VSD) → diuretics + surgical closure
recognised feature · 7
SBP (ascitic neutrophils ≥250) → antibiotics + albumin; high mortality and recurrence
Pulmonary hypertension; severe RSV bronchiolitis
NEW change in bowel habit, rectal bleeding, weight loss, anaemia, abdominal/rectal mass, age ≥50 → investigate for color
UKMEC: caution if multiple osteoporosis risk factors; age <18 (peak bone mass) and >45 are relative cautions; current br
Underlying malignancy (small-cell lung) → investigate/stage urgently
Severe neuroglycopenia (seizures, coma)
Renal vein thrombosis / PE (loss of clotting inhibitors) — sudden flank pain/haematuria or pleuritic chest pain
differential of the above · 5
Life-threatening features (silent chest, SpO2 <92%, exhaustion, normal/rising PaCO2) → ITU/anaesthetic involvement — a n
Anaphylaxis (IgE); faltering growth
RED-FLAG features that mean refer/echo (NOT innocent): diastolic murmur, pansystolic, loud (≥grade 3)/thrill, harsh, abn
Weight loss/anaemia/blood → not simple lactose intolerance; investigate (coeliac, IBD)
Acute severe MR from papillary muscle rupture (days after an inferior MI) → cardiogenic shock → emergency surgery