MLA Domain 5 · Presentation
Weight loss
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 · 28
Sudden, rapidly extensive, or unusual-site (palms/mucosae — "tripe palms") acanthosis nigricans in a non-obese adult → p
Addisonian CRISIS: hypotension/shock, vomiting, hyponatraemia, hypoglycaemia, often triggered by illness/surgery → emerg
Malignant biliary obstruction with cholangitis -> decompression + antibiotics
New/worsening pain + weight loss → exclude pancreatic cancer (chronic pancreatitis raises the risk)
NEW change in bowel habit, rectal bleeding, weight loss, anaemia, abdominal/rectal mass, age ≥50 → investigate for color
Acute severe flare, obstruction (stricture), abscess/fistula, perforation, toxic dilatation → urgent
Underlying malignancy (small-cell lung) → investigate/stage urgently
Dyspepsia + ALARM features, or age ≥55 with weight loss + upper abdominal pain → urgent (2-week-wait) endoscopy
B symptoms, bulky/advanced disease, or histologic transformation to diffuse large B-cell lymphoma → systemic chemo-immun
Venous thromboembolism risk
ALARM features → urgent endoscopy: Anaemia (iron-deficiency), Loss of weight, Anorexia, Recent-onset/progressive symptom
Dysthyroid optic neuropathy (reduced colour vision/acuity, RAPD) → urgent (sight-threatening — see ophthalmology)
Rectal bleeding with change in bowel habit, weight loss, anaemia, or age ≥50/≥60 → investigate for COLORECTAL CANCER, do
AIDS-defining illness (PCP, cryptococcal meningitis, cerebral toxoplasmosis, CMV retinitis) → urgent specialist treatmen
Severe (>3.5 mmol/L) or symptomatic (confusion, dehydration, arrhythmia) → emergency IV fluids + bisphosphonate
Thyroid storm (fever, agitation, tachyarrhythmia, delirium, often precipitated by illness/surgery) → emergency
Red flags → investigate, NOT IBS: rectal bleeding, weight loss, anaemia, nocturnal symptoms, family history of bowel/ova
Haemoptysis/persistent cough/weight loss in a smoker → urgent 2-week-wait referral + urgent CXR (NICE NG12)
Mediastinal mass with SVC obstruction, or airway/cord compression → oncological emergency
Significant weight loss / vitamin K deficiency coagulopathy
Established CVD or T2DM → manage as secondary prevention / diabetes
Excessive sleepiness with driving/occupational risk → advise re driving and DVLA notification (group 1: stop until contr
ANY dysphagia → urgent (2-week-wait) endoscopy
Painless obstructive jaundice + weight loss → urgent imaging/2-week-wait (pancreatic cancer)
TB meningitis / disseminated (miliary) TB → urgent treatment; airborne isolation for suspected active pulmonary TB
Don't give blind/empirical antibiotics or steroids before a diagnosis (unless septic) — they obscure the picture
Apathetic thyrotoxicosis in the elderly (AF, weight loss, low mood) — easily missed
DKA (ketonaemia + acidosis + hyperglycaemia) → emergency (see acute care)
recognised feature · 2