Clinical workups

DiagnosisAcetaminophen overdoseAcetaminophen poisoning is common and treatable. Plot a 4–24 hour level on the Rumack–Matthew nomogram for a single acute ingestion; start IV N-acetylcysteine for any… Presenting complaintAcute abdominal painAcute abdominal pain in an adult. Identify the unstable patient and the surgical abdomen first, then use location, history and targeted tests to narrow the cause. Older… DiagnosisAcute aortic dissectionAcute aortic syndrome (dissection, intramural hematoma, penetrating ulcer) is a time-critical diagnosis. Use the Aortic Dissection Detection Risk Score with D-dimer to… DiagnosisAcute cholangitis and choledocholithiasisAcute cholangitis is biliary obstruction with infection: fever, jaundice and RUQ pain (Charcot triad), with shock and confusion in severe cases. Grade severity (Tokyo… DiagnosisAcute decompensated heart failureAcute decompensated heart failure. Classify by congestion and perfusion (warm/cold, wet/dry), find the precipitant, decongest with IV loop diuretics, and keep… DiagnosisAcute diverticulitisAcute diverticulitis usually presents with left lower quadrant pain, fever and leukocytosis. CT confirms the diagnosis and separates uncomplicated from complicated… Presenting complaintAcute dizziness and vertigoClassify acute dizziness by timing and triggers (acute vestibular syndrome, spontaneous episodic, triggered episodic), not by the patient's word choice. Use HINTS plus… DiagnosisAcute ischemic stroke and TIASudden focal neurological deficit. Time is brain: establish last known well, check glucose, get a non-contrast CT (with CT angiography for large-vessel occlusion), and… DiagnosisAcute kidney injuryAcute kidney injury: creatinine rise of 0.3 mg/dL within 48 h, or 1.5 times baseline within 7 days, or urine output under 0.5 mL/kg/h for 6 h (KDIGO). Classify as… DiagnosisAcute pancreatitisAcute pancreatitis is diagnosed with two of three: typical epigastric pain, lipase or amylase >3× the upper limit of normal, or characteristic imaging. Find the cause… DiagnosisAcute pericarditisAcute pericarditis needs 2 of 4: pericarditic chest pain, friction rub, widespread ST elevation or PR depression, new or worsening effusion. Exclude MI, tamponade and… DiagnosisAdrenal crisisAdrenal crisis is life-threatening: hypotension or shock, vomiting, abdominal pain, confusion, hyponatremia or hyperkalemia in someone with known or suspected adrenal… DiagnosisAlcohol withdrawalAlcohol withdrawal begins 6–24 hours after the last drink. Seizures peak at 12–48 hours and delirium tremens at 48–96 hours. Assess severity and risk (CIWA-Ar, PAWSS)… DiagnosisAlcohol-associated hepatitisAlcohol-associated hepatitis: rapid-onset jaundice (bilirubin >3 mg/dL) with AST/ALT elevated but usually <400 U/L and AST:ALT >1.5 after heavy alcohol use within the… DiagnosisAnaphylaxisAnaphylaxis is a severe, rapid-onset systemic allergic reaction. Intramuscular epinephrine is the first and most important treatment and should not be delayed for… Presenting complaintAnemia in hospitalized adultsNew or worsening anemia in hospital: first exclude bleeding and hemolysis, then classify by MCV and reticulocyte count. Transfuse by restrictive thresholds and symptoms… DiagnosisAsthma exacerbationAcute asthma: assess severity with work of breathing, ability to speak, oxygen saturation and peak flow. Treat with oxygen to 93–95%, repeated inhaled short-acting… DiagnosisAtrial fibrillation with rapid ventricular responseAF with rapid ventricular response. Unstable patients get synchronized cardioversion. In stable patients, control rate, look for the trigger, and decide on… DiagnosisBacterial meningitisSuspected bacterial meningitis is an emergency: blood cultures, then dexamethasone and empiric antibiotics without delay. Do not hold antibiotics for CT or lumbar… DiagnosisCellulitisAcute spreading skin infection. Separate purulent (abscess, usually S. aureus) from non-purulent (usually streptococcal) infection, exclude mimics and necrotizing… Presenting complaintChest painAcute chest pain in an adult. First job is to exclude the six immediate killers (ACS, aortic dissection, PE, tension pneumothorax, tamponade, esophageal rupture), then… DiagnosisClostridioides difficile infectionC. difficile infection: ≥3 unformed stools in 24 hours with a positive toxin or toxin-gene test, usually after antibiotics or healthcare exposure. Test only patients… DiagnosisCommunity-acquired pneumoniaCommunity-acquired pneumonia: acute respiratory symptoms with a new infiltrate. Use CURB-65 or PSI with clinical judgement to choose site of care, and ATS/IDSA criteria… DiagnosisCOPD exacerbationAcute COPD exacerbation: worsening dyspnea, cough or sputum beyond day-to-day variation. Treat with bronchodilators, a short steroid course, antibiotics when sputum is… DiagnosisDecompensated cirrhosis (ascites, SBP, hepatic encephalopathy)Admission with decompensated cirrhosis: new or worsening ascites, hepatic encephalopathy, variceal bleeding or jaundice. Every admitted patient with ascites needs a… DiagnosisDeep vein thrombosisSuspected DVT: estimate pre-test probability with the Wells DVT score, use D-dimer to exclude DVT when probability is low, and compression ultrasound otherwise. Most… Presenting complaintDelirium / acute confusionAcute fluctuating disturbance of attention and awareness. Delirium is a medical emergency with an underlying cause, often more than one. Screen with CAM, look… DiagnosisDiabetic foot infection and osteomyelitisDiabetic foot infection is diagnosed clinically (≥2 signs of inflammation or purulence) and graded by IWGDF/IDSA severity. Look for osteomyelitis (probe-to-bone… DiagnosisDiabetic ketoacidosisDKA (2024 ADA/EASD/JBDS/AACE/DTS consensus): glucose ≥200 mg/dL or known diabetes, ketonemia (β-hydroxybutyrate ≥3.0 mmol/L) and acidosis (pH <7.3 or bicarbonate <18… DiagnosisFebrile neutropeniaTemperature ≥38.3 °C once, or ≥38.0 °C sustained for 1 h, with ANC under 500/µL or expected to fall under 500 within 48 h. An oncological emergency: broad-spectrum… Presenting complaintFirst seizure and status epilepticusA seizure lasting 5 minutes or longer, or repeated seizures without recovery, is status epilepticus and needs immediate benzodiazepine then a second-line antiseizure… DiagnosisHypercalcemiaRaised corrected or ionized calcium. Primary hyperparathyroidism and malignancy cause about 90%. Severity and symptoms drive treatment: volume repletion first, then… Presenting complaintHyperglycemia in hospitalized adultsMost non-critically ill hospitalized patients with diabetes or hyperglycemia should get scheduled basal (± prandial) insulin plus correction insulin, aiming for 140–180… DiagnosisHyperkalemiaSerum potassium above 5.0 mEq/L. Get an ECG immediately: ECG changes or K ≥6.5 need emergency treatment in three steps: stabilize the membrane, shift K into cells, then… DiagnosisHypernatremiaSerum sodium >145 mEq/L means a free water deficit, usually from impaired thirst or access to water combined with losses. Estimate the free water deficit, replace with… DiagnosisHyperosmolar hyperglycemic state (HHS)HHS: severe hyperglycemia (usually ≥600 mg/dL) with effective serum osmolality >300 mOsm/kg, profound dehydration and often altered mental status, without significant… DiagnosisHypertensive emergencySevere hypertension (usually >180/120 mmHg) with acute target-organ damage is a hypertensive emergency needing IV therapy and controlled lowering in a monitored setting… DiagnosisHypoglycemiaGlucose <70 mg/dL (level 1), <54 mg/dL (level 2), or any level with altered mental status needing assistance (level 3). Treat immediately, then find the cause. In people… DiagnosisHypokalemiaSerum potassium <3.5 mEq/L. Check the ECG and magnesium, replace potassium (oral when possible), and find the cause: GI losses, diuretics, transcellular shift or renal… DiagnosisHyponatremiaSerum sodium under 135 mEq/L. Severity of symptoms, not the number alone, decides urgency. Confirm hypotonicity, classify by volume status and urine studies, and limit… DiagnosisInfective endocarditisSuspect endocarditis with bacteremia from a typical organism, fever with a predisposing valve or device, injection drug use, or embolic events. Diagnose with the 2023… DiagnosisLower GI bleedAcute lower GI bleeding presents with hematochezia. Resuscitate, exclude an upper GI source in hemodynamically unstable patients, risk-stratify (e.g., Oakland score)… DiagnosisMajor bleeding on anticoagulants (reversal)Major bleeding on an anticoagulant: stop the drug, resuscitate, find and control the source, and reverse when bleeding is life-threatening or in a critical site… DiagnosisMalignant spinal cord compressionNew back pain in a patient with cancer is spinal metastasis until proven otherwise. Neurological deficits, bladder or bowel dysfunction, or saddle anesthesia mean… DiagnosisNSTEMI and non-ST-elevation ACSNSTE-ACS covers NSTEMI (rising/falling troponin above the 99th percentile with ischemia) and unstable angina. Separate type 1 MI from type 2 MI and myocardial injury… DiagnosisOpioid overdose and opioid use disorderOpioid overdose presents with respiratory depression, miosis and reduced consciousness. Support ventilation, give naloxone titrated to breathing, observe for recurrent… DiagnosisPulmonary embolismSuspected PE. Use pre-test probability (Wells, PERC) to choose D-dimer (age-adjusted) or CTPA. The 2026 AHA/ACC multisociety guideline classifies confirmed PE into… DiagnosisPyelonephritis and complicated UTIPyelonephritis: fever, flank pain or costovertebral angle tenderness with pyuria and bacteriuria. Send urine culture before antibiotics, look for obstruction or abscess… DiagnosisRhabdomyolysisRhabdomyolysis is muscle breakdown with CK usually >5× the upper limit (often >1000 U/L), myalgia and dark urine. The main dangers are AKI, hyperkalemia and compartment… DiagnosisSepsisSuspected sepsis: life-threatening organ dysfunction from infection. The 2026 Surviving Sepsis Campaign ties antibiotic timing to how likely sepsis or shock is… Presenting complaintShortness of breathAcute dyspnea in an adult. Assess airway, work of breathing and oxygenation first, then separate cardiac, pulmonary and systemic causes with ECG, CXR, gas and focused… DiagnosisSickle cell vaso-occlusive crisisVaso-occlusive crisis is the most common reason adults with sickle cell disease come to hospital. Give effective analgesia within an hour using the patient's… DiagnosisStaphylococcus aureus bacteremiaEvery S. aureus bloodstream isolate is real until proven otherwise. Infectious diseases consultation reduces mortality. Find and control the source, repeat cultures… DiagnosisSymptomatic bradycardia and heart blockBradycardia (HR <50) matters when it causes symptoms or instability, or reflects high-grade AV block. Treat instability with atropine, chronotropes or pacing, look for… Presenting complaintSyncopeTransient loss of consciousness with spontaneous full recovery. Distinguish true syncope from seizure, then identify cardiac syncope, which carries the mortality risk. DiagnosisThrombocytopenia (including TTP, HIT and ITP)Thrombocytopenia (platelets <150,000/µL) in hospital is usually from sepsis, drugs, DIC or dilution, but the dangerous causes are TTP, HIT and DIC. Confirm on a smear… Presenting complaintThunderclap headache (rule out subarachnoid hemorrhage)Thunderclap headache reaches maximum intensity within one minute. Subarachnoid hemorrhage must be excluded: a non-contrast CT within 6 hours of onset is highly… DiagnosisThyroid stormThyroid storm is life-threatening thyrotoxicosis with organ dysfunction: hyperthermia, tachycardia or AF, heart failure, agitation or coma, and GI or hepatic… DiagnosisTumor lysis syndromeTumor lysis syndrome: hyperuricemia, hyperkalemia, hyperphosphatemia and secondary hypocalcemia from rapid tumor cell death, usually after starting therapy for… DiagnosisUpper GI bleedUpper GI bleeding (hematemesis, coffee-ground emesis or melena). Resuscitate, risk-stratify with Glasgow-Blatchford, decide early whether varices are likely, and arrange…