Medical and Health Care

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GENERAL / SYSTEMIC PRESENTATION

01

Fever

Possible Causes

Investigations

Possible Cause

Infection → viral, bacterial, parasitic, fungal

Investigation

FBC & film, CRP/ESR, procalcitonin, blood cultures ×2, urine dip + MSU, stool culture, throat swab, sputum culture, CXR, viral PCR (influenza/COVID/RSV), malaria film/antigen

Possible Cause

Autoimmune/Inflammatory → SLE, RA, vasculitis

Investigation

ANA, ENA, dsDNA, ANCA, rheumatoid factor, complements (C3/C4), serum ACE

Possible Cause

Malignancy → lymphoma/leukaemia, metastasis

Investigation

LDH, peripheral smear, flow cytometry, serum electrophoresis, ferritin, PET-CT

Possible Cause

Drug fever → antibiotics, antiepileptics

Investigation

Medication review + CRP trend

RED FLAGS

rigors + hypotension → sepsis panel IMMEDIATE

Second-line:

Hepatitis panel, HIV screen, TB IGRA and CSF (LP) if meningitis signs

Gold-standard

Bone marrow biopsy (suspected haematologic cancer)

02

Weight Loss (Unintentional)

Causes

Tests

Cause

Cancer → GI, pancreatic, lung, prostate, breast

Tests

FBC, LFT, U&E, CA19-9, CEA, PSA, LDH, faecal occult blood, CT CAP

Cause

Endocrine → hyperthyroid, adrenal insufficiency

Tests

TFTs, ACTH stimulation test, cortisol, HbA1c

Cause

Chronic infection → TB, HIV

Tests

IGRA, HIV 1/2 screen, sputum AFB, CRP

Cause

Malabsorption → coeliac, pancreatic insuff

Tests

tTG-IgA, faecal elastase, vitamin levels A-D-E-K, zinc, copper

RED FLAGS

night sweats, lymph nodes, painless jaundice → urgent cancer workup

03

Fatigue

Differentials

anaemia, hypothyroidism, vitamin D deficiency, CKD, liver failure, CHF, sleep apnoea, depression, ME/CFS

Investigations

Primary: FBC, ferritin, B12, folate, U&E, LFT, TFTs, HbA1c, Vit D, CRP/ESR

Secondary: cortisol AM, CK, SPEP, light chains, reticulocytes

Specialised: sleep study (OSA)