5. Medicine
1- Any person suffering from whole body itching for more than 2 weeks
especially at night but spares the face is Scabies until proven otherwise.
2- Any Ulcerating Skin Lesion that Does Not Heal is Basal or Squamous
Cell Carcinoma until proven otherwise.
3- Skin boil that does not heal for more than 21 days is Leishmania until
proven otherwise.
4- Fever and New Murmur is Infective Endocarditis until proven
otherwise.
5- Acute onset of Aphasia is Stroke until proven otherwise.
( The Most Specific Type of CVA that causes Aphasia is Middle
Cerebral Artery Stroke “which is also the commonest artery involved
in Stroke ).
6- Trigeminal neuralgia in a patient less than 40 years old is Multiple
Sclerosis until proven otherwise.
7- Any new nonspecific symptom in elderly patients is due to Drug Side
Effect until proven otherwise.
6. 8- Monoarthritis is Septic Arthritis until proven otherwise.
9- Hypoxia with clear lungs is Pulmonary Embolism until proven
otherwise.
10- Painful complete 3rd nerve palsy ( Oculomotor Nerve Palsy ) is due
to Aneurysm until proven otherwise.
11- Any food-induced asthmatic attack should be considered
Anaphylaxis until proven otherwise.
12- Tachycardia and Low QRS Voltage on ECG is Pericardial Effusion
until proven otherwise.
13- Breathing Problems are potentially Life-Threatening until proven
otherwise.
14- Patient older than 40 years with clinical features of renal colic and
no history of renal stones should be considered to have Abdominal
Aortic Aneurysm until proven otherwise.
15- Sudden new-onset Macroglossia in adult is mostly Amyloidosis until
proven otherwise.
16- More than six Café-au-lait spots being more than 1.5 cm in diameter
is Neurofibromatosis until proven otherwise.
7. 17- All Diastolic Heart Murmurs are pathological until proven
otherwise.
18- Every acute Sore Throat with Dysphagia is Epiglottitis until proven
otherwise.
19- Focal Brain Lesions in HIV patient indicate Cerebral Toxoplasmosis
until proven otherwise.
20- Ptosis that is minimal on awakening and worsens throughout the day
is Myasthenia Gravis until proven otherwise.
21- Syncope should always be suspected due to cardiac origin until
proven otherwise.
23- Wide QRS Complex + Regular Tachycardia is VT ( Ventricular
Tachycardia ) until proven otherwise.
24- Fever in elderly patients is Sepsis until proven otherwise.
25- Fever in patient who has returned from traveling is Malaria until
proven otherwise.
26- Osteoporosis associated with High ESR is Myeloma until proven
otherwise.
8. 27- Testicular mass in Men older than 50 years old is Lymphoma until
proven otherwise.
28- Unilateral Lower Limb Swelling is DVT ( Deep Venous Thrombosis
) until proven otherwise.
29- Fever and cough for more than two weeks is TB ( Tuberculosis )
until proven otherwise.
30- Fever and Bone Pain is Osteomyelitis until proven otherwise.
31- Syncope and Outflow murmur that increases with Valsalva
Maneuver is HCM ( Hypertrophic Cardiomyopathy ) until proven
otherwise.
32- Low Serum Calcium with Low Serum Phosphorus is due to Vitamin
D deficiency until proven otherwise.
33- Acute onset of Severe Chest Pain in patient with Marfan Syndrome
should warn you to suspect Aortic Dissection until proven otherwise.
34- Any Skin Lesions in a Dermatomal Distribution with or without
associated pain and whether or not “classic lesions” should be
considered as Herpes Zoster until proven otherwise.
9. 35- Patient with Lower Extremity Weakness and Absent Reflexes should
be considered to have GBS (Guillain-Barré Syndrome) until proven
otherwise.
36- Acute Hemifacial Weakness that spares the forehead is the result of
Stroke until proven otherwise.
39- A Patient with Thalassemia in Heart Failure should be assumed to
have Cardiac Iron Overload until proven otherwise.
40- Atrial Fibrillation associated with Abdominal Pain is suspected to be
Mesenteric Ischemia until proven otherwise.
41- Dysphagia with No systemic illness, should be considered from an
Anatomical Cause until proven otherwise.
42- Facial Nerve Palsy in endemic area is Lyme Disease until proven
otherwise.
43- Arterial Hypertension and Anemia is Chronic Kidney Disease until
proven otherwise.
44- Erosive Mucocutaneous Lesion in an immunocompromised patient
is HSV ( Herpes Simplex Virus ) infection until proven otherwise.
10. 45- Heartburn in HIV positive patient is Candida Esophagitis until
proven otherwise.
46- Acute change in mental status in geriatric patient is Delirium until
proven otherwise.
47- Motor and/or Sensory partial seizure is due to structural cause until
proven otherwise.
48- Heart Failure should firstly be suspected to be due to Structural
Cause until proven otherwise.
49- Epigastric Pain in patient older than 50 years is IHD ( Ischemic
Heart Disease ) until proven otherwise.
50- Any Rheumatic Carditis with Unexplained fever is an Infectious
Endocarditis until proven otherwise.
51- Iron Deficiency Anemia should firstly be suspected due to Blood
Loss until proven otherwise.
52- Projectile Vomiting is Brain Related until proven otherwise.
53- Hot Painful Swelling in One Joint is Septic Arthritis until proven
otherwise.
11. 54- All forms of Aneurysms of Abdominal Aorta ( fusiform, cylindrical
and saccular ) should be considered Atherosclerotic until proven
otherwise.
55- If patient with history of heart failure presents with ( Dyspnea +
Tachycardia + Basal Crepitations + Gallop Rhythm ) is considered
Pulmonary Edema until proven otherwise.
56- Hives and Hypotension mean Anaphylactic Reaction until proven
otherwise.
57- Back Pain and Syncope mean Acute Aortic Dissection until proven
otherwise.
58- Acute onset of Symmetric Proximal Weakness and Decreased or
Absent Deep Tendon Reflexes means Guillain-Barré Syndrome until
proven otherwise.
59- Chest Pain Associated with ST segment elevation on ECG is
Myocardial Infarction until proven otherwise.
60- Fever in Immunocompromised Patients is Infectious in origin until
proven otherwise.
61- Sudden Severe Throbbing Headache should be considered
Subarachnoid Hemorrhage until proven otherwise.
12. 62- Recurrent Itching, Burning, Blistering Erythema below the Waist
should be considered as Genital HSV (Herpes Simplex Virus) infection
until proven otherwise.
Brain power improves by brain use,
Just as our muscular strength
grows with exercise.
13.
14. Surgery
1- Painless progressive jaundice in elderly patient is Cancer of Head of
the Pancreas until proven otherwise.
2- Unilateral SNHL ( Sensory Neural Hearing Loss ) is Acoustic
Neuroma until proven otherwise.
3- Sudden acute onset of testicular pain is Torsion until proven
otherwise.
4- Unilateral rhinorrhea with bad foul smelling is a Foreign body in the
nose until proven otherwise.
5- Iron deficiency anemia with positive fecal occult blood test in an
elderly patient is Colorectal Cancer until proven otherwise.
6- Wheezing associated with flushing is Carcinoid Syndrome until
proven otherwise.
7- When you see Wounds involving cut through tendons, always suspect
Nerve and/or Arterial injury until proven otherwise.
15. 8- Hepatic artery bruit and Hepatic friction rub on auscultation is
Hepatic Cancer until proven otherwise.
9- Painless non-transilluminating testicular mass in patients younger
than 40 years old is Testicular Cancer until proven otherwise.
10- Any Pancreatic Mass in patient older than 40 years old should be
considered as Pancreatic Cancer until proven otherwise.
11- Unexplained Recurrent Vomiting is Brain Tumor until proven
otherwise.
12- Unilateral Nasal Polyp is Tumor until proven otherwise.
13- Any Athlete patient with an on-field head injury should be
considered to have a concomitant cervical spine injury until proven
otherwise.
14- Patient with Knee Dislocation should be considered to have
Popliteal Artery Injury until proven otherwise.
15- Any firm lump in the testis should be considered as a Potential
Tumor until proven otherwise.
16. 16- Isolated Lesser Trochanter Fracture should always be considered
Pathological Fracture until proven otherwise.
17- Drooling and Toxic Appearing patient with cervical swelling is
Ludwig Angina until proven otherwise.
18- Oral Ulcer lasting more than 2 weeks is a Cancerous Lesion until
proven otherwise.
19- All pigmented subungual lesions should be considered as Melanoma
until proven otherwise.
20- Hoarseness of the voice for more than 2 weeks with no sign of
improvement is Laryngeal Carcinoma until proven otherwise.
21- First Spontaneous Unprovoked Seizure in an adult patient should be
considered as Intracranial Tumor until proven otherwise.
22- Bitemporal Hemianopia is Space Occupying Lesion pressing on the
Optic Chiasm until proven otherwise.
23- Patient with Head and/or Neck trauma, Spinal Cord Injury should
always be suspected until proven otherwise.
17. 24- Painless Unexplained Hematuria is of Malignant Origin until proven
otherwise.
25- If an unconscious male has an erection, always think about Spinal
Cord injury, until proven otherwise.
26- Painless Hematuria in Elderly Patients is due to Bladder Cancer until
proven otherwise.
27- Hemoptysis in elderly patients should be considered as Lung Cancer
until proven otherwise.
28- Horner’s Syndrome in heavy smokers is due to Lung Cancer until
proven otherwise.
29- Progressive Leg Weakness associated with Urinary symptoms
should be suspected due to Spinal Cord Compression until proven
otherwise.
30- Respiratory Distress in a patient with Tracheostomy indicates Tube
Obstruction until proven otherwise.
31- Abdominal Pain after Peritoneal Dialysis is Peritonitis until proven
otherwise.
18. 32- Glasgow Coma Scale score less than 9 after head trauma means the
patient has increased ICP ( Intracranial Pressure ) until proven
otherwise.
33- Homogenous Anterior Mediastinal Masses are always considered as
Lymphoma until proven otherwise.
34- A Supraclavicular Node is Cancer until proven otherwise.
35- Every Shock should at first be suspected as Hypovolemic until
proven otherwise.
36- Back Pain in patient receiving corticosteroids is Compression
Fracture until proven otherwise.
37- Breast Mass and/or Nipple Discharge in Male with Gynecomastia is
always suspected to be due to Breast Cancer until proven otherwise.
38- Severe Limb Pain is Thromboembolic in origin until proven
otherwise.
39- Hypotension in Trauma patient is thought to be Internal Hemorrhage
until proven otherwise.
19. 40- Dysphonia more than Two Weeks in geriatric patients is Laryngeal
Carcinoma until proven otherwise.
41- Any old male suffering from Rectal Bleeding is considered due to
Colorectal Carcinoma until proven otherwise.
42- Any Focal Strictures of the Bile Ducts should be considered
Malignant until proven otherwise.
43- Iron Deficiency Anemia in an adult male is Gastrointestinal Blood
Loss until proven otherwise.
44- Right Iliac Fossa Pain is Appendicitis until proven otherwise.
45- Recurrent Epistaxis in Adolescent Boy is Angiofibroma until proven
otherwise.
46- Hepatitis C with elevated alfa feto protein is Hepatocellular
Carcinoma until proven otherwise.
47- Monophonic Localized Wheeze is Lung Cancer until proven
otherwise.
20. 48- Any multiple trauma is suspected to be associated with Cervical
Injury until proven otherwise.
49- Unexplained, Unintentional Weight Loss in an elderly patient is
Cancer until proven otherwise.
50- Any Elderly Patient with Groin Pain and History of Trauma should
be considered as Fracture Neck Femur until proven otherwise.
51- Clear Fluid Leaking from the Nose and/or Ears after Head Trauma
should be considered Skull Base Fracture until proven otherwise.
( Anterior Fossa Basal Fractures cause CSF Rhinorrhea, while
Middle Fossa Basal Fractures cause CSF Otorrhea )..
52- Any Ulcerating Skin Lesion that Does Not Heal is Basal or
Squamous Cell Carcinoma until proven otherwise.
53- Shock in Trauma Patient or Postoperative Patient should be
suspected as Hemorrhage until proven otherwise.
54- Any Young Patient with sudden onset Shortness of Breath
associated with Chest Pain is Spontaneous Pneumothorax until proven
otherwise.
21. Fill your Brain with Giant Dreams,
So it has no space for little pursuits.
22.
23. Pediatrics
1- Any delay of passing stool for more than 24 hours in neonates is
diagnosed as Hirschsprung’s Disease until proven otherwise.
2- Newborn presented with frothy saliva is should be considered as
Esophageal Atresia until proven otherwise.
3- Fever and New Rash is considered to be Contagious until proven
otherwise.
4- Recurrent urinary tract infection in infants is Structural Abnormality
until proven otherwise.
5- Widened Physis ( Growth Plate ) in children is Rickets until proven
otherwise.
6- Knee pain in pediatric age group is considered due to Hip Pathology
until proven otherwise.
7- Posterior mediastinal mass in a child less than 5 years old is
Neuroblastoma until proven otherwise.
24. 8- Healthy afebrile child between 4 and 9 years old is with sudden
unexplained Limping is Legg-Calve-Perthes disease until proven
otherwise.
9- Any infant with bilious vomiting should be considered to have
Malrotation with Midgut Volvulus until proven otherwise.
10- Child having Nasal Polyps is considered Cystic Fibrosis until proven
otherwise.
11- Fever in infants less than 3 years old should be assumed to be due to
Bacterial Sepsis until proven otherwise.
12- In a Child with Syphilis, Sexual Abuse should be suspected until
proven otherwise.
13- Any healthy child with sudden onset of choking, wheezing and
stridor is suffering from Foreign Body Aspiration until proven
otherwise.
14- Jaundice during the first 24 hours of life is mostly considered due to
Hemolysis until proven otherwise.
25. 15- Child with Sickle Cell Disease, Fever and Reticulocytopenia should
be considered to have Parvovirus B19 infection until proven otherwise.
16- Any injured child who cannot easily breathe, cough, cry or speak is
having Upper Airway Obstruction until proven otherwise.
17- Children with Sickle Cell Disease or Hemolytic Anemia who are
suffering from Upper Abdominal Pain should be considered to have
Cholelithiasis until proven otherwise.
18- Male Child with Liver Abscess should be considered to have
Chronic Granulomatous Disease until proven otherwise.
19- A child with cough for more than two weeks should be considered to
have Pertussis until proven otherwise.
20- Meconium ileus in newborns is indicative of Cystic Fibrosis until
proven otherwise.
21- A Firm Neck Mass in a child without signs of inflammation is
considered Malignant until proven otherwise.
22- Generalized Edema with Heavy Proteinuria and Hypoalbuminemia
is Nephrotic Syndrome until proven otherwise.
26. 23- Prolonged Apnea with Tachycardia is a Seizure until proven
otherwise.
24- A Purpuric Rash in an unwell child should be treated as
Meningococcal Septicemia until proven otherwise.
25- All infants with Low T4 and High TSH levels should be considered
to have Congenital Hypothyroidism until proven otherwise.
26- Hypocalcemia in case of Congenital Heart Disease is due to
DiGeorge Syndrome until proven otherwise.
27- Any Term Neonate with ICH ( intracranial hemorrhage ) should be
evaluated as Hemophilia until proven otherwise.
28- Any child with Hematemesis and Splenomegaly should be suspected
to have Esophageal Variceal Bleeding until proven otherwise.
29- The Passage of large amount of bright to dark red blood by a healthy
wealthy child should be considered due to Bleeding from Meckel’s
Diverticulum until proven otherwise.
27. 30- Unexplained Joint Pain in a child with Hemophilia should be
suspected due to Hemarthrosis ( hemorrhage into joint cavity ) until
proven otherwise.
31- Persistent Tachycardia in quiet and afebrile child should always be
considered as a sign of Shock until proven otherwise.
32- The Association of Acute Hemolysis with Liver Failure in an
adolescent patient should be diagnosed as Wilson’s Disease until proven
otherwise.
33- A toddler with Abdominal Pain and a Lower Gastrointestinal
Bleeding should be suspected to have intussusception until proven
otherwise.
34- Any Child ( regardless of age ), who presents with a history of
recurrent episodes of wheezing, dyspnea, or chronic cough should be
considered to be suffering from Asthma until proven otherwise.
35- All Children who are Fire Victims should be suspected to have CO
Poisoning until proven otherwise.
( as these children may have extreme levels of tissue hypoxia yet will not
be cyanotic !! ).
28. 36- Chest Pain in children and adolescents with a previous history of
Kawasaki Disease should be considered Ischemic in Origin until proven
otherwise.
37- A Hypotonic Newborn should be considered Septic until proven
otherwise.
38- Metaphyseal Spiral Fractures ( except in toddlers ) are considered a
result of Child Abuse until proven otherwise.
39- Prolonged Neonatal Jaundice with Raised Conjugated Bilirubin , the
diagnosis is Extrahepatic Biliary Atresia until proven otherwise.
40- Hyperthermia in an infant during the first week of life should be
considered as Herpes Virus infection until proven otherwise.
41- Bradycardia in any child should at first be considered a sign of
Hypoxia until proven otherwise.
42- Every Child with Infantile Spasms, should be suspected to have
Tuberous Sclerosis Complex until proven otherwise.
43- Hematuria + Proteinuria = Glomerulonephritis until proven
otherwise.
29. 44- Vomiting after Cough is Pertussis until proven otherwise.
45- All Down Syndrome Patients should be considered to have
AtlantoAxial Instability until proven otherwise.
46- Healthy child older than 9 years old with a limp is Slipped Capital
Femoral Epiphysis until proven otherwise.
47- Every Infant with absent or diminished Femoral Pulses should be
considered having Coarctation of the Aorta until proven otherwise.
48- Persistent ongoing fever for more than five days in children is
considered Kawasaki Disease until proven otherwise.
49- Any Child with Trauma to his/her Arm should be considered as
Supracondylar Fracture until proven otherwise.
50- Persisting Jaundice in neonate who have pale stool and dark urine is
Hepatobiliary Disease until proven otherwise.
30. There is always room in
Your Brain for thinking
Bigger, pushing limits
And imagining the
Impossible.
31.
32. Gynecology & Obstetrics
1- Hypertension plus Proteinuria in Pregnancy is Preeclampsia until
proven otherwise.
2- Painless Vaginal Bleeding during the second half of pregnancy is
Placenta Previa until proven otherwise.
3- Any Adnexal Mass in Postmenopausal women should be considered
as Malignancy until proven otherwise.
4- Iron deficiency anemia in Postmenopausal women should be
suspected to be due to Colorectal Cancer until proven otherwise.
5- Dimpling or Puckering of the Breast, should always be regarded as
Breast Cancer until proven otherwise.
6- The Presence of Free Pelvic Fluid and/or Adnexal Mass indicate
Ectopic Pregnancy until proven otherwise.
33. 7- Postmenopausal Vaginal Bleeding should always be considered as
Endometrial Cancer until proven otherwise.
( Although most references state that the most common cause of
bleeding is Atrophic Vaginitis !! )..
8- Amenorrhea with Unilateral Abdominal and/or Pelvic Pain, Irregular
Vaginal Bleeding and Positive Pregnancy Test is indicative of Ectopic
Pregnancy until proven otherwise.
9- The combination of Hypospadias and Unilateral or Bilateral
Cryptorchidism should be considered as Intersex until proven otherwise.
10- Solid Ovarian mass in Childhood should always be considered as
Malignancy until proven otherwise.
11- Girls with continuous wetting should be considered to have an
Ectopic Ureteral Orifice until proven otherwise.
12- Bloody Nipple Discharge associated with Breast Mass in females
older than 50 years, Breast Cancer is suspected until proven otherwise.
13- Any reproductive female with acute abdomen is considered as
having Ectopic Pregnancy until proven otherwise.
34. 14- Missed Menses in Previous Normally Menstruating Women should
firstly be considered as Pregnancy until proven otherwise.
15- Any Postcoital Bleeding should be considered as Cervical
Carcinoma until proven otherwise.
16- If a Female has Bone Metastasis, the Origin is Breast until proven
otherwise.
17- Convulsions in Pregnant Lady is Eclampsia until proven otherwise.
18- Coexistence of Galactorrhea and Amenorrhea is suspected to be due
to Pituitary Adenoma until proven otherwise.
19- Acute Suppurative Mastitis in Non-Lactating women should be
considered as Cancer until proven otherwise.
20- Sudden Unilateral Nipple Retraction in a woman over the age of 40
years should be considered as Breast Cancer until proven otherwise.
21- Every Pregnant Lady with Uterus Larger than Expected plus
Difficult to Palpate Fetal Parts and/or Difficult to Hear Fetal Heart
Sounds is suspected to be having Polyhydramnios until proven
otherwise.
35. 22- Any Painless Vaginal Bleeding occurring between implantation and
24 Weeks of Gestation should be considered as Threatened Abortion
until proven otherwise.
23- Any Thin Female with Eating Disorders and Menstrual Disturbances
will Probably have concomitant Osteoporosis or Osteopenia until proven
otherwise.
( The Athlete Female Triad !! )..
24- All Females who have Acne with Excessive Body Hair and Male-
Pattern Baldness should be firstly considered as having PCOs
( Polycystic Ovarian Syndrome ) until proven otherwise.
25- Any married female with previous vaginal deliveries and then
suffering from intermenstrual bleeding should firstly be suspected to
have Polyp until proven otherwise.
26- Females with Dysmenorrhea in their fourth and fifth decades, the
first etiology you should think about is Endometriosis until proven
otherwise.
27- Pregnant Lady with Steady Leakage of Small Amounts of Fluid
prior to 37 weeks of gestation is in PPROM ( Preterm Premature
Rupture Of Membranes ) until proven otherwise.
36. 28- Fetal/Neonatal Macrosomia is due to Maternal Diabetes until proven
otherwise.
29- In any Female who is Infertile, the first cause to think about is POI
( Primary Ovarian Insufficiency ) until proven otherwise.
30- Any Enlargement in Ovarian Size in Postmenopausal Women is
Cancer until proven otherwise.
The Brain is like a puzzle,
You must unlock it
To read its Hidden Secrets …
