NCBI STATPEARLS + PUBMED + OPEN-I VERIFIED SEED TAXONOMY

Taxonomía Clínica Maestra de Medipaedia.org (Por Especialidad y CIE-10/11)

Matriz de referencia clínica estandarizada de 10 secciones en 19 Especialidades Médicas con códigos CIE-10/11 verificados, tríadas clásicas, pruebas diagnósticas de elección y protocolos de primera línea.

Las 19 Especialidades (60)Cardiología Neumología Gastroenterología y Hepatología Nefrología y Urología Neurología Endocrinología y Metabolismo Hematología y Oncología Enfermedades Infecciosas Reumatología e Inmunología Urgencias y Cuidados Intensivos Cirugía General y Especialidades Pediatría Obstetricia y Ginecología Dermatología Psiquiatría Oftalmología y ORL Patología y Medicina de Laboratorio Traumatología y Ortopedia Radiología e Imagen Médica

#	Tema, Especialidad y CIE-10/11	Tríada Clásica / Presentación	Prueba Diagnóstica de Elección	Tratamiento de Primera Línea	Estado
1	Acute pericarditis ICD-10: I30.9 ICD-11: BB20.Z Cardiología	Pleuritic chest pain relieved by sitting forward + Pericardial friction rub + Widespread concave ST elevation & PR depression	12-Lead ECG + Transthoracic Echocardiography (≥2 of 4 ESC Criteria)	High-dose Aspirin (750–1000 mg q8h) or Ibuprofen (600 mg q8h) + Colchicine (0.5 mg OD/BD for 3 months)	✓ Publicado (mID 10001)
2	ST-elevation myocardial infarction ICD-10: I21.3 ICD-11: BA41.0 Cardiología	Crushing retrosternal chest pain >20 min + Diaphoresis/autonomic surge + Contiguous J-point ST elevation (or new LBBB)	12-Lead ECG within 10 min of FMC + Emergency Coronary Angiography	Immediate DAPT loading (Aspirin 300 mg + Ticagrelor 180 mg / Prasugrel 60 mg) + Primary PCI within 120 minutes	✓ Publicado (mID 10002)
3	Atrial fibrillation ICD-10: I48.91 ICD-11: BC81.3 Cardiología	Irregularly irregular pulse + Absence of distinct P waves on ECG + Variable ventricular rate (palpitations/dyspnoea)	12-Lead ECG (or ≥30s single-lead rhythm strip showing absent P waves and irregular RR intervals)	CHA₂DS₂-VASc stroke anticoagulation (DOAC: Apixaban/Rivaroxaban) + Rate control (Bisoprolol/Diltiazem) or Rhythm control	✓ Publicado (mID 10016)
4	Infective endocarditis (modified Duke criteria) ICD-10: I33.0 ICD-11: BB40 Cardiología	Persistent fever + New regurgitant heart murmur + Embolic/immunological phenomena (Janeway lesions, Osler nodes, splinter haemorrhages)	3 sets of peripheral blood cultures prior to antibiotics + Transoesophageal Echocardiography (TOE/TEE)	Empiric IV bactericidal antibiotics (Amoxicillin + Flucloxacillin + Gentamicin or Vancomycin) for 4–6 weeks + early valve surgery if heart failure	✓ Publicado (mID 10018)
5	Cardiac tamponade (Beck triad) ICD-10: I31.4 ICD-11: BB24 Cardiología	Beck's Triad: Systemic hypotension + Distended neck veins (raised JVP with absent y-descent) + Muffled heart sounds (+ Pulsus paradoxus >10 mmHg)	Bedside Transthoracic Echocardiography (diastolic RV collapse, systolic RA collapse, swinging heart, electrical alternans on ECG)	Immediate ultrasound-guided pericardiocentesis (or surgical pericardiotomy in traumatic/post-cardiotomy tamponade)	✓ Publicado (mID 10019)
6	Aortic dissection ICD-10: I71.00 ICD-11: BD50.0 Cardiología	Sudden tearing interscapular chest/back pain + Inter-arm BP differential >20 mmHg / pulse deficit + Mediastinal widening / aortic regurgitation	ECG-gated CT Aortography (CTA) demonstrating intimal flap separating true and false lumens (TOE if unstable)	Anti-impulse therapy (IV Labetalol/Esmolol targeting HR <60 bpm and SBP 100–120 mmHg) + Emergency surgical repair for Stanford Type A	✓ Publicado (mID 10020)
7	Brugada syndrome ICD-10: I49.8 ICD-11: BC65.0 Cardiología	Type 1 coved ST-segment elevation ≥2 mm in V1–V2 + Negative T wave + Syncope or nocturnal polymorphic VT/VF in structurally normal heart	12-Lead ECG with high precordial leads (2nd/3rd intercostal space) ± Sodium channel blocker provocation (Ajmaline/Flecainide)	Implantable Cardioverter-Defibrillator (ICD) for cardiac arrest survivors/spontaneous Type 1 + syncope; aggressive antipyretics during fever	✓ Publicado (mID 10009)
8	De Winter T waves ICD-10: I21.0 ICD-11: BA41.0 Cardiología	Upsloping J-point ST depression (1–3 mm) in V1–V6 + Tall, prominent symmetric hyperacute T waves + ST elevation (0.5–2 mm) in lead aVR	12-Lead ECG (recognized immediately as an acute proximal LAD occlusion STEMI equivalent) + Emergent Coronary Angiography	Immediate Cath Lab activation for Primary PCI + Dual Antiplatelet Therapy (Aspirin + Ticagrelor/Prasugrel) + Anticoagulation	✓ Publicado (mID 10010)
9	Sgarbossa criteria ICD-10: I21.9 ICD-11: BA41 Cardiología	Concordant ST elevation ≥1 mm in positive QRS lead (5 pts) + Concordant ST depression ≥1 mm in V1–V3 (3 pts) + Smith-modified discordant STE/S-wave ratio ≤ -0.25	12-Lead ECG using Smith-Modified Sgarbossa Rule in LBBB or Ventricular Paced Rhythm	Treat immediately as STEMI equivalent -> Emergent Primary PCI reperfusion protocol	✓ Publicado (mID 10011)
10	Dressler syndrome ICD-10: I24.1 ICD-11: BB20.2 Cardiología	Fever + Pleuritic pericarditic chest pain (2–8 weeks post-MI or cardiac surgery) + Pericardial/pleural effusion with elevated CRP/ESR	Transthoracic Echocardiography + 12-Lead ECG + Inflammatory markers (CRP/ESR) after excluding recurrent ischaemia	High-dose Aspirin (750–1000 mg q8h) + Colchicine (0.5 mg BD for 3 months)	✓ Publicado (mID 10012)
11	Takotsubo cardiomyopathy ICD-10: I51.81 ICD-11: BC43.4 Cardiología	Acute chest pain/dyspnoea after severe emotional/physical stressor + Transient LV apical ballooning + Absence of obstructive culprit coronary artery disease	Coronary Angiography with Left Ventriculography + Transthoracic Echocardiography / Cardiac MRI (InterTAK Criteria)	Supportive heart failure therapy (ACE inhibitor/ARB + Beta-blocker); avoid inotropes if LV outflow tract obstruction (LVOTO) is present	✓ Publicado (mID 10013)
12	Pulmonary embolism ICD-10: I26.99 ICD-11: BB00 Neumología	Sudden-onset dyspnoea + Pleuritic chest pain + Tachycardia / Hypoxaemia (or obstructive shock in massive PE)	CT Pulmonary Angiography (CTPA) (after Wells Score + Age-adjusted D-dimer in low/intermediate probability)	Direct Oral Anticoagulant (Apixaban or Rivaroxaban); Systemic Thrombolysis (Alteplase) for haemodynamically unstable high-risk PE	✓ Publicado (mID 10003)
13	Light criteria for pleural effusion ICD-10: J90 ICD-11: CB27 Neumología	Exudate if ≥1 of 3: Pleural/Serum protein >0.5 + Pleural/Serum LDH >0.6 + Pleural LDH >2/3 upper limit of normal serum LDH	Ultrasound-guided diagnostic thoracentesis with paired pleural fluid and serum protein, LDH, pH, glucose, cytology, and microbiology	Treat underlying cause; chest tube drainage if complicated parapneumonic effusion/empyema (pleural pH <7.20, frank pus, or positive Gram stain)	✓ Publicado (mID 10021)
14	CURB-65 pneumonia severity score ICD-10: J18.9 ICD-11: CA40 Neumología	Confusion (AMTS ≤8) + Urea >7 mmol/L + Respiratory rate ≥30/min + BP <90 systolic or ≤60 diastolic + Age ≥65 years (1 point each)	Chest Radiograph (new focal consolidation) + Clinical/Biochemical CURB-65 stratification	Score 0–1: Oral Amoxicillin outpatient; Score 2: Inpatient IV/PO Amoxicillin + Clarithromycin; Score ≥3: Co-amoxiclav + Clarithromycin ± ICU assessment	✓ Publicado (mID 10023)
15	Acute severe asthma ICD-10: J45.901 ICD-11: CA23.3 Neumología	PEF 33–50% best/predicted + Respiratory rate ≥25/min + Heart rate ≥110/min and inability to complete sentences in one breath (Life-threatening: silent chest, PEF <33%, normal/raised PaCO2)	Serial Peak Expiratory Flow (PEF) + Arterial Blood Gas (ABG — normal or rising PaCO2 >4.6 kPa indicates impending respiratory arrest)	High-flow Oxygen (target SpO2 94–98%) + Back-to-back nebulised Salbutamol (5 mg) & Ipratropium (0.5 mg) + Systemic Corticosteroids (Prednisolone 40–50 mg PO or Hydrocortisone 100 mg IV) + IV Magnesium sulfate (2 g over 20 min)	✓ Publicado (mID 10024)
16	Tension pneumothorax ICD-10: J93.0 ICD-11: CB21.0 Neumología	Severe respiratory distress & hypoxia + Unilateral absent breath sounds & hyperresonance + Tracheal deviation away from affected side with obstructive shock	Clinical diagnosis (NEVER delay decompression for chest X-ray; bedside eFAST ultrasound shows absent lung sliding and 'barcode/stratosphere sign')	Immediate needle thoracostomy decompression (5th intercostal space, mid-axillary line in adults, or 2nd ICS mid-clavicular line) followed by chest drain insertion	✓ Publicado (mID 10022)
17	Acute pancreatitis ICD-10: K85.9 ICD-11: DC31 Gastroenterología y Hepatología	Revised Atlanta Criteria (≥2 of 3): Severe epigastric pain radiating to the back + Serum lipase/amylase ≥3× ULN + Characteristic CECT/MRI pancreatitis findings	Serum Lipase (more specific and stays elevated longer than amylase) + Right Upper Quadrant Ultrasound (to detect gallstones)	Goal-directed balanced crystalloid resuscitation (Ringer's Lactate) + Multimodal analgesia + Early oral/enteral nutrition within 24–48h + Index laparoscopic cholecystectomy if gallstone-induced	✓ Publicado (mID 10006)
18	Spontaneous bacterial peritonitis ICD-10: K65.2 ICD-11: DB99.7 Gastroenterología y Hepatología	Ascites in cirrhotic patient + Fever / Diffuse abdominal tenderness + Hepatic encephalopathy or acute kidney injury (often asymptomatic in 30%)	Diagnostic Paracentesis showing Ascitic Fluid Absolute Polymorphonuclear (PMN / Neutrophil) count ≥250 cells/mm³ (≥0.25 × 10⁹/L)	Empiric IV 3rd-generation Cephalosporin (Cefotaxime 2 g q8h or Ceftriaxone 2 g OD for 5 days) + IV Albumin (1.5 g/kg on Day 1 and 1.0 g/kg on Day 3 to prevent Hepatorenal Syndrome)	✓ Publicado (mID 10025)
19	Acute cholangitis ICD-10: K83.0 ICD-11: DC12.0 Gastroenterología y Hepatología	Charcot's Triad: Fever with rigors + Right upper quadrant pain + Obstructive jaundice (Reynolds' Pentad adds: Septic shock + Confusion/altered mental status)	Tokyo Guidelines (systemic inflammation + cholestasis + biliary dilatation/choledocholithiasis on RUQ Ultrasound, MRCP, or EUS)	IV broad-spectrum antibiotics (Piperacillin-tazobactam or Ceftriaxone + Metronidazole) + Crystalloid resuscitation + Urgent biliary decompression via ERCP within 24–48 hours	✓ Publicado (mID 10026)
20	Upper gastrointestinal bleeding ICD-10: K92.2 ICD-11: ME24.90 Gastroenterología y Hepatología	Haematemesis (red blood or coffee-ground emesis) + Melaena (black, tarry stools) + Haemodynamic instability / elevated urea-to-creatinine ratio	Oesophagogastroduodenoscopy (OGD / EGD) within 24 hours (within 12 hours if suspected variceal bleed) + Glasgow-Blatchford Score risk stratification	Restrictive RBC transfusion (threshold Hb <70 g/L) + Non-variceal: Endoscopic therapy (clips/adrenaline/thermal) + IV PPI; Variceal: IV Terlipressin/Octreotide + IV Ceftriaxone + Endoscopic variceal band ligation	✓ Publicado (mID 10027)
21	Acute appendicitis ICD-10: K35.80 ICD-11: DB10.0 Cirugía General y Especialidades	Migratory periumbilical pain localising to McBurney's point (RIF) + Anorexia/nausea + Rebound tenderness / Rovsing's / Psoas / Obturator sign & low-grade pyrexia	Contrast-enhanced CT Abdomen & Pelvis in adults (appendiceal diameter >6 mm, wall thickening, periappendiceal fat stranding); Graded-compression Ultrasound in children/pregnancy	Laparoscopic Appendicectomy + Perioperative IV broad-spectrum antibiotics (e.g., Cefuroxime + Metronidazole or Co-amoxiclav)	✓ Publicado (mID 10015)
22	Boerhaave syndrome (oesophageal perforation) ICD-10: K22.3 ICD-11: DA25.2 Cirugía General y Especialidades	Mackler's Triad: Forceful retching/vomiting + Sudden severe lower thoracic/epigastric chest pain + Subcutaneous cervical emphysema (+ Hamman's crunch)	CT Thorax/Oesophagography with water-soluble oral contrast (Gastrografin — NEVER barium due to mediastinitis risk) showing transmural posterolateral left distal oesophageal leak	NPO + Nasogastric decompression + Broad-spectrum IV antibiotics & antifungals + Urgent primary surgical repair (<24h) or endoscopic covered stent/vacuum therapy	✓ Publicado (mID 10028)
23	Acute mesenteric ischaemia ICD-10: K55.0 ICD-11: DD30.0 Cirugía General y Especialidades	Sudden severe abdominal pain out of proportion to physical examination findings + Gut emptying (vomiting/diarrhoea) + Embolic source (Atrial fibrillation) & rising serum lactate	Biphasic CT Mesenteric Angiography (CTA) demonstrating superior mesenteric artery (SMA) thromboembolism, absent bowel wall enhancement, or pneumatosis intestinalis	Immediate IV unfractionated heparin + Fluid resuscitation + Broad-spectrum antibiotics + Emergent endovascular/open SMA embolectomy and laparotomy for necrotic bowel resection	✓ Publicado (mID 10029)
24	Diabetic ketoacidosis ICD-10: E10.10 ICD-11: 5A10 Endocrinología y Metabolismo	UK JBDS Triad: Ketonaemia ≥3.0 mmol/L (or ketonuria ≥2+) + Blood glucose >11.0 mmol/L (or known diabetes) + Venous HCO3- <15.0 mmol/L and/or venous pH <7.3	Bedside capillary beta-hydroxybutyrate ketones + Venous Blood Gas (pH, HCO3-, anion gap, K+) + Plasma glucose	IV 0.9% NaCl resuscitation + Potassium replacement (40 mmol/L if K+ 3.5–5.5) + Fixed-Rate IV Insulin Infusion (0.1 units/kg/hr; add 10% glucose when BG <14 mmol/L)	✓ Publicado (mID 10004)
25	Thyroid storm (Burch-Wartofsky score) ICD-10: E05.91 ICD-11: 5A02.Z Endocrinología y Metabolismo	Hyperpyrexia (>38.5–40°C) + Severe tachycardia / atrial fibrillation / high-output heart failure + CNS agitation, delirium, or coma	Clinical diagnosis supported by Burch-Wartofsky Point Scale (≥45 points highly suggestive) + Suppressed TSH (<0.01 mIU/L) and markedly elevated free T4/free T3	1. Beta-blockade (IV Propranolol/Esmolol) -> 2. Thionamide (Propylthiouracil 500–1000 mg loading then 250 mg q4h) -> 3. Lugol's Iodine (given ≥1 hour AFTER PTU) -> 4. IV Hydrocortisone (100 mg q8h)	✓ Publicado (mID 10030)
26	Addisonian crisis (acute adrenal insufficiency) ICD-10: E27.2 ICD-11: 5A74.1 Endocrinología y Metabolismo	Vasopressor-refractory hypotensive shock + Acute abdominal pain/vomiting + Classic biochemical pattern: Hyponatraemia, Hyperkalaemia, and Hypoglycaemia	Random serum cortisol & ACTH drawn prior to steroid administration (never delay treatment for Short Synacthen / Cosyntropin stimulation test)	Immediate IV Hydrocortisone 100 mg stat bolus (followed by 200 mg/24h infusion or 50 mg q6h) + Rapid IV 0.9% Sodium chloride resuscitation + IV Dextrose for hypoglycaemia	✓ Publicado (mID 10031)
27	Phaeochromocytoma ICD-10: D35.00 ICD-11: 2F37 Endocrinología y Metabolismo	Classic Episodic Triad: Paroxysmal headache + Profuse diaphoresis + Palpitations/tachycardia with severe episodic or sustained hypertension	Plasma free metanephrines or 24-hour urinary fractionated metanephrines and catecholamines + Adrenal CT/MRI (T2 'light-bulb' hyperintensity) ± 68Ga-DOTATATE PET	Pre-operative Alpha-blockade FIRST (Phenoxybenzamine or Doxazosin for 10–14 days) + high-sodium/fluid intake, FOLLOWED BY Beta-blockade (never give beta-blocker before alpha-blockade), then Laparoscopic Adrenalectomy	✓ Publicado (mID 10032)
28	Guillain-Barré syndrome ICD-10: G61.0 ICD-11: 8C01.0 Neurología	Progressive symmetrical ascending flaccid weakness + Areflexia/hyporeflexia + Preceding respiratory or Campylobacter jejuni GI infection 1–4 weeks prior	Lumbar Puncture CSF showing Albuminocytological Dissociation (elevated CSF protein with normal WCC <5/mm³) + Nerve Conduction Studies (demyelination / absent F-waves)	Serial Forced Vital Capacity (FVC <20 mL/kg mandates intubation/ICU) + IV Immunoglobulin (IVIG 0.4 g/kg/day for 5 days) or Plasma Exchange (corticosteroids are ineffective)	✓ Publicado (mID 10008)
29	Myasthenia gravis and myasthenic crisis ICD-10: G70.00 ICD-11: 8C60 Neurología	Fatigable fluctuating skeletal muscle weakness (worsening at end of day) + Ocular ptosis & diplopia + Bulbar dysphagia/dysarthria with preserved deep tendon reflexes and sensation	Serum anti-Acetylcholine Receptor (anti-AChR) antibodies (or anti-MuSK if seronegative) + Repetitive Nerve Stimulation (decremental response) / Single-fibre EMG + CT Thorax (to exclude thymoma)	Symptomatic: Pyridostigmine + Immunosuppression (Prednisolone/Azathioprine) + Thymectomy; Myasthenic Crisis: Intubation (if FVC <15–20 mL/kg) + Plasma Exchange or IVIG	✓ Publicado (mID 10033)
30	Wallenberg syndrome (lateral medullary syndrome) ICD-10: I63.53 ICD-11: 8B11 Neurología	Ipsilateral Horner's syndrome + Ipsilateral facial pain/temperature loss & cerebellar ataxia + Contralateral trunk/limb pain & temperature loss (+ dysphagia/hoarseness from nucleus ambiguus)	Diffusion-Weighted MRI (DWI) of the Brain & Posterior Fossa + CT/MR Angiography of the Vertebral and Posterior Inferior Cerebellar Artery (PICA)	Acute ischaemic stroke protocol (IV Alteplase/Tenecteplase if within 4.5h window) + Strict NPO & speech/swallow evaluation to prevent aspiration pneumonia + Secondary stroke prevention	✓ Publicado (mID 10034)
31	Wernicke encephalopathy ICD-10: E51.2 ICD-11: 5B55.1 Neurología	Classic Triad: Acute confusion/encephalopathy + Oculomotor dysfunction (horizontal nystagmus, bilateral CN VI palsy, conjugate gaze palsy) + Gait ataxia	Clinical diagnosis (MRI Brain shows symmetric T2/FLAIR hyperintensity in mammillary bodies, dorsomedial thalami, tectal plate, and periaqueductal grey)	Immediate high-dose parenteral IV Thiamine (Vitamin B1, 500 mg IV TDS for 3–5 days) ALWAYS administered BEFORE or concurrently with IV glucose to prevent precipitating Korsakoff syndrome	✓ Publicado (mID 10035)
32	Pre-eclampsia and eclampsia ICD-10: O14.9 ICD-11: JA24 Obstetricia y Ginecología	New-onset hypertension (BP ≥140/90 mmHg) after 20 weeks' gestation + Proteinuria (urine PCR ≥30 mg/mmol or ≥300 mg/24h) or maternal end-organ dysfunction (thrombocytopenia, elevated transaminases, renal insufficiency, pulmonary oedema, visual/cerebral symptoms)	Repeated BP measurements + Spot Urine Protein:Creatinine Ratio (PCR ≥30 mg/mmol) + sFlt-1:PlGF ratio + FBC, LFTs, Creatinine, and Fetal Umbilical Artery Doppler	Antihypertensive control (Oral Labetalol, Nifedipine MR, or Methyldopa; IV Labetalol/Hydralazine if BP ≥160/110) + IV Magnesium sulfate (4 g loading over 15–20 min then 1 g/hr infusion) for seizure prophylaxis/eclampsia + Definitive delivery	✓ Publicado (mID 10017)
33	HELLP syndrome ICD-10: O14.2 ICD-11: JA24.2 Obstetricia y Ginecología	Tennessee Criteria Triad: Haemolysis (schistocytes on blood film, LDH ≥600 IU/L, or bilirubin ≥1.2 mg/dL) + Elevated Liver enzymes (AST/ALT ≥2× ULN) + Low Platelets (<100 × 10⁹/L) with RUQ/epigastric pain	Peripheral Blood Smear (schistocytes/helmet cells) + Serum LDH, haptoglobin, AST/ALT, and platelet count	Maternal stabilization (IV Magnesium sulfate for eclampsia prophylaxis + IV Labetalol/Nifedipine for severe hypertension) + Prompt delivery once maternal coagulopathy/BP stabilized (if ≥34 weeks or deteriorating)	✓ Publicado (mID 10036)
34	Ectopic pregnancy ICD-10: O00.9 ICD-11: JA01 Obstetricia y Ginecología	Amenorrhoea (6–8 weeks) + Unilateral iliac fossa/pelvic pain + Vaginal bleeding (+ shoulder-tip pain and haemodynamic shock if ruptured)	Transvaginal Ultrasound (TVUS showing empty uterine cavity with adnexal mass / 'tubal ring sign' / free fluid in Pouch of Douglas) + Serial serum quantitative beta-hCG (48h rise <63%)	Ruptured/haemodynamically unstable or fetal heartbeat or beta-hCG >5000 IU/L: Laparoscopic Salpingectomy; Unruptured, stable, adnexal mass <35 mm, beta-hCG <1500–5000 IU/L: Single-dose IM Methotrexate (50 mg/m²)	✓ Publicado (mID 10037)
35	Henoch-Schönlein purpura (IgA vasculitis) ICD-10: D69.0 ICD-11: 4A44.90 Pediatría	Classic Tetrad: Palpable purpura over buttocks & extensor lower limbs (with normal platelets) + Arthralgia/arthritis + Colicky abdominal pain (risk of intussusception) + IgA glomerulonephritis (haematuria/proteinuria)	Clinical diagnosis (EULAR/PRINTO/PRES criteria) + FBC/coagulation screen (normal platelets exclude ITP) + Urine dipstick/PCR & BP monitoring (skin/renal biopsy shows IgA immune complex deposition)	Supportive analgesia + 6–12 months of regular urinalysis and blood pressure monitoring for HSP nephritis; corticosteroids reserved for severe GI pain/haemorrhage or progressive crescentic nephritis	✓ Publicado (mID 10038)
36	Toxic epidermal necrolysis (SCORTEN score) ICD-10: L51.2 ICD-11: EB13.1 Dermatología	Febrile prodrome after culprit drug (Allopurinol, Lamotrigine, Carbamazepine, Sulfonamides) + Painful erythematous/dusky macules with positive Nikolsky sign (>30% BSA detachment in TEN; <10% in SJS) + Haemorrhagic mucositis of ≥2 mucosal surfaces (oral, ocular, urogenital)	Clinical assessment of Body Surface Area (BSA) epidermal detachment + Skin Biopsy (frozen/paraffin section showing full-thickness epidermal keratinocyte necrosis and subepidermal split) + SCORTEN prognostic score	Immediate withdrawal of culprit drug + Transfer to ICU / Severe Burns Unit + Aggressive fluid/electrolyte & nutritional support + Non-adherent wound dressings + Urgent Ophthalmology review (Ciclosporin/Etanercept/IVIG per specialist protocol)	✓ Publicado (mID 10039)
37	Heparin-induced thrombocytopenia (HIT) ICD-10: D75.82 ICD-11: 3B64.13 Hematología y Oncología	4Ts Score: Platelet count fall >50% (nadir typically 20–100 × 10⁹/L) + Onset 5–10 days after starting UFH/LMWH + Paradoxical arterial or venous thrombosis (white clot syndrome) with absence of other causes	4Ts Pre-test Probability Score + Anti-PF4/heparin IgG ELISA immunoassay, confirmed by functional Serotonin Release Assay (SRA) or HIPA	STOP all heparin immediately (including heparin flushes and LMWH) + Start non-heparin therapeutic anticoagulation (Argatroban, Bivalirudin, Fondaparinux, or Danaparoid; avoid warfarin until platelets recover >150 × 10⁹/L; avoid platelet transfusions)	✓ Publicado (mID 10040)
38	Thrombotic thrombocytopenic purpura (TTP) ICD-10: M31.1 ICD-11: 3B64.14 Hematología y Oncología	Classic Pentad: Microangiopathic haemolytic anaemia (MAHA with schistocytes) + Severe thrombocytopenia + Fluctuating neurological deficits + Renal impairment + Fever (caused by severe ADAMTS13 deficiency <10%)	Peripheral Blood Film (numerous schistocytes) + PLASMIC Score + Severe ADAMTS13 activity deficiency (<10%) with anti-ADAMTS13 autoantibodies	Emergency daily Plasma Exchange (PEX) started within 4–8 hours + High-dose Corticosteroids (Methylprednisolone) + Rituximab + Caplacizumab (anti-vWF nanobody); NEVER transfuse platelets unless life-threatening haemorrhage	+ Reclamar / Redactar
39	Biceps femoris avulsion fracture ICD-10: S82.40 ICD-11: NC92 Traumatología y Ortopedia	Acute posterolateral knee pain after varus/hyperextension trauma + Tenderness/swelling over lateral fibular head with varus laxity + Avulsed osseous fragment from lateral fibular head (risk of common peroneal nerve foot drop)	AP/Lateral Knee Radiograph + Knee MRI (delineating conjoined biceps femoris & fibular collateral ligament tendon attachment, posterolateral corner structures, ACL/PCL, and common peroneal nerve)	Displaced fragment or posterolateral rotatory instability: Prompt open anatomic suture-anchor / screw fixation of the fibular head avulsion with common peroneal nerve neurolysis and concurrent cruciate reconstruction	✓ Publicado (mID 10005)
40	Acute kidney injury (KDIGO classification) ICD-10: N17.9 ICD-11: GB60 Nefrología y Urología	KDIGO Criteria: Serum creatinine rise ≥26.5 µmol/L (0.3 mg/dL) within 48h + OR ≥1.5× baseline within 7 days + OR Urine output <0.5 mL/kg/h for ≥6 hours	Serial Serum Creatinine & Hourly Urine Output + Urinalysis/Microscopy (muddy brown granular casts in ATN) + Renal Tract Ultrasound (to exclude post-renal hydronephrosis)	Stop nephrotoxins (NSAIDs, ACEi/ARBs, aminoglycosides, iodinated contrast) + Euvolaemic isotonic crystalloid resuscitation + Treat hyperkalaemia (IV Calcium gluconate + Insulin/Dextrose) + Urgent RRT if refractory	✓ Publicado (mID 10041)
41	Nephrotic syndrome ICD-10: N04.9 ICD-11: GB41 Nefrología y Urología	Classic Tetrad: Heavy proteinuria (>3.5 g/24h or Urine PCR >300–350 mg/mmol) + Hypoalbuminaemia (<25–30 g/L) + Generalized pitting oedema (periorbital/peripheral) + Hyperlipidaemia / lipiduria ('Maltese cross' casts)	24-hour Urine Protein or Spot Urine Protein:Creatinine Ratio (PCR) + Serum Albumin + Ultrasound-guided Percutaneous Renal Biopsy in adults (Light, Immunofluorescence, and Electron Microscopy)	Sodium restriction + Loop diuretics (Furosemide) + ACE inhibitor/ARB (antiproteinuric) + VTE prophylaxis if albumin <20 g/L + Disease-specific immunosuppression (Prednisolone in Paediatric Minimal Change Disease; Rituximab/Calcineurin inhibitor in Membranous Nephropathy)	✓ Publicado (mID 10042)
42	Testicular torsion ICD-10: N44.00 ICD-11: GB01 Nefrología y Urología	Sudden-onset severe unilateral scrotal/inguinal pain + High-riding transversely oriented testis ('bell-clapper deformity') + Absent ipsilateral cremasteric reflex & negative Prehn's sign with nausea/vomiting	Clinical diagnosis (NEVER delay theatre for imaging if high suspicion; Color Doppler Scrotal Ultrasound shows absent intratesticular arterial blood flow and 'whirlpool sign' of twisted spermatic cord)	Emergency surgical scrotal exploration within the 6-hour golden viability window: Detorsion and bilateral orchidopexy (or orchidectomy if necrotic + contralateral orchidopexy)	✓ Publicado (mID 10043)
43	Hepatorenal syndrome ICD-10: K76.7 ICD-11: DB99.6 Nefrología y Urología	Decompensated cirrhosis with ascites + Progressive KDIGO AKI (unresponsive after 48h of diuretic withdrawal and IV Albumin 1 g/kg/day expansion) + Bland urine sediment (<50 RBCs/hpf, protein <500 mg/day) and normal renal ultrasound	International Club of Ascites (ICA) Diagnostic Criteria + Fractional Excretion of Sodium (FENa <0.2%) + Diagnostic Paracentesis (to exclude Spontaneous Bacterial Peritonitis)	IV Terlipressin (2–12 mg/24h continuous infusion or 1 mg q4–6h) OR IV Noradrenaline + Daily IV 20% Albumin (20–40 g/day) + Expedited Liver Transplantation evaluation	✓ Publicado (mID 10044)
44	Acute bacterial meningitis ICD-10: G00.9 ICD-11: 1D01.0 Enfermedades Infecciosas	Classic Triad: Fever + Neck stiffness (nuchal rigidity) + Altered mental status/photophobia (+ Kernig's sign, Brudzinski's sign, and non-blanching petechial/purpuric rash in meningococcal septicaemia)	Lumbar Puncture CSF Analysis (elevated opening pressure, turbid appearance, polymorphonuclear pleocytosis >1000/mm³, CSF protein >1 g/L, CSF:serum glucose ratio <0.4) + CSF PCR & Blood Cultures	Immediate IV Ceftriaxone (2 g BD) + IV Dexamethasone (10 mg q6h for 4 days given before or with first antibiotic dose) + Add IV Amoxicillin (2 g q4h) if age >50, immunocompromised, or pregnant (Listeria coverage)	✓ Publicado (mID 10045)
45	Sepsis and septic shock (Sepsis-3 criteria) ICD-10: A41.9 ICD-11: 1G40 Enfermedades Infecciosas	Sepsis-3: Suspected/confirmed infection + Acute SOFA score increase ≥2 points; Septic Shock adds: Vasopressor requirement to maintain MAP ≥65 mmHg + Serum Lactate >2.0 mmol/L despite adequate fluid resuscitation	2 sets of Blood Cultures (aerobic & anaerobic) prior to antimicrobials + Serial Arterial/Venous Serum Lactate + Full SOFA organ dysfunction panel (PaO2/FiO2, platelets, bilirubin, creatinine, GCS, MAP)	Sepsis Six / Surviving Sepsis 1-Hour Bundle: IV broad-spectrum antimicrobials within 1 hour + 30 mL/kg balanced crystalloid for hypotension/lactate ≥4 mmol/L + Early Noradrenaline vasopressor targeting MAP ≥65 mmHg + Source control	✓ Publicado (mID 10046)
46	Severe falciparum malaria ICD-10: B50.0 ICD-11: 1F40 Enfermedades Infecciosas	Cyclical fever/rigors in returning traveller from endemic region + Thick & thin blood film showing Plasmodium falciparum hyperparasitaemia (>2–5%) / Maurer's clefts + Cerebral malaria, severe anaemia, hypoglycaemia, metabolic acidosis, or blackwater fever (AKI)	3 serial Giemsa-stained Thick (sensitivity) and Thin (species identification & percentage parasitaemia) Peripheral Blood Films + Rapid Diagnostic Antigen Test (HRP2/pLDH)	Parenteral IV Artesunate (2.4 mg/kg at 0, 12, and 24 hours, then daily) followed by a full 3-day oral Artemisinin-based Combination Therapy (ACT, e.g., Artemether-lumefantrine) + Strict blood glucose monitoring	✓ Publicado (mID 10047)
47	Dengue haemorrhagic fever and dengue shock syndrome ICD-10: A97.2 ICD-11: 1D2Z Enfermedades Infecciosas	Defervescence critical phase (Days 3–7): High fever with retro-orbital headache/myalgia + Progressive thrombocytopenia (<100 × 10⁹/L) with rising haematocrit (≥20% haemoconcentration from plasma leakage) + Narrow pulse pressure (≤20 mmHg) / pleural effusion / ascites	Dengue NS1 Antigen ELISA/Rapid Test (Days 1–5) + Dengue IgM/IgG MAC-ELISA (Day ≥5) + Serial hourly Haematocrit (PCV) and Platelet monitoring	Protocolized judicious isotonic crystalloid titration (0.9% NaCl / Ringer's Lactate guided by hourly urine output 0.5–1 mL/kg/h and serial haematocrit; rescue colloid/blood transfusion if refractory shock; strictly avoid NSAIDs/Aspirin)	✓ Publicado (mID 10048)
48	Systemic lupus erythematosus (EULAR/ACR criteria) ICD-10: M32.9 ICD-11: 4A40.0 Reumatología e Inmunología	Entry criterion ANA ≥1:80 + Mucocutaneous (malar butterfly rash sparing nasolabial folds, photosensitivity, oral ulcers) + Non-erosive polyarthritis / Serositis / Lupus nephritis / Cytopenias with hypocomplementaemia (low C3/C4)	Antinuclear Antibody (ANA ≥1:80 screening) + High-specificity Anti-dsDNA (correlates with lupus nephritis disease activity) and Anti-Smith (Anti-Sm) antibodies + Complement C3/C4 + Urine PCR/Renal Biopsy	Universal Hydroxychloroquine (≤5 mg/kg/day for all patients unless contraindicated) + Photoprotection + Corticosteroids for flares + Mycophenolate mofetil / Cyclophosphamide / Belimumab / Rituximab for organ-threatening Lupus Nephritis	✓ Publicado (mID 10049)
49	Giant cell arteritis (temporal arteritis) ICD-10: M31.6 ICD-11: 4A44.2 Reumatología e Inmunología	Age >50 years with new unilateral temporal headache & scalp tenderness + Jaw claudication + Visual disturbance (amaurosis fugax / anterior ischaemic optic neuropathy) & Polymyalgia rheumatica with ESR >50 mm/hr / elevated CRP	Colour Duplex Ultrasound of the Temporal & Axillary Arteries (non-compressible hypoechoic 'halo sign') + Temporal Artery Biopsy within 2 weeks of starting steroids (granulomatous panarteritis with multinucleated giant cells and internal elastic lamina fragmentation)	IMMEDIATE High-Dose Corticosteroids (NEVER wait for biopsy): Visual symptoms present -> IV Methylprednisolone 500–1000 mg daily for 3 days then Prednisolone 60 mg OD; No visual loss -> Oral Prednisolone 40–60 mg OD + Tocilizumab (IL-6 inhibitor) steroid-sparing therapy	✓ Publicado (mID 10050)
50	Septic arthritis ICD-10: M00.9 ICD-11: FA10 Reumatología e Inmunología	Acute hot, swollen, erythematous monoarthritis + Severe pain with complete inability to bear weight or tolerate passive range of motion + Fever & elevated CRP/ESR/WCC (Kocher criteria in paediatric hip)	Urgent Synovial Fluid Aspiration PRIOR to antibiotics (Synovial WCC >50,000/mm³ with >90% neutrophils, Gram stain, culture, and polarized light microscopy to exclude crystal arthropathy) + Blood Cultures	Emergency arthroscopic or open surgical joint washout/debridement + Empiric IV antibiotics (Flucloxacillin or Vancomycin + Ceftriaxone if gonococcal/Gram-negative risk) for 4–6 weeks	✓ Publicado (mID 10051)
51	Neuroleptic malignant syndrome ICD-10: G21.0 ICD-11: 8A04.4 Psiquiatría	FEVER Mnemonic after dopamine D2 antagonist (Haloperidol/Olanzapine) or dopamine withdrawal: Fever (>38.5–40°C) + Encephalopathy (delirium/stupor) + Vitals unstable (autonomic lability/tachycardia/diaphoresis) + Elevated enzymes (CK >1,000–100,000 IU/L) + Lead-pipe muscle Rigidity (hyporeflexia)	Clinical diagnosis (DSM-5 / Levenson Criteria) + Markedly elevated Serum Creatine Kinase (CK), leukocytosis, metabolic acidosis, and urine myoglobin (to monitor for rhabdomyolysis-induced AKI)	Immediate cessation of causative antipsychotic (or restart dopaminergic agent if withdrawal-induced) + ICU supportive cooling & aggressive IV crystalloid hydration + IV Dantrolene (1–2.5 mg/kg) + Oral Bromocriptine (dopamine agonist) or Lorazepam	✓ Publicado (mID 10052)
52	Serotonin syndrome (Hunter criteria) ICD-10: G92.0 ICD-11: NE60 Psiquiatría	Rapid-onset (<24h) Classic Triad after serotonergic drug (SSRI + MAOI/Tramadol/Linezolid/MDMA): Neuromuscular hyperactivity (spontaneous/inducible ankle clonus, hyperreflexia, tremor) + Autonomic hyperactivity (hyperthermia, diaphoresis, mydriasis, tachycardia) + Altered mental status (agitation/delirium)	Hunter Serotonin Toxicity Criteria (clinical diagnosis in the presence of a serotonergic agent + inducible/spontaneous/ocular clonus, agitation, diaphoresis, tremor, and hyperreflexia)	Stop all serotonergic agents immediately + Benzodiazepines (IV Lorazepam/Diazepam for agitation, tremor, and hyperthermia) + IV fluids & active cooling + Serotonin 5-HT2A antagonist Cyproheptadine (12 mg PO/NG stat then 2 mg q2h) in moderate-to-severe cases	✓ Publicado (mID 10053)
53	Delirium tremens (alcohol withdrawal delirium) ICD-10: F10.231 ICD-11: 6C40.4 Psiquiatría	Onset 48–96 hours after last alcohol drink: Global confusion & terrifying visual/tactile hallucinations (formication / Lilliputian hallucinations) + Severe autonomic hyperactivity (fever, profuse diaphoresis, tachycardia, hypertension) + Coarse tremor / generalized tonic-clonic withdrawal seizures	Clinical assessment using CIWA-Ar Score (≥20 indicates severe withdrawal) + Serum Electrolytes (correct hypomagnesaemia, hypokalaemia, and hypophosphataemia), glucose, and LFTs	Symptom-triggered or front-loaded long-acting Benzodiazepines (Oral Chlordiazepoxide or IV Diazepam; use Lorazepam/Oxazepam in severe hepatic cirrhosis) + High-dose parenteral IV Thiamine (Pabrinex) BEFORE glucose + Magnesium/potassium replacement	✓ Publicado (mID 10054)
54	Acute angle-closure glaucoma ICD-10: H40.21 ICD-11: 9C61.2 Oftalmología y ORL	Sudden severe unilateral ocular/peri-orbital pain with headache, nausea & vomiting + Blurred vision with rainbow-coloured halos around lights + Red eye (ciliary flush), hazy oedematous cornea, fixed mid-dilated non-reactive pupil, and rock-hard globe on palpation	Goldmann Applanation Tonometry (Intraocular Pressure IOP typically >40–60 mmHg; normal 10–21 mmHg) + Slit-lamp examination & Gonioscopy of both eyes showing closed iridocorneal angle	Immediate IOP reduction: IV Acetazolamide (500 mg stat) + Topical Timolol 0.5%, Apraclonidine/Brimonidine, and Pilocarpine 2%–4% (once IOP <40 mmHg) + Supine positioning + Definitive Bilateral Laser Peripheral Iridotomy (LPI) once corneal oedema clears	✓ Publicado (mID 10055)
55	Central retinal artery occlusion (CRAO) ICD-10: H34.1 ICD-11: 9B75.0 Oftalmología y ORL	Sudden, painless, profound unilateral visual loss (counting fingers/light perception) + Relative Afferent Pupillary Defect (RAPD / Marcus Gunn pupil) + Fundoscopy showing pale whitened oedematous retina with a pathognomonic foveal 'Cherry-Red Spot' and cattle-trucking of retinal arterioles	Urgent Dilated Fundoscopy & Optical Coherence Tomography (OCT) + Immediate ESR/CRP (to exclude Giant Cell Arteritis in patients >50 years) + Carotid Duplex Ultrasound & Echocardiography/ECG (stroke workup)	Ophthalmic & Stroke Emergency (<4.5h window): Exclude arteritic CRAO (give IV Methylprednisolone immediately if GCA suspected) + Ocular massage / IOP reduction (IV Acetazolamide) + Hyperacute Stroke Unit assessment for thrombolysis and secondary vascular prevention	✓ Publicado (mID 10056)
56	Ludwig angina ICD-10: K12.2 ICD-11: DA04 Oftalmología y ORL	Rapidly progressive bilateral cellulitis of submandibular, sublingual, and submental spaces (usually from mandibular 2nd/3rd molar dental infection) + Woody, brawny induration of the floor of the mouth + Superior/posterior displacement of the tongue causing drooling, trismus, 'hot-potato voice', stridor, and impending airway occlusion	Clinical airway assessment first + Contrast-enhanced CT Neck & Thorax (performed ONLY after airway is secure) demonstrating polymicrobial gas-forming submandibular space phlegmon/abscess	1. Immediate Airway Security (Awake fibreoptic nasotracheal intubation or surgical tracheostomy) -> 2. High-dose IV broad-spectrum antibiotics (Ceftriaxone + Metronidazole or Piperacillin-tazobactam + IV Dexamethasone) -> 3. Surgical decompression and extraction of culprit mandibular molars	✓ Publicado (mID 10057)
57	High anion gap metabolic acidosis (GOLD MARK) ICD-10: E87.2 ICD-11: 5C73 Patología y Medicina de Laboratorio	Arterial pH <7.35 + Serum Bicarbonate (HCO3-) <22 mmol/L + Elevated Serum Anion Gap ([Na+] - ([Cl-] + [HCO3-])) >12 mmol/L (adjusted for hypoalbuminaemia) with compensatory Kussmaul hyperventilation (Winter's formula: PaCO2 = 1.5 × [HCO3-] + 8 ± 2)	Arterial Blood Gas (ABG) + Serum Electrolytes & Albumin-Corrected Anion Gap + Delta Ratio (ΔAG / ΔHCO3-) + Serum Osms & Osmolar Gap + Lactate, Beta-hydroxybutyrate, Urinalysis (oxalate crystals), and Salicylate/Toxicology screen	Treat the underlying GOLD MARK cause (Glycols -> Fomepizole/Haemodialysis; Oxoproline -> stop paracetamol/NAC; L-lactate -> shock resuscitation; D-lactate -> short-bowel antibiotics; Methanol -> Fomepizole; Aspirin -> urinary alkalinisation with IV NaHCO3; Renal failure -> RRT; Ketoacidosis -> Insulin/fluids)	✓ Publicado (mID 10058)
58	Disseminated intravascular coagulation (ISTH score) ICD-10: D65 ICD-11: 3B62.0 Patología y Medicina de Laboratorio	Systemic thrombo-haemorrhagic activation (triggered by sepsis, obstetric catastrophe, trauma, or APL/malignancy) + Diffuse mucocutaneous oozing from venepuncture sites / purpura fulminans + Microvascular thrombosis causing multi-organ dysfunction	ISTH Overt DIC Scoring System (≥5 points): Thrombocytopenia (<100 × 10⁹/L) + Prolonged PT and APTT + Markedly elevated D-dimer / Fibrin Degradation Products + Consumed low Fibrinogen (<1.0–1.5 g/L) + Schistocytes on peripheral blood smear	Aggressively treat the underlying trigger (sepsis/obstetric/APL) + Supportive blood component replacement in bleeding patients: Platelets (keep >50 × 10⁹/L), Fresh Frozen Plasma (15 mL/kg for prolonged PT/APTT), and Cryoprecipitate or Fibrinogen concentrate (if fibrinogen <1.5 g/L)	✓ Publicado (mID 10059)
59	Subarachnoid haemorrhage ICD-10: I60.9 ICD-11: 8B01 Radiología e Imagen Médica	Sudden-onset 'thunderclap' occipital headache reaching maximal intensity within seconds to <1–5 minutes + Meningism (neck stiffness, photophobia, vomiting) + Transient loss of consciousness or focal cranial nerve palsy (e.g., pupil-involving CN III palsy from PCom aneurysm)	Non-contrast CT Head within 6 hours of headache onset (>98.5% sensitivity showing hyperdense blood in basal cisterns/Sylvian fissures); if CT negative >6 hours -> Lumbar Puncture at ≥12 hours for CSF Spectrophotometry (bilirubin xanthochromia) + CT Angiography (CTA) / Digital Subtraction Angiography (DSA)	Neurosurgical ICU admission + Oral Nimodipine (60 mg q4h for 21 days to prevent delayed cerebral ischaemia/vasospasm) + BP control (SBP <160 mmHg pre-securing) + Urgent Endovascular Coiling or Microsurgical Clipping of ruptured berry aneurysm within 24–72 hours	✓ Publicado (mID 10060)
60	Acute ischaemic stroke (ASPECTS and NIHSS) ICD-10: I63.9 ICD-11: 8B11 Radiología e Imagen Médica	Sudden-onset focal neurological deficit conforming to a vascular territory (FAST: Contralateral hemiparesis, facial droop, aphasia/dysarthria, gaze deviation, or homonymous hemianopia) + NIHSS quantification + Hyperdense MCA sign / loss of insular ribbon on non-contrast CT	Immediate Non-Contrast CT Head (to exclude haemorrhage and calculate ASPECTS score) + CT Angiography (arch-to-vertex for Large Vessel Occlusion in ICA/M1/M2/Basilar) + CT Perfusion (core-to-penumbra mismatch in 6–24h window)	IV Thrombolysis within 4.5 hours of onset (Alteplase 0.9 mg/kg or Tenecteplase 0.25 mg/kg after excluding haemorrhage; keep BP <185/110 mmHg) + Mechanical Endovascular Thrombectomy within 6–24 hours for anterior/posterior Large Vessel Occlusion + Aspirin 300 mg started 24h post-thrombolysis after repeat CT	✓ Publicado (mID 10061)