Triads in Medicine – Rapid Review for Medical Students

triads in medicine

One of the most convenient ways of learning and remembering the main components of disease and identifying a medical condition on an exam are Triads, and medical students/interns/residents swear by them.

Be it a question during rounds, a multiple-choice exam question to be solved, or even in medical practice, the famous triads help physicians recall important characteristics and clinical features of a disease or treatment in an instant.

Since exam season is here, this could serve as a rapid review to recall the most common medical conditions.

While there are a vast number of triads/pentads available online, I have listed the most important (high-yy) ones that every student would be asked about at least once in the duration of their course.

1) Lethal Triad also known as The Trauma Triad of Death
Hypothermia + Coagulopathy + Metabolic Acidosis

2) Beck’s Triad of Cardiac Tamponade
Muffled heart sounds + Distended neck veins + Hypotension

3) Virchow’s Triad – Venous Thrombosis
Hypercoagulability + stasis + endothelial damage

4) Charcot’s Triad – Ascending Cholangitis
Fever with rigors + Right upper quadrant pain + Jaundice

5) Cushing’s Triad – Raised Intracranial Pressure
Bradycardia + Irregular respiration + Hypertension

6) Triad of Ruptured Abdominal Aortic Aneurysm
Severe Abdominal/Back Pain + Hypotension + Pulsatile Abdominal mass

7) Reactive Arthritis
Can’t See (Conjunctivitis) + Can’t Pee (Urethritis) + Can’t Climb a Tree (Arthritis)

8) Triad of Opioid Overdose
Pinpoint pupils + Respiratory Depression + CNS Depression

9) Hakims Triad – Normal Pressure Hydrocephalus
Gait Disturbance + Dementia + Urinary Incontinence

10) Horner’s Syndrome Triad
Ptosis + Miosis + Anydrosis

11) Mackler’s Triad – Oesophageal Perforation (Boerhaave Syndrome)
Vomiting + Lower Thoracic Pain + Subcutaneous Emphysema

12) Pheochromocytoma
Palpitations + Headache + Perspiration (Diaphoresis)

13) Leriche Syndrome
Buttock claudication + Impotence + Symmetrical Atrophy of bilateral lower extremities

14) Rigler’s Triad – Gallstone ileus
Gallstones + Pneumobilia + Small bowel obstruction

15) Whipple’s Triad – Insulinoma
Hypoglycemic attack + Low glucose + Resolving of the attack on glucose administration

16) Meniere’s Disease
Tinnitus + Vertigo + Hearing loss

17) Wernicke’s Encephalopathy- Thiamine Deficiency
Confusion + Ophthalmoplegia + Ataxia

18) Unhappy Triad – Knee Injury
Injury to Anterior Cruciate Ligament + Medial collateral ligament + Medial or Lateral Meniscus

19) Henoch Schonlein Purpura
Purpura + Abdominal pain + Joint pain

20) Meigs Syndrome
Benign ovarian tumor + pleural effusion + ascites

21) Felty’s Syndrome
Rheumatoid Arthritis + Splenomegaly + Neutropenia

22) Cauda Equina Syndrome
Low back pain + Bowel/Bladder Dysfunction + Saddle Anesthesia

23) Meningitis
Fever + Headache + Neck Stiffness

24) Wolf Parkinson White Syndrome
Delta Waves + Short PR Interval + Wide QRS Complex

25) Neurogenic Shock
Bradycardia + Hypotension + Hypothermia

Further Reading

Cite this article as: Sumaiya Hafiz, UAE, "Triads in Medicine – Rapid Review for Medical Students," in International Emergency Medicine Education Project, June 12, 2020, https://iem-student.org/2020/06/12/triads-in-medicine/, date accessed: December 3, 2022

Sudden Shortness of Breath

In case you didn’t encounter a sudden shortness of breath today!

A 23-year-old male patient presented with sudden onset SOB and chest pain. BP: 121/68 mmHg, HR: 102 bpm, RR: 22/min, T: 37, SpO2: 93% in room air. He has no history of disease. On the exam, you appreciated a decreased breath sound on the left and checked the thorax with bedside ultrasound. Here are the ultrasound findings of the patient.

What is your next action?

624.5 - Figure 5_Lung Point on M Mode

iEM Education Project Team uploads many clinical picture and videos to the Flickr and YouTube. These images are free to use in education. You can also support this global EM education initiative by providing your resources. Sharing is caring!

Pneumonia is just uploaded!

377.1 - pneumonia1

Pneumonia chapter written by Mary J O from USA is just uploaded to the Website!

Asthma is just uploaded!

Inhaler

Asthma chapter written by Ayse Ece Akceylan from Turkey is just uploaded to the Website!

I…can’t…breathe!

A New Chapter Is Just Uploaded To The Website!

35.3 - pulmonary congestion

An ambulance crew rushes into your emergency department with a 56-year-old man. He is severely short of breath, sitting upright on the stretcher, using his accessory respiratory muscles, and gasping for air. You find that he is diaphoretic, tachypneic, and in severe respiratory distress. You ask him, “What’s going on?” He replies: “I…can’t…(pauses and inhales a shallow breath)…breathe!”

The paramedics inform you that they received a call from the patient’s wife about 6:30 that morning, saying that her husband was short of breath and sweaty and that he had vomited once. The wife told them that she and her husband had returned from a long trip the night before and that her husband had not taken his “water pills” because he did not want to stop for frequent restrooms breaks during their drive. When they got home, he still did not take his pills because he wanted to sleep through the night. His breathing problems woke him during the night, and he tried to get more comfortable by adding pillows under his head to the point that he was almost sitting up in bed.

You thank the paramedics and turn back to the patient, who now looks even worse. He is more short of breath, and you sense that he is getting tired, about to give up. He looks like he is about to collapse. What is your next step?

by Walid Hammad from USA

A 68-year-old with wheezing

copd

Chronic Obstructive Pulmonary Disease (COPD)

by Ramin Tabatabai, David Hoffman, and Tiffany Abramson, USA

A 68-year-old male presents to the emergency department (ED) with audible wheezing, and he is in severe respiratory distress. He is speaking in 2-3 word sentences, and he is diaphoretic and slightly confused. Per the paramedic report, the patient is a two pack per day smoker. On physical examination, the patient demonstrates poor air movement, and you note that he has a “barrel chest.” As you pick up the phone to call the respiratory therapist for airway management, you wonder, “What other interventions should I initiate and are there other diagnoses I should be considering?”

What is the value of BiPAP on COPD?

Touch Me

BiPAP on COPD

The use of BiPAP led to decreased mortality (NNT=10), reduction in treatment failure (NNT=5) and decreased need for intubation (NNT=4).
Answer

Dramatic Diaphragmatic Hernia

In case you didn’t encounter shortness of breath today!

15.3 - diaphragmatic hernia 3

iEM Education Project Team uploads many clinical picture and videos to the Flickr and YouTube. These images are free to use in education. You can also support this global EM education initiative by providing your resources. Sharing is caring!