General

Question 1

Cause of central/ peripheral cyanosis

Answer 1

Lip blue but normal tongue = peripheral cyanosis

Central cyanosis

1) decrease arterial O2 sat
- lung disease: COPD, cor pulmonale, large PE
- hypoventilation
- decreased inspired O2 conc eg high altitude (never gonna be this lol)
- Right) to Left) cardiac shunt eg cyanotic heart disease (likely dead when reach us)
2) Polycythaemia
3) Abnormal Hb eg Meth

Peripheral cyanosis

1) all of above
2) cold/ raynaud
3) reduced cardiac output eg L) ventricular failure, shock
4) arterial/ venous obstruction

Question 2

5 types of shock

Answer 2

1) hypovolaemia
2) cardiac failure
3) obstructive/ PE
4) sepsis
5) anaphylaxis
6) endo failure eg addison, hypothyroidism
7) drugs eg antihtn, anaesthesia

other random
- spinal cord injury/ autonomic neuropathy

Question 3

Nail changes

Answer 3

Blue nails = cyanosis, Wilson disease, ochronosis (blue black discolouration of tissue eg metabolic condition)
Red nails = polycythaemia (reddish-blue), CO poisoning (cherry red)
Clubbing = see separate
Splinter haemorrhage = IE, vascultiits
Koilonychia (spoon shaped nails) = Fe def, Raynaud, fungal
Onycholysis (loosening/ separation of nail from nail bed) = thyrotoxicosis, psoriasis
Beau’s line (non pigmented transverse band in nail bed) = fever, cachexia, malnutrition
Leuconychia (white nails) = liver, hypo albumin
Muehrcke’s lines (transverse opaque white bands) = the kind you get when you accidentally trap your finger btw doors – trauma, chemo, hypo albumin
Nail fold erythema/ telangiectasia = lupus
Terry’s nail (half proximal white to pink, half distal red/ brown) = CKD, cirrhosis

Question 4

Clubbing

Answer 4

Definition

• loss of angle between nail bed and finger (hyponychial angle)
• Schamroth’s sign = disappearance of diamond shaped space formed when nails of 2 similar fingers held together
• interphalangeal depth ratio > 1 = ratio of Distal pharyngeal AP depth/ Interphalangeal AP depth)

Cause

1) Cardio
- cyanotic congenital heart
- infective endocarditis

2) Resp
- lung carcinoma - usually not small cell
- chronic eg bronchiectasis, lung abscess, emphysema
- idiopathic pull fibrosis
less common resp
- CF
- asbestosis
- pleural mesothelioma/ plural fibroma

other less common

3) Gastro
- cirrhosis esp PBC
- IBD
- coeliac

4) Thyrotoxicosis

Question 5

Marfan

Answer 5

• tall stature
  = thoracic kyphosis
• pacts excavatum (sternum is sunken into chest)
• long limbs
• aortic regurgitation
• arachodactyly (spider limbs) = abnormally long, slender fingers/ toes in cf to palm
  — can be assoc w deformity/ contractures
• high arch palate = high, narrow palate, almost as if there is a space to fit a finger in