Medical Quiz on Cyanosis and Related Conditions

General Surgery - I: Clinical Part

• Importance of patient familiarity:

  • Understanding the patient is crucial.
  • Ensuring patient reassurance is key.
  • Determining the type and degree of risk associated with procedures, diseases, and their relationship is essential.
  • Reducing patient errors requires multiple identification methods (name, age, patient number, admission time).

• Personal History includes: name, age, living situation, marital status, occupation, special habits.

• Age and Disease Correlations:

  • Rheumatic heart disease (RHD) and tuberculosis (TB) are common in pediatric and young patients.
  • Hypertension (HTN), coronary artery disease (CAD), diabetes mellitus (DM), and kidney diseases are prevalent in older patients.

• Sex and Disease Correlations:

  • Bronchogenic carcinoma is more common in males.
  • Thyroid diseases are more prevalent in females.
  • Hemophilia is predominantly associated with males.

• Occupation and Disease Correlations:

  • Lead workers have a higher risk of anemia and nephropathy.
  • Farmers have a higher incidence of bilharziasis.
  • Medical and paramedical staff are more likely to be exposed to infections and x-ray exposure effects.

• Geographical Location and Disease:

  • Filariasis is common in El Sharkia.
  • Iodine deficiency is a concern in Oasis and Siwa.

Special Habits

• Smoking is linked to various orodental issues such as oral ulceration, delayed wound healing, dental caries, dental abrasion, tooth staining, and gum disease, and Burgers disease.

• Smoking Index:

  • Mild smoking: 10 cigarettes/day or 100 packs per year.
  • Moderate smoking: 10-20 cigarettes/day or 100-400 packs per year.
  • Heavy smoking: more than 20 cigarettes/day or 400 packs per year.

• Alcohol Consumption:

  • Increases the risk of mucosal abrasions, dental erosion, cavitary lesions, oropharyngeal cancers, and pancreatitis.
  • Increased risk with ≥30 units per day of alcohol consumption.

• Socioeconomic History:

  • Hypertension (HTN), ischemic heart disease (IHD), oral cancers, smoking, and alcohol hazards are more common in high-social class individuals.
  • Certain diseases associated with malnutrition, infections, and poor oral hygiene are predominant in lower socioeconomic groups.

Menstrual History

• Date of menarche
• Regularity of menstrual cycle
• Amount of bleeding in each cycle
• Time of each cycle
• Hazards of contraceptive pills or injections

Family History

• Familial diseases like familial adenomatous polyposis frequently occur in families, in addition to hemophilia.
• Size and shape of the mouth and facial features.

Complaint

• Detailed description of the patient's condition, including the onset, progression, and duration of symptoms.

Present History

• Analyzing patient complaints in detail

Past History

• Medications: antihypertensive drugs, anticoagulant drugs.
• Chronic diseases: diabetes, ischemic heart disease.
• Hospital admissions: causes, timings, investigations, management.
• Operations: description of procedures and complications.
• Blood transfusions.

Pain Analysis

• Site (S): Location of pain.
• Onset (O): Sudden or gradual onset of pain.
• Character (C): Description of pain (e.g. sharp, dull,throbbing).
• Radiation (R): Extent of pain to other parts of the body, compared with the original site.
• Association (A): Any conditions associated with the pain (e.g., headache, fever).
• Time, treatment, and symptoms (T): when the pain occurs, associated treatment and symptoms to determine the etiology.
• Exacerbation (E): Aggravating factors like temperature or particular positions.

Swelling Analysis

• Inspection:
  • Site: location of swelling.
  • Size: dimensions.
  • Shape: form.
  • Surface: texture or appearance of the skin over the swelling.
  • Surrounding area: whether there is edema or erythema.
  • Number of pulsations: whether there are pulsatile or other movement.
  • Margins: well or poorly defined.
  • Movement: Movement of the swelling when the patient moves.
  • Impulse on cough: impact on the swelling with a cough.

Palpation

• Temperature: of the affected area (by using back of hand/dorsal surface of hand).
• Tenderness: any tenderness or pain upon touch.
• Pulsation: feeling of rhythmic movement of blood through blood vessels.
• Reducibility: if the swelling decreases or ceases.
• Compressibility: whether the swelling compresses.
• Consistency: degree of firmness of the swelling (e.g., soft, firm, hard).
• Fluctuations: testing for fluid in the affected swelling using a combination of hands and finger.
• Trans-illumination: evaluation in a darken area to assess the content of swelling whether solid or gas.
• Thrill: vibrating sensations upon palpating the swelling.
• Impulse on cough: impact on swelling.
• Mobility and fixity test: moving the swelling and evaluate if the skin is fixed to underlying structure.

Percussion, auscultation: (additional diagnostic techniques).

Vital Data

• Pulse: Using three middle fingers to palpate over peripheral pulse sites.
• Temperature (using different methods: oral. Rectal, axillary, and tympanic).
• Blood pressure (auscultatory and palpatory to determine the upper limit of systolic pressure and lower limit of diastolic pressure using a mercury sphygmomanometer.
• Respiratory rate

Body Weight, BMI, Comorbidities

• Body Weight: BMI calculation and evaluation of obesity categories. Evaluation of associated health risks (comorbidities) with obesity.

Jaundice

• Meaning: Yellowish discoloration of skin, sclera, mucous membranes, and/or color changes in urine/stool.
• Types of Jaundice: Normal, subclinical and clinical, based on levels of serum bilirubin.
• Types of jaundice based on cause (e.g., hepatocellular, obstructive, hemolytic) and associated color changes (e.g., orange yellow, lemon yellow, olive green).

Cyanosis

• Meaning: Bluish discoloration of skin and mucous membranes due to reduced oxygen saturation.
• Types: Peripheral (extremities only) and Central (whole body).
• Differentiate among causes of peripheral cyanosis (e.g., Diminished arterial oxygen saturation; Diminished flow of blood to the local part).

Decubitus Position

• Orthopnea: Dyspnea (difficulty breathing) worsened when lying down.
• Trepopnea: Dyspnea aggravated by turning/lying on one side.
• Platypnea: Difficulty breathing worsened when sitting upright rather than lying down

Head and Neck Examination

• Inspect the head and neck from various angles (examining facial expression, and inspecting visible glands).
• Check for any abnormalities in or around the eyes, oral cavity, lips, and scalp including abnormal pulse in the neck veins. (Check if there are any abnormal veins, like congested pulsatile neck veins).
  • Conditions associated with congested pulsatile neck veins: right-sided heart failure, tension pneumothorax, pregnancy, hypervolemia & hyperdynamic circulation.
• Check for any abnormalities and associated conditions with the visible lymph node including whether the lymph node is hard, tender or enlarges.

Eye Examination

• Inspect for eye conditions, like abnormalities in the eye brows and eye balls (anomalies in their form, loss or presence of anomalies in eye balls structure which could cause swelling).

Teeth examination

• Evaluate any mobility or loosening of teeth based on factors like diabetes mellitus, osteoporosis, or trauma.
• Evaluate color changes, gap between teeth (diastema), size of teeth (over-sized or under sized) and loss of teeth .

Gums

• Observe for bleeding (e.g., due to liver disease, Vitamin C deficiency, hematological disorders or use of drugs like cyclosporine), gum hypertrophy, and presence of blue lines that could indicate lead poisoning.

Tongue Examination

• Check for tongue discoloration, atrophy, micro-glossia, macro-glossia or presence of abnormalities in the oral cavity.

Wound Dressings and Bleeding Control

• Methods of wound care & management of bleeding including washing the wound, controlling bleeding, disinfecting, suturing and dressing with sterile gauze.
• Methods of bleeding control like elevation, direct compression, and use of tourniquet

Surgical Methods

• Suturing methods using suture materials.

Suturing and Suture Materials

• Definition and types of suture materials (natural, synthetic, metallic). This section would include detailed information about the classifications of sutures based on structure (monofilament, multifilament), absorption (absorbable, non-absorbable), and coating.

Surgical Knots and Technique

• Components and principles of different surgical knots (e.g., simple, square, surgeon's, half-hitch, granny). Explanation of different suture techniques.

Stitch Removal

• Factors influencing the appropriate time for stitch removal. The process of stitch removal and the different sites appropriate for stitch removal.

Alternatives to Sutures

• Stapling, tissue adhesives, and tapes as alternatives to sutures

Clinical Examination of Sinus and Fistula

• Inspection: Site location, type of opening or sprouting, discharge appearance (color, consistency) and associated symptoms.
• Palpation: Temperature, tenderness, discharge characteristics and consistency, and presence of any rigidity or fixation to the surrounding tissues.

Clinical Examination of Ulcer

• Inspection: Site, size, shape, floor, edge, discharge, surrounding area that could include redness and swelling.
• Palpation determining the Tenderness, and consistency of the ulcer, edge, surrounding area, or edema.
• Pathological Exam: Location of the ulcer, arterial and venous ulcers.

Relevant Clinical Exam

• Regional lymph nodes: tenderness.
• Peripheral vessels: Presence of weak or absent pulses.
• Sensations: Loss of vibration sense.