Cyanosis Past Paper PDF

## History Station 2.2: Cyanosis **Identity:** Age (newborn or older child; see below) **Chief complaint:** Cyanosis, a bluish discoloration of the skin, lips, mucous membranes, or nailbeds **History of present illness:** 1. Onset of cyanosis: Sudden or gradual 2. Duration 3. Timing of cyanosis...

## History Station 2.2: Cyanosis **Identity:** Age (newborn or older child; see below) **Chief complaint:** Cyanosis, a bluish discoloration of the skin, lips, mucous membranes, or nailbeds **History of present illness:** 1. Onset of cyanosis: Sudden or gradual 2. Duration 3. Timing of cyanosis 4. Location: What parts of the body are involved? 5. Frequency of cyanotic episode **2.3 Cyanosis** 6. Continuous or intermittent 7. Associated symptoms: Dyspnea, cough, wheezing, stridor, fever, excessive crying 8. Precipitating, aggravating, and relieving factors: exercise, feeding, crying, special positions, etc. 9. Chest trauma **Past history:** * **A-Birth history:** Maternal diabetes, maternal drug use during pregnancy, polyhydramnios, oligohydramnios, ruptured membrane, prolonged labor, meconium-stained amniotic fluid, a history of birth asphyxia, gestational age, birth weight * **B-Past medical and surgical history:** Previous episodes of cyanosis, child's age when the first episode of cyanosis occurred, congenital heart disease, prior lung disease (e.g. asthma), neurological diseases like seizures or neuromuscular disease **Medication history:** Recent use of medications (e.g. amiodarone), medications that may cause methemoglobinemia (e.g. antibiotics: sulphonamides, antimalarial drugs). **Developmental history:** Has the child's development and growth been normal? **Feeding/dietary history:** Feeding difficulty, fast breathing or diaphoresis with feedings, prolonged feeding time **Family history:** Family history of asthma, hemoglobinopathy, congenital heart disease, or birth defects. **Social history:** Contact with anyone who has an infectious disease, drug abuse, exposure to oxidant toxins, smoke inhalation, or cold exposure. ### Key Points 2.2: #### In newborns: * Maternal diabetes may be associated with cyanotic congenital heart disease, neonatal hypoglycemia, and neonatal polycythemia. * Polyhydramnios is associated with fetal airway, esophageal, and neurological conditions. * Oligohydramnios may be associated with pulmonary hypoplasia and renal defects. * Meconium staining of the amniotic fluid is associated with meconium aspiration syndrome and persistent pulmonary hypertension. #### In older children: * Persistent cyanosis may be caused by congenital heart disease, primary lung disease, pulmonary artery hypertension, or abnormal hemoglobin. * A history of crying, followed by sudden breath-holding in forced expiration with apnea and cyanosis, suggests cyanotic breath-holding spells. * Cyanotic (Tet) spells or breath-holding spells occur commonly after the child wakes in the early morning. ## Surgical cause of bloody diarrhea * Intussception * Anal fissure * Haemorrhoid ## Constipation and rectal bleeding * Constipation + rectal bleeding significant --> associated distention + pain, amount of bleed, bowel sound ## 13 years old with car accident and trauma to the abdomen * Mechanism of injury: penetrating or blunt trauma * Number of deaths * Loss of consciousness ## Rectal Bleeding | Category | Severe | Mild | | --------------------------------- | ---------------------------------------------------------------------------------- | ----------------------------------------------------------------------- | | **With Diarrhea and/or Mucus** | Ulcerative colitis, amebic dysentery, bacillary dysentery | Carcinoma of colon, ulcerative colitis, Crohn's disease, Meckel's diverticulum, diverticulitis, coagulation disorder | | **With Signs of Intestinal Obstruction** | Intussusception, mesenteric thrombosis or embolism | Painless bowel movement | | **Without Significant Diarrhea or Mucus** | Diverticulitis, ischemic colitis, coagulation disorder, painful bowel movement, anal fissure, thrombosed haemorrhoid | Rectal fistula, proctitis | | **Rectal Mass** | Polyp, carcinoma, haemorrhoids | | ## 4 years patient present with rectal bleeding * Q/hx + dd x of rectal bleeding * Q/ Is there difference for you to know if the bleeding was before or after defecation? * And what is it? ## Answers to the questions about rectal bleeding * **Difference regarding the diagnosis:** * Example/ bleeding in case with anal fissure happened before defecation * While bleeding in hemorrhoids occur after defecation