1. This is Cental cyanosis (cyanosis involve tongue and lip).

2. Possible causes of central cyanosis (dt decrease arterial oxygen satuation)
- respiratory diseases
- cyanotic heart diseases
- haemoglobinopathies (methaemoglobinaemia)

3. In CVS station, two most common cases are TOF and Eisenmenger syndrome.

1. TOF
-Right ventricular outflow tract obstruction
-RVH
-VSD
-Overriding of aorta

2. Eisenmenger S
- long term complication of unrepaired heart defect (ASD, VSD, PDA) which result in severe pulmonary HT with reversed shunt (right to left)

#Same features
cyanosis and clubbing
RVH (LPSH)

#Differentiation points
TOF
- ESM must be present
- No pul HT (No loud P2 & Palpable P2)
- No LVH

Eisenmenger S
- Severe pul HT must be present
- Functional TR and PR can be heard dt severe pul HT
- Murmur of intracardiac shunt softer or absent because of reversed shunt
- LVH usually present

Diet 3/26 application period from June 16 to June 23

Updated on 28.6.26

Here are different types of angioedema, their key differences, investigations and treatment.

Things to be covered during breaking bad news of HIV

There are 3 main types of clinical consultation scenarios.

1. Symptom based scenarios
(eg. Patient presenting with chest pain - we have to do good symptom analysis and rule out differentials to reach to Dx)

2. Syndrome based scenarios
(eg. Patient with high BP difficult to control - we have to sort out by checking nature and pattern of high BP, find likely causes of high BP and complications of high BP)

3. Investigations based scenarios
(eg patient presenting with impaired liver function tests mainly raised AST, ALT - we have to ask cardinal symptoms of liver, search causes of hepatocellular liver injury (NOT obstructive causes) and consequences of liver injury like liver failure)

Approaching patient presenting with ANAEMIA is a common scenario and CBC result is usually given in the scenario.

We need to work out by using investigation based approach. MCV is the key in considering likely causes of anaemia.

Questions that should be asked will vary greatly between patient with low MCV, normal MCV and high MCV.

💌 Practice Makes Perfect 💯

This is a frequently appeared case in PACES exam. This can be linked with many symptoms and presentations.

If this patient presented to you with high blood pressure, what are possible etiologies?

This is obviously Neurofibromatosis.

When neurofibromatosis patient presents with hypertension,

First consider association -
1. Renal artery stenosis (check renal bruit)
2. Pheochromocytoma (check proxysmal attack of raised BP together with other sympathetic overactivity symps)
3. Coarchtation of aorta ( check radiofemoral delay and radioradial delay)

But always bear in mind hypertension in neurofibromatosis patients can be due to usual and common causes like essential hypertension, drug induced, thyroid problem, OSA, etc.