Sandbox:Chandra: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Xyz}}


{{CMG}}; {{AE}} {{CK}}
{{CMG}}; {{AE}}


==Causes==
==Overview==
[[Cyanosis]] can be caused by the following mechanisms, systemic arterial oxygen desaturation and increased oxygen extraction by the tissues. Based on these mechanisms, Cyanosis can be either Central or Peripheral. Certain conditions present with bluish purple discoloration of skin or mucous membranes, can mimic cyanosis, are not associated with [[hypoxemia]] or peripheral vasoconstriction and is called Pseudocyanosis.
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
====Central Cyanosis:====
There following are some of the common causes of central cyanosis:<ref name="pmid1523025">{{cite journal |vauthors=DiMaio AM, Singh J |title=The infant with cyanosis in the emergency room |journal=Pediatr. Clin. North Am. |volume=39 |issue=5 |pages=987–1006 |date=October 1992 |pmid=1523025 |doi= |url= |author=}}</ref> <ref name="pmid2407997">{{cite journal |vauthors=Driscoll DJ |title=Evaluation of the cyanotic newborn |journal=Pediatr. Clin. North Am. |volume=37 |issue=1 |pages=1–23 |date=February 1990 |pmid=2407997 |doi= |url= |author=}}</ref> <ref name="pmid25604592">{{cite journal |vauthors=Frank DB, Hanna BD |title=Pulmonary arterial hypertension associated with congenital heart disease and Eisenmenger syndrome: current practice in pediatrics |journal=Minerva Pediatr. |volume=67 |issue=2 |pages=169–85 |date=April 2015 |pmid=25604592 |pmc=4382100 |doi= |url= |author=}}</ref> <ref name="pmid22482063">{{cite journal |vauthors=Izraelit A, Ten V, Krishnamurthy G, Ratner V |title=Neonatal cyanosis: diagnostic and management challenges |journal=ISRN Pediatr |volume=2011 |issue= |pages=175931 |date= 2011 |pmid=22482063 |pmc=3317242 |doi=10.5402/2011/175931 |url= |author=}}</ref> <ref name="pmid21462449">{{cite journal |vauthors=Serino G, Giacomazzi F |title=[Pulmonary arterial hypertension in adult patients with congenital heart disease] |language=Italian |journal=Pediatr Med Chir |volume=32 |issue=6 |pages=274–9 |date= 2010 |pmid=21462449 |doi= |url= |author=}}</ref> <ref name="pmid7073040">{{cite journal |vauthors=Curry S |title=Methemoglobinemia |journal=Ann Emerg Med |volume=11 |issue=4 |pages=214–21 |date=April 1982 |pmid=7073040 |doi= |url= |author=}}</ref> <ref name="pmid15342970">{{cite journal |vauthors=Ash-Bernal R, Wise R, Wright SM |title=Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals |journal=Medicine (Baltimore) |volume=83 |issue=5 |pages=265–73 |date=September 2004 |pmid=15342970 |doi= |url= |author=}}</ref> <ref name="pmid28722923">{{cite journal |vauthors=Kondamudi NP, Dulebohn SC |title= |journal= |volume= |issue= |pages= |date= |pmid=28722923 |doi= |url= |author=}}</ref>


*'''Conditions associated with decreased concentration of inspired oxygen (FiO2):'''
OR
**[[Smoke inhalation]] most commonly from house fires
**[[Carbon monoxide poisoning]]
**Hydrogen [[cyanide poisoning]]
**Intentional or unintensional exposure to asphyxiating gases (eg, [[Propane]], [[methane]], [[Butane|butane,]] [[Hydrogen sulfide|hydrogen sulphide]])
*'''Decresed atmospheric pressure: [[Altitude sickness|High altitude]]'''
*'''Disorders associated with impairment of chest wall or lung expansion:'''
**External compression
**[[Pneumothorax]]
**[[Hemothorax]]
**[[Flail chest]]
*'''Hypoventilation:'''
**'''Upper airway obstruction:'''
***[[Foreign body aspiration]]
***[[Pertussis]] / [[Croup]]
***[[Epiglottitis]]
***[[Tracheitis]] mostly bacterial
***Traumatic disruption (burns, fractures)
***Congenital airway abnormalities:
****[[Choanal atresia]]
****[[Laryngotracheomalacia]]
****[[Macroglossia]]
****[[Micrognathia]] or [[Retrognathism|retrognathia]] (eg, Pierre-Robin syndrome)
**'''Neurologic abnormalities:'''
***[[CNS depression]]
***Severe head trauma
***[[Apnea of prematurity]]
***Infections (eg, [[meningitis]], [[encephalitis]])
***[[Intraventricular hemorrhage]]
***[[Seizure|Seizures]]
***Cyanotic breath holding spells
***[[Coma]]
**'''Neuromuscular disorders:'''
*** [[Myasthenia gravis]]
***Injury to the phrenic nerve
***Type 1 spinal muscular dystrophy (Wernig-Hoffman disease)
**'''Metabolic disorders:'''
***Severe [[hypoglycemia]]
***In born errors of metabolism
*'''Ventilation/perfusion mismatch:'''
**[[Asthma]]
**[[Pulmonary embolism]]
**[[Atelectasis]]
**[[Alveolar capillary dysplasia]]
**[[emphysema]] or [[Chronic obstructive pulmonary disease|COPD]]
**[[Pulmonary edema]]
**Pulmonary hypoplasia
**[[Pulmonary hemorrhage]]
**[[Acute respiratory distress syndrome|Respiratory distress syndrome]] (Hyaline membrane disease)
**[[Transient tachypnea of the newborn]]
*'''Conditions causing impaired oxygen diffusion:'''
**[[Pulmonary fibrosis]]
**[[Pulmonary edema]]
*[[Pneumonia]]
*[[Bronchiolitis]]
*[[Bronchopulmonary dysplasia]]
*[[Cystic fibrosis]]
*[[Empyema]]
*'''Vascular causes:'''
**'''Cyanotic congenital heart diseases (Right to left shunts):'''
***'''Decreased pulmonary flow:'''
****[[Tetralogy of Fallot|Tetralogy of fallot]]
****Tricuspid valve anomalies:
*****[[Tricuspid atresia]]
*****[[Tricuspid stenosis]]
*****[[Ebstein's anomaly of the tricuspid valve|Ebstein's anomaly]]
****[[Pulmonary valve stenosis|Pulmonary stenosis]] (critical valvular)
****[[Pulmonary atresia]] with intact ventricular septum
***'''Increased pulmonary flow:'''
****[[TGA]] (Transposition of great arteries, most common dextro type)
****[[Truncus arteriosus]]
****[[Total anomalous pulmonary venous connection|TAPVC]] (Total anamalous pulmonary venous connection)
***'''Heart failure:'''  Condition that present with cyanosis and  severe heart failure include:
****Left sided obstructive lesion ([[Hypoplastic left heart syndrome|HLHS]])
****[[Aortic coarctation|Coarctation of aorta]]
****Critical valvular [[aortic stenosis]]
**'''[[Eisenmenger's syndrome|Eisenmenger syndrome]]'''
**'''Pulmonary causes:'''
***[[Pulmonary hypertension]]
***[[Pulmonary edema]]
***[[Pulmonary hemorrhage]]
***[[Pulmonary embolism]]
***Pulmonary arterio venous malformations
***Multiple small intrapulmonary shunts
**'''[[Shock]]'''
**'''[[Sepsis]]'''
**'''[[Acute chest syndrome]]'''
*'''Hematologic abnormalities:'''
**[[Methemoglobinemia]] (congenital or acquired)
**[[Sulfhemoglobinemia]] (acquired)
**Hemoglobin mutations with low oxygen affinity: Hb Kansas,  Hb Beth israel, Hb Saint Mande, Hb Bruxells
**[[Polycythemia]]
*Brief resolved unexplained events (BRUE)


====Peripheral Cyanosis:====
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
There following are some of the Common causes of Peripheral Cyanosis: <ref name="pmid27899893">{{cite journal |vauthors=Fardoun MM, Nassif J, Issa K, Baydoun E, Eid AH |title=Raynaud's Phenomenon: A Brief Review of the Underlying Mechanisms |journal=Front Pharmacol |volume=7 |issue= |pages=438 |date= 2016 |pmid=27899893 |pmc=5110514 |doi=10.3389/fphar.2016.00438 |url= |author=}}</ref> <ref name="pmid24249890">{{cite journal |vauthors=Das S, Maiti A |title=Acrocyanosis: an overview |journal=Indian J Dermatol |volume=58 |issue=6 |pages=417–20 |date=November 2013 |pmid=24249890 |pmc=3827510 |doi=10.4103/0019-5154.119946 |url= |author=}}</ref>
*Various conditions that cause central cyanosis can also cause peripheral cyanosis.
*[[Hypothermia|Cold exposure]]
*Decreased cardiac output ([[Congestive heart failure|Left sided heart failure]], [[shock]] or [[hypovolemia]])
*[[Acrocyanosis]]
*[[Raynaud's phenomenon]]
*Arterial obstruction [[Peripheral arterial disease|(Peripheral vascular disease]])
*Venous obstruction ([[Thromboembolism]])
*Redistribution of blood flow from extremities


===Life Threatening Causes===
OR
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
{{MultiCol|80%}}
*[[Carbon monoxide poisoning]]
*[[Cardiac tamponade]]
*[[Cyanide poisoning]]
*[[Disseminated intravascular coagulation]]
*[[Epiglottitis]]
*[[Ethylene glycol]]
*[[Foreign body aspiration]]
*[[Hemothorax]]
*[[Malathion]]
*[[Myocardial infarction]]
*[[Parathion]]
*[[Pulmonary embolism]]
*[[Tension pneumothorax]]


The presence of [finding(s)] on physical examination is diagnostic of [disease name].


OR


The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
* Physical examination of patients with [disease name] is usually normal.
OR
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


<references />
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].
 
===Vital Signs===
 
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
 
===Skin===
* Skin examination of patients with [disease name] is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 
===Neck===
* Neck examination of patients with [disease name] is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion / Decreased chest expansion
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
Abdominal examination of patients with [disease name] is usually normal.
 
OR
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
* Back examination of patients with [disease name] is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
 
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
 
==References==
{{Reflist|2}}
 
{{WH}}
{{WS}}
[[Category: (name of the system)]]

Revision as of 16:00, 27 March 2018

Xyz Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Xyz from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Sandbox:Chandra On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Sandbox:Chandra

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Sandbox:Chandra

CDC on Sandbox:Chandra

Sandbox:Chandra in the news

Blogs on Sandbox:Chandra

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Sandbox:Chandra

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

  • Physical examination of patients with [disease name] is usually normal.

OR

  • Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
  • The presence of [finding(s)] on physical examination is diagnostic of [disease name].
  • The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Appearance of the Patient

  • Patients with [disease name] usually appear [general appearance].

Vital Signs

  • High-grade / low-grade fever
  • Hypothermia / hyperthermia may be present
  • Tachycardia with regular pulse or (ir)regularly irregular pulse
  • Bradycardia with regular pulse or (ir)regularly irregular pulse
  • Tachypnea / bradypnea
  • Kussmal respirations may be present in _____ (advanced disease state)
  • Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
  • High/low blood pressure with normal pulse pressure / wide pulse pressure / narrow pulse pressure

Skin

  • Skin examination of patients with [disease name] is usually normal.

OR

HEENT

  • HEENT examination of patients with [disease name] is usually normal.

OR

  • Abnormalities of the head/hair may include ___
  • Evidence of trauma
  • Icteric sclera
  • Nystagmus
  • Extra-ocular movements may be abnormal
  • Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
  • Ophthalmoscopic exam may be abnormal with findings of ___
  • Hearing acuity may be reduced
  • Weber test may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
  • Rinne test may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
  • Exudate from the ear canal
  • Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
  • Inflamed nares / congested nares
  • Purulent exudate from the nares
  • Facial tenderness
  • Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae

Neck

  • Neck examination of patients with [disease name] is usually normal.

OR

Lungs

  • Pulmonary examination of patients with [disease name] is usually normal.

OR

  • Asymmetric chest expansion / Decreased chest expansion
  • Lungs are hypo/hyperresonant
  • Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
  • Rhonchi
  • Vesicular breath sounds / Distant breath sounds
  • Expiratory/inspiratory wheezing with normal / delayed expiratory phase
  • Wheezing may be present
  • Egophony present/absent
  • Bronchophony present/absent
  • Normal/reduced tactile fremitus

Heart

  • Cardiovascular examination of patients with [disease name] is usually normal.

OR

  • Chest tenderness upon palpation
  • PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
  • Heave / thrill
  • Friction rub
  • S1
  • S2
  • S3
  • S4
  • Gallops
  • A high/low grade early/late systolic murmur / diastolic murmur best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope

Abdomen

Abdominal examination of patients with [disease name] is usually normal.

OR

Back

  • Back examination of patients with [disease name] is usually normal.

OR

  • Point tenderness over __ vertebrae (e.g. L3-L4)
  • Sacral edema
  • Costovertebral angle tenderness bilaterally/unilaterally
  • Buffalo hump

Genitourinary

  • Genitourinary examination of patients with [disease name] is usually normal.

OR

  • A pelvic/adnexal mass may be palpated
  • Inflamed mucosa
  • Clear/(color), foul-smelling/odorless penile/vaginal discharge

Neuromuscular

  • Neuromuscular examination of patients with [disease name] is usually normal.

OR

  • Patient is usually oriented to persons, place, and time
  • Altered mental status
  • Glasgow coma scale is ___ / 15
  • Clonus may be present
  • Hyperreflexia / hyporeflexia / areflexia
  • Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
  • Muscle rigidity
  • Proximal/distal muscle weakness unilaterally/bilaterally
  • ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
  • Unilateral/bilateral upper/lower extremity weakness
  • Unilateral/bilateral sensory loss in the upper/lower extremity
  • Positive straight leg raise test
  • Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
  • Positive/negative Trendelenburg sign
  • Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
  • Normal finger-to-nose test / Dysmetria
  • Absent/present dysdiadochokinesia (palm tapping test)

Extremities

  • Extremities examination of patients with [disease name] is usually normal.

OR

  • Clubbing
  • Cyanosis
  • Pitting/non-pitting edema of the upper/lower extremities
  • Muscle atrophy
  • Fasciculations in the upper/lower extremity

References

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Sandbox:Chandra&oldid=1456882"