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Chest Pain:

Chest Pain Chest pain may be a symptom of a number of serious conditions and is generally considered a medical emergency. Patients presenting with chest pain often undergo a thorough evaluation to assess the possible presence of anginal pain due to coronary ischemia .

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Coronary ischemia Compensatory mechanism occurs in response Anaerobic respiration Convertion of pyruvic acid Increased lactic acid production Chest pain

Chest pain:

Chest pain


Dyspnea Dyspnea results when there is an imbalance between the perceived need to breathe and the perceived ability to breathe. CO2 build-up and oxygen deprivation were the critical factors that result in dyspnea. Types of Dspnea:

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1. PAROXYMAL NOCTURNAL Also known as CARDIAC ASTHMA Characterized by attacks of severe SOB that occur at night and usually awakens the patient from sleep. Nocturnal dyspnea in chronic bronchitis characterised by hypersecretion of mucus and production of wheezing Nocturnal dyspnea in asthma is severe between 2am and 4am in the morning. Patient wakes up with sense of suffocation, extreme dyspnea, and wheezing.

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2. ORTHOPNEA Dyspnea that occurs in supine position . The cause is the effect of gravitational forces that elevates the pulmonary venous and capillary pressure. Seen in cases of CHF, Severely obese individual, Bilateral phrenic nerve palsy and Diaphragmatic disorder. 3. TREPOPNEA Dyspnea that is relieved when the patient is in lateral recumbent position. 4. PLATYPNEA Dyspnea that occurs only in upright position . Seen in cases of Chronic liver disease Pulmonary arteriovenous metastasis.

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Mechanism Reabsorption of edema from dependent position of body Increase in total blood volume Increased pulmonary venous pressure Thickening of the walls of pulmonary vessels

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Competition of space among vessels, airways & increased fluid in interstitial space Compression of small airway Increased airway resistance Increased work of breathing Dyspnea

Syncope (sin-ko-pea):

Syncope (sin-ko-pea) Partial or complete loss of consciousness with interruption of awareness of oneself and ones surroundings. When the loss of consciousness is temporary and there is spontaneous recovery, it is referred to as syncope or, in nonmedical quarters, fainting .

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Non-cardiac causes Postural (orthostatic) hypotension: Drop in blood pressure due to changing body position to a more vertical position after lying or sitting; Dehydration causing a decrease in blood volume. Blood pressure medications leading to low blood pressure. High altitude Brain stroke or "near-stroke" (transient ischemic attack). A migraine attack. (situational syncope) such as: Blood drawing, Urinating (micturition syncope) Defecating (defecation syncope) Swallowing (swallowing syncope) Coughing (cough syncope) that trigger a reflex of the involuntary nervous system (the vasovagal reaction) that slows the heart and dilates blood vessels in the legs and cause one to feel nausea , sweating, or weakness just before losing fainting.

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Cardiac causes Abnormal heart rhythms (heart beating too fast or too slow). Abnormalities of the heart valves (aortic stenosis or pulmonic valve stenosis). Tears in the aorta (aortic dissection). Widespread disease of the heart muscle (cardiomyopathy).

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What are symptoms? Before one faints, he or she may experience: Pale skin appearance Light headedness Nausea Feeling of warmth A cold, clammy sweat

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Cardiac causes Non-Cardiac causes Reduction in blood flow Temporary impairment of the blood supply to the brain shortage of oxygen to the brain Lightheadedness "black out" episode, a loss of consciousness(syncope)



dependent edema or pedal edema.:

dependent edema or pedal edema . Is the extravasation and accumulation of interstitial fluid in tissues. Edema is gravitational and will develop in dependent areas of the body, for example, in feet and legs when one is standing for prolonged periods.

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The circulatory system isn't getting the fluid delivered in the blood plasma back up to the rest of the body against gravity. Ex? Pitting edema is a type of edema in which the skin surface, when pressed by a finger, leaves an indentation . Pitting edema is more severe than non-pitting edema.

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Causes: blockages in the venous drainage from your legs…ex? liver problems protein imbalances congestive heart failure kidney failure lymphatic system




cyanosis A bluish color of the skin and the mucous membranes due to the tissues near the skin surface being low on oxygen. It is derived from the color cyan , which comes from kyanos , the Greek word for blue. This color shift occurs because the optical properties of skin shift the darker red colors towards the bluer.

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1. Peripheral Cyanosis It is usually confined to the area around the mouth ("muzzle area") and the hands and feet . It usually lasts for a few minutes and the child is asymptomatic and unaware of any problem. The technical term for this colour change is acrocyanosis . 2. Central cyanosis This is present when the tongue itself is noted to be blue. This occurs when there is more than 5g of reduced haemoglobin per 100 ml blood . It is therefore more easily seen in those with polycythaemia and masked when anaemia is present.

Hemoptysis vs. hematemesis?:

Hemoptysis vs. hematemesis? pink, frothy sputum with traces of blood.

Causes of hemoptysis:

Causes of hemoptysis

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Laryngeal carcinoma Foreign body (wishbone) Carcinoma RHD Bronchopnemonia Trauma CHF Bronchoectasis Pulmonary infarction Aortic aneurism Tuberculosis

Chief complaints in arterial and venous disorders :

Chief complaints in arterial and venous disorders

Intermittent claudication:

Intermittent claudication a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue), classically in the calf muscle , which occurs during exercise and is relieved by a short period of rest . Claudication derives from the Latin verb claudicare , "to limp".

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hardening of the arteries (atherosclerosis) narrowing or blockage in artery blood flow is restricted No enough oxygen from the blood in leg muscle Cramps or pain occurs




Pallor reduced amount of oxyhaemoglobin in skin or mucous membrane It is distinguished from similar symptoms such as hypopigmentation (loss of skin pigment). Paleness of the skin needs to be distinguished from other symptoms such as whitening of the skin or hypopigmentation (loss of skin pigment)

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Pallor is more evident on the face and palms. It is not usually clinically significant unless it is accompanied by a general pallor (pale lips, tongue, palms, mouth and other regions with mucous membranes). Several severe illnesses lead to general pallor of the body ranging from anemia to leukemia to heart conditions. Localized pallor can also occur in areas of poor circulation such as the hands and fingers.


Flushing become markedly red in the face and often other areas of the skin, from various physiological conditions Blushing which is milder, generally restricted to the face, cheeks or ears Flushing is also a cardinal symptom of carcinoid syndrome—the syndrome that results from hormones (often serotonin or histamine) being secreted into systemic circulation.


Jaundice Jaundice comes from the French word jaune , meaning yellow. also known as icterus a yellowish pigmentation of the skin, the conjunctival membranes over the  and other mucous membranes caused by hyperbilirubinemia . Typically, the concentration of bilirubin in plasma must exceed 1.5 mg/dL(>26µmol/L), three times the usual value of approximately 0.5 mg/dL, for the coloration to be easily visible.

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The conjunctiva of the eye are one of the first tissues to change color as bilirubin levels rise in jaundice( scleral icterus).

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What causes jaundice? Bilirubin comes from red blood cells. When red blood cells get old, they are destroyed. Hemoglobin , the iron-containing chemical in red blood cells that carries oxygen, is released from the destroyed red blood cells after the iron it contains is removed. The chemical that remains in the blood after the iron is removed becomes bilirubin.

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The two major causes are chronic congestion due to heart failure and ischaemic hepatitis from acute circulatory impairment. On rare occasions the first manifestation of heart disease is jaundice, caused by passive congestion of the liver or acute ischaemic hepatitis.


Angioma Angiomas are benign tumors derived from cells of the vascular or lymphatic vessel walls ( epithelium ) or derived from cells of the tissues surrounding these vessels. They are not commonly associated with malignancy.

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Cherry angiomas are the most common vascular lesions to appear on human skin. They are made up of clusters of dilated capillaries on the surface of the skin, which accounts for the cherry-red or purple color. A cherry angioma is painless and harmless, but many persons want them removed for cosmetic reasons.


telangiectasis Telangiectasias are small dilated blood vessels near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter. They may be composed of abnormal aggregations of arterioles , capillaries , or venules . Telangiectasia in the legs is often related to the presence of venous hypertension within underlying varicose veins.

Spider nevus (spider angioma):

Spider nevus (spider angioma) A spider angioma is a type of telangiectasis, grouping of small blood vessels at the skin surface. Characterized by a central red arteriole, or punctum, representing the body of the spider, surrounded by a radial pattern of thin-walled capillaries, resembling legs.

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Nevus araneus lesions range in size from 1-10 mm in diameter. In adults, spider angiomas (nevus araneus) are most frequently found on exposed areas of the body, such as the face, neck, upper trunk (above the nipple line), and arms. In children, the backs of the hands and fingers are commonly affected.

Degrees of Bruises:

Degrees of Bruises Extravasation of red blood cells into the skin produces erythematous or violaceous lesions that do not blanch . Petechiae .Small lesions (<2 mm) platelet disorders produce petechiae Purpura .Intermediate size (2 mm to 1 cm) vasculitis causes purpura that is elevated (palpable purpura) ecchymoses . larger than 1 centimeter coagulation disorders result in ecchymoses that may be palpable.


petechiae Pinpoint flat round red spots under the skin surface caused by intradermal hemorrhage (bleeding into the skin Petechiae are quite tiny (less than 2 millimeters in diameter) and do not blanch when pressed upon. Petechiae are thought to result from an increase of pressure in the veins and hypoxic damage to endothelia of blood vessels.


ecchymosis An ecchymosis is t he skin discoloration caused by the escape of blood into the tissues from ruptured blood vessels.

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After local trauma red blood cells  phagocytosed by macrophages enzymatic conversion of hemoglobin into bilirubin(blue-green) The bilirubin is then converted into hemosiderin(golden brown color)


Hematoma The word derives from the Greek roots "hemat-" (blood) and -oma, from soma, meaning body = a body of blood. It is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. This distinguishes it from an ecchymosis, which is the spread of blood under the skin in a thin layer.


hematoma Hematomas can occur within a muscle. Some hematomas form into hard masses under the surface of the skin In most cases the sac of blood or hematoma eventually dissolves


plasmacytoma Plasmacytoma is a type of cancer that starts in plasma cells. A plasma cell is a type of white blood cell that makes antibodies. the abnormal plasma cells (myeloma cells) collect in one location and form a single tumor, called a plasmacytoma

Chloroma(Granulocytic Sarcoma) :

Chloroma(Granulocytic Sarcoma) The development of multiple, malignant, localized green masses of abnormal cells, usually myeloblasts. A rare type of tumor that develops from myeloid cells (type of immature white blood cell) and tends to usually have a greenish color.




Ataxia is a neurological sign and symptom that consists of gross lack of coordination of muscle movements. Wobbliness, incoordination and unsteadiness due to the brain's failure to regulate the body's posture and regulate the strength and direction of limb movements. Ataxia is usually a consequence of disease in the brain, specifically in the cerebellum




Paresthesia From the Greek para- (abnormal) + esthesis (feeling) = an abnormal feeling. is a sensation of tingling, pricking, or numbness of a person's skin with no apparent long-term physical effect. It is more generally known as the feeling of "pins and needles" or of a limb "falling asleep".

Nuchal rigidity:

Nuchal rigidity rigidity refers to stiffness of the neck that prevents flexion. To elicit this sign, is through kernig’s and brudzinski’s sign. Nuchal rigidity develops immediately after bleeding into the subarachnoid space.

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Nuchal rigidity Nuchal rigidity is the inability to flex the head forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent.

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Kernig's sign Kernig's sign (after Waldemar Kernig (1840–1917), a Baltic German neurologist) is positive when the leg is bent at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance). [3] This may indicate subarachnoid haemorrhage or meningitis. [4] Patients may also show opisthotonus —spasm of the whole body that leads to legs and head being bent back and body bowed backwards.

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Brudzinski's signs Jozef Brudzinski (1874–1917), a Polish pediatrician, is credited with several signs in meningitis. The most commonly used sign (Brudzinski's neck sign) is the appearance of involuntary lifting of the legs in meningeal irritation when lifting a patient's head off the examining couch, with the patient lying supine . [


epistaxis Epistaxis (from Greek ( epistazo ) : ( epi ) - "above", ( stazo ) - "to drip" to bleed from the nose relatively common occurrence of hemorrhage from the nose, usually noticed when the blood drains out through the nostrils.

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The nose is (vascular). the nasal membranes dry out and crack. High blood pressure.

decubitus ulcer:

decubitus ulcer A decubitus ulcer is a pressure sore or what is commonly called a "bed sore". It can range from a very mild pink coloration of the skin, which disappears in a few hours after pressure is relieved on the area, to a very deep wound extending to and sometimes through a bone into internal organs.

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Pressure, friction , prolonged exposure to cold weight presses on the bone bone presses on the tissue and skin tissue is trapped between the bone structure and bed lack of blood circulation tissue begins to decay

Decubitus ulcers:

Decubitus ulcers

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