ghe han

Ahoau Aupeieal ulenel Recduh hnge dlt oxy - Hb

3Ant.Rem of Losen Palpebvel coguehva

Terngue
loxygunatd)
Palns
Anemia 6-<13gl.
Cnd'i af lalor cout Anomia f-<12 gt.
CLso has cMouad S e

Blood fow dsed RIeedng

anclenies Kolenuyonia
Hy penpqmentaon
of knees
Shock Lyt Hecunt J
Bone
feue Marw Fe) Anemic
Penpheral Waulan
curecss (9) wnon wil sahe ollo ha Qrt!
Blood P r e e sed
pallor Not Ont alo y
-AddeAs
’ Corhso l dsd’Ne sed
-Hypopiht muews marnbvare
- ypo ttyvodeam Syrmphathe lied H5 <logm'l.
Thoxine Nomlly
iç Pal Ot onpm
Tec calekolcunine Rscepby (

AeuthuA
F ) d then

IC Pall nt - pLqmenhn oun

Lgies Skn coey coparec ho Covnpon. Awnouy ea
thn seuer lay Hb <8 qm

Ayush Praup Bingh

MOBL 2ol9
lceA = Lahn wrd eowish descolorahn Df Eyes Skes
Talke pt to Ncel day bght Don't Comment on
Palo f leens
Areas to Look in Day uglct Snt whan UiLe ?
qvading ?
Jaundke Hy pecarnotenemiq
Urpor Bulba wher >2.Smgla
Conyuchua Bilwubin ‘e Vit A Hypcyvodusm
Sdara depos1hnt lntke when
Motabo um >0.8 mglad a
Selena <2.smglal
Lalent Hypubilbne
Brubun has hghoig
- Ist place ho ueaie it pt hasSaundue Sut
No lcters
Lwhy Uppen ? Firs t plae Fust plee
hauds as hae
Ib (Duung Roersd
couered by upp
ny
Epelid but louer s then it moy he deey
xposeel o enuir¡n met
cases bf Jandue
dlt &x pose dlt Biuubn bindng

Musdy Louen Cxpocne desinkgehs sowy

when T. Bibin
>0.8 mq lc
fae Iaunduee Aczunlal
Fal e Non- souble
Biubtn ho Ehology
Boube
Souble lBiwubin
pre hepahc Hapah
Fae Gue Post
2) Hand Palate Geenis h kepahe
Coloved yellow
3
Dasnk
underuwgae af Togue
Hemhage collh
may he nt Chavacewhc
Kranmn Zone hradg? (Hhamoys a it fa may &ath
may be causing
4-b
Lounda Dleading pounb
(upw chet
’ Chepman k faces 4ynacomasha
hands (at éxhamedllay Enyhema pebmen
Arm |Lose hematopocais Secondaay Mast cols
forot
(2-14
>IS
- Brasyaeia
(d lt BLe Sct
Nenaal hubilea Caesia sA NodQ
 Gyanosi emel

(anyhena blue in blood)

Locuhon
deoxy Hb

Ean obes >54'1. >lql. >0.sqm,

Lips
Tongue Conganital Apnomade
Bueeal Mucoa toxis
Fngen Tps O e , nAiy hgh Aunhde NTG bapsone LAt

Psudo lyanosis
Cenral y cunosis
Aweoi Amiderone
Dpper Lowe
Obshuhue tneunonia Mnocy ene
CHE -Aeee
Aute Exoon - ARDS
Botn (enral t - &pigloth bs of AsmoUna
feniperal yansis COPD
yanohe H. Dae
Blood flew abnomal Jsed Blood fowabnomal blood fhow ’CHF
blw Heat A pumonany aorhe enels
BLODd neacning
CAwwuy )
Hipen UsOshy
Local Blod leaels Obshuchon PADeoü | Cynduomey
pulmmany kdena Cof tugion) Vasspaam ’ Raynaud's cHE
Perpheral
Lyanos1s
Jsed Blood ho Organs
P+ comes E Bluesh Diseoloohon
synphahc Shmsiahon DDy’ Deoxy Hb MaM Hb,
Vaa ospaam of
Cenhal Perephena
Locahon
(Penpneral ycnosia Lgs, Gueal Wucos, ’Can tp, Fngen hip
Cuncwn Oval
lsed O2 ho hisueA <txtemehes al - Voipasm- ed Blood
Wan
Tse Laclab No changye
Jse on wan ming
Vasodulho7 caLes
Refex Vas odlhon 4of &xtumehes’Yes
by mad ag.
Uaualyy Assouabhd Polyyhma Net csocated
yauosis neleued Respoe ho \bo / ya sit peuict
CyanosIS contd...
younosis ’ t s allw aus the Absole amoent Rahen han Relahue
CuMount of DeOxy Hb. Hhat leads ho yooss
Cyanosis in Soue Lem whely as Hb' > Sgil. d s i t to eoch
Anema alendy Lo

Cyanosis in Moe chace Reddsh hnge t PolyythemiU

polyeyheMIa yooss dlt + Bwesh d lt yauosis
dus tad paut
B e Provimal
paut of
Dfkenenhal)
yanos ti Lousen lums Cyanois a.k.a Ruddy Cyanos (s
Patent buchus Arenios C
Hene Aotol
Enunqenishn
giues Nomal
Cennohom blw Pulan ey 4
Oy Bood ho cles cencung Aotal dustal to
RsA + LSA Branh o L Aus lwlan Auy

Rt as pulnonay Art has deory ub

oxy Hb Bo Cencen is
It gou o lou
exemihy
Reene dlnenhal
Cyaunoss PDA Trasposihon of Geat nels
eRSA
L<A - Lt Jubcleusiun Arteus

Bood but Connehon

UPper wnb has Lane mb
ArAa
amonay
Ary RSA

(3l4Gyaost LsA

PDA T Coechon prokmal ho LSA Psorinal o

LSA
eoxy B\oocl bo Lt
 Lubbing = Qulbows eangemant cutal 7hadanges fngem
beul plate dlt profohon c.N. Tsue beneah Na Bed.
Naul Bed (a) Hoo to lcnow Cuebbing o o FPhene eà gvocs
prorhon tha
no poblem but ow o
OFwwhuahon Nal Bed
Bendurg
a.k.a
e Loviband Lle
lel in

cubbug 3) Shamoh uoindow

(Nrmally Diambnd Chapd orndo)
Phalynqeal Deph Ratio
Louband e Phaygel dapm Raio
Red
o (Les hayl0° Lu b)u Na
Nomal plati a pvo ximal
Ink 1PO <D PD
phalyga halynga
copta daps Lubbihg
clubbrng
Cuboing
Pucnhon
Na Be
2 Hhmbs belew Nal
-The adhesiblw blate
Bd deieed
of Nal plae Teed
Then co siceusays mouemet
b) Case Mechan)sml
if mobtliy Tud
Clubbing r
Theores
(mfsmp)
Hypoxia Dcus Pratelt Chonic
Inplemahm Nenoqenic
Tsed ve Hn Fauhrs o Naub hed
lnouased PNS
dlt Load beslea haus Plcuelet duiod Vasodlron
J Croutn fator (PDGF)
CuLAA poluperahon Dx Hepahe
Comnechwe Tisue Aaseat Sach Naul Bed n
Chychati, Mone aF
lae,
CelLec duatse
(Infeehuu Endolardiit)
Comgenital
Absees) Bronchectasie) ANo dubbing wn
Gyshe fibvosis/ Empyema) lwnglanen CoPD AT8)py Inhibihm of
MeActhegma LD Pro shaglandin dehydno
if (ont hen genae
6 Heant dueases Tse in eG
Gyanohe HD /Ayanohc Hp C
&vgvnchechals
Cod. Nxt Pagl.
 Lomgeniha lause ’ Pachycma Peniostosis t of PG dehycogenaNa

DLahon ubbing
Cbbing Tnad
Pathydeuma
Beriosteat
I ’Frheanbn Ont
Hypckeraeais
unine Ilovib nd Lie (>i80°)/Shamroh
windous obleiahon
Pauot Beak bmhck cepp
qradung of Chubbing ’ 4 Leuela
WHypehephic osieoantophy
Hena the custal Ephiphyses of
Long Boned at leuels of Joink (Adeno aunoa)
Tee m n n Bloud
Thootít
d) seal ase Tsed plaet Td Clebbirg
dlL pvotedahnoJoint.
Diffeenhal
Cubbiig LL to es Cubbing PDA T Euenmengarssah
yonosis)
Reue
dadfeehat UL uwbbing rt dlt hyPoIG
Cusbirg LL beulN
Ubiaea
1ubbing 2) ubclaoian A. Anewysm’ Emboi of anyym ’ b]L Lemb

Unidugiial OModuan N. Pesy

Repend tremo o linge ge
 -See dagramVden or lmp lymph nodes,
Lymph-adenopabny
Impotnt Gn of L.N. to be Louked br?
7 tn helaron bo fascia
Horigental 4p (spuyiua)xt aAdayor Ruhg
Cenuical Gvoup of Pse awwurcs
L.N
Uenh 4rp COeep)
LIncuda L.N clong sCM
Awb mental
tn pot le ulong Sus manoblar
L.N Trahea
(Grp iA, iB, 1, In, w,V, vi)
Axiay avp of (polpcsle )
LN
Aupryiual- Horigontal) les alog lnguenal gament
(4 lngunal ap o N Venhe lies lngunal wgaet
In femorel Caral a.ka loaet Node
Leuncae qvp Hogontal arp
Venbcal Gp (along scM in Post. Ale 2 along Trasnea)
la - Qub Nental V- L. Nbehind scM à Post Ole
lb- &wb Mandwbula VI- along the rachea. ¯ pancbrahead negi

along How ho palpate 2 stand behung he pahent

5UM

Cund pLlp che en as kng pt ho bend on te

dsced by Line
(maginay)
O thogh hyoid
Hhogn Gcoid
Suprackasilan lnfraclawieleon L.N.
Le b]w Aot &Post Head af sC
Axilary Grp Cse Vdeo duagvarm) (supraclawiwa)
aka Vehows Nodey
Aot Gnp -along ant Axilauy bld
fost Grp - alon ort
Ihguunl >2em
Canal qrp Ceubal pout af Axun Sign hcant
Apicae rp -deep within eahal Lymghadenapcley >lem
paut Axlay
Loa 4rp-along hneUh ome boule

Houw ho palpase? tpihooianr Aupra

claviulcn

Rt aun of docor Rt had

of BoctoY palpat along the

for lat Noces Eitnen pclp ase fon

Ehologiea of Caue of L.A
ymphasanpay aays check Geneared or NoT ( Iwoad Not

Not Genenand
Genohad
J
Ryslemie cutases Drseare of Locl
Dreuning aeq

Infechoma
Bact- TB,typhoid, Syphillis
Vral tat of
Noe
Paraike Toxoplasmois
Funga hbplanoi Juguladanq arie
& (wood L·Nin cat ot
AlIdases (honc Tomaikts)
SLE Caodosis lSjorgren
Hypeue huuy Nerplaum’Tenailan Ca Lanynqal a Naso f
desodeu
Thyvotc a| lung la
Neoplashc ymphema
Leukam ia
pephng lonplans
Phey oin
Axilany L..
NSAIOs

auboepine
5) Epihochean L,N.
Sn cboue hochea on med 0upracautular L.N.
aspct of Arn
dyps Cat Suatn dusan
ak.a oisien ign
But ib pwnasly para Dx : (Ray leex rey
Bst, Malig
Lung Malg
Jn caue of ugn hunor load mea LiN G Malignancy) dlt Rojx of Tumor Lela
of beshua la 4et seeded fom tnovacd duct into
ln Sootal LN. hen lngnl For Gicaws Bladdun Malig
LN Swe Gonodas Mag cuct Aupplying C.LiN

ausays checde fr epig ashc Lum(1 Ingunad L.N ’55ul ’ dauna Lowen umb
Horigomta drawin Caluubih ymphedama,
Ext qenitaka ’)an into Pana
Curh'e gp of l,N Avus blow Dentte lune
Malgna
(buey t
eshs) e wtnin abdomen Penneun
Hos ho Gues Eioloau ON GKaminahon z Frst Ae 2ge hen

O Tendennon Infechue Cond t

Consi stesy Hand -Malgancy

Saf- IFrmnfechous AT dusorca
Ruub ley Hodg kin's Lymphema
Dishee Mated If we ane able to papate epsratey ane Hoy
Jn a single gup
ln TB Mated - dlt peniadenihí ’sordng l.N
Come ho qehen d It
mobity to Auundg be Jed in
Aruuehe n Malgnany lemi dey cles.
 Eclema
Ancsar genalned Edomc + Vcible gmosely.

Mechanum a Aky Capiuay Vein This s matauned

Caues
(nahhum

hsss
EndoLhenune
In case of denangd
hne? of the 3 fachos ’Edema ymphahe Brcunage

Tsein Cunout of ud acwnahy

ìn lrteshun.

deteumund by S, Abumio

Edena Causes Deep VenTheombosisVaucoe Vein

Adlt Venous Pewic inwaab domnal mans obsleuchi
Obshuchn the liae Veins lCHFlhae
Peeanalhs

In hea Tse Blooc comingcFI Corskruhue Peucndhie

CKp Cotume
masy In Care of CKA
dlt Uolun Ounload Tse e Natuo by DCT
BL
&dena 1n

Lse Blood bo

Rhng
dema ahvhon
Kdney
Renl olahaa
b
’Je Rul in apillany CLD (L ed Arod)
on
preang in Aypo pvolenemia Nephohc Synd (Tud txoahon)
MOnwion ( sed lntalce)
30
Prolein loo sing enieopa
dapresionC ’aluihs (aeeendey ho nplemnahom)
(apillang
ytorolerini
11
 hyvoidim ’ BnmaeCa
Porolen 4 Hypo
d)’ tse OP: > Tse
arclahon Jse feot Ca
(Hardnes 9nt)
(NON PITTING)
Inthally Ptng
Later n Pithng
Trauma
Tce aLccurahom
Filan iasís
Non iethng
Pi thy
Has BohP d t+ olen Congenital dema

Radahon
wn Time he fuid qea Indued lnshally Laten
Sesoed by kmally ym
Lells
fobstAhmwlahon
Lymph leads to
Antohen theony acu Selrosi's
Lynaph dranae ob ihuchon Lead o faosis &
hssue

e bhe Lepodeo
Sleross
-Locahen lo1hal Site us
ohene Aiid an Gorawitae down Non Pi th ng edena

Dependet pants Semmen siga

Non Anmbulay Pt
AmbuloyPt skì he
On pnchrg
Anke LLyabs Saural edong skn wn't pinh
dlt wduying
aboue nedunl malleoi) upodna seeoi<

B]L Rednes of Skes+

Celuuii Paun
Vaicoe Veina Torheous
Nn Pithing
Pith ng suelli
jnihally Pedal Cdarma Hy potnyvoidum DUT>euene Buhng Reen
(CHF then Anasar
B|L Lymphedema
Hlo proaged mmobilenet
A derna les in Movnifg SUewng auuna
mou in euanng d 4sLlly in Cong.
Pued gvowi teh on
ho L. yro
Lymphecenna
ynpheeema - Slemmu Sign
follousd by (Slemmen's Sign)
CLO = Inihally Aseikes Amosaa
Pedal dama hen
Feee Anaiare ( idema More o Monng
Nephuoic Synd ’ lnially Puiotal Edema in Pubrbltal alema
Protun asi g tneephado paty Dicvhoea rt CA n Ngnt Pwd es

CKD ’ sed Wene Output Wremia lenac

 bguug ndeueed Edlama
Caune of Faclad Eoema
Dx’Nephohc S* Auppose pt of longstcg HTN
SVC Obshuchon
we thenk it mght e dlt CHP
Edema uer Chest
dilted Mens oen Chus
we forget tha Dsug nduced cdama
Angiotdema 2 hdugs
Wke Ace # lrgens always tule out Drua ataee
Hypo hyidum
Paathe Iaf' Trichinosis Ace = died Proleolysis af Brady kiun
1se in eracykenin

Tse in Inamnahon
Anasanca Caues
- may aho DilhazarmCcawn chanl ocee
ude
Conshwhe Penicancleis NihraeA

1sed Vasodilahos

slenoids ’ ALdot kune nladney

Teed Abtovphon of Mao+ bat

By x Ray- CauocHaant Ss.

biff blu Conmchwe teLOdis A (oudinc
Tamponade?Casae
(wnally Ubon'i) Cacute cwexe
enagemt
 Histoy of Psneen hng lLes ( HOPI)
- what us h yaem lnwoued ie. whati he lese
for cuy Aymphw ’ - whct s me LaAe ? (Ehology)
(3c)
- Are there ay omphucuho?

q Bnetenennau be d lt candue Respi Cone

Now wue hauo bo auk ardunal fetwes f Earh ysem Ranal

Cancac Syatem Respinahy GIT Endoone

PND?
Orhopnen? Spuhum?
Talpitohona ? Humophyrs ?
hest aun ?
wnegrng
Syncope ?
inibly
Pedal Edoma ? Auppose if pt had cough sphn
Foloed by Boumlen ney
Now movng on 20 2nd
Queshon i-e. whatis he Respi Cytem robasy
Cause
for any ystem dulerent aes
Mneunonic - VITAM)N CD
Linvowed
Ate Aub-Aute Chomic 9. In thù case se haue
Vao ulan - Reiononay enbolr Localseel Rap!
can be
arute
-Preunenia |wng Absce) Bronchstasia teuna
Trouma - Praumo horaK
Auboimmune Chuenic
AUangic As haa
Mehaboic (a endoownal
(b) mhonal BouathnoA
Cel elecho lyte dt easpi Skm
lahogenic
Neoplashe onL -Lung Tuumors
Cyhe fb votis Cby eh
2 Toxins ’Aeue coeD (smokng)
 &o along with tha pewias
Histomes we eed ho teuke hesh
embolm Hlo bVT| Lmmobtuehon
lnfechue Respi c l e s ofeun large amont spehn frl Smellng
Hlo TB celso
FrumooYa 1Hlo Treuma
lLo |Pewel ElluM H|o alepecia Oral wns
Acthana ’Hlo alegen enpotwe laute ex anseahn eguma)

yihe hbosisHo snee Birth ?

C cucek excacwh ?
2nd Queahon
Assend suppose Pt has hhes ichey

we moua om ho Sd Queshon i.e Comuplcat

Hlo ny Compluatons ? hospitseel r Not.

Acuhe 2xcnlsenahes ary 4lo auk atta fes puwlent
Mhir focad-Ahl
2 Mlo pclptahons
Tacnyada
lo moune hedache, ab) beh,alined Sleep,
cleed Ses on en, doma
Cor Pumonale Ay Pedal Cdema (Aaundu clesoed Weens

(n ANut Shel
wnat is he Case ? yalm Landinal Synoho

Case?>VITA M]N CA t hshoes

What us whe

For cch synphom

Negahue Hishie for
Cade
PAST 2 PERsONAL HisTORIES

’
TB |Dml thyod |HTN
1st Lune HIs hoie

Exenioms of HOPI plaeEahen in HOPI | Past)

Suppote f Pt hs ho
Cau if case suspeced cfHna lbe stonel Seeocla

hn Hlo bdarmina SX
DMA MTN P4 muy
be cgrrawcleol
Complicahon ’

Pt of HTN may raue

PCsat Episodes massiwu BLeec
Pt of hyd may
haue hyod shone
TIT plan hangs aewrdigi
lo ABCP gdenes.
P} E PAD ’ Hlo m)shoke uled out

TNM staqina s nw TN

Pensonal Hishoy
Diet ’ Veg l Mix ed
mallq naees
In PND
Slaop / ake ue ycle Imp in y n|Hypouyoidun afles Ileep
Orthopren P+ catt Sleep)
Bouel 2adden Habik Problemahe or pt
L IF signih Lont t HOPI,con be nenh orec thene
Aubstane Abe ng taMedt
ls choud taee cotulorl Hlo Alcohol
A Smokay

a) Alcohol lntake alahon’ gnday us Vany lmp

>l60gm day for lo -20yh
Conch in eoch Ty pe X amont taken
pnd c -Luen Chwhosis
lpeg - a 3oml
whuy-4o1. Qualen l80 ml - Faty Luen
12gmaloho

7S0 m
y 20-40 gm clay fo lo-loys
Vo da -fathy Lçes.
 ((IMgm
lay Aeohol gn
\o-IS Besr 346m
Conetzi0-1cgm
Aeohol Cmgh Vodka onusly- lpeg- ml43
meduecny Angy
ho
smokua CrLcohotl AbwseSubstance
hobih BLOolen Bowel
Habs Seep
NutShell AIn
meduatos ay
3tenhng before out bmedeaho’
ab
know ks ALLengy
nek ’Lung
a plday 3o >
Tvisk pD
>1sp|day
co ’
day pask ofn0. a0Amownt
hangut mone
cigoeke -Beedi Type?Loncn ’O Amokuig