1. General examination Whether patient is conscious, Oriented to place/person/time, His built, nourishment, Dehydrated, depressed, distress, Anxious,

2. General examination Level of consciousness, Built and nutrition, Cyanosis, Clubbing Anemia, Jaundice, Recording B.P, Temperature, Pulse,

3. Definition Bluish discoloration of skin or mucous membrane caused by excess amounts of reduced hemoglobin or abnormal hemoglobin. 5% of reduced Hb in capillaries required for cyanosis to be apparent.

4. Cyanosis Bluish discoloration of the skin and mucous membrane, Due to increased amount of reduced hemoglobin(more than 5%)

5. Central cyanosis is caused by decreased SaO2(increased amount of reduced Hb) Central cyanosis only occurs when the oxygen saturation of arterial blood is less than 85%.

6. Central cyanosis Look on Tip of the tongue, Lips, Nose, Mucous membrane, Relieved by O2 Peripheral cyanosis Skin, Localized to one part

7. Cyanosis Skin temp. Massage or warming Central Warm No change Peripheral Cool Cyanosis fades

9. Causes Cardiac causes Cyanotic congenital heart diseases Eisenmenger’s syndrome C.C.F Respiratory causes, Chronic obstructive pulmonary disease, Collapse and fibrosis of the lung Pulmonary A.V. fistulas, High altitude,

11. Differential cyanosis, Cyanosis in the lower limbs, PDA, Coarctation of the aorta, Differential cyanosis

12. Clubbing Definition Enlargement of soft parts of the terminal phalanges with both longitudinal and transverse curving of the nails. Grades of the clubbing 1.Softening of the nail bed, 2.Obliteration of the angle of the nail, 3.Swelling of the subcutaneous tissue over the base of the nail, 4.Hypertrophic pulmonary osteoarthropathy,

14. Clubbing, Schamroth's window test.

15. Causes Respiratory cause T.B Carcinoma of the lung Bronchiactasis Cystic fibrosis, Pulmonary fibrosis Cardiac Cyanotic congenital heart diseases. Bacterial endocarditis GIT causes Crohn’s disease ulcerative colitis Biliary cirrhosis

16. Koilonychiajaundice