MLA Domain 5 · Presentation

Cyanosis

19 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 5

Eisenmenger syndrome

Established Eisenmenger CONTRAINDICATES shunt closure (the shunt is now offloading the right heart) — the window was mis

Meconium aspiration syndrome

Persistent pulmonary hypertension (severe hypoxia, pre/post-ductal saturation difference) → intensive care (± nitric oxi

Tetralogy of Fallot

Hypercyanotic 'tet' spell → knee-chest position, oxygen, morphine, IV fluids, beta-blocker/phenylephrine — can be life-t

Total anomalous pulmonary venous return (TAPVR)

Obstructed (infradiaphragmatic) TAPVR → emergency surgery (prostaglandin may not help; obstruction is the problem)

Transposition of the great arteries (TGA)

Profound day-1 cyanosis → emergency: PROSTAGLANDIN (keep the duct open) ± balloon atrial septostomy

recognised feature · 14

Acute asthma (severe/life-threatening)

A SILENT chest, exhaustion, normal or rising CO2, or SpO2 <92% = life-threatening → seek ICU

Airway compromise / stridor

Exhaustion, cyanosis, falling GCS, silent chest = peri-arrest airway → immediate senior airway support

Asthma

Life-threatening features (silent chest, SpO2 <92%, exhaustion, normal/rising PaCO2) → ITU/anaesthetic involvement — a n

Atrioventricular septal defect (AVSD)

Heart failure + early pulmonary hypertension (complete AVSD) → timely surgical repair

Coarctation of the aorta

Critical neonatal coarctation presenting as collapse when the duct closes → PROSTAGLANDIN to reopen/maintain the duct +

Congenital heart disease (adult presentation)

Eisenmenger physiology → avoid pregnancy and systemic vasodilators; refer to specialist adult congenital heart disease (

Ebstein anomaly

Severe neonatal Ebstein (cyanosis + heart failure) → intensive care ± prostaglandin

Pulmonary stenosis

Critical neonatal PS → prostaglandin (duct-dependent) + intervention

Raynaud's & vasospastic disorders

Digital ulceration/critical ischaemia → urgent treatment (secondary Raynaud's)

Respiratory distress syndrome (RDS)

Worsening distress → pneumothorax (sudden deterioration), need for escalating support

Respiratory failure & ARDS

Exhaustion, rising CO2 with acidosis, or peri-arrest → urgent ventilatory support (NIV/intubation) and critical care

Superior vena cava obstruction

Stridor/airway compromise, cerebral oedema (severe headache, confusion) → emergency treatment

Tricuspid atresia

Duct closure → worsening cyanosis → prostaglandin

Truncus arteriosus

Early heart failure and pulmonary hypertension → timely surgery