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UCPEX > Cardio, Resp, Neuro > Flashcards

Cardio, Resp, Neuro Flashcards

1
Q

Marburg heart score

A

Rule out ACS

1 point each:
- Woman >64 or man >54
- Known CAD, cerebrovascular disease, peripheral vascular disease
- Pain worse on exertion
- Pain not reproducible on palpation
- Patient assumes cardiac cause

Score 2 or less - 98% non cardiac

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2
Q

Risk factors for ACS

A

Maori/Pacific
Male>female
Increasing age
First degree relative with cardiac/vascular event age <60
Smoker
Diabetes
HTN
Obesity
Hyperlipidaemia

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3
Q

ECG findings for STEMI

A

STE 1mm in 2+ limb leads
STE 2mm in 2+ precordial leads
STE >0.5mm in posterior leads
New LBBB

Sgarbossa criteria:
Positive QRS, concordant ST elevation 1mm
Negative QRS, discordant ST elevation 5mm
V1-V3, concordant ST depression 1mm
Discordant ST elevation at least 25% amplitude of preceding S wave

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4
Q

Types of ACS

A

STEMI - STE ECG changes, positive troponin
NSTEMI - other/no ECG changes, positive troponin
Unstable angina - new onset severe angina, prolonged angina at rest, increasing frequency/duration/lower threshold angina, angina after recent MI

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5
Q

Management of ACS + contraindications

A

Acute referral cardiology

Aspirin 300mg stat
IV morphine - if required for pain
O2 - if sats <93%, cardiogenic shock, respiratory distress
GTN - contraindicated in right ventricular, inferior MI, recent use of PDE5-i (sildenafil), hypotension, severe AS
Antiemetic if nausea/vomiting

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6
Q

Risks for aortic dissection

A

STEMI
Smoking
HTN
Connective tissue disorder (Marfan, Turner, Ehlers-Danlos)
Atherosclerosis
Iatrogenic injury, blunt trauma

80% mortality - 1/5 prehospital, 1/3 peri/post-op

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7
Q

Symptoms and signs of aortic dissection

A

Tearing thoracic pain radiating between scapula
SOB, palpitations, syncope, collapse
Hyper/hypotension, pulse delay, tachycardia, diastolic murmur, asymmetrical BP

Horner’s syndrome possible

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8
Q

Management of aortic dissection

A

No anticoagulants
BP control - aim 100-110 systolic
O2 if hypoxic
Urgent referral to vascular

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9
Q

Risk factors for infective endocarditis

A

Prosthetic valves
Rheumatic heart disease
Prev endocarditis
Immunocompromised
Unrepaired cyanotic congenital heart disease
Repair of congenital heart disease within 6 months
IVDU - suspect in right heart endocarditis

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10
Q

Antibiotic prophylaxis for endocarditis for at risk patients

A

Amoxicillin/clindamycin/clarithromycin 60mins PO/30 mins IM/ immediately IV prior to tonsillectomy or any dental procedure

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11
Q

Duke’s criteria for endocarditis diagnosis

A

Pathological criteria:
Microorganism isolated from specimen vegetation/abscess
OR specimen of vegetation/abscess showing active endocarditis

Clinical criteria:
2 major
OR 1 major + 3 minor
OR 5 minor

Major:
- 2 positive blood cultures with typical organisms, 12 hours apart/1 positive culture with Coxiella buretii
- Evidence of endocardial involvement (new murmur, cardiac mass, abscess, valve dehiscence on echo)

Minor:
- Fever >38 deg
- Vascular phenomena (Janeway lesions, splinter haemorrhage, petechiae, systemic emboli)
- Immunologic phenomena (Osler’s nodes, Roth spots)
- Prev endocarditis or IVDU
- Microbiological evidence not meeting major criteria

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12
Q

Causes of myocarditis

A

Viral infection
Autoimmune disease
Drug hypersensitivity/toxic reaction
ETOH
Thyrotoxicosis

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13
Q

ECG changes in myocarditis

A

Diffuse ST concave elevation without reciprocal change
Mild left ventricular dilatation + mild AV block
Long QRS

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14
Q

Diagnostic criteria for pericarditis

A

At least 2:
- Chest pain (sharp, retrosternal, pleuritic, better leaning forward)
- Pericardial rub
- Pericardial effusion
- ECG - widespread ST elevation or PR depression

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15
Q

Causes of pericarditis

A

Idiopathic
Infective - viral/bacterial/TB
Non-infective
- rheumatological disorder - autoimmune/vasculitis/SLE/rheumatic fever
- cancer, paraneoplastic, radiotherapy
- trauma
- medications - hydralazine, procainamide, isoniazid, phenytoin
- recent MI (Dressler’s syndrome)

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16
Q

Signs of poor prognosis in pericarditis

A

Temp >38
Subacute course
TB or cancer
Large pericardial effusion
Failure to resolve after 7 days NSAIDs

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17
Q

ECG progression of pericarditis

A
  1. Diffuse ST elevation, PR depression, aVR reciprocal changes (2 weeks)
  2. Normalisation, T wave flattening (1-3 weeks)
  3. Deep, symmetric, diffuse T wave inversion (3- several weeks)
  4. Normalisation (several weeks +)
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18
Q

Common organisms in endocarditis

A

Staph aureus, Strep bovis, Strep viridans, Enterococci
HACEK - Haemophilus sp, Aggregatibacter sp, Cardiobacterium hominis, Eikenella corrodens, Kingella sp

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19
Q

Management of pericarditis

A

Discuss with cardiology
NSAIDs
Colchicine 0.5mg OD/BD to reduce recurrence rate (normally 20-50%)

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20
Q

NZ criteria for diagnosis of rheumatic fever

A

Definite ARF:
- GAS infection + 2 major criteria
- GAS infection + 1 major + 2 minor criteria

Probable ARF:
- GAS infection + 1 major + 1 minor criteria

Possible ARF:
- Strong clinical suspicion

Recurrent ARF:
- Prev hx ARF + GAS infection + 2 major criteria OR 1 major, 2+ minor

Major manifestations:
- Carditis - subclinical rheumatic valve disease on echo
- Polyarthritis or aseptic monoarthritis
- Chorea
- Erythema marginatum
- Subcutaneous nodules

Minor criteria:
- Fever
- Raised ESR/CRP
- Polyarthralgia (present in 75% cases, can be masked by NSAID use)
- ECG - PR prolongation

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21
Q

Risk factors for rheumatic fever

A

Maori (x20) /Pacific (x40)
Crowded household
Age 3-35
Low SES
Prev rheumatic fever
FHx ARF/RHD

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22
Q

Causes of heart failure -
Cardiac
Systemic

A

Cardiac:
MI, arrhythmia, valvular disease, cardiomyopathy, conduction disorders

Systemic:
Sepsis, hyperthyroidism, hypertension

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23
Q

Heart failure severity - New York Heart Association classification

A

Class I - no restriction to physical activity
Class II - Slight limitation to physical activities, ordinary activity results in some symptoms
Class III - Marked limitation to physical activities, less than ordinary activities cause symptoms
Class IV - No physical activity, symptoms at rest

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24
Q

Management of heart failure

A

IV access
O2
ECG
Fluid restriction
Inpatient management - diuresis

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25
Q

Ddx for syncope

A

SAH, ICH
Ruptured AAA, aortic dissection
Ectopic pregnancy
GI bleed
PE
ACS
Dysrhythmia
Orthostatic hypotension
Hypoglycaemia
CVA
Pain

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26
Q

High risk syncope vs low risk syncope

A

High risk:
- Age >65
- ECG changes (New LBBB, bifasicular block + 1st degree AV block, Brugada, ischaemia, long QT, non-sinus rhythm)
- Hx HF, structural heart disease, IHD
- Syncope while supine, during exercise, without prodrome
- Dyspnoea
- Hypotension <90 SBP
- Haematocrit <30%
- Male
- Evidence of bleed
- Family hx sudden death age <50

Low risk:
- Age <40
- Consistent with orthostatic/vasovagal
- Syncope while standing
- Syncope while standing from supine/sitting
- Nausea/vomiting prior
- Feeling of warmth prior
- Triggered by pain/emotional distress
- Triggered by cough, defecation, micturition

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27
Q

Complications of atrial fibrillation

A

CVA
Dementia (vascular/Alzheimers)
Heart failure
MI

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28
Q

Atrial fibrillation red flags

A

Chest pain
Haemodynamically unstable
Heart failure
Recent stroke/TIA <14 days
Mitral stenosis
Syncope
HR >100

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29
Q

Risk factors for AF

A

Male
Advanced age
European
Thyrotoxicosis
Obesity
Diabetes
HTN
Sleep apnoea
ETOH
IHD
valvular heart disease
Cardiomyopathy
Heart failure
Acute infection

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30
Q

Management of AF

A

Acute onset <48 hours - discuss with cardio for cardioversion

Red flags - discuss with cardio

> 48 hours, no red flags
- routine work up (bloods, ECG, CXR)
- rate control (Beta blocker/CCB, aim <80 at rest, <120 exercise)
- Consider anticoagulation
- GP follow up

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31
Q

CHA2DS2VASc score

A

CHF
Hypertension
Age >75 = 2
Diabetes
Stroke/TIA/thromboembolism = 2
Vascular disease (MI, PAD, aortic plaque)
Age 65-74
Sex category - female

> 2 consider anticoagulation
- dabigatran, rivaroxaban, warfarin
- Do no use with antiplatelets

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32
Q

Symptoms and signs of life threatening asthma

Management:

A

Any one of:
Unable to talk
Feeble resp effort/exhaustion
Altered consciousness
Cyanosis
PEF <30% predicted
Silent chest
Sats <92%
Hypotension, bradycardia

  • Continuous nebulised salbutamol
    O2 - aiming sats >92%
  • Single nebulised ipratropium 500mcg
  • Prednisone 40mg PO or Hydrocortisone 100mg IV
  • Prepare to intubate/LMA, ventilate 10-12 breaths/min, avoid breath stacking (risk of pneumothorax or arrest)
  • Immediate hospital transfer
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33
Q

Signs and symptoms of severe asthma

Management:

A

Short sentences
PEF 33-50% of predicted
Sats >92%
HR >110
RR >25

  • 6 puffs salbutamol + 6 puffs ipratropium
    OR 2.5mg salbumtaol + 500mcg ipratropium nebulised
  • Complete salbutamol blast
  • Prednisone 40mg PO or hydrocortisone 100mg IV
  • Consider hospital transfer if not improving
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34
Q

Signs and symptoms of mild-mod asthma

Management:

A

Normal speech
Cough, wheeze, SOB, chest tightness
PEF >50% predicted
RR <25
HR <110

  • 6 puffs salbutamol then reassess, can consider full blast
  • If moderate - prednisone 40mg 5 days
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35
Q

COPD definition

A

Hx of smoking or exposure to noxious substance
FEV1/FVC <0.7 post bronchodilator

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36
Q

Modified Medical Research Council (mMRC) Dyspnoea Score

A

0 - breathless with strenuous activity
1 - SOB while hurrying on level ground or walking up slight hill
2 - Walking slower than others of same age on level ground due to dyspnoea, or stop for breath when walking at own pace
3 - Stop for breath after 100m or a few minutes on level ground
4 - Too breathless to leave house, breathless getting dressed

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37
Q

Indications for referral of COPD to hospital

A

Cannot manage at home without help - eat or sleep, walking short distances
High risk comorbidity
Altered mental state
Cor pulmonale, hypoxaemia
New arrhythmia
Not responding to treatment in community
Diagnosis uncertain

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38
Q

Treatment of COPD exacerbation

A

Prednisone 40mg max 2 weeks
Salbutamol + ipratropium Q1-6H, titrate to response

If fever, increased sputum, purulent sputum, increased dyspnoea, CRP <40 - consider abx:
Amoxicillin 500mg tds 5/7
Doxycycline 100mg bd 5/7
Failing above: Augmentin 625mg tds 5/7

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39
Q

Typical vs atypical pneumonia bacteria

A

Typical:
Strep pneumoniae
Haemophilus influenzae

Atypical:
Legionella
Chlamydia pneumoniae
Mycoplasma pneumoniae
Chlamydia psittaci
Coxiella burnetti

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40
Q

Symptoms of atypical pneumonia

A

Insidious onset (4 weeks)
Cough, SOB, fever, sputum (scant), pleuritic CP, wheeze, haemoptysis
GI symptoms
Arthritis/arthralgia
Erythema multiform, erythema nodosum
Pericarditis
Pancreatitis

Not improving after 48 hrs abx

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41
Q

Abx for pneumonia

A

Typical:
Amoxicillin 500mg tds 7/7

Atypical:
Roxithromycin 300mg OD/150mg BD 7/7
Erythromycin 400mg QID 7/7
Doxycycline 200mg stat, then 100mg OD 6/7

Post viral/influenza:
Augmentin
Doxycycline

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42
Q

CURB-65 score

Pitfalls

A

Confusion
Urea >7mmol
RR >30
BP <90mmHg systolic, <60mmHg diastolic
Age 65

2 or less - community management

Pitfalls
- Poor prediction of ICU admission
- Does not take into account cormorbidities/rest home resident

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43
Q

Hospital acquired pneumonia criteria

A

More than 2 days in hospital in last 90 days

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44
Q

URTI symptoms and duration

A

Fever 3-5 days
Headache/sore throat - 1 week
Nasal obstruction 7-10 days
Nasal discharge 2 weeks
Cough 2-4 weeks

Overall:
Illness peaks day 3-4
Significant improvement by day 7
Total 1-2 weeks, sometimes 3+ weeks

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45
Q

TB symptoms

A

Productive cough >2 weeks
Haemoptysis
SOB

Lymphadenopathy - cervical/mediastinal (most common form of extrapulmonary TB)
Prolonged fever
Tiredness
Anorexia, weight loss, no weight gain (children)
Night sweats

May mimic hyperthyroidism or lung cancer

46
Q

Site of progressive primary TB

A

Occurs in 10% after primary infection
TB pneumonia
Hilar lymphadenopathy
Cervical lymphadenopathy
Pleural TB
Meningitis
Pericarditis
Abdominal TB
Miliary dissemination

47
Q

Risk factors for TB

A

Immigration from country with high TB
Living in household with immigrant from high TB country
Contact with active TB last 2 years
Prev TB
Concurrent HIV
Recent chemo, immunosuppression, monoclonal abs
ETOH
Age <5

48
Q

Micro diagnostic criteria for TB

A

1 of
- Positive culture for TB
- Positive acid-fast bacilli on Ziehl Neelsen stain
- M tuberculosis complex DNA from specimens
- Histology strongly suggestive, strong clinical suspicion

49
Q

Causes of haemoptysis

A

40% unknown

Infective - most common
- Pneunomia (Klebsiella, staph, influenza)
- Brochitis (mild blood loss)
- Bronchiectasis (severe pneumonia, TB)
- Primary lung abscess (fungi - aspergillus)

Neoplasm - next most common
- Bronchogenic ca (age 40-60 smokers)
- Renal, colorectal ca - most likely metastases to bronchi

Others
- PE (10-20%)
- Foreign body
- Pulmonary-renal syndromes (Goodpastures, Wegeners granulomatosis)
- Pulmonary endometriosis (cyclical haemoptysis)

50
Q

Sources of blood in “haemoptysis”

A

Haemoptysis - frothy bright red sputum
Pseudohaemoptysis (extra-pulmonary) - darker blood, post nasal drip, epistaxis
Haematemesis - coffee ground, food particles

51
Q

Life threatening haemoptysis amount

A

> 150mL - can fill up pulmonary dead space

Mild - <30mL in 24h
Moderate - 30-600mL in 24h
Severe - >600mL in 24h

52
Q

Wells Criteria for PE

A

Symptoms of DVT = 3
PE #1 diagnosis = 3
HR >100 = 1.5
Immobilisation 3/7 or surgery in last 4/52 = 1.5
Prev DVT/PE = 1.5
Haemoptysis = 1
Malignancy w treatment in last 6/12 or palliative = 1

Low risk (12.1% PE) = 1-4 - high sensitivity D dimer
High risk (37%) = 5+ - straight to CTPA

53
Q

Revised Geneva score for PE

A

LL tenderness + oedema = 4
HR >95 = 5
HR 75-94 = 3
Unilateral LL pain = 3
Prev DVT/PE = 3
Surgery or LL fracture in last 1/12 = 2
Active malignancy = 2
Haemoptysis = 2
Age > 65 = 1

0-3 = low risk
4-10 = moderate risk
11+ = high risk

54
Q

Symptoms of iliofemoral thrombosis

A

Groin/buttock pain
Collateral superficial veins
Thigh swelling

55
Q

Well score for DVT

A

1 point each
- Active cancer
- Paralysis, paresis, recent cast immobilisation of LL
- Bedridden >3/7, surgery within 4/52
- Localised tenderness
- Entire limb swollen
- Calf swelling >3cm more than other (10cm below tibial tuberosity)
- Unilateral pitting oedema
- Collateral superficial veins

-2 for other diagnosis more likely

Low risk 1-2 - D-dimer
High risk 3+ - USS

56
Q

Netherlands primary care decision rule for DVT

A

1 point each
- Male
- COCP
- Malignancy
- Recent surgery
- Absence of trauma
- Vein distension

2 points for
- Calf difference >3cm

6 points for
- Abnormal D-dimer

0-3 - very low 0.7%
4-6 - low 4.5%
7-9 - moderate 21.7%
10-13 - high 51.3%

57
Q

Risk factors for spontaneous pneumothorax

A

Male
Smoking/vaping
Age <40
Connective tissue disorder/Marfan’s
Tall
Family hx

58
Q

Criteria for referral for pneumothorax

A

Apex to cupola >3cm
Interpleural distance at hilum >2cm
Oxygen requirement
Tension pneumothorax

  • otherwise observe for 6 hours, repeat CXR
59
Q

Sign of dizziness indicating stroke

A

Mortality of 40% if missed CVA

  • Single, protracted episode of dizziness

HINTS (in first 24-48hrs more sensitive than MRI or ABCD2 score):
- Normal head impulse (can be abnormal in pontine + cerebellar strokes)
- Nystagmus (except for horizontal in direction of gaze)
- Vertical skew deviation

60
Q

Causes of dizziness other than stroke

A

Cardiovascular (21%)
Respiratory (11%)
Neuro (11%, CVA 4%)
Metabolic (11%)
Injury/poision (10%)
Psych (7%)
Digestive (7%)
GU (5%)
Infection (3%)

61
Q

Peripheral vestibular causes of dizziness

A

Meniere’s Disease
Vestibular neuritis
BPPV
Migrainous vertigo
Chronic dizziness (>3months)

62
Q

Diagnostic criteria for Ménière’s disease

A
  • 2 spontaneous episodes rotational vertigo lasting >20mins
  • Audiometry confirmed sensorineural hearing loss
  • Tinnitis/sense of aural fullness
  • Other causes excluded
63
Q

Diagnosis of BPPV

A

Brief, recurrent episodes of vertigo triggered by positional change.

Most commonly posterior canal

Dix-Hallpike - diagnosis
Epley Manoeuvre - repositioning otolith

64
Q

Classification of mild, moderate, severe traumatic brain injury

A

Mild - <30mins LOC, GCS 13-15, <24 hrs post traumatic amnesia
Normal CT head
= Concussion
Moderate - 30mins - 24 hrs LOC, GCS 9-12, 1-7 days post traumatic amnesia
Severe - >24 hours LOC, GCS <8, >7 days post traumatic amnesia

65
Q

Cushing’s triad

A

Bradycardia
Irregular decreased resps
Systolic hypertension

= imminent brain herniation

66
Q

Canadian CT head rule

A

Include: At least one of- LOC, amnesia to event, witnessed disorientation
Exclude: Age <16, blood thinners, seizure after injury

Consider CT if any of following:
- GCS <15 2 hours post injury
- Suspected open or depressed skull fracture
- Signs of basal skull fracture
- 2+ episodes of vomiting
- Age >65
- >30 mins retrograde amnesia
- Dangerous mechanism (struck pedestrian, ejected from vehicle, fall from >1m, >5 steps

67
Q

NICE CT head criteria

A

GCS <13
GCS <15 2 hours post injury
Suspected open/depressed skull fracture
Signs of basal skull fracture
2+ episodes of vomiting
Focal neurology
Post traumatic seizure

If any amnesia or LOC:
Age >65
Hx bleeding/clotting disorder
Dangerous mechanism
>30 mins retrograde amnesia

68
Q

PECARN CT head (paeds)

A

<2 years
- GCS 14
- Palpable skull fracture/tense fontanelle
- Altered mental state - somnolence, agitation, repetitive questioning, slow response
—
- occipital/parietal/scalp haematoma
- LOC >5 sec
- Not acting normal
- Severe mechanism

> 2 years
- GCS 14
- Signs of basal skull fracture
- Altered mental state
—
- Vomiting
- Severe headache
- LOC
- Severe mechanism

69
Q

History taking for patients with altered level of consciousness

A

AMPLE
Allergies
Medications
Past medical history/Pregnancy
Last meal
Events/Environment related to injury

70
Q

Glasgow Coma Scale

A

Eyes
4 - open spontaneously
3 - open to voice
2 - open to pain
1 - not opening

Verbal
5 - normal speech
4 - confused
3 - incomprehensible words
2 - moaning
1 - no sound

Motor
6 - moves on command
5 - localises pain
4 - Withdraws from pain
3 - Flexion to pain
2 - Extension to pain
1 - No movement

71
Q

Definition of orthostatic hypotension

A

Measure after 5 mins supine
Standing up, measure at 1 min and 3 mins

Difference of >20 SBP or >10 DBP within 3 mins of standing

> 30 difference in hypertensive patients

Delayed orthostatic hypotension within 10-15mins

72
Q

Primary and secondary causes of orthostatic hypotension

A

Primary:
Primary autonomic failure
- Middle age, insidious onset
- Constipation, urinary retention, loss of sweating, temp intolerance, dry mouth

Multiple system atrophy
- Urinary + faecal incontinence
- Iris atrophy, external ocular palsy
- Rigidity, tremor, loss of sweating, erectile dysfunction

Parkinson’s Disease/Lewy body dementia

Acute autonomic neuropathy
- failure of sympathetic + parasympathetic
- young people preceded by febrile illness
- Loss of sweating, severe bladder + bowel dysfunction
- HR 45-55, chronotropic incompetence
- Dilated pupils, not responding to light

Secondary
- Bed rest, immobilisation
- Dehydration, anaemia
- UTI
- Amyloidosis, diabetes, renal failure
- Malignancy, MS, Alzheimer’s
- Meds: vasodilators, diuretics, alpha/beta blockers, TCA, dopamine agonists

73
Q

Management of orthostatic hypotension

A

Volume expansion - 500mL water stat. Aim 1.5L water/day. Aim 10g sodium/day.
Avoid extreme heat, prolonged standing - change positions, compressive hosiery/abdominal binder, crossing legs/flex arms/rock on toes
Sleep with head up 10-30 deg
Avoid large meals
Avoid ETOH

Meds:
Fludrocortisone - may worsen supine hypertension and hypokalaemia
Midodrine
Desmopressin
Methylphenidate

74
Q

Investigation adult with first seizure

A

CT head
BSL
Pregnancy test
Lumbar puncture if immunocompromised/febrile

75
Q

Signs of status epileptics

A

> 5mins continuous clinical seizure or seizure activity on EEG OR recurrent seizure activity without recovery to baseline

Tonic, clonic, tonic-clonic, symmetrical or lateralised
With prolonged seizure, motor signs may be less apparent - look for nystagmus, twitching, deviation of eyes

76
Q

Precipitants of status epileptics in adults and children

A

Children
- Infection/fever
- Congenital malformation
- Anoxia
- Metabolic causes
- Low anticonvulsant levels

Adults
- CVA/CNS insult
- Low anticonvulsant level
- Drug/ETOH withdrawal
- Anoxia

77
Q

Management of status epilepticus

A

Ideally IV
Lorazepam 4-8mg or diazepam 10mg
+ Phenytoin 18mg/kg

Monitor:
- Glucose: children 2mL/kg 25% dextrose, adults - 50mL 50% dextrose + 100mg thiamine
- Temp: Often hypertensive from seizure, passive cooling
- Cardiac: arrhythmia/ischaemia
- Fluid balance: over hydration can cause cerebral oedema
- Acidosis: respiratory acidosis - ventilation support, metabolic acidosis - bicarb

78
Q

Risk factors for stroke

A

Smoking
Hyperlipidaemia
AF
Fijian Indian
Age
HTN
Diabetes
FHx heart disease

79
Q

Management of stroke

A

Immediate hospital transfer
Consider reperfusion if <6 hours since symptom onset or wake up stroke
Consider clot retrieval if moderate-severe symptoms and between 6-24h since onset of symptoms
Supplementary O2 aiming 92-96%
Do not anticoagulant until CT done

80
Q

TIA presentation

A

Transient focal neurological deficit
Lasting <6 hours
Most true TIAs resolve in 1 hour

81
Q

ABCD2 score

A

Age > 60 = 1
BP > 140/90 = 1
Clinical features: unilateral weakness =2, speech disturbance without weakness = 1
Duration of symptoms:
10-59mins = 1
>60mins = 2
Diabetes = 1

0-3 = low risk
4-5 = moderate risk
6-7 high risk

82
Q

TIA patients needing urgent work up

A

ABCD2 score >3
Crescendo TIAs - >2 in 1 week
AF
On anticoagulant
Know carotid stenosis

83
Q

Signs and symptoms of cerebellar CVA

A

Vertigo
Headache
Unsteadiness

Poor coordination
Positive HINTS
Sometimes dysarthria

84
Q

Risks for cervical artery dissection

A

Smoking
HTN
Marfans
Age
Vasculopathy

85
Q

Types of cervical artery dissection

A

Intimal tear - Intraluminal > embolic stroke
Subintimal dissection > artery stenosis
Subadventitial dissection > artery dilatation

> Vessel rupture > Subarrachnoid haemorrhage

86
Q

Symptoms + signs of cervical artery dissection

A

Neck pain (anterior/posterior)
Headache (anterior/posterior)
Horner’s syndrome
Expanding neck haematoma
Neurological deficit (speech, coordination, vision)
Vascular bruit

87
Q

Characteristic symptoms of meningitis

A

Fever, neck stiffness, altered mental state
Meningitis can be excluded if none present

88
Q

Contraindications for lumbar puncture

A

Age >60
Immunocompromised
History of CNS disease
Seizure within 1 week
Abnormal LOC, cannot answer 2 consecutive questions
Gaze palsy, abnormal visual fields, facial palsy, arm/leg drift
Aphasia

89
Q

POUND symptoms for migraine

A

Pulsating headache
Onset - 4-72 hours without medication
Unilateral
Nausea
Disabling/disrupts normal activity

4+ symptoms likely migraine

90
Q

Cluster headache symptoms

A

Intense pain behind the eye
Up to 8 attacks/day, or every other day, 15-180mins
Autonomic symptoms- lacrimation, rhinorrhoea, diaphoresis, ptosis, mitosis
Restlessness/agitation

91
Q

Cluster headache management

A

12L/min 100% O2 via non rebreather
Subcut or intranasal triptans
Do not use paracetamol, NSAIDs, oral triptans, ergots
Discuss with gen med for ?imaging ?verapamil/prednisone prophylaxis

92
Q

Cluster headache risk factors

A

Overcrowding
40-50 years
Male
Smoking
Family hx
ETOH

93
Q

Tension headache symptoms

A

Bilateral, band-like pressure radiating to neck
30+ mins
Mild nausea, no other associated symptoms
Pericranial tenderness elicited by palpation - frontal, temporal, masseter, pterygoid, SCM, splenius, trapezius

94
Q

Causes of tension headache

A

Stress, tiredness, emotional upset
Tension and excessive contraction in face/neck - poor work ergonomics, anxiety, teeth grinding, gum chewing, sleep apnoea, obesity, C-spine arthritis
Bright lights, prolonged reading, loud noises
Medication overuse

95
Q

Prophylaxis for recurrent tension headache

A

Naproxen 250-500mg BD 3 weeks
Amitriptyline/nortriptyline 2-3 months
Propanolol/metoprolol

96
Q

Characteristic symptoms of subarachnoid haemorrhage

A

Sudden onset thunderclap headache
Occipital
Neck stiffness

10-40% sentinel headache 2-8 weeks prior
Seizure within 24 hours (20%)
Focal neurology
- third nerve palsy - posterior communicating artery
- sixth nerve palsy - increased intracranial pressure
- bilateral leg weakness - anterior communicating artery
- loss of decision making/voluntary actions - anterior communicating artery
- hemiparesis, aphasia, neglect - middle cerebral artery
Altered mental state
Collapse

97
Q

Ottawa subarachnoid haemorrhage clinical prediction rule

A

> 15 new severe headache, maximal intensity within 1 hr, no neurology

CT head if any of:
Age >40
Neck pain/stiffness
LOC
Onset during exertion
Thunderclap headache
Limited neck flexion

98
Q

Most common brain tumours

A

Metastases
Glioma
Meningioma
Pituitary adenoma
Acoustic neuroma

95% all brain tumours

99
Q

Signs of frontal lobe SOL

A

Personality change
Hemiparesis
Executive dysfunction, inappropriateness
Anosmia
Dysphasia

100
Q

Signs of parietal lob SOL

A

Hemisensory loss
Astereogenesis - recognise by touch
Reduced 2 point discrimination
Neglect
Sensory inattention
Dysphasia
Gertsmann’s syndrome - dysgraphia, dyscalculia, finger agnosia, left-right disorientation

101
Q

Signs of temporal lobe SOL

A

Dysphasia
Contralateral upper quadrant homonymous hemianopia
Amnesia, depersonalisation, psychosis, emotional change
Fugue
Temporal lobe epilepsy (hallucination, deja vu)

102
Q

Signs of occipital lobe SOL/relation to optic chiasm

A

In front of optic chiasm - single eye visual defect
At optic chiasm - bitemporal hemianopia
Behind optic chiasm - left/right homonymous hemianopia
Visual cortex - congruent contralateral visual defect

103
Q

Signs of corpus callous SOL

A

Rapid intellectual deterioration + adjacent lobe symptoms
Inability of left hand to carry out verbal commands

104
Q

Signs of midbrain SOL

A

Unequal pupils
Loss of upwards + downwards gaze
Amnesia, confabulation
Somnolence

105
Q

Signs of cerebellopontine angle SOL

A

Usually acoustic neuroma
Deafness
Tinnitis
Nystagmus
Reduced corneal reflex
Facial + trigeminal nerve palsy
Cerebellar signs

106
Q

Signs of cerebellum SOL

A

DASHING
Dysdiadochokinesis
Ataxia
Slurred speech (staccato)
Hypotonia
Intention tremor (past pointing)
Nystagmus
Gait abnormality

107
Q

Predisposing factors for migraines

A

Female, young adults
Strong FHx
Stress
Caffeine
Chocolate
ETOH
Bright lights

108
Q

International Headache Society criteria for migraine

A

Migraine with aura
A. At least 2 attacks
B. 1+ fully reversible aura symptom - visual, sensory, speech, motor, brainstem, retinal
C. At least 2 of:
- At least 1 aura over 5 mins, or 2+ auras in succession
- Each aura 5-60mins
- At least one aura unilateral
- Aura accompanied or followed by headache within 60mins
D. TIA, other causes excluded

Migraine without aura
A. At least 5 attacks
B. 4-72 hours untreated
C. At least 2 of:
- pulsatile, unilateral, moderate-severe, aggravated by physical activity
D. At least one of: nausea/vomiting or photophobia/phonophobia
E. Other causes excluded

109
Q

Symptoms of cerebral venous thrombosis

A

Headache
Pain with lateral gaze - involvement of contralateral eye is diagnostic

3 categories:
Isolated intracranial hypertension - vomiting, papilloedema, visual disturbance
Focal syndrome - focal deficits, seizure
Encephalopathy - multifocal, change in mental status, stupor, coma

110
Q

Causes of cerebral venous thrombosis
Microbes
Risk factors

A

Staph aureus, occasionally Strep, Pneumococcus, fungal

Following facial infection (6-12%) - sinusitis, furuncle
Prothrombotic conditions
COCP
Pregnancy, puerperium
Malignancy
Head injury

111
Q

Management of cerebral venous thrombosis

A

Urgent medical referral

If infection:
Penicilinase-resistant penicillin + 3rd,4th gen cephalosporin
+/- anaerobe cover if dental source
3-4 weeks IV

Analgesia
Antiemetic
Antispasmodic

Early anticoagulation
Corticosteroids if pituitary insufficiency

UCPEX (13 decks)

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