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UCPEX > Cardio, Resp, Neuro > Flashcards

Cardio, Resp, Neuro Flashcards

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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
Ddx for syncope
SAH, ICH Ruptured AAA, aortic dissection Ectopic pregnancy GI bleed PE ACS Dysrhythmia Orthostatic hypotension Hypoglycaemia CVA Pain
26
High risk syncope vs low risk syncope
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
27
Complications of atrial fibrillation
CVA Dementia (vascular/Alzheimers) Heart failure MI
28
Atrial fibrillation red flags
Chest pain Haemodynamically unstable Heart failure Recent stroke/TIA <14 days Mitral stenosis Syncope HR >100
29
Risk factors for AF
Male Advanced age European Thyrotoxicosis Obesity Diabetes HTN Sleep apnoea ETOH IHD valvular heart disease Cardiomyopathy Heart failure Acute infection
30
Management of AF
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
31
CHA2DS2VASc score
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
32
Symptoms and signs of life threatening asthma Management:
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
33
Signs and symptoms of severe asthma Management:
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
34
Signs and symptoms of mild-mod asthma Management:
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
35
COPD definition
Hx of smoking or exposure to noxious substance FEV1/FVC <0.7 post bronchodilator
36
Modified Medical Research Council (mMRC) Dyspnoea Score
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
37
Indications for referral of COPD to hospital
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
38
Treatment of COPD exacerbation
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
39
Typical vs atypical pneumonia bacteria
Typical: Strep pneumoniae Haemophilus influenzae Atypical: Legionella Chlamydia pneumoniae Mycoplasma pneumoniae Chlamydia psittaci Coxiella burnetti
40
Symptoms of atypical pneumonia
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
41
Abx for pneumonia
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
42
CURB-65 score Pitfalls
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
43
Hospital acquired pneumonia criteria
More than 2 days in hospital in last 90 days
44
URTI symptoms and duration
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
45
TB symptoms
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
Site of progressive primary TB
Occurs in 10% after primary infection TB pneumonia Hilar lymphadenopathy Cervical lymphadenopathy Pleural TB Meningitis Pericarditis Abdominal TB Miliary dissemination
47
Risk factors for TB
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
Micro diagnostic criteria for TB
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
Causes of haemoptysis
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
Sources of blood in "haemoptysis"
Haemoptysis - frothy bright red sputum Pseudohaemoptysis (extra-pulmonary) - darker blood, post nasal drip, epistaxis Haematemesis - coffee ground, food particles
51
Life threatening haemoptysis amount
>150mL - can fill up pulmonary dead space Mild - <30mL in 24h Moderate - 30-600mL in 24h Severe - >600mL in 24h
52
Wells Criteria for PE
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
Revised Geneva score for PE
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
Symptoms of iliofemoral thrombosis
Groin/buttock pain Collateral superficial veins Thigh swelling
55
Well score for DVT
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
Netherlands primary care decision rule for DVT
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
Risk factors for spontaneous pneumothorax
Male Smoking/vaping Age <40 Connective tissue disorder/Marfan's Tall Family hx
58
Criteria for referral for pneumothorax
Apex to cupola >3cm Interpleural distance at hilum >2cm Oxygen requirement Tension pneumothorax - otherwise observe for 6 hours, repeat CXR
59
Sign of dizziness indicating stroke
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
Causes of dizziness other than stroke
Cardiovascular (21%) Respiratory (11%) Neuro (11%, CVA 4%) Metabolic (11%) Injury/poision (10%) Psych (7%) Digestive (7%) GU (5%) Infection (3%)
61
Peripheral vestibular causes of dizziness
Meniere's Disease Vestibular neuritis BPPV Migrainous vertigo Chronic dizziness (>3months)
62
Diagnostic criteria for Ménière's disease
- 2 spontaneous episodes rotational vertigo lasting >20mins - Audiometry confirmed sensorineural hearing loss - Tinnitis/sense of aural fullness - Other causes excluded
63
Diagnosis of BPPV
Brief, recurrent episodes of vertigo triggered by positional change. Most commonly posterior canal Dix-Hallpike - diagnosis Epley Manoeuvre - repositioning otolith
64
Classification of mild, moderate, severe traumatic brain injury
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
Cushing's triad
Bradycardia Irregular decreased resps Systolic hypertension = imminent brain herniation
66
Canadian CT head rule
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
NICE CT head criteria
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
PECARN CT head (paeds)
<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
History taking for patients with altered level of consciousness
AMPLE Allergies Medications Past medical history/Pregnancy Last meal Events/Environment related to injury
70
Glasgow Coma Scale
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
Definition of orthostatic hypotension
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
Primary and secondary causes of orthostatic hypotension
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
Management of orthostatic hypotension
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
Investigation adult with first seizure
CT head BSL Pregnancy test Lumbar puncture if immunocompromised/febrile
75
Signs of status epileptics
>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
Precipitants of status epileptics in adults and children
Children - Infection/fever - Congenital malformation - Anoxia - Metabolic causes - Low anticonvulsant levels Adults - CVA/CNS insult - Low anticonvulsant level - Drug/ETOH withdrawal - Anoxia
77
Management of status epilepticus
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
Risk factors for stroke
Smoking Hyperlipidaemia AF Fijian Indian Age HTN Diabetes FHx heart disease
79
Management of stroke
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
TIA presentation
Transient focal neurological deficit Lasting <6 hours Most true TIAs resolve in 1 hour
81
ABCD2 score
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
TIA patients needing urgent work up
ABCD2 score >3 Crescendo TIAs - >2 in 1 week AF On anticoagulant Know carotid stenosis
83
Signs and symptoms of cerebellar CVA
Vertigo Headache Unsteadiness Poor coordination Positive HINTS Sometimes dysarthria
84
Risks for cervical artery dissection
Smoking HTN Marfans Age Vasculopathy
85
Types of cervical artery dissection
Intimal tear - Intraluminal > embolic stroke Subintimal dissection > artery stenosis Subadventitial dissection > artery dilatation >Vessel rupture > Subarrachnoid haemorrhage
86
Symptoms + signs of cervical artery dissection
Neck pain (anterior/posterior) Headache (anterior/posterior) Horner's syndrome Expanding neck haematoma Neurological deficit (speech, coordination, vision) Vascular bruit
87
Characteristic symptoms of meningitis
Fever, neck stiffness, altered mental state Meningitis can be excluded if none present
88
Contraindications for lumbar puncture
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
POUND symptoms for migraine
Pulsating headache Onset - 4-72 hours without medication Unilateral Nausea Disabling/disrupts normal activity 4+ symptoms likely migraine
90
Cluster headache symptoms
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
Cluster headache management
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
Cluster headache risk factors
Overcrowding 40-50 years Male Smoking Family hx ETOH
93
Tension headache symptoms
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
Causes of tension headache
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
Prophylaxis for recurrent tension headache
Naproxen 250-500mg BD 3 weeks Amitriptyline/nortriptyline 2-3 months Propanolol/metoprolol
96
Characteristic symptoms of subarachnoid haemorrhage
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
Ottawa subarachnoid haemorrhage clinical prediction rule
>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
Most common brain tumours
Metastases Glioma Meningioma Pituitary adenoma Acoustic neuroma 95% all brain tumours
99
Signs of frontal lobe SOL
Personality change Hemiparesis Executive dysfunction, inappropriateness Anosmia Dysphasia
100
Signs of parietal lob SOL
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
Signs of temporal lobe SOL
Dysphasia Contralateral upper quadrant homonymous hemianopia Amnesia, depersonalisation, psychosis, emotional change Fugue Temporal lobe epilepsy (hallucination, deja vu)
102
Signs of occipital lobe SOL/relation to optic chiasm
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
Signs of corpus callous SOL
Rapid intellectual deterioration + adjacent lobe symptoms Inability of left hand to carry out verbal commands
104
Signs of midbrain SOL
Unequal pupils Loss of upwards + downwards gaze Amnesia, confabulation Somnolence
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Signs of cerebellopontine angle SOL
Usually acoustic neuroma Deafness Tinnitis Nystagmus Reduced corneal reflex Facial + trigeminal nerve palsy Cerebellar signs
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Signs of cerebellum SOL
DASHING Dysdiadochokinesis Ataxia Slurred speech (staccato) Hypotonia Intention tremor (past pointing) Nystagmus Gait abnormality
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Predisposing factors for migraines
Female, young adults Strong FHx Stress Caffeine Chocolate ETOH Bright lights
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International Headache Society criteria for migraine
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
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Symptoms of cerebral venous thrombosis
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
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Causes of cerebral venous thrombosis Microbes Risk factors
Staph aureus, occasionally Strep, Pneumococcus, fungal Following facial infection (6-12%) - sinusitis, furuncle Prothrombotic conditions COCP Pregnancy, puerperium Malignancy Head injury
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Management of cerebral venous thrombosis
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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