Case 4- Headache Flashcards

Question

Management of MOH

Answer 1

Withdraw analgesia (analgesics and Triptans- abruptly) Opioids- gradual NB+0- may get withdrawal symptoms eg. Vomiting, hypotension, tachycardia, restlessness, sleep disturbance, anxiety

Answer 2

Sensory neural hearing loss

Answer 3

Tiredness, stress Alcohol Combined OCP Lack of food or dehydration Cheese chocolate red wine Menstruation Bright lights

Answer 4

Paracetamol NSAIDs (1st and 2nd trimester) Avoid aspirin Migraine with aura- COC pill contraindicated (stroke)

Answer 5

Compression of brachial plexus, subclavian artery or vein at site of thoracic outlet (NB can have neurogenic or vascular presentation, or both) Painless muscle wasting of hand muscles, hand weakness, altered sensation, cold hands, swollen hands, painful arm claudication, distended veins

Answer 6

5 HT1B and D agonists

Answer 7

Autosomal dominant Depigmented ash leaf spots that fluoresce under UV light Roughened patches of skin over the lumbar spine (Shagreen patches) Angiofibromas Cafe au lait spots may be seen Fibromata beneath nails Developmental delay and intellectual impairment Epilepsy Retinal harmatomas

Answer 8

Don’t take within 24 hours of one another- coronary artery spasm

Answer 9

Constitutional- fever, weight loss, night sweats Temporal artery inflammation- temporaL headache, tender temporal artery, jaw claudication, scalp tenderness Vistula defecits- scotoma (curtain), amaurosis fugax (complete vision loss) Diplopia Poly myalgia rheumatica Sx (aching, morning stiffness in proximal limb muscles)

Answer 10

Group B Streptococcus (most common cause in neonates) E. coli Listeria monocytogenes

Answer 11

Neisseria meningitidis Streptococcus pneumoniae Haemophilus influenzae

Answer 12

Neisseria meningitidis Streptococcus pneumoniae

Answer 13

Streptococcus pneumoniae Neisseria meningitidis Listeria monocytogenes

Answer 14

metoclopramide

Answer 15

Paroxysmal hemicrania (PH) is defined by attacks of severe, unilateral headache, usually in the orbital, supraorbital or temporal region. These attacks are often associated with autonomic features, usually last less than 30 minutes and can occur multiple times a day. Shares many features with cluster headaches Management- indomethacin.

Answer 16

disulfiram-like reaction with alcohol (find what disulfiram does)

Answer 17

fever malaise, muscular pain parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70% Management; rest paracetamol for high fever/discomfort notifiable disease Prevention- MMR vaccine (80% effective) Complications -orchitis (more common in post-pubertal males) -hearing loss - usually unilateral and transient -meningoencephalitis -pancreatitis

Answer 18

type 1 is caused by mixed anaerobes and aerobes (often occurs post-surgery in diabetics). This is the most common type type 2 is caused by Streptococcus pyogenes Risk factors; skin factors: recent trauma, burns or soft tissue infections diabetes mellitus (the most common preexisting medical condition, particularly if the patient is treated with SGLT-2 inhibitors) intravenous drug use immunosuppression

Answer 19

The most commonly affected site is the perineum (Fournier's gangrene). Features; acute onset pain, swelling, erythema at the affected site often presents as rapidly worsening cellulitis with pain out of keeping with physical features extremely tender over infected tissue with hypoaesthesia to light touch skin necrosis and crepitus/gas gangrene are late signs fever and tachycardia may be absent or occur late in the presentation Management; urgent surgical referral debridement intravenous antibiotics

Answer 20

also known as the winter vomiting bug, is one of the most common causes of gastroenteritis in the UK Features; Develop within 15 - 50 hours of infection patients experience nausea, vomiting, and diarrhoea, which may be accompanied by headaches, low-grade fevers, and myalgia. Transmission- Faecal-oral route, with the virus becoming aerosolized Investigations- stool culture viral PCR (polymerase chain reaction).

Answer 21

Limit transmission- isolate patients, handwashing (not hand gel) Ensure adequate hydration (D+V)

Answer 22

Streptococcus pneumoniae (pneumococcus) is the most common cause of community-acquired pneumonia Characteristic features of pneumococcal pneumonia -rapid onset -high fever -pleuritic chest pain -herpes labialis (cold sores)

Answer 23

an aerobic Gram-negative rod. It causes a number of clinically important infections in humans: chest infections (especially in cystic fibrosis) skin: burns, wound infections, 'hot tub' folliculitis otitis externa (especially in diabetics who may develop malignant otitis externa) urinary tract infections

Answer 24

an occipital-frontal circumference < 2nd centile Causes include -normal variation e.g. small child with small head -familial e.g. parents with small head -congenital infection (Zika) -perinatal brain injury e.g. hypoxic ischaemic encephalopathy -fetal alcohol syndrome -syndromes: Patau -craniosynostosis

Answer 25

Mitochondrial inheritance has the following characteristics: -inheritance is only via the maternal line as the sperm contributes no cytoplasm to the zygote -none of the children of an affected male will inherit the disease -all of the children of an affected female will inherit the disease -generally, encode rare neurological diseases poor genotype:phenotype correlation - within a tissue or cell there can be different mitochondrial populations - this is known as heteroplasmy Histology -muscle biopsy classically shows 'red, ragged fibres' due to increased number of mitochondria

Answer 26

Irritant dermatitis- the most common cause, due to irritant effect of urinary ammonia and faeces Creases are characteristically spared Candida dermatitis- typically an erythematous rash which involve the flexures/creases and has characteristic satellite lesions Seborrhoeic dermatitis- erythematous rash with flakes. May be coexistent scalp rash Psoriasis- a less common cause characterised by an erythematous scaly rash also present elsewhere on the skin Atopic eczema- other areas of the skin will also be affected General management points; -disposable nappies are preferable to towel nappies -expose napkin area to air when possible -apply barrier cream (e.g. Zinc and castor oil) -mild steroid cream (e.g. 1% hydrocortisone) in severe cases -management of suspected candidal nappy rash is with a topical imidazole. Cease the use of a barrier cream until the candida has settled NB- candida/creases (C for C)

Answer 27

pass medicine

Answer 28

Necrotising enterocolitis is one of the leading causes of death among premature infants. Initial symptoms can include feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis. Abdominal x-rays are useful when diagnosing necrotising enterocolitis, as they can show: -dilated bowel loops (often asymmetrical in distribution) -bowel wall oedema -pneumatosis intestinalis (intramural gas) -portal venous gas -pneumoperitoneum resulting from perforation -air both inside and outside of the bowel wall (Rigler sign) -air outlining the falciform ligament (football sign) Management; Neonates with suspected NEC need to be nil by mouth with IV fluids, total parenteral nutrition (TPN) and antibiotics to stabilise them. A nasogastric tube can be inserted to drain fluid and gas from the stomach and intestines. NEC is a surgical emergency and requires immediate referral to the neonatal surgical team. Some neonates will recover with medical treatment. In others, surgery may be required to remove the dead bowel tissue. Babies may be left with a temporary stoma if significant bowel is removed.

Answer 29

Performed at 5-9 days of life The following conditions are currently screened for: -congenital hypothyroidism -cystic fibrosis -sickle cell disease -phenylketonuria -medium chain acyl-CoA dehydrogenase deficiency (MCADD) -maple syrup urine disease (MSUD) -isovaleric acidaemia (IVA) -glutaric aciduria type 1 (GA1) -homocystinuria (pyridoxine unresponsive) (HCU)

Answer 30

Transient hypoglycaemia in the first hours after birth is common. Persistent/severe hypoglycaemia may be caused by: -preterm birth (< 37 weeks) -maternal diabetes mellitus -IUGR -hypothermia -neonatal sepsis -inborn errors of metabolism -nesidioblastosis -Beckwith-Wiedemann syndrome Features may be asymptomatic autonomic -'jitteriness' -irritable -tachypnoea -pallor neuroglycopenic -poor feeding/sucking -weak cry -drowsy -hypotonia -seizures other features may include -apnoea -hypothermia Management; asymptomatic -encourage normal feeding (breast or bottle) -monitor blood glucose symptomatic or very low blood glucose -admit to the neonatal unit -intravenous infusion of 10% dextrose

Answer 31

Early-onset sepsis in the UK is primarily caused by group B strep infection (75%) Risk factors -Mother who has had a previous baby with GBS infection, who has current GBS colonisation from prenatal screening, current bacteruria, intrapartum temperature ≥38ºC, membrane rupture ≥18 hours, or current infection throughout pregnancy -Premature (<37 weeks): approximately 85% of neonatal sepsis cases are in premature neonates -Low birth weight (<2.5kg): approximately 80% are low birth weight -Evidence of maternal chorioamnionitis Patients typically present with a subacute onset of; Respiratory distress (85%) Grunting (grunting neonate, think sepsis) Nasal flaring Use of accessory respiratory muscles Tachypnoea Tachycardia: common, but non-specific Apnoea (40%) Apparent change in mental status/lethargy Jaundice (35%) Seizures (35%): if cause of sepsis is meningitis Poor/reduced feeding (30%) Abdominal distention (20%) Vomiting (25%) Temperature The clinical presentation can vary from very subtle signs of illness to clear septic shock Frequently, the symptoms will be related to the source of infection (e.g. pneumonia + respiratory symptoms, meningitis + neurological symptoms) NB- all the usual tests eg. urine, LP, 2x blood cultures etc. NB- sepsis 6 (oxygen, fluids and ABX in etc.) The NICE guidelines recommend use of intravenous benzylpenicillin with gentamicin as a first-line regimen for suspected or confirmed neonatal sepsis

Answer 32

In children the peak incidence is between 2 and 5 years of age. Around 80% of cases in children are due to a condition called minimal change glomerulonephritis. The condition generally carries a good prognosis with around 90% of cases responding to high-dose oral steroids.

Answer 33

1. Dry baby and maintain temperature 2. Assess tone, respiratory rate, heart rate 3. If gasping or not breathing give 5 inflation breaths* 4. Reassess (chest movements) 5. If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1

Answer 34

The majority of children achieve day and night time continence by 3 or 4 years of age. Enuresis may be defined as the 'involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract' NB- before 5, reassurance and follow up given Nocturnal enuresis can be defined as either primary (the child has never achieved continence) or secondary (the child has been dry for at least 6 months before) Management; look for possible underlying causes/triggers -constipation -diabetes mellitus -UTI if recent onset general advice -fluid intake -toileting patterns: encourage to empty bladder -regularly during the day and before sleep -lifting and waking reward systems (e.g. Star charts) -NICE recommend these 'should be given for agreed behaviour rather than dry nights' e.g. Using the toilet to pass urine before sleep enuresis alarm -generally first-line for children -have sensor pads that sense wetness -high success rate desmopressin -particularly if short-term control is needed (e.g. for sleepovers) or an enuresis alarm has been ineffective/is not acceptable to the family

Answer 35

An autosomal dominant condition associated with a normal karyotype. It is thought to be caused by a defect in a gene on chromosome 12 As well as features similar to Turner's syndrome (webbed neck, widely-spaced nipples, short stature, pectus carinatum and excavatum), a number of characteristic clinical signs may also be seen: -cardiac: pulmonary valve stenosis -ptosis -triangular-shaped face -low-set ears -coagulation problems: factor XI deficiency

Answer 36

pass medicine

Answer 37

Cause of obesity in children -growth hormone deficiency -hypothyroidism -Down's syndrome -Cushing's syndrome -Prader-Willi syndrome Consequences of obesity in children -orthopaedic problems: slipped upper femoral epiphyses, Blount's disease (a development abnormality of the tibia resulting in bowing of the legs), musculoskeletal pains -psychological consequences: poor self-esteem, bullying -sleep apnoea -benign intracranial hypertension -long-term consequences: increased incidence of type 2 diabetes mellitus, hypertension and ischaemic heart disease

Case 4- Headache Flashcards

(61 cards)