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1
Q

What are general red flags in a diagnostic assessment?

A

night pain, sweats, unexplained weight loss, thunderclap headache, meningism, saddle anaesthesia, sudden onset weakness, ascending paralysis, numbness, paraesthesia, rapid onset paraplegia, fever, acute onset of confusion, sudden personality changes

Meningism includes headache, stiff neck, photosensitivity, nausea, and vomiting.

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2
Q

What is a thunderclap headache?

A

A sudden, severe headache that reaches maximum intensity within minutes

Often associated with serious conditions such as subarachnoid hemorrhage.

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3
Q

Define meningism.

A

A combination of headache, stiff neck, photosensitivity, nausea, and vomiting

Indicates possible meningeal irritation.

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4
Q

What does saddle anaesthesia refer to?

A

Loss of sensation in the areas that would contact a saddle: perineum and inner thighs

Can indicate cauda equina syndrome.

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5
Q

What is meant by sudden onset weakness?

A

A rapid and unexpected decrease in muscle strength

May be a sign of neurological emergencies.

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6
Q

What is ascending paralysis?

A

A type of paralysis that starts in the lower limbs and moves upward

Often seen in conditions like Guillain-Barré syndrome.

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7
Q

What are numbness and paraesthesia?

A

Numbness is loss of sensation; paraesthesia is abnormal sensation such as tingling

Both can indicate neurological issues.

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8
Q

What does rapid onset paraplegia indicate?

A

Sudden loss of movement or sensation in the lower half of the body

Requires immediate medical evaluation.

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9
Q

What are possible causes of fever in a diagnostic context?

A

Infections, inflammatory conditions, malignancies

Fever can indicate systemic illness.

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10
Q

What does acute onset of confusion suggest?

A

A sudden change in cognitive function or awareness

May be due to metabolic disturbances, infections, or neurological events.

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11
Q

What are sudden personality changes indicative of?

A

Alterations in behavior or mood that arise unexpectedly

Can signal neurological or psychiatric conditions.

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12
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A
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13
Q

What are the evolution symptoms that are considered very important over years?

A

benign tumour’s/degenerative conditions

These symptoms indicate gradual changes in the body over a long period.

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14
Q

What evolution symptoms occur over months and weeks?

A

malignancy, chronic inflammation

These conditions suggest a more significant pathological process developing over an intermediate time frame.

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15
Q

What symptoms are associated with evolution over weeks and days?

A

demyelination CNS, acute inflammation

These symptoms indicate a more rapid onset of neurological or inflammatory conditions.

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16
Q

What type of symptoms are observed over days and hours?

A

very acute inflammation

These symptoms reflect a critical and rapid inflammatory response.

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17
Q

What is the nature of symptoms that are instantaneous?

A

vascular/trauma

These symptoms arise suddenly, often due to an injury or acute vascular event.

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18
Q
A
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19
Q

What are the categories of conditions listed in the VITAMINGDE framework?

A
  • Vascular (V)
  • Infectious
  • Trauma (T)
  • Autoimmune/Inflammatory (A)
  • Metabolic/Toxic (M)
  • Idiopathic/Inherited
  • Neoplastic (N)
  • Congenital (C)
  • Degenerative (D)
  • Endocrine (E)
  • Functional/Psychogenic (F)
  • Miscellaneous (Not explicitly in VITAMIN)

These categories help classify various neurological conditions.

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20
Q

What are examples of vascular conditions in the VITAMINGDE framework?

A
  • Stroke (ischemic, hemorrhagic)
  • TIA
  • Aneurysms
  • Venous thrombosis

These conditions affect blood vessels in the central nervous system.

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21
Q

Name some infectious conditions listed in the VITAMINGDE framework.

A
  • CNS vasculitis
  • Meningitis
  • Encephalitis
  • Brain abscess
  • Neurocysticercosis
  • Neurosyphilis
  • PML
  • HIV-associated disorders

Infectious conditions can lead to significant neurological impairment.

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22
Q

What are examples of trauma-related conditions in the VITAMINGDE framework?

A
  • Traumatic brain injury
  • Spinal cord injury
  • Subdural/epidural hematoma
  • Diffuse axonal injury

These conditions result from physical injury to the nervous system.

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23
Q

List some autoimmune/inflammatory conditions identified in the VITAMINGDE framework.

A
  • Multiple sclerosis
  • Neuromyelitis optica
  • Myasthenia gravis
  • Autoimmune encephalitis
  • Guillain-Barré syndrome

Autoimmune conditions can cause widespread inflammation in the nervous system.

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24
Q

What metabolic/toxic conditions are included in the VITAMINGDE framework?

A
  • Hypoglycemia
  • Hyperglycemia
  • Hepatic encephalopathy
  • Uremic encephalopathy
  • Vitamin deficiencies (B12, thiamine)
  • Toxic encephalopathy

These conditions arise from metabolic imbalances or toxic exposures.

25
What are examples of idiopathic/inherited conditions mentioned in the VITAMINGDE framework?
* Idiopathic intracranial hypertension * Genetic conditions (e.g., Charcot-Marie-Tooth, mitochondrial disorders) ## Footnote These conditions often lack a clear cause or are passed down through genetics.
26
Name some neoplastic conditions in the VITAMINGDE framework.
* Primary brain tumors (glioblastoma, meningioma) * Metastatic brain tumors * Spinal cord tumors * Paraneoplastic syndromes ## Footnote Neoplastic conditions involve abnormal growths in the nervous system.
27
What congenital conditions are listed in the VITAMINGDE framework?
* Neural tube defects (e.g., spina bifida) * Epilepsy syndromes * Congenital malformations ## Footnote Congenital conditions are present at birth and can affect neurological function.
28
Identify some degenerative conditions mentioned in the VITAMINGDE framework.
* Alzheimer's disease * Parkinson's disease * Huntington's disease * ALS * Spinocerebellar ataxias ## Footnote Degenerative conditions progressively impair neurological function over time.
29
What endocrine conditions are included in the VITAMINGDE framework?
* Hypothyroidism * Hyperthyroidism * Pituitary tumors * Addison's disease * Cushing's disease ## Footnote Endocrine conditions can significantly impact neurological health due to hormonal imbalances.
30
True or False: Functional/Psychogenic conditions are acknowledged in the VITAMINGDE framework.
True ## Footnote Functional/Psychogenic conditions can mimic neurological disorders without clear organic causes.
31
Fill in the blank: Conditions such as normal pressure _______ and chronic fatigue syndrome fall under the functional/psychogenic category.
hydrocephalus ## Footnote These conditions can have significant impacts on a patient's quality of life.
32
What are examples of anhythmias?
Bradycardia, tachycardia, atrial fibrillation, ventricular tachycardia ## Footnote Anhythmias refer to irregular heart rhythms that can lead to syncope.
33
Name structural cardiac causes of syncope.
Aortic stenosis, hypertrophic cardiomyopathy, myocardial infarction ## Footnote Structural causes involve abnormalities in the heart's structure that can impede blood flow.
34
What are some other cardiac causes of syncope?
Pulmonary embolism, cardiac tamponade ## Footnote These conditions can lead to reduced cardiac output and result in syncope.
35
What triggers vasovagal syncope?
Emotional stress, prolonged standing, pain ## Footnote Vasovagal syncope is a common form of fainting triggered by various stressors.
36
What are examples of situational syncope?
Cough, micturition, swallowing ## Footnote Situational syncope occurs in response to specific actions or stimuli.
37
What causes carotid sinus hypersensitivity?
Head rotation, tight collars ## Footnote This condition can lead to excessive vagal response and syncope.
38
What is a common cause of orthostatic hypotension?
Dehydration, blood loss, medications (diuretics, antihypertensives) ## Footnote Orthostatic hypotension occurs when blood pressure drops significantly upon standing.
39
What neurological conditions can cause syncope?
Parkinson's disease, diabetic neuropathy ## Footnote Autonomic failure in these conditions can lead to syncope due to impaired blood pressure regulation.
40
What are the types of seizures that can lead to syncope?
Generalized or focal seizures ## Footnote Seizures can cause transient loss of consciousness.
41
What does TIA stand for in the context of neurological causes?
Transient Ischemic Attack ## Footnote TIAs can lead to temporary loss of consciousness due to reduced cerebral perfusion.
42
What is a potential cause of syncope related to migraine?
Basilar migraine ## Footnote This type of migraine can cause symptoms that lead to syncope.
43
Fill in the blank: Impaired cardiac output due to abnormal rhythm is a mechanism of _______.
syncope ## Footnote Abnormal heart rhythms can significantly affect blood flow and lead to fainting.
44
What is the mechanism behind reflex bradycardia and vasodilation?
Causing transient hypotension ## Footnote This reflex can occur due to various triggers, leading to a temporary drop in blood pressure.
45
What triggers an excessive vagal response?
Carotid sinus stimulation ## Footnote This can lead to bradycardia and syncope.
46
What is a consequence of reduced cerebral perfusion due to vasospasm?
Transient ischemia or infarction in the brainstem ## Footnote This can affect consciousness and lead to syncope.
47
What metabolic disturbances can impair cerebral function?
Hypoglycemia, hypoxia, hyperventilation-induced hypocapnia ## Footnote These disturbances can lead to reduced consciousness and possible syncope.
48
What is syncope?
A transient loss of consciousness due to decreased blood flow to the brain. ## Footnote Syncope often involves a quick recovery without confusion.
49
What are triggering factors of syncope?
Factors that can lead to a loss of consciousness, such as dehydration, standing up too quickly, or emotional stress. ## Footnote Identifying triggering factors is essential for diagnosis.
50
What is a distinct prodrome in syncope?
Symptoms that precede the loss of consciousness, such as dizziness or lightheadedness. ## Footnote These symptoms can help differentiate syncope from seizures.
51
What characterizes the duration of syncope?
Short duration, typically lasting seconds. ## Footnote Recovery is usually rapid, with ongoing lethargy but no confusion.
52
What is a key difference between syncope and seizures regarding loss of consciousness?
In syncope, there is a quick recovery without confusion, while seizures often involve a post-ictal phase. ## Footnote The post-ictal phase can include confusion and lethargy.
53
What is a common symptom during the onset of seizures?
Convulsions at the onset of loss of consciousness. ## Footnote This is different from syncope which does not typically involve convulsions.
54
What is the typical duration of seizures compared to syncope?
Longer duration than syncope. ## Footnote Seizures can last from seconds to minutes.
55
What are post-ictal symptoms?
Confusion, lethargy, and sometimes headache following a seizure. ## Footnote These symptoms can last from minutes to hours.
56
What are some physical signs associated with seizures?
*Tongue biting* *Incontinence* *Automatisms* ## Footnote These signs can help differentiate seizures from syncope.
57
Fill in the blank: Syncope typically involves a _______ recovery.
[quick] ## Footnote Recovery from syncope is generally rapid and uncomplicated.
58
True or False: Both syncope and seizures can involve a loss of consciousness.
True ## Footnote However, the mechanisms and recovery processes differ significantly.

Clinical Reasoning (12 decks)

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