OSCE Flashcards
HA red flags
Intracranial bleed: thunderclap, recent trauma
Raised ICP: posture/ valsalva related
SOL: immunosuppression, malignancy, focal neurology, onset >50 yo
Meningitis: rash, fever, neck stiffness, photophobia
GCA: visual problmes, jaw claudication, scalp tenderness
Glaucoma: visual blurring, red eye, halos
Differentials for HA
Primary HA: tension, cluster, migraine, trigeminal neuralgia
Secondary - intracranial: meningitis, SAH, raised ICP, other intracranial causes: venous sinus thrombosis, intracranial hemorrhage, infections, spontaneous intracranial hypotension, pituitary apoplexy
Secondary- extracranial: GCA, glaucoma, sinusitis, HTN HA, hypoxia/hypercapnia, cervical spondylosis, pre-eclampsia, drugs- nitrates, PPI, caffeine, analgesia overuse, hormones
Differentials for red eye
Extra-ocular/orbit: pre-septal/orbital cellulitis, CST, CCF
External eye disease: blepharitis, conjunctivitis, episcleritis, keratitis
Internal eye disease: iritis, uveitis, acute angle closure
Key neurological symptoms
HA
Seizures
LOC
Muscle weakness, fasiculations, twitches
Peripheral sensory - parasethias, loss
Speech disturbance
Visual changes
Hearing changes
Olfactory changes
Dizzy, vertigo
AMS
Delirium causes/ triggers
PINCH ME
Pain
Infection
Nutrition
COnstipation
Hydration
Meds
Environment
Old people risk assessemtn
4FS - fire, floods, famine, falls
Agression, risky behaviour
Carer- burden and support
Relevant associated symptoms to enquire about in HPC = memory impairment
Psych sx- depression, hallucinations
Behavioural/ personality changes
Sleeping patterns
Cognitive changes- speech, recognition, planning
Bowel and urinary symtpoms
Relevant PMH for a HPS = memory impairment
Parkinson’s
Vascular diseases, DM
Head injuries
Recent, recurrent infection
Depression, anxiety
Work up for memory impairment
Exam- neuro, CNs
Bedside - ECG, UA, BGL, Vitals
Bloods- FBC, UEC, LFT, TFT, BGL, Ca, cortisol, Vitamins - b12 and folate
Imagine- NCCT head, MRI brain
Other: ADL assessment, formal cognitive profiling, LP, EEG, depression screening
Types of head injury
Concussion
Skull fracture
Hemorrhage
Edema
Diffuse axonal injury
Which part of the skull is most susceptible to fracturing
Pterion
Cx of pterion skull fracture
Extradural hemorrhage due to MMA rupture
Red flags in head injury
LOC following injury
GCS<15 on intial assessment
Post injury seizure or vomiting
Persistent and constant HA since injury
FND since injury
Signs of a penetrating injury or visible trauma to the scalp or skull, including fractures (e.g. leakage of blood or fluid from the nose or ears)
Amnesia (specifically retrograde amnesia 30 minutes immediately before the injury)
Dangerous mechanism of head injury (e.g. high-speed road traffic accident)
Relevant PMH in head injury
Previous head inury
Bleeding/coagulation disorders
Previous brain surgery
Seizures/ epilepsy
Bone disorders
Relevant meds in head injury
Anticoags
Antiplatelets
Antiepileptics
