Stress at Home Flashcards
1
Q
What features would suggest a diagnosis of a migraine?
A
- Localised headache - usually temporal
- Visual aura before onset of headache - may be described as ‘zig zags’ in the side of their vision
- Numbness - face and limbs
2
Q
What would you be considering in a headache presentation?
A
- If patient complains of vomiting with headaches, consider serious causes like mass, brain abscess or carbon monoxide poisoning. If household contacts have similar symptoms, then definitely consider carbon monoxide.
- A headache that worsens on standing - consider CSF leak
- If immunocompromised - consider serious causes like cerebral infection or malignancy
3
Q
What are the red flags of headache?
A
- Malignancy
- Pregnancy
- Sudden onset
- Associated fever
- Hx of head trauma
- Worse on coughing/sneezing
- Immunosuppression
4
Q
What would a new severe or unexpected headache indicate?
A
- Sudden-onset severe headache reaching maximum intensity within 5 minutes may indicate serious causes such as intracranial haemorrhage, venous sinus thrombosis, hypertensive encephalopathy and vertebral artery dissection.
- New onset headache in a person aged over 50 years may indicate a serious cause such as giant cell arteritis or space occupying lesion.
5
Q
What would a progressive or persistent headache or headache that has changed dramatically indicate?
A
Consider serious causes such as mass lesion or subdural haematoma.
6
Q
What could associated features with a headache indicate?
A
- Fever, impaired consciousness, seizure, neck pain/stiffness or photophobia — consider serious causes such as meningitis and encephalitis.
- Papilloedema — consider space occupying lesions, cerebral venous sinus thrombosis and benign intracranial hypertension.
- New-onset neurological deficit, change in personality and new-onset cognitive dysfunction — consider serious causes such as a cerebrovascular event, malignancy or other space occupying lesions such as subacute or chronic subdural hematoma.
- Atypical aura (duration greater than 1 hour, or including motor weakness) or aura occurring for the first time in a patient during use of combined oral contraceptives — consider serious causes such as cerebrovascular event.
- Dizziness — consider serious causes such as ischaemic or haemorrhagic stroke.
- Visual disturbance — can be associated with migraine but also with serious causes such as acute closure glaucoma and temporal arteritis.
- Vomiting — can associated with migraine but may also be associated with a serious cause of headache such as mass lesion, brain abscess, or carbon monoxide poisoning.
7
Q
What precipitating factors can be linked to a headache?
A
- Preceding recent (usually within the past 3 months) head trauma — consider serious causes such as subacute or chronic subdural haematoma.
- Headache triggered by a valsalva manoeuvre (such as coughing, sneezing, bending or exertion [physical or sexual]) — consider serious causes such as Chiari 1 malformation or a posterior fossa lesion.
- Headache that worsens on standing — consider a CSF leak.
- Headache that worsens on lying down — consider a space-occupying lesion or cerebral venous sinus thrombosis.
8
Q
What co-morbidities can be associated with headaches?
A
- Compromised immunity (for example due to HIV or immunosuppressive drugs) — consider serious causes such as cerebral infection or malignancy.
- Current or past malignancy — consider serious causes such as cerebral metastases.
- Current or recent pregnancy — consider serious causes such as pre-eclampsia.
9
Q
What investigations can you do for headaches?
A
- Neuro exam
- BP
- HR
- Palpation of temporal arteries
- Fundoscopy (if room dark enough)
10
Q
What would you ask about in a history of low mood?
A
- Do you feel that life is hopeless and not worth living?
- Do you ever think about suicide?
- Have you made any plans for ending your life?
- Do you have the means for doing this available to you?
- What has kept you from acting on these thoughts?
- Identify risk factors that increase the risk of suicide, particularly previous attempts at suicide or self harm or a feeling of hopelessness
- Assess adequacy of social support and current personal circumstances
- Identify factors that reduce suicide risk, including social support and responsibility for children
11
Q
What are risk factors for suicide?
A
- Male
- Young age (<30yrs)
- Advanced age
- Single or living alone
- Prior suicide attempt(s)
- FH of suicide
- History of substance or alcohol abuse
- Recently started on antidepressants
- Hopelessness
- Psychosis
- Anxiety/agitation/panic attacks
- Concurrent physical illness
- Severe depression
12
Q
What is the HARK questionnaire?
A
To elicit possible domestic abuse - one point is given for every yes answer. Can make sure someone is SAFE to go home by adding an S - SHARK.
- (H) Humiliation: within the last year, have you been humiliated or emotionally abused in other ways by your partner or ex-partner?
- (A) Afraid: within the last year, have you been afraid of your partner or ex-partner?
- (R) Rape: within the last year, have you been raped or forced to have any kind of sexual activity by your partner or ex-partner?
- (K) Kick: within the last year, have you been kicked, hit, slapped or otherwise physically hurt by your partner or ex-partner?
- Address if there are children at home
13
Q
What is prescribed for depression and anxiety?
A
- Depression: sertraline is 1st line
- If patient is suffering from acute anxiety and needs short course antidepressants - diazepam
- Antidepressants can take 4-6 weeks before symptoms improve and it’s recommended to take them for at least 6 months to reduce risk of relapse. They should not be stopped suddenly due to side effects, they should be weaned off.
14
Q
What is a SENCO?
A
Special Educational Needs Coordinator (SENCO): critical role in ensuring that children with disabilities and special educational needs within a school receive the support they need. If the child has suspected mental health problems, they can be referred to CAMHS for assessment.
15
Q
What are the signs that could indicate abuse or neglect?
A
Anyone who is dependent on anyone else could be abused, and several features apply to both children and adults.
- Children or adults whose behaviour changes – they may become aggressive, challenging, disruptive, withdrawn or clingy, or they might have difficulty sleeping or start wetting the bed;
- Children or adults with clothes which are ill-fitting and/or dirty;
- Children or adults with consistently poor hygiene;
- Children or adults who make strong efforts to avoid specific family members or friends, without an obvious reason;
- Children or adults who don’t want to change clothes in front of others or participate in physical activities;
- Children or adults with frequent injuries or unexplained or unusual injuries, bite marks, burns or cuts
- Children who are having problems at school, for example, a sudden lack of concentration and learning or they appear to be tired and hungry;
- Children who reach developmental milestones, such as learning to speak or walk, late, with no medical reason;
- Children who drink alcohol regularly from an early age;
- Children who use sexual language or have sexual knowledge that you wouldn’t expect them to have or ask others to behave sexually or play sexual games;
- Children with physical sexual health problems, including soreness in the genital and anal areas, sexually transmitted infections or underage pregnancy
