Well Persons Check- Preventitive Activities Concussion, Headaches

Question 1

• What are the major screening areas for a “well Persons check”?
• What are these?
• What is AUSDRISK? What is it
• What are the leading factors contributing to the burden of disease?
• List the major contributors to disease

Answer 1

1. Eye checks and glasses
2. hearing and hearing aids check
3. Blood Sugar and diabetes
4. Blood pressuree
5. Bone denisity + Osteoporosis
6. Cancer Screening and depression
7. Smoking
8. Nutrition
9. Alcohol
10. Physical activity
11. Immunizations

Question 2

What are the screening requirments for non aborginal australaians 45-49?

Answer 2

Preventative activities by age

• Middle age (45-49):Ask
• SNAP screen - smoking every visit ; NAP at least every 2 years
• Depression screen
• Signs of skin cancer - any new or changing lesions?
• Family Hx screening questionnaire

Measure

• BMI (weight and height) + waist circumference
• BP
• Fasting lipids - every 5 years as part of CV assessment

PerformScreening

• Cervical cancer screen - every 5 years from 25
• Vaccination
• Influenza vaccination - recommend for all; particularly for at risk
• Pneumococcal - ATSI and chronic lung disease
• DTPA - pregnant

Calculate

• AUSDRISK - every 3 years from 40 for low risk or every 1 year for high risk
• Absolute CV risk - every 2 years 45+
• Osteoporosis risk factors - post-menopausal women and men >50

Question 3

What is important in regard to following up patients (e.g middle aged man has bloods done but does not return)?

Answer 3

• Recall everyone for their results
• Recall if Abnormal
• Rely on returning and discuss next time they are back
• State or National reminders include: Mammmograms (breast screening australia, CST)

Question 4

What screening and preventitive activities does people between 50-64 require?

Answer 4

Middle age 50-64y

As above PLUS

Screening

• CRC - FOBT every 2 years from 50
• Breast cancer - mammogram every 2 years from 50
• Cervical cancer - every 5 years

Question 5

Patient Case: Martha - PC Worst headache she has ever had

• Headache for a couple days
• Behind her L eye
• Has had soem associated nausea, dizziness and blurred vision - developed this morning
• Some relief from panadol
• UTRI
• last week
• Aslo had bad tooth ache

What are you differential diagnosis?

What are your red flags

DDX:

Answer 5

1. Cluster Headache
2. Migraine
3. SOL
4. Severe sinusitits
5. Viral Encephalitis
6. Tension headaches

Question 6

What are the red flags and symptoms for headaches?

Question 7

List 6 symptoms of OR examination findings that would support a diagnosis of 1) Tension Headache (3 marks)

List 6 Symptoms or examinations findings that would support a diagnosis of migraine (3 marks)

Answer 7

Tension Headache:

1. Band tension distribution
2. Worse at the end of the
3. Last anywhere between- 60 mins to 7 dayys.
4. most common 30-40 years
5. most ocmmon type of headaches
6. NO Naussea and vommitting
7. Can be triggered by stress/depression
8. Bilateral, dullnesss, on pulsatile band like or por vice

Migraine:

1. 3:1 more common in women
2. duration 4 to 72 hours
3. age of onset (adolescent 15-25)
4. Therapy NSAIDS or triptans, antiemetics for nausea
5. COurse of an Attack if comes on and progressively gets worse
6. Triggers: Weather alcohol, stress, menstruation, oral contraceptive pills
7. Character of pain: Severe pounding
8. has auro phenomena- Birght lights, flashing ,

Question 8

What are red flags for headaches?

Answer 8

Question 9

What would make you think of Space occupying lesion as being a cause headache?

Answer 9

• Focal neuralgia
• Headaches.
• Neck pain or stiffness.
• Nausea, vomiting, and lack of appetite.
• Vision changes or eye pain.
• Changes in mood, personality, behavior, mental ability, and concentration.
• Memory loss or confusion.
• Seizures.
• Fever

Question 10

What is the management of acute sinusitis?

Question 11

What are two concussion assessmenet tools

What are the questions to ask post concussion?

(Somatic, cognitive, emotional,

Answer 11

SCAT 5

Question 12

What advice will you provide regarding management of the concussion?

Answer 12

Any atheleted with suspected or confirmed concussion should:

• Remain in the company of a responsible adult
• not be allowed to drive

Be advised to alcohol

How to manage concussion

Any athlete with suspected or confirmed concussion should:

• remain in the company of a responsible adult
• not be allowed to drive
• be advised to avoid alcohol
• have their medications reviewed.
• Specifically, concussed athletes should avoid:
• aspirin
• anti-inflammatories (such as ibuprofen, diclofenac or naproxen),
• sleeping tablets
• sedating pain medications.
• If the athlete is diagnosed with concussion, immediate management is physical and cognitive rest. This may include time off school or work, and relative rest from cognitive activity. Having rested for 24 – 48 hours after sustaining a concussion, the athlete can begin moderate intensity physical activity - as long as the activity doesn’t cause significant and sustained deterioration in symptoms. Concussive symptoms usually resolve in 10 – 14 days.

Children and adolescents

• Sport-related concussions are common in children and adolescents aged 18 years or younger. For this age group, a more conservative approach to diagnosis and management is recommended. This is because this age group:
• has a slower rate of recovery from concussion
• has unique physical, cognitive and emotional differences
• is more vulnerable to concussion, due to factors including decreased myelination, poor cervical musculature, and (possibly) increased head to neck ratio
• the role of cerebral blood flow alterations in the pathophysiology of concussion may be more significant
• Return to learn
• ‘Return to learn’ is about the athlete’s gradual return to their usual program at school or work.
• ‘Return to learn’ should take priority over ‘Return to sport’. School programs may need to include more regular breaks, rests and increased time to complete tasks.
• Medical practitioners can use the Return to Learn Care Plan to communicate to teachers the requirements for a concussed child or adolescent.
• Return to sport
• ‘Return to sport’ is about the athlete’s gradual return to full sporting activity.
• Having rested for 24 – 48 hours after sustaining a concussion, the patient can begin moderate intensity physical activity - as long as the activity doesn’t cause significant and sustained deterioration in symptoms. Concussive symptoms usually resolve in 10 - 14 days, after which the athlete can begin a staged return to sport.

Question 13

What are screening tool, tools can be used to determine if a patient can return to sport following a concussion?

What are the minimum requirements for diagnosis? e.g what symptoms, clinical features should be noted?

Answer 13

Minimum criteria for diagnosing concussion are:

A thorough assessment looking at loss of consciousness, symptoms, cognition, neurobehavioural symptoms, and balance – with any abnormality being a potential sign of concussion.

A concussion assessment using the SCAT5 for adults or Child-SCAT5 for children aged 5 – 12 years. Note: the diagnostic utility of the SCAT decreases 3-5 days post-concussion.

Question 14

What are the major clinical features and questions to ask with a patient with concussion?

What are the 4 major clinical domains of a concussion (somatic, emotional, cognitive, behavioural)

Answer 14

Discussion

• Good clinical care of a patient with concussion by the primary care physician is the best prevention of adverse outcomes.
• The ability of the primary care physician to recognise when to treat and when to refer will be an important agent for change in this field.
• Traumatic brain injury is one of the most common causes of neurological morbidity, and is more common in childhood and adolescence than at any other time of life.
• 1–3 Concussions in young people account for 90% of all traumatic brain injuries.
• 4 One in five children will experience a concussion by the age of 10 years.5 Falls (51%) and sports-related activities (25%) are the most common causes of concussion.5,6 The highest rates of sports-related concussion are reported in males aged 10–19 years, although young females also sustain concussions.7,8 Contact football has the highest reported rate of concussion, although all sports-related activities entail some risk.9 Early detection of injury, proper evaluation and appropriate decision-making for return to activity (physical and cognitive) remain paramount for the treating clinician in the care of post-concussive injury in young people.

Definitions and presentation

1. Concussion is defined as a form of mild-traumatic brain injury that occurs as a result of a direct impact to the head or impact to the body that causes transmission of forces to the head and brain. In terms of initial presentation, common early symptoms include:

• headache
• dizziness
• vertigo or imbalance
• lack of awareness of surroundings
• nausea
• vomiting.

Confusion is another hallmark of concussion and may include amnesia, usually of the traumatic event, but can frequently include losing recall of events immediately preceding a traumatic insult.

• Previous generations of concussion experts have defined loss of consciousness as necessary for the diagnosis of concussion, but nowadays, this is not the case; indeed, loss of consciousness is noted in only 8–10% of concussion cases.12 Patients with a concussion usually experience symptomatic recovery within 2–10 days of injury.
• However, this can vary, particularly in cases where concussion is complicated by other factors and important comorbidities.
• Symptoms experienced by patients in the context of concussion can vary widely and evolve over time.
• This makes it difficult, and indeed inaccurate, to predict the severity of total symptom load for a patient at the time of injury

Question 15

Red flags symptoms/signs for headaches? (SNOOPPP) Systemic/Neurological deficits,

Answer 15

Question 16

What are the clincal features natural course of Cluster headaches?

Answer 16

Headache, cluster

SIGNS / SYMPTOMS

INVESTIGATIONS

• Cluster headache is rare. It is more common in men; by contrast, migraine is more common in women.
• Cluster headache causes extremely severe pain around only one eye, becomes maximally severe in a few minutes, and does not switch side.
• Attacks last up to 3 hours (differentiating feature as migraine can last 4-72 hours) and cause restlessness and agitation with autonomic signs or symptoms on the side of the pain.
• Cluster attacks can occur up to 8 times per day, with intervals of no headache between attacks.
• Attacks may occur at exactly the same time of the day or night (so-called ‘alarm clock’ headaches), especially during rapid eye movement sleep.
• The distinction is best made by taking a careful history and having the patient keep a diagnostic headache diary.
• Cluster headache may occur in patients with migraine.
• The very short duration of headache relative to migraine, combined with several attacks per day, differentiates migraine and cluster headache.

Question 17

What are the signs and symptoms of migraines?

Answer 17

• Migraine is a chronic, episodic, neurological disorder that has a strong genetic component and usually presents in early-to-mid life. It can have a severe effect on quality of life, but it is often under-diagnosed and under-treated.
• Patients complain of intermittent headache and associated symptoms, such as visual disturbance, nausea, vomiting, and sensitivity to light or noise (photophobia and phonophobia).
• Some women experience menstrual migraine, which is most likely to occur in the 2 days leading up to a period and in the first 3 days of a period.
• Diagnosis is based on history and physical examination. No laboratory or imaging tests are essential for diagnosis.
• Treatment approaches involve identifying and avoiding trigger factors, and the use of medication to treat the acute attack and to prevent future attacks. Triptans are preferred over non-specific treatments.

Definition

• Migraine is a chronic, episodic neurological disorder that has a strong genetic component and usually presents in early-to-mid life. Key features in the history that support a diagnosis of migraine are nausea, photophobia, and reduced ability to function, along with headache. Typical migraine aura (a complex of reversible visual, sensory, or speech symptoms), which precedes or occurs during headache, is pathognomonic of migraine but occurs only in 15% to 30% of patients

Question 18

What are key diagnostic features of a migraine?

Answer 18