Diagnosis and Investigations Flashcards
What are the causes of falls?
DAME -
Drugs: Polypharmacy, anti-hypertensives, oral hypoglycemics, anticholinesterase inhibitors, opiates, sedatives
Ageing: Vision changes, Osteoarthritis, Cognitive decline, Gait abnormalities
Medical: Arrhythmias/heart problems, seizure, cataracts, hypotension, stroke, neuropathy, PD
Environmental: Home hazards, shoes, walking aids
What is vertigo?
A feeling of the room spinning around you
Suggests the problem is in the ear or brain
Differential diagnosis for vertigo?
Meniere's Disease Labyrinthitis BPPV Vestibular Schwannoma Vestibular Neuronitis Migraine MS Cerebellar Problem
What is BPPV?
Short spells lasting up to 2 mins of vertigo
Recur many times throughout the day
Triggers include head movements
Diagnosed using the Dix-Hallpike manouevre
Differential Diagnosis for dizziness?
Vertigo - see ddx vertigo
Presyncope
Unsteady
Psychogenic
What symptoms would someone having presyncope experience?
Light-headedness
Clammy/hot
Pale
Blurred vision
In general what does a patient mean when they say they are unsteady?
A general feeling of unsteadiness coming from the patients’ legs
Why would a patient experience psychogenic dizziness?
Fear of falling
Loss of confidence
Panic attacks or anxiety
Investigations of someone who is falling?
FBC, U&E, Bone Profile
ECG
TFT, B12, Folate
What are the risk factors for delirium?
Pain Dementia Hip fracture Immobility Dehydration or constipation Polypharmacy Unfamiliar environment Hypoxia Infection Sleep disturbance Lack of visual or hearing aids
What are the features of an essential tremor?
Bilateral
Familial
Worse on movement
Jaw tremor
Differential diagnosis for Parkinsonism?
Idiopathic PD Lewy Body Dementia Vascular Parkinsonism Multi System Atrophy Drug Induced Parkinsonism Normal Pressure Hydrocephalus Progressive Supranuclear Palsy Corticobasal Degneration
What is the key feature of idiopathic PD?
Asymmetry of clinical features
What is the key feature of lewy body dementia?
Marked cognitive impairment - presenting first
Visual hallucinations
Parkinsonism
What is the key feature of vascular Parkinsonism?
Vascular risk factors i.e. smoking, high blood pressure, high cholesterol
Predominant lower body signs
What is the key feature of drug induced Parkinsonism?
History of anti-psychotic drugs or other anti-dopaminergic drugs i.e. Prochlorperazine
What is the key feature of Multi System Atrophy?
Autonomic dysfunction i.e. labile BP, bladder instability
What is the key feature of Normal pressure hydrocephalus?
Dementia
Gait disturbance
Bladder instability
What is the key feature of PSP?
Vertical gaze restriction
Early falls
Truncal rigidity
What is the key feature of corticobasal degeneration?
Asymmetrical Parkinsonism and dyspraxia
What is the average age of onset for IPD?
60
What are the risk factors for developing pressure sores?
Prolonged periods of immobility Nutritional deficiencies Loss of sensation A previous or current pressure sore Inability to reposition yourself Cognitive impairment
What are the categories of elder abuse?
Psychological Physical Neglect Sexual Financial Discriminatory
What are the risk factors for elder abuse?
Patient: Has cognitive impairment, has a number of health needs, shared living and low income
Abuser: Caregiver burden, drug and alcohol dependency, psychiatric illness
Relationship factors: Disharmony in the relationship between the patient and the abuser, conflicted relationships
Environmental factors: Shared living, low social support
What are the areas in which someone is assessed in a Nursing Needs Assessment?
Mobility Skin integrity Continence Nutrition Behaviour Cognition Psychological/Emotional Communication Breathing Medications Altered states of consciousness
How do you prevent pressure ulcers?
Support surface is adequate Skin inspection for early signs Keep moving and mobilising Incontinence Nutrition and hydration
What is involved in the NIHSS scale?
Dysarthria Alertness Patient knows own age and current month Patient can open and close eyes on command Best gaze Facial paresis Motor upper limb, L and R side Motor lower limb, L and R side Limb ataxia Visual field defect Sensory by pinprick Language Inattention
What are the mimics of a TIA?
Hypoglycaemia Atypical seizure Syncope Retinal tear or detachment Migraine Temporal Arteritis Labyrinthine disorders i.e. vertigo
What tests should be done to investigate someone with a suspected TIA?
Blood tests including FBC, U&E and lipids ECG Height and weight (BMI) Carotid artery USS doppler BM
What is the tool used to assess immediate risk of stroke?
ABCD2 score
The higher the score the more likely a stroke or TIA in the next 48 hours
Indicates how quickly someone needs to be seen in TIA clinic
What clinical signs point more towards a haemorrhagic stroke as opposed to an ischaemic stroke?
Evolution of symptoms but still over a relatively quick period of time (i.e. ~30 mins) rather than an ischaemic stroke which by definition comes on extremely quickly and is maximal at onset
What is the main cause of a TIA?
Thrombus i.e. from AF or from atherosclerosis in the carotids
