DPD: Fits, Faints + Funny turn

Question 1

List 3 types of primary headache

Answer 1

Migraine
Tension
Cluster

Question 2

What red flags do you look for in history of headache? What do these indicate?

Answer 2

New headache Age >50: GCA
Thunderclap (abrupt + severe): SAH
Progressively severe/ increasing frequency: SOL
Signif. changes in headache pattern
Triggers (Posture, vaslsalvar, coughing, exertion): raised ICP

Question 3

What signs must you look for on examination of headache?

Answer 3

Neuro. signs e.g. LOC, meningism, confusion

FLAWS

Question 4

What secondary risk factors must you look for in patients presenting with headache?

Answer 4

Cancer
HIV
3rd trim. pregnancy
Recent head injury

Question 5

What is detected in CSF on lumbar puncture post-SAH?

Answer 5

~12 hours: Xanthochromia (from RBC lysis)

Question 6

What feeling characterises vertigo? What may cause this?

Answer 6

False sense of motion
Spinning sensation
BPPV, Vestibular neuritis, Menieres

Question 7

What feeling characterises disequilibrium? What may cause this?

Answer 7

Off balance
Wobbly
VIsual disturbance, Stroke, PD

Question 8

What feeling characterises presyncope? What may cause this?

Answer 8

Feeling of losing consciousness/ faint

VAOP

Question 9

What feeling characterises light-headedness? What may cause this?

Answer 9

Vague symptoms, possibly feeling disconnected with the environment
“Giddiness”
Anxiety, hyperventilation, alcohol

Question 10

What structures are implicated in the vestibular system in peripheral vertigo? List 3 causes. What examination would you want to perform?

Answer 10

Semicircular canals
Vestibular nerve
BPPV, Vestibular neuritis, Menieres
Dix Hallpike: BPPV

Question 11

What structures are implicated in the vestibular system in peripheral vertigo? What else would you expect to see? What could be the cause?

Answer 11

Brainstem
Cerebellum
Other CNS deficits e.g. ataxia
4% = stroke

Question 12

What should you ask about double vision?

Answer 12

Horizontal or vertical axis

Question 13

List 5 features seen on examination of 3rd nerve palsy

Answer 13

Ptosis 
Mydriasis
Inferio-lateral deviation of eye in primary position 
Diplopia on upwards + inwards gaze 
Loss of accommodation

Question 14

List 3 features seen on examination of 6th nerve palsy

Answer 14

Normal eye in primary position.
Diplopia + strabismus on lateral gaze towards the side of the lesion.
Binocular horizontal diplopia. (disappears when you test one eye)

Question 15

List 4 features of Horner’s syndrome. What is it caused by?

Answer 15

Mild ptosis
Miosis 
Anhdrosis 
Enophthalmos 
Lesions in the sympathetic pathway (allows unopposed parasympathetic action)

Question 16

A lesion at what level of the nervous system would you see fatiguability?

Answer 16

Neuromuscular junction

Question 17

What are the 5 types of general seizure?

Answer 17

Tonic-clonic: LOC, stiffening, jerking, deep sleep, wake
Absence: brief staring episodes with behavioural arrest
Tonic/ atonic: sudden stiffening/ loss of control
Myoclonic: sudden, brief contractions
Status epilepticus: >5 mins continuous seizure

Question 18

What are general and partial seizures?

Answer 18

General: begin simultaneously in both hemispheres
Partial: begin within a particular area of brain + may spread

Question 19

Give the 2 types of partial seizure

Answer 19

Simple: retained consciousness
Complex: impaired consciousness

Question 20

What is a loop recorder? What does it aim to find?

Answer 20

ECG device implanted under skin

Causes of fainting, palpitations, arrhythmias

Question 21

What is a telemetry? What does it aim to find?

Answer 21

Portable measuring device of ECG, RR +/- O2 Sats.

Causes of fainting, palpitations, arrhythmias