Fits, faints and funny turns

Question 1

What examinations should you perform on someone who presents with a headache?

Answer 1

Full neurological exam 
Fundoscopy 
Meningism assessment 
Basic obs - temp and BP 
Systems review

Question 2

What investigations should you order for someone with a headache?

Answer 2

CT or MRI head

ESR, bloods, LP

Question 3

What are primary headaches?

Answer 3

Headaches with no underlying cause

Question 4

List types of primary headaches

Answer 4

Migraine
Tension type
Cluster

Question 5

What are secondary headaches?

Answer 5

Headaches with a cause

Question 6

List types of secondary headaches

Answer 6

Head and neck trauma 
Vascular disorder 
CNS infection 
ICP disorder
Metabolic disorder 
Drug withdrawal 
Dental / ENT

Question 7

List headache red flags

Answer 7

> 50
Abrupt / severe onset
Progressively severe / increasing frequency
Change in type of headache
Meningism / focal signs /confusion / LOC
FLAWS
Worse when lying down / valsalva / coughing
Cancer / HIV / preg / head injury

Question 8

What 1 Sx can SAH present with alone?

Answer 8

Severe headache

Question 9

What does a CT show in SAH under 12 hours?

Answer 9

Hyperdense blood in sulcus

Question 10

What does CT show in SAH past 12 hours?

Answer 10

Potentially nothing - blood broken down

Question 11

How can you detect a SAH after 12 hours?

Answer 11

LP showing xanthochromia

Question 12

What do you need to ask of someone presenting with diplopia (double vision)?

Answer 12

Onset
Character - horizontal / vertical 
Duration - only when reading / waking up? 
Pain
Triggers

Question 13

How do the presentations of Horners and CN3 palsy differ?

Answer 13

Horners = PARTIAL ptosis, miosis and anhydrosis

CN3 palsy = FULL ptosis

Question 14

What is myasthenia gravis?

Answer 14

NMJ fatiguability

Question 15

What are symptoms of MG?

Answer 15

Dysarthria and intermittent diplopia

Question 16

What investigations must you do for someone presenting with fainting?

Answer 16

ECG 
Lying and standing BP 
24hr telemetry 
Echo 
Loop recorder 
CT head

Question 17

What does third degree heart block look like on ECG?

Answer 17

No relationship between P and QRS