HTN & funny turns Flashcards
Difference between primacy and secondary HTN?
Primary: hypertension with no identifiable underlying cause
o Secondary: reversible cause can be found
5 red flag symptoms associated with HTN?
- Headache
- Blurred vision
- Dyspnoea
- Dizziness
- Nose bleeds
- Haematuria
4 Key PMH finding in HTN
Previous stroke or TIA
▪ Ischaemic heart disease, angina, MI
▪ Elevation of cholesterol or triglycerides
▪ Diabetes
Age and ethnic considerations for HTN?
ACE inhibitor initially UNLESS >55 or African/Caribbean (any age)
▪ Calcium channel blocker if >55 of African/Caribbean (any age)
Cut off for treatment of HTN?
140 systolic
Pt tired all the time with night sweats and fatigue what possible diagnosis?
TB
Malignancy
Pt tired all the time with changed mood what possible diagnosis?
Depression
Pt tired all the time with Breathless, heavy periods, melaena what possible diagnosis?
Anemia
Pt tired all the time with Cold, gaining weight, losing hair what possible diagnosis?
Hypothyroid
Sleep hygiene tips
Exercise earlier in day
▪ Fixed going to bed and getting up time
▪ Restful activity 30 minutes before bed
▪ Dark, quiet room: not too hot, cold, noisy, or bright
▪ Avoid caffeine, nicotine and alcohol from late afternoon
▪ Avoid watching or checking the clock throughout the night.
▪ Note worrying problems for morning (notebook and pen next to bed)
▪ Only use the bedroom for sleep and sexual activity
▪ Don’t nap next day
Medication for sleep hygiene
▪ Over the counter – e.g. Nytol
▪ Prescription
• Benzodiazepine / Z drug – “only if daytime impairment”
o E.g. temazepam 10mg or zopiclone (3.75mg)
o Document: patient informed addictive, tolerance, driving
& <14/7
6 red flag conditions for sudden headache
Meningitis Epidural haematoma Subdural haematoma Subarachnoid haemorrhage Giant Cell Arteritis
Red flag symptoms in chronic headache?
Unexplained weight loss, focal neurological
deficits, Hx of cancer, headache on waking,
aggravated by exertion or Valsalva
(coughing/sneezing)
Generalised throughout the head, often bilateral
pressure-like and non-throbbing pain, Often
described as feeling like a tight band around the
head describes what sort of headache?
Tension
Previous, FH, unilateral, throbbing, visual aura,
nausea and vomiting, photophobia, significant
disability, sensitivity to noise describes what sort of headache
Migraine
When would you suspect medication overuse headache?
Many headaches in preceding month,
medication used to control headache >10 days
in a month for 3 months
Lifestyle changes for headache
headache diary / avoidance of triggers / better hydration / reduce coffee / sleep hygiene
Prophylaxis for migraine
propranolol
Key structure of funny turn history
Before
during
After
What investigations for funny turn?
o Bloods: FBC
o BM
o ECG
If vasovagal syncope then what advice?
`▪ Stay hydrated ▪ Stay out of sun / hot places ▪ Avoid triggers ▪ Maximise anti-hypertensives ▪ Get up slowly from sitting position
Safety net funny turn symptoms
o Biting self
o Incontinence
o Uncontrolled shaking
senso of dread, wobbly legs, shaky, tachycardia, choking sensation, Pain anywhere
• Tingling in fingers/around mouth
• Over-breathing
Panic attack
Investigations in panic attack
GAD7 if anxiety, Bloods: FBC, TFTs, ECG
What examinations would you perfom for someone with suspected panic attack?
– therapeutic exam: HR & auscultation, RR, thyroid
Management advice for panic attack
o Explain physiology of anxiety (e.g. common, flight – fight response)
o Deep breathing / put on radio
o Suggest speaking to university tutor / welfare / family
o Self-help steps: mindfulness, yoga, relaxation exercises, apps, leaflets
o Over the counter “calms”, “rescue” medicine
