PMM Flashcards
Tension-type headache
Bi-lateral, band like pressure at the base of skull, in face or both.
Constant, squeezing tightness. Cycles for several years and it intermittent in nature. Ass. symptoms - palpable neck and shoulder stiffness.
Migraine headache
Uni-lateral commonly anterior, throbbing synchronous with pulse. 4-72 hour duration. May be preceded by prodromal stage, onset after waking, gets better with sleep.
Nausea + vomiting, oedema, sweating, photophobia ass. symptoms.
Cluster headache
Uni-lateral radiating up or down from one eye.
Severe, bone crushing quality. May have months or years between attacks and occurs in clusters (1-3 a day for a period of 4-8 weeks).
Nocturnal in nature- wakens pt. from sleep.
Ass. symptoms- vasomotor such as flushing or pallor.
Red Flags of Concern
Thunderclap/worst of my life headache, abnormal neurological symptoms, new onset followed by collapse, associated with altered conscious state, patient age >50, seizure activity, medication history.
SNOOP Acronym
Systemic illness
Neurological symptoms
Onset is new (age>50) or sudden (thunderclap)
Other associated symptoms
Previous headache history with changed progression or intensity.
Stroke (CVA) definition
An acute, clinical syndrome of vascular origin that causes focal or global cerebral injury secondary to interruption of blood flow to an area/s of the brain.
Ischemic Stroke Causes
Emboli (circulating blood clot from outside the brain)
Thrombosis (atherosclerotic plaque formation)
Hypoperfusion/Watershed- reduced cerebral blood flow.
Haemorrhagic Stroke Causes
Intracerebral haemorrhage.
Subarachnoid haemorrhage.
Transient Ischemic attack
Patient who has stoke symptoms which have resolved themselves, usually within 24 hours.
Ischemic stoke symptoms
Anterior circulation: weakness/sensory loss affecting contralateral side, difficulty speaking, weakness in arm or slouched face.
Posterior: difficult to recognise, can see bilateral or unilateral motor and sensory symptoms e.g. blindness, vertigo.
Haemorrhagic stroke symptoms
Thunderclap headache (subarachnoid), loss of consciousness, collapse, seizures, vomiting, and neck stiffness.
Risk factors for Stroke
Hypertension, increasing age, >55 years, smoking, diabetes, AF, hyperlipidemia, family history, ethnicity, previous TIA
Stroke mimics
Seizures, syncope, primary headache disorder, hypoglycaemia, sepsis, drug use (ETHOH), neuropathy, brain tumours, electrolyte disorders.
Seizure definition
Transient alteration of cerebral function due to excessive synchronise discharge of neurons in the brain.
Status Epilepticus (GCSE)
Defined as 5 or more minutes of either continuous seizure activity or repetitive seizures without regaining consciousness.
Guillain-Barre Syndrome
Acquired inflammatory condition that leads to peripheral nerve demyelination. Bilateral ascending weakness, distal limb numbness and weakness.
Myasthenia Gravis
Autoimmune condition that affects the acetylcholine receptors on skeletal muscle.
Multiple Sclerosis
Autoimmune disease that cause demyelination of myelin sheaths and neuro-inflammation in the CNS.
Sepsis
A systemic response to a severe, usually bacterial infection characterised by varying degree of cardiovascular and other organ system dysfunction.
Septic Shock
Subset of a sepsis with circulatory, cellular and metabolism dysfunction associated with a higher risk of mortality.
SIRS Criteria
HR >90, RR >20, Temp <36 or >38, BP <90 mmHg and elevated white blood cell count.
qSOFA scoring
Quick sequential organ failure assessment. Criteria: RR >22 Change in mental status SBP <100 mmHg
Meningitis
Inflammation of the membranes (meninges) surrounding your brain and spinal cord. Can be bacterial (Streptococcus pneumoniae) or viral (human enterovirses)
Meningitis Symptoms
Viral:
Fever, headache, nausea and vomiting, photophobia and neck stiffness.
Bacterial:
Focal neuro deficits, gait/balance problems and hearing problems.
Bacterial is generally a quicker onset
Encephalitis
Inflammation of the brain parenchmya tissue associated with clinical evidence of neurological dysfunction.
Encephalitis symptoms
Altered conscious state, seizures, cranial nerve palsies, speech problems, motor and sensory deficits.
Allergic reactions
Same pathophysiological pathway as IgE mediated immune response seen in anaphylaxis but does not progress to involving the respiratory, cardiovascular or gastrointestinal systems.
Anaphylaxis definition
Any acute hypersensitivity reaction with typical skin features plus the involvement of respiratory and/or cardiovascular and/or persistent severe gastrointestinal symptoms or any acute onset of hypotension or bronchospasms or upper airway obstruction where anaphylaxis is considered possible ever if typical skin features are not present.
Anaphylactoid reactions
Are immediated systemic reactions that mimic anaphylaxis but are not caused by IgE-mediated immune response.
Termed ‘non-immunologic anaphylaxis’.
Anaphylaxis Pathology
- Increased capillary permeability 2. Increased smooth muscle contraction
- peripheral vasodilation
Anaphylaxis symptoms
flushing, hives, angioedema, stridor, wheezing, vomiting, diarrhoea or hypotension.
Biphasic reactions
A recurrent reaction or appearance of new symptoms after the initial allergy-related presentation without further exposure to the causative agent.
Adrenaline use in anaphylaxis
Creates vasoconstriction, increases blood pressure, causes bronchodilation, stabilises mast cell membranes- reducing vasoactive mediators, and fluid therapy increases circulating intravascular volume.
Toxicology definition
The scientific discipline of the nature, effects and detection of poisons and the treatment of poisonings.
Poisonings
When people drink, eat, breathe, inject or touch enough of a hazardous substance (poison) to cause symptoms of illness or progression to death.
Symptoms of Opioid overdose
Euphoria, drowsiness, unconsciousness, respiratory distress, bradycardia, hypotension and pupillary constriction.
Psychostimulant symptoms
agitation, panic, behavioural disturbances, psychosis, hyperthermia, hypertension, tachycardia/arrhythmias, hyponatremia, hyperkalemia, hypoglycaemia.
Tricyclics Antidepressants (TCA) symptoms
CNS depression (blockage of muscarinic receptors), coma, dilated pupils, respiratory depression, slurred speech, twitching movements, seizures, and arrhythmias.
Sedatives (Benzos/ETHOH) symptoms
CNS depression, altered conscious state, slurred speech, respiratory depression, bradycardia, hypotension and seizures.
Sedatives (GHB) symptoms
Irregular or shallow breathing, hallucinations, euphoria followed by coma, confusion, irritation and agitation, vomiting.
Paracetamol overdose symptoms
No clinical manifestations of an overdose until fatal liver damage 1-3 days post ingestion.
Insulin defined
Release is stimulated by increased serum glucose levels, the amino acids arginine and lysine free-fatty acids and parasympathetic stimulation. Released from beta cells.
Glucagon defined
Acts primarily in the liver, stimulation glycogenolysis and gluconeogensis in response to hypoglycaemia, resulting in increased blood glucose. Released from alpha cells.
Type 1 Diabetes
Autoimmune disease of unknown cause which results in the destruction of pancreatic B cells in the islets of Langerhans resulting in cessation of insulin production.
Type 2 Diabetes
Progressive disease that sees the body become resistant to the normal effects of insulin (insulin resistant) and/or an insulin secretatory defect that may also be associated with or without insulin resistance.
Hypoglycaemia Symptoms
Headache, tremors, aggression or agitation, altered conscious state or be complete unresponsive, diaphoresis, pallor, poor perfusion and occasionally may see seizures.
Hyperglycaemia- DKA
Kussmal’s respirations, ketotic breath smell, hypovolemia and dehydration, polyuria, polydipsia, polyphagia, elevated BSL, ALOC, fatigue and abdominal pain/nausea and vomiting.
Diabetic Ketoacidosis
Associated with type 1 diabetes (normally). Secondary to insulin deficiency hyperglycaemia results in peripheral glucose uptake does not occur and leads to fat breakdown by cells. Fat metabolism then occurs instead of carbs. Leads to ketones bodies and an acidotic state.
Hyperglycaemia - Hyperosmolar syndrome (HHS)
Gradual onset over a period of weeks, generally associated with type 2. Characterised by hyperglycaemia and high plasma osmolality. Ketone bodies are not present because in most cases enough insulin exists.
Appendicitis
Develops secondary to bacterial invasion of the appendiceal opening due to obstruction. If left untreated can lead to rupture into the peritoneal space.
Appendicitis Symptoms
Onset of periumbilical pain, loss of appetite, followed by RLQ pain, nausea and vomiting.
Bowel obstruction
Can be either mechanical (blockage within the lumen) or non-mechanical (muscle activity problem). Obstruction sees accumulation of gastric contents above the point of obstruction, bowel oedema and increased capillary permeability then occurs.
Bowel obstruction symptoms
Colic, cramping pain that comes in intermittent waves, abdominal distention, diffuse tenderness, rigidity and constipation also occurs.
Fever, tachycardia and hypotension may also be noted in the VSS.
Cholecystitis
Inflammation of the gallbladder following bacterial invasion or in most cases the development of gallstones.
Cholecystitis symptoms
Pain usually develops post consumption of fried or fatty foods. Sudden onset abdominal pain, intermittent in nature and variable intensity. Radiation of pain from epigastrium to the RUQ, localised and rebound tenderness may also be elicited during palpation. Low grade fever, tachycardia, nausea and vomiting and flatulence.
Pancreatitis
Inflammation of the pancreas which can develop from numerous causes.
Pancreatitis symptoms
Pain usually located in the epigastric region with radiation through the back, dull and steady quality. Abdominal tenderness, distension, rebound discomfort and guarding. Fever, tachycardia, tachypnoea, hypotension and decreased/absent bowel sounds may be noted.
Gastroenteritis symptoms
Nausea, vomiting, diarrhoea, abdominal cramps, hyperactive bowel sounds.
Fever, headache and other clinical signs of dehydration.
