QBCL 3 Flashcards
Which large vessels can a stroke occur in and how do these present?
Internal Carotid Artery and Verterobasilar system.
ICA Symptoms: Typically symptoms consistent with MCA stroke, occasionally ACA stroke. Monocular blindness if opthalmic artery affected (amaurosis fugax).
VBS Symptoms: Cranial nerve palsies, Cross sensory deficits, 4Ds: Diplopia, Dysarthria, Dysphagia, Dizziness, Vertigo, Nausea, Vomiting, Gait ataxia, Coma, Motor deficits
Which medium veesels can a stroke occur in and how do these present?
ACA, MCA, PCA
ACA: Motor/sensory deficits, more so in lower extensors than face/upper extensors, abulia, rigidity, apraxia
MCA: Motor and sensory deficits more so in UE and face than LE, homonymous hemianopia, aphasia (if dominant hemisphere affected), neglect (if non-dominant hemisphere affected)
PCA: homonymous hemianopia, alexia, visual hallucinations, oculomotor nerve palsy
Which small vessel can a stroke occur in and how does this present?
Lacunar vessels.
Symptoms: pure motor hemiparesis, pure sensory deficits, hemiparesis ataxia, dysarthria
What are the 2 main forms of inflammatory bowel disease and what characterises them?
Ulcerative colitis and Crohn’s disease
UC:
Diarrhoea - bloody/chronic/both
Lower abdominal pain
Faecal urgency
Extraintestinal mainfestations
Colon/rectum only affected with crypt abscesses
Crohn’s:
Chronic diarrhoea
Weight loss
RLQ pain mimicking acute appendicitis
Terminal ileum commonly has cobblestone pattern
Can occur anywhere from mouth to anus
How does acute diverticulitis usually present?
LLQ pain, PR bleeding, fever
How would IBS present?
Recurrent abdominal pain/discomfort associated with change in stool frequency/for.
Pain releieved by defecation.
No bleeding/mucus.
How would ischaemic colitis present?
Sudden onset abdominal pain followed by profuse diarrhoea - risk factors strong indicators.
How does pulmonary embolism present and how is it diagnosed?
Presents with: dyspnoea, pleuritic chest pain and hypoxaemia. May have evidence of concurrent DVT. Hypotension, syncope, tachycardia, signs of RHF.
Diagnose with Wells Score and CTPA - also check D-dimer.
How is a pulmonary embolism managed?
If haemodynamically unstable - urgent primary reperfusion (usually thrombolysis), anticoagulation and supportive care.
If not, ongoing anticoagulation considered to reduce risk of recurrent events.
How does an aortic dissection present?
Abrupt onset chest, back or abdominal pain
Severe intensity
Ripping/tearing
FHx
Marfan’s/Ehlers-Danlos makes it more likely
How would pneumonia present?
Fever and cough present along with dyspnoea and chest pain
How does pneumothorax present?
Dyspnoea, chest pain.
Tension: Rapid laboured repsiration, cyanosis, profuse diaphoresis, tachycardia.
How would an abdominal aortic aneurysm rupture present?
Ruptured AAA may present with new abdominal/back pain, cardiovascular collapse or loss of consciousness.
Urgent imaging with bedside aortic ultrasound/CTA needed.
High mortality rate
What are the causes of transient loss of consciousness?
Acute illness - P BAID (pulmonary embolism, bleeding, ACS, infection, dissection of aorta)
Syncope - NOCS (neural mediated, orthostatic, cardiac arrhymthias, structural)
Non-syncopal - CF SHIV (cataplexy, found lying, seizure, hypoglycaemia, intoxication, vertebrobasilar migraine)
How would an alcohol withdrawal seizure present?
Hx of sudden cessation/reduction of ETOH would be expected.
Hx of seizure activity, rigidity, tongue biting, incontinence, post ictal phase
How would a subarachnoid haemorrhage present?
Sudden, severe headache which peaks in 1-5 mins (thunderclap headache)
Lasts over one hour
Alongside vomiting, photophobia and non-focal neurological signs
How would vasovagal syncope present?
Hx of prodromal symptoms like light-headedness, dizziness or feeling faint.
What is Cor Pulmonale?
Alteration in structure (hypertrophy/dilatation) and function of the right ventricle of the heart caused by a primary disorder of the respiratory system resulting in pulmonary hypertension.
What is not classified as Cor Pulmonale?
Right sided heart failure secondary to LHF or congenital heart disease
What are the commonest causes of Cor Pulmonale?
- COPD
- Massive PE most common cause of acute CP
- Diseases of the lung (COPD, ILD, Scleroderma, CF)
- Vasculature (idiopathic pulmonary arterial hypertension)
- Upper airway (OSA)
- Chest wall (kyphoscoliosis)
What are signs and symptoms of Cor Pulmonale?
Dyspnoea on exertion, fatigue, lethargy, exertional syncope, exertional chest pain, abdominal oedema or distension, lower extremity oedema.
How does Bell’s Palsy present?
Acute, sudden onset, unilateral facial palsy of probable viral aetiology - is a clinical diagnosis of exclusion
How is Bell’s Palsy treated and when should a different diagnosis be considered?
Treatment: High-dose corticosteroids, antiviral agents, physiotherapy, surgical decompression
Alt diagnosis consider if hemi-facial tone/movement not recovered in 4-6 months.
What are the functions of the facial nerve?
Motor - facial expression muscles, posterior belly of digastric muscle, stylohyoid muscle and stapedius muscle (acoustic reflex - middle ear)
Sensation - taste from anterior 2/3 of tongue via chorda tympani, oropharynx, skin around outer ear (auricle)
Parasympathetic - submandibular gland + sublingual glands via chorda tympani; nasal mucosa and lacrimal gland via pterygopalatine ganglion.
Is Bell’s Palsy forehead sparing or not?
Not forehead sparing because in the lower motor neurone so contra-fibres also affected.
How does chronic otitis media present?
Infection - presents with fever and ear pain (otalgia).
Bulging/dull tympanic membrane on examination
Ear discharge if membrane is perforated.
Unlikely neurological signs.
How does facial schwannoma present?
Slow growing, progressive symptoms, may be acute.
Mass effect on adjacent nerves may cause sensory neural hearing loss or conductive if growth affects ossicle function in middle ear.
Can lead to cerebellar pontine angle syndrome due to mass effect.
