Signs And Symptoms Flashcards
Long history of dysphasia, maybe with regurgitation. Maybe retrosternal chest pain.
Achalasia
Progressive dysphasia and weight loss. Bolus food impactation may cause chest pain.
Malignant oesophageal tumour
Burning epigastric pain, relieved by antacids. Occurs when the patient is hungry and at night. Nausea, heartburn and flatulence may occur.
Duodenal ulcer
Burning epigastric pain. Relieved by antacids. Pain often occurs during eating. Nausea, heartburn and flatulence may occur
Stomach ulcer
Indigestion, vomiting and haemorrhage.
Gastropathy/gastritis
Epigastric burning pain. Nausea, anorexia and weight loss are common. Vomiting and dysphasia. Palpable epigastric mass.
Gastric tumour
Tiredness and malaise. Diarrhoea, steatorrhoea, abdominal pain or discomfort, anorexia causing weight loss. Anaemia and nutritional deficiency.
Coeliac disease
Diarrhoea , steatorrhoea , and megaloblastic anaemia. Occurs in residents of the tropics.
Tropical sprue
Severe abdominal pain with little to find on abdominal examination
Intestinal ischaemia
Abdominal pain, diarrhoea , anorexia and anaemia
Tumour of the small intestine
Flushing, wheezing, diarrhoea, abdominal pain, right sided cardiac valvular fibrosis causing stenosis and regurgitation.
Carcinoid tumours
Abdominal pain, usually with weight loss.
Small bowel disease
Acute abdomen with right iliac fossa pain mimicking appendicitis
Terminal ileal disease
Diarrhoea, bleeding and pain related to defecation
Colin disease
Anal tags, fissures, fistulae and abscess formation
Perianal disease
Abdominal pain and rectal bleeding, and occasionally shock
Ischaemic colitis
Rectal bleeding and stenosis, alteration in bowel habit and colicky abdominal pain
Colorectal cancer
Globus, regurgitation, and midline chest pain
Functional oesophageal disorder
Epigastric pain or discomfort, early satiety, bloating and nausea
Functional dyspepsia
Crampy abdominal pain relieved by defecation or the passage of wind, a sensation of incomplete evacuation, abdominal bloating and distension
Irritable bowel syndrome
Central abdominal pain which then becomes localised to the right iliac fossa, accompanied by anorexia and sometimes vomiting and diarrhoea. The patient is pyrexial, with tenderness and guarding in the RIF due to localised peritonitis
Appendicitis
There is a sudden onset of abdominal pain which rapidly becomes generalised. The patient is shocked and lies still as movement exacerbates the pain
Generalised acute peritonitis
Colicky abdominal pain, associated with vomiting and absolute constipation. Abdominal distension and ‘tinkling’ bowel sounds
Mechanical bowel obstruction
Pale stools and dark urine
Cholestatic jaundice
Patient is jaundiced, with an enlarged and tender liver, raised serum aminotransferase levels
Acute hepatitis
Nausea, anorexia and distaste for cigarettes. After 1 or 2 weeks the patient has dark urine and pale stools.
Hepatitis A
Anorexia, malaise, nausea and fatigue.
Autoimmune hepatitis
GI bleeding from oesophageal or gastric varices, Ascites, hepatic encephalopathy
Portal hypertension
Fullness in the flanks, with shifting dullness. May be uncomfortable and produces respiratory distress. A pleural effusion and peripheral oedema may be present.
Ascites
The patient becomes increasingly drowsy and eventually comatose. May be irritable, confused, with slow, slurred speech and a reversal of sleep often. The signs are dehorn hepaticus, asterixis, constructional apraxia
Portosystemic encephalopathy
Pruritis, with or without jaundice. Hepatosplenomegaly and xanthelasma.
Primary biliary cirrhosis
Fulimant hepatic failure and cirrhosis, Parkinson’s and eventual dementia, Kayser-Fleischer rings and renal tubules
Wilson’s disease/hepatolenticular degeneration
Rapid onset of jaundice. Nausea, anorexia, right upper quadrant pain, encephalopathy, fever, Ascites and tender hepatomegaly
Alcoholic hepatitis
Pruritis, jaundice or cholangitis
Primary sclerosing cholangitis.
Fever, lethargy, weight loss and abdominal pain. May be hepatomegaly
Liver abscess
Weight loss, anorexia, fever, Ascites and abdominal pain occur.
Hepatocellular carcinoma
Recurrent episodes of sever constant pain in the upper abdomen, which subsides over several hours. The pain may radiate to the right shoulder and right subscapular region and is often associated with vomiting.
Bile duct stones/biliary pain
Originally biliary colic. However, over a number of hours there is progression to severe pain localised in the right upper quadrant, which is associated with a fever and tenderness and muscle guarding on examination. The tenderness is worse on inspiration
Acute Cholecystitis
Epigastric or upper abdominal pain radiating through to the back, associated with nausea and vomiting. Epigastric tenderness, guarding and rigidity.
Acute pancreatitis
Heartburn. May be also regurgitation and odynophagia. Cough and nocturnal asthma can occur.
GORD. Cough and nocturnal asthma can occur from aspiration of gastric contents into the lungs
Epigastric abdominal pain, either intermittent or constant, and radiating through to the back is the commonest symptom. Diabetes and steatorrhoea may develop due to endocrine and exocrine insufficiency
Chronic pancreatitis
Painless jaundice and weight loss. A distended palpable gall bladder. There may be a central abdominal mass.
Cancer affecting the head of the pancreas or ampulla of Vater
Abdominal pain, weight loss and anorexia
Cancer of the body of tail of the pancreas
Neonatal jaundice, chronic haemolytic anaemia and acute haemolysis
Glucose-6-phosphate dehydrogenase deficiency
A fluctuating course, with easy bruising, epistaxis and menorrhagia. Often in immunosupressed patients
Immune thrombocytopaenic purpura
Florid purpura, fever, fluctuating cerebral dysfunction and haemolytic anaemia, renal failure
Thrombotic thrombocytopaenic purpura
Varies from no bleeding to complete haemostatic failure, with bleeding from venepuncture sites and the nose and mouth
Disseminated intravascular coagulation
Anaemia, bleeding and infection e.g. sore throat and pneumonia. Sometimes there is peripheral lymphadenopathy and hepatosplenomegaly
Acute leukaemia
Insidious onset, with fever, weight loss, sweating and symptoms of anaemia. Massive splenomegaly.
Chronic myeloid leukaemia
Usually asymptomatic but can be: anaemia, infections and bleeding. May be lymphadenopathy and in advanced disease hepatomegaly
Chronic lymphocytic leukaemia
Painless lymph node enlargement. May be hepatomegaly. Fever, drenching night sweats and weight loss.
Hodgkin’s lymphoma
Rare before 40. Painless peripheral lymph node enlargement. Anaemia, recurrent infections and bleeding.
Non-Hodgkin’s lymphoma
Bone pain, osteolytic lesions, spinal cord compression, hypercalcaemia, anaemia, infections and bleeding,hyperuricaemia, paraproteins, blurred vision, gangrene
Multiple myeloma
Asymmetrical joint pain, made worse by movement and relieved by rest. Mainly the distal interphalangeal joints and first carpometacarpal joint of the hands and the weight bearing joints. Deformity and bony enlargement of the joints, limited joint movements and muscle wasting of surrounding muscle groups
Osteoarthritis
Synovitis, early morning stiffness in the small joints of hand and feet. Weakening of joint capsules, joint instability, subluxation and deformity. Swan-neck deformity, ulnar deviation, boutonnière deformity
Rheumatoid arthritis
Young man with increasing pain and prolonged morning stiffness in the lower back and buttocks. Pain improves with exercise but not at rest. Tenderness around the pelvis and chest wall
Ankylosing spondylitis
Asymmetrical involvement of small joints, symmetrical seronegative polyarthritis, sacroiliitis
Psoriatic arthritis
Young man present s with acute arthritis shortly after an enteric or sexually acquired infection. Joints of lower limbs affects in an asymmetrical pattern. Skin lesions. Ulcers around the penile meatus
Reactive arthritis
Middle aged man. Sudden onset of severe pain, sweeping and redness of the metetarsophalangeal joint of the big toe
Gout
Hot, painful, swollen, red joint which developed acutely. There may be fever.
Septic arthritis
Fever, local pain and erythema and sinus formation
Osteomyelitis
Butterfly rash, myalgia, tiredness, fever, depression, weight loss, photosensitivity, anaemia, leucopaenia, thrombocytopenia, pericarditis, myocarditis, thrombosis, Raynauds, glomerulonephritis, migraine, cerebellar ataxia, aseptic meningitis
SLE
Stroke, TIA, MI, DVT, recurrent miscarriages, valvular heart disease, migraine, epilepsy, renal impairment
Antiphospholipid syndrome
Systemic progressive muscle weakness and wasting affecting the proximal muscles of the shoulder and pelvic girdle. Difficulty squating, going upstairs, rising from a chair. Pain and tenderness are uncommon. Heliotrope discolouration of the eyelids and scaly erythematous plaques over the knuckles
Polymyositis and dermatomyositis
Dry eyes and dry mouth. Arthritis, Raynauds, NDI, pulmonary fibrosis and vasculitis
Sjögren’s syndrome
Abrupt onset of stiffness and intense pain of the muscles of the neck and shoulder and hips and lumbar spine. Constitutional symptoms. Headache and claudication on eating
Polymyalgia
Fever, malaise, weight loss, abdominal pain, renal impairment and hypertension
Polyarthritis nodosa
Nausea, vomiting, fever and confusion
Hypernatraemia
Usually asymptomatic, although muscle weakness may occur is if is severe. Results in cardiac arrhythmias.
Hypokalaemia
Usually produces few symptoms or signs, until it is high enough to cause cardiac arrest. Other symptoms include weakness and paralysis
Hyperkalaemia
Increased renal excretion of potassium, inhibits secretion of PTH and leads to parathyroid hormone resistance. Many of the symptoms are due to Hypokalaemia and hypocalcaemia.
Hypomagnesaemia
Hyperventilation, hypotension and cerebral dysfunction
Metabolic acidosis
Oedema of the ankles, genitals and abdominal wall. The face and arms may also be involved in severe cases
Nephrotic syndrome
Haematuria, proteinuria, hypertension and oedema, oliguria and uraemia
Acute glomerulonephritis / nephritic syndrome
Frequency of micturition, dysuria, supra public pain and tenderness, haematuria and smelly urine
Lower UTI
Loin pain and tenderness, nausea, vomiting and fever
Acute pyelonephritis
Renal colic, a severe intermittent pain lasting for hours. The pain is felt anywhere between the loin and the groin and may radiate into the scrotum or labium or into the tip of the penis. Nausea, vomiting and sweating are common. Haematuria often occurs.
Ureteric stones
Urinary frequency and haematuria
Bladder stones
Anuria and painful bladder distension
Urethral stones
Dull ache in the flank or loin, which may be provoked by an increase in urine volume. Anuria or polyuria
Upper urinary tract obstruction
Hesitancy, poor stream, terminal dribbling and a sense of incomplete emptying
Bladder outlet obstruction
Alteration of urine volume, biochemical abnormalities and symptoms of uraemia
Acute Renal failure
Anaemia, bone disease, neurological complications, CVD, platelet abnormality, GI tract, renal osteodystrophy
Chronic kidney disease
Acute loin pain, abdominal discomfort, hypertension, renal impairment
Policytic kidney disease
Haematuria, loin pain and a mass in the flank
Renal cell carcinoma
Painless haematuria (either visible or non-visible), frequency, urgency and dysuria
Uroethlial tumour
Frequency of micturition, nocturia, delay in initiation of micturition and post-void dribbling. Acute urinary retention or retention with overflow incontinence. Enlarge smooth prostate
Benign enlargement of the prostate gland
Frequency of micturition, nocturia, delay in initiation of micturition and post void dribbling. Acute urinary retention or retention with overflow incontinence. Rectal examination may reveal a hard irregular gland
Prostatic carcinoma
Painless lump in the testicle. Presentation may also be cough and dyspnoea or back pains
Testicular tumour
Rapid regular palpitations usually with abrupt onset and sudden termination. Dizziness, dyspnoea, central chest pain and syncope
Supraventricular arrhythmias
Exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea and fatigue. Cardiomegaly, displaced apex beat, third and fourth heart sounds, elevated JVP, tachycardia, hypotension, pleural effusion, ankle oedema, Ascites
Heart failure
High blood pressure, preserved left ventricular function, pulmonary oedema on CXR
Hypertensive heart failure
Acutely breathless, tachycardia, profuse sweating, wheezes and clock ales throughout the chest, hypoxia,
Pulmonary oedema
Hypotension, tachycardia, oliguria, cold extremities
Cardiogenic shock
Warm peripheries, pulmonary congestion, blood pressure may be low
Septic shock
Low CO, elevated JVP, hepatomegaly, hypotension
Right heart failure
Chest pain on lying down
Decubitus angina
Chest pain that occurs at night and may waken the patient from sleep
Nocturnal angina
Chest pain that rapidly increases in severity, occurs at rest, or is of recent onset (1 month)
Unstable angina
Patient with known anyone and worsening pain on minimal exertion, chest pain at rest or chest pain unrelieved in the usual time by nitrates.
Acute coronary syndromes
Central severe chest pain that occurs at rest that lasts from many hours. Often associated with sweating, breathlessness, nausea, vomiting and restlessness. Often pale, sweaty and grey
STEMI
Suddenly fever, joint pains and loss of appetite. Also changing heart murmurs, mitral and aortic regurgitation, heart failure and chest pains. Polyarthritis.
Rheumatic fever
Progressive exertional dyspnoea. cough productive of blood-tinged sputum. AF. Pulmonary oedema. Fatigue and lower limb oedema. Mitral facies.
Mitral stenosis
Pulmonary oedema. Exertional dyspnoea , fatigue and lethargy. Alex beat displaced laterally, with a diffuse thrusting character. Soft first heart sound. Pansystolic murmur loudest at the apex. Often third heart sound
Mitral regurgitation
Angina, Exertional syncope. Carotid pulse is slow rising (plateau plate) and the apex beat thrusting. Harsh systolic ejection murmur at the right upper sternal border and radiating to the neck.
Aortic stenosis
Painless haematuria (either visible or non-visible), frequency, urgency and dysuria
Uroethlial tumour
Frequency of micturition, nocturia, delay in initiation of micturition and post-void dribbling. Acute urinary retention or retention with overflow incontinence. Enlarge smooth prostate
Benign enlargement of the prostate gland
Frequency of micturition, nocturia, delay in initiation of micturition and post void dribbling. Acute urinary retention or retention with overflow incontinence. Rectal examination may reveal a hard irregular gland
Prostatic carcinoma
Painless lump in the testicle. Presentation may also be cough and dyspnoea or back pains
Testicular tumour
Rapid regular palpitations usually with abrupt onset and sudden termination. Dizziness, dyspnoea, central chest pain and syncope
Supraventricular arrhythmias
Exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea and fatigue. Cardiomegaly, displaced apex beat, third and fourth heart sounds, elevated JVP, tachycardia, hypotension, pleural effusion, ankle oedema, Ascites
Heart failure
High blood pressure, preserved left ventricular function, pulmonary oedema on CXR
Hypertensive heart failure
Acutely breathless, tachycardia, profuse sweating, wheezes and clock ales throughout the chest, hypoxia,
Pulmonary oedema
Hypotension, tachycardia, oliguria, cold extremities
Cardiogenic shock
Warm peripheries, pulmonary congestion, blood pressure may be low
Septic shock
Low CO, elevated JVP, hepatomegaly, hypotension
Right heart failure
Chest pain on lying down
Decubitus angina
Chest pain that occurs at night and may waken the patient from sleep
Nocturnal angina
Chest pain that rapidly increases in severity, occurs at rest, or is of recent onset (1 month)
Unstable angina
Patient with known anyone and worsening pain on minimal exertion, chest pain at rest or chest pain unrelieved in the usual time by nitrates.
Acute coronary syndromes
Central severe chest pain that occurs at rest that lasts from many hours. Often associated with sweating, breathlessness, nausea, vomiting and restlessness. Often pale, sweaty and grey
STEMI
Suddenly fever, joint pains and loss of appetite. Also changing heart murmurs, mitral and aortic regurgitation, heart failure and chest pains. Polyarthritis.
Rheumatic fever
Progressive exertional dyspnoea. cough productive of blood-tinged sputum. AF. Pulmonary oedema. Fatigue and lower limb oedema. Mitral facies.
Mitral stenosis
Pulmonary oedema. Exertional dyspnoea , fatigue and lethargy. Alex beat displaced laterally, with a diffuse thrusting character. Soft first heart sound. Pansystolic murmur loudest at the apex. Often third heart sound
Mitral regurgitation
Angina, Exertional syncope. Carotid pulse is slow rising (plateau plate) and the apex beat thrusting. Harsh systolic ejection murmur at the right upper sternal border and radiating to the neck.
Aortic stenosis
A ‘collapsing’ pulse with a wide pulse pressure. The apex beat is displaced laterally and is thrusting in quality. Dyspnoea, orthopnoea, and fatigue but usually asymptomatic. An Austin Flint murmur. A blowing early diastolic murmur at the left sternal edge in the fourth intercostal space
Aortic regurgitation
Malaise, fever, night sweats, weight loss and anaemia. New or changing heart murmurs. Pulmonary infection and pneumonia. Splinter haemorrhages, roths spots, osler’s nodes and janeway lesions are uncommon.
Infective endocarditis
Exertional dyspnoea, lethargy and fatigue. Peripheral oedema and abdominal pain. Loud pulmonary second sound, right parasternal heave, cor pulmonale
Pulmonary hypertension
Breathlessness, pleuritic chest pain and haemoptysis. Tachypnoeic and have a pleural rub and an educative pleura effusion.
Small/medium PE
Severe central chest pain and suddenly becomes shocked, pale and sweaty, with marked tachypnoea and tachycardia. Central cyanosis, elevated JVP, a right ventricular heave, accentuation of the second heart sound and a gallop rhythm
Massive Pulmonary embolism
Acute illness characterised by fever and varying degrees of biventricular failure. Cardiac arrhythmia and pericarditis may also occur.
Myocarditis
Patients may be symptom-free or have breathlessness, angina or syncope. Jerky carotid pulse. Ejection systolic murmur
Hypertrophic cardiomyopathy
Shortness of breath is usually the first complaint, less often patients present with embolism or arrhythmia. Subsequently there is progressive heart failure
Dilated cardiomyopathy
Sharp retrosternal chest pain which is characteristically relived by leaning forward. Pain may be worse on inspiration and radiate to the neck and shoulders. The cardinal clinical sign is a pericardial friction rub, which may be transient
Acute pericarditis
Hypotension, tachycardia and an elevated JVP, which paradoxically rises with inspiration
Pericardial effusion and tamponade
May be asymptomatic. Found as a pulsating mass on abdo examination or as calcification on a plain x-Ray. May cause epigastric or back pain or rupture
Abdominal aortic aneurysm
May be asymptomatic, or back pain, dysphasia and cough
Thoracic aortic aneurysm
Tearing central chest pain that radiates through to the back
Dissecting aortic aneurysm
Initial pallor, followed by cyanosis and finally redness. Often in the extremities
Raynaud’s disease
Leg may be warm and swollen with calf tenderness and superficial venous distension
DVT
Abrupt onset of fever, generalising aching in the limbs, sever headche, sore throat and dry cough, all of which may last several weeks
Influenza
Common cough and sputum, persistent and progressive breathlessness and wheeze. Pursed-lip breathing, thin with loss of muscle mass
COPD
Chronic productive cough and recurrent chest infections. Copious amounts of thick, foul-smelling green sputum. Haemoptysis, breathlessness and wheeze
Bronchiectasis
Progressive Bronchiectasis, airflow limitation and eventually respiratory failure. Finger clubbing. Sinusitis and nasal polyps. Steatorrhoea, diabetes mellitus
Cystic fibrosis
Wheezing attacks, shortness of breath, chest tightness and cough. Symptoms tend to be intermittent, worse at night and in the early morning and provoked by triggers
Asthma
Pyrexia, cough, sputum production, pleurisy and dyspnoea
Pneumonia
Usually symptomless, occasionally erythema nodosum, a small pleural effusion or pulmonary collapse with fever
TB
Non-productive cough, breathlessness and sometimes a wheeze
Sarcoidosis
Progressive breathlessness and a non-productive cough. Respiratory failure, pulmonary hypertension and cor pulmonale. Often finger clubbing
Idiopathic pulmonary fibrosis
Cough, chest pain, haemoptysis and breathlessness
Lung cancer
Localised sharp pain made worse on deep inspiration, coughing and bending or twisting movements
Pleurisy
Sudden onset of pleuritic chest pain and breathlessness. Reduced breath sounds and hyperresonant percussion on examination
Pneumothorax
Tachycardia, sweating, cold clammy skin and slow capillary refill
Hypovolaemic shock
Raised JVP, pulsus arternans, a ‘gallop’ rhythm and pulmonary oedema
Cardiogenic shock
Muffled heart sounds, pulsus paradoxus, elevated JVP, Kussmaul’s sign.
Cardiac tamponade
Right heart strain, raised JVP with prominent ‘a’ waves, right ventricular heave and a loud pulmonary second sound
Massive pulmonary embolism
Warm peripheries, hypotension, urticaria, angio-oedema, wheezing and upper airway obstruction
Anaphylactic shock
Tachypnoea, increasing hypoxia and laboured breathing are the initial features.
Acute respiratory distress syndrome
Tiredness/malaise, weight gain, cold intolerance, goitre, mental slowness, dry thin hair, dry skin, bradycardia, slow-relaxing reflexes
Hypothyroidism
Weight loss, increased appetite, irritability, tremor, heat intolerance, tremor, tachycardia, full pulse, warm vasodilate drew peripheries, goitre, lid lag, exophthalmos
Hyperthyroidism
Pressure or pain in the eye, a gritty sensation, decreased vision and photophobia. Exophthalmos and ophthalmoplegia, conjunctival oedema, lid lag and corneal scarring
Graves’ disease
Insidious presentation of lethargy, depression, anorexia and weight loss. Postural hypertension. Hyperpigmentation. Vitiligo and loss of body hair
Addison’s disease/primary hypoadrenalism
Obesity, typically central, affecting the trunk, abdomen and neck (buffalo hump). Plethoric complexion with a moon face, thin skin, bruising, hypertension, fractures, striae, proximal myopathy
Cushing’s syndrome
Polyuria (15L in 24 hours) and polydipsia
Diabetes insipidus
Nausea, irritability and headache with mild dilutional hyponatraemia. Fits and coma may occur with severe hyponatraemia
Syndrome of inappropriate ADH secretion
Often asymptomatic. Symptoms of general malaise and depression, bone pain, abdominal pain, nausea and constipation. Polyuria and nocturia
Hypercalcaemia
Increased excitability of muscles and nerves. There is numbness around the mouth and in the extremities, followed by cramps, tetany, convulsions and death of untreated. Chvostek’s and Trousseau’s sign test for neuromuscular excitability
Hypocalcaemia
Muscle weakness leading to respiratory failure, impaired myocardial contractile th and cardia failure and skeletal muscle weakness and rhabdomolysis. Encephalopathy and rarely haemolysis
Hypophosphataemia
Hypertension and Hyperkalaemia
Conn’s syndrome
May be episodic and include headache, palpitations, sweating, anxiety, nausea and weight loss. May also be intermittent hypertension, tachycardia and pallor
Phaeochromocytoma
Thirst, polyuria and weight loss. May also be lack of energy, visual problems and pruritis.
Diabetes mellitus
Profound dehydration. Vomiting. The eyes are sunken, tissue turgor is reduced and the tongue is dry. Kussmaul’s respiration. Breath smells of ketones. Low temperature
Ketoacidosis
Fluctuating cognition with pronounced variation in attention and alertness. Impairment in attention, frontal, subcortical and visuospatial ability is prominent. Depression and sleep disorders occur. Recurrent formed visual hallucinations are a feature. Delusions and transient loss of consciousness occur. Cortical Lewy bodies are prominent at autopsy
Dementia with Lewy bodies
Short-term memory loss but subsequently there is slow disintegration of the personality and intellect, eventually affecting all aspects of cortical function. There is decline in language, visuospacial skills, apraxia and agnosia
Dementia, Alzheimer’s disease
Progressive tetraparesis
Primary lateral sclerosis (motor neurone disease)
Dysarthria, dysphagia with wasting and fasciculation of the tongue
Progressive bulbar and pseudobulbar palsy (motor neurone disease)
Progressive spastic tetraparesis or paraparesis with added wasting and fasciculation
Amyotrophic lateral sclerosis (motor neurone disease)
Weakness, wasting and fasciculation (spontaneous, irregular and brief contractions of part of a muscle) in the hands and arms
Progressive muscular atrophy (motor neurone disease)
Bladder and bowel dysfunction and perianal and perineal numbness. May also be back pain, numbness and weakness in the legs with reduced reflexes
Cauda equina lesion
Progressive weakness of the legs with upper motor neurone pattern and eventual paralysis. The onset may be acute or chronic, depending on the cause. Sometimes loss of sphincter control with urinalysis incontinence
Spinal cord compression
Headache, scalp tenderness and occasionally pain in the jaw and mouth which is characteristically worse on eating. The superficial temporal artery may be tender film and pulseless. Blindness occurs in 25% of untreated cases. Also weight loss, malaise and a low-grade fever
Giant cell arteritis
Rapid onset, severe, short-lived (1-2 hours), unilateral headaches with a clustering of painful attacks over weeks or months. Often begins around the eye or temple. Lacrimation and redness of the eye
Cluster headaches
Unilateral, throbbing and builds up over minutes to hours. May be associated with nausea, vomiting and photophobia. It may last for days and is made worse by exercise. Auras may occur. The patient is irritable and dark
Migraine
Feeling of pressure or rightness all around the head
Tension headache
Progressive focal neurological deficit, raised intracranial pressure, focal or generalised epilepsy
Brain tumour
Cerebral function is usually abnormal with altered mental state, motor and sensory deficits
Encephalitis
Headache, neck stiffness and fever develop over minutes to hours. Photophobia and vomiting are often present. Kernig’s sign is usually present. Papilloedema.
Bacterial meningitis
Young adult with two or more clinically distinct episodes of CNS dysfunction followed by a remission during which symptoms and signs resolve to extent within weeks. Common ones are optic neuropathy, brainstem demyelination and spinal cord lesions
Multiple sclerosis
A relentlessly progressive course with chorea and personality change preceding dementia and death, usually begin in middle age
Huntington’s disease
Rest tremor, rigidity and bradykinesia develops over months or several years together with changes in posture. Usually more prominent on one side
Parkinson’s disease
Isolated muscle jerking, intense stiffening of the body or cessation of movement, falling and loss of consciousness.
Myoclonic, tonic and akinetic seizures
Usually a disorder of childhood in which the child ceases activity, stares and pales for a few seconds only.
Typical absence seizures (petit mal)
Sudden onset of rigid tonic phase followed by a convulsion in which the muscles jerk rhythmically. The episode lasts typically for seconds to minutes, may be associated with tongue biting and I continence of urine and is often followed by a period of drowsiness or coma for several hours
Generalised tonic-clonic epileptic seizures
Head injury with a brief period of unconsciousness followed by a lucid interval of recovery. Followed by rapid deterioration with focal neurological signs and deterioration in conscious level
Extradural haemorrhage
Headache, drowsiness and confusion, which may fluctuate
Subdural haemorrhage
Sudden onset of severe headache, often occipital, that reaches maximum intensity immediately or within minutes. Often accompanied by nausea and vomiting and sometimes lack of consciousness.
Subarachnoid haemorrhage
Severe paroxysms of knife-like pain occur in one or more sensory divisions of the trigeminal nerve, brought on by specific triggers
Trigeminal neuralgia
Profound dehydration, decreased level of consciousness, bloods differentiate between this and Ketoacidosis
Hyperosmolar hyperglycaemic state
