Systemic (Red flag conditions) Flashcards
What is cervical artery dissection?
A tear in the tunica adventitia of the carotid and or vertebral arteries
What is the aetiology for CAD?
- History of Cx trauma (major/trivial)
- Recent trauma
- CVS risk factors
- Past or family history of migraine
- Recent URTI
What are the features of a CAD?
At least two of the following features:
- Sudden onset or “thunderclap” headache
- Unilateral pain: frontal, temporal, occipital or supraorbital region
- Unilateral neck or facial pain
- Constant and severe pain (ache/throbbing/sharp) – unlike anything ever experienced
- Neurological symptoms such as:
- Upper or lower limb deficits
- Horner’s syndrome
- Cranial nerve neuropathy
- Pulsating tinnitus
What is deep vein thrombosis (DVT)?
Thrombosis formation in a deep veins in the absence of obvious inflammation
Aetiology and risk factors for a DVT?
- Typically occurs in the lower limb vein (calf common)
- Trauma and IV drug use
- Immobility
- Obesity
- Advancing age
- Pregnancy
- Smoking
- OCP
- Malignancy
What are signs and symptoms of a DVT?
- Can be asymptomatic or unreliable
- Calf pain/ache, with tenderness
- Pitting oedema + increased warmth of affected area
- Prominent/engorged superficial veins
- Mild fever (pyrexia)
- May see colour change: dusky, cyanotic, pale
- Homan’s sign is neither sensitive or specific
What is angina?
Gradual decrease in coronary blood flow, with 50-70% of lumen compromised
What is the aetiology and risk factors for angina?
-Caused by atherosclerotic plaques building up - leading to cardiac mm ischaemia/necrosis
*First three are the main risk factors* •Hyperlipidemia •Smoking •HTN •Obesity •Physical inactivity •Advancing age •Female > Male
Signs and symptoms of angina?
- Chest pain
- Compressive/squeezing/sharp
- Central chest
- Radiation- left arm, jaw scapulae
- Aggravated by exercise and emotional stress
- Relieved by rest
Can be associated with: •Pallor •Diaphoresis - excessive sweating •Dyspnoea •Palpations •Sense of unease •Severe fatigue
What are some DD’s for angina?
GIT disorders: GORD, peptic ulcers
Musculoskeletal disorders: Costochondritis, rib pain, pectoral/intercostal strain
Pericarditis: Inflammation of the pericardium
Psychosocial: Anxiety attack
What is meningitis?
Infection of the meningeal layer (lining tissue) of the brain
What is the aetiology
-Relies on bacterial or viral meningitis as it can pass through the blood brain barrier
What are the features of meningitis?
- Focal neurological SSx
- Severe headache
- Neck pain and stiffness
- Confusion
- Severe muscle pain
- Photophobia
- Systemic signs
What is cauda equina?
Pathological compression of the cauda equina
What is the aetiology of cauda equina?
- Lumbar disc- most common
- Spinal stenosis
- Sever spondylolisthesis
- Trauma – haematoma
- Tumor
- Infection (abscess)
What are the SSx of cauda equina?
- Severe LBP
- Saddle (across pelvis area) paraesthesia or anaesthesia
- Bladder, bowel or sexual dysfunction
- Lower limb motor and sensory deficits (unilateral/bilateral)
- Hyporeflexia or areflexia
What are the typical SSx of a malignancy being present?
- Previous hx of malignancy
- Fever
- Night sweats and night pain
- Constant, unremitting pain
- Unexplained weight loss
- Feelings of fatigue and tiredness that are unexplained
- Pain at rest
- Pain with no improvement > 1 month
- Lumps at the site or in other systems
What is pelvic inflammatory disease?
- PID is not one specific disease but the outcome of any infection in the genitourinary tract which has not been adequately treated.
- Can effect the endometriosis layer, uterine tubes, ovaries and peritoneum
Risk factors for PID?
- Sexually active women with more than one partner
- Inadequately treated STI’s
- Abortion
- Dilation or curettage
- IUD insertion
- Caesarian complications
Clinical SSx and complications of PID?
Sometimes asymptomatic*
-Lower abdominal pain (worse with movement, palpation, intercourse (dyspareunia) or urination (dysuria))
- Irregular bleeding
- Mucopurulent discharge
Complications include:
-Infertility, pelvic adhesions, abscess formation, ectopic pregnancy and chronic pain
What is endometriosis?
Deposits of endometrial tissue found anywhere than the uterine mucosa
Epidemiology of endometriosis?
- 10-15% of women in their reproductive years
- Peak age is 25-35
- Can start as young as 11
- Family history increases risk
How does endometriosis occur?
1, Retrograde menstruation: opposite flow of endometrial tissue in the uterine tubes and pelvic cavity
- Embryonic cells: Remain scattered throughout the body from embryonic development
- Endometrial emboli: Travels via blood and lymphatics and seed in a new area
SSx of endometriosis?
- Pain: pelvic pain, dysmenorrhea, dyspareunia
- Bleeding: menorrhagia (heavy periods), irregular periods, spotting
- Bowel or bladder symptoms: dysuria, dyschezia, cyclical IBS syndrome
- Reduced fertility
- Systemic: fatigue, lethargy, depression
What is osteoarthritis?
A type of arthritis which affects the whole joint (bone, cartilage, ligaments, muscles) which is a progressive loss of articular cartilage and remodelling of the underlying bone
What is the aetiology of OA?
- Most commonly in the knees, hips. Finger joints, big toe
- > 40 y/o
- Overweight
- Previous injury
- Jobs/occupations (which place a large load on the hip, knees & toes - due to over repetitiveness or carrying heave loads)
- Climbing and squatting kneeling
- Family history of OA
What is the pathophysiology of OA?
Once believed to be due to wear and tear over age. Recent studies suggest it, involves the degradation of cartilage and remodelling of bone due to active response of chondrocytes in the articular cartilage and the inflammatory cells in the surrounding tissues. The release of enzymes from these cells break down collagen and proteoglycans, destroying the articular cartilage. The exposure of the underlying subchondral bone results in sclerosis, followed by reactive remodelling changes that lead to the formation of osteophytes and bone cysts.
What are the SSx of general OA?
- Deep ache pain
- Gradual onset
- Morning stiffness that eases within 30 minutes of moving
- Aggravated by excessive activity
- +/- crepitus
- May be locking/catching sensations
- May be associated with local weakness
- Not typically red and warm (More RA)
- Pain and sensitivity on palpation
What is an aortic aneurysm?
Enlargement (dilation) of the aorta to greater than 1.5 times its normal size - this causes wall weakness and risk of rupture
What are the SSx of an aortic aneurysm?
- No symptoms usually experienced until rupture
- May be occasional back pain
- Patient may be pale
- Perishingly cold
- Pulseless
- Paraesthetic
- Paralysed
- Pulsatile mass in the stomach may be visible
