1 Social history Syncope What are the patients disabilities? - PDF document

Session overview 1. Neurology presenting symptoms Neurology teaching 2. History taking History taking and common presenting neurological 3. Syncope –EMQs and history symptoms 4. Headache –EMQs and history 5. Summary Agata Plonczak Thursday Feb 21 st 2013 Neurological symptoms Past Medical History • Headache • Any previous neurological disorder? • Fits, faints and funny turns • Any systemic diseases, particularly cardiovascular conditions (stroke is a very common cause of • Disturbance of higher mental function neurological deficit) • Visual, hearing disturbance • Speech difficulties • Dizzness • Swallowing difficulty • Weakness, numbness, paraesthesia • Problems with sphincter control (bowel/bladder) Drug History Family History • Consider both treatment of neurological disorders • Any family history of neurological disease? and medication that may be causing symptoms • There may be important hereditary neurological conditions such as Huntington’s chorea • Draw a family tree if appropriate 1

Social history Syncope • What are the patient’s disabilities? • Any mobility aids? • Where does the patients live? Do they receive any help? What support is available to them? • Smoking, alcohol, drug misuse? Causes of collapse Causes of collapse A. Acute myocardial infarction A. Acute myocardial infarction B. Cerebrovascular accident B. Cerebrovascular accident 1. A 45 year old woman collapses during 1. A 45 year old woman collapses during C. Dissecting aortic aneurysm C. Dissecting aortic aneurysm a church service in summer. Her a church service in summer. Her D. Drug allergy hisband states that she turned pale D. Drug allergy husband states that she turned pale and collapsed shortly after standing and collapsed shortly after standing E. First-dose hypotension E. First-dose hypotension up. She did not jerk or lose urinary up . She did not jerk or lose urinary F. Left ventricular failure F. Left ventricular failure continence. She denies chest pain, continence. She denies chest pain, G. Ruptured Abdominal aortic aneurysm G. Ruptured Abdominal aortic aneurysm shortness of breath and palpitations. shortness of breath and palpitations. H. Stable angina H. Stable angina She recovered after 30 secs and now She recovered after 30 secs and now I. Stokes-Adams attack feels back to her usual self. All I. Stokes-Adams attack feels back to her usual self . All observations –including blood tests, observations –including blood tests, J. Supraventricular tachycardia J. Supraventricular tachycardia ECG and lying and standing BP are ECG and lying and standing BP are K. Vasovagal syncope K. Vasovagal syncope normal normal L. Ventricular rupture L. Ventricular rupture M. Wolf-Parkinson-White syndrome M. Wolf-Parkinson-White syndrome Causes of collapse Causes of collapse A. Acute myocardial infarction A. Acute myocardial infarction B. Cerebrovascular accident B. Cerebrovascular accident 1. A 45 year old woman collapses during 1. A 25 year old woman collapses C. Dissecting aortic aneurysm C. Dissecting aortic aneurysm a church service in summer. Her suddenly while visiting her D. Drug allergy husband states that she turned pale D. Drug allergy grandmother in hospital. There and collapsed shortly after standing appears to be no pulse. The crash E. First-dose hypotension E. First-dose hypotension up . She did not jerk or lose urinary team is called and manage to F. Left ventricular failure F. Left ventricular failure continence. She denies chest pain, resuscitate her after identifying G. Ruptured Abdominal aortic aneurysm G. Ruptured Abdominal aortic aneurysm shortness of breath and palpitations. ventricular fibrillation on the cardiac H. Stable angina H. Stable angina She recovered after 30 secs and now monitor. The attending anaesthetist feels back to her usual self . All records a repeat ECG and notes that I. Stokes-Adams attack I. Stokes-Adams attack observations –including blood tests, the QRS complexes are broad with J. Supraventricular tachycardia J. Supraventricular tachycardia ECG and lying and standing BP are slurred upstroke of R wave K. Vasovagal syncope K. Vasovagal syncope normal L. Ventricular rupture L. Ventricular rupture M. Wolf-Parkinson-White syndrome M. Wolf-Parkinson-White syndrome 2

Causes of collapse Causes of collapse A. Acute myocardial infarction A. Acute myocardial infarction B. Cerebrovascular accident B. Cerebrovascular accident 1. A 25 year old woman collapses 1. A 25 year old woman collapses C. Dissecting aortic aneurysm C. Dissecting aortic aneurysm suddenly while visiting her suddenly while visiting her D. Drug allergy grandmother in hospital. There D. Drug allergy grandmother in hospital. There appears to be no pulse . The crash appears to be no pulse . The crash E. First-dose hypotension E. First-dose hypotension team is called and manage to team is called and manage to F. Left ventricular failure F. Left ventricular failure resuscitate her after identifying resuscitate her after identifying G. Ruptured Abdominal aortic aneurysm G. Ruptured Abdominal aortic aneurysm ventricular fibrillation on the cardiac ventricular fibrillation on the cardiac H. Stable angina H. Stable angina monitor. The attending anaesthetist monitor. The attending anaesthetist records a repeat ECG and notes that records a repeat ECG and notes that I. Stokes-Adams attack I. Stokes-Adams attack the QRS complexes are broad with the QRS complexes are broad with J. Supraventricular tachycardia J. Supraventricular tachycardia slurred upstroke of R wav e slurred upstroke of R wave K. Vasovagal syncope K. Vasovagal syncope L. Ventricular rupture L. Ventricular rupture M. Wolf-Parkinson-White syndrome M. Wolf-Parkinson-White syndrome Causes of collapse Causes of collapse A. Acute myocardial infarction A. Acute myocardial infarction B. Cerebrovascular accident B. Cerebrovascular accident 1. A 25 year old woman collapses 1. A 75 year old woman is brought to the C. Dissecting aortic aneurysm C. Dissecting aortic aneurysm suddenly while visiting her A&E department after collapsing. On D. Drug allergy grandmother in hospital. There D. Drug allergy examination, her heart rate is 80 bpm appears to be no pulse . The crash and irregular with a BP of 150/90 E. First-dose hypotension E. First-dose hypotension team is called and manage to mmHg. She has difficulty moving her F. Left ventricular failure F. Left ventricular failure resuscitate her after identifying arm and leg . G. Ruptured Abdominal aortic aneurysm G. Ruptured Abdominal aortic aneurysm ventricular fibrillation on the cardiac H. Stable angina H. Stable angina monitor. The attending anaesthetist I. Stokes-Adams attack records a repeat ECG and notes that I. Stokes-Adams attack the QRS complexes are broad with J. Supraventricular tachycardia J. Supraventricular tachycardia slurred upstroke of R wave K. Vasovagal syncope K. Vasovagal syncope L. Ventricular rupture L. Ventricular rupture M. Wolf-Parkinson-White syndrome M. Wolf-Parkinson-White syndrome Causes of collapse Causes of collapse A. Acute myocardial infarction A. Acute myocardial infarction B. Cerebrovascular accident B. Cerebrovascular accident 1. A 75 year old woman is brought to 1. A 75 year old woman is brought to C. Dissecting aortic aneurysm C. Dissecting aortic aneurysm the A&E department after collapsing. the A&E department after collapsing. D. Drug allergy On examination, her heart rate is 80 D. Drug allergy On examination, her heart rate is 80 bpm and irregular with a BP of bpm and irregular with a BP of E. First-dose hypotension E. First-dose hypotension 150/90 mmHg . She has difficulty 150/90 mmHg . She has difficulty F. Left ventricular failure F. Left ventricular failure moving her arm and leg . moving her arm and leg . G. Ruptured Abdominal aortic aneurysm G. Ruptured Abdominal aortic aneurysm H. Stable angina H. Stable angina I. Stokes-Adams attack I. Stokes-Adams attack J. Supraventricular tachycardia J. Supraventricular tachycardia K. Vasovagal syncope K. Vasovagal syncope L. Ventricular rupture L. Ventricular rupture M. Wolf-Parkinson-White syndrome M. Wolf-Parkinson-White syndrome 3