Fits/Falls/LOC :: PLAB 2 Symptomatic Differential Stations

• Bacterial meningitis

  • Other presenting symptoms: 

    • Acute history

    • Seizure

    • Fever, flu like illness

    • Neck stiffness, photophobia, rash

  • Past history and PMAFTOSA: 

    • Travel history 

    • Allergy history

    • Recreational drugs

  • Social:

    • Living situation

  • Exam and Invs:

    • GPE, vitals

    • Head-to-toe examination

    • Neurological examination

    • Routine bloods, blood sugar, urine dipstick, blood culture

    • Lumbar puncture

  • Referral:

    • Medicine admission

    • Notify the health protection team

  • Treatment: 

    • IV painkillers, antipyretics

    • IV fluids, IV antibiotics

    • Antibiotics to contacts

    • Involve senior

  • Warning signs:

    • Worsening symptoms, drowsiness, confusion

• Malaria with meningitis

  • Other presenting symptoms: 

    • Headache, photophobia, neck pain

    • Constant high-grade Fever

    • Returned from Kenya

  • Past history and PMAFTOSA: 

    • Travel history

    • Allergy history

  • Social:

    • Living situation

  • Exam and Invs:

    • GPE, vitals

    • Head-to-toe examination

    • Neurological examination (Kernig’s and Brudzinski’s)

  • Referral:

    • Medicine admission

    • Notify Public health authority

  • Treatment: 

    • IV painkillers, antipyretics

    • IV fluids, IV antibiotics

    • Antibiotics to contacts

    • Involve senior

  • Warning signs:

    • Worsening symptoms

    • Headache, photophobia, neck stiffness

• Viral encephalitis

  • Other presenting symptoms: 

    • Acute history

    • Seizure

    • Fever, flu like illness

  • Past history and PMAFTOSA: 

    • Travel history

    • Recreational drugs

  • Social:

    • Living situation

  • Exam and Invs:

    • GPE, vitals

    • Head-to-toe examination

    • Neurological examination

    • Routine bloods, blood sugar, urine dipstick, blood culture

    • Lumbar puncture

  • Referral:

    • Medicine admission

  • Treatment: 

    • IV fluids

    • Involve senior for antivirals

  • Warning signs:

    • Worsening symptoms, drowsiness, confusion

• Epilepsy

  • Other presenting symptoms: 

    • First time fit

      • Sleep deprivation

      • Flashing lights

  • Past history and PMAFTOSA: 

    • Family history

    • Rule out meningitis

  • Social:

    • Living situation

    • Work, Driving

  • Exam and Invs:

    • GPE, vitals

    • Neurological examination

  • Referral:

    • Neurology urgent referral

  • Treatment: 

    • General advice:

      • Give leaflets and pamphlets to partner as well

      • Explain relatives about what to do when he gets a seizure

      • Avoid driving till advised

      • Avoid potentially dangerous work or leisure

      • Avoid locking doors from inside

      • Keep a seizure diary

  • Warning signs:

    • Worsening symptoms

    • Headache, photophobia, neck stiffness

• TIA

  • Other presenting symptoms: 

    • Sudden vision loss

    • Weakness in limbs

    • Slurring of speech

    • Facial deviation

  • Past history and PMAFTOSA: 

    • Hypertension history

    • Lifestyle history

  • Social:

    • Life effects

    • Living situation 

    • DVLA

  • Exam and Invs:

    • GPE, vitals

    • Routine bloods (Cholesterol, glucose)

    • Eye examination

    • Cranial nerve examination

    • ECG, CT head

  • Referral:

    • Neurology admission

  • Treatment: 

    • Aspirin

    • PPI

    • Lifestyle modification

  • Warning signs:

    • FAST

    • No driving for 1 month

• Cerebellar ataxia

  • Other presenting symptoms: 

    • Clumsiness, dropping things, falling down

    • Problem wearing clothes and other daily things

  • Past history and PMAFTOSA: 

    • Medication history

  • Social:

    • Life effects

    • Living situation

  • Exam and Invs:

    • GPE, vitals

    • Ear examination

    • Cerebellar examination

    • Neurological examination

    • Routine examination

    • MRI brain

  • Referral:

    • Neurology admission

  • Treatment: 

    • Specialist treatment based on diagnosis

  • Warning signs:

    • Worsening symptoms

    • FAST

• Mechanical fall - Hip fracture/previous stroke/in the ward

  • Other presenting symptoms: 

    • Tripped and fell

    • Take before, during, after history

  • Past history and PMAFTOSA: 

  • Social:

    • Living situation

    • Life and work effects

  • Exam and Invs:

    • GPE, vitals

    • Hip examination

    • Neurological examination

    • Xray hip

  • Referral:

    • Don’t discharge if hip fracture

  • Treatment: 

    • Pain Killers

    • Orthopedics referral if fracture confirmed

    • Physio and occupational therapist

  • Warning signs:

    • Worsening symptoms

    • FAST