Neurology – Headaches and Migraines
1. Migraine with Aura Considering Pregnancy
- Key Areas:
- Additional symptoms indicating a serious underlying cause of headache
- Prophylactic medication for migraine suitable for pregnancy
- Long-term effective contraception considering migraine with aura
- Common Errors:
- Asking for symptoms already provided, examination findings, or irrelevant history
- Giving acute migraine treatment rather than prophylaxis or unsuitable medications for pregnancy
- Not recognizing that migraine with aura contraindicates combined hormonal contraception
2. Migraines
- Key Topics:
- Appropriate management for migraines
- Consideration of prophylaxis options
- Improvements Needed:
- Avoiding medication redundancy
- Providing relevant, specific lifestyle advice
3. Facial Pain and Headaches Management
- Key Topics Discussed:
- Pharmacological management options for initial symptoms
- Investigations
- Management for persistent symptoms and rash
- Candidate Performance:
- Inadequate knowledge on specific dosages and pharmacological management
- Improvement Areas:
- Provide accurate, dosage-specific pharmacological management
- Tailor investigation plans to evolving symptoms
4. Chronic Headaches and Rash Management
- Key Topics Discussed:
- Differential diagnoses for chronic headaches
- Pharmacological management
- Rash management
- Candidate Performance:
- Non-specific differential diagnoses
- Improvement Areas:
- Provide specific and relevant differential diagnoses and management plans
5. Headaches and Fatigue Management
- Key Topics Discussed:
- Initial pharmacological management
- Appropriate investigations
- Candidate Performance:
- Overcoding by providing excessive responses
- Improvement Areas:
- Adhere to question requirements, focusing on concise, relevant pharmacological management and investigation plans
6. Chronic Headaches in a Young Adult Female
- Key Topics Discussed:
- Differential diagnoses for chronic headaches
- Pharmacological management
- Later presentation of a rash
- Candidate Performance:
- Provision of generic diagnoses like “daily headaches” without specificity
- Improvement Areas:
- Provide specific, case-relevant differential diagnoses and management plans
7. Post-Lumbar Puncture Headache
- Specifics:
- Difficulty in distinguishing the initial post-procedure complication from a subsequent, unrelated headache presentation indicating new pathology
- Improvement Areas:
- Enhance clinical reasoning to consider new diagnoses in patients with previous significant health episodes presenting with similar symptoms
8. Evolving Neurological Condition
- This case focused on a female patient with a previous history of musculoskeletal problems but presents with symptoms suggestive of an evolving neurological condition.
- Common Errors:
- Not identifying the new neurological symptoms within the history
- Only managing the musculoskeletal diagnoses provided as part of the patient’s past medical history
- Improvement Areas:
- Consider all information in the stem
- Provide answers within the context of the case
Neurology – Vertigo and Dizziness
1. Vertigo
- Insight:
- Differentiating between central and peripheral causes of vertigo through targeted examination and history
- Strengths:
- Identification of red flag signs and a systematic approach to diagnosis
- Improvements:
- Clarify management strategies for vertigo, considering patient safety and quality of life
2. Dizziness, Nausea, and Vomiting with a Focus on Central Causes
- Key Topics Discussed:
- Differential diagnosis for dizziness
- Specific examination findings for central causes
- Management of skin lesion
- Candidate Performance:
- Repetitive and nonspecific examination findings
- Improvement Areas:
- Identify and articulate specific findings indicative of central neurological causes
- Manage skin lesions with precision
3. ‘Funny Turn’
- Topic Discussed:
- A male patient presents with a non-specific ‘funny turn,’ possibly indicating a transient neurological or cardiovascular event
- Candidates Did Well On:
- Identifying the correct diagnosis based on the provided scenario
- Improvement Areas:
- Selecting appropriate and immediate investigations was challenging for some
- Candidates often chose investigations relevant for later stages rather than focusing on those needed immediately upon presentation
4. Male with Collapse, Loss of Consciousness, and Muscle Jerking
- Key Medical Subject: Neurology and General Practice
- Topic Discussed:
- Differential diagnoses for fits, faints, or dizzy spells
- Key features in history to establish a diagnosis
- What Candidates Did Well:
- Considered a range of possible causes for the presentation
- What Candidates Did Poorly:
- Focused solely on different forms of epilepsy without considering other possibilities
- Gave a narrow neurological history rather than appreciating the range of possible causes
Neurology – Facial and Cranial Conditions
1. Ramsay Hunt Syndrome
- Key Topics:
- Initial investigations
- Management of the syndrome
- Subsequent management of post-herpetic neuralgia
- Improvements Needed:
- Correct diagnosis from provided information
- Avoiding incorrect medication-class associations
2. Facial Palsy Management
- Medical Heading: Neurology
- Key Topics:
- Differential diagnosis for facial palsy
- Focused history for neurological symptoms
- Specific pharmacological and non-pharmacological management
- Candidate Performance:
- Missteps in pharmacological management specifics
- Non-targeted non-pharmacological advice
- Some lacked specificity in steroid dosing or comprehensive care strategies
- Improvement Areas:
- Precise pharmacological treatment regimens for neurological conditions
- Tailored non-pharmacological management plans that reflect patient-specific needs
3. Unilateral Severe Facial Pain
- Medical Heading: Neurology, specifically assessing and managing trigeminal neuralgia
- Candidates Did Well On:
- Diagnosing based on classic presentation but struggled with further assessment specifics
- Improvement Areas:
- Providing focused management strategies beyond investigations
- Specifically targeting the facial pain with appropriate treatments
Neurology – General Conditions
1. Progressive Fatigue and Muscle Weakness
- Medical Heading: Neurology
- Key Topics:
- Identifying symptoms indicative of neurological conditions
- Initial neurological investigation selection
- Management of a suspicious skin lesion
- Candidate Performance:
- Good identification of symptoms suggestive of myasthenia gravis
- Some confusion over specific neurological investigations needed
- Management strategies for the skin lesion sometimes missed the mark
- Improvement Areas:
- Enhance knowledge on neurological investigation specifics for conditions like myasthenia gravis
- Clarify dermatological management principles for common skin conditions