MIND MAPS FOR MEDICINE - Mohsin Azam - Scion Publishing
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Definition Causes / risk factors
Symptoms
Signs
Pathophysiology
Clinical features
MIND MAPS
FOR MEDICINE
Blood tests
Management
Investigations
Pharmacological
Imaging
Lifestyle Surgical
Complications
Mohsin Azam
MIND MAPS
FOR MEDICINE
Mind Maps for Medics.indb 1 7/13/2021 12:33:16 PM
MIND MAPS
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We are grateful for their essential feedback.
Mohsin Azam, MBChB, BSc, MRCGP
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(simon.watkins@scionpublishing.com) and explain why you would be suitable for the role. General Practitioner, North London
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© Scion Publishing Ltd, 2021
First published 2021
All rights reserved. No part of this book may be reproduced or transmitted, in any form or by
any means, without permission.
A CIP catalogue record for this book is available from the British Library.
Contents
ISBN 9781911510369
Scion Publishing Limited
The Old Hayloft, Vantage Business Park, Bloxham Road, Banbury OX16 9UX, UK
www.scionpublishing.com Preface...............................................................................................................................................................ix
Acknowledgements ................................................................................................................................. x
Important Note from the Publisher Dedications .................................................................................................................................................... x
The information contained within this book was obtained by Scion Publishing Ltd Abbreviations................................................................................................................................................xi
from sources believed by us to be reliable. However, while every effort has been made
to ensure its accuracy, no responsibility for loss or injury whatsoever occasioned to
any person acting or refraining from action as a result of information contained herein
Chapter 1: Cardiology 1
can be accepted by the authors or publishers.
Readers are reminded that medicine is a constantly evolving science and while the Angina pectoris............................................................................................................................................ 2
authors and publishers have ensured that all dosages, applications and practices Acute coronary syndrome..................................................................................................................... 4
are based on current indications, there may be specific practices which differ
Acute pericarditis......................................................................................................................................... 8
between communities. You should always follow the guidelines laid down by the
manufacturers of specific products and the relevant authorities in the country in Atrial fibrillation......................................................................................................................................... 10
which you are practising. Valvular heart disease............................................................................................................................ 12
Although every effort has been made to ensure that all owners of copyright material Heart failure.................................................................................................................................................. 14
have been acknowledged in this publication, we would be pleased to acknowledge in Hypertrophic obstructive cardiomyopathy............................................................................. 18
subsequent reprints or editions any omissions brought to our attention. Hypertension.............................................................................................................................................. 20
Registered names, trademarks, etc. used in this book, even when not marked as such, Infective endocarditis............................................................................................................................ 24
are not to be considered unprotected by law.
Chapter 2: Respiratory 27
Acute respiratory distress syndrome............................................................................................ 28
Asthma............................................................................................................................................................ 30
Bronchiectasis............................................................................................................................................. 34
Chronic obstructive pulmonary disease.................................................................................... 36
Cystic fibrosis............................................................................................................................................... 40
Interstitial lung disease......................................................................................................................... 42
Lung cancer................................................................................................................................................. 46
Obstructive sleep apnoea................................................................................................................... 50
Pleural effusion.......................................................................................................................................... 52
Pneumonia................................................................................................................................................... 54
Pneumothorax........................................................................................................................................... 56
Typeset by Medlar Publishing Solutions Pvt Ltd, India
Pulmonary embolism............................................................................................................................ 60
Printed in the UK Respiratory failure.................................................................................................................................... 62
Last digit is the print number: 10 9 8 7 6 5 4 3 2 1 Sarcoidosis.................................................................................................................................................... 64
Mind Maps for Medicine \ v
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Chapter 3: Gastroenterology 67
Hypoglycaemia........................................................................................................................................168
Hyponatraemia........................................................................................................................................170
Acute liver failure...................................................................................................................................... 68 Hypopituitarism......................................................................................................................................174
Acute pancreatitis.................................................................................................................................... 70 Phaeochromocytoma..........................................................................................................................176
Alpha-1 antitrypsin deficiency......................................................................................................... 72 Polycystic ovary syndrome...............................................................................................................178
Chronic pancreatitis................................................................................................................................ 74
Cirrhosis.......................................................................................................................................................... 76 Chapter 6: Neurology 181
Coeliac disease........................................................................................................................................... 80
Bell’s palsy....................................................................................................................................................182
Crohn’s disease........................................................................................................................................... 82
Delirium........................................................................................................................................................186
Gastric cancer............................................................................................................................................. 86
Epilepsy.........................................................................................................................................................190
Gastro-oesophageal reflux disease............................................................................................... 88
Extradural haematoma (epidural haemorrhage)................................................................194
Hereditary haemochromatosis........................................................................................................ 90
Guillain–Barré syndrome...................................................................................................................196
Irritable bowel syndrome.................................................................................................................... 92
Migraine and other causes of headache.................................................................................198
Jaundice......................................................................................................................................................... 94
Motor neurone disease.......................................................................................................................202
Oesophageal cancer and other causes of dysphagia........................................................ 96
Multiple sclerosis....................................................................................................................................204
Peptic ulcer disease...............................................................................................................................100
Myasthenia gravis...................................................................................................................................206
Primary biliary cholangitis.................................................................................................................102
Neurofibromatosis.................................................................................................................................208
Primary sclerosing cholangitis........................................................................................................104
Parkinsonism.............................................................................................................................................210
Ulcerative colitis......................................................................................................................................106
Polyneuropathies....................................................................................................................................214
Upper gastrointestinal bleed..........................................................................................................108
Transient ischaemic attack................................................................................................................216
Wilson’s disease.......................................................................................................................................112
Stroke.............................................................................................................................................................218
Chapter4: Renal 115
Subarachnoid haemorrhage...........................................................................................................222
Subdural haematoma..........................................................................................................................224
Acute kidney injury...............................................................................................................................116
Chronic kidney disease.......................................................................................................................118 Chapter 7: Rheumatology 227
Nephritic syndrome..............................................................................................................................122
Ankylosing spondylitis........................................................................................................................228
Nephrotic syndrome............................................................................................................................126
Fibromyalgia..............................................................................................................................................230
Urinary tract infection..........................................................................................................................128
Giant cell arteritis....................................................................................................................................232
Chapter 5: Endocrinology 131
Gout................................................................................................................................................................234
Osteoarthritis.............................................................................................................................................236
Acromegaly................................................................................................................................................132 Osteoporosis..............................................................................................................................................238
Adrenal insufficiency............................................................................................................................134 Paget’s disease.........................................................................................................................................240
Cushing syndrome................................................................................................................................136 Polymyalgia rheumatica.....................................................................................................................242
Diabetes insipidus..................................................................................................................................138 Polymyositis and dermatomyositis..............................................................................................244
Diabetes mellitus: overview and management..................................................................140 Psoriatic arthritis......................................................................................................................................246
Diabetic ketoacidosis...........................................................................................................................148 Reactive arthritis......................................................................................................................................248
Hyperaldosteronism.............................................................................................................................152 Rheumatoid arthritis.............................................................................................................................250
Hypocalcaemia........................................................................................................................................154 Scleroderma...............................................................................................................................................254
Hypercalcaemia and hyperparathyroidism............................................................................156 Septic arthritis...........................................................................................................................................256
Hyperprolactinaemia...........................................................................................................................158 Sjögren syndrome..................................................................................................................................258
Hypothyroidism.......................................................................................................................................160 Systemic lupus erythematosus......................................................................................................260
Hyperthyroidism.....................................................................................................................................164 Vitamin D deficiency............................................................................................................................264
vi / Contents Mind Maps for Medicine \ vii
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Chapter 8: Infectious diseases 267
Hepatitis A...................................................................................................................................................268
Hepatitis D and E....................................................................................................................................270
Hepatitis B...................................................................................................................................................272
Hepatitis C...................................................................................................................................................274
Human immunodeficiency virus..................................................................................................276
Malaria...........................................................................................................................................................280
Tuberculosis...............................................................................................................................................282
Preface
Appendix: Figure acknowledgements..................................................................................... 287 Mind maps (or similar concepts) have been used for mind map, taking readers consistently through
Index.............................................................................................................................................................. 293 centuries, for learning, brainstorming, visual thinking definition, pathophysiology, causes, clinical features,
and problem solving amongst educators, psychologists investigations, management, complications and more.
and people in general. They are particularly helpful The book is primarily aimed at medical students, but
for visual learners and help with memorisation and it should also be useful for junior doctors and general
retention, and are a more engaging form of learning, practitioners.
helping to improve productivity, efficiency and Chapters are largely laid out in alphabetical order
creativity. Studies on medical students have shown to allow for readers to easily locate medical conditions.
that using mind maps may yield better pass rates than There are a few exceptions, however, where it was felt
traditional note-taking. that some conditions should be grouped together in
It was during my second year of medical school terms of a spectrum from less to more severe, such
that I first really appreciated the value of mind maps as the sections covering angina pectoris and acute
after having a go at constructing some myself for the coronary syndrome, and also the sections on TIA
first time. It was certainly a game-changer for me. and stroke.
It enabled me to digest and retain a large amount For substantial topics where all the relevant and
of information in a structured manner, and therefore important information cannot feasibly fit onto one
resulted in a more efficient learning style. Prior to this mind map, additional supplementary information is
I had spent much more time making lengthy notes provided on a Notes page overleaf, in an easy to read
which I found far less productive and rather tedious. bullet point format.
It was at that point that the phrase ‘work smarter, not Additional memory aids in the form of mnemonics
harder’ hit home. During medical school, using mind are also included alongside photographs and
maps helped me with recall in written examinations, illustrations to further enhance retention and
but I also found that they enabled me to provide more visualisation.
structured and cogent answers in an OSCE setting, and It is important to note that this book is not intended
examiners seemed to prefer this to simply regurgitating as a replacement for larger textbooks but should be
lists of unstructured and undifferentiated information. seen as a companion to them, giving you a more
A few years ago I recognised the need for a medical innovative and fun way of learning.
revision guide set out in a mind map format – existing I hope that readers not only find this book enjoyable
books seemed to oversimplify their mind maps and not and useful in providing medical knowledge but that it
provide sufficient detail. They also failed to supplement also inspires you to create your own medical mind maps.
the written information with drawings and photos, Finally, I wish all readers the best with your medical
which I feel is vital in a visual memory aid. exams and future careers.
This book takes a systems-based approach and
for each of over 100 conditions presents a detailed Mohsin Azam
viii / Preface Mind Maps for Medicine \ ix
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Abbreviations
Acknowledgements
I would like to thank the student reviewers for their valuable feedback ABC Airway, breathing, circulation COPD Chronic obstructive pulmonary disease
on the content of some of the chapters. ABG Arterial blood gas CPAP Continuous positive airway pressure
ABPM Ambulatory blood pressure monitoring CRH Corticotropin-releasing hormone
I am extremely grateful to the team at Scion Publishing Ltd, particularly ACE Angiotensin-converting enzyme CRP C-reactive protein
Dr Jonathan Ray for his advice, encouragement and, above all, patience. ACR Albumin : creatinine ratio CSF Cerebrospinal fluid
ACS Acute coronary syndrome CT Computed tomography
ACTH Adrenocorticotropic hormone CTPA Computed tomography pulmonary angiogram
ADH Antidiuretic hormone CV Cardiovascular
ADL Activities of daily living CVA Cerebrovascular accident
Dedications AF Atrial fibrillation CVD Cardiovascular disease
AIDS Acquired immune deficiency syndrome CWP Coal worker’s pneumoconiosis
AKI Acute kidney injury CXR Chest X-ray
To my beloved parents for all the unconditional love and support
ALP Alkaline phosphatase DEXA Dual energy X-ray absorptiometry
they have given me throughout my life.
ALT Alanine transaminase DI Diabetes insipidus
To my sweetheart Sevda for the continued love and patience you have for me. AMA Anti-mitochondrial antibody DIDMOAD Diabetes insipidus, diabetes mellitus,
AMTS Abbreviated mental test score optic atrophy, and deafness
A special mention goes to my adorable baby daughter, Elanur, ANA Anti-nuclear antibody DIP Distal interphalangeal
you have made me a happy and proud father! ANCA Anti-neutrophil cytoplasmic antibody DKA Diabetic ketoacidosis
Anti-CCP Anti-cyclic citrullinated peptide DMARD Disease-modifying anti-rheumatic drug
APTT Activated partial thromboplastin time DOAC Direct oral anticoagulant
ARB Angiotensin II receptor blocker DVLA Driver and Vehicle Licensing Agency
ARDS Acute respiratory distress syndrome DVT Deep vein thrombosis
AS Ankylosing spondylitis EBV Epstein–Barr virus
ASMA Anti-smooth muscle antibodies ECG Electrocardiogram
AST Aspartate transaminase ECHO Echocardiogram
ATP Adenosine triphosphate EEG Electroencephalogram
AV Atrioventricular eGFR Estimated glomerular filtration rate
AVP Arginine vasopressin ELISA Enzyme-linked immunosorbent assay
AXR Abdominal X-ray EMG Electromyography
BE Base excess ERCP Endoscopic retrograde
BIPAP Bilevel positive airway pressure cholangiopancreatography
BNP Brain natriuretic peptide ESR Erythrocyte sedimentation rate
BP Blood pressure FBC Full blood count
CABG Coronary artery bypass grafting FEV Forced expiratory volume
CBT Cognitive behavioural therapy FSH Follicle-stimulating hormone
CCF Congestive cardiac failure FVC Forced vital capacity
CK Creatine kinase G6PD Glucose-6-phosphate dehydrogenase
CKD Chronic kidney disease GBS Guillain–Barré syndrome
CMV Cytomegalovirus GCA Giant cell arteritis
CNS Central nervous system GCS Glasgow Coma Scale
COCP Combined oral contraceptive pill GFR Glomerular filtration rate
x / Acknowledgements and Dedications Mind Maps for Medicine \ xi
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GI Gastrointestinal MI Myocardial infarction SDH Subdural haematoma TED Thrombo-embolus deterrent
GLP Glucagon-like peptide MND Motor neurone disease SHBG Sex hormone binding globulin TENS Transcutaneous electrical nerve stimulation
GORD Gastro-oesophageal reflux disease MPTP 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine SIADH Syndrome of inappropriate ADH secretion TFTs Thyroid function tests
GRA Glucocorticoid-remediable aldosteronism MRA Magnetic resonance angiogram SLE Systemic lupus erythematosus TIA Transient ischaemic attack
GTN Glyceryl trinitrate MRCP Magnetic resonance cholangiopancreatography SMA Smooth muscle antibody TNM Tumour, node, metastasis
GU Genitourinary MRI Magnetic resonance image SNRI Serotonin and noradrenaline reuptake inhibitor TRH Thyrotropin-releasing hormone
HAART Highly active antiretroviral therapy MS Multiple sclerosis SNS Sympathetic nervous system TSH Thyroid-stimulating hormone
HAV Hepatitis A virus MSK Musculoskeletal SOB Shortness of breath TTG Tissue transglutaminase
HBA1c Haemoglobin A1c MSM Men who have sex with men SPECT Single photon emission computed tomography U&Es Urea and electrolytes
HBPM Home blood pressure monitoring MTP Metatarsophalangeal SS Sjögren syndrome UC Ulcerative colitis
HDU High dependency unit NAC N-acetyl cysteine SSRI Selective serotonin reuptake inhibitor UGIB Upper gastrointestinal bleeding
HDV Hepatitis D virus NBM Nil by mouth STEMI ST elevation myocardial infarction US Ultrasound
HELLP Haemolysis, elevated liver enzymes NG Nasogastric STI Sexually transmitted infection UTI Urinary tract infection
and low platelet count NICE National Institute for Health and Care Excellence T1DM Type 1 diabetes mellitus VF Ventricular fibrillation
HEV Hepatitis E virus NSAID Non-steroidal anti-inflammatory drug T2DM Type 2 diabetes mellitus VT Ventricular tachycardia
HF Heart failure NSCLC Non-small cell lung carcinoma TB Tuberculosis VTE Venous thromboembolism
HH Hereditary haemochromatosis NSTEMI Non-ST elevation myocardial infarction TCA Tricyclic antidepressant WCC White cell count
HHS Hyperosmolar hyperglycaemic state OA Osteoarthritis
HIV Human immunodeficiency virus OD Omnie die (once a day)
HLA Human leucocyte antigen OGTT Oral glucose tolerance test
HOCM Hypertrophic obstructive cardiomyopathy ON Omni nocte
HRT Hormone replacement therapy OSA Obstructive sleep apnoea
HSP Henoch–Schönlein purpura PBC Primary biliary cholangitis
HTN Hypertension PCI Percutaneous coronary intervention
IBD Inflammatory bowel disease PCOS Polycystic ovary syndrome
IBS Irritable bowel syndrome PD Parkinson’s disease
ICD Implantable cardioverter-defibrillator PE Pulmonary embolism
ICP Intracranial pressure PEF Peak expiratory flow
ICS Inhaled corticosteroid PEFR Peak expiratory flow rate
ICU Intensive care unit PENS Percutaneous electrical nerve stimulation
IDDM Insulin-dependent diabetes mellitus PET Positron emission tomography
IE Infective endocarditis PIP Proximal interphalangeal
IGF Insulin-like growth factor PM Polymyositis
IHD Ischaemic heart disease PMR Polymyalgia rheumatica
INR International normalised ratio PPI Proton pump inhibitor
IPF Idiopathic pulmonary fibrosis PSC Primary sclerosing cholangitis
ITU Intensive treatment unit PT Prothrombin time
IV Intravenous PTH Parathyroid hormone
JVP Jugular venous pressure PVD Peripheral vascular disease
KUB Kidneys, ureter, bladder RA Rheumatoid arthritis
LABA Long-acting beta agonist RAAS Renin–angiotensin–aldosterone system
LAD Left anterior descending RBBB Right bundle branch block
LBBB Left bundle branch block RCA Right coronary artery
LCx Left circumflex RF Rheumatoid factor
LDH Lactate dehydrogenase RR Respiratory rate
LFTs Liver function tests RV Right ventricular
LMWH Low molecular weight heparin SABA Short-acting beta agonist
LOS Lower oesophageal sphincter SAH Subarachnoid haemorrhage
LTRA Leukotriene receptor antagonist SALT Speech and language therapy
LVEF Left ventricular ejection fraction SAMA Short-acting muscarinic antagonist
LVH Left ventricular hypertrophy SBP Systolic blood pressure
MART Maintenance and reliever therapy SC Subcutaneous
MCP Metacarpophalangeal SCC Squamous cell carcinoma
MEN Multiple endocrine neoplasia SCLC Small cell lung carcinoma
xii / Abbreviations Mind Maps for Medicine \ xiii
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Acute coronary syndrome (ACS) encompasses a spectrum The underlying cause of coronary artery disease is atherosclerosis which has Non-modifiable • Chest pain Typically central and ‘crushing’ in nature and often radiates to
of unstable coronary artery diseases. It covers the several stages: arms, shoulders, neck or jaw
following diagnoses: • Endothelial cell injury and inflammation Lipids deposited in the • Increasing age • Shortness of breath
• Unstable angina Symptoms at rest with ECG changes; intima layer of coronary arteries together with vascular injury (e.g. from • Male sex • Nausea
the myocardial ischaemia is not sufficient to cause hypertension) cause inflammation, increased permeability and recruitment • Family history of premature coronary heart disease • Palpitations
myocardial damage and therefore there is no rise in of white cells; over time inflammatory cells, particularly macrophages, take • Premature menopause • Sweating
serum markers of myocardial injury e.g. troponin up the lipid and become foam cells
Note: Some patient groups, e.g. elderly, diabetics, females and those with CKD,
• Non-ST elevation myocardial infarction (NSTEMI) • Plaque formation Foam cells accumulate and smooth muscle cells Modifiable
may have little or no chest pain, and may present with atypical features such as
As above but with myocardial ischaemia sufficient to proliferate resulting in the growth of the plaque
• Smoking abdominal pain, altered mental state or jaw pain, so-called ‘silent MI’
cause myocardial damage and therefore elevation in • Plaque rupture Activates the clotting cascade and thrombosis which
serum markers of myocardial injury might be sufficient to cause partial occlusion (resulting in myocardial • Diabetes mellitus (and impaired glucose tolerance)
• ST elevation myocardial infarction (STEMI) ischaemia and angina) or total occlusion (resulting in myocardial necrosis • Hypertension
Symptoms with ST elevation on ECG due to complete and myocardial infarction, MI) • Dyslipidaemia Clinical features
occlusion of the coronary artery • Obesity
• Sedentary lifestyle
Pathophysiology
Definition Risk factors
Epidemiology • Coronary heart disease is the most
common cause of death in the UK
• Incidence increases with age, and
elderly people also tend to have
higher rates of morbidity and
Acute coronary syndrome
mortality from their infarcts
Investigations
ECG
Bloods
• Unstable angina and NSTEMI May be normal, show ST-segment
Complications Management depression or non-specific abnormalities e.g. T-wave inversion • Routine FBC (to exclude anaemia), U&Es (to assess
renal function), fasting lipids (risk stratification), LFTs
• STEMI Acute ST-segment elevation or new left bundle branch block (LBBB)
(see Figs. 1–3) (baseline before starting statins), TFTs
• Troponin and other cardiac enzymes Cardiac
Complications of ACS (DARTH VADER) Acute Normal Hours Days Weeks Months troponins T and I are highly sensitive and specific for
• Death/cardiac arrest Most commonly occurs due to MI (normal in unstable angina); other cardiac enzymes
patients developing ventricular fibrillation Initial* treatment for all patients (MONA) such as creatinine kinase will also be raised but this is
• Arrhythmias Tachyarrhythmias (e.g. VF and VT) or • Morphine Oral or IV diamorphine, e.g. 2.5–5mg, less specific
- ST elevation - ST elevation - ST flattening off - Pathological Q waves
bradyarrhythmias (atrioventricular block is more can be given for pain relief; an anti-emetic such as - Pathological Q waves - Pathological Q waves
metoclopramide should be co-prescribed - Inverted T waves CXR
common following inferior myocardial infarctions)
• Rupture Free ventricular wall/ventricular septum/ • Oxygen Should only be given if hypoxic, or evidence Fig. 1 ECG changes in MI
• To assess for presence or absence of heart failure/
papillary muscles of pulmonary oedema, or continuing myocardial
pulmonary oedema and exclude other diagnoses
• Tamponade and cardiogenic shock ischaemia
• Heart failure Acute or chronic • Nitrates To relieve ischaemic pain (initially sublingual, ECHO
• Ventricular Free wall or interVentricular septum rupture e.g. two sprays of GTN); if not effective, IV or buccal
• Aneurysm Of the left ventricle GTN or IV isosorbide dinitrate can be given • Can assess for regional wall abnormalities and
• Dressler syndrome Tends to occur around 2–6 weeks • Aspirin All patients should receive 300mg aspirin define the extent of the infarction and assess overall
following a MI (thought to be autoimmune) crushed or chewed ASAP ventricular function and can identify complications
• thromboEmbolism Mural thrombus
*Subsequent management depends on whether Coronary angiography
• Rupture Of the papillary muscle and mitral valve
the patient has unstable angina/NSTEMI or STEMI
Regurgitation
(see flow chart on Notes page overleaf) • Cardiac angiography defines the patient’s coronary
anatomy and the extent of the disease
Chronic
See Notes page overleaf.
Fig. 2 LBBB on ECG
4 / Chapter 1 Cardiology: Acute coronary syndrome Mind Maps for Medicine \ 5
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Acute coronary syndrome notes
ECG localisation of myocardial infarction Long-term treatment
NICE guideline (NG185) on the acute management of ACS
It is possible to localise the ischaemic area of the heart by assessing the leads Non-pharmacological
that show ST segment elevation (see Table 1). • Smoking cessation
Table 1 ECG localisation of myocardial infarction • Weight control
Initial treatment: • Diet Mediterranean-style diet is advised
• Morphine Leads Affected myocardial area Occluded coronary artery • Exercise Advise 20–30min/day until patients are ‘slightly breathless’; refer to
• Oxygen cardiac rehabilitation
• Nitrates V1-V2 Septal Proximal LAD • Driving If treated successfully by coronary angioplasty, group 1 driving
• Aspirin – 300mg orally (crushed or chewed) may recommence after 1 week; if not successfully treated, driving may
V3-V4 Anterior LAD recommence after 4 weeks
• Sexual activity May resume 4 weeks after uncomplicated MI; PDE5
V5-V6 Apical Distal LAD, LCx or RCA inhibitors (e.g. sildenafil) cannot be used until 6 months after MI and should
be avoided if patient is on nitrates or nicorandil
Unstable angina/NSTEMI *STEMI
1, AVL Lateral LCx
Pharmacological (DABS)
2, AVF, 3 Inferior 90% RCA, 10% LCx
• Dual antiplatelet therapy (DAPT) Aspirin 75mg OD lifelong and one other
Estimate 6m mortality, No antiplatelet (ticagrelor, prasugrel or clopidogrel) for at least 1 year; consider
Suitable for reperfusion therapy?
e.g. using GRACE score co-prescribing a PPI (e.g. omeprazole) for gastric protection
• Ace inhibitor or ARB (If intolerant to ACE inhibitor)
Yes • Beta blocker e.g. Bisoprolol, carvedilol and metoprolol; start low and
increase gradually as blood pressure and pulse allow; if contraindicated
consider calcium channel blocker e.g. verapamil or diltiazem
Low risk (≤3%) Intermediate/high risk (≥3%) PCI possible within 120min? • Statin High dose e.g. atorvastatin 80mg ON
• An aldosterone antagonist e.g. Eplerenone for patients who have had
an acute MI and evidence of heart failure and left ventricular systolic
Yes No dysfunction
Fig. 3 ECG showing anteroseptal MI
Typical contraindications to fibrinolytic therapy
Manage conservatively PCI Fibrinolysis Risk assessment tools for ACS
Table 2 Typical contraindications to fibrinolytic therapy
1. GRACE
• Give ticagrelor – initially For unstable angina/NSTEMI: For STEMI: Indicated if• Most commonly caused by a fractured • History of trauma Typically a head strike from sports injury or motor
temporal or parietal bone which causes vehicle accident; classically, this is followed by a lucid interval after which Notes
Extradural haematoma is the collection Parietal Frontal Extradural Acute
haematoma
respiratory
(epidural
distress
haemorrhage)
syndrome
damage to the middle meningeal artery or the patient deteriorates
of blood between the dura and the bone vein • Loss of consciousness
Sphenoid
(usually skull but may be spinal column) • Typically caused by trauma to the pterion, the • Severe headache
(see Fig. 1). It is immediately life-threatening. Ethmoid region where the frontal, parietal, temporal and • Nausea/vomiting
Temporal
Nasal sphenoid bones join together (see Fig. 2). • Confusion
Lacrimal
Occipital • Young people are more commonly • Evidence of skull fractures, haematomas or lacerations
Maxilla
Zygomatic
affected, not only because of the prevalent • Otorrhoea or rhinorrhoea Resulting from skull fracture
Skull demographics of patients with a head injury, • Unequal pupils
Mandible but it also relates to the changes that occur in • Hemiparesis With brisk reflexes and up-going plantar reflex
Dura
the dura in older patients, as the dura is much • Other focal neurological deficits e.g. Aphasia, visual field defects,
Extradural Fig. 2 The pterion, the weakest part of the skull; a more adherent to the inner surface of the skull numbness, ataxia
haematoma traumatic blow to the pterion may rupture the middle • Children are less likely to have associated skull • Bradycardia and hypertension Late signs (Cushing reflex)
meningeal artery causing an epidural haematoma fractures than adults • Death Follows a period of coma and is due to respiratory arrest
• Extradural haemorrhage in the spinal column • Spinal cord compression Produced by a haematoma in the spinal
Fig. 1 Diagram of an extradural haematoma can occur as a result of epidural anaesthesia or column; features may include: weakness, numbness, alteration in reflexes,
Pathophysiology lumbar puncture urinary incontinence and faecal incontinence
Definition Clinical features
Extradural haematoma
(epidural haemorrhage)
Investigations
• CT head Shows haematoma
(often biconvex /lens-shaped, see
Complications Management Prognosis Fig. 3); if there is deterioration, CT
must be repeated
• Bloods FBC, U&Es, coagulation
• Neurological deficits (temporary • ABC approach of resuscitation • Overall mortality rate is approx. 30% screen (if any suspicion of
or permanent) • Control of airway in unconscious • Those alert on admission rarely die abnormality of coagulation),
• Death patient; oxygen may be given but a low Glasgow Coma Scale (GCS) group and save
• Post-traumatic seizures • IV fluids may be required to score worsens the prognosis • Plain skull X-ray head May
• Post-concussion syndrome maintain the circulation and • The earlier the intervention, the more be normal or show fracture line
• Spasticity, neuropathic pain and preserve cerebral perfusion likelihood of survival crossing the course of the middle
urinary complications (spinal • Stabilise and transfer urgently • Risk factors for poor prognosis include: meningeal vessels
extradural haematoma) (with skilled medical and nursing older age, intradural lesions, increasing • Cervical spine X-ray Spinal injury
escorts) to a neurosurgical unit volume of haematoma, temporal must be excluded Fig. 3 Extradural haematoma on
• Measures to decrease raised ICP location, rapid clinical progression, • MRI head Gives detailed images CT scan
with IV mannitol or hypertonic pupillary abnormalities, raised ICP but may not be suitable for a
saline patient in an unstable condition
• Conservative management for
small haematomas
• Surgical intervention with burr
holes may be required to evacuate
a large haematoma
194 / Chapter 6 Neurology: Extradural haematoma (epidural haemorrhage) Mind Maps for Medicine \ 195
Mind Maps for Medics.indb 194-195 7/13/2021 12:33:35 PMBooks for Medical Students
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@ScionMedical @scionpub scionpublishingMIND MAPS FOR MEDICINE
An innovative, visual textbook to help medical students learn
and understand core medical conditions.
The book features over 100 easy to follow, All mind maps are presented consistently
full colour mind maps of clinically relevant and cover:
medical conditions using a systems-based • Definition
structure: • Pathophysiology
• Cardiology • Causes and risk factors
• Respiratory • Clinical features: signs and symptoms
• Gastroenterology • Epidemiology
• Renal • Investigations: blood tests and imaging
• Endocrinology • Management: lifestyle, pharmacological
• Neurology and surgical
• Rheumatology • Complications
• Infectious diseases
Other key features:
The mind maps give you quick access to • Images are provided throughout the
key information in a visually appealing book to help illustrate key signs.
way. Where appropriate the mind map • Mnemonics are used throughout to
is followed by additional reference aid learning.
information to remind you about, for • Information is up-to-date and based
example, risk assessment tools, staging around the latest guidelines.
criteria, and treatment algorithms. • All topics are clinically relevant or likely to
appear in medical school examinations.
Mind Maps for Medicine is crucial reading for all medical students
but particularly those who consider themselves visual learners.
Pre-publication reviews from medical students
“Exactly what has been missing from the medical school textbook scene. It encompasses all
the need-to-know conditions, in a succinct yet detailed way, which makes studying easy.”
“This great book utilises the mind map format to present the core information, with handy
revision aids throughout!”
“Concise, colourful, and easy-to-follow – a great guide to common medical pathologies.”
“The mind maps are great – easy to follow with just the right amount of detail for medical students.”
“The level of detail, organisation of information and layout are great and will make studying very
enjoyable!! I think the addition of the ‘notes’ areas for many of the conditions is a great feature too!”
“These mind maps look great! Absolutely nailed it in terms of level of detail and layout/design”
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