2. First tonic-clonic seizure

3. Single episode of prolonged vertigo

4. Single attack of prolonged vertigo: red flags
Focal neurological symptoms or signs at any time
Headache
Acute hearing loss
Abnormal eye movements not consistent with acute unilateral vestibular failure
If a patient with a single attack of prolonged vertigo has any of these red flags then you must assume their vertigo is central.
[read red flags]
Example: man with vertigo/balance problems but numb left arm 10 mins diagnosed as VN = pontine infarct.
Now the knowledgeable ones among you will know that acute hearing loss and headache are both features of migraine, but NEVER diagnose migraine in an older person presenting for the first time with a single episode of prolonged vertigo.
Reasons are: still need to meet IHS criteria; 10-34% of all stroke pts experience headaches around the time of their stroke – more common in post circ stroke. And some types of post circ strokes eg thalamus also cause “visual spectra” and odd sensory symptoms that may cause non-experts to confidently assume is due to migraine. I have seen registrars confidently diagnose migraine in these situations because they did not know what they did not know.
Yes it is possible that you might come across a first episode of migrainous vertigo – but always investigate (MR scan is the investigation of choice) and consult a specialist.

5. https://youtu.be/1q-VTKPweuk

6. Cardiac-sounding chest pain

7. Cluster headache

8. Deliberate paracetamol overdose

9. True or false?
The NAC infusion should be continued as the INR has risen from 0.9 to 1.3 indicating early hepatotoxicity
FALSE
NAC treatment itself may cause mild increases in PT (destabilises proteins including clotting factors) and an INR of ≤1.3 post-infusion is acceptable (especially as the ALT has not risen from baseline).

10. The LFTs in this case: when are test results significantly different?
Natural variation in biology and lab testing means that repeated tests on the same person are not identical
The limit of difference accounted for by these factors is called the ‘critical difference’
Different lab tests have different critical difference values …
e.g. the CD for AST is 27% - so a result of 200 can vary between 146 and 254 U/L due to biological and analytical variation

12. Recurrent falls

13. Single large pleural effusion

14. BTS guideline
Drain with VATS or using USS-guidance

16. Trainee update / feedback
SCE
ARCPs in February
Guide for Ed/Clin Sups AIM E Midlands
Suggestions?
Volunteers to lead a session please!
Best way to do exit questionnaires