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OXFORD CASES > BLACKOUT > Flashcards

BLACKOUT Flashcards

1
Q

Transient loss of conscious can be divided into

A

Syncopal and non syncopal

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2
Q

TYPES OF SYNCOPAL

A

Reflex
Vasovagal- Brady cardia, reduced perfusion, cerebral hypoperfusion. Pain, fear, straining.
Carotid sinus hypersensitivity
Situational syncope

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3
Q

Types of syncope

A

Cardiac

Arrhythmias- reduction in cardiac output
Structural pathology eg aortic stenosis
Massive pe

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4
Q

Types of syncope

A

Orthostatic *when he stand there is a drop in by, compensated by vasoconstriction. TO prevent a transient fall in by as this mechanism takes a few seconds there is an increase in HR. If a patient has a reduced intravascular volume eg from dehydration this response is blunted.

Dehydration
Drugs- anti htn, anti sums
Autonomic instability

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5
Q

Types of non syncopal transient loc

A 
Intoxication eg alcohol sedatitives
Head trauma
Hypoglycaemia
Non epileptic seizure
Epileptic seizure 
Narcolepsy
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6
Q

MOST COMMON CASES OF LOC IN A 25 YEAR OLD

A

Vasovagal syncope

May have warning signs- calmly, sweating, pale, odd sensation in tummy, ear fullness

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7
Q

Most common cause of LOC in 55 year old

A

Vasovagal syncope or arrhythmia

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8
Q

Most common cause of loc in elderly

A

Orothsatic hypotension causes by meds
Diuretics - reduced blood volume and vasodilation
ACE- ‘’
b blockers- inability to increase HR
A blockers- inability to vasoconstriction
CCB- Inability to vasoconstrict

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9
Q

Epilepsy BEOFRE DURING AND AFTER

A

Before;
May have stereotypical aura or no warning
During;
Lasts minutes, incontinence, tongue biting, jerking, dropping, stiffening.
After;
Slowed recovery confused for 5-30minutes

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10
Q

Vasovagal before during after

A

Before;
Vagal symtptoms- sweating pallor, nausea, may be a precipitent
During
Lasts seconds, may be twitching or incontinence
After;
Rapid recovery on sitting/lying.

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11
Q

Arrhythmia before during and after

A 
Before;
No warning
During
Lasts seconds, may be twitching/ incontinence
After
Rapid spontaneous recovery
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12
Q

Past medical hx questions to ask after LOC

A 
Previous episode
Diabetes
Epilepsy
Cardiac illness
PVD- claudication 
Anemia - hypoxia 
Psychiatric illness- panic attacks, non epileptic seizures
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13
Q

Drug hx after LOC

A 
Insulin
Oral hypoglycemics
HTN
Vasodilators
Anti arrhythmias
Anti depressants- hypotension
Recreational drugs
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14
Q

Exam after LOC

A

Tongue- bitten - look at sides
Dehydration- dry mucous membranes, tachycardia, hypotension, decreased skin tugor
Head trauma- did it happen before/during/after LOC
Heart- rate, rhythm, jvp for cannon waves- complete heart block
Murmurs- aortic stenosis
Carotid brutish
BP- orthostatic hypotension. Lying down and within two minutes of standing. Drop in 20mm systolic or 10 diastolic on standing
Focal neuro signs- peripheral neuropathy, Parkinson’s. Full neuro recovery.

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15
Q

Investigations LOC

A

O2 says
Bloods- glucose FBC- anemia, U&E- electrolyte abnormality
ECG- BBB, short PR, long QT

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16
Q

Three main causes of aortic stenosis

A

Young patient- biscuit aortic valve
Elderly- calcification of aortic valve
RF

Differential diagnosis sudden LOC in young- HOCM

Slow rising pulse is seen in aortic stenosis

17
Q

LVH ECG

A

T wave inversion in lateral leads I aVL, V5-6

18
Q

RVH ECG

A

T wave inversion leads V1-V3 II III aVF

19
Q

Pulmonary embolism ecg

A

S1 Q3 T3

T wave inversion

20
Q

Hypertrophic cardiomyopathy

A

Deep t wave inversion on all leads

21
Q

RBBB

A

T wave inversion in right leads V1-3

22
Q

LBBB

A

T wave inversion in lateral leads I aVL V5-6

23
Q

Pulmonary hypertension

A

RVG- dominant r waves in v1 v2
RAD
P Pulmonslr peaked p- RAH
Right ventricular strain ST depression, t inversion V1-3

24
Q

Status epilepticus

A

Emergency
Start with abc
High flow O2, continuous ECG, pulse oximetry and bp cuff, glucose cap, 2 Iv lines, send of FBC U&E Ca and Mg.
selective toxin screen and levels of AED’s may be appropriate
Benzodiazepines used to terminate seizure need own line.
If hypoglycaemic 20% dextrose 50mL.
D E

To end seizure
2-4mg of lorazepam IV as slow bonus over 2 mins
If fitting 10mins later, repeat.
If 10mins later and still fitting intensive care consult and give phenytoin infusion loading dose of 18mg/kg at a rate of 50mg/min. Monitor ecg and be for arrhythmias and hypotension.
Still fitting may need GA- thiopentone

25
Q

Causes of status epilepicus

A 
Poor compliancce with AED
Metabolic causes- hypoglycaemia, electrolyte imbalance
Alcohol or other toxins 
Hypoxia 
Infection 
Hypertensive encephalopathy
26
Q

Complications of status epilepticus

A

Acute- hyperthermia, pulmonary oedema, arhtthmias and cardiovascular collapse

27
Q

First degree heart block

A

Slowing down of signal from atrium to ventricle. Longer PR >200ms interval. Due to damage of AV node ; ischemia, inflammation, fibrosis

28
Q

Second degree heart block

A

Some not all atrial contractions are transmitted to the ventricle.
Mobitz type 1; progressive lengthening of PR interval followed by miss QRS complex. Wenckebach pattern on ECG

Mobitz type 2; no warning by PR lengthening, random missed QRS- High risk it will progress to a complete heart block.

29
Q

Third degree heart block

A

No CONDUCTION between atria and ventricles. Random P waves- very broad. Ventricles rely on escape beats- 40bpm.

30
Q

Main side effects of AEDRUGS

A

Teratogenic
Sodium valproate- NTD
Phenytoin - cleft palate, congenital heart disease
Carbamazepine and phenytoin interfere with metabolism of contraceptive pill- should double dose/ use barrier. Can interfere with warfarin dosing.

31
Q

SE of sodium valproate

A

Weight gain, hair loss, hair curling, nausea, rash, drowsiness, tremor, drug induced hepatitis.

32
Q

Lamotrigine

A 
Rash, SJS
Headaches
Dizziness
Insomnia 
Vivid dreams
33
Q

Carbamezipine SE

A 
Rash
Nausea
Ataxia
Diplopoda
Agranulocytosis
Hyponatraemia
34
Q

Phenytoin side effects

A 
Acne
Rash
Ataxia
Opthalmoparesis 
Sedation
Gingival hyperplasia

OXFORD CASES (2 decks)

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