Blackout hx

Question 1

Key question

Answer 1

Did anyone see you fall?

Question 2

Types of falls

Answer 2

Mechanical
Cardiovascular
Cerebrovascular (Neuro)

Question 3

What questions would you ask?

Answer 3

What shoes were you wearing?

Question 4

Cardio causes of falls

Answer 4

AF/arrhythmias
Postural hypotension (new BP bloods)
Mitral valve regurg
HF

Question 5

Symptoms of cardio falls

Answer 5

Palpitations 
SOB
Dizziness/light headed 
Nausea 
Chest pain

Question 6

Main cause of neuro falls?

Answer 6

Epilepsy

Question 7

If they have epilepsy, is the patient conscious?

Answer 7

No! Hence collateral history

Question 8

What would you ask for neurogenic seizure focussed fall?

Answer 8

Did you feel funny before you fell? (prodromal auras)
During - ask for collateral history
Was your tongue bleeding? (tongue biting)
Did you notice that you had weed yourself? (epilepsy)

Question 9

How would you diagnose epilepsy?

Answer 9

Requires two seizures

Only consultant neurologists can diagnose

Question 10

Describe what symptoms a patient with TIA and visual disturbance would cause

Answer 10

Sudden or curtain drop?

Question 11

What three questions would you ask about what happened BEFORE the blackout?

Answer 11

Was there any warning?
Were there precipitating factors?
Was there any recent head trauma?

Question 12

Which conditions have warning signs?

Answer 12

Partial seizures
Vasovagal

NOTE: usually cardiac causes do not have warning signs

Question 13

What warning sign would be present in partial seizures?

Answer 13

Auras

Question 14

Precipitating factors (triggers) for MI causes

Answer 14

Exercise

Question 15

Short lived syncope causes with spontaneous recovery

Answer 15

Cardiac

vasovagal causes

Question 16

What three questions would you ask about what happened DURING the blackout?

Answer 16

How long was the patient unconscious? Minutes? Seconds?

Did they bit their tongue/move limbs/ were incontinent

Question 17

Which causes of syncope would cause tongue biting / limb movemnet

Answer 17

Vasovagal (parasympathetic loss of tone)

Seizures

Question 18

What three questions would you ask about what happened AFTER the blackout?

Answer 18

Did they recover spontaneously?
How long did it take to recover?
Were they confused after recovery?

Question 19

Give examples of ‘vagal’ symptoms

Answer 19

Clammy
sensation in stomach
Nausea

Question 20

What is the classic triad of aortic stenosis?

Answer 20

Dypsnoea
Chest pain
Syncope

Question 21

Systems questions????????

Answer 21

Chest pain, palpitations?

Resp: dyspnoea, cough, sputum, wheeze, haemoptysis, pleurtiic chest pain

GI: dyspepsia, nausea, voimiting, dyspahgia, abdo pain

Genitourinary: oliguria, polyuria, dysuria

Question 22

Relevant pre existing conditions

Answer 22

Epilepsy/seizures
Diabetes
Cardiac illness e.g:
congenital bicuspid aortic valve
Heart disease
MI
Aortic stenosis
Hypertrophic obstructive cardiomyopathy 

Anaemia
Psych conditions e.g. depression/anxiety

Question 23

Relevant drug hx

Answer 23

Insulin
AntiHTN
Vasodilators

Question 24

Relevant drug hx

Answer 24

Insulin
AntiHTN
Vasodilators
Anything that prolongs the QT interval

Question 25

Why is smoking a relevant risk factor?

Answer 25

Can cause calcification of the aortic valve and thus aortic stenosis

Question 26

Which recreational drugs are relevant?

Answer 26

Cocaine -> tachyarrythmias

Question 27

What other social history factors would you ask about?

Answer 27

Diet
Exercise
Occupation 
Stress
Travel 
Sexual history