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1
Q

Causes of falls

A 
. Delirium
. Cardiac, neuro, muscular-skeletal condition
. Side-effects from medications
. Balance, strength, mobility 
. Poor eyesight 
. Poor memory 
. Incontinence, unitary urgency
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2
Q

Collapse

A

. Fall down and become unconscious

. Nonspecific term w/ mult. Etiologies

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3
Q

Causes of collapse

A 
. Alcohol
. Epilepsy 
. Infection
. Overdose
. Uremia 
. Trauma
. Insulin
. Psychogenic 
. Stroke

(AEIOU TIPS)

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4
Q

Syncope

A

. Most common cause collapse
. Temporary loss of consciousness related to insufficient blood flow to brain
. Some stimulus causes neural reflex to certain triggers
. Characterized by bradycardia (+vagus nerve) an/or peripheral vasodilation (-sympathetic)
. Benign

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5
Q

Cardiac Syncope

A

. Loss of adequate cerebral perfusion from sudden reduction in CO

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6
Q

Cardiac syncope signs and symptoms

A 
. Collapse
. Blurred vision
. Dizziness
. Pale/dusky appearance
. Cardiac arrhythmia/murmur
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7
Q

Cardiac syncope etiology

A

. Ventricular rate <35 or >180 bpm

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8
Q

Common history/ROS relating to cardiac syncope

A

. History of HTN, CVD, hypercholesterolemia,
. Assoc. w/ inc. physical activity, rising from seated position, dec. fluid intake, warm environment
. Collapse, palpitations, cough, chest pain, arm/jaw pain, diaphoresis, nausea/vomiting

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9
Q

Physical exam findings related to cardiac syncope

A

. Abnormal vital signs, anxious appearance, respiratory distress, weakness, JVD, arrhythmia, cardiac murmur, muffled heart sounds. Bilateral crackles, peripheral edema
. OMM/musculoskeletal, sympathetic T1-5 on left, parasympathetic occiput, C1 C2 w/ lack of localized peripheral findings

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10
Q

Cerebrovascular accident(CVA)

A

. Stroke

. Dec. (ischemic) or inc. (hemorrhagic) blood flow to specific brain region

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11
Q

CVA signs and symptoms

A 
. Headache
. Altered mental/confusion
. Vision changes
. Vertigo/dizziness
. Focal neurologic deficits (sensory/motor loss)
. Papilledema
. Retinal hemorrhage 
. Apraxia
. Agnosia
. Dysarthria
. Dysphagia
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12
Q

CVA etiology

A

. Ischemic (thrombotic, embolic secondary to dissection/hypoperfusion)
. Hemorrhagic (spontaneous trauma)
. Embolic from mural thrombi
. Abnormal cardiac valves/rhythms

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13
Q

Transient Ischemic Attacks (TIA)

A

. NOT STROKE
. Brief stroke-like event that resolve in minutes to hours but require immediate medical attention to distinguish from actual stroke
. Assoc. w/ decreased blood flow to specific portion of brain
. Warning sign for CVA

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14
Q

History/ROS related to CVA

A 
. Collapse
. Headache
. Altered mental/confusion
. Vision change
. Apraxia 
. Agnosia
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15
Q

Physical exam findings related to CVA

A 
. Abnormal vitals
. Acute visual acuity changes
. Focal neurologic deficits
. Rhomberg’s 
. Papilledema
. Retinal hemorrhage
. Carotid bruits 
. OMM: sensory/motor deficits
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16
Q

Vasovagal syncope (neurocardiogenic syncope, fainting)

A

. Transient loss of consciousness assoc. w/ loss of tone from lack of oxygen to brain stem from dec. Cardiac output (CO)

17
Q

Vasovagal syncope signs and symptoms

A 
. Prodromal symptoms vague
. Lightheadedness
. Diaphoresis
. Dimming vision
. Nausea 
. Weakness
. Signs of resulting trauma
18
Q

Vasovagal syncope etiology

A

. Reflex response causing vasodilation
. Initiated by pain/fear, cough, sneeze, GU/GI stimulation, volume depletion, drugs, hemorrhage
. Precipitating factors: stress, pregnancy, dehydration, previous history

19
Q

physical exam findings related to vasovagal syncope

A

. Normal findings

. OMM: normal except possible injury from fall itself

20
Q

Partial (focal) seizures

A

. Affect single area brain (medial temporal most common)
. Preceded bu aura
. Can secondarily generalize
. Simple partial (consciousness maintained)
. Complex partial (impaired consciousness)

21
Q

Generalized seizures

A

. Affect brain diffusely
. Absence (petit mal): blank store, no post-Ictal confusion
. Myoclonic: quick repetitive jerks
. Tonic-clonic: grand mal, alternating stiffening and movement
. Atonic: drop seizures, mistaken for fainting

22
Q

Seizure signs and symptoms

A 
. Various 
. Altered level consciousness
. Involuntary muscular movements 
. Nuchal rigidity
. Papilledema (inc. ICP)
. Tongue lacerations
. Incontinence
. Post ictal confusion
23
Q

Seizure etiology

A 
. Infection
. Hypoxia
. Stroke
. Toxins
. Fever (usually children)
. Genetic
. Metabolic
. Trauma
. Idiopathic
24
Q

Epilepsy

A

. Characterized by recurrent seizure activity

. Febrile seizures NOT epilepsy

25
Q

Status epilepticus

A

. Continuous/recurring seizures may result in brain injury

. More than 5 minutes duration

26
Q

Most common cause of seizure for infant

A

. Infection
. Prenatal injury/ischemia
. Genetic
. Metabolic

27
Q

Most common cause of seizure in children

A 
. Fever (inc. neural irritability, dec. seizure threshold)
. Genetic
. Infection
. Trauma
. Metabolic
28
Q

Most common causes of seizure in adults

A

. Tumor
. Trauma
. Stroke
. Infection

29
Q

Most common cause of seizures in elderly

A 
. Stroke
. Tumor
. Trauma
. Metabolic
. Infection
30
Q

How to diagnose seizure

A

EEG

31
Q

Pulmonary embolism (PE/PTE)

A

. Pulmonary vessel obstruction causing ventilation-perfusion (VQ) mismatch to hypoxemia and hypocapnia (dec. carbon in blood)
. Leads to respiratory alkalosis

32
Q

PTE signs and symptoms

A

. Often variable and nonspecific
. May have sudden onset dyspnea, cough, chest pain, tachypnea, collapse
. Large embolis (traveled thrombus) or saddle embolis may cause sudden death

33
Q

PTE etiology

A

. Majority from thrombus in deep veins of lower leg and pelvis
. Can be from Fat, air, thrombus, bacteria, amniotic, tumor (FAT BAT)

34
Q

PTE risk factors

A 
. Obesity
. Smoking
. Trauma
. Infection
. heart disease
. Immobility
. Malignancy
. Surgery
. Factor 5 Leiden deficiency
. Pregnancy
. Oral contraceptives (OTCs)
35
Q

Physical exam findings related to PE

A

. Normal/abnormal vitals
. Conversational dyspnea
. Respiratory distress
. Unilateral adventitious (abnormal) lung sounds
. OMM: T1-4 unilateral/bilateral, accessory respiratory muscle use

36
Q

High risk patients w/ syncope

A

. Clinical history suggestive of arrhythmic syncope
. Comorbities
. EEG history suggestive of arrhythmic syncope
. Family history of sudden death
. Hypotension
. Older age
. Severe structural heart disease, congestive heart failure, coronary artery disease

37
Q

Low risk patients w/ syncope

A 
. Less than 50 y/o
. No history of cardiovascular disease 
. Normal EEG findings
. Symptoms consistent w/ neurally mediated or orthostatic hypotension syncope 
. Unremarkable cardiovascular findings

PSP (35 decks)

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