Elderly

Question 1

Syncope definition and subclassifications

Answer 1

Transient loss of consciousness due to global cerebral hypo-perfusion with rapid onset, short duration and spontaneous complete recovery
Cardiovascular
Reflex
Orthostatic

Question 2

Causes of cardiovascular syncope

Answer 2

Tachyarrhythmia
Bradyarrhythmia
Structural disease
PE

Question 3

Types of orthostatic hypotension and causes

Answer 3

Primary autonomic - MSA, lewy body dementia, pure autonomic failure
Secondary autonomic - diabetes, amyloidosis, uraemia, addisons
Drug induced - alcohol, vasodilators, diuretics, antidepressants
Volume depletion - lack of intake, D+V etc

Question 4

Types of reflex syncope and causes

Answer 4

Vasovagal - mediated by emotional or orthostatic stress
Situational - cough, micturition, postprandial
Carotid sinus - oversensitivity of carotid sinus

Question 5

Treatment options for orthostatic hypotension

Answer 5

Treat underlying cause
Increase salt intake 
Advice on slow rising 
Compression stockings
Fludrocortisone

Question 6

When would fludrocortisone be contrindicated/cautioned

Answer 6

Chf / hypokalaemia

Question 7

When would syncope mean no driving?

Answer 7

Cardiogenic until incestigated and deemed safe

Neurally mediated if no prodrome or occurs when sitting

Question 8

Differentiate types of ending up on floor and potential causes

Answer 8

Unconcious
Transient loss of consciousness (syncope, seizure, psychogenic, trauma)
Falls