Exam 4 Syncope

Question 1

Syncope is?

a/w?

Result of?

Answer 1

Sudden, transient LOC w/ spontaneous recovery

Postural tone loss

↓ cerebral blood flow

Question 2

Syncope etiology? (4)

Answer 2

Reflex (vasovagal, situational)
Cardiac (obstruction, arrhy)
Ortho/autonomic
Psych (anxiety, panic somatization)

Question 3

Meds that cause Syncope? (8)

Answer 3

Anti-HTN
Anti-depress
Anti-anginal
Anti-arrhy
Anti-ED
Analgesics
EtOH
Drugs

Question 4

Syncope prodrome signs? (10)

Answer 4

Lightheaded
Facial pallor
Diaphoresis
Nausea
Uneasy
Visual blur
Chest pain
SOB
HA
Focal neuro

Question 5

Syncope exam should include? (4)

Answer 5

Orth BP both arms: drop > 20 SBP or > 10 DBP

Cardiac: rr, murmur, displ PMI, carotid bruits

Resp: hypervent

Neuro: LOC, CN, motor, cerebellar

Question 6

Syncope tests? (7)

Answer 6

ECG
Echo if card dz
Electrophys test (conduction system)
Stress test if a/w exertion
Carotid US
MRI
EEG (r/o seizure)

Question 7

Syncope labs?

Answer 7

CBC
e-
Glucose

Question 8

Tilt Table when?

Answer 8

Recurrent, unexplained syncope

No hx of cardiac dz

Question 9

Carotid Sinus Massage when?

Answer 9

Recurrent syncope w/ neg w/u

Hx of carotid sinus syncope

Question 10

Cardiac causes of Syncope?

Answer 10

Bradyarrhy:
SN dysf
AV block

Tachy

Outflow obstruction:
Aortic stenosis/dissection

Question 11

Syncope DDX?

Answer 11

Hypertrophic obstructive cardiomyopathy
PE
Cardiac tamponade
Cardia sinus syncope

Question 12

Vasovagal Syncope is?

Answer 12

Loss of sump tone or increase in parasym tone ->

vasodilation and brady -> hypoTN -> syncope

Question 13

Vasovagal Syncope a/w?

Answer 13

Stress

Pain/Shock

Question 14

Vasovagal Syncope prodrome? (4)

Answer 14

Lightheaded
Facial pallor
Diaphoresis
Nausea

Question 15

Micturition Syncope is?

Answer 15

Sync afte emptying distended bladder from excess fluids/etoh

2° to vagal stim or orthostasis

Question 16

Tussive Syncope is?

U seen in who?

Answer 16

Severe cough -> ↑intrathoracic pressure and CO

Barrel-chest/COPD, asthmatic kids

Question 17

Orthostatic HypoTN/Vasomotor syncope seen in who?

a/w?

Answer 17

U elderly

AntiHTN meds or TCAs
Dehydration

Question 18

Autonomic Syncope a/w?

Answer 18

DM neuropathy
Parkinson’s
Debilitation: malnutrition, anemia, adrenal insuff

Question 19

Subclavian Steal Synd is?

Answer 19

Subclavian artery stenosis near origin ->
flow reversal in ipsilat vertebral artery ->
↓ cerebral perfusion

Question 20

Subclavian Steal Synd presentation? (3)

Answer 20

Diplopia, vertigo, dysarthria
Sxs w/ arm exertion
Unequal pulses in UE

Question 21

Syncope tx?

Hospitalize when? (5)

Answer 21

tx cause

> 70yo
Heart dz
Neuro sxs
Freq or exertional syncope
Mod/severe ortho hypoTN

Question 22

Syncope vs Seizure:

Posture related?

Aura/prodrome?

Convulsion?

Skin color?

Cardio signs?

Answer 22

Posture related:
Sync = common
Seiz = no

Aura/prodrome:
Sync = long
Seiz = brief

Convulsion:
Sync = rare
Seiz = common

Skin color:
Sync = pallor
Seiz = cyanotic

Cardio signs:
Sync = common
Seiz = no

Question 23

Syncope vs Seizure:

Injury?

Urinary incont?

Postictal confusion?

Postictal HA?

Focal neuro?

Abn EEG?

Answer 23

Injury?:
Sync = rare
Seiz = common

Urinary incont:
Sync = rare
Seiz = common

Postictal confusion:
Sync = rare
Seiz = common

Postictal HA:
Sync = no
Seiz = common

Focal neuro:
Sync = no
Seiz = occasional

Abn EEG:
Sync = rare
Seiz = common