FN: Blackouts

Question 1

Causes Pneumonia

Answer 1

CRASH
Cardiac
Reflexes
Arterial
Systemic
Head

Question 2

Cardiac causes of blackouts

Answer 2

Stokes-Adams Attacks

• Brady: heart block, sick sinus, long QT
• Tachy: SVT, VT
• Structural
  1. Weak heart: LVF, tamponade
  2. Block: AS, HOCM, PE

Question 3

Refexes

Answer 3

1. Vagal overactivity

2. sympathetic underactivity

Question 4

Vagal overactivity

Answer 4

• vasovagal syncope
• Situational: cough, effort, micturition
• Carotid sinus syncope

Question 5

Sympathetic underactivity

Answer 5

STANDUP

1. Salt deficiency: addisons, hypovolaemia
2. Toxin
3. Autonomic Neuropathy: DM, Parkinsons. GBS
4. Dialysis
5. Unwell: chronic bed rest
6. Pooling venous: varicose veins, prolonged standing

Question 6

Toxins cause sympathetic underactivity

Answer 6

Cardiac: ACEi, diuretics, nitrates, alpha blockers

Neuro: TCAs, benzos, antipsychotics, L-DOPA

Question 7

Arterial causes of blackouts

Answer 7

1. Vertebrobasilar insufficiency: migraine, TIA, CVA, subclavian steal
2. Shock
3. Hypertension: Phaeochromocytoma

Question 8

Systemic causes fo blackouts

Answer 8

1. Metabolic: reduced glucose
2. Resp: hypoxia, Hypercapnoea (e.g. anxiety)
3. Blood: anaemia, hyperviscosity

Question 9

Head causes of blackouts

Answer 9

Epileps

Drop attacks + cataplexy emotional collapse

Question 10

Examiantion findings

Answer 10

Postural hypotension: difference of >20/10 after standing for 3 min vs. ;ing down
Cardiovascular examination
Neurological examination

Question 11

investigations

Answer 11

ECG ± 24hr ECG
U+E, FBC, Glucose
Tilt table
EEG, sleep EEG
Echo, CT, MRI brain

Question 12

Cardiogenic syncope presentation trigger

Answer 12

Exertion, drug, unknow

Question 13

Cardiogenic syncope presentation before

Answer 13

palpitations, chest pain, dyspnoea

Question 14

Cardiogenic syncope presentation during

Answer 14

pale, slow/absent pulse, conic jerks may occur

Question 15

Cardiogenic syncope presentation after

Answer 15

rapid recovery

Question 16

Cardiogenic syncope presentation investigations

Answer 16

ECG, 24hr ECG, Echo

Question 17

Reflex: vasovagal presentation trigger

Answer 17

prolonged standing, heat, fatigue, stress

Question 18

Reflex: vasovagal presentation before

Answer 18

Gradual onset: secs- mins
Nausea, pallor, sweating, tunnel vision, tinnitus
Cannot occur lying down

Question 19

Reflex: vasovagal presentation during

Answer 19

Pale, grey, clammy, brady

Clonic jerks and incontinence can occur, ut no tongue bitting

Question 20

Reflex: vasovagal presentation after

Answer 20

Rapid recovery

Question 21

Reflex: vasovagal presentation Investigations

Answer 21

Tlt-table testing

Question 22

Reflex: Postural Hypotension trigger

Answer 22

STanding up

Question 23

Reflex: Postural Hypotension before, during and after

Answer 23

same as vasovagal

Question 24

Reflex: Postural Hypotension Ix

Answer 24

Tilt-table testing

Question 25

Arterial trigger

Answer 25

Arm elevation (subclavin steel) migraine

Question 26

Arterial before, during and after

Answer 26

As for vasovagal ± brainstem Sx (diplopia, nausea, dysarthria)

Question 27

Arterial Ix

Answer 27

MRA, duplex vertebrobasilar circulation

Question 28

Systemic symtpoms

Answer 28

Hypoglycaemia: tremor, hunger, sweating, light-headness - LOC

Question 29

Head: epileptic trigger

Answer 29

Flashing lights, fatigue, fasting

Question 30

Head: epileptic before

Answer 30

e.g. aura in complex partial seizures - feeling strange, epigastric rising, deja.jamais vu, smells, lights, automatisms

Question 31

Head: epileptic during

Answer 31

Tongue biting, incontinence, stiffness - jeking, eyes open, cyanosis, reduced sats

Question 32

Head: epileptic after

Answer 32

headache, confusion, sleeps, todds palsy

Question 33

Head: epileptic Ix

Answer 33

EEG, raised Serum prlactin at 10-20 mins

Question 34

Head: drop attacks trigger

Answer 34

nil

Question 35

Head: drop attacks before

Answer 35

no warning

Question 36

Head: drop attacks during

Answer 36

sudden weakness of legs cause older women to fall to the ground

Question 37

Head: drop attacks after

Answer 37

no post-ictal phase