History

Question 1

What are the common causes of TLoC?

Answer 1

• CV
• Neurological
• Psychogenic

Question 2

How would you divide your history?

Answer 2

• What happened before?
• What happened during?
• What happened after?
• Have there been episodes in the past?

Question 3

What would you asked in the ‘before’ section of the history?

Answer 3

o What were you doing?
o Any potential trigger?
o Did you get any warning?

Question 4

How do you clarify what a patient means by dizziness?

Answer 4

Dizziness can mean loss of balance or a spinning room

Did you lose your balance?
Was there a sensation like the room was spinning?

Question 5

What would you asked in the ‘during’ section of the history?

Answer 5

o Is there anyone I could speak to who saw your blackout?
o How long did it go on for?
o Were you stiff or floppy?
o How did you look?

Question 6

What would you asked in the ‘after’ section of the history?

Answer 6

o How did you feel when you came round?
o Tongue biting?
o Incontinence?
o Injury?

Question 7

What triggers differentiate between vasovagal syncope and seizures?

Answer 7

VV

• Pain
• Illness
• Emotion
• Dehydration
• Standing for a prolonged period of time

S

• Sleep deprivation
• Drugs
• Alcohol

Question 8

What prodromal symptoms differentiate between vasovagal syncope and seizures?

Answer 8

VV

• Feeling faint/light-headed
• Nausea
• Tinnitus
• Vision dimming

S

• Focal onset (not always present)
• Auras

Question 9

How does the duration of unconsciousness differentiate between vasovagal syncope and seizures?

Answer 9

VV
- <60s

S
-1-2 minutes

Question 10

How do the description of convulsions differentiate between vasovagal syncope and seizures?

Answer 10

VV
- Brief myoclonic jerks

S
- Tonic-clonic

Question 11

How does the colour of the patient differentiate between vasovagal syncope and seizures?

Answer 11

VV
- Pale/grey

S

• Flushed
• Cyanosied
• Pale

Question 12

What injuries differentiate between vasovagal syncope and seizures?

Answer 12

VV
- Uncommon to get injuries

S

• Lateral tongue biting
• Headache
• Generalised myalgia
• Back pain
• Shoulder fracture

Question 13

How does the recovery period differentiate between vasovagal syncope and seizures?

Answer 13

VV

• Rapid
• No confusion

S

• Gradually over 30 minutes
• Confusion, agitation, aggression

Question 14

What are the differentials of TLoC?

Answer 14

• Vasovagal syncope
• Seizures
• Panic attacks with hyperventilation
• NEAD
• Migraine
• Medication, alcohol or drug intoxication
• Sleep disorders
• Movement disorders
• Delirium or dementia

Question 15

What are the red flags for TLoC?

Answer 15

• MI
• Arrhythmias
• TIA
• Occult haemorrhage
• Aortic dissection
• Cardiac tamponade
• Severe hypoglycaemia
• Addison’s disease
• Massive PE