Lightheadedness, Dizziness and Syncope (Selby)

Question 1

What are the three major type of syncope?

Answer 1

Cardiac, reflex* and orthostatic hypotension

Question 2

Squatting increases they intensity of all murmurs except which two?

Answer 2

MVP and HCM– valsalva and standing increase their intensity

Question 3

What is the MOA of ADH?

Answer 3

ADH binds ot V2R and increases cAMP levels, leading to AQP-2 and urea-transporter insertion.

This is why urea levels rise with dehydration

Question 4

Who typically presents with postural tachycardia syndrome (POTS)?

Answer 4

14-45YO, F>M

Question 5

What is the major PE findings with hypertrophic cardiomyopathy?

Answer 5

Systolic murmur*

Question 6

How does the tx for CDI vs. NDI differ?

Answer 6

CDI: ADH
NDI: decrease solute intake, thiazide diuretics, NSAIDs, ADH*

Question 7

How do we dx PE?

Answer 7

Wells criteria
D-dimer– only rules out PE in low-intermediate risk pts
Doppler US
Echocardiogram

Question 8

What are some signs of hypovolemia or pre renal azotemia?

Answer 8

Hemoconcentration
Hypernatremia
Contraction metabolic alkalosis
BUN/Cr ratio > 20:1
Hyaline casts
FENA < 1%

Question 9

What are some classic sx that present with PE?

Answer 9

Dyspnea, pleuritic chest pain, cough, sx of DVT

Question 10

What is the tx/maintenance for HCM?

Answer 10

Avoid strenuous exercise
ICD
B-blocker

Question 11

What are some tx for reflex syncope?

Answer 11

Liberalize salt intake, encourage fluid intake, compression socks, abdominal binders

Question 12

What are the four types of orthostatic hypotension syncope?

Answer 12

Drug-induced, autonomic failure, postural tachycardia syndrome, volume depletion

Question 13

How do we dx postural tachycardia syndrome (POTS)?

Answer 13

Tilt table testing– sustained HR increase >30 bpm or absolute HR >120 bpm with first 10 minutes

Question 14

What is the pattern of inheritance of hypertrophic cardiomyopathy?

Answer 14

AD

Question 15

What are some inherited risk factors for VTE?

Answer 15

Factor 5 Leiden mutation, prothrombin mutation, protein C or S deficiency, anti-thrombin deficiency

Question 16

A sluggish capillary refill and skin tenting tells us what about the patient?

Answer 16

Dehydrated

Question 17

What is a specific finding we see in patients with autonomic failure orthostatic hypotension syncope?

Answer 17

Supine HTN but hypotension when upright

Question 18

What are the three main types of reflex syncope?

Answer 18

Carotid sinus hypersensitivity and syndrome, situational syncope, and vasovagal syncope

Question 19

Valsalva and standing increase the intensity of which two murmurs?

Answer 19

HCM and MVP