Loss of consciousness

Question 1

Key history in loss of consciousness

Answer 1

Preceding symptoms (nausea, diaphoresis, palpitations, pallor, lightheadedness)
Context (exertional, postural, traumatic, dehydration, stressful/painful/claustrophobic experience)
Tongue biting or incontinence
Tonic-clonic movements
Prolonged confusion
Dyspnea or pulmonary embolism risk factors
Hx of heart disease, arrhythmia, HTN, DM
Alcohol or drug use

Question 2

Key physical exam in loss of consciousness

Answer 2

Vital signs, including orthostatics
Neurologic exam
Carotid and cardiac exam
Lung exam
Lower extremities exam

Question 3

26 yo M who fell and lost consciousness at work
\+ rhythmic movements of limbs
\+ tongue biting
\+ urinary incontinence
\+ postictal confusion

Answer 3

Generalized tonic-clonic seizure
Convulsive syncope
Substance abuse/overdose

CBC, electrolytes, glucose, urine toxicology, EEG, MRI-brain, CT-head, LP-CSF analysis, ECG

Question 4

55 yo M fell after feeling dizzy and unsteady
+ transient LOC
+ PMHx significant for HTN and DM

Answer 4

Drug-induced orthostatic hypotension causing syncope
Hypoglycemia
Cardiac arrhythmia

Orthostatic vital signs, CBC, electrolytes, glucose, echocardiography, CT-head, ECG, V/Q scan, CTA-chest with IV contrast, D-dimer

Question 5

65 yo M fell without warning and had transient LOC
+ recent palpitations
+ PSHx of coronary artery bypass graft

Answer 5

Cardiac arrhythmia causing syncope
Severe aortic stenosis
Syncope

ECG, Holter monitoring, CBC, electrolytes, glucose, echocardiography, CT-head