BLOCK 5 - EXAM 3 (- WEEK 9) | TOP SCORES MADE
SIMPLE | TRUSTED TEST SOLUTIONS!
Syncope Answer: Sudden transient loss of consciousness (LOC) due to inadequate
cerebral blood flow
Sudden transient loss of consciousness (LOC) due to inadequate cerebral blood flow
Answer: Syncope
Presyncope Answer: A light-headed, swimming sensation or feeling of fainting or falling
caused by decreased blood flow to brain or heart irregularity causing decreased cardiac
output
- No loss of concious
A light-headed, swimming sensation or feeling of fainting or falling caused by decreased
blood flow to brain or heart irregularity causing decreased cardiac output
- No loss of consciousness Answer: Presyncope
Prodrome of syncope Answer: Dizziness, palpitations, nausea, diaphoresis, light-
headed etc.
Dizziness, palpitations, nausea, diaphoresis, light-headed etc. Answer: Prodrome of
syncope
CVA/TIA and Syncope Answer: Unusual causes of syncope unless there isbilateral
carotid artery disease or vertebrobasilar/brainstem disease
Unusual causes of syncope unless there is bilateral carotid artery disease or
vertebrobasilar/brainstem disease Answer: CVA/TIA
Global cerebral ischemia is required for? Answer: syncope
What is required for syncope Answer: Global cerebral ischemia
Vasovagal Syncope Answer: Syncope caused by overreaction of the vagus nerve,
leading to a drop in blood pressure and heart rat
- Associated with stress, pain, emotional disturbance, acute illness etc.
- Better with lying flat
Syncope caused by overreaction of the vagus nerve, leading to a drop in blood pressure
and heart rat
1
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,- Associated with stress, pain, emotional disturbance, acute illness etc.
- Better with lying flat Answer: Vasovagal Syncope
What syncope is better when lying flat? Answer: Vasovagal Syncope
Orthostasis Answer: Syncope that occurs upon standing from lying or sitting position
Syncope that occurs upon standing from lying or sitting position Answer: Orthostasis
Causes of Orthostasis Answer: - Drugs
- Volume depletion
- Autonomic dysfunction
Diagnosis of Orthostasis Answer: Vital signs are taken lying, sitting and standing
- Positive if HR increases by 20-30 bpm, SBP decreases by 20-30 mmHg, or
symptomatic
Vital signs are taken lying, sitting and standing
- Positive if HR increases by 20-30 bpm, SBP decreases by 20-30 mmHg, or
symptomatic Answer: Orthostasis
Cardiogenic Syncope Answer: Syncope with no prodrome so more injuries related to
falling
- Caused by sudden decrease in cardiac output
- Often associated with CAD or other vascular disease
Syncope with no prodrome so more injuries related to falling
- Caused by sudden decrease in cardiac output
- Often associated with CAD or other vascular disease Answer: Cardiogenic Syncope
CNS syncope Answer: Syncope that results in aura, tonic-clonic activity, tongue-biting,
bowel/bladder incontinence, postictal confusion
- Tend to be unconscious for longer periods of time
Syncope that results in aura, tonic-clonic activity, tongue-biting, bowel/bladder
incontinence, postictal confusion
- Tend to be unconscious for longer periods of time Answer: CNS syncope
Metabolic syncope Answer: Typically caused by hypoglycemia
- Prodrome of agitation/confusion, tachycardia, diaphoresis, shaking etc.
2
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,- Always check blood glucose on an unconscious patient
Typically caused by hypoglycemia
- Prodrome of agitation/confusion, tachycardia, diaphoresis, shaking etc.
- Always check blood glucose on an unconscious patient Answer: Metabolic syncope
Micturition syncope Answer: Syncope with urination
Post-tussive syncope Answer: Syncope with coughing
Syncope with urination Answer: Micturition syncope
Syncope with coughing Answer: Post-tussive syncope
Hypersensitive carotid sinus syncope Answer: Syncope with carotid sinus massage
What is the most common physical exam finding with P.E. Answer: Syncope
Syncope evaluation Answer: Orthostatic VS, cardiac exam (murmurs), neuro exam,
carotid sinus massage
- EKG is often useful
- ECHO to evaluate for structural heart disease
Holter monitor Answer: portable ECG monitor worn by patient for period of few hours to
few days to assess heart and pulse activity as person goes through activities of daily
living
- Used in patients with syncope
portable ECG monitor worn by patient for period of few hours to few days to assess
heart and pulse activity as person goes through activities of daily living
- Used in patients with syncope Answer: Holter monitor
Tilt-table testing Answer: Used in the diagnosis of orthostatic hypotension
55 yo f presents to the E.D. with recurrent syncope. She has a 1 month h/o postural
light-headedness with 2 recent syncopal episodes. Both episodes occurred while the
patient was standing and were immediately preceded by light-headedness and tunnel
vision. Each episode was witnessed and did not appear to be associated with tongue
biting, bowel/bladder incontinence, focal neurologic changes, jerking or twitching. She
denies any chest pain, palpitations, dyspnea or diaphoresis during her episodes. She
regained consciousness within a minute without any confusion. She also complained of
dry eyes, dry mouth and constipation. Her medical history is otherwise unremarkable.
3
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, She is not taking any medications. She is a 20 pack-year smoker and drinks alcohol
occasionally. Answer: Orthostasis due to autonomic dysfunction
What test/labs/imaging etc. do you want to order for a patient with syncope? Answer: -
Orthostatic VS, cardiac exam (murmurs), neuro exam, carotid sinus massage
- EKG is often useful
- ECHO to evaluate for structural heart disease
A condition where blood pressure drops significantly upon standing up, due to an
inability of the body to compensate for the change in position. Answer: Orthostatic
Hypotension
What enables such a fast and profound
change in muscle perfusion? Increase in:
A. Cardiac output
B. Cardiac index
C. Total peripheral resistance
D. Systolic blood pressure
E. Heart rate
F. Diastolic blood pressure Answer: A. Cardiac output
B. Cardiac index
D. Systolic blood pressure
E. Heart rate
Exercise effect on cardiac output Answer: Increases cardiac output
Exercise effect on cardiac index Answer: Increases cardiac index
Exercise effect on total peripheral resistance Answer: Decreases TPR
Exercise effect on SBP Answer: Increases SBP
Exercise effect on HR Answer: Increases HR
Exercise effect on DBP Answer: No effect
Exercise effect on Stroke volume Answer: Increases stroke volume
Exercise effect on MAP Answer: Increases MAP
4
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SIMPLE | TRUSTED TEST SOLUTIONS!
Syncope Answer: Sudden transient loss of consciousness (LOC) due to inadequate
cerebral blood flow
Sudden transient loss of consciousness (LOC) due to inadequate cerebral blood flow
Answer: Syncope
Presyncope Answer: A light-headed, swimming sensation or feeling of fainting or falling
caused by decreased blood flow to brain or heart irregularity causing decreased cardiac
output
- No loss of concious
A light-headed, swimming sensation or feeling of fainting or falling caused by decreased
blood flow to brain or heart irregularity causing decreased cardiac output
- No loss of consciousness Answer: Presyncope
Prodrome of syncope Answer: Dizziness, palpitations, nausea, diaphoresis, light-
headed etc.
Dizziness, palpitations, nausea, diaphoresis, light-headed etc. Answer: Prodrome of
syncope
CVA/TIA and Syncope Answer: Unusual causes of syncope unless there isbilateral
carotid artery disease or vertebrobasilar/brainstem disease
Unusual causes of syncope unless there is bilateral carotid artery disease or
vertebrobasilar/brainstem disease Answer: CVA/TIA
Global cerebral ischemia is required for? Answer: syncope
What is required for syncope Answer: Global cerebral ischemia
Vasovagal Syncope Answer: Syncope caused by overreaction of the vagus nerve,
leading to a drop in blood pressure and heart rat
- Associated with stress, pain, emotional disturbance, acute illness etc.
- Better with lying flat
Syncope caused by overreaction of the vagus nerve, leading to a drop in blood pressure
and heart rat
1
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,- Associated with stress, pain, emotional disturbance, acute illness etc.
- Better with lying flat Answer: Vasovagal Syncope
What syncope is better when lying flat? Answer: Vasovagal Syncope
Orthostasis Answer: Syncope that occurs upon standing from lying or sitting position
Syncope that occurs upon standing from lying or sitting position Answer: Orthostasis
Causes of Orthostasis Answer: - Drugs
- Volume depletion
- Autonomic dysfunction
Diagnosis of Orthostasis Answer: Vital signs are taken lying, sitting and standing
- Positive if HR increases by 20-30 bpm, SBP decreases by 20-30 mmHg, or
symptomatic
Vital signs are taken lying, sitting and standing
- Positive if HR increases by 20-30 bpm, SBP decreases by 20-30 mmHg, or
symptomatic Answer: Orthostasis
Cardiogenic Syncope Answer: Syncope with no prodrome so more injuries related to
falling
- Caused by sudden decrease in cardiac output
- Often associated with CAD or other vascular disease
Syncope with no prodrome so more injuries related to falling
- Caused by sudden decrease in cardiac output
- Often associated with CAD or other vascular disease Answer: Cardiogenic Syncope
CNS syncope Answer: Syncope that results in aura, tonic-clonic activity, tongue-biting,
bowel/bladder incontinence, postictal confusion
- Tend to be unconscious for longer periods of time
Syncope that results in aura, tonic-clonic activity, tongue-biting, bowel/bladder
incontinence, postictal confusion
- Tend to be unconscious for longer periods of time Answer: CNS syncope
Metabolic syncope Answer: Typically caused by hypoglycemia
- Prodrome of agitation/confusion, tachycardia, diaphoresis, shaking etc.
2
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,- Always check blood glucose on an unconscious patient
Typically caused by hypoglycemia
- Prodrome of agitation/confusion, tachycardia, diaphoresis, shaking etc.
- Always check blood glucose on an unconscious patient Answer: Metabolic syncope
Micturition syncope Answer: Syncope with urination
Post-tussive syncope Answer: Syncope with coughing
Syncope with urination Answer: Micturition syncope
Syncope with coughing Answer: Post-tussive syncope
Hypersensitive carotid sinus syncope Answer: Syncope with carotid sinus massage
What is the most common physical exam finding with P.E. Answer: Syncope
Syncope evaluation Answer: Orthostatic VS, cardiac exam (murmurs), neuro exam,
carotid sinus massage
- EKG is often useful
- ECHO to evaluate for structural heart disease
Holter monitor Answer: portable ECG monitor worn by patient for period of few hours to
few days to assess heart and pulse activity as person goes through activities of daily
living
- Used in patients with syncope
portable ECG monitor worn by patient for period of few hours to few days to assess
heart and pulse activity as person goes through activities of daily living
- Used in patients with syncope Answer: Holter monitor
Tilt-table testing Answer: Used in the diagnosis of orthostatic hypotension
55 yo f presents to the E.D. with recurrent syncope. She has a 1 month h/o postural
light-headedness with 2 recent syncopal episodes. Both episodes occurred while the
patient was standing and were immediately preceded by light-headedness and tunnel
vision. Each episode was witnessed and did not appear to be associated with tongue
biting, bowel/bladder incontinence, focal neurologic changes, jerking or twitching. She
denies any chest pain, palpitations, dyspnea or diaphoresis during her episodes. She
regained consciousness within a minute without any confusion. She also complained of
dry eyes, dry mouth and constipation. Her medical history is otherwise unremarkable.
3
APPHIA - Crafted with Care and Precision for Academic Excellence.
, She is not taking any medications. She is a 20 pack-year smoker and drinks alcohol
occasionally. Answer: Orthostasis due to autonomic dysfunction
What test/labs/imaging etc. do you want to order for a patient with syncope? Answer: -
Orthostatic VS, cardiac exam (murmurs), neuro exam, carotid sinus massage
- EKG is often useful
- ECHO to evaluate for structural heart disease
A condition where blood pressure drops significantly upon standing up, due to an
inability of the body to compensate for the change in position. Answer: Orthostatic
Hypotension
What enables such a fast and profound
change in muscle perfusion? Increase in:
A. Cardiac output
B. Cardiac index
C. Total peripheral resistance
D. Systolic blood pressure
E. Heart rate
F. Diastolic blood pressure Answer: A. Cardiac output
B. Cardiac index
D. Systolic blood pressure
E. Heart rate
Exercise effect on cardiac output Answer: Increases cardiac output
Exercise effect on cardiac index Answer: Increases cardiac index
Exercise effect on total peripheral resistance Answer: Decreases TPR
Exercise effect on SBP Answer: Increases SBP
Exercise effect on HR Answer: Increases HR
Exercise effect on DBP Answer: No effect
Exercise effect on Stroke volume Answer: Increases stroke volume
Exercise effect on MAP Answer: Increases MAP
4
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