4.1 D) Medicine Cardiovascular Syncope (Multiple Sources )

Front 1

(The NNT.com)
Which of the following is correct regarding

Syncope?
A. The San Francisco Syncope Rule criteria numbers 4.
B. 1 in 5 patients presenting with syncope will have a serious outcome by 7 days.
C. 0.4% of all syncope patients will die by 7 days.
D. 3% of patients that are SFSR negative will have a 7 day serious

outcome.

Back 1

C.

A = 5
B = 1 in 10 Patients presenting with syncope will have a serious outcome by 7 days.
D = 1.4% of SFSR negative patients with have a 7 day serious outcome.

Front 2

Which of the following is not a well-known

Syncope study?
A. Boston Syncope Rule
B. ROSE study
C. OESAL risk score
D. San Francisco Syncope Rule

Back 2

C. OESIL risk score

Front 3

Which of the following is incorrect regarding

Syncope. ?
A. The SFSR has been externally validated > 7 times
B. Most patients who have syncope ultimately have a benign aetiology and Clinical course.
C. Arrhythmia is the largest category of pathology found in syncope.
D. The SFSR has a pooled Sensitivity for significant pathology of 93%

Back 3

D. The San Francisco Syncope Rule Has a pooled sensitivity for serious pathology of 86%

Front 4

In regards to the SFSR, which of the following is incorrect?
A. The study was a prospective cohort study
B. Syncope accounts for 1-2% of all ED visits per annum.
C. The rule aims to define a group of patients who are at low risk for acute complications, and can be discharged from the ED.
D. Of the 670 patients presenting with Syncope, 54 had serious outcomes after their ED visit, of which 23 were arrhythmias.

Back 4

D. 760 patients.

Front 5

Of the Arrhythmias encountered in the SFSR, the types diagnosed were?

Back 5

1. Bradyarrhythmias
2. Sick Sinus Syndrome
3. Supraventricular arrhythmias
4. Ventricular arrhythmias.

Front 6

[Tintinalli]

In the Framingham Heart Study, list the

approximate % incidence of each of the

following causes of syncope :

1. Vasovagal

2. Cardiac

3. Orthostatic

4. mediation related

5. Seizure

6. Unknown

Back 6

Unknown : 37%

Vasovagal : "reflex mediated" - 21%

Cardiac : 10%

Orthostatic : 9%

Medication related : 7%

Seizure 5%

Front 7

[Tintinalli]

List 4 causes of Structural Cardiopulmonary

disease - related Syncope.

Back 7

1. Aortic stenosis **

2. Cardiomyopathy

3. Tricuspid and mitral stenosis

4. Congenital heart disease

5. Pulmonary embolism

6. AMI

7. Aortic dissection

Front 8

[ Tintinalli]

In regards to Vasovagal Syncope, which of the following is incorrect ?

A. It is associated with inappropriate vasodilation and or bradycardia.

B. It usually is a result of inappropriate vagal OR sympathetic

stimulation

C. It usually occurs with a prodrome of light headedness, sweating and nausea.

D. It differs from Orthostatic hypotension by the presence of light

headedness.

Back 8

D. Vasovagal differs from Orthostatic by the presence of nausea and sweating in the

former.

Both have light headedness.

Front 9

[ Tintinalli]

List 5 medications contributing to Orthostatic Hypotension.

Back 9

1. B Blockers (BB)

2. Calcium Channel Blockers (CCB)

3. Diuretics

4. Antiparkinsonism drugs

5. Antiarrhythmics

6. Digoxin (cardiac glycosides )

Front 10

[ Tintinalli]

List 5 symptoms / signs suggest a seizure - Not syncope ?

Back 10

1. Post Ictal state (confusion )

lasting > 5 minutes

2. Tongue biting [ lateral tongue > tip ]

3. Incontinence - common

4. Epileptic aura [sometimes ]

5. Non -brief tonic clonic movements-common

Front 11

[ Tintinalli]

In regards to the Elderly and syncope, which of the following is incorrect ?

A. Aortic stenosis is the most common obstructive cardiac lesion in the elderly.

B. The incidence of vasovagal syncope increases with age.

C. The elderly have a less sensitive thirst

mechanism, and a decreased endocrine response to volume depletion.

D. Diabetes may lead to both autonomic

dysfunction AND peripheral neuropathy.

Back 11

B. Vasovagal syncope actually decreases with age.

Front 12

List the component of the San Francisco

Syncope Rule .

Back 12

"CHESS"

CCF

Haematocrit < 30

ECG abnormal ( Any)

Systolic BP < 90 mmHg in the ED

Shortness of Breath

Patients at risk of a cardiac cause of syncope > 55 years age

95% sensitive

60% specific

12% have serious outcomes < 7 days [ mortality ; arrhythmias]

Front 13

List Low Risk criteria for Syncope.

Back 13

1. Age < 45 years

2. Normally well - Otherwise Healthy

3. Normal ECG

4. Normal Cardiovascular examination

5.Prodrome consistent with vasovagal /

orthostatic hypotension

Front 14

Define Syncope.

Back 14

A symptom complex composed of a brief LOC associated with an inability to maintain

postural tone that spontaneously resolves without medical intervention .