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Clin Med - NEURO > Syncope, Vertigo and Altered Mental Status (AMS) > Flashcards

Syncope, Vertigo and Altered Mental Status (AMS) Flashcards

1
Q

what is the presentation of increased arousal

A

hypervigilant, agitated

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2
Q

what is the presentation of decreased arounsal

A

lethargic, stuporous, comatose

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3
Q

what is the presentation of decreased cognition

A

confusion, amnesia, hallucinations, detachment from reality

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4
Q

define hyper alter

A

increased arousal with increased sensitivity to surroundings

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5
Q

define confused

A

disoriented, bewildered, difficulty following commands

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6
Q

define delirous

A

disoriented, restless, hallucinating, may be delusional

acute onset - usually reversible

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7
Q

defne somnolent

A

sleepy, response to stimuli with incoherent mumbles

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8
Q

define lethargic

A

reduced level of alertness, decreased interest in surroundings

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9
Q

define obtunded

A

like lethargy but more so. slowed response to stimulation, sleeps more than normal, drowsy between sleep episodes

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10
Q

define stuprous

A

profoundly reduced alterness, requres continued novious stimuli for arousal

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11
Q

define comatose

A

state of deep, unarousable, unconsciousness

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12
Q

what is the presentation of dementia

A

slow onset, progressive, degenerative

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13
Q

what is the presentation of psychosis

A

sudden onset, need to rule out organic causes

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14
Q

what are the initial actions for AMS

A

look for reversible causes and address ASAP
Dextrose - POC glucose
Oxygen - pulse ox
Narcan - check pupils
Thiamine - ETOH?

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15
Q

what is one of the first tests that are run on patients who present with AMS

A

CT head

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16
Q

what is the vestibular system

A

complex arrangement of bones and cartilage in the ear, network of semicircular canals filled with fluid. fluid position changes with movement, sensor in ears sends info to brain to contribute to balance

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17
Q

what underlying conditions can cause problems with the vestibular system that lead to balance issues

A

medications
infections
inner ear problems - such as circulation
calcium debris in semicircular canals
central problems in brain, e.g. TBI

18
Q

what is the diagnostic approach to virtigo and dizziness complaints

A

TiTrATE

Timing of symptoms
Triggers that provoke symptoms
And a
Targeted
Evaluation

19
Q

what are the three main categories of vertigo

A

triggered episodic vertigo
spontaneous episodic vertigo
continuous vestibular vertigo

20
Q

what is triggered episodic vertigo

A

brief episodes lasting seconds to hours, intermittent
triggered by head or body movement or position change

21
Q

what is spontaneous episodic vertigo

A

last seconds to days - no triggers

22
Q

what is continuous vestibular vertigo

A

lasting days to week - need to ask about hearing loss

23
Q

what can trigger ‘triggered episodic vertigo’

A

BPPV (benign paroxysmal positional vertigo)
Orthostatic hypotension

24
Q

what is BPPV

A

benign paroxysmal positional vertigo - displaced canaliths in semicircular canals
most commonly occurs between 50-70 yo, no known cause in older people
can occur with head trauma in younger people
usually <1minute
often with rolling over in bed, always with change in head position

25
Q

what is orthostatic hypotension

A

change in vitals with change from supine to standing for one minute
SBP down 20mmHg, DBP down 10mmHg, HR up 30 bpm

26
Q

what conditions cause spontaneous episodic vertigo

A

Meniere’s disease and vestibular migraine

27
Q

what is Meniere’s disease

A

with low frequency hearing loss, often unilateral
associated with pain, pressure and/or fullness in affected ear
hearing usually improves between attacks but can become permanent

28
Q

what is the treatment of Meniere’s disease

A

diuretics, sodium restriction are initial treatments

29
Q

what is Dix Hallpike Maneuver used for

A

determining which type of triggered episodic vertigo a patient has based on the direction of their nystagmus

30
Q

what is epley maneuvers used for

A

therapeutic of for BPPV

31
Q

what is vestibular migraine

A

common, under-diagnosed, +/- headache
duration of vertigo from minutes to hours (can be longer)
motion sensitivity, and sensitive to visual motion (like movies)
may also have photophobia, phonophobia and visual aura

32
Q

what is the treatment of vestibular migraine

A

migraine meds and anti-emetics

33
Q

what is continuous vestibular vertigo

A

not positional, continues regardless of head motion
hearing is intact
affect ages 30-50, possible viral trigger
acute onset

34
Q

what is psychosomatic and functional dizziness

A

can be manifestation of depression, anxiety or panic disorder
need to also consider that anxiety can result from vestibular disorders
persistent postural-perceptual dizziness (PPPD)

35
Q

what is the treatment for psychosomatic and functional dizziness

A

SSRI, SBT, vestibular rehabilitation. avoid vestibular suppressants

36
Q

what is pre-syncopal dizziness due to

A

brain hypo-perfusion (often due to low BP)

37
Q

what is the pre-syncopal prodrome

A

poor hearing, feeling warm/cold, pallor, diaphoresis, abdominal pain, palpitations, hearing strange sounds, weakness, blurred vision, feeling “faint”

38
Q

what is syncope

A

loss of consciousness and muscle strength

39
Q

what are the most common causes of syncope

A

neurocardiogenic syncope
reflex syncope
vasovagal syncope

40
Q

what is cardiogenic syncope

A

life threatening
most commmon cause is arrhythmia - also ichemia, valvular abnormalities
often occurs without a prodrome

41
Q

what are the risk factors for cardiogenic syncope

A

FH of sudden cardiac death or MI (esp younger than 50yo)
cardiac disease
cardiac symptomatology

42
Q

what are differential diagnoses for syncope

A

seizure
stroke
trauma/head injury
sleep disturbance

Clin Med - NEURO (13 decks)

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