3. Blackout

Question 1

Mr Williams is a 19 year old student who is brought in by ambulance after collapsing while at a university ball. A friend who witnessed the collapse has accompanied him to the hospital and confirms that he lost consciousness. What are the commonest causes of a transient loss of consciousness?
- 4 Mechanisms of syncope?
- 3 Reflex causes?
- 3 Cardiac causes?
- 4 Orthostatic causes?
- 3 Cerebrovascular causes?
- Non-syncopal causes? (6)

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Question 2

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Question 3

Now that you have your differential diagnosis and some idea of what is most common in a person of Mr William’s age, you can move onto the history.
What questions should you ask about the episode of loss of consciousness itself?

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Question 4

• Past medical history?

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Question 5

• Medications?
• Social history?
• Family history?

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Question 6

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Question 7

Mr William’s examination is unremarkable. What first-line investigations would you order and why?

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Question 9

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Question 10

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Question 11

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Mr Woodward has a history of light-headedness associated with standing that suggests orthostatic hypotension. The timing of these symptoms coincides with his new prescription of doxazosin for his prostate problems.

Question 12

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Question 13

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Question 14

A couple of months later, Miss Gokhale comes back to hospital via ambulance while fitting. The seizure started at a dinner while with her friends over half an hour ago and she has not fully regained consciousness at any time. What complication has happened to Miss Gokhale and how should she be managed acutely? What possible causes are there?

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Question 16

How would you define epilepsy? How are seizures classified?

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Question 17

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Question 18

Heart block is a common cardiac cause of loss of consciousness. What is the classification of heart block affecting the AV node (ie. not the bundles or fascicles)? How are different types distinguished on ECG?

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Question 19

What is a tilt table test and what is it used for?

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Question 20

What are the main side effects and interactions of anticonvulsant drugs in general and specifically: sodium valproate, lamotrigine, carbamazepine, phenytoin?

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Question 21

What should you, by law, advise patients with an episode of loss of consciousness about driving?

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Question 22

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Question 23

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Question 24

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Question 25

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Question 26

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Question 27

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Question 28

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