SYNCOPE

Question 1

triggered by centrally mediated inhibition of the normal tonic sympathetic
influences, is often associated with excessive vagal
effect and bradycardia (vagal effect)

Answer 1

vasovagal syncope

Question 2

is meant the withdrawal of sympathetic tone through a

reflex neural mechanism

Answer 2

neurocardiogenic syncope

Question 3

Neurocardiogenic syncope usually

signifies that the inciting stimulus originates in ________

Answer 3

neural

receptors within the heart

Question 4

failure of sympathetic innervation of blood vessels and of autonomically activated compensatory responses (reflex tachycardia and vasoconstriction), which occurs with assumption of the upright body position
and leads to pooling of blood in the lower parts of
the body

Answer 4

orthostatic hypotension

Question 5

caused by a primary diminished
cardiac output because of disease of the heart itself
as in the ____________ bradyarrhythmia attack, severe
aortic or subaortic stenosis, or ischemic heart disease

Answer 5

Stokes-Adams

Question 6

The vasodepressor faint occurs

(1) in normal health under the influence of strong emotion, particularly in some susceptible individuals (sight of blood or an accident) or in conditions that ___________
e. g., hot, crowded rooms (“heat syncope”), e

Answer 6

favor peripheral vasodilatation,

Question 7

The vasodepressor faint occurs

2) during a ____________ (especially
of the abdomen or genitalia), as a consequence of
fright, pain, and other factors (where pain is involved, the
vagal element tends to be more prominent in the genesis
of the faint

(3) during ______ in some sensitive persons

Answer 7

painful illness or after bodily injury

exercise

Question 8

authentic seizure caused by a prolonged period of

brain hypoxia

Answer 8

con vulsive syncope

Question 9

heightened vagal discharge produced by compression
of the eyeballs _________could produce brief periods of cardiac
arrest and syncope

Answer 9

( oculovagal reflex, a cause of syncope in

acute glaucoma)

Question 10

T or F

In essence, all the types of
syncope in this category are “vasovagal,” meaning a combination
of vasodepressor and vagal effects in varying
proportions; the only differences are in the stimuli that
elicit the reflex response.

Answer 10

T

Question 11

Unmyelinated (postganglio􀄠􀄡 sympathe􀅐c)
fibers cease firing during vasovagal famting at a pomt
when the blood pressure falls below _______ mm Hg
and the pulse, below ________

Answer 11

80/40

60

Question 12

There is agreement that peripheral vascular resiStance
is greatly reduced just prior to and at th􀂴 onset of
fainting. This drop in resistance has been attributed to
an initial _______discharge that, at high levels, causes
a ___________

Answer 12

adrenergic

vasodilatation

Question 13

the drp􀂵p in blood
pressure is the result of a transient 􀀖ut excessive activity
of sympathetic nerves that paradoXIcally leads to vascular dilatation in muscle and viscera from an _______

Answer 13

imbalance between beta-adrenergic and alpha-adrenergic activity
peripherally.

Question 14

Oberg and Thoren were the first to observe tha􀅑 the
_______ itself can be the source of neurally mediated
syncope in much the same way as the _______when
stimulated, produces vasodilatation and bradycardi􀄥.

Answer 14

left ventricle

carotid sinus

Question 15

the heart as the afferent

source of vasodepressor reflexes

Answer 15

Bezold-Jansch reflex.

Question 16

The _______ is the site of most ofthe
subendocardial mechanoreceptors that are responsible
for the afferent impulses to the nucleus tractus solitarius

Answer 16

inferoposterior

wall of the left ventricle

Question 17

a proclivity to primary neurocardiogenic
syncope can be identified by the finding of
delayed fainting when the patient is placed at 􀉞__________ position on a tilt table.

After approXImately _________ the blood pressure dr􀂶ps bel􀂶w100 mm Hg; soon thereafter, the patient complams of diZziness and sweating and subsequently faints.

In contrast,
patients with primary sympathetic failure􀄬 will faint________

Answer 17

60-degree upright

10 min of upright posture,

s 􀄭oon
after upward tilting.

Question 18

Th e ____________ i s normally sensitive t o stretch and gives rise to sensory impulses carried via the nerve of Hering, a tributary of the glossopharyngeal nerve, to the medulla.

Answer 18

carotid sinus

Question 19

Massage of one of the carotid sinuses or of both alternately, particularly in elderly persons, causes

(1) a reflex cardiac
slowing (sinus bradycardia, sinus arrest, or even atrioventricular
block)-the ________, or

(2) a fall of
arterial pressure without cardiac slowing-the __________

Answer 19

vagal type of response

vasodepressor type of response.

Question 20

Pathophysio of syncope in Glossopharyngeal neuralgia

Answer 20

Presumably the pain gives rise to a massive volley of afferent impulses
along the ninth cranial nerve, activating the medullary
vasomotor centers via collateral fibers from the nucleus
of the tractus solitarius. An increase in parasympathetic
(vagal) activity slows the heart

Question 21

consciousness is
lost during or immediately after a forceful swallow.

The
administration of anticholinergic drugs ___________ has abolished these attacks

Answer 21

deglutitional syncope

propantheline 15 mg tid

Question 22

Pathophysio of micturition syncope

A full bladder causes reflex ______ as the bladder empties, this gives way to ______ which, combined with
an element of postural hypotension, might be sufficient to
cause fainting in some individuals

Answer 22

vasoconstriction;

vasodilatation,

Question 23

Pathophysio of tussive syncope

This is mainly attributable to the greatly elevated
intrathoracic pressure, which interferes with venous
return to the heart.

______and ________, with resultant cerebral vaso­ constriction, are possibly contributing factors

Answer 23

Increased cerebrospinal fluid (CSF) pressure

diminished Pco2

Question 24

the so-called ________ in infants probably represent

reflex vasodepression

Answer 24

pallid attacks

Question 25

The bedside testing of orthostatic blood pressure is best performed by; having the patient stand quickly and taking readings immediately
and again at _____ and at _________, rather than using
the lying-sitting-standing sequence

Answer 25

1 min

3 min

Question 26

The maintenance of blood pressure during various levels of activity and with postural changes depends on ____________ in the aortic arch and _______________ in the walls of the heart

Answer 26

pressure-sensitive receptors (baroreceptors)

carotid sinus and mechanoreceptors

Question 27

Axons from the NTS project to the
________ of the ventrolateral medulla, which
in turn, sends fibers to the _________________
of the spinal cord, thereby controlling vasomotor tone in
skeletal muscles, skin, and the splanchnic bed.

Answer 27

reticular formation

intermediolateral cell column

Question 28

intolerance of
the standing position accompanied by tachycardia up
to 120 beats per minute or more, but withou t orthostatic
hypotension

Answer 28

Post u r a l O rthostatic Ta c h yca rd i a Sy n d ro m e

Question 29

In P ri m a ry Auto n o m i c I n s u ffi c i e n cy ( I d i o path i c O rt h ostatic H y p ote n s i o n )

1. there is a selective degeneration of neurons in the _________ with denervation of smooth muscle vasculature and ______
2. there is a degeneration of
   _________ in the lateral columns of gray matter in the spinal cord, leaving postganglionic neurons
   isolated from spinal control

Answer 29

sympathetic ganglia

adrenal glands.

preganglionic neurons

Question 30

There are cases in which neuronal
degeneration is limited to the sympathetic neurons of
the intermediolateral cell columns-_______

Answer 30

the Shy-Drager syndrome.

Question 31

Cardiac syncope occurs most frequently in patients
with complete atrioventricular block and a heart rate of
___________ (Stokes-Adams attacks, or
Adarns-Stokes-Morgagni syndrome

Answer 31

40 beats or less per minute

Question 32

If the duration of

cerebral ischemia exceeds_______ there are a few clonic jerks

Answer 32

15 to 20 s,

Question 33

An inherited syndrome with right
bundle branch block and ST-segment elevation in the
right precordial leads is known to cause syncope and
even sudden death ________

Answer 33

(Brugada syndrome

Question 34

__________ and ______ from cardiomyopathy
often sets the stage for exertional syncope, because
cardiac output cannot keep pace with the demands of
exercise

Answer 34

Aortic stenosis or subaortic stenosis

Question 35

Cases of syncope that do occur are usually associated
with multiple occlusions of the large arteries in the thorax
or neck. The main examples are found in patients with
the ______________ in which the
brachiocephalic, common carotid, and vertebral arteries
have become narrowed.

Answer 35

aortic-arch syndrome (Takayasu disease)

Question 36

Stenosis or occlusion
of vertebral arteries and the _________
are other examples of cerebrovascular diseases
that may cause syncope under the special circumstance
of overuse of an arm

Answer 36

“subclavian steal syndrome”

Question 37

Fainting also occurs
occasionally in patients with congenital anomalies of the
upper cervical spine____________ or cervical
spondylosis, in which the vertebral circulation is compromised.

Answer 37

(Klippel-Feil syndrome)

Question 38

This term has been applied to falling spells that occur
without warning and without loss of consciousness or
postictal symptoms

Answer 38

DROP attacks

Question 39

Pathophysio of drop attack

Answer 39

One potential mechanism is a lapse of tone
in leg muscles during the silent phase of an unnoticed
myoclonic or axterixis jerk

Question 40

The epileptic attack may occur day or night,
regardless of the position of the patient; syncope rarely
appears when the patient is ________ the only common
exception being the ________

Answer 40

recumbent,

Stokes-Adams attack

Question 41

Elevated __________ levels have not proved discriminating
enough for routine use in separating seizure from
syncope but remain useful in distinguishing both of these
from other causes of loss of consciousness, particularly
hysteria, in which such elevations do not occur

Answer 41

prolactin

Question 42

Cardiovascular structures represented in the____________may give rise to seizures that produce cardiac
arrhythmias, leading in turn to syncope

Answer 42

insular

cortex

Question 43

seizures arising from the _________prolong the QT interval and increase sympathetic tone, thereby lowering the threshold for ventricular arrhythmia, whereas those
arising from the __________ shorten the QT interval
and increase parasympathetic tone, thereby increasing
the risk of vagally mediated syncope

Answer 43

left insula

right insula

Question 44

Normal response to tilt table test

Answer 44

Upright tilting o n a tilt table may cause, within seconds,
up to 20 or 25 mm Hg drop in systolic blood pressure and 5 to 10 mm Hg in diastolic pressure in normal individuals, usually with only minor symptoms

Question 45

There are 2 types of abnormal response to upright
tilting: (1)____________ (occurring within moments
of tilting) that slowly progresses with continued upright
posture; this signifies _______________; and

(2) a delayed (up to several minutes) hypotension that appears abruptly at the end of that period and indicates a ________________

Answer 45

early hypotension

inadequate sympathetic tone and baroreceptor function

neurocardiogenic mechanism

Question 46

The normal response to a 60- to 80-degree head-up
tilt after approximately 10 min is a transient drop in systolic blood pressure_____________, a rise in diastolic
pressure__________ and a rise in heart rate __________

Answer 46

(5 to 15 mm Hg)

(5 to 10 mm Hg),

(10 to 15 beats per minute)