Fit/Fall/Syncope Flashcards
when exploring symptoms for this what do you. want to be asking in regards to the attack
Before
- any warning, the circumstances
During
- any LOC, the duration, movements such as floppy, stiff jerking), incontinence/tongue biting, complexion
- get collateral history
After:
- any amnesia, muscle pain, confusion/sleepiness, injuries from the fall
Back ground
- have had this before, how often does it happen, how does it impact on life
what relevant systems review questions would you ask
general: fever
cardiorespiratory: chest pain, SOB, palpitations, cough, sputum, leg swelling
neurological:
- general: fits/falls/LOC, headache dizziness, vision/hearing loss, memory loss, neck stiffness/photophobia
- motor: weakness/wasting, incontinence
- Sensory: pain, numbness, tingling
what differentials are you thinking of for fit/fall/syncope
Cardiovascular
- postural hypotension
- arrhythmia
- aortic stenosis
neurological
- seizure
- parkinsons
- TIA/stroke
- vasovagal
others
(see next questions)
what other differentials are you thinking of that aren’t the main ones but you should still consider (use the following headings to help)
- mechanical
- cardiovascular
- neurological
- drugs
- abdo
- misc
mechanical
-mechincal fall/postural instability
cardiovascular
- structural
- situational syncope ie cough,effort, micturition
neurological
- neuropathy ie MS
- intracranial haemorrhages
- drop attack
drugs
- alcohol, poly pharmacy
abdo
- Ectopic pregnancy
- ruptured AAA
misc
- delirium (secondary to infection), any cause of vertigo, anaemia, hypoglycaemia, eyesight problems, arthritis
for the following condition what are the common clues/symptoms to help differentiate:
postural hypotension
dizziness and LOC on standing from lying
recently started/changed medications
for the following condition what are the common clues/symptoms to help differentiate:
arrhythmia’s
fall after transient arrhythmia
may have palpitations or feel very strange before the attack
cardiac history or family history of sudden death
may have occurred during exercise or when supine
for the following condition what are the common clues/symptoms to help differentiate:
aortic stenosis
collapse on exertion
breathlessness worse on exertion
for the following condition what are the common clues/symptoms to help differentiate:
seizure
partial
- simple partial: focal motor seizure, no LOC,
- complex partial (ie temporal lobe) will have strange actions with impaired awareness
generalised
- tonic-clonic: sudden LOC, limbs stiff then jerk, may become incontinent, bite tongue, feel awful with myalgia and confusion afterwards
- absence: unresponsive stare into space (in childhood)
- atonic: all muscles relax and drop to the floor
- tonic: all muscles become rigid
- myoclonic: involuntary flexion
for the following condition what are the common clues/symptoms to help differentiate:
parkinsons
QUADRAD= rigidity and tremor and bradykinesia and postural instability
for the following condition what are the common clues/symptoms to help differentiate:
TIA/stroke
neurological symptoms such as limb/face weakness, slurred speech, hemianopia
for the following condition what are the common clues/symptoms to help differentiate:
vasovagal
occurs in response to stimuli ie emotion/pain/fear/prolonged standing
preceding nausea, pallor, sweat. closing visual fields
then LOC for 2 mins
what condition are the following symptoms describing:
dizziness and LOC on standing from lying
recently started/changed medications
postural hypotension
what condition are the following symptoms describing:
fall after transient arrhythmia
may have palpitations or feel very strange before the attack
cardiac history or family history of sudden death
may have occurred during exercise or when supine
arrhythmia
what condition are the following symptoms describing:
collapse on exertion
breathlessness worse on exertion
aortic stenosis
what condition are the following symptoms describing:
partial
- simple partial: focal motor seizure, no LOC,
- complex partial (ie temporal lobe) will have strange actions with impaired awareness
generalised
- tonic-clonic: sudden LOC, limbs stiff then jerk, may become incontinent, bite tongue, feel awful with myalgia and confusion afterwards
- absence: unresponsive stare into space (in childhood)
- atonic: all muscles relax and drop to the floor
- tonic: all muscles become rigid
- myoclonic: involuntary flexion
seizure
