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Common transient loss of consciousness exam questions for medical finals, OSCEs and MRCP PACES

 

Question 1.

Define the terms syncope and seizure.

  • Syncope: transient loss of consciousness due to global cerebral hypoperfusion caused by hypotension secondary to a fall in cardiac output (CO) or systemic vascular resistance (SVR)
  • Seizure: episode of abnormal electrical activity in the brain

 

Question 2.

List three main causes of syncope.

  • Reflex/neural
  • Orthostatic hypotension
  • Cardiac

 

Question 3.

List four causes of non-syncopal transient loss of consciousness.

  • Seizure
  • Hypoglycaemia
  • Head injury
  • Narcolepsy

 

Question 4.

What features are suggestive of syncope?

  • Prodromal symptoms
    • Lightheadedness
    • Feeling of ‘impending doom’
    • Sweating and clamminess
    • Pallor
  • Last seconds
  • May twitch but no convulsions
  • Rapid recovery on lying

 

Question 5.

What features are suggestive of a seizure?

  • Prodromal symptoms
    • Aura
    • No warning
  • Last minutes
  • Tongue biting
  • Convulsions
  • Urinary and/or faecal incontinence
  • Slow recovery with confusion (post-ictal phase)

 

Question 6.

What features would you assess on cardiovascular examination?

  • Signs of dehydration
  • Pulse rate and rhythm
  • Lying and standing blood pressure
  • Apex beat
  • Cardiac murmurs

 

Question 7.

What red flags would necessitate urgent specialist cardiovascular assessment within 24 hours?

  • Exertional loss of consciousness
  • New or unexplained dyspnoea
  • Age 65 or older without prodromal symptoms
  • Family history of SCD in people aged under 40 years
  • Heart failure
  • Heart murmur
  • Conduction abnormality
  • Long (>450 ms) or short (<350 ms) QT interval: measured from the beginning of the QRS complex to the end of the T wave
  • Brugada syndrome: hereditary sodium channelopathy resulting in downsloping ST elevation in V1-3
  • ST segment or T wave abnormalities
  • Inappropriate persistent bradycardia
  • Left or right ventricular hypertrophy

 

Question 8.

What follow up would you arrange for a patient with suspected epilepsy?

  • First fit clinic

 

Question 9.

What advice about driving would you give to patients awaiting specialist cardiovascular assessment or first fit clinic?

    • Do not drive whilst awaiting assessment
    • It is their responsibility to inform the DVLA