USMLE Forum Archives - USMLE Step 3 - second syncopal spell
second syncopal spell
harry206 - 05-03-09 15:55
A 24-year-old right-handed woman presents to you in
the ED with a report of second syncopal spell. The
first spell occurred 6 months ago and was associated
with a 60-second loss of consciousness and jerking
movements of her arms and legs. Following the spell,
she was confused for about 15 minutes. At that time,
her initial ED evaluation was unremarkable. She presents
today following a spell that occurred about 45
minutes ago. Her friends observed her fall to the
ground and shake her arms and legs for about 60 seconds.
They could not get her to respond during this
time. Afterward, she was confused and they chose to
bring her to the ED. Upon arrival in the ED, she is
mildly drowsy but otherwise oriented. She has no
memory of the earlier events. Her general medical
examination and neurological examination are unremarkable.
Which of these tests would be LEAST helpful
in determining the etiology of this spell?
harry206 - 05-03-09 15:55
A 24-year-old right-handed woman presents to you in
the ED with a report of second syncopal spell. The
first spell occurred 6 months ago and was associated
with a 60-second loss of consciousness and jerking
movements of her arms and legs. Following the spell,
she was confused for about 15 minutes. At that time,
her initial ED evaluation was unremarkable. She presents
today following a spell that occurred about 45
minutes ago. Her friends observed her fall to the
ground and shake her arms and legs for about 60 seconds.
They could not get her to respond during this
time. Afterward, she was confused and they chose to
bring her to the ED. Upon arrival in the ED, she is
mildly drowsy but otherwise oriented. She has no
memory of the earlier events. Her general medical
examination and neurological examination are unremarkable.
Which of these tests would be LEAST helpful
in determining the etiology of this spell?
The correct answer and explanation will be available after you answer.
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#1
Re: second syncopal spell InSitu - 05-03-09 17:25 C since seizure activity can not be detected by imaging.
#2
Re: second syncopal spell InSitu - 05-03-09 17:27 Well unless its associated with a tumor or a mass.
#3
Re: second syncopal spell InSitu - 05-03-09 21:44 Ooops I change my answer now to D. I thought that was EEG...lol
#6
Re: second syncopal spell ammara - 05-04-09 01:19 my ans d...ecg wont b helpful regarding seizure activity
#7
Re: second syncopal spell InSitu - 05-04-09 01:23 Hello ammara..please use the answering feature. select you answer then click on post answer.
#8
Re: second syncopal spell ammara - 05-04-09 02:43 My answer is: d.
i hope i m doin in rite way now...
#9
Re: second syncopal spell bingousmle - 05-04-09 02:56 My answer is: d.
it seems more of GTC rather than syncopal attack though...
#10
Re: second syncopal spell InSitu - 05-04-09 03:03 yep you guys did it right but doctok IT will make it even more easier. thanks
#13
Re: second syncopal spell
harry206 - 05-05-09 13:28 Correct ans ic C: ECG,
As Syncope can be due to either Cardiac or neural causes mainly
Here it is pointing toward Neural cause (seizures)
So ECG is LEAST helpful here
but in CCS, atleast one ECG should be done.
GL
#31
Re: second syncopal spell ammulufy - 03-20-10 18:44 My answer is: b.
History is suggestive of a convulsive episode......and the confusion is because of the post ictal phase........hence neuroimaging n ecg is very much essential to throw light upon the etiology n also to rule out cardiac cause of the syncopal attack......sometimes drug overdose also can manifest in the form of convulsive episodes,hence urine toxicology screen is also required....however there is not a condition wherein electrolyte abnormalities can result convulsions hence electrolyte levels are least helpful.
#32
Re: second syncopal spell ammulufy - 03-20-10 18:46 I never knew dyselectrolytemia can manifest in convulsions per se....can u pls throw light upon this issue?
#39
Re: second syncopal spell babbu5508 - 07-28-10 03:29 My answer is: d.
syncope here seems to be due to a neural origin...more like a tonic-clonic seizures...electrocardiogram has no role..
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