Syncope

HISTORY_LIST
loss of consciousness: time 
duration of unconsciousness
sudden onset
gradual onset
was it witnessed?
witnessed by who?
activity before & after event
arm position: reaching
neck position: turning to side 
recumbent or upright position
mental status before & after
precipitant event
   (fear, tension, hunger, pain)
relationship to meal
defecation exertion syncope
valsalva
hyperventilation
chest pain
palpitations
tonic-clonic movements
tongue biting
PRODROMAL SYMPTOMS
sweating
blurred/dimming vision 
nausea
tinnitus
aura
cough
micturation
headache
SYMPTOMS OF THE EVENT
post syncope lethargy
confusion
lightheadedness
vertigo
flushing
pruritis
leg pain
pleuritic pain
dyspnea
vomiting
melena
hematemesis
CHRONIC DISEASE
SYSTEMIC DISORDERS
past Hx of syncope
stroke
TIA
seizures
valvular dz.
arrhythmia
HTN
anemia
diabetes
anxiety attacks
PREVIOUS TESTS
carotid Doppler studies
24 hr Holter monitor
EEG
cardiac testing
exercise tolerance
SOCIAL HISTORY
smoking
alcohol
caffeine
illicit drugs - cocaine

MEDS_LAB_TESTS
**** MEDS
Digoxin
Insulin
alcohol
oral hypoglycemics
phenothiazines
CNS depressants
nitrates
quinidine
beta blockers
calcium channel blockers
diuretics
antiarrhythmics
anticonvulsants
sedatives
antidepressants
marijuana
cocaine
**** LAB
Electrolytes
BUN
Creatnine
CBC
LFT's
CPK
cholesterol
triglycerides
uric acid
UA with microscopic analysis
**** TESTS
ECG
CXR
EEG
Holter monitor
MRI
CT scan


REVIEW_OF_SYSTEMS_1
GENERAL
weight changes
appetite changes
anorexia
difficulty sleeping
fever
chills
polyphagia
hypophagia
changes in thirst
sleeping habit change
bowel habit change
fatigue
hypertension
previous physical exams
SKIN
pigmentation changes
texture changes
lesions
eruptions
pruritis
easy bruising
easy bleeding
unusual hair loss
changes in hair distribution
skin masses
finger/toe nail change
rashes
hives
striae
skin atrophy
uremic frost
hirsutism
plethora
neurofibromatosis lesion
HEENT
head trauma
skull fractures
head masses
hearing loss
vertigo
chronic ear infection
ear discharge
ear pain
hearing aid use
loss of vision
recent change in vision
photophobia
diplopia (double vision)
glaucoma
exudates
dry eyes
eye pain
cataracts
eye surgery
itchy eyes
excessive tearing
corrective lenses
nose bleeds
chronic sinusitis
nasal fractures
nasal drainage
polyps
changes in sense of smell
edentulous (without teeth)
partial plate
full plate
recent dental work
oral lesions
tonsillitis
strep throat
tongue problems
voice changes
chronic hoarseness
chronic halitosis
NECK
neck masses
enlarged thyroid gland
brachial cleft cysts
neck injury

REVIEW_OF_SYSTEMS_2
CHEST
chronic coughing
sputum production
hemoptysis
wheezing
pneumonia
bronchitis
TB
TB exposure
SOB (altered by position?)
edema
chest pains
pacemaker
HEART
MI
coronary artery disease
heart murmur
heart valve disease
left ventricular hypertrophy
mistral valve stenosis
pericarditis
palpitations
DOE
paroxysmal nocturnal dyspnea
orthopnea
edema
hypertension
rheumatic fever
cardiomyopathy
ectopic heart beats
arrhythmia
exercise intolerance
claudication
heart medications
ABDOMEN
abdominal pain
nausea
vomiting
diarrhea
constipation
hematochezia
hematemesis
hemorrhoids
GI x-rays
GI scopings
rectal bleeding
ulcers
bowel polyps
bowel incontinence
gall bladder disease
gall stones
hepatitis
cirrhosis
hepatomegaly
splenomegaly
GU
renal insufficiency
renal failure
dialysis
kidney stones
kidney disease
kidney cyst
flank pain
hematuria
pyuria
dysuria
chronic cystitis
nocturia
anuria
hesitancy
enuresis
change in urine color
prostatitis
epididymitis
scrotal problems
TURP
pain on intercourse
genital lesions
genital discharge

REVIEW_OF_SYSTEMS_3
OB/GYN
metorrhagia
menorrhagia
irregular menses
problems in pregnancy
use of contraception
breast masses
nipple discharge
breast skin changes
changes in axillary nodes
monthly breast exam
breast feeding children
EXTREMITIES
difficulty with gait
weakness
joint swelling
joint stiffness
muscle pain
muscle swelling
muscle injuries
sagittal plan scoliosis
coronal plane scoliosis
fractured bones
SLE
osteoarthritis
rheumatoid arthritis
fibromyalgia
NEURO
seizures
head injury
LOC
loss of coordination
difficulty in balance
sciatica
difficulty: fine motor skills
difficulty speaking
CVA (stroke)
weakness in arms
weakness in legs
tingling in legs and feet
tingling in arms
PSYCHIATRIC
depression
bipolar disorder
suicide attempts
hospitalization
   for psychiatric problems
personality disorders
ENDOCRINE
goiter
exophthalmos
dry skin
dry hair
intolerance to heat
intolerance to cold
changes in growth
sterility
impotence
decreased libido
LYMPHATIC AND HEMATOLOGICAL
lymphadenopathy
transfusion
anemia

PHYSICAL_EVAL_1
VITALS
supine BP #1 =
supine Pulse #1 =
supine Heart rate #1 =
supine BP #2 =
supine Pulse #2 =
supine Heart rate #2 =
up right BP #1 =
upright Pulse #1 =
upright Heart rate #1 =
up right BP #2 =
upright Pulse #2 =
upright Heart rate #2 =
Temp =
GENERAL
pallor
level of alertness
HEENT
pupil size and reactivity
extraocular movements
retinal subhyloid hemorrhages
tongue or buccal lacerations

PHYSICAL_EVAL_2
SKIN
turgor
capillary refill
NECK
jugular vein volume depletion
jugular cannon A waves
carotid pulse amplitude
carotid duration
carotid bruits
neck rigidity
CHEST
breath sounds
crackles
rhonchi
HEART
"irregular rhythm
accentuated S2
accentuated S3
accentuated S4
systolic ejection murmur
cardiac rub
irregular, dyskinetic pulse
ABDOMEN
abdominal bruits
abdominal tenderness
pulsatile mass
GU
occult blood
urinary incontinence
EXTREMITIES
trauma to extremities
NEURO
cranial nerves:
   2 - 12 grossly intact
Babinski's sign
strength
gait
coordination
sensory
memory
DTR's
mental status
nystagmus
facial paralysis
head turned side to side
head moved up and down
reaching above head
bend at waist & pick up object
resist push


DIFF_DIAGNOSIS
Vasovagal
Postural hypotension
Autonomic insufficiency
Medication related syncope
Stroke
Stokes-Adams attack 
   (AV block, 
    sinus bradycardia, 
    sinoatrial block, 
    sinus arrest,
    sick-sinus syndrome,
    SVT)
Ventricular tachycardia
Carotid sinus hypersensitivity
PE
MI
Basilar artery insufficiency
Carotid steal syndrome
Hypovolemia (GI blood loss)
Valsalva, cough
defecation/micturition syncope
Aortic stenosis
Hypoxia
Hyperventilation
Anemia
Addison's dz.
Hypoglycemia
TIA
Hypertensive encephalopathy
Anxiety attack
Psychogenic


