Syncope PDF

1. Syncope is a transient, self-limited loss of consciousness due to what primary cause? A) Hypoxemia B) Seizures C) Hypoglycemia D) Acute cerebral blood flow impairment Correct Answer: D (Reference: “Syncope is a transient, self-limited loss...

1. Syncope is a transient, self-limited loss of consciousness due to what primary cause? A) Hypoxemia B) Seizures C) Hypoglycemia D) Acute cerebral blood flow impairment Correct Answer: D (Reference: “Syncope is a transient, self-limited loss of consciousness due to acute global impairment of cerebral blood flow.”) 2. How is the onset of syncope typically described? A) Gradual B) Delayed C) Prolonged D) Rapid Correct Answer: D (Reference: “The onset is rapid, duration brief, and recovery spontaneous and complete.”) 3. Which condition is not a cause that needs to be differentiated from syncope? A) Hypoglycemia B) Bradycardia C) Vertebrobasilar ischemia D) Seizures Correct Answer: B (Reference: “Other causes of transient loss of consciousness need to be distinguished from syncope; these include seizures, vertebrobasilar ischemia, hypoxemia, and hypoglycemia.”) 4. What symptom is commonly seen before a syncopal episode? A) Shortness of breath B) Presyncope C) Cough D) Lightheadedness Correct Answer: D (Reference: “A syncopal prodrome (presyncope) is common, although loss of consciousness may occur without any warning symptoms.”) 5. Which of the following is NOT typically a presyncopal symptom? A) Faintness B) Dizziness C) Visual disturbance D) Cough Correct Answer: D (Reference: “Typical presyncopal symptoms include lightheadedness or faintness, dizziness, weakness, fatigue, and visual and auditory disturbances.”) 6. Syncope can be divided into how many general categories? A) Two  B) Three C) Four D) Five Correct Answer: B (Reference: “The causes of syncope can be divided into three general categories…”) 7. Neurally mediated syncope is also known as what? A) Reflex syncope B) Cardiac syncope C) Seizure D) Hypoglycemia Correct Answer: A (Reference: “Neurally mediated syncope (also called reflex or vasovagal syncope)…”) 8. Which of the following is NOT a category of syncope? A) Reflex syncope B) Cardiac syncope C) Orthostatic hypotension D) Hypertension Correct Answer: D (Reference: “…categories: (1) neurally mediated syncope… (2) orthostatic hypotension, and (3) cardiac syncope.”) 9. Neurally mediated syncope is characterized by a change in what? A) Reflexes maintaining cardiovascular homeostasis B) Heart rhythm C) Breathing rate D) Muscle tone Correct Answer: A (Reference: “…characterized by a transient change in the reflexes responsible for maintaining cardiovascular homeostasis.”) 10. Which cardiovascular event is commonly associated with neurally mediated syncope? A) Increased blood pressure B) Increased heart rate C) Bradycardia D) Tachycardia Correct Answer: C (Reference: “Episodic vasodilation… decreased cardiac output, and bradycardia occur in varying combinations.”) 11. What cardiovascular effect is common in neurally mediated syncope? A) Hypertension B) Increased output C) Tachycardia  D) Vasodilation Correct Answer: D (Reference: “Episodic vasodilation (or loss of vasoconstrictor tone)…”) 12. Orthostatic hypotension is due to failure in which system? A) Endocrine system B) Autonomic nervous system C) Skeletal system D) Digestive system Correct Answer: B (Reference: “…orthostatic hypotension due to autonomic failure…”) 13. Which of the following is NOT a result of autonomic failure in orthostatic hypotension? A) Chronic impairment B) Acute response C) Loss of blood pressure control D) Reflex failure Correct Answer: B (Reference: “…autonomic failure, these cardiovascular homeostatic reflexes are chronically impaired.”) 14. Cardiac syncope may be caused by what? A) Structural cardiac diseases B) Respiratory disorders C) Kidney disorders D) Infections Correct Answer: A (Reference: “Cardiac syncope may be due to arrhythmias or structural cardiac diseases…”) 15. Which of the following is NOT a cause of cardiac syncope? A) Bradycardia B) Arrhythmias C) Structural disease D) Fatigue Correct Answer: D (Reference: “…cardiac syncope may be due to arrhythmias or structural cardiac diseases…”) 16. What differs among the types of syncope?  A) Only treatment B) Only pathophysiology C) Only prognosis D) Clinical features, mechanisms, interventions, and prognoses Correct Answer: D (Reference: “The clinical features, underlying pathophysiologic mechanisms, therapeutic interventions, and prognoses differ…”) 17. What kind of consciousness loss is NOT syncope? A) Sudden B) Persistent C) Transient D) Recurrent Correct Answer: B (Reference: “Syncope is a transient, self-limited loss of consciousness…”) 18. Loss of consciousness due to cerebral blood flow impairment is described as: A) Coma B) Lethargy C) Syncope D) Seizure Correct Answer: C (Reference: “Syncope is a transient, self-limited loss of consciousness…”) 19. What symptom is commonly a part of presyncope? A) Pain B) Vomiting C) Fatigue D) Auditory disturbances Correct Answer: D (Reference: “Typical presyncopal symptoms include lightheadedness or faintness, dizziness, weakness, fatigue, and visual and auditory disturbances.”) 20. Which type of syncope involves impaired cardiovascular homeostasis reflexes? A) Orthostatic hypotension B) Cardiac C) Reflex D) All of the above Correct Answer: A (Reference: “In contrast, in patients with orthostatic hypotension due to autonomic failure…”)  21. Neurally mediated syncope results in failure of what? A) Lung capacity B) Blood pressure control C) Muscle strength D) Kidney function Correct Answer: B (Reference: “…resulting in temporary failure of blood pressure control.”) 22. What is a common presyncope symptom? A) Memory loss B) Muscle pain C) Lightheadedness D) Numbness Correct Answer: C (Reference: “Typical presyncopal symptoms include lightheadedness or faintness, dizziness…”) 23. The onset of syncope is generally: A) Gradual B) Unpredictable C) Rapid D) Permanent Correct Answer: C (Reference: “The onset is rapid, duration brief…”) 24. Cardiac syncope can be caused by: A) Lung disorders B) Liver issues C) Arrhythmias D) Muscle weakness Correct Answer: C (Reference: “Cardiac syncope may be due to arrhythmias…”) 25. A major distinguishing factor of syncope is its: A) Sudden onset B) Delayed recovery C) Chronic nature D) Transient loss of consciousness Correct Answer: D (Reference: “Syncope is a transient, self-limited loss of consciousness…”) 26. Syncope accounts for approximately what percentage of emergency department (ED) visits? A) 2% B) 4% C) 1% D) 3% Correct Answer: D (Reference: “Syncope is a common presenting problem, accounting for ~3% of all emergency department (ED) visits.”) 27. What percentage of hospital admissions is due to syncope? A) 1% B) 3% C) 5% D) 2% Correct Answer: A (Reference: “Syncope is a common presenting problem, accounting for ~3% of all emergency department (ED) visits and 1% of all hospital admissions.”) 28. The estimated annual cost of syncope-related hospitalizations in the United States is approximately: A) $1.5 billion B) $3 billion C) $2.4 billion D) $4 billion Correct Answer: C (Reference: “The annual cost for syncope-related hospitalization in the United States is ~$2.4 billion.”) 29. What is the lifetime cumulative incidence of syncope in the general population? A) 25% B) 50% C) 20% D) 35% Correct Answer: D (Reference: “Syncope has a lifetime cumulative incidence of up to 35% in the general population.”)  30. The peak incidence of syncope in young individuals occurs between which age ranges? A) 5-15 years B) 10-30 years C) 20-40 years D) 15-25 years Correct Answer: B (Reference: “The peak incidence in the young occurs between ages 10 and 30 years.”) 31. What is the median peak age for syncope in young individuals? A) 10 years B) 18 years C) 15 years D) 12 years Correct Answer: C (Reference: “…with a median peak around 15 years.”) 32. Which type of syncope is most commonly observed in young individuals? A) Cardiac syncope B) Orthostatic hypotension C) Neurally mediated syncope D) Reflex syncope Correct Answer: C (Reference: “Neurally mediated syncope is the etiology in the vast majority of these cases.”) 33. In older adults, the incidence of syncope sharply rises after what age? A) 50 years B) 60 years C) 65 years D) 70 years Correct Answer: D (Reference: “In older adults, there is a sharp rise in the incidence of syncope after 70 years of age.”) 34. Which demographic shows the highest incidence of neurally mediated syncope according to population-based studies? A) Men B) Women  C) Children under 10 D) Individuals over 70 Correct Answer: B (Reference: “The incidence is higher in women than men.”) 35. In young individuals with syncope, what family history is often noted? A) Heart attack in parents B) Stroke in grandparents C) Family history in first-degree relatives D) Hypertension Correct Answer: C (Reference: “In young subjects, there is often a family history in first-degree relatives.”) 36. Cardiovascular disease due to structural issues or arrhythmias is most commonly associated with syncope in: A) Children B) Athletes C) Older adults D) Pregnant women Correct Answer: C (Reference: “Cardiovascular disease due to structural disease or arrhythmias is the next most common cause in most series, particularly in ED settings and in older patients.”) 37. Orthostatic hypotension increases with age due to a decline in which physiological response? A) Muscle strength B) Baroreflex responsiveness C) Cognitive function D) Heart rate Correct Answer: B (Reference: “Orthostatic hypotension also increases in prevalence with age because of the reduced baroreflex responsiveness…”) 38. Aging affects syncope prevalence by decreasing which of the following? A) Lung capacity B) Cardiac compliance C) Reflex speed D) Metabolic rate Correct Answer: B (Reference: “…decreased cardiac compliance, and attenuation of the vestibulosympathetic reflex associated with aging.”) 39. Which is a contributing factor to increased orthostatic hypotension in the elderly? A) Excessive sleep B) High-calorie intake C) Reduced fluid intake D) Vitamin deficiency Correct Answer: C (Reference: “Other contributors are reduced fluid intake and vasoactive medications, also more likely in this age group.”) 40. Where is orthostatic hypotension more common among the elderly? A) At home B) In institutionalized settings C) In outpatient clinics D) In rural areas Correct Answer: B (Reference: “In the elderly, orthostatic hypotension is more common in institutionalized than community-dwelling individuals…”) 41. Syncope of noncardiac origin in younger individuals typically has what kind of prognosis? A) Poor B) Fair C) Excellent D) Critical Correct Answer: C (Reference: “Syncope of noncardiac and unexplained origin in younger individuals has an excellent prognosis.”) 42. Life expectancy in young individuals with syncope of noncardiac origin is generally: A) Reduced B) Extended C) Unaffected D) Variable Correct Answer: C (Reference: “…life expectancy is unaffected.”)  43. Syncope due to cardiac causes is associated with an increased risk of: A) Cancer B) Stroke C) Kidney disease D) Sudden cardiac death Correct Answer: D (Reference: “…syncope due to a cardiac cause, either structural heart disease or a primary arrhythmic disorder, is associated with an increased risk of sudden cardiac death…”) 44. In older adults, the mortality rate is increased for those with syncope due to: A) Orthostatic hypotension B) Muscular atrophy C) Gastrointestinal disorders D) Endocrine issues Correct Answer: A (Reference: “…mortality rate is increased in individuals with syncope due to orthostatic hypotension…”) 45. In the elderly, syncope related to orthostatic hypotension is linked to what factor? A) Athletic activity B) Age and comorbid conditions C) Increased water intake D) Improved cardiovascular health Correct Answer: B (Reference: “…related to age and the associated comorbid conditions.”) 46. Syncope due to a primary arrhythmic disorder is associated with: A) Reduced mental clarity B) Increased stroke risk C) Increased risk of sudden cardiac death D) Lower mortality rates Correct Answer: C (Reference: “…a primary arrhythmic disorder, is associated with an increased risk of sudden cardiac death.”) 47. Which group has a higher risk of hospitalization following a syncope episode? A) Younger adults B) Women C) Older adults  D) Adolescents Correct Answer: C (Reference: “The likelihood of hospitalization and mortality risk are higher in older adults.”) 48. What position most commonly leads to syncopal episodes? A) Sitting B) Lying down C) Walking D) Standing Correct Answer: D (Reference: “Most, although not all, syncopal episodes occur from a standing position.”) 49. Standing results in pooling of how much blood in the lower extremities and splanchnic circulation? A) 100-200 mL B) 300-400 mL C) 500-1000 mL D) 1200-1500 mL Correct Answer: C (Reference: “Standing results in pooling of 500–1000 mL of blood in the lower extremities, buttocks, and splanchnic circulation.”) 50. Dependent pooling of blood leads to a decrease in which of the following? A) Heart rate B) Blood oxygen levels C) Venous return to the heart D) Muscle strength Correct Answer: C (Reference: “The dependent pooling leads to a decrease in venous return to the heart.”) 51. Reduced ventricular filling due to blood pooling results in diminished: A) Respiratory rate B) Muscle tone C) Reflexes D) Cardiac output Correct Answer: D (Reference: “…reduced ventricular filling that result in diminished cardiac output and blood pressure.”)  52. Which reflex response is initiated by baroreceptors due to hemodynamic changes from standing? A) Increased vagal activity B) Decreased sympathetic outflow C) Reflex sweating D) Increased sympathetic outflow Correct Answer: D (Reference: “These hemodynamic changes provoke a compensatory reflex response, initiated by the baroreceptors in the carotid sinus and aortic arch…”) 53. The baroreceptor reflex response increases all of the following EXCEPT: A) Peripheral resistance B) Venous return to the heart C) Cardiac output D) Digestive enzyme production Correct Answer: D (Reference: “The reflex increases peripheral resistance, venous return to the heart, and cardiac output…”) 54. What can occur if the baroreceptor response fails in individuals with neurally mediated syncope? A) Tachycardia B) Cerebral hypoperfusion C) Seizures D) Hyperventilation Correct Answer: B (Reference: “…if this response fails, as is the case chronically in orthostatic hypotension and transiently in neurally mediated syncope, hypotension and cerebral hypoperfusion occur.”) 55. Syncope is primarily a result of: A) Local trauma B) Cerebral inflammation C) Cerebral hypoperfusion D) Increased cerebral blood flow Correct Answer: C (Reference: “Syncope is a consequence of global cerebral hypoperfusion…”) 56. What is responsible for the autoregulation of cerebral blood flow?  A) Genetic factors B) Digestive enzymes C) Myogenic factors and local metabolites D) Atmospheric pressure Correct Answer: C (Reference: “Myogenic factors, local metabolites, and to a lesser extent autonomic neurovascular control are responsible for the autoregulation of cerebral blood flow.”) 57. How long is the latency period of the cerebral blood flow autoregulatory response? A) 2-4 s B) 5-10 s C) 12-15 s D) 20-25 s Correct Answer: B (Reference: “The latency of the autoregulatory response is 5–10 s.”) 58. The normal range of cerebral blood flow is approximately: A) 30–40 mL/min per 100 g B) 40–50 mL/min per 100 g C) 50–60 mL/min per 100 g D) 60–70 mL/min per 100 g Correct Answer: C (Reference: “Typically, cerebral blood flow ranges from 50–60 mL/min per 100 g brain tissue…”) 59. At what blood flow rate does consciousness begin to be impaired? A) 50 mL/min per 100 g B) 40 mL/min per 100 g C) 35 mL/min per 100 g D) 25 mL/min per 100 g Correct Answer: D (Reference: “…impairment of consciousness ensues when blood flow decreases to 25 mL/min per 100 g brain tissue.”) 60. Syncope typically occurs if blood flow to the brain ceases for how many seconds? A) 3-4 s B) 6-8 s C) 10-12 s D) 15-20 s Correct Answer: B (Reference: “Cessation of blood flow for 6–8 s will result in loss of consciousness…”) 61. Autoregulation of cerebral blood flow is achieved through: A) Blood pH adjustments B) Muscular adjustments C) Neurovascular control and local metabolites D) Blood type adjustments Correct Answer: C (Reference: “Myogenic factors, local metabolites, and to a lesser extent autonomic neurovascular control are responsible for the autoregulation of cerebral blood flow.”) 62. Which pressure range maintains consistent cerebral blood flow? A) 20–100 mmHg B) 50–150 mmHg C) 60–160 mmHg D) 70–170 mmHg Correct Answer: B (Reference: “…remains relatively constant over perfusion pressures ranging from 50–150 mmHg.”) 63. When blood flow drops below what rate, impairment of consciousness begins? A) 50 mL/min per 100 g B) 40 mL/min per 100 g C) 35 mL/min per 100 g D) 25 mL/min per 100 g Correct Answer: D (Reference: “…impairment of consciousness ensues when blood flow decreases to 25 mL/min per 100 g brain tissue.”) 64. Blood pooling in the lower extremities during standing leads to decreased: A) Respiratory rate B) Oxygenation C) Venous return D) Cardiac arrest Correct Answer: C (Reference: “The dependent pooling leads to a decrease in venous return to the heart.”) 65. Baroreceptors in the carotid sinus are involved in regulating:  A) Digestive enzymes B) Peripheral vision C) Heart rate and blood pressure D) Bone density Correct Answer: C (Reference: “…baroreceptors in the carotid sinus and aortic arch, resulting in increased sympathetic outflow…”) 66. Failure of the baroreceptor reflex during orthostatic hypotension results in: A) Increased heart rate B) Cerebral hypoperfusion C) Muscle spasms D) Reflex suppression Correct Answer: B (Reference: “…as is the case chronically in orthostatic hypotension and transiently in neurally mediated syncope, hypotension and cerebral hypoperfusion occur.”) 67. Cerebral blood flow autoregulation is influenced by: A) Respiratory rate only B) Muscle strength C) Myogenic factors and local metabolites D) Skin temperature Correct Answer: C (Reference: “Myogenic factors, local metabolites, and to a lesser extent autonomic neurovascular control are responsible for the autoregulation of cerebral blood flow.”) 68. Standing causes blood to pool primarily in which areas? A) Head and neck B) Abdomen and shoulders C) Lower extremities and splanchnic circulation D) Brain Correct Answer: C (Reference: “Standing results in pooling of 500–1000 mL of blood in the lower extremities, buttocks, and splanchnic circulation.”) 69. What process is essential for maintaining blood pressure when standing? A) Immune response B) Hormonal fluctuation C) Compensatory baroreceptor reflex D) Cerebral autoregulation only Correct Answer: C (Reference: “These hemodynamic changes provoke a compensatory reflex response, initiated by the baroreceptors…”) 70. If the baroreceptor reflex fails in conditions like orthostatic hypotension, what outcome may result? A) Increased blood pressure B) Cerebral hypoperfusion C) Enhanced oxygenation D) Improved venous return Correct Answer: B (Reference: “If this response fails, as is the case chronically in orthostatic hypotension…hypotension and cerebral hypoperfusion occur.”) 71. What is the primary consequence of a failure in cerebral blood flow autoregulation? A) Muscle fatigue B) Cerebral hypoperfusion C) Enhanced alertness D) Increased heart rate Correct Answer: B (Reference: “Syncope is a consequence of global cerebral hypoperfusion and thus represents a failure of cerebral blood flow autoregulatory mechanisms.”) 72. The baroreceptor reflex aims to stabilize blood pressure by increasing: A) Peripheral resistance and venous return B) Respiratory rate C) Muscular contractions D) Oxygen saturation Correct Answer: A (Reference: “The reflex increases peripheral resistance, venous return to the heart, and cardiac output and thus limits the fall in blood pressure.”) 73. Over which range of perfusion pressures does cerebral blood flow remain relatively constant? A) 60–100 mmHg B) 50–150 mmHg C) 70–130 mmHg  D) 40–120 mmHg Correct Answer: B (Reference: “Cerebral blood flow… remains relatively constant over perfusion pressures ranging from 50–150 mmHg.”) 74. What is the latency period of the autoregulatory response in cerebral blood flow? A) 1–3 seconds B) 5–10 seconds C) 12–15 seconds D) 20–25 seconds Correct Answer: B (Reference: “The latency of the autoregulatory response is 5–10 s.”) 75. Cessation of blood flow to the brain for how many seconds will result in loss of consciousness? A) 3–4 seconds B) 5–6 seconds C) 6–8 seconds D) 10–12 seconds Correct Answer: C (Reference: “Cessation of blood flow for 6–8 s will result in loss of consciousness.”) 76. From a clinical standpoint, syncope is likely to occur when systolic blood pressure falls to: A) 70 mmHg B) 60 mmHg C) 80 mmHg D) 50 mmHg Correct Answer: D (Reference: “A fall in systemic systolic blood pressure to ~50 mmHg or lower will result in syncope.”) 77. Which of the following directly underlies the pathophysiology of syncope? A) Hyperventilation B) Decreased cardiac output or systemic vascular resistance C) Increased respiratory rate D) Elevated blood volume Correct Answer: B (Reference: “A decrease in cardiac output and/or systemic vascular resistance… underlies the pathophysiology of syncope.”) 78. A decrease in effective circulating blood volume may impair: A) Heart rate B) Cardiac output C) Muscle tone D) Lung function Correct Answer: B (Reference: “Common causes of impaired cardiac output include decreased effective circulating blood volume…”) 79. Which condition is NOT commonly associated with impaired cardiac output? A) Valvular heart disease B) Pulmonary embolus C) Muscle cramps D) Myocardial dysfunction Correct Answer: C (Reference: “…causes of impaired cardiac output include… massive pulmonary embolus, cardiac brady- and tachyarrhythmias, valvular heart disease, and myocardial dysfunction.”) 80. Systemic vascular resistance can be decreased by: A) Increased cardiac output B) Sympatholytic medications C) High blood volume D) Cold exposure Correct Answer: B (Reference: “Systemic vascular resistance may be decreased by central and peripheral autonomic nervous system diseases, sympatholytic medications…”) 81. In neurally mediated syncope, systemic vascular resistance may be: A) Decreased B) Increased C) Unchanged D) Exaggerated Correct Answer: A (Reference: “…and transiently during neurally mediated syncope.”) 82. Increased cerebral vascular resistance may be caused by:  A) Hypoventilation B) Hypocarbia induced by hyperventilation C) Elevated oxygen levels D) Increased heart rate Correct Answer: B (Reference: “Increased cerebral vascular resistance, most frequently due to hypocarbia induced by hyperventilation…”) 83. Which factor is most commonly linked to increased cerebral vascular resistance? A) Hypertension B) Low oxygen levels C) Hypocarbia D) High blood sugar Correct Answer: C (Reference: “…increased cerebral vascular resistance, most frequently due to hypocarbia…”) 84. One EEG pattern seen in syncope is: A) High-amplitude slow delta waves B) Fast alpha waves C) Theta wave increase D) High-frequency beta waves Correct Answer: A (Reference: “The first is a ‘slow-flat-slow’ pattern…in which normal background activity is replaced with high-amplitude slow delta waves.”) 85. In the “slow-flat-slow” EEG pattern, what occurs after the appearance of delta waves? A) Increased beta activity B) Sudden flattening of the EEG C) Decreased alpha rhythm D) Increased theta activity Correct Answer: B (Reference: “This is followed by sudden flattening of the EEG—a cessation or attenuation of cortical activity…”) 86. What follows the “flat” phase in the “slow-flat-slow” EEG pattern? A) Beta wave reactivity B) Slow waves return C) Theta wave activity  D) Sharp wave spikes Correct Answer: B (Reference: “…followed by the return of slow waves, and then normal activity.”) 87. The “slow pattern” on EEG is characterized by: A) Only increasing slow waves B) Increasing and decreasing slow wave activity C) Continuous delta wave flattening D) Continuous beta activity Correct Answer: B (Reference: “A second pattern, the ‘slow pattern,’ is characterized by increasing and decreasing slow wave activity only.”) 88. EEG flattening in the “slow-flat-slow” pattern indicates: A) Mild cerebral hypoperfusion B) No cerebral hypoperfusion C) Severe cerebral hypoperfusion D) Minimal brain activity Correct Answer: C (Reference: “The EEG flattening that occurs in the slow-flat-slow pattern is a marker of more severe cerebral hypoperfusion.”) 89. During some syncopal episodes, what movements may be present despite lack of seizure activity on EEG? A) Slow eye movements B) Myoclonic movements C) Continuous muscle twitching D) Rapid finger movements Correct Answer: B (Reference: “Despite the presence of myoclonic movements and other motor activity during some syncopal events…”) 90. EEG studies in syncopal events do NOT typically show: A) Seizure discharges B) Slow wave patterns C) Flattening of cortical activity D) Delta wave activity Correct Answer: A (Reference: “…EEG seizure discharges are not detected.”)  91. Cardiac bradyarrhythmias contribute to syncope by: A) Decreasing cerebral perfusion B) Increasing heart rate C) Reducing respiratory rate D) Enhancing blood flow Correct Answer: A (Reference: “…causes of impaired cardiac output include… cardiac brady- and tachyarrhythmias.”) 92. Which of the following does NOT typically decrease systemic vascular resistance? A) Autonomic nervous system diseases B) Sympatholytic medications C) Neurally mediated syncope D) Physical exercise Correct Answer: D (Reference: “Systemic vascular resistance may be decreased by central and peripheral autonomic nervous system diseases, sympatholytic medications…”) 93. Increased thoracic pressure may impair cardiac output by: A) Enhancing venous return B) Reducing pulmonary circulation C) Lowering blood pressure D) Decreasing effective blood volume Correct Answer: D (Reference: “Common causes of impaired cardiac output include… increased thoracic pressure…”) 94. A massive pulmonary embolus contributes to syncope by: A) Increasing systemic vascular resistance B) Blocking pulmonary blood flow C) Raising oxygen levels D) Enhancing cardiac output Correct Answer: B (Reference: “Common causes of impaired cardiac output include… massive pulmonary embolus…”) 95. Valvular heart disease may lead to syncope due to: A) Enhanced cerebral blood flow  B) Impaired cardiac output C) Increased blood volume D) Enhanced blood pressure Correct Answer: B (Reference: “Common causes of impaired cardiac output include… valvular heart disease…”) 96. Myocardial dysfunction is associated with syncope due to: A) Enhanced respiratory rate B) Increased cardiac output C) Impaired cardiac output D) Lowered venous pressure Correct Answer: C (Reference: “Common causes of impaired cardiac output include… myocardial dysfunction.”) 97. Syncope due to hyperventilation is associated with: A) Increased blood carbon dioxide B) Hypocarbia and increased cerebral vascular resistance C) Increased systemic blood pressure D) Elevated oxygen saturation Correct Answer: B (Reference: “Increased cerebral vascular resistance, most frequently due to hypocarbia induced by hyperventilation…”) 98. The “slow-flat-slow” EEG pattern begins with: A) Flattened EEG activity B) Beta wave increase C) Slow delta waves D) Gamma waves Correct Answer: C (Reference: “The first is a ‘slow-flat-slow’ pattern in which normal background activity is replaced with high-amplitude slow delta waves.”) 99. Which of the following is true regarding EEG findings in syncope? A) No change in EEG activity B) Presence of high-amplitude slow delta waves C) Continuous seizure discharges D) Increased beta waves Correct Answer: B (Reference: “…normal background activity is replaced with high-amplitude slow delta waves.”)  100. During syncope, EEG typically shows seizure discharges: A) True B) False C) Only with loss of consciousness D) Only in severe cases Correct Answer: B (Reference: “Despite the presence of myoclonic movements and other motor activity during some syncopal events, EEG seizure discharges are not detected.”) 101. Neurally mediated syncope is the result of which type of reflex arc? A) Somatic reflex arc B) Autonomic nervous reflex C) Endocrine reflex D) Central and peripheral nervous system reflex arc Correct Answer: D (Reference: “Neurally mediated (reflex; vasovagal) syncope is the final pathway of a complex central and peripheral nervous system reflex arc.”) 102. Which nervous system response is associated with neurally mediated syncope? A) Increased sympathetic activity B) Increased parasympathetic outflow and sympathoinhibition C) Increased respiratory rate D) Increased cardiac output Correct Answer: B (Reference: “…increased parasympathetic outflow, plus sympathoinhibition…”) 103. The result of sympathoinhibition in neurally mediated syncope includes: A) Tachycardia B) Vasoconstriction C) Bradycardia D) Increased respiratory rate Correct Answer: C (Reference: “…resulting in bradycardia, vasodilation, and/or reduced vasoconstrictor tone…”) 104. The vasodepressor response in neurally mediated syncope leads to: A) Reduced cardiac output  B) Increased cardiac output C) Improved blood pressure D) Elevated heart rate Correct Answer: A (Reference: “…resulting in bradycardia, vasodilation, and/or reduced vasoconstrictor tone (the vasodepressor response) and reduced cardiac output.”) 105. In neurally mediated syncope, a drop in systemic blood pressure can reduce: A) Blood oxygenation B) Cerebral blood flow C) Heart rate D) Lung function Correct Answer: B (Reference: “…the resulting fall in systemic blood pressure can then reduce cerebral blood flow to below the compensatory limits of autoregulation.”) 106. Neurally mediated syncope requires a functioning: A) Respiratory system B) Endocrine system C) Autonomic nervous system D) Immune system Correct Answer: C (Reference: “In order to develop neurally mediated syncope, a functioning autonomic nervous system is necessary.”) 107. Afferent triggers of neurally mediated syncope can be caused by: A) Excessive sleep B) Physical exertion C) Stimuli from the carotid sinus or gastrointestinal tract D) Increased blood pressure Correct Answer: C (Reference: “Triggers…can result in neurally mediated syncope… e.g., orthostatic stress and stimulus of the carotid sinus, the gastrointestinal tract, or the bladder.”) 108. Which of the following is NOT an easily recognized trigger for neurally mediated syncope? A) Orthostatic stress B) Carotid sinus stimulation C) Bladder stimulation D) Eating Correct Answer: D (Reference: “In some situations, these can be clearly defined, e.g., orthostatic stress and stimulus of the carotid sinus, the gastrointestinal tract, or the bladder.”) 109. Less easily recognized triggers for neurally mediated syncope are often: A) Genetic B) Structural C) Multifactorial D) Chemical Correct Answer: C (Reference: “Often, however, the trigger is less easily recognized and the cause is multifactorial.”) 110. Where do different afferent pathways converge in neurally mediated syncope? A) Cerebral cortex B) Cerebellum C) Medulla D) Hypothalamus Correct Answer: C (Reference: “…afferent pathways converge on the central autonomic network within the medulla…”) 111. The central autonomic network integrates neural impulses and mediates which response in neurally mediated syncope? A) Tachycardia B) Vasodilation-bradycardic response C) Hypertension D) Increased cardiac output Correct Answer: B (Reference: “…central autonomic network within the medulla… mediates the vasodepressor-bradycardic response.”) 112. Neurally mediated syncope can be subdivided based on: A) Genetic factors B) The afferent pathway and trigger C) Dietary habits D) Physical fitness Correct Answer: B (Reference: “Neurally mediated syncope may be subdivided based on the afferent pathway and provocative trigger.”)  113. Which type of syncope is also known as the “common faint”? A) Orthostatic syncope B) Reflex syncope C) Vasovagal syncope D) Cardiac syncope Correct Answer: C (Reference: “Vasovagal syncope (the common faint) is provoked by intense emotion, pain, and/or orthostatic stress…”) 114. Which of the following is a typical trigger for vasovagal syncope? A) Increased physical activity B) Intense emotion or pain C) Lack of sleep D) High-fat diet Correct Answer: B (Reference: “…vasovagal syncope (the common faint) is provoked by intense emotion, pain, and/or orthostatic stress…”) 115. Situational reflex syncopes are triggered by: A) Increased oxygen levels B) Hyperthermia C) Localized stimuli D) Increased exercise Correct Answer: C (Reference: “…situational reflex syncopes have specific localized stimuli that provoke the reflex…”) 116. In situational reflex syncopes, reflex vasodilation and bradycardia lead to: A) Tachycardia B) Hypertension C) Syncope D) Increased blood flow Correct Answer: C (Reference: “…specific localized stimuli that provoke the reflex vasodilation and bradycardia that leads to syncope.”) 117. The afferent trigger of situational reflex syncopes may originate in all EXCEPT: A) Pulmonary system  B) Gastrointestinal system C) Endocrine system D) Urogenital system Correct Answer: C (Reference: “…afferent trigger may originate in the pulmonary system, gastrointestinal system, urogenital system, heart, and carotid sinus…”) 118. Hyperventilation leads to cerebral vasoconstriction due to: A) Hypocarbia B) Increased blood pressure C) Hypertension D) High oxygen levels Correct Answer: A (Reference: “Hyperventilation leading to hypocarbia and cerebral vasoconstriction…”) 119. Raised intrathoracic pressure during situational syncope affects: A) Increased blood pressure B) Heart rate C) Venous return to the heart D) Oxygen levels Correct Answer: C (Reference: “…raised intrathoracic pressure that impairs venous return to the heart…”) 120. In situational reflex syncopes, which reflex arc component varies? A) Efferent pathway B) Respiratory pathway C) Afferent pathway D) Cardiac output Correct Answer: C (Reference: “…the afferent pathway of the reflex arc differs among these disorders…”) 121. Which pathway is involved in the efferent response in situational reflex syncopes? A) Digestive pathway B) Sympathetic and vagus pathways C) Muscular pathway D) Renal pathway Correct Answer: B (Reference: “…the efferent response via the vagus and sympathetic pathways is similar.”)  122. Neurally mediated syncope is often associated with: A) Respiratory infections B) Neuromuscular disorders C) Autonomic reflex dysfunction D) Hormonal imbalance Correct Answer: C (Reference: “Neurally mediated syncope is the final pathway of a complex central and peripheral nervous system reflex arc.”) 123. Vasovagal syncope can be triggered by which of the following? A) Extreme cold B) Emotional stress C) High altitude D) Sedentary lifestyle Correct Answer: B (Reference: “Vasovagal syncope…is provoked by intense emotion, pain, and/or orthostatic stress.”) 124. Which response characterizes situational reflex syncope? A) Reflex tachycardia B) Reflex vasodilation and bradycardia C) Increased heart rate D) Muscle contraction Correct Answer: B (Reference: “…situational reflex syncopes have specific localized stimuli that provoke the reflex vasodilation and bradycardia…”) 125. Which organ systems may be involved as afferent triggers in situational reflex syncopes? A) Nervous and endocrine systems B) Muscular and skeletal systems C) Pulmonary, gastrointestinal, and urogenital systems D) Immune and lymphatic systems Correct Answer: C (Reference: “The afferent trigger may originate in the pulmonary system, gastrointestinal system, urogenital system, heart, and carotid sinus…”) 126. Neurally mediated syncope can be subdivided based on which pathway?  A) Genetic pathway B) Endocrine pathway C) Predominant efferent pathway D) Respiratory pathway Correct Answer: C (Reference: “Neurally mediated syncope may be subdivided based on the predominant efferent pathway.”) 127. Syncope due to efferent sympathetic vasoconstrictor failure is known as: A) Cardioinhibitory syncope B) Reflex syncope C) Mixed syncope D) Vasodepressor syncope Correct Answer: D (Reference: “Vasodepressor syncope describes syncope predominantly due to efferent, sympathetic, vasoconstrictor failure…”) 128. Syncope associated with bradycardia or asystole due to increased vagal outflow is known as: A) Mixed syncope B) Orthostatic syncope C) Cardioinhibitory syncope D) Reflex syncope Correct Answer: C (Reference: “…cardioinhibitory syncope describes syncope predominantly associated with bradycardia or asystole due to increased vagal outflow…”) 129. Mixed syncope involves changes in which reflex pathways? A) Endocrine and respiratory B) Sympathetic and vagal C) Only sympathetic D) Only vagal Correct Answer: B (Reference: “…mixed syncope describes syncope in which there are both vagal and sympathetic reflex changes.”) 130. Symptoms of orthostatic intolerance include all EXCEPT: A) Lightheadedness B) Dizziness  C) Diaphoresis D) Fatigue Correct Answer: C (Reference: “In addition to symptoms of orthostatic intolerance such as dizziness, lightheadedness, and fatigue…”) 131. Which symptom is associated with autonomic activation in neurally mediated syncope? A) High fever B) Sweating (diaphoresis) C) Increased appetite D) Muscle weakness Correct Answer: B (Reference: “These include diaphoresis, pallor, palpitations, nausea, hyperventilation, and yawning.”) 132. During neurally mediated syncope, which type of myoclonus may occur? A) Rhythmic B) Focal C) Proximal and distal, arrhythmic and multifocal D) Continuous Correct Answer: C (Reference: “During the syncopal event, proximal and distal myoclonus (typically arrhythmic and multifocal) may occur…”) 133. In neurally mediated syncope, the eyes usually: A) Close tightly B) Remain closed C) Remain open and deviate upward D) Flutter continuously Correct Answer: C (Reference: “The eyes typically remain open and usually deviate upward.”) 134. What may occur with eye movements during a syncopal event? A) Continuous twitching B) Downward gaze C) Roving eye movements D) Complete stillness Correct Answer: C (Reference: “Roving eye movements may occur.”)  135. Which of the following breathing sounds may be present during a syncopal event? A) Wheezing B) Stertorous breathing C) Hiccups D) Shallow breathing Correct Answer: B (Reference: “Grunting, moaning, snorting, and stertorous breathing may be present.”) 136. Which is rare during a syncopal event? A) Fecal incontinence B) Urinary incontinence C) Eye deviation D) Yawning Correct Answer: A (Reference: “Urinary incontinence may occur. Fecal incontinence is very rare, however.”) 137. Which is also rare following a syncopal event? A) Visual hallucinations B) Postictal confusion C) Auditory hallucinations D) Near-death experiences Correct Answer: B (Reference: “Postictal confusion is also rare, although visual and auditory hallucinations and near-death and out-of-body experiences are sometimes reported.”) 138. Which of the following is a predisposing factor for neurally mediated syncope? A) High altitude B) Motionless upright posture C) Low-sodium diet D) High calcium intake Correct Answer: B (Reference: “Predisposing factors… include motionless upright posture, warm ambient temperature, intravascular volume depletion, alcohol ingestion…”) 139. A common provocative stimulus for neurally mediated syncope is: A) Cold temperature B) Pain  C) Loud noises D) Bright light Correct Answer: B (Reference: “…provocative stimuli are well established (for example, motionless upright posture… pain, the sight of blood…”) 140. Intense emotion as a trigger for neurally mediated syncope is best associated with: A) Exercise-induced syncope B) Vasovagal syncope C) Cardiac syncope D) Orthostatic syncope Correct Answer: B (Reference: “…intense emotion, pain, the sight of blood, venipuncture, and intense emotion.”) 141. Which environmental factor may predispose someone to neurally mediated syncope? A) Cold environment B) Warm ambient temperature C) High altitude D) Low altitude Correct Answer: B (Reference: “…predisposing factors and provocative stimuli… warm ambient temperature…”) 142. Which type of blood condition may predispose to neurally mediated syncope? A) Hyperglycemia B) Anemia C) Leukopenia D) Hypernatremia Correct Answer: B (Reference: “…predisposing factors and provocative stimuli… anemia…”) 143. Which of the following has been suggested as a possible genetic influence on syncope? A) Hormonal imbalance B) Increased incidence in first-degree relatives C) Metabolic syndrome D) Elevated cholesterol Correct Answer: B (Reference: “…several studies have reported an increased incidence of syncope in first-degree relatives of fainters…”) 144. Which potential syncope trigger has NOT been clearly defined as genetic? A) A genetic marker B) First-degree relatives C) Cultural factors D) Social influences Correct Answer: A (Reference: “…no gene or genetic marker has been identified…”) 145. Which of the following factors has NOT been excluded as influencing syncope? A) Genetic mutation B) Environmental factors C) Lack of exercise D) Social factors Correct Answer: D (Reference: “…environmental, social, and cultural factors have not been excluded by these studies.”) 146. Alcohol ingestion can predispose to neurally mediated syncope because it: A) Lowers blood pressure B) Reduces alertness C) Decreases core body temperature D) Increases heart rate Correct Answer: A (Reference: “…predisposing factors and provocative stimuli… alcohol ingestion…”) 147. Venipuncture may trigger neurally mediated syncope due to: A) Hormonal release B) Vagal response to pain or sight of blood C) Low blood volume D) Decreased temperature Correct Answer: B (Reference: “…predisposing factors… the sight of blood, venipuncture…”) 148. Visual and auditory hallucinations following a syncopal event are considered: A) Common B) Unrelated  C) Rare D) Indicative of brain injury Correct Answer: C (Reference: “…postictal confusion is rare, although visual and auditory hallucinations…are sometimes reported.”) 149. Which term describes syncope due to sympathetic vasoconstrictor failure? A) Cardioinhibitory syncope B) Vasodepressor syncope C) Mixed syncope D) Emotional syncope Correct Answer: B (Reference: “Vasodepressor syncope describes syncope predominantly due to efferent, sympathetic, vasoconstrictor failure.”) 150. Hyperventilation may lead to syncope by causing: A) Hypercarbia B) Cerebral vasodilation C) Hypocarbia and cerebral vasoconstriction D) Increased blood pressure Correct Answer: C (Reference: “Hyperventilation leading to hypocarbia and cerebral vasoconstriction…”) 151. The cornerstone management of neurally mediated syncope includes all EXCEPT: A) Plasma volume expansion B) Avoidance of provocative stimuli C) Dietary fat reduction D) Reassurance and education Correct Answer: C (Reference: “Reassurance, education, avoidance of provocative stimuli, and plasma volume expansion with fluid and salt are the cornerstones of the management of neurally mediated syncope.”) 152. Which maneuver is particularly effective for raising blood pressure in neurally mediated syncope? A) Arm tensing B) Leg crossing C) Deep breathing  D) Abdominal muscle tensing Correct Answer: D (Reference: “Of these, abdominal muscle tensing is the most effective.”) 153. Isometric counterpressure maneuvers in neurally mediated syncope help by: A) Reducing blood volume B) Increasing central blood volume and cardiac output C) Lowering heart rate D) Raising body temperature Correct Answer: B (Reference: “Isometric counterpressure maneuvers… may raise blood pressure by increasing central blood volume and cardiac output.”) 154. Randomized controlled trials have shown support for which intervention in neurally mediated syncope? A) Electroshock therapy B) Use of diuretics C) Isometric counterpressure maneuvers D) Reducing salt intake Correct Answer: C (Reference: “Randomized controlled trials support this intervention.”) 155. Which medication is sometimes used by experts to treat refractory neurally mediated syncope? A) Diuretics B) Antihistamines C) Fludrocortisone D) Corticosteroids Correct Answer: C (Reference: “Fludrocortisone, vasoconstricting agents, and β-adrenoreceptor antagonists are widely used by experts to treat refractory patients.”) 156. Evidence from randomized controlled trials for pharmacotherapy in neurally mediated syncope is: A) Consistent B) Abundant C) Lacking D) Overwhelming Correct Answer: C (Reference: “…there is no consistent evidence from randomized controlled trials for any pharmacotherapy to treat neurally mediated syncope.”) 157. Which device is rarely beneficial for treating neurally mediated syncope? A) Defibrillator B) Oxygen tank C) Cardiac pacemaker D) Blood pressure cuff Correct Answer: C (Reference: “…use of a cardiac pacemaker is rarely beneficial.”) 158. Cardiac pacing in neurally mediated syncope may be an option for: A) Younger patients B) Patients with bradycardia only C) Patients with cardioinhibition due to carotid sinus syndrome D) All patients Correct Answer: C (Reference: “…patients with prominent cardioinhibition due to carotid sinus syndrome.”) 159. Orthostatic hypotension is defined as a reduction in systolic blood pressure of at least: A) 5 mmHg B) 10 mmHg C) 20 mmHg D) 25 mmHg Correct Answer: C (Reference: “Orthostatic hypotension, defined as a reduction in systolic blood pressure of at least 20 mmHg…”) 160. The reduction in diastolic blood pressure for diagnosing orthostatic hypotension is at least: A) 15 mmHg B) 5 mmHg C) 20 mmHg D) 10 mmHg Correct Answer: D (Reference: “…or diastolic blood pressure of at least 10 mmHg after 3 min of standing.”) 161. Orthostatic hypotension is a manifestation of:  A) Autonomic failure B) Muscular weakness C) High blood sugar D) Chronic fatigue Correct Answer: A (Reference: “…a manifestation of sympathetic vasoconstrictor (autonomic) failure.”) 162. In partial autonomic failure, heart rate: A) Does not change B) Always decreases C) Increases slightly but is insufficient to maintain output D) Always returns to normal Correct Answer: C (Reference: “…heart rate may increase to some degree but is insufficient to maintain cardiac output.”) 163. Delayed orthostatic hypotension is a form of: A) Primary hypertension B) Sympathetic adrenergic dysfunction C) Heart failure D) Muscular dystrophy Correct Answer: B (Reference: “…delayed orthostatic hypotension… may reflect a mild or early form of sympathetic adrenergic dysfunction.”) 164. Initial orthostatic hypotension occurs within how many seconds of standing? A) 30 s B) 5 s C) 10 s D) 15 s Correct Answer: D (Reference: “…orthostatic hypotension occurs within 15 s of standing…”) 165. The main cause of initial orthostatic hypotension is thought to be: A) Loss of blood volume B) Transient mismatch between cardiac output and peripheral vascular resistance C) Increased stroke volume D) Elevated heart rate Correct Answer: B (Reference: “…a finding that may reflect a transient mismatch between cardiac output and peripheral vascular resistance.”) 166. Symptoms of orthostatic hypotension often occur in response to: A) Eating large meals B) Physical exertion C) Sudden postural change D) Cold exposure Correct Answer: C (Reference: “…symptoms of orthostatic hypotension include light-headedness, dizziness, and presyncope (near-faintness) occurring in response to sudden postural change.”) 167. Visual blurring in orthostatic hypotension is likely due to: A) Low blood sugar B) High blood pressure C) Retinal or occipital lobe ischemia D) Muscle fatigue Correct Answer: C (Reference: “Visual blurring may occur, likely due to retinal or occipital lobe ischemia.”) 168. The term “coathanger headache” in orthostatic hypotension refers to: A) Severe frontal headache B) Headache in the occipital and posterior cervical regions C) Headache in the temples D) Randomly occurring headache Correct Answer: B (Reference: “…neck pain, typically in the suboccipital, posterior cervical, and shoulder region (the ‘coathanger headache’)…”) 169. Orthostatic dyspnea is thought to result from: A) High lung pressure B) Ventilation-perfusion mismatch in the lung apices C) Decreased oxygen intake D) Increased blood volume Correct Answer: B (Reference: “…orthostatic dyspnea (thought to reflect ventilation-perfusion mismatch due to inadequate perfusion of ventilated lung apices)…”) 170. Orthostatic angina may occur due to:  A) Blood clots in the heart B) Impaired myocardial perfusion C) High cholesterol levels D) High blood volume Correct Answer: B (Reference: “…angina (attributed to impaired myocardial perfusion even with normal coronary arteries).”) 171. Symptoms of orthostatic hypotension may be exacerbated by: A) Cold environments B) Drinking water C) Exertion and meals D) Medication adherence Correct Answer: C (Reference: “Symptoms may be exacerbated by exertion, prolonged standing, increased ambient temperature, or meals.”) 172. Syncope in orthostatic hypotension usually includes: A) Sudden onset without warning B) Rapid recovery only C) Warning symptoms prior to onset D) Fever Correct Answer: C (Reference: “Syncope is usually preceded by warning symptoms…”) 173. Profound decreases in blood pressure during orthostatic hypotension may lead to: A) Muscle cramps B) Heightened alertness C) Risk for falls and injuries D) Increased energy Correct Answer: C (Reference: “…placing them at risk for falls and injuries if the autoregulatory threshold is crossed…”) 174. Profound drops in blood pressure during orthostatic hypotension can result in: A) Increased blood volume B) Enhanced physical performance C) Cerebral hypoperfusion D) Elevated heart rate Correct Answer: C (Reference: “…profound decreases in blood pressure, sometimes without symptoms but placing them at risk for falls and injuries if the autoregulatory threshold is crossed with ensuing cerebral hypoperfusion.”) 175. Orthostatic hypotension symptoms may be nonspecific and include: A) Muscle twitching B) Cognitive slowing C) Enhanced focus D) Increased appetite Correct Answer: B (Reference: “Symptoms may be absent or nonspecific, such as generalized weakness, fatigue, cognitive slowing, leg buckling, or headache.”) 176. Supine hypertension is common in patients with orthostatic hypotension due to: A) Cardiovascular failure B) Renal failure C) Autonomic failure D) Muscular dystrophy Correct Answer: C (Reference: “Supine hypertension is common in patients with orthostatic hypotension due to autonomic failure…”) 177. In some series, what percentage of patients with orthostatic hypotension experience supine hypertension? A) 50% Correct Answer: D (Reference: “…affecting >50% of patients in some series.”) 178. Orthostatic hypotension may follow the initiation of therapy for which condition? A) Diabetes B) Hypotension C) Hypertension D) Heart failure Correct Answer: C (Reference: “Orthostatic hypotension may present after initiation of therapy for hypertension…”) 179. Supine hypertension may follow the treatment of: A) Diabetes B) Cardiac arrhythmias C) Orthostatic hypotension D) Liver failure Correct Answer: C (Reference: “…supine hypertension may follow treatment of orthostatic hypotension.”) 180. The association between supine hypertension and orthostatic hypotension may be due to: A) Nutritional deficiencies B) Baroreflex dysfunction with residual sympathetic outflow C) Increased heart rate D) Higher blood volume Correct Answer: B (Reference: “…it may in part be explained by baroreflex dysfunction in the presence of residual sympathetic outflow…”) 181. Baroreflex dysfunction with residual sympathetic outflow is particularly seen in patients with: A) Muscular disorders B) Central autonomic degeneration C) Respiratory diseases D) Cardiac failure Correct Answer: B (Reference: “…particularly in patients with central autonomic degeneration.”) 182. Neurogenic orthostatic hypotension is often caused by dysfunction in which nervous system? A) Central nervous system B) Endocrine system C) Peripheral and central autonomic nervous systems D) Muscular system Correct Answer: C (Reference: “Causes of neurogenic orthostatic hypotension include central and peripheral autonomic nervous system dysfunction.”)  183. Neurogenic orthostatic hypotension often accompanies dysfunction of which organ system? A) Gastrointestinal system only B) Muscular system C) Multiple organ systems including bladder and bowels D) Cardiovascular system Correct Answer: C (Reference: “…dysfunction of other organ systems (including the bladder, bowels, sexual organs, and sudomotor system)…”) 184. Which primary autonomic degenerative disorder is also known as Shy-Drager syndrome? A) Parkinson’s disease B) Dementia with Lewy bodies C) Multiple system atrophy D) Pure autonomic failure Correct Answer: C (Reference: “…multiple system atrophy (Shy-Drager syndrome)…”) 185. Primary autonomic degenerative disorders often include all EXCEPT: A) Multiple system atrophy B) Rheumatoid arthritis C) Parkinson’s disease D) Dementia with Lewy bodies Correct Answer: B (Reference: “The primary autonomic degenerative disorders are multiple system atrophy, Parkinson’s disease, dementia with Lewy bodies, and pure autonomic failure.”) 186. The primary autonomic degenerative disorders are also called: A) Glialopathies B) Synucleinopathies C) Neurofibromas D) Spongiopathies Correct Answer: B (Reference: “These are often grouped together as ‘synucleinopathies’ due to the presence of α-synuclein…”) 187. The protein α-synuclein aggregates mainly in neurons in which disorders? A) Cardiovascular diseases  B) Rheumatologic disorders C) Lewy body disorders D) Infectious diseases Correct Answer: C (Reference: “…α-synuclein, a protein that aggregates predominantly in the cytoplasm of neurons in the Lewy body disorders…”) 188. In multiple system atrophy, α-synuclein aggregates primarily in: A) Neurons B) Muscles C) Glia D) Kidneys Correct Answer: C (Reference: “…and in the glia in multiple system atrophy.”) 189. Peripheral autonomic dysfunction may accompany small-fiber neuropathies associated with: A) Diabetes mellitus B) Hypertension C) Glaucoma D) Asthma Correct Answer: A (Reference: “…small-fiber peripheral neuropathies such as those associated with diabetes mellitus…”) 190. Which hereditary condition is associated with peripheral autonomic dysfunction? A) Muscular dystrophy B) Hereditary amyloidosis C) Rheumatoid arthritis D) Hepatitis Correct Answer: B (Reference: “…hereditary amyloidosis, immune-mediated neuropathies, and hereditary sensory and autonomic neuropathies (HSAN)…”) 191. Which type of hereditary sensory and autonomic neuropathy is also known as familial dysautonomia? A) HSAN type I B) HSAN type II C) HSAN type III D) HSAN type IV Correct Answer: C (Reference: “…particularly HSAN type III, familial dysautonomia…”) 192. Which nutrient deficiency is associated with peripheral neuropathies and orthostatic hypotension? A) Vitamin D B) Vitamin B12 C) Iron D) Calcium Correct Answer: B (Reference: “…peripheral neuropathies that accompany vitamin B12 deficiency…”) 193. Neurogenic orthostatic hypotension can be associated with exposure to: A) High altitudes B) Neurotoxins C) Cold temperatures D) Excessive sunlight Correct Answer: B (Reference: “…neurotoxin exposure, HIV and other infections…”) 194. Which infection is sometimes associated with peripheral neuropathies leading to orthostatic hypotension? A) Tuberculosis B) HIV C) Hepatitis A D) Influenza Correct Answer: B (Reference: “…orthostatic hypotension is associated with the peripheral neuropathies that accompany… HIV and other infections…”) 195. Which of the following is least likely to cause peripheral autonomic dysfunction? A) Hereditary amyloidosis B) Vitamin B12 deficiency C) Neurotoxin exposure D) Common cold Correct Answer: D (Reference: “…vitamin B12 deficiency, neurotoxin exposure, HIV and other infections…”) 196. Pure autonomic failure is categorized as a:  A) Muscular disorder B) Synucleinopathy C) Genetic mutation D) Respiratory disease Correct Answer: B (Reference: “…pure autonomic failure… grouped together as ‘synucleinopathies’ due to the presence of α-synuclein.”) 197. Neurogenic orthostatic hypotension primarily affects: A) The musculoskeletal system B) The autonomic nervous system C) The digestive system D) The respiratory system Correct Answer: B (Reference: “Causes of neurogenic orthostatic hypotension include central and peripheral autonomic nervous system dysfunction.”) 198. Dementia with Lewy bodies is classified as a: A) Muscular dystrophy B) Synucleinopathy C) Neurofibroma D) Cardiovascular disorder Correct Answer: B (Reference: “…dementia with Lewy bodies… grouped together as ‘synucleinopathies’…”) 199. Which condition associated with orthostatic hypotension involves small-fiber neuropathy? A) Hyperthyroidism B) Glaucoma C) Diabetes mellitus D) Hemophilia Correct Answer: C (Reference: “…small-fiber peripheral neuropathies such as those associated with diabetes mellitus…”) 200. Pure autonomic failure typically involves: A) Muscle weakness only B) Synuclein aggregation C) Low blood sugar D) High blood pressure Correct Answer: B Reference: “…pure autonomic failure… grouped together as ‘synucleinopathies’ due to the presence of α-synuclein.”) 201. Patients with autonomic failure are prone to blood pressure drops after: A) Physical exercise B) Sleeping C) Eating meals D) Taking vitamins Correct Answer: C (Reference: “Patients with autonomic failure and the elderly are susceptible to falls in blood pressure associated with meals.”) 202. Which of the following meal characteristics can worsen postprandial blood pressure drops? A) High protein B) High carbohydrate C) Low fat D) Low calorie Correct Answer: B (Reference: “The magnitude of the blood pressure fall is exacerbated by large meals, meals high in carbohydrate, and alcohol intake.”) 203. The exact mechanism behind postprandial syncope is: A) Fully understood B) Known to be genetic C) Not fully elucidated D) Caused by dehydration Correct Answer: C (Reference: “The mechanism of postprandial syncope is not fully elucidated.”) 204. Orthostatic hypotension is often caused by: A) Lifestyle choices B) Dehydration only C) Genetic mutations D) Iatrogenic factors Correct Answer: D (Reference: “Orthostatic hypotension is often iatrogenic.”) 205. Which class of drugs used for hypertension can lower peripheral resistance?  A) β-blockers B) α-adrenoreceptor antagonists C) Calcium channel blockers D) Diuretics Correct Answer: B (Reference: “…α-adrenoreceptor antagonists used to treat hypertension and prostatic hypertrophy…”) 206. Iatrogenic volume depletion can result from all EXCEPT: A) Hemorrhage B) Vomiting C) Sedentary lifestyle D) Diuresis Correct Answer: C (Reference: “Iatrogenic volume depletion due to diuresis and volume depletion due to medical causes…”) 207. A common cause of orthostatic hypotension related to medical treatment is: A) Viral infection B) Volume depletion C) Increased blood sugar D) High protein intake Correct Answer: B (Reference: “…volume depletion due to medical causes… may also result in decreased effective circulatory volume, orthostatic hypotension…”) 208. The initial step in treating orthostatic hypotension is to: A) Increase dietary carbohydrates B) Remove reversible causes C) Start drug therapy immediately D) Limit physical activity Correct Answer: B (Reference: “The first step is to remove reversible causes—usually vasoactive medications.”) 209. Patients with orthostatic hypotension should be educated to move from supine to upright: A) Very quickly B) In stages C) Only in emergencies  D) While holding their breath Correct Answer: B (Reference: “Nonpharmacologic interventions should be introduced… staged moves from supine to upright.”) 210. Which measure is recommended to reduce nocturnal diuresis and supine hypertension? A) Daily exercise B) Raising the head of the bed C) Low-carbohydrate diet D) Frequent naps Correct Answer: B (Reference: “…raising the head of the bed to reduce supine hypertension and nocturnal diuresis.”) 211. To expand intravascular volume, patients should: A) Decrease salt intake B) Increase fluid and salt intake C) Avoid carbohydrates D) Limit protein consumption Correct Answer: B (Reference: “Intravascular volume should be expanded by increasing dietary fluid and salt.”) 212. Isometric counterpressure maneuvers help increase: A) Heart rate B) Intravascular pressure C) Sugar levels D) Breathing rate Correct Answer: B (Reference: “…isometric counterpressure maneuvers that increase intravascular pressure…”) 213. If nonpharmacologic measures fail, which drug may be introduced for orthostatic hypotension? A) Diuretics B) Fludrocortisone acetate C) Antihistamines D) Corticosteroids Correct Answer: B (Reference: “…pharmacologic intervention with fludrocortisone acetate…”)  214. Which agent is commonly used as a vasoconstrictor for orthostatic hypotension? A) Ibuprofen B) Midodrine C) Acetaminophen D) Metformin Correct Answer: B (Reference: “…vasoconstricting agents such as midodrine…”) 215. Which medication is sometimes used to manage refractory orthostatic hypotension? A) Pyridostigmine B) Ibuprofen C) Amoxicillin D) Dexamethasone Correct Answer: A (Reference: “…supplementary agents that include pyridostigmine, atomoxetine, yohimbine…”) 216. Which of the following is NOT commonly recommended for treating orthostatic hypotension? A) Fludrocortisone acetate B) Midodrine C) Diuretics D) l-dihydroxyphenylserine Correct Answer: C (Reference: “…pharmacologic intervention with fludrocortisone acetate and vasoconstricting agents such as midodrine and l-dihydroxyphenylserine…”) 217. Octreotide is used in treating orthostatic hypotension to: A) Reduce blood sugar B) Increase blood volume C) Vasoconstrict blood vessels D) Lower heart rate Correct Answer: C (Reference: “…additional therapy with supplementary agents that include… octreotide…”) 218. Which medication for orthostatic hypotension mimics the antidiuretic hormone? A) Desmopressin acetate (DDAVP) B) Fludrocortisone C) Atomoxetine  D) Yohimbine Correct Answer: A (Reference: “…additional therapy with supplementary agents that include… desmopressin acetate (DDAVP)…”) 219. Erythropoietin is sometimes prescribed in orthostatic hypotension treatment to: A) Reduce salt levels B) Increase red blood cell production C) Lower blood pressure D) Stabilize sugar levels Correct Answer: B (Reference: “…additional therapy with supplementary agents that include… erythropoietin.”) 220. Alcohol consumption may worsen postprandial blood pressure drops by: A) Reducing blood volume B) Decreasing blood pressure C) Increasing heart rate D) Decreasing fluid retention Correct Answer: B (Reference: “…blood pressure fall is exacerbated by large meals, meals high in carbohydrate, and alcohol intake.”) 221. Which class of drugs is often responsible for iatrogenic orthostatic hypotension? A) Antibiotics B) Antihypertensive agents C) Antidepressants D) Antihistamines Correct Answer: B (Reference: “…antihypertensive agents of several classes; nitrates and other vasodilators…”) 222. Diuretics may lead to orthostatic hypotension by causing: A) Increased blood pressure B) Volume depletion C) Hyperglycemia D) Higher heart rate Correct Answer: B (Reference: “Iatrogenic volume depletion due to diuresis… may also result in decreased effective circulatory volume, orthostatic hypotension…”) 223. Orthostatic hypotension can also result from volume depletion due to:  A) Excessive sleep B) Physical activity C) Medical conditions like hemorrhage D) Increased calorie intake Correct Answer: C (Reference: “…volume depletion due to medical causes (hemorrhage, vomiting, diarrhea, or decreased fluid intake)…”) 224. Which of the following nonpharmacologic measures is recommended for orthostatic hypotension? A) Avoiding salt B) Staged movement from lying to standing C) High protein diet D) Running daily Correct Answer: B (Reference: “…staged moves from supine to upright…”) 225. Which intervention is used to increase intravascular volume in orthostatic hypotension? A) Fluid restriction B) Increased dietary fluid and salt C) Low carbohydrate diet D) High protein diet Correct Answer: B *(Reference: “Intravascular volume should be expanded) 226. Cardiac syncope is primarily caused by: A) Genetic disorders B) Respiratory failure C) Arrhythmias and structural heart disease D) Immune responses Correct Answer: C (Reference: “Cardiac (or cardiovascular) syncope is caused by arrhythmias and structural heart disease.”) 227. Structural heart disease increases vulnerability to: A) High blood pressure B) Genetic mutations C) Abnormal electrical activity  D) Respiratory infections Correct Answer: C (Reference: “Structural disease renders the heart more vulnerable to abnormal electrical activity.”) 228. Bradyarrhythmias associated with syncope are caused by: A) Low blood sugar B) Severe sinus node dysfunction or AV block C) High cholesterol D) Muscle weakness Correct Answer: B (Reference: “Bradyarrhythmias that cause syncope include those due to severe sinus node dysfunction… and atrioventricular (AV) block.”) 229. Bradyarrhythmias from sinus node dysfunction are often linked to: A) Atrial tachyarrhythmia B) Low oxygen levels C) Respiratory diseases D) Muscle fatigue Correct Answer: A (Reference: “…bradyarrhythmias due to sinus node dysfunction are often associated with an atrial tachyarrhythmia…”) 230. A common cause of syncope in tachycardia-bradycardia syndrome is: A) Muscle atrophy B) Prolonged pause after tachycardic episode C) Increased blood sugar D) Constant high blood pressure Correct Answer: B (Reference: “A prolonged pause following the termination of a tachycardic episode is a frequent cause of syncope in patients with the tachycardia-bradycardia syndrome.”) 231. Bradycardia-induced syncope is sometimes called: A) Stokes-Adams attack B) Tachycardia attack C) Muscular atrophy D) Respiratory episode Correct Answer: A (Reference: “Syncope due to bradycardia or asystole has been referred to as a Stokes-Adams attack.”)  232. Ventricular tachyarrhythmias frequently cause: A) Syncope B) Hypertension C) Muscle spasms D) Hyperglycemia Correct Answer: A (Reference: “Ventricular tachyarrhythmias frequently cause syncope.”) 233. Ventricular tachycardia rates below what value are less likely to cause syncope? A) 150 beats/min B) 180 beats/min C) 200 beats/min D) 250 beats/min Correct Answer: C (Reference: “The likelihood of syncope with ventricular tachycardia is in part dependent on the ventricular rate; rates 400 ms  C) >500 ms D) >600 ms Correct Answer: C (Reference: “Prolonged QT interval (>500 ms)”) 8. Repetitive sinoatrial block or sinus pauses are high-risk indicators in syncope because they may cause: A) Increased blood pressure B) Intermittent loss of consciousness C) Increased respiratory rate D) Enhanced kidney function Correct Answer: B (Reference: “Repetitive sinoatrial block or sinus pauses”) 9. Persistent sinus bradycardia is considered a high-risk feature in which condition? A) Syncope B) Hypertension C) Asthma D) Liver disease Correct Answer: A (Reference: “Persistent sinus bradycardia”) 10. What conduction delay duration (QRS) is considered high risk in syncope patients? A) ≥80 ms B) ≥100 ms C) ≥120 ms D) ≥150 ms Correct Answer: C (Reference: “Bi- or trifascicular block or intraventricular conduction delay with QRS duration ≥120 ms”) 11. Atrial fibrillation is considered a high-risk feature in syncope because it can lead to: A) Stable heart rhythms B) Increased oxygen intake C) Irregular heartbeats and risk of stroke D) Enhanced muscle strength Correct Answer: C (Reference: “Atrial fibrillation”) 12. Nonsustained ventricular tachycardia is a high-risk feature in syncope due to its potential to cause: A) Loss of appetite B) Reduced brain perfusion C) Enhanced sleep patterns D) Increased digestion speed Correct Answer: B (Reference: “Nonsustained ventricular tachycardia”)  13. A family history of which condition is considered high risk in patients with syncope? A) Hypertension B) Sudden death C) Migraine headaches D) Asthma Correct Answer: B (Reference: “Family history of sudden death”) 14. Which syndrome, if present on an ECG, is considered high risk in syncope patients? A) Marfan syndrome B) Preexcitation syndrome C) Metabolic syndrome D) Chronic fatigue syndrome Correct Answer: B (Reference: “Preexcitation syndromes”) 15. The presence of a Brugada pattern on an ECG is a high-risk feature in syncope due to its association with: A) Low blood pressure B) Risk of ventricular arrhythmias C) Slow heart rate D) Improved lung function Correct Answer: B (Reference: “Brugada pattern on ECG”) 16. Palpitations at the time of syncope may indicate a high risk for: A) Increased respiratory function B) Underlying cardiac arrhythmia C) Enhanced renal function D) Stable heart rate Correct Answer: B (Reference: “Palpitations at time of syncope”) 17. Syncope that occurs at rest or during exercise is considered high risk due to the potential for: A) Blood pressure stabilization B) Underlying structural or electrical heart disease C) Improved respiratory rate D) Reduced blood glucose levels Correct Answer: B (Reference: “Syncope at rest or during exercise”) 18. Which of the following is considered a high-risk feature on ECG in a patient with syncope? A) ST elevation in leads II, III, and aVF B) Prolonged QT interval greater than 500 ms C) T wave inversion in all leads  D) PR interval less than 120 ms Correct Answer: B (Reference: “Prolonged QT interval (>500 ms)”) 19. In syncope patients, which of the following blocks is considered high-risk? A) First-degree AV block B) Second-degree AV block, type I C) Bi- or trifascicular block D) AV dissociation Correct Answer: C (Reference: “Bi- or trifascicular block or intraventricular conduction delay with QRS duration ≥120 ms”) 20. What family medical history element is considered high-risk in syncope patients? A) Family history of hypertension B) Family history of sudden death C) Family history of arrhythmias with exercise D) Family history of respiratory disease Correct Answer: B (Reference: “Family history of sudden death”) 21. Which specific pattern on ECG is associated with a high risk in syncope patients due to the risk of ventricular arrhythmias? A) Brugada pattern B) Sinus tachycardia C) Left bundle branch block D) Non-specific T wave changes Correct Answer: A (Reference: “Brugada pattern on ECG”) 22. Which symptom at the time of syncope increases the risk and suggests the need for further evaluation? A) Headache B) Palpitations C) Shortness of breath D) Nausea Correct Answer: B (Reference: “Palpitations at time of syncope”) 23. Which situation for syncope is considered high-risk and indicates the need for hospitalization or further evaluation? A) Syncope upon standing up B) Syncope at rest or during exercise C) Syncope upon sitting down D) Syncope after a meal Correct Answer: B (Reference: “Syncope at rest or during exercise”) 24. Which of the following ECG abnormalities in a syncope patient indicates a high risk of a serious underlying condition?  A) Sinus arrhythmia B) Prolonged QT interval >500 ms C) Shortened PR interval D) High QRS voltage in precordial leads Correct Answer: B (Reference: “Prolonged QT interval (>500 ms)”) 25. Persistent sinus bradycardia in a syncope patient is considered a high-risk feature because it may indicate: A) Reduced oxygen levels B) Potential for asystole or cardiac arrest C) Enhanced renal function D) Improved cardiac output Correct Answer: B (Reference: “Persistent sinus bradycardia”)