Syncope assessment — KFP-style written assessment

KFP 1 (10 marks)

A 19-year-old student faints twice in six months: once at a blood donation, once standing in a hot lecture theatre. Both times she felt hot, sweaty and grey-visioned first. There was no tongue biting or confusion afterwards. She drives to university. ^[7]

1. Classify her episodes and state the discriminators that exclude seizure here. (3) ^[7]
2. Outline first-line management including what she must do at prodrome onset. (4) ^[8]
3. What driving advice do you give? (3) ^[7]

Model answers

1. Reflex (vasovagal) syncope triggered by orthostatic and emotional stress. Seizure is excluded by absence of tongue biting and postictal confusion, plus a rapid spontaneous recovery; prodromal warmth, sweating and visual greying are classic vasovagal warnings. ^[7]
2. Education naming the mechanism and its benign prognosis; recognise the warning window and immediately lie flat with legs raised; physical counterpressure manoeuvres (leg crossing with tensing, hand gripping) at onset; two-to-three litres fluid daily with liberal salt. Review after each episode; escalate only if attacks continue despite this. ^[8]
3. Reflex syncope with clear prodrome and no cardiac disease carries a short abstention only — commonly days to weeks while counterpressure and hydration measures are established — then private driving resumes per local licensing authority rules. Document the conversation. If an attack occurs without prodrome, or during driving, the advice changes entirely. ^[7]