Prolonged Syncope Differential — ORE Part 1 MCQ
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Correct answer: C — Consider other diagnoses (cardiac arrhythmia, hypoglycaemia, seizure, stroke); call 999
Vasovagal syncope characteristically results in spontaneous complete recovery within seconds to ~1 minute with appropriate positioning (lying flat with legs elevated). Failure to recover within 2 minutes is abnormal and mandates reconsideration of diagnosis per NICE CG109 recommendation 1.1.1.1. Alternative life-threatening causes—cardiac arrhythmia (detectable on ECG or ambulatory monitoring), seizure (with prolonged post-ictal confusion), hypoglycaemia (requiring bedside glucose), or stroke (with focal neurological deficit)—must be excluded. Emergency services (999) should be called to facilitate rapid assessment including ECG, blood glucose, and specialist evaluation. Option B is incorrect: uncomplicated vasovagal syncope does not typically persist >2 minutes. Option D (adrenaline) is not indicated for syncope. Option A (oral glucose) is incorrect as a first response unless hypoglycaemia is suspected. Option E (upright positioning, GTN) contradicts first-aid principles and worsens cerebral perfusion.
Reference: NICE Clinical Guideline CG109, Section 1.1.1.1: 'If the person with suspected transient loss of consciousness (TLoC) has sustained an injury or they have not made a full recovery of consciousness, use clinical judgement to determine appropriate management and the urgency of treatment.' https://www.nice.org.uk/guidance/cg109/chapter/1-guidance