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Deconditioning after pneumonia — SCE Geriatric Medicine MCQ

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HardRehabilitationDeconditioning after pneumoniaSCE Geriatric Medicine

A 72-year-old has unexplained abrupt blackouts. Monitored carotid sinus massage produces 5 seconds of asystole and a 55-mmHg systolic fall, but he remains completely asymptomatic and says this is unlike his attacks. What is the correct interpretation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Not diagnostic without symptom reproduction; proceed to ambulatory ECG

Explanation lettering: E = shown as A · D = shown as C · A = shown as D · C = shown as E

E is correct. NICE requires reproduction of syncope with the marked bradycardic/asystolic or hypotensive response; an asymptomatic physiological response is not carotid sinus syncope, so unexplained syncope proceeds to ambulatory ECG. A–C ignore symptom reproduction. D substitutes an unrelated diagnosis without seizure evidence.

Reference: NICE CG109 transient loss of consciousness recommendations: https://www.nice.org.uk/guidance/CG109/chapter/recommendations