• Dr. Paul Dhillon MB BCh CCFP & Dr. Simon Moore

Syncope in the Fall, or Autumn?

Choosing your syncope work-up wisely.


Syncope is common, occurring in up to 30% of the adult population at some stage in their life. Common things being common, it could very well show up on your exam, and it will show up in your future practice.

Your job, if you choose to accept it, is to decide who needs that urgent head CT and who you can wisely choose to receive an ECG with thorough history and physical and discharge home. Before scrolling down for some answers, can you accept the mission and try and name 3 RED FLAGS for Syncopal patients that would require more work up than just an ECG?





DID YOU KNOW CHOOSING WISELY CANADA recommends not routinely obtaining neuroimaging (CT/MRI/US-Carotid) in the evaluation of syncope in patients with normal neurological examination.



1. Seizure activity

2. History/Signs of CVD (Aortic Stenosis, MI, HF)

3. Exertional syncope

4. ECG changes

5. Palpitations concurrent with syncope

6. Family Hx of sudden cardiac death

7. New neurologic signs

8. No prodrome


EXAM TIP – On the exam you have to Choose Wisely while at the same time make sure you know the RED FLAGS for more urgent investigation and possibly intervention. During residency take the time to take a moment after a patient encounter and write down in your note what RED FLAGS you screened for as way to study for the exam.

Reference List

Christine Soong, Benjamin H. Chen, and Brian M. Wong. Decisions: A 62-year- old woman with syncope. CMAJ January 6, 2015 187:48-49; published ahead of print December 1, 2014, doi:10.1503/cmaj.141313.


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The only Canada-Wide CCFP exam course - created by two Family Doctors who wished this existed when we were residents, and are on a mission to help CCFP exam candidates. Disclosures: The Review Course founders have no conflicting commercial interests. As is the case with any private events hosted on a university campus or hospital, this event is not affiliated with nor endorsed by the host venues. Our materials are peer-reviewed and prepared by Canadian physicians; we do not guarantee that our preparation materials are representative of any Canadian examination and we do not provide questions from any other examination nor are they intended as medical advice. The College of Family Physicians of Canada does not affiliate with nor endorse any exam preparation course.