13. Approuch to lightheadedness/Dizziness DSAs

Question 1

When someone presents with dizziness/syncope, there are many questions to ask and important exam findings. One being a positive Dix-Hallpike maneuver which shows?

Answer 1

Benign positional vertigo

Question 2

Common tests for diziness and syncope include orthostatic vital signs, ECG, Holter monitor, Event loop monitor, Implanatable loop recorder, tilt table test (table from 0 to 70deg), EEG, carotid doppler US, carotid sinus massage and basic?

Answer 2

Blood work (CBC/CMP)

Question 3

There are 3 kinds of syncope: cardiac (20%), reflex (neurally 60%), and orthostatic hypotension syncope (10%). Cardiac syncope includes aortic stenosis, HCM, cardiac tamponade, cardiac mass/tumor, PE, severe pulm HTN and?

Answer 3

aortic dissection

Question 4

Neurally mediated or reflex syncope occur due to carotid sinus syndrome or hypersensitivity, situational or vasovagal. Orthostatic hypotension is caused by drugs, postural tachycardia synd, primary autonomic failure, and?

Answer 4

volume depletion

Question 5

Hypertrophic cardiomyopathy is characterized by left ventricular hypertrophy without a clear secondary cause mostly inheritable. AD- LV outflow tract obstruction do to eecentric thickening of the ventricular septum. S4 may be present, with a systolic murmur which is intensified by valvasa/standing and NOT by?

Answer 5

squatting

NOTE: squatting intensifies all murmurs except MVP and HCM

Question 6

Which type of syncope has the worst prognosis?

Answer 6

cardiac - 50% dead at 5 years

Question 7

Postural tachycardia syndrome POTS is seen in young adult women, and can be diagnosed using?

Answer 7

tilt table testing - can see sustained heart rate increase greater than 30 beats per min or a HR >120bpm in first 10 mins of tilt (NO hypotension)

Question 8

PE is commonly d/t Factor 5 leiden mutation, prothrombin mutation, protein C or S deficiency, anti thrombin deficiency or can be acquired., if D Dimer is low what should be done?

Answer 8

Nothing - rules out PE

Question 9

If wells critieria suggests high risk of PE and there is elevated D dimer one should do CT pulmonary angiography or ventilation perfusion scan or MR pulmonary angiography or ?

Answer 9

pulmonary angiography

Question 10

To form concentrated urine, one needs hypertonic medullary interstitium and high levels of ADH. Serum osmolality is usuall 282 and is regulated by osmoreceptor ADH system and thirst mechanism. Glomerulus filters 180L of fluid per day, 162 is absorbed in PCT/ TAL and the 18L is reabsorbed under the regulation of?

Answer 10

Antidiuretic Hormone ADH, vasopressin

Question 11

ADH at the collecting ducts binds V2 receptors and increases cAMP levels which leads to insertion of AQP2 and urea transporters. What is a DO resulting in decrased ability to concentrated urine resulting in polyuria and polydipsia?

Answer 11

Diabetes insipidus (DI)

Question 12

There are two types of Diabetes insipidus, which is caused by decreased release of ADH from the supraoptic nuceli SON?

Answer 12

Central diabetes insipidus

Question 13

What type of Diabetes insipidus is caused by decreased response to ADH at the collecting duct, causing lithium toxicity and hypercalcemia?

Answer 13

Nephrogenic diabetes insipidus

Question 14

Diabetes insipidus presents with polyuria, nocturia, polydipsia, hypernatremia, othrostasis, and DX via 24hr urine volume collection, with a urine osmolality of less than 300 and then do what test?

Answer 14

water deprivation test

Question 15

Tx central diabetes with vasopressin and nephrogenic with decreased solute intake and thiazide diuretics/NSAIDs and?

Answer 15

vasopressin