CASE 22 - Dizziness

Question 1

Q1:

Answer 1

Describe the meaning of dizziness to me ==> As if the room is spinning around me.

Question 2

Q2:

Answer 2

Duration of dizziness.

Question 3

Q3:

Answer 3

Positions that can elicit the dizziness ==> Lying down, sitting, standing up.

Question 4

Q4:

Answer 4

Tinnitus.

Question 5

Q5:

Answer 5

Falls ==> No, sometimes I feel unsteady as if I were going to fall down, but I don’t fall.

Question 6

Q6:

Answer 6

Recent infections ==> I have had a really bad diarrhea.

Question 7

PEx — Key aspects:

Answer 7

1. HEENT ==> Inspected for nystagmus—fundoscopic exam—otoscopy—assessed hearing—Rinne/Weber—Inspected mouth and throat.
2. NEURO ==> CNs — motor — DTRs — Gait — Romberg — Tilt test (eg Dix-Hallpike).

Question 8

HEENT — what to write:

Answer 8

NC/AT, PERRLA, EOMI w/o nystagmus, no papilledema, no cerumen, TMs normal, mouth and oropharynx nl.

Question 9

Neuro:

Answer 9

CN 2-12 grossly intact except for decreased hearing acuity in the left ear.
+Rinne (air conduction > bone conduction on the left).
Weber no lateralization.
(-)Titl test.
Motor: Strength 5/5 throughout.
DTRs: 2+ intact, symmetric.
(-)Babinski bilaterally.
Cerebellar: (-)Romberg, finger to nose nl.
Gait: Nl.