Dizziness Flashcards
Key history in dizziness
Lightheadedness vs. vertigo vs. pre-syncope vs. dysequilibrium
Auditory symptoms (hearing loss, tinnitus)
Duration
Context (e.g. position changes, trauma)
Other associated symptoms (visual disturbance, URI, nausea)
Neck pain or injury
Medications
Atherosclerosis
Key physical exam in dizziness
Vital signs
Neurologic exam, including Romberg test, nystagmus, tilt test, gait, hearing, and Weber and Rinne tests
ENT and CV exams
35 yo F with intermittent vertigo, tinnitus, nausea and hearing loss over last week
Meniere’s disease
Vestibular neuronitis
Labyrinthitis
CBC, VDRL/RPR (syphilis is a cause of Meniere’s disease), MRI-brain, tilt test (Dix-Hallpike maneuver)
55 yo F with dizziness and feeling faint for one day
+ severe diarrhea over last two days
+ taking furosemide for HTN
Orthostatic hypotension due to dehydration
Vestibular neuronitis
Labyrinthitis
Orthostatic vital signs, CBC, electrolytes, rectal exam, stool for occult blood, stool leukocytes
65 yo M with postural dizziness and unsteadiness
+ starting taking HCTZ two days ago for HTN
Drug-induced orthostatic hypotension
Vestibular neuronitis
Labyrinthitis
Orthostatic vital signs, CBC, electrolytes, echocardiogram, MRI-brain
44 yo F with dizziness on moving head to L
+ vertigo (“room is spinning around head”)
+ tilt test results in nystagmus and nausea
Benign positional vertigo
Vestibular neuronitis
Labyrinthitis
Tilt test (Dix-Hallpike maneuver), MRI-brain, audiogram
55 yo F with dizziness since this morning
+ nauseated and vomited once
+ URI two days ago
+ no hearing loss
Vestibular neuronitis
Labyrinthitis
Meniere’s disease
CBC, electrolytes, electronystagmography, MRI/MRA-brain
55 yo F with dizziness since this morning and decreased hearing
+ nausea and vomited once
+ URI two days ago
Labyrinthitis
Vestibular neuronitis
Meniere’s disease
Audiogram, electronystagmography, MRI/MRA-brain
