Dizziness and Syncope

Question 1

benign positional vertigo

Answer 1

when vertigo is provoked by positional changes, such as sitting or standing up, or turning the head-common in older pts or after head trauma
-test with Dix-Hallpike manuever

Question 2

Merniere’s disease

Answer 2

recurrent subacute attacks of vertigo, deafness, and tinnitus

Question 3

What is dizziness that is consistently provoked by standing?

Answer 3

orthostatic hypotension

Question 4

what is the post-ictal phase s/p generalized seizures

Answer 4

• lethargic
• confused
• irritable
• unable to recall what happened
• vs. fainting pts: recall pre-syncopal s/s, not confused, and quickly return to their baseline mental status

Question 5

synonym for fainting

Answer 5

vasovagal syncope

Question 6

what are some types of syncope

Answer 6

• vagally-mediated syncopal spells; carotid sinus syncope

- micturition (urination) syncope

Question 7

when syncope occurs independently of pt activity what should be considered?

Answer 7

cardiac arrhythmias or heart block

Question 8

diagnostic testing in orthostatic hypotension

Answer 8

• supine and upright bp and pulse should be taken
• will see: persistent systolic pressure drop of 20mmHg or more after standing for 3 mins
• -compensatory inc in pulse=intravascular hypovolemia
• -no compensatory inc=neurological problem with the autonomic system

Question 9

what is the benefit of checking bp in both arms?

Answer 9

-help exclude dizziness or vertigo d/t subclavian steal syndrome

Question 10

any of the following warrant a head CT without contrast in kids 2-18

Answer 10

• focal neurologic findings
• skull fracture, especially signs of basilar skull fracture
• seizure
• persistent AMS (lethargy, slow response, agitation)
• prolonged loc