GP - Dizziness Flashcards
1
Q
What are the common side effects of opioids?
A
- Nausea & vomiting (often transient) - may need anti-emetic
- Drowsiness (often transient) - may need dose changed
- Constipation - prescribe laxative e.g. senna
- Itching / urticaria
- Sweating
- Pupil constriction
2
Q
What are some important questions to ask in a Dizziness history?
A
PC / HPC:
- Describe what you mean by dizziness? - off-balance (disequilibrium), room-spinning (vertigo), light-headed (pre-syncope) etc.
- Noticed ringing in ears? (tinnitus)
- Hearing difficulty? (timeline of ↓ hearing & sensorineural vs conductive)
- Changes in vision?
- Headaches?
- What brings on the dizziness? (standing - orthostatic hypotension)
- Worse at certain time of day? (morning headache/dizziness - ↑ ICP / acoustic neuroma)
- Rash? (blistered external meatus - herpes zoster oticus)
Red-Flags:
- Weight loss, night sweats, fever?
- Sudden change in vision? (stroke, TIA, intraoccular bleed, brain haemorrhage)
- Weakness? (facial palsy - Herpes zoster oticus i.e. Ramsay Hunt Syndrome, limb weakness / sensation change - MS)
- Temporal tenderness? (GCA)
DH:
- Current medications?
- New medications (including OTC)? - (ototoxic drugs e.g. streptomycin, vancomycin, gentamicin, chloroquines)
- Allergies?
SH:
- Smoking?
- Alcohol?
- Recreational drugs?
- Job - impact on job?
FHx:
- Hx of ear pathologies?
- Strokes, TIAs, HTN?
- FHx of eye issues e.g. glaucoma?
3
Q
How reliable is a urine pregnancy test?
A
97%
Home pregnancy tests are ~97% accurate when used on the day of the 1st missed period
4
Q
What drugs can be used to manage Meniere’s Disease?
A
-
Acute attacks –> vestiubular sedative e.g. buccal or IM Prochlorperazine (D2 receptor antagonist)
- Cyclizine (anti-histamine)
- Cinnarizine (anti-histamine + calcium channel blocker - used for motion sickness, chemo-sickness, vertigo and Meniere’s)
- Prevention –> Betahistine (vasodilator)
5
Q
Study this mind map of causes of Dizziness - then cover it and test yourself!
A
6
Q
What type of drug is Dabigitran and what is its MoA?
A
Dabigitran = NOAC (New oral anticoagulant)
MoA = direct inhibition of thrombin
