Weak + Dizzy

Question 1

how to manage a patient with muscle weakness? (2)

Answer 1

secure ability to ventilate
refer to specialist

Question 2

what must be differentiated when a patient presents with dizziness?

Answer 2

central vs peripheral vertigo

Question 3

dysfunction of the brain or brain stem leading to a misinterpretation or peripheral stimuli

Answer 3

central vertigo

Question 4

dysfunction of the inner ear or vestibular nerve creating incorrect stimuli that is sent to the brain

Answer 4

peripheral vertigo

Question 5

what is central vertigo considered until proven otherwise?

Answer 5

CVA (stroke)

Question 6

a patient presents with cranial nerve deficits, vertical nystagmus, and ataxia. Dx?

Answer 6

central vertigo

Question 7

a patient presents with unilateral hearing loss, and tinnitus, which are all positional. Dx?

Answer 7

peripheral vertigo

Question 8

what is the management for central vertigo? (4)

Answer 8

activate stroke protocol if w/in window
brain CT w/o contrast
brain MRI
admit if not thrombolytic candidate

Question 9

what is the management for peripheral vertigo? (4)

Answer 9

epley maneuver
meclizine (antiemetic)
scopolamine (anticholinergic)
diazepam (benzodiazepine)

Question 10

LOC after a psychological stressful event

Answer 10

vasovagal syncope (situational syncope)

Question 11

LOS not related to psychological stressful event

Answer 11

syncope / presyncope

Question 12

management for syncopal patient? (3)

Answer 12

fingerstick glucose
pregnancy test
detailed physical exam

Question 13

what is the syncope rule for patients to determine if the patient is at high risk?

Answer 13

CHESS

Congestive heart failure
Hematocrit < 30
EKG abnormality
Shortness of breath
SBP < 90

Question 14

what is the management for syncopal patient? (4)

Answer 14

O2
IV
monitor vitals
EKG

Question 15

syncope + headache = (2)

Answer 15

subarachnoid
intracerebral hemorrhage

Question 16

syncope + neuro deficit = (2)

Answer 16

CVA
intracerebral hemorrhage

Question 17

syncope + confusion = (3)

Answer 17

seizure
intracerebral hemorrhage
CVA

Question 18

syncope + chest pain = (3)

Answer 18

MI
PE
aortic dissection

Question 19

syncope + back/abdominal pain in older patient =

Answer 19

abdominal aortic aneurysm (AAA)

Question 20

syncope + positive HCG =

Answer 20

ectopic pregnancy

Question 21

what is the evaluation for a syncopal patient that is low risk? (5)

Answer 21

D/C with PCP follow up
no exercise until evaluated + cleared
give seizure precautions
no driving / swimming
shower with chair