Case 33 - 28 yo with dizziness

Question 1

Sx of influenza

Answer 1

fever, cough, myalgias, sore throat

Question 2

Dizziness

Answer 2

Can encompass syncope, disequilibrium and vertigo
Syncope - temporary LOC, “passing out” - due to hypotension or hypovolemia
Disequilibrium - feeling of being off balance, cerebellar degeneration
Vertigo - room spinning

Question 3

Physical exam for dizziness

Answer 3

• look for nystagmus
• head thrust - demonstrates likely peripheral lesion
• dix-hallpike maneuver

Question 4

Differential diagnosis for vertigo

Answer 4

1. BBPV - episodic vertigo triggered by change in position, etiology is calcium carbonate debris in semicircular canals, dx by dix-hallpike, treat with epley maneuver
2. Cerebellar infarct
3. Meneire’s disease - unilateral hearing loss, tinnitus, vertigo
4. TIA
5. Vesitbular migraine
6. Vestibular neuritis - assoc with recent URI
   Less likely: anemia, anxiety, arrhythmias orthostatic hypotension, otitis media

Question 5

Studies for vertigo

Answer 5

• MRI if sign of central lesion

Question 6

What types of respiratory infections do you treat with antibiotics? And which ones don’t you?

Answer 6

Treat otitis in children t treat children over 2 with uncomplicated otitis, uncomplicated maxillary sinusitis, and viral URis with abx

Question 7

Management of vertigo

Answer 7

vestibular rehab
vestibular suppressant medications - anticholinergics like meclizine or dimenhydrinate - can be effective in teh short term