Dizziness is very high yield and it is commonly tested on USMLE step 2 CS because the underlying etiologies can present in a similar fashion, which makes it confusing and hard to make the correct diagnosis if you’re not asking the right question or doing the right work-up.
PHYSICAL EXAMINATION Dizziness Mnemonic
NOTE: Make sure to wash your hands or wear gloves before you start physical examination. Make sure to ask for permission before you start each physical exam. Make sure to use proper draping (don’t forget to tie back patient’s gown). Make sure to explain each physical examination in layman’s term to your patient. Do NOT repeat painful maneuvers.
- HEENT: Inspect for Nystagmus, Rinne & Weber test, Whisper test, Otoscopy, Funduscopic exam, Mouth & Throat.
- Cardiovascular: Auscultation
- Respiratory System: Auscultation
- Neuro: Cranial nerves (2-12), Sensation, Motor, Motor, DTRs, Gait, Romberg test, Dix-Hallpike Maneuver.
DIFFERENTIAL DIAGNOSIS Dizziness Mnemonic
Clarify if patient is having Vertigo “sensation of room spinning” or Lightheadedness.
- Ménière disease: associated with Vertigo, Tinnitus, Hearing loss
- Orthostatic hypotension due to dehydration: patient has recent history of diarrhea, vomiting or increased use of diuretic use. [Presents with lightheadedness not vertigo]
- Benign paroxysmal positional vertigo (BPPV): associated with exacerbation of dizziness that is associated with position changes. Patients also have nystagmus.
- Labyrinthitis: history of recent upper respiratory infection. Associated with hearing loss and vertigo.
- Vestibular neuritis: history of recent upper respiratory infection, however is NOT associated with hearing loss
DIAGNOSTIC WORK UP Dizziness Mnemonic
- Dix-Hallpike Maneuver
- VDRL/RPR (to rule out syphilis which is associated with Ménière disease)
- Tilt table test
- MRI of brain
- Brain stem auditory evoked potentials
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