ICCH

Question 1

What are the DDx of dizziness?

Answer 1

Peripheral disorders:

• Labyrinth:
  
  • Labyrinthitis: viral or suppurative
  • Ménière syndrome
  • Benign paroxysmal positional vertigo (BPPV)
  • Drugs
  • Trauma
  • Chronic suppurative otitis media
• Eight nerve:
  
  • Vestibular neuronitis
  • Acoustic neuroma
  • Drugs

Cervical disorders

• Brain stem (TIA or stroke):
  
  • Vertebrobasilar insufficiency
  • Infarction
• Cerebellum:
  
  • Degeneration
  • Tumours
• Migraine
• Mutiple sclerosis

Question 2

What are the red flags for dizziness/ vertigo?

Answer 2

• Neurological signs
• Ataxia out of proportion to vertigo
• Nystagmus out of proportion to vertigo
• Central nystagmus
• Central eye movement abnormalities

Question 3

What do you want to know from a patients Hx about dizziness?

Answer 3

• SOCRATES: key questions.
  
  • Is it vertigo or pseudovertigo?
  • Symptoms pattern:
    
    • paraoxysmal or continuous?
    • Effect of position and change of posture?
  • Any aural symptoms? Tinnitus? Deafness?
  • Any visual symptoms?
  • Any nausea or vomiting?
  • Any symptoms of psychoneurosis?
  • Any recent colds
  • And recent head injury (even trivial)?
  • Any drugs being taken?
    
    • alcohol?
    • marijuana?
    • hypotensive?
    • psychotropics?
    • other drugs?

Question 4

How do you examine a patient who presents with dizziness?

Answer 4

• Ear disease:
  
  • Auroscopic examination: ?wax, ?drum
  • Hearing tests
  • Weber and Rinne tests
• The eyes:
  
  • Visual acuity
  • Test movements for nystagmus
• Cardiovascular system:
  
  • Evidence of atherosclerosis
  • BP: supine, standing, sitting
  • Cardiac arrhythmias
• Cranial nerves:
  
  • 2nd, 3rd, 4th, 6th and 7th
  • Corneal response for 5th
  • 8th -auditory nerve
• The cerebellum or its connections:
  
  • Gait
  • Coordination
  • Reflexes
  • Romberg test
  • Finger nost test: ?past pointing
• The neck, including cervical spine
• General search for evidence of:
  
  • Anaemia
  • Polycythaemia
  • Alcohol dependence
• Hallpike manoeuvre
• Carotid arteries and carotid sinus

Question 5

What investigations can be order for dizziness?

Answer 5

• FBC
• Blood glucose
• ECG: ?holter monitor
• Audiometry
• Brain-stem evoked audiometry
• Caloric test
• Visual evoked potentials (MS)
• Electrocochleography
• Electro-oculography
• Rotational tests
• Radiology:
  
  • Chest X-ray (?bronchial carcinoma)
  • Cervical spine x-ray
  • CT scan
  • MRI: the choice to locate acoustic neuroma or other tumour - may detect MS and vascular infarction)

Question 6

What medications can be used to provide symptomatic relief of vertigo?

Answer 6

• Anti-emetics:
  
  • Prochlorperazine
  • Metoclopramide
• Antihistamines:
  
  • Promethazine
  • Betahistine
• Benzodiazepines
  
  • Diazepam
  • Lorazepam

Question 7

What are the DDx of neonatal jaundice?

Answer 7

Unconjugated hyperbilirubinaemia:

• Physiologic jaundice
• Breast milk jaundice
• Alloimmune haemolysis : haemolysis from blood group incompatibility -rhesus
• Others: Sepsis, excessice, non-haemolytic red cell destruction (polycythaemia, brusing, or cephalhaematoma), GIT obstruction or ileus (pyloris stenosis), prematurity, hypothyroidism.

Conjugated hyperbilirubinaemia:

• Biliary atresia
• Gilberts syndrome
• Crigler-Najjar syndrome
• Others causes:
  
  • Choledochal cyst
  • Neonatal hepatitis (congenital infection, alpha-1 antitrypsin deficiency; often idiopathic)
  • Metabolic (galactosaemia, fructose intolerance)
  • Complication of TPN

Question 8

What is the antidote to paracetamol poisoning?

Answer 8

N-Acetylcysteine

Question 9

What is the antidote for tricyclic antidepressant or aspirin overdose?

Answer 9

Sodium bicarcbonate

Question 10

What is used to treat mild to moderate and moderate to severe lead poisoning?

Answer 10

• Mild to moderate: Oral succimer - lead chelator
• Moderate to severe: Calcium EDTA - it is a lead chelator

Question 11

What is the antidote for iron overdose?

Answer 11

• IV fluids
• Deferoxamine