Dizziness is one of the highly tested conditions that is tested on USMLE step 2 CS since it is very common and has many different etiologies. Are you Having trouble remembering all the important questions to ask during your patient encounter? Then try this Dizziness Mnemonic for USMLE Step 2 CS.
- HEENT: Inspect for Nystagmus, Rinne & Weber test, Whisper test, Otoscopy, Funduscopic exam, Mouth & Throat.
- Cardiovascular: Auscultation
- Pulmonary: Auscultation
- Neuro: Cranial nerves (2-12), Renne & Weber test, Sensation, Motor, DTRs, Gait, Romberg test, Dix-Hallpike Maneuver.
Be sure to ask your patient whether they are experiencing vertigo “sensation of room spinning around their head” or lightheadedness “fainting”.
- Orthostatic hypotension is a very common complication of dehydration. Look for history of diarrhea, vomiting or diuretic use. Patient presents with lightheadedness not vertigo. Also, there is no complains of tinnitus or hearing loss.
- Benign paroxysmal positional vertigo (BPPV): Patient presents with chief complaint of vertigo, which is exacerbated with position changes. There is no complaint of hearing loss or vertigo. BPPV is due to canalithiasis or the presence of calcium rocks within the posterior semicircular canal leading to sensation of spinning with movement. BPPV can be treated with Eply’s maneuver.
- Vestibular neuronitis: Patient presents with vertigo that is not related to position changes. There may also be a history of recent upper respiratory infection. This is due to idiopathic inflammation of the vestibular portion of the 8th CN. Since only the vestibular portion is involved, there is NO hearing loss & NO tinnitus.
- Ménière disease: this is a chronic condition (vs. labyrinthitis) that comes and goes and is due to abnormal accumulation of endolymph within the inner ear. Patient presents with classic triad of vertigo, tinnitus and hearing loss.Patient may also complain of increase pressure in their ears. Ménière disease is also associated with syphilis, so make sure to ask about sexual history.
- Labyrinthitis: This is an acute condition (vs. ménière disease) and is due to inflammation of the cochlear portion of the inner ear. Patient presents with history of recent upper respiratory infection, hearing loss and vertigo.
- Acoustic neuroma: is due to 8th CN tumor that can be related to neurofibromatosis or Von Recklinghausen’s syndrome. Patient presents with ataxia, unilateral hearing loss and tinnitus.
- Perilymph fistula: This is due to perilymphatic fistula between the middle and inner ear, which may have been caused by barotrauma from scuba diving, as well as by direct blows, heavy weight bearing, and excessive straining [e.g., with sneezing or bowel movements].
- Orthostatic blood pressue (lying down, sitting up and standing) – This is time consuming and you can skip it for your exam.
- Dix-Hallpike Maneuver to screen for BPPV
- VDRL/RPR (to rule out syphilis as a potential etiology for Ménière disease)
- Tilt table test
- MRI of brain and the internal auditory canal
- Brain stem auditory evoked potentials
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