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Dizziness (Scenario C)

HKCEM College Tutorial. Dizziness (Scenario C). Author Dr. TW Wong revised by Dr. Lam Pui Kin , Rex Oct., 2013. Scenario C-- F/35, good past health. O Today, gradual P ? GE, mild abdominal pain Q Lightheadedness, not true vertigo

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Dizziness (Scenario C)

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  1. HKCEM College Tutorial Dizziness(Scenario C) Author Dr. TW Wongrevised by Dr. Lam Pui Kin, Rex Oct., 2013

  2. Scenario C-- F/35, good past health • O Today, gradual • P ? GE, mild abdominal pain • Q Lightheadedness, not true vertigo • R Dizziness has decreased with lying; head turning will not aggravate symptom • S Feel OK now lying on a stretcher • T for a few hours • Associated symptoms: nausea, no vomiting, loose motion once, subjective SOB, no chest pain • Exam: looks pale, mild epigastric tenderness, otherwise NAD

  3. Any specific points you want to ascertain in the history and physical? • Drugs e.g. NSAID, Po Chai pill… • Omit meal (other features of hypoglycemia) • Palpitation (arrhythmia) • BP postural changes • Tarry stool (melena PR) LMP in younger patient

  4. How do you check postural BP? • BP lying • repeat BP after patient stands for ~ 1min • SBP  > 20 mmHg is significant • may reproduce dizziness This patient has SBP drop ~ 20 mmHg + recurrence of dizziness on standing up

  5. PR shows no melena. Is GIB ruled out? • It takes hours for melena to reach rectum. Any other sources of bleeding? Hemolysis?

  6. Gut bleeding peptic ulcer bleeding colon cancer Bleeding hemorrhoid GU tract menorrhagia ectopic pregnancy hematuria Concealed bleeding AAA Blood disorders hemolysis e.g. drug induced leukemia Sources of bleeding/anemia Hemodilution takes time.

  7. Are you going to give her some symptomatic treatment? • Stemetil? • Doubtful effectiveness for non-vestibular dizziness We need to find out the cause. Ix?

  8. Investigations • Hb 10 g/dL • H’stix 5 mmol/L • LFT, RFT pending • ECG NSR

  9. What other investigation may help…?

  10. Bedside USG

  11. Mx and Disposition • Admit Gyneacology • Laparoscopy for ? Ectopic pregnancy

  12. The end Back to Dizziness (introduction)

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