Transcript 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
▪ 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
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
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
PR shows no melena. Is GIB ruled out?
▪ It takes hours for melena to reach
rectum.
Any other sources of bleeding? Hemolysis?
Sources of bleeding/anemia
▪ 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
Hemodilution takes time.
Are you going to give her some
symptomatic treatment?
▪ Stemetil?
▪ Doubtful effectiveness for nonvestibular dizziness
We need to find out the cause. Ix?
Investigations
▪ Hb
10 g/dL
▪ H’stix
5 mmol/L
▪ LFT, RFT
pending
▪ ECG
NSR
What other
investigation
may help…?
Bedside USG
Mx and Disposition
▪ Admit Gyneacology
▪ Laparoscopy for ? Ectopic pregnancy
The end
BACK TO DIZZINESS (INTRODUCTION)