Return to Scenario ListShow Learning Points most relevant to Phase 1:

Dizziness and vertigo

Clinical Discipline(s)/Organ System(s)
Nervous System, Neurology, Otorhinolaryngology, General Practice
Progress Test Topic(s)
A 45 year old Chinese female who helps run her family's furniture store comes to see her GP. She is a frequent attender and on this visit she complains of dizziness, ringing in her ears and feeling like she's veering to one-side when walking. Her medication history reveals she is taking a herbal remedy prescribed by a traditional Chinese medicine consultant.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of hearing and balance
   - Physiology of hearing and balance
   - Physiology of vomiting
   - Pharmacology of antiemetics
   - Pharmacology of commonly used herbal remedies, interactions with prescribed medications
Clinical and Communication Skills 
   - History from a patient with light headedness or 'dizziness'
   - Examination of the cardiovascular and neurological systems relevant to a patient presenting with dizziness
   - Define vertigo and differentiate it from dizziness, pre-syncope and light headedness
   - Differential diagnosis of tinnitus and vertigo; differentiating central from peripheral vertigo
   - Indications for intracranial imaging in a 'dizziness' presentation
   - Interpretation of caloric testing
   - Management of diseases that commonly cause vertigo
   - Non-pharmacological treatments for vertigo
   - Role of surgical management of in diseases that commonly cause vertigo
   - Role of psychological support and cognitive therapy in the treatment of tinnitus
   - Elicit history of alternative medicine treatments
   - Structuring, framing and timing of consultation
Personal and Professional Skills 
   - Approach to establishing the diagnosis when there is a wide range of differential diagnoses
   - Communication with a patient for whom English is a second language, and use of interpreter vs family/whānau member
   - Examine 'frequent attendance behaviour' and personal perceptions of this
   - Impact of chronic symptoms on self employed patients and the contextual factors associated with fitness for work
   - Patient autonomy and unconventional treatment
   - Working with alternative medicine providers
Population Health 
   - Epidemiology of dizziness, including prevalence of serious pathology
   - Effect of prevalence on predictive values for diagnostic tests
Conditions to be considered relating to this scenario
labyrinthitis, vestibular neuritis, benign paroxysmal positional vertigo, Ménière's disease, motion sickness, alcohol intoxication
Less common but 'important not to miss'
cerebellopontine angle tumour, acoustic neuroma, TIA, stroke, vertebrobasilar insufficiency
multiple sclerosis, ototoxic drugs (including herbal remedies), migraine, Ramsey Hunt syndrome