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===HEENT=== | ===HEENT=== | ||
* HEENT examination of patients with vertigo is very important. Following examinations should be performed in every patient presenting with vertigo: | * [[HEENT]] [[examination]] of patients with vertigo is very important. Following [[examinations]] should be performed in every [[patient]] presenting with vertigo: | ||
**Otoscopic Exam: Can identify [[cholesteatoma]], [[herpes zoster oticus]]([[vesicles]] on [[tympanic membrane]]), [[acute]] [[otitis media]]. | **[[Otoscopic]] Exam: Can identify [[cholesteatoma]], [[herpes zoster oticus]]([[vesicles]] on [[tympanic membrane]]), [[acute]] [[otitis media]]. | ||
**Hennebert’s sign, pushing tragus provokes vertigo or [[nystagmus]] on the affected side in patients with [[perilymphatic fistula]].<ref name="RosenbergGizzi2000">{{cite journal|last1=Rosenberg|first1=Michael L.|last2=Gizzi|first2=Martin|title=NEURO-OTOLOGIC HISTORY|journal=Otolaryngologic Clinics of North America|volume=33|issue=3|year=2000|pages=471–482|issn=00306665|doi=10.1016/S0030-6665(05)70221-8}}</ref> | **Hennebert’s sign, pushing tragus provokes vertigo or [[nystagmus]] on the affected side in patients with [[perilymphatic fistula]].<ref name="RosenbergGizzi2000">{{cite journal|last1=Rosenberg|first1=Michael L.|last2=Gizzi|first2=Martin|title=NEURO-OTOLOGIC HISTORY|journal=Otolaryngologic Clinics of North America|volume=33|issue=3|year=2000|pages=471–482|issn=00306665|doi=10.1016/S0030-6665(05)70221-8}}</ref> | ||
**Hearing: Weber or Rinne's test is done in the [[clinic]] or at the bedside to determine if it is conductive or [[sensorineural hearing loss]]. | **[[Hearing]]: Weber or Rinne's test is done in the [[clinic]] or at the bedside to determine if it is conductive or [[sensorineural hearing loss]]. | ||
**'''HINTS''': '''H'''ead '''I'''mpulse, '''N'''ystagmus, '''T'''est of '''S'''kew (cover/uncover test) to identify if the cause of [[vestibular neuritis]] is central or peripheral.<ref name="TarnutzerBerkowitz2011">{{cite journal|last1=Tarnutzer|first1=A. A.|last2=Berkowitz|first2=A. L.|last3=Robinson|first3=K. A.|last4=Hsieh|first4=Y.-H.|last5=Newman-Toker|first5=D. E.|title=Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome|journal=Canadian Medical Association Journal|volume=183|issue=9|year=2011|pages=E571–E592|issn=0820-3946|doi=10.1503/cmaj.100174}}</ref> | |||
**Look for evidence of [[trauma]]. | |||
**[[Nystagmus]] assessment is an important feature to distinguish peripheral from the central cause of vertigo: | **[[Nystagmus]] assessment is an important feature to distinguish peripheral from the central cause of vertigo: | ||
***[[Peripheral]]: Horizontal nystagmus with a torsional component, adaptive. | ***[[Peripheral]]: Horizontal nystagmus with a torsional component, adaptive. | ||
***Central: Could be in any direction horizontal, vertical, or torsional, non- adaptive. | ***Central: Could be in any direction horizontal, vertical, or torsional, non- adaptive. | ||
===Neck=== | ===Neck=== | ||
Revision as of 20:07, 21 January 2021
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Vertigo Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Sandbox:ZMalik On the Web |
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American Roentgen Ray Society Images of Sandbox:ZMalik |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]
Overview
Common physical examination findings associated with vertigo include nystagus hearing impairment , vision changes, and imbalance.
Physical Examination
Physical examination of patients with vertigo is usually remarkable for nystagmus, hearing impairment, nausea, imbalance, vision changes.
Appearance of the Patient
- Patients with vertigo have variable general appearance depending on the underlying etiology.
- Unsteady gait (cerebellar involvement), sensitivity to motion/light/smell/noise (vestibular migraine) could be observed.
Vital Signs
- Blood pressure should be assessed to rule out orthostatic hypotension.
- Hyperthermia could be associated with vestibular neuronitis, herpes zoster oticus, acute labyrinthitis.
Skin
- Skin examination of patients with vertigo is usually normal. However, any signs of trauma should be assessed.
HEENT
- HEENT examination of patients with vertigo is very important. Following examinations should be performed in every patient presenting with vertigo:
- Otoscopic Exam: Can identify cholesteatoma, herpes zoster oticus(vesicles on tympanic membrane), acute otitis media.
- Hennebert’s sign, pushing tragus provokes vertigo or nystagmus on the affected side in patients with perilymphatic fistula.[1]
- Hearing: Weber or Rinne's test is done in the clinic or at the bedside to determine if it is conductive or sensorineural hearing loss.
- HINTS: Head Impulse, Nystagmus, Test of Skew (cover/uncover test) to identify if the cause of vestibular neuritis is central or peripheral.[2]
- Look for evidence of trauma.
- Nystagmus assessment is an important feature to distinguish peripheral from the central cause of vertigo:
- Peripheral: Horizontal nystagmus with a torsional component, adaptive.
- Central: Could be in any direction horizontal, vertical, or torsional, non- adaptive.
Neck
- Neck examination of patients with [disease name] is usually normal.
OR
- Jugular venous distension
- Carotid bruits may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
- Lymphadenopathy (describe location, size, tenderness, mobility, and symmetry)
- Thyromegaly / thyroid nodules
- Hepatojugular reflux
Lungs
- Pulmonary examination of patients with [disease name] is usually normal.
OR
- Asymmetric chest expansion OR decreased chest expansion
- Lungs are hyporesonant OR hyperresonant
- Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
- Rhonchi
- Vesicular breath sounds OR distant breath sounds
- Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
- Wheezing may be present
- Egophony present/absent
- Bronchophony present/absent
- Normal/reduced tactile fremitus
Heart
- Cardiovascular examination of patients with [disease name] is usually normal.
OR
- Chest tenderness upon palpation
- PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
- Heave / thrill
- Friction rub
- S1
- S2
- S3
- S4
- Gallops
- A high/low grade early/late systolic murmur / diastolic murmur best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope
Abdomen
- Abdominal examination of patients with [disease name] is usually normal.
OR
- Abdominal distension
- Abdominal tenderness in the right/left upper/lower abdominal quadrant
- Rebound tenderness (positive Blumberg sign)
- A palpable abdominal mass in the right/left upper/lower abdominal quadrant
- Guarding may be present
- Hepatomegaly / splenomegaly / hepatosplenomegaly
- Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
Back
- Back examination of patients with [disease name] is usually normal.
OR
- Point tenderness over __ vertebrae (e.g. L3-L4)
- Sacral edema
- Costovertebral angle tenderness bilaterally/unilaterally
- Buffalo hump
Genitourinary
- Genitourinary examination of patients with [disease name] is usually normal.
OR
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
- Clear/(color), foul-smelling/odorless penile/vaginal discharge
Neuromuscular
- Neuromuscular examination of patients with [disease name] is usually normal.
OR
- Patient is usually oriented to persons, place, and time
- Altered mental status
- Glasgow coma scale is ___ / 15
- Clonus may be present
- Hyperreflexia / hyporeflexia / areflexia
- Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
- Muscle rigidity
- Proximal/distal muscle weakness unilaterally/bilaterally
- ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
- Unilateral/bilateral upper/lower extremity weakness
- Unilateral/bilateral sensory loss in the upper/lower extremity
- Positive straight leg raise test
- Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
- Positive/negative Trendelenburg sign
- Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
- Normal finger-to-nose test / Dysmetria
- Absent/present dysdiadochokinesia (palm tapping test)
Extremities
- Extremities examination of patients with [disease name] is usually normal.
OR
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity
References
- ↑ Rosenberg, Michael L.; Gizzi, Martin (2000). "NEURO-OTOLOGIC HISTORY". Otolaryngologic Clinics of North America. 33 (3): 471–482. doi:10.1016/S0030-6665(05)70221-8. ISSN 0030-6665.
- ↑ Tarnutzer, A. A.; Berkowitz, A. L.; Robinson, K. A.; Hsieh, Y.-H.; Newman-Toker, D. E. (2011). "Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome". Canadian Medical Association Journal. 183 (9): E571–E592. doi:10.1503/cmaj.100174. ISSN 0820-3946.