Summary of Common Conditions Seen in OSCEs
Vertigo
Faintness
Lateral Instability
Hints and Tips for the Exam
As you can see from the tables above, the differential diagnosis of ‘dizzy’ is extensive. Therefore your first goal should be to clarify exactly what the patient means by use of word ‘dizzy.’ If they cannot clearly describe the sensation, provide possible examples such as:
- Do you feel the room is spinning around you?
- Do you feel unsteady on your feet?
- Do you feel faint?
Do not assume you know what the patient means by feeling ‘dizzy′ – each meaning will lead you down a different diagnostic path.
Addressing the social issues in this history and your management is important. If an elderly patient or someone living alone is complaining of dizziness and/or falls, are they safe in their current environment? In a hospital setting, admitting this patient might be the best and safest next step. Mentioning a multidisciplinary team review is likely to score a mark. This will involve an occupational therapist (who will check safety and provide aids), a physiotherapist (to help improve mobility) and a carer. Mentioning this will look impressive as you will be highlighting the holistic approach to managing the case.
Offer to conduct a full neurological and cardiovascular examinations in your presentation to the examiner.
Questions You Could Be Asked
Q. What symptoms should you consider when a patient complains of dizziness?
A.
- Vertigo
- Faintness
- Instability
Q. What commonly used medications are ototoxic?
A.
- Gentamicin
- Furosemide (reversible)
Q. What is the definition of postural hypotension?
A. Postural hypotension is a drop in blood pressure on standing that is sufficient to cause reduced perfusion of the brain. It is usually said to occur if there is a drop greater than 20 mmHg systolic or 10 mmHg diastolic. Patients’ blood pressure should be measured after lying down.
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