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Approach Dizziness

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Question 1

Stem 1 of 3

A 72 year old male presents with dizziness, recent syncopal event and pallor. The GP takes sitting and standing blood pressure measurement and notes a 40mmHg discrepancy in systolic blood pressure. History is notable for COPD, heart failure with preserved ejection fraction and recurrent left thigh cellulitis.
What is the most likely diagnosis?
A
Cholesteatoma
B
Diabetic neuropathy
C
Meniere’s disease
D
Orthostatic hypotension
E
Seizure (absence)
Question 2

Stem 2 of 3

What is the next best investigation in this patient?
A
Carotid doppler
B
Electrocardiogram
C
Optical coherence tomography
D
Plain X-ray thorax
E
Pure tone audiometry
Question 3

Stem 3 of 3

Why did the doctor order urea and electrolyte investigations?
A
Check for dehydration
B
Monitor COPD progression
C
No rationale to order
D
Suspicion of acute hepatotoxicity
E
Suspicion of renal artery stenosis
Question 4

Stem 1 of 3

A patient is brought to his GP by his wife after two incidents of “fainting” at home. He had a transient, acute loss of consciousness, but “came to his senses” immediately thereafter. The attacks had a “weird feeling” prodrome. History is notable for rate-controlled atrial fibrillation, diet-controlled type-two diabetes and hypercholesterolaemia - for which he takes atorvastatin.
What is the most likely cause of the patient’s presentation?
A
Cor pulmonale
B
Dehydration
C
Heart failure
D
Iatrogenic
E
Tachyarrhythmia
Question 5

Stem 2 of 3

Of the medications he is taking, which is the most likely cause of the event?
A
Amiodarone
B
Bendroflumethiazide
C
Beta blocker
D
Calcium channel blocker
E
Digoxin
Question 6

Stem 3 of 3

Which of the following histories lends itself to syncope over seizure?
A
Absence of post-ictal
B
Absence of prodrome
C
Incontinence
D
Less abrupt onset
E
Previous history of events
Question 7

Stem 1 of 3

A 44 year old female presents with acute onset dizziness that lasts a day. She reports rotatory vertigo but no other symptoms beside related nausea. History is notable for type one diabetes, controlled, with a two week history of sinusitis.
What is the most likely diagnosis?
A
Benign paroxysmal positional vertigo
B
Labyrinthitis
C
Meniere’s disease
D
Posterior circulation syndrome
E
Vestibular neuronitis
Question 8

Stem 2 of 3

Which label corresponds to the area most likely inflamed in this patient?
A
A
B
B
C
C
D
D
E
E
Question 9

Stem 3 of 3

Which additional symptom would make you consider labyrinthitis?
A
Conductive hearing loss
B
Disequilibrium
C
Sensorineural hearing loss
D
Tinnitus
E
Vertigo
Question 10
Stand-alone A 59 year old male presents for a health checkup. HbA1C is recorded. What is the diabetic threshold as per WHO/NICE 2021 guidelines (mmol/L)?
A
47
B
48
C
49
D
50
E
51
Question 11
Stand-alone To be diagnosed with a posterior circulation syndrome cerebrovascular accident, which artery is more likely implicated?
A
External carotid
B
Internal carotid
C
Middle cerebral
D
Ophthalmic
E
Vertebral
Question 12
Stand-alone A patient presents with bilateral cranial nerve palsy, cerebellar signs and hearing loss. A diagnosis of stroke is made and imaging is undertaken. Which is the most appropriate acute-phase order?
A
CT angiography
B
MRI T2 weighting
C
Non-contrast CT
D
Plain X-ray head
E
Plain X-ray posterior cranial fossa
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