American College of Physicians: Internal Medicine — Doctors for Adults ®


The MKSAP Challenge

From the December ACP Observer, copyright © 2005 by the American College of Physicians.

Clinical scenario

A 45-year-old man is evaluated in the emergency department for nausea and severe dizziness. His symptoms developed earlier in the evening, awakened him from sleep, worsened when he attempted to sit up and caused him to fall on standing.

The patient noted no tinnitus. Thirty minutes of bed rest provided him with no relief. He has no history of dizziness or hearing loss and no other medical problems.

In the emergency department, his nausea improves with administration of intravenous fluids and prochlorperazine, but he needs help walking. On physical examination, pulse rate is 71/min, and blood pressure is 130/80 mm Hg. The tympanic membranes are intact. Diplopia, dysarthria, hearing loss and weakness are absent on neurologic examination. However, spontaneous nystagmus with a rotatory component is noted. Results of a Romberg test are positive, and a contrast-enhanced head CT scan is normal.

Which of the following is the most likely diagnosis?

A. Benign paroxysmal positional vertigo
B. Menière's disease
C. Perilymphatic fistula
D.Vestibular neuritis



This is a printer-friendly version of this page

Print this page  |  Close the preview



Internist Archives Quick Links

Have questions about the new ABIM MOC Program?

Have questions about the new ABIM MOC Program?

ACP explains the ABIM requirements and offers many free solutions to earn MOC points.

One Click to Confidence - Free to members

One Click to Confidence - Free to members ACP Smart Medicine is a new, online clinical decision support tool specifically for internal medicine. Get rapid point-of-care access to evidence-based clinical recommendations and guidelines. Plus, users can easily earn CME credit. Learn more