Internal-Medicine

Questions: 51–58 145
(C)
(D)
(E)
she has had two falls
the room is spinning around her
a prior Holter monitor was negative
during episodes of dizziness
57. A 65-year-old woman complains of recurrent
episodes of sudden-onset dizziness and nausea.
She notices an abrupt onset of a spinning sensation
when rolling over or sitting up in bed.
The symptoms last for 30 seconds and then
completely resolve. She has no hearing change
or other neurologic symptoms, and her physical
examination is completely normal. A Dix-
Hallpike maneuver reproduces her symptoms.
Which of the following findings on vestibular
testing favors the diagnosis of benign paroxysmal
positional vertigo (BPPV) over central positional
vertigo?
Figure 7–2a.
(A)
(B)
(C)
(D)
(E)
no latency period
no fatigability
habituation occurs
mild vertigo
symptoms consistently the same from
one set of tests to the next
58. A 23-year-old man complains of intermittent
double vision and fatigue at the end of the
day. Further history reveals difficulty in chewing
food, and some weakness in climbing
stairs. He has stopped working as a courier
because of easy leg fatigue and weakness. The
symptoms improve with resting. On examination,
there is weakness of the eyelids, masticatory
muscles, and thigh flexors. Having
him look up at the ceiling for a long period
brings on his double vision. His handgrip
decreases with repetitive action. There is no
sensory abnormality, and reflexes are normal.
Which of the following treatments is contraindicated
in this patient?
56. A 79-year-old woman is seen in the office for
“dizziness.” Which of the following findings
would suggest true vertigo?
(A)
(B)
Figure 7–2b.
the patient is taking multiple antihypertensives
the symptoms are worse on standing
(A)
(B)
(C)
(D)
(E)
anticholinergic drugs
surgery
plasmapheresis
cyclophosphamide
high-dose prednisone