Fever, Painful Ear, Sore Throat, Dizziness & Vertigo [Case #2]

“John, a 72 year old man woke up this morning and felt dizzy when getting out of bed. Since then whenever he stands up or moves he describes a spinning sensation and feels sick.”

This has also caused him to fall down, but without loss of consciousness. When he is still his symptoms are not present. He has a past medical history that includes diabetes and a previous MI. He has never had a stroke. Neurological exam is essentially unremarkable and there is no postural drop. His ECG is a sinus LBBB.

Questions

Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

1. What is your differential diagnosis?

2. Name and describe a special test can be performed as part of your examination to help confirm the diagnosis?

3. List the clinical features that would lead you to perform a CT on a patient with dizziness?

4. How would you manage this gentleman (hint: is there anything non-pharmaceutical  that might resolve his symptoms)?

5. In what circumstances might you consider prescribing medication for a patient presenting with vertigo or dizziness and what drugs would you use?