Musculoskeletal: limb weakness and joint pain can cause feelings of unsteadiness, as can loss of joint proprioception. If you have not elicited specific features of conditions which are described in either of the first two categories, consider the information which you have gathered and ask yourself whether there are any features which do not fit with a non-serious, peripheral cause of vertigo. For example, are you considering a diagnosis of vestibular neuronitis, but the patient has described hyper-acute onset and has vascular risk factors? A key component of history taking involves exploring a patient’s ideas, concerns, and expectations (often referred to as ICE) to gain insight into how a patient currently perceives their situation, what they are worried about and what they expect from the consultation. Vasovagal pre-syncope (near-fainting): bradycardia and/or vasodilatation are triggered by parasympathetic activation, often in response to a trigger such as heat or prolonged standing. Syncope (fainting) can be averted by the patient recognising the symptoms and lying down, which increases venous return. Class IV — Cars, taxis, minibuses and ambulances up to 12 passenger seats, Goods Vehicles not exceeding 3,000 kg Design Gross Weight (DGW), motor caravans and Dual Purpose Vehicles.

Clarify the time course of the dizziness, and whether it occurs in discrete episodes or is continuous: Stanton, M, Freeman, AM. Vertigo. [Updated 2022 Mar 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: [ LINK].

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Rome has so often been a model for later imitators that it is sometimes easy to forget how different it was from what followed. This is not the most famous of Beard’s many books on Rome, but it played an important part in exploring the combination of savagery and ceremonial that followed Roman victories. It also described the enormously creative efforts of Romans who reshaped their religion and their monumental city for each generation. Conditions which may cause acute blood loss: menorrhagia, inflammatory bowel disease or peptic ulcer disease Posterior circulation stroke: causes hyper-acute (within seconds) onset of continuous vertigo, which may be so severe that the patient cannot stand unaided. Although vertigo is the most common symptom (and may be the only symptom), additional neurological symptoms, including occipital headache, increase the possibility of this diagnosis. 2

How about fact Dominoes? Create a grid and then put lots of names, events, dates and facts down in each square that are connected with the topic/s that you are revising. Then cut them up. Play fact dominoes with a friend/s. Each time you lay a domino down, it must have a link to the previous one and you must explain the link. The first person to get rid of all of their dominoes is the winner. Do any of your parents or siblings have a history of heart disease, stroke or other problems with the nerves?” Another book that leaves its mark . Where others had seen Rome reach its peak around the turn of the second and third centuries, Brown begins there and tells the story of the new worlds that emerged between the reign of Marcus Aurelius and the prophet Muhammad. The new cultures and religions and languages of late antiquity have been a fertile field for recent research. When revising my own book this was the period in which Roman History had changed the most over the last decade. Brown started the study of late antiquity, which now has its own journals, encyclopedias and conferences, and he has continued to lead from the front.Deciding on which symptoms to ask about depends on the presenting complaint and your level of experience. Silverston, P. SAFER diagnosis: a teaching system to help reduce diagnostic errors in primary care. British Journal of General Practice 2020 70(696):354-355 This is where the hype about "remastered with DSD technology" is rubbish if you are still using the same old crappy tapes as the source.

Once you have summarised, ask the patient if there’s anything else that you’ve overlooked. Continue to periodically summarise as you move through the rest of the history. Signposting Postural orthostatic tachycardia syndrome (POTS): typically affects young people, autonomic dysfunction causes postural dizziness and patients have inappropriate tachycardia on standing. Suspicion’ sounds terrible here placed after ‘My Boy’ and yet it sounded so much better on ‘Such A Night – Essential Vol.6’ rather than this echoey ‘60’s box-set’ version. ‘US Male’ was also superior on ‘Today, Tomorrow & Forever’. It’s clear that you’ve given this a lot of thought and it would be helpful to hear what you think might be going on.” Long-Term Foreign Exchange Rate Predictions 2023-2027: Goldman Sachs » US Dollar in Decline While Other Currencies Hold Steady

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Drug-related: diuretics may cause volume depletion, whilst anti-hypertensives may cause orthostatic hypotension. This makes it easy for the patient and clinician to misunderstand each other, leading to the risk of diagnostic error. It is essential to ask the patient to be as specific as possible about what they have experienced, using open and closed questions.