MLA Domain 5 · Presentation
Tinnitus
14 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.
classic presentation · 6
Progressive visual field loss / worsening papilloedema → sight-threatening, urgent ophthalmology
Asymmetric/progressive features warrant MRI to exclude a vestibular schwannoma; drop attacks (Tumarkin) risk injury
Papilloedema + focal neurology → urgent neuroimaging for a space-occupying lesion/haemorrhage
Severe acidosis, very high levels, altered consciousness, seizures, renal failure → haemodialysis
Any sudden sensorineural loss is an emergency; accompanying neurology (ataxia, diplopia) → posterior-circulation stroke;
Any asymmetric/unilateral sensorineural hearing loss → MRI to exclude this; brainstem compression if large
recognised feature · 6
Persistent/vertical/non-fatiguing nystagmus or other neurology → central cause (posterior fossa) → image
Stroke/TIA from dissection → urgent stroke pathway; thrombolysis decisions need imaging confirmation
Mixed/sensorineural component (cochlear involvement) affects management; exclude other conductive causes
Perforation with vertigo/sensorineural loss after trauma → suspect ossicular/inner-ear injury (perilymph fistula) → urge
ASYMMETRIC sensorineural loss or unilateral tinnitus → exclude a vestibular schwannoma (MRI) — see neurology; sudden SNH
Central features (HINTS exam suggesting stroke — direction-changing nystagmus, normal head-impulse test, skew deviation)
differential of the above · 2