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PCM II Final Exam > 3 > Flashcards

3 Flashcards

1
Q

Occipital Neuralgia

Side:
D/t:
What can confirm dx:
Tx:

A

Usually unilateral, starts at the area where the neck meets the skull and
moves => ear and forehead

trauma to nerves; d/t tight paraspinal neck muscles, osteoarthritis pinching of nerves,, tumors in neck

greater occipital nerve block

NSAIDS, muscles, muscle relaxants

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2
Q

what abnormal findings are often seen in occipital neuralgia

A
  1. obese
  2. hold hands to L side of head
  3. painful
  4. TTP at L occipitale condyle
  5. Paraspinal neck musculature are tight,
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3
Q

Dizziness affects ______
of adults in large
population studies.

A

15-20%

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4
Q

Subjective Data to Obtain w dizziness

A
  1. hx
  2. frequency, intensity and how long does it last
  3. severity (HOW IT AFFECTS LIFE NOOOOOT a scale from 1-10)
  4. familal and person hx
  5. meds
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5
Q

assx sxs with dizziness

A
  1. syncope
  2. blurry vision
  3. N/V
  4. hearing loss
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6
Q

Dizziness that increases with motion is common to what?.

A

PERIPHERAL and CENTRAL causes

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7
Q

what is vertigo

A

self motion when not moving or distorted self-motion when rotating head normall

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8
Q

Vertigo can be d/t

A
  1. asymmetry in vestibular system

2. problem with peripheral labrythin and central connections

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9
Q

Migrains are most common where

A

adults: 60-70 unilateral
kids: mostly bilateral

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10
Q

migraine characteristic

A

gradual onset; pulsating; moderate to severe in pain

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11
Q

do migraines get better or worse w activbivty

A

worse

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12
Q

duration of migraines

A

4-72 hrs

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13
Q

assx sx of migranins

A

N/V
photophobia, phonophobia
visual auroas

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14
Q

tension HA are most common where

A

bilateral

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15
Q

tension HA charactersitics

A

pression/tesnion that waxes and wanes

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16
Q

do tension HA get better or worse w activbivty

A

pt can be active but may need rest

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17
Q

duration of tension HA

A

30 min- 7 days

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18
Q

assx sx of tension HA

A

none

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19
Q

cluster HA are most common where

A

always unilateral and begin around ear and temple

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20
Q

cluster HA charactersitics

A

deep, excruciating, explosive pain begins quickly and reaches peak in minues.

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21
Q

do cluster HA get better or worse w activbivty

A

pt can stay active

22
Q

duration of cluster HA

A

15- 30 minutes

23
Q

cluster HA assx sx

A

ipsilateral lacrimination, red eye

24
Q

SNOOP

A

DANGER for subarachnoid hemo, vascular disease, metabolic synx

  1. systemic problem (fever, cancer)
  2. Neuro problems (confusion)
  3. Onset is new (esp if under 50 or thunderclap
  4. Other ASSx sx: head trauma, drugs
  5. Previous HA that has progressed or changed
25
Q

how to examine for dizziness

A

TiTrATE

  1. Timing (onset, duration and evolution of sx)
    - first Q: episodic or continuous
  2. Triggers that provoke the sx
  3. And a Targeted Exam
26
Q

what are episodic triggered sxs?

A

Brief episodes of intermittent dizziness lasting seconds => hours d/t head motion or change in body position

27
Q

most common cause of episodic triggered sxs is

A

BPPV

benign paroxsmal positional vertigo

28
Q

Spontaneous Episodic Symptoms are what

A

those that have no triggers and dizziness lasts seconds => days

to dx; we need other info from history

29
Q

pt has dizziness that has NO triggers and lasts seconds -> days and also has unilateral loss of hearing

A

meniers dz

spontaneous episodic symtoms

30
Q

pt has dizziness that has NO triggers and lasts seconds -> days and also has assx sx of migraine

A

vestibular migraine

spontaneous episodic symtoms

31
Q

pt has dizziness that has NO triggers and lasts seconds -> days that becomes continous and assx with psych disorder (anxiety, bipolar depression)

A

psych disorder

spontaneous episodic symtoms

32
Q

what are Continuous Vestibular Symptoms

A

dizziness that lasts days -> weeks that is ass with N/V, problems with gait, nystagmus, head motion intolerance

33
Q

Continuous Vestibular Symptoms are often d/t what?

A

trauma or toxins (in 23% of adults, meds are the cause of dizziness)

34
Q

• Use of ___ or more meds is associated with increased risk for dizziness

A

5

35
Q

If no toxin or trauma exposure, consider

A

vestibular neuritis or central cause

36
Q

most common peripheral cause of dizziness

A
  1. BPPV
  2. vestibular neuritis
  3. Meiners
  4. ostesclerosis
37
Q

most common central cause of dizziness

A
  1. vestibular migraine
  2. CerebroV disease
    3
38
Q

other causes of dizzines

A
  1. psyciatric
  2. meds
  3. CV/metabolic
    4.
39
Q

what is a directed exam for dizzniess

A
  1. HEENT
  2. CV
  3. Neurologic, including Romberg
  4. Dix-hallpike maneuar
40
Q
  1. Dix-hallpike maneuar is used to dx what?
A

BPPV

doc rotates pts head to 45 with eyes open while they are sitting up; then; have the pt lay down with head off of the table. stay in position for 30 seconds

pt goes back to upright position for 30 sec and examined

Next, the maneuver is repeated with the patient’s head turned to the left.

A
positive test is indicated if any of these maneuvers trigger vertigo with or without
nystagmus.

41
Q

BPPV Occurs when loose canaliths ”get stuck” in semicircular canals.
• Affect people at any age, but most common between _____

A

50-70 YO

42
Q

tx bPPv

A

Epley maneuvers in the office; no meds

43
Q

Vestibular Neuritis

sx

A

2nd most common cause of vertigo; often d.t a virus; most often in M=F and (20-30)

rotatory vertigo with apparent movement of objects in
visual field; horizontal nystagmus to NON-affected side (pt feels like they are spinning + objects in ivsual field are spinning)

abnormal gait

44
Q

Meniere Disease

A

vertigo + tinnitus + hearing loss that is so bad pt needs to sleep

45
Q

Meniere Disease most common age

A

20-60 but any age

46
Q

can pts have MD and BPPV?

A

yes, causing Dix test to be +

47
Q

what suggests a Vestibular Migraine

A

CENTRAL CAUSE: episodic vertigo in a patient with in a patient with vestibular migraines

48
Q

what is the most common cause of vertigo in kids

A

vestibular migraine

49
Q

vestibular migraines are more common in who?

A

kids
adult women are 2-3x more likely
ages: 20-50
runs in fam

50
Q

can we use dix test for vestibular neuritis?

A

no bc it is not positional

51
Q

pt is in moderate distress, sitting with a large bowl that contains emesis

nystagmus
failed whisper test
Romberg test +
Meiner dz+

A

Meinerz dz

PCM II Final Exam (7 decks)

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