33 - 28 yo F with dizziness

Question 1

definition: orthostatic hypotension

Answer 1

• drop in systolic 20 or more
• drop in diastolic 10 or more
• when changing from supine to standing
• accompanied by feelings of dizziness or light headedness

Question 2

what is the most common cause of vertigo in primary practice? second and third most common?

Answer 2

• first: benign paroxysmal positional vertigo
• second: vesstibular neuritis
• third: acute labryinthitis

Question 3

what is essential in differentiating between peripheral and central vertigo?

Answer 3

observation of nystagmus

Question 4

with a dix-hallpike maneuver, nystagmus will have the fast component ________________ (toward / away from) the pathology

Answer 4

toward

Question 5

what test is used to demonstrate a likely peripheral lesion for vertigo?

Answer 5

head thrust

Question 6

what does a normal head thrust test in the presence of vertigo mean?

Answer 6

peripheral vestibular system is intact and the lesion is central

Question 7

what is the head thrust technique?

Answer 7

• normally, when you face your patient and ask them to keep looking at your nose, his eyes will stay
  fixed on your nose if you move his head suddenly to the side
• if there is a peripheral lesion in the
  vestibular system, the vestibular ocular reflex will be disrupted and his eyes will move with the head and then saccade back to center when his head is moved in the direction of the lesion

Question 8

does benign paroxysmal positional vertigo cause episodic or constant vertigo? what triggers it?

Answer 8

• episodic

- triggered by positional change

Question 9

central or peripheral vertigo?

• unidirectional nystagmus that does not change direction
• inhibited by fixating on a point
• intensifies when fixation is withdrawn

Answer 9

peripheral

Question 10

peripheral or central vertigo?

• purely horizontal, vertical, or rotational nystagmus
• does not lessen when the patient focuses gaze
• persists for a long period of time

Answer 10

central

Question 11

what is the triad of menieres disease?

Answer 11

• unilateral hearing loss
• tinnitus
• vertigo

Question 12

what 3 therapies can be used for peripheral vertigo?

Answer 12

• diuretics
• epley maneuver
• vestibular suppressant medications

Question 13

what is used to treat the vertigo of menieres disease?

Answer 13

• diuretics
• low salt diet

decreases endolymphatic pressure

Question 14

what is the hallmark testing for BPPV?

Answer 14

epley maneuvers

Question 15

what are commonly used vestibular suppressant medications?

Answer 15

• meclizine, dimenhydrinate (anticholinergics)

- metoclopramide, promethazine (non-selective phenothiazine anti-emetics)