33- dizzy

Question 1

at what age do you prescribe antibiotics to acute otitis media

Answer 1

below 6 mo

6 mo-2 yrs- observe, variable

Question 2

Presyncope

Answer 2

Feeling light-headed or faint, as opposed to actually passing out. Sometimes patients with presyncope feel worse when they stand up quickly

Question 3

Disequilibrium -

Answer 3

A feeling of being off balance.

Question 4

Presyncope etiologies

Answer 4

inadequate cerebral perfusion:

MI
afib
bradyarrhythmias
valvular heart disease aortic stenosis
acute blood loss such as gastric ulcer bleed
thyroid storm- tachycardia

Question 5

Orthostatic Hypotension criteria

Answer 5

A drop in systolic blood pressure of ≥ 20 mmHg or
A drop in diastolic blood pressure of ≥ 10 mmHg

when changing position from supine to standing
accompanied by feelings of dizziness or light-headedness

Question 6

Vestibular neuritis

Answer 6

Commonly associated with a recent URI.

Nystagmus caused by a peripheral lesion such as this does not change direction with gaze.

Question 7

Benign paroxysmal positional vertigo (BPPV)

Answer 7

Causes acute onset vertigo that can be associated with nausea and vomiting and intact hearing.

caused by calcium carbonate debris in the semicircular canals.

episodic rather than constant vertigo that is triggered by positional change as calcium debris moves within the semicircular canals. Symptoms usually resolve several seconds to minutes following position change in BPPV

Question 8

Vestibular migraine

Answer 8

a variant of migraine that can cause central vertigo.

Most patients will give a history of previous migraine headaches. However, at the time of a vestibular migraine, many patients do not have a headache.

Question 9

Peripheral vs. Central Vertigo in location of problem

Answer 9

peripheral: problems with the inner ear or vestibular system
central: problems in CNS (more serious)

Question 10

nystagmus in peripheral veritgo

Answer 10

unidirectional (usually horizontal and rotational) and does not change direction

inhibited by fixating on a point and intensifies when fixation is withdrawn

Frenzel glasses prevent fixation and bring out the nystagmus

Question 11

nystagmus in central veritgo

Answer 11

purely horizontal, vertical, or rotational

does not lessen when the patient focuses gaze

persists for a longer period

Question 12

classic triad of Meniere’s disease.

Answer 12

unilateral hearing loss, tinnitus, and vertigo

Question 13

cause of vestibular neuritis

Answer 13

viral (or, less commonly, bacterial) infection of the inner ear causes inflammation of the vestibular branch of the eighth cranial nerve.

Question 14

Acute labyrinthitis occurs when

Answer 14

an infection affects both branches of the nerve resulting in tinnitus and/or hearing loss as well as vertigo.

Question 15

Dix-Hallpike Maneuver

Answer 15

diagnose BPPV

Turn the patient’s head to 45 degrees and quickly lay him down supine with his head just over the end of the exam table. Then turn the head to the side which should reproduce the symptoms of dizziness and produce nystagmus. Observe for 20 to 30 seconds. If present, the nystagmus will have the fast component in the direction of the pathology. Next, sit the patient up and observe again for nystagmus.

Question 16

diagnosing BPPV and vestibular neuritis

Answer 16

clinical (MRI to rule out scary things)

Question 17

head thrust test

Answer 17

demonstrate a likely peripheral lesion.

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. A normal head thrust test in the presence of vertigo means the peripheral vestibular system is intact and that the lesion is central.

Question 18

When Neuroimaging is Indicated for Patients with Vertigo

Answer 18

age, HTN

nystagmus that changes direction and that does not inhibit with focus (central)

A normal head thrust test in the face of constant and new vertigo combined with a history of migraines indicates a possible central lesion.

Question 19

acute vestibular neuritis management

Answer 19

self limiting- days - week

Question 20

what can help manage menieres>

Answer 20

diuretics

Question 21

hallmark of treatment for BPPV

Answer 21

Epley maneuver- relieves symptoms by returning the deposits back to the vestibule

Question 22

Epley maneuver- how to do it

Answer 22

To perform the Epley maneuver for right-sided symptoms, the patient sits on the exam table with his head turned 45 degrees to the right. With the clinician supporting the head, the patient quickly lies back with his head hanging over the exam table supported by the clinician as in the Dix-Hallpike test. Once the nystagmus has stopped, the clinician turns the head 90 degrees to the left and the position is held for 30 seconds. Next, the patient rolls onto his left side, with his face at a 45 degree angle to the floor. This position is held for 30 more seconds. The patient returns to the sitting position now with his legs off the left edge of the table. After another 30 seconds, the patient can resume normal head position. The maneuver can also be repeated on the other side.

Question 23

management for unilateral peripheral vestibular dysfunction

Answer 23

vestibular rehabilitation- PT

Question 24

Vestibular suppressant medications

Answer 24

Effective short-term treatment of vertigo.

Commonly used anticholinergic vestibular suppressants such as meclizine and dimenhydrinate also have some anti-emetic effects that are useful in controlling the nausea and vomiting associated with vertigo.

Question 25

Safety of Vestibular Suppresant Medications While Breastfeeding

Answer 25

Occasional doses of meclizine are probably acceptable during breastfeeding. Large doses or more prolonged use may cause effects in the infant or decrease the milk supply…”

“Based on minimal excretion of other phenothiazine derivatives, it appears that occasional short-term use of promethazine for the treatment of nausea and vomiting poses little risk to the breastfed infant. With repeated doses, observe infants for excess sedation.”

Question 26

Safety of Vestibular Suppressant Medications While Breastfeeding

Answer 26

Occasional doses of meclizine are probably acceptable during breastfeeding. Large doses or more prolonged use may cause effects in the infant or decrease the milk supply…”

“Based on minimal excretion of other phenothiazine derivatives, it appears that occasional short-term use of promethazine for the treatment of nausea and vomiting poses little risk to the breastfed infant. With repeated doses, observe infants for excess sedation.”