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ENT Week 2 2017/18 > 4: Dizzy patient > Flashcards

4: Dizzy patient Flashcards

1
Q

Is dizziness the same as vertigo?

A

Dizziness is the patient’s word for how they feel

Vertigo is the sensation of spinning

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2
Q

When a patient says they’re dizzy, what might they mean?

A

Vertigo

Pre-syncope

Seizures

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3
Q

What is vertigo?

A

Sensation of spinning

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4
Q

Vertigo has a good chance of being related to which organ?

A

Ear

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5
Q

Which structures do the vestibular nerves supply?

A

Semicircular canals

Urticle

Saccule

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6
Q

Which vestibular structures detect

a) head movements
b) horizontal motion
c) vertical motion?

A

a) Semicircular canals

b) Urticle

c) Saccule

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7
Q

What systems control balance?

A

Ear

Eyes

Joints (proprioception)

Heart

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8
Q

What eye conditions upset balance?

A

Anything causing vision loss (cataracts, diabetic retinopathy, glaucoma, macular degeneration…)

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9
Q

What diseases can affect joint sensation, which itself affects balance?

A

Arthritis

Neurological disorders

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10
Q

Which cardio conditions affect balance?

A

Arrythmias

Postural hypotension

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11
Q

What brain disorders can cause balance problems?

A

Migraine

Space-occupying lesions

Multiple sclerosis

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12
Q

What is the vestibulocular reflex?

A

Ability to keep focused on an object when your head is moving

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13
Q

What are the sensory organs of rotation found in the semicircular canals?

A

Crista ampullaris

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14
Q

What eye sign is caused by an impaired vestibulo-ocular reflex?

A

Nystagmus

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15
Q

Which eye sign indicates a vestibular problem?

A

Nystagmus

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16
Q

What is the most common GP presenting complaint in people over 75?

A

Dizziness

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17
Q

What questions should you ask when taking a history from someone with dizziness?

A

Triggers?

Duration?

Associated symptoms? pain, hearing loss, vision, cardio

Alleviating factors?

Medication?

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18
Q

What should be examined in someone who is dizzy?

A

Ear exam

Neuro exam

Blood pressure (lying/standing)

19
Q

What is the most common ENT cause of dizziness?

A

Benign positional paroxysmal vertigo (BPPV)

20
Q

What is the symptom of BPPV?

A

Veritgo on changing position, looking up

21
Q

What is the most common cause of BPPV?

A

Idiopathic

22
Q

What is the pathophysiology of BPPV?

A

Movement of otolith (calcium carbonate crystals) from urticle into semicircular canals, causing sensation of motion

23
Q

How long do episodes of BPPV last?

A

Never more than 30s

24
Q

Does BPPV have any associated symptoms?

A

No

25
Q

What test is used to detect BPPV?

A

Hallpike test

26
Q

What is the Hallpike test used to detect?

How do you do it?

What are you looking for?

A

BPPV

Lie head over end of couch, turn head 45 to one side then return as quickly as possible, EYES OPEN

Nystagmus

27
Q

What do you need to see on performing a Hallpike test to diagnose BPPV?

A

Nystagmus

patient saying they’re dizzy isn’t enough

28
Q

Why must you wait 30s before finishing a Hallpike test?

A

Nystagmus can be delayed by up to 30s

29
Q

Which manoeuvre can be used to alleviate BPPV?

A

Epley manoeuvre

30
Q

How are patients with BPPV advised to sleep?

A

Sitting up slightly

31
Q

What is vestibular neuronitis?

A

Prolonged vertigo associated with vomiting

No other associated symptoms

32
Q

What is a condition causing prolonged vertigo AND tinnitus, hearing loss?

A

Labyrinthitis

33
Q

How are vestibular neuronitis and labyrinthitis managed?

A

Supportive (sedatives, anti-emetics)

34
Q

How long do vestibular neuronitis and labyrinthitis last?

A

Days - Weeks

35
Q

What is a disease causing recurrent rotational vertigo lasting 2+ hours?

A

Meniere’s disease

36
Q

What are the symptoms required to diagnose Meniere’s disease?

A

Recurrent, prolonged rotational vertigo attacks

Worsening of hearing > hearing loss

Aural fullness

all on one side

37
Q

What type of hearing loss is seen in Meniere’s disease?

A

Sensorineural hearing loss

38
Q

What type of anti-emetic is used in vertigo?

A

Buccastem

buccal administration

39
Q

How is Meniere’s disease treated?

A

Supportive

Tinnitus therapy

Hearing aids

Restrict triggers

40
Q

What are some possible triggers of Meniere’s disease?

A

Caffeine

Alcohol

Stress

41
Q

Which antibiotic can be used to intentionally destroy residual balance function to stop vertigo in Meniere’s disease?

A

Gentamicin

42
Q

Which common condition, causing headache, can also cause balance problems?

A

Migraine

43
Q

___ and vertigo often go together.

A

Migraine

ENT Week 2 2017/18 (10 decks)

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