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1. Clin Med III > 4- Vertigo and Syncope > Flashcards

4- Vertigo and Syncope Flashcards

1
Q

What is defined as a sensation of abn movement (spinning, tumbling, falling forward/ backward) when there is no motion and what is it often a/w?

A

Vertigo- a symptom

A/w nystagmus and postural instability

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2
Q

What is defined as a sense of imbalance (losing balance w/o sensation of movement) and is characterized by imbalance and gait difficulties?

A

Disequilibrium

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3
Q

What is defined as vague and nonspecific dizziness?

A

Lightheadedness

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4
Q

What is defined as a feeling of impending faint or LOC and is generally a/w cardiac etiology?

A

Presyncope

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5
Q

Peripheral vs central causes of syncope imply a lesion where?

A

Peripheral- vestibular lesion

Central- central lesion

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6
Q

What is the suspected cause of vertigo if sudden/ acute onset, and horizontal or torsional nystagmus?

Would you expect ear sxs and/ or neuro sxs?

A

Peripheral

YES ear sxs, NO neuro sxs

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7
Q

What is the suspected cause of vertigo if gradual/ progressive onset, associated HA or N/V and vertical, nonfatigable nystagmus?

Would you expect ear sxs and/ or neuro sxs?

A

Central

NO ear sxs, YES neuro sxs

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8
Q

What are a few serious causes of vertigo that must be ruled out as part of a workup for a “dizzy” pt?

A

CV disease

MS

Acoustic neuroma

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9
Q

PE of “dizzy” pt should include what specifically?

(in additional to general PE)

A

Check BP for orthostasis

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10
Q

How is nystagmus characterized and referred to?

A

Slow drift in one direction followed by fast response in opposite direction

Referred to by direction of fast component

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11
Q

Horizontal nystagmus indicates what cause?

A

Peripheral or metabolic

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12
Q

Horizontal/ torsional nystagmus indicates what cause?

A

Peripheral or positional

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13
Q

Vertical nystagmus indicates what cause?

A

CNS

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14
Q

What dx study is the most helpful for BPPV as it reproduces vertigo and horizontal nystagmus?

(BPPV: benign paroxysmal positional vertigo)

A

Dix-Hallpike maneuver

(quickly lower seated pt to supine position w/ head turned to right w/ head to 30˚ below horizontal, observe for nystagmus, repeat w/ head turned to left)

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15
Q

What dx studies would you use to assess for vestibular function/ ocular motility?

A

ENG (electronystagmography) or VNG (videonystagmography)

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16
Q

What dx study would you use to test the vestibulo-ocular reflex?

A

Caloric testing- CN III, VI

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17
Q

What is considered a normal result for caloric testing?

A

Cold water: eyes deviate ipsilateral and nystagmus beats away to opposite side

Warm water: eyes deviate contralateral and nystagmus beats toward same side

COWS

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18
Q

What is considered an abnormal result for caloric testing and what does it indicate?

A

Vestibular paresis (absent thermally induced nystagmus) → pathology in labyrinth on irrigated side

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19
Q

What is the most common cause of vertigo?

A

BPPV

(secondary to canalithiasis)

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20
Q

Pt w/ hx of prolonged bedrest following head trauma presents with transient (< 1 min) episodes of vertigo a/w changes in head position and no hearing changes. What are you concerned for?

A

BPPV

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21
Q

What would you note with BPPV sxs with repeated Dix-Hallpike test?

A

Fatigue

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22
Q

What is the management for BPPV?

A

Pt EDU/ reassurance (self-limited weeks to months)

Particle repositioning maneuvers

OT/ positional exercises

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23
Q

What vestibular suppressant meds can be used in the tx of vertigo?

(not effective for BPPV)

A

Anticholinergics (scopalamine)

Antihistamines (meclizine, dimenhydrinate)

24
Q

What condition is often preceded by a viral infection (URI)?

A

Vestibular neuritis

(vestibular neuronitis = vestibular n. only

labyrinthitis = vestibular & cochlear n.)

25
Q

Pt presents with single attack of severe vertigo (sxs last days- 1 week), N/V, gait instability, and NO associated tinnitus or hearing loss. Hx of viral URI. What are you concerned for?

A

Vestibular neuritis

(labyrinthitis if (+) hearing loss)

26
Q

How is vestibular neuritis diagnosed?

A

(+) head thrust test = nystagmus

(+) caloric testing = vestibular paresis

No CNS deficits, N audiogram

27
Q

What is the management for vestibular neuritis?

A

Symptomatic tx, self-limited

28
Q

What condition is thought to be secondary to endolymphatic hydrops?

A

Meniere disease

29
Q

Pt presents with sudden onset attacks of episodic vertigo, tinnitus, and fluctuating hearing loss. Associated sxs include ear fullness, N/V. Audiogram shows sensorineural hearing loss. What are you concerned for?

A

Meniere disease

30
Q

How does hearing loss progress with Meniere disease?

A

Becomes irreversible → low tones lost first

Attacks of vertigo stop when deafness complete

31
Q

What is the tx for an acute attack of Meniere disease?

A

Bed rest, symptomatic care

32
Q

What is used for prophylactic management of Meniere disease?

A

Low salt diet, diuretics

Limit caffeine, nicotine, EtOH, MSG

33
Q

What is the tx for refractory Meniere?

A

Surgery

34
Q

What is defined as an abn connection between the perilymph and the middle ear?

A

Perilymphatic fistula

35
Q

Pt presents with hearing loss and tinnitus and hx of head trauma/ barotrauma. What are you concerned for and how would you confirm your suspected dx?

A

Perilymphatic fistula

Dx with pneumatic otoscopy

36
Q

What is the management for perilymphatic fistula?

A

Bedrest, hydration, sx tx, surgery

37
Q

What would be considered red flags in vertigo? (4)

A

Neuro deficit

Ipsilateral hearing loss

Gait abn

Direction changing nystagmus

38
Q

What is defined as a sudden, transient LOC w/ spontaneous recovery, and is a/w loss of postural tone due to diminished cerebral BF?

A

Syncope- a symptom

39
Q

What syncope etiology is a/w a higher risk of death?

A

Cardiac

40
Q

What prodromal sxs are consistent w/ vasovagal syncope?

A

Lightheadedness

Facial pallor

Diaphoresis

Nausea

(other general: uneasiness/ apprehension, visual blurring, CP/ SOB, HA/ focal neuro sxs)

41
Q

What BP changes are considered (+) for othostasis?

A

P systole > 20 mmHg

P diastole > 10 mmHg

42
Q

What provacative test is indicated if recurrent episodes of unexplained vasovagal syncope and no hx of cardiac disease?

A

Tilt table

Abn: exaggerated drop in BP, dizziness/lightheadedness +/- drop in HR

(normal: minimal drop in BP/increase in HR)

43
Q

What test is indicated for recurrent episodes of syncope with negative work-up and used if NO prior hx of carotid sinus syncope?

A

Carotid sinus massage

Palpate/auscultate for carotid bruits → STOP if present → massage carotid sinus for 5-10 sec → (+) if sxs reproduced and peroid of asystole > 3-5 sec or drop in BP > 50 mmHg

44
Q

What are contraindications for carotid sinus massage?

A

Hx of TIA/ stroke w/i past 3 months

Carotid bruits

45
Q

Pt presents with episodes of presyncope/ syncope and associated palpiations with NO prodrome. EKG shows sinus node dysfunction and AV block. What are you concerned for?

A

Cardiac syncope due to bradyarrhythmia

46
Q

Pt presents with episodes of presyncope/ syncope and associated palpiations with NO prodrome. EKG shows SVT, Wolff Parkinson White, and VT. What are you concerned for?

A

Cardiac syncope due to tachyarrhythmia

47
Q

What is the most common cause of obstructive cardiac syncope?

A

Aortic stenosis (a/w exertion)

(can also be due to aortic dissection)

48
Q

What type of syncope is neurally mediated, and due to loss of SNS tone or sudden ↑ in PNS tone?

A

Reflex syncope

49
Q

What is the most well-known reflex syncope and is aka “common faint”?

A

Vasovagal syncope

(attacks solitary, no long term rx needed)

50
Q

What type of syncope is typically seen in middle aged/ eldery pts w/ athersclerotic vascular disease and is due to the carotid sinus being abnormally responsive to pressure (ex. tight shirt collor/shaving)?

A

Carotid sinus syncope

51
Q

What is the tx for carotid sinus syncope?

A

Cardiac pacemaker

52
Q

What is defined as a syncopal episode after emptying a distended bladder and is seen after excess fluid ingestion?

A

Micturition syncope

53
Q

What type of syncope is seen with severe coughing leading to increased intrathoracic pressure and decreased CO and may be a/w with barrel chest/ COPD or children w/ asthma?

A

Tussive syncope

54
Q

When is orthostatic (postural) hypotension more worrisome?

A

Delayed sxs

(a few moments to several min after standing)

(orthostatic hypotension worsened by autonomic/ peripheral neuropathies and debilitation)

55
Q

What is the management of orthostatic hypotension?

A

Avoid volume depletion, behavior mod

(slow changes in position, dorsiflexion of feet/ handgrip exercises prior to standing, Jobst stockings)

56
Q

Pt presents with vertigo, syncope, +/- diplopia, dysarthria, and ataxia. You eval for sxs with arm exertion and look for difference in pulses in the UEs. What are you concerned for?

A

Subclavian steal syndrome

(stenosis of subclavian artery near origin, reversal in ipsilateral vertebral artery = decreased cerebral perfusion)

57
Q

What is indicated if syncope remains unexplained after workup?

A

Benign w/ good prognosis

1. Clin Med III (29 decks)

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