B7-098 Dizziness Flashcards

1
Q

a sensation that the environment or the self is moving/spinning

A

vertigo

(important to distinguish between vertigo/poor balance/pre-syncope)

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2
Q

uncontrolled repetitive movements of the eyes with a fast and slow component

A

jerk nystagmus

(pendular nystagmus would be even pacing)

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3
Q

patient is asked to point at an object with their eyes closed and consistently deviate to one side

A

past pointing

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4
Q

senses linear acceleration (including gravity) and angular motion

A

vestibular system

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5
Q

most medial nuclei of the brainstem

A

oculomotor (midbrain)
trochlear (midbrain)
abducens (pons)
hypoglossal (medulla)

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6
Q

most lateral nuclei of the brainstem

A

vestibular cochlear (pons/medulla)

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7
Q

the inner ear is in the […] bone

A

temporal

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8
Q

cranial nerves that pass through the internal auditory meatus [2]

A

CN VII
CN VIII

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9
Q

the lateral vestibulospinal tract is found in the […] of the spinal cord

A

anterior funiculus

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10
Q

[…] tract controls the extensor muscle to aid in posture and balance

A

lateral vestibulospinal tract

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11
Q

past pointing and + Rombergs indicate an issue with the […] tract

A

lateral vestibulospinal

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12
Q

medial vestibulospinal tract is another name for the

A

descending MLF

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13
Q

[….] tract provides reflex head and eye stabilization

A

medial vestibulospinal

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14
Q

target nuclei of medial vestibulospinal tract

A

oculomotor nuclei
spinal accessory
cervical motor neurons

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15
Q

responsible for the vestibulo-ocular reflex (VOR)

A

medial vestibulospinal tract

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16
Q

tests for the VOR

A

head impulse test (loose fixation with head turning)
cold calorics

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17
Q

contrast focal vs. diffuse vestibulopathy

A

focal will have unilateral, asymmetric findings

diffuse will have bilateral symmetric findings

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18
Q

peripheral vestibulopathy refers to what structures?

A

CN VIII and inner ear

(extra-axial)

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19
Q

the fast phase of nystagmus goes […] the lesion
the slow phase goes […] from the lesion

A

fast: away
slow: toward

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20
Q

unidirectional horizontal nystagmus, fast phase away from lesion

nystagmus less severe when looking toward side of lesion

nystagmus more severe when looking away from side of lesion

VOR abnormal when head is tilted toward the side of the lesion

A

unilateral peripheral lesion causing issues with medial vestibulospinal tract

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21
Q

falling toward side of lesion

past pointing toward side of lesion

A

unilateral peripheral lesion causing issues with lateral vestibulospinal tract

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22
Q

environment rotating toward side of lesion

body leaning away from side of lesion

A

unilateral peripheral lesion causing issues with perception

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23
Q

in a peripheral pattern symptoms of […] and […] would be seen together

A

medial and lateral vestibulospinal tracts

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24
Q

if the symptoms and signs do not follow the expected peripheral pattern, the lesion is

A

central

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25
vertical nystagmus indicates a [...] lesion (up or down beating)
central
26
direction changing nystagmus indicates [...] lesion
central
27
abnormal VOR to the right, but the patient falls to the left
central pattern
28
hearing loss or tinnitus ipsilateral to the vestibular lesion favors a [...] lesion
peripheral
29
long tract findings (weakness, decreased sensation) favors a [...] lesion
central
30
other CN signs favors a [...] lesion
central (diplopia, facial weakness, facial numbness, dysphagia, dysarthia)
31
idiopathic inflammation of CN VIII or cochlea symptoms for days
vestibular neuronitis labyrinthitis
32
free floating debris in the semicircular canal, most commonly otoconia symptoms for seconds after change in head position
benign paroxysmal positional vertigo
33
causes of peripheral focal vestibulopathies [4]
vestibular neuronitis labyrinthitis benign paroxysmal positional vertigo meniere's disease
34
high endolymphatic pressure-acute symptoms with rupture of membranous labyrinth symptoms >20 min to a few hours
meniere's disease
35
causes of central vestibulopathies indicate pathology of the [...] or [...]
brainstem cerebellum
36
medications used as vestibular suppressants to decrease the severity of vertigo [4]
antihistamines (Meclizine) anticholinergics antiemetics benzodiazepines **temporary use**, central compensation will occur eventually
37
how do peripheral vestibulopathies self resolve?
compensation in the cerebellum
38
what symptom will remain even following central compensation for peripheral vestibulopathy?
abnormal VOR will persist
39
failure of stabilization of the eyes with movement objects in visual field tend to bounce when walking
oscillopsia (diffuse)
40
no nystagmus in primary position symmetric-direction changing gaze evoke nystagmus
diffuse vestibulopathy
41
toxic causes of diffuse vestibulopathies [3]
alcohol vestibular suppressants aminoglycosides (gentamycin)
42
acceleration to the left would [...] left CN VIII activity and [...] right CN VIII activity
increase left decrease right
43
a right peripheral neuropathy would cause the eyes to move [...] toward the right and fast corrective saccade to the [...]
slowly left
44
structure that sits on top of the hair cell stereocilia in the semicircular canals that provide information about angular acceleration or head motion
cupula
45
macular organs in which otolith crystals sit on top of stereocilia [2]
utricle saccule
46
static information about your position in space is provided by the [...] in the ear
macular organs (utricle and saccule)
47
output nucleus for the spinocerebellar system dealing with posture
fastigial
48
nucleus of the cerebellum concerned with motor planning
dentate
49
vestibular neuronitis, labrinthitis, and Meniere's cause a [...] pattern of nystagmus
peripheral
50
direction-changing gaze evoked nystagmus
central lesion (stroke)
51
when patients say they are dizzy, what are the 3 most likely meanings?
vertigo poor balance lightheadedness
52
vestibular projections are [bilateral/ipsilateral]
bilateral (diffuse cortical associations)
53
when positive, the Romberg sign indicates (difficultly with balance with eyes closed)
vestibular or proprioceptive problem
54
problems with the spino-cerebellar system cause difficulty with balance when eyes are [...]
opened and closed
55
intense vertigo lasting several hours associated with hearing loss
Menieres
56
brief vertigo precipitated by movements normal examination
benign paroxysmal vertigo
57
vestibular neuronitis would cause vertigo that lasts [...]
several days
58
absence of movement
akinesia
59
difficulty with rapid supination-pronation
dysdiadochokinesis
60
overshooting or undershooting a target
dysmetria