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BMB Test 2 > B7-098 Dizziness > Flashcards

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
Q

vertical nystagmus indicates a […] lesion
(up or down beating)

A

central

26
Q

direction changing nystagmus indicates […] lesion

A

central

27
Q

abnormal VOR to the right, but the patient falls to the left

A

central pattern

28
Q

hearing loss or tinnitus ipsilateral to the vestibular lesion favors a […] lesion

A

peripheral

29
Q

long tract findings (weakness, decreased sensation) favors a […] lesion

A

central

30
Q

other CN signs favors a […] lesion

A

central

(diplopia, facial weakness, facial numbness, dysphagia, dysarthia)

31
Q

idiopathic inflammation of CN VIII or cochlea

symptoms for days

A

vestibular neuronitis
labyrinthitis

32
Q

free floating debris in the semicircular canal, most commonly otoconia

symptoms for seconds after change in head position

A

benign paroxysmal positional vertigo

33
Q

causes of peripheral focal vestibulopathies [4]

A

vestibular neuronitis
labyrinthitis
benign paroxysmal positional vertigo
meniere’s disease

34
Q

high endolymphatic pressure-acute symptoms with rupture of membranous labyrinth

symptoms >20 min to a few hours

A

meniere’s disease

35
Q

causes of central vestibulopathies indicate pathology of the […] or […]

A

brainstem
cerebellum

36
Q

medications used as vestibular suppressants to decrease the severity of vertigo [4]

A

antihistamines (Meclizine)
anticholinergics
antiemetics
benzodiazepines

temporary use, central compensation will occur eventually

37
Q

how do peripheral vestibulopathies self resolve?

A

compensation in the cerebellum

38
Q

what symptom will remain even following central compensation for peripheral vestibulopathy?

A

abnormal VOR will persist

39
Q

failure of stabilization of the eyes with movement

objects in visual field tend to bounce when walking

A

oscillopsia (diffuse)

40
Q

no nystagmus in primary position

symmetric-direction changing gaze evoke nystagmus

A

diffuse vestibulopathy

41
Q

toxic causes of diffuse vestibulopathies [3]

A

alcohol
vestibular suppressants
aminoglycosides (gentamycin)

42
Q

acceleration to the left would […] left CN VIII activity and […] right CN VIII activity

A

increase left
decrease right

43
Q

a right peripheral neuropathy would cause the eyes to move […] toward the right and fast corrective saccade to the […]

A

slowly
left

44
Q

structure that sits on top of the hair cell stereocilia in the semicircular canals that provide information about angular acceleration or head motion

A

cupula

45
Q

macular organs in which otolith crystals sit on top of stereocilia [2]

A

utricle
saccule

46
Q

static information about your position in space is provided by the […] in the ear

A

macular organs (utricle and saccule)

47
Q

output nucleus for the spinocerebellar system dealing with posture

A

fastigial

48
Q

nucleus of the cerebellum concerned with motor planning

A

dentate

49
Q

vestibular neuronitis, labrinthitis, and Meniere’s cause a […] pattern of nystagmus

A

peripheral

50
Q

direction-changing gaze evoked nystagmus

A

central lesion (stroke)

51
Q

when patients say they are dizzy, what are the 3 most likely meanings?

A

vertigo
poor balance
lightheadedness

52
Q

vestibular projections are [bilateral/ipsilateral]

A

bilateral

(diffuse cortical associations)

53
Q

when positive, the Romberg sign indicates

(difficultly with balance with eyes closed)

A

vestibular or proprioceptive problem

54
Q

problems with the spino-cerebellar system cause difficulty with balance when eyes are […]

A

opened and closed

55
Q

intense vertigo lasting several hours associated with hearing loss

A

Menieres

56
Q

brief vertigo precipitated by movements

normal examination

A

benign paroxysmal vertigo

57
Q

vestibular neuronitis would cause vertigo that lasts […]

A

several days

58
Q

absence of movement

A

akinesia

59
Q

difficulty with rapid supination-pronation

A

dysdiadochokinesis

60
Q

overshooting or undershooting a target

A

dysmetria

BMB Test 2 (17 decks)

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