Balance

Question 1

PE: SNNOOP

Answer 1

systemic
neurologic
neck
ophtha
otologic
psychiatric

Question 2

BPPV treatment (2)

Answer 2

epley maneuver

semont libertoy

Question 3

labyrinthitis and neuritis (affecting cochlea and vestibular system plus nerves)

etiology
treatment

Answer 3

bacterial or viral

ab or av…

Question 4

meniere’s disease

triad of symptoms

Answer 4

periodic rotatory vertigo
fluctuating progressive low frequency tinnitus
tinnitus (wtf)
ear fullness

SILM:
fluctuating low f HL
episodic vertigo
tinnitus

Question 5

meniere’s disease

first line treatment
and other treatment (5)

Answer 5

first line: salt restriction (2g Na) + diuretics

other:
vestibular suppressants (meclizine, clonazepam)
Ca blockers (cinnarizine, fluranazine)
H3 receptor antagonist (betahistine) - inc vestibular blood flow
gentamycin
surgery (last resort)
steroid

Question 6

not recommended for meniere’s disease (CATSS)

Answer 6

caffeine
alcohol
tobacco
salt
stress

Question 7

acoustic neuroma affects what? etiology? bilateral or not?

Answer 7

vestibular branch of cn8

unknown, maybe neurofibromatosis type 2 (hereditary)

asymmetric

Question 8

acoustic neuroma treatment

Answer 8

multidisciplinary (conservative or surgical)
gamma knife (radiation)

Question 9

test for BPPV. this tests what?

positive result?

Answer 9

dix-hallpike
posterior SCC

rotational nystagmus towards affected ear/nearest ground

Question 10

test for proprioception and vestibular influences

procedure?
what is “sharpened”?

implication of findings?

Answer 10

romberg test

eyes open, jendrassik’s
then eyes closed
sharpened - one foot fwd

fall towards side of lesion

Question 11

unterberger test

tests for what?
procedure?

Answer 11

vestibular pathology

walk in place with eyes closed

rotation on side of lesion

Question 12

head thrust (halmagyi)

detects what?
procedure?

implication of findings?

Answer 12

severe unilateral loss of scc

px look at ex nose, quickly turn patients head

no corrective saccade - maybe cns localization
corrective saccade - vestibular

Question 13

ancillary diagnostic tests

blood tests :)

cbc
electrolytes
ca
thyroid fxn tests
fta-abs/tpa
chl and tag
diabetes and hypoglycemia

Answer 13

cbc - anemia
electrolytes - imbalance
ca - hypercalcemia
thyroid fxn tests - hypothyroidism
fta-abs/tpa - tertiary syphilis
chl and tag - hyperlipoproteinemia
diabetes and hypoglycemia

Question 14

gold standard for diagnosing acoustic neuroma

Answer 14

mri with gandolinium

Question 15

imaging study indicated for elderly

Answer 15

cervical spine xray

Question 16

mechanism of action of the ff medications

h3 receptor antagonist (betahistine)
benzodiazepene (diazepam, clonazepam)
ca channel blockers (cinnarizine, fluranazine)
diuretics (thiazide)

Answer 16

h3 receptor antagonist (betahistine)
inc vestibular blood flow (more on peripheral vestibular level)

benzodiazepene (diazepam, clonazepam)
modulates GABA receptors :) relaxant; for acute severe attacks of vertigo

ca channel blockers (cinnarizine, fluranazine)
inhibit ca influx (hair cels)

diuretics (thiazide)
inhibits na, cl transport in cortical thick ascending limb and early distal tubule
inhibits carbonic anhydrase –> reduce endolymph volume

Question 17

bending of kinocilia results to

Answer 17

depol due to influx of k, increase of ca at the base

Question 18

which scc have ampullas oriented toward the canal? implication?

Answer 18

posterior, superior

ampullofugal –> depolarization

Question 19

ewald’s law (3)

Answer 19

nystagmus at same plane of scc
ampullopetal depol for horizontal
ampullofugal depol for anterior and superior