Chapter 13 Module 6; Dizziness

Question 1

Elderly; acute-onset; recurrent vertigo; tinnitus; hearing OK

Answer 1

Brainstem dysfunction/ cerebellar dysfunction

Question 2

Symptoms of brainstem/vertebrobasilarvascular abnormality: ataxia, double vision; lack of coordination; sensory/ motor deficits; vertical, lateral, rotary nystagmus; hearing normal; cerebellar: impaired RAM, finger-to-finger testing

Answer 2

Brainstem dysfunction/ cerebellar dysfunction

Question 3

DIAGNOSTIC STUDIES OF Brainstem dysfunction cerebellar dysfunction?

Answer 3

MRI

Question 4

Onset is often in third or fourth decade of life

Answer 4

Multiple sclerosis

Question 5

Can have no other findings or can have other neurological symptoms

Answer 5

Multiple sclerosis

Question 6

DIAGNOSTIC STUDIES OF Multiple sclerosis?

Answer 6

MRI

Question 7

Headache history; other migraine symptoms

Answer 7

Migraine headache

Question 8

Can have symptoms of vertebrobasilarvascular abnormalities, as above

Answer 8

Migraine headache

Question 9

DIAGNOSTIC STUDIES OF Migraine headache?

Answer 9

None

Question 10

Adults:associated with positional changes; recurrent episodes; lasts seconds to minutes; some relief if motionless

Answer 10

Benign paroxysmal positional vertigo (BPPV)

Question 11

Lateral or rotary nystagmus; no tinnitus or hearing loss

Answer 11

Benign paroxysmal positional vertigo (BPPV)

Question 12

DIAGNOSTIC STUDIES OF Benign paroxysmal positional vertigo (BPPV)

Answer 12

Provoke nystagmus and vertigo by position that causes response; Dix-Hallpike maneuver; ENG

Question 13

Children: usually 2-3 yr old, sudden onset with crying by child

Answer 13

Benign paroxysmal vertigo of childhood

Question 14

Vomiting, pallor, sweating, and nystagmus common; no loss of consciousness; neurological and audiological examination can be normal

Answer 14

Benign paroxysmal vertigo of childhood

Question 15

DIAGNOSTIC STUDIES OF Benign paroxysmal vertigo of childhood?

Answer 15

Can have hypoactive or absent response to caloric testing

Question 16

Sudden onset; lasts hours, recurrent; tinnitus and fullness in ears

Answer 16

Meniere disease

Question 17

Lateral or rotary nystagmus; fluctuating hearing loss: low tones; sensorineural

Answer 17

Meniere disease

Question 18

DIAGNOSTIC STUDIES OF Meniere disease?

Answer 18

Positional maneuvers, positive VOR test, audiometry, ENG

Question 19

Sudden onset; antecedent viral infection

Answer 19

Vestibular neuronitis

Question 20

Nausea andvomiting; nystagmus; no hearing loss, lossofequilibriumalwaysto the same side

Answer 20

Vestibular neuronitis

Question 21

DIAGNOSTIC STUDIES OF Vestibular neuronitis?

Answer 21

Positional maneuvers; positive VOR test

Question 22

Sudden onset, lasts hours to days

Answer 22

Labyrinthitis

Question 23

Can currently be ill; lateral nystagmus; hearing loss; rarely tinnitus; nausea and vomiting can be present

Answer 23

Labyrinthitis

Question 24

DIAGNOSTIC STUDIES OF Labyrinthitis?

Answer 24

Positional maneuvers, positive VOR test, audiometry

Question 25

Adults;  gradual  onset;  mild vertigo;  persistent  tinnitus; facial  numbness,  weakness

Answer 25

Acoustic  neuroma

Question 26

Unilateral  hearing  loss,  poor  speech discrimination

Answer 26

Acoustic  neuroma

Question 27

DIAGNOSTIC STUDIES OF Acoustic  neuroma?

Answer 27

MRI;  audiometry

Question 28

History  of  trauma;  hearing loss

Answer 28

Perilymph  fistula

Question 29

Nystagmus  and  vertigo  with  pneumatic otoscopy;  sensorineural  hearing  loss

Answer 29

Perilymph  fistula

Question 30

DIAGNOSTIC STUDIES OF Perilymph  fistula?

Answer 30

Audiometry

Question 31

Pain  in  ear  or  face;  history  of ear  or  sinus  infections; gradual  onset  of  vertigo

Answer 31

Otitis/sinusitis

Question 32

Serous  otitis,  otitis  media;  tenderness over  sinuses;  purulent  nasal  discharge; no  nystagmus

Answer 32

Otitis/sinusitis

Question 33

History  of  chronic  middle  ear infections

Answer 33

Cholesteatoma

Question 34

Shiny  white  irregular  mass  on  otoscopic examination;  foul-smelling  discharge can  be  present;  bone  destruction  can  be visible;  conductive  hearing  loss  can  be present

Answer 34

Cholesteatoma

Question 35

DIAGNOSTIC STUDIES OF Cholesteatoma?

Answer 35

Audiometry

Question 36

Vague  symptoms;  recurrent; can  describe  self  as anxious;  can  have  other psychiatric  diagnoses

Answer 36

Psychogenic

Question 37

Normal  neurological  and  auditory examinations

Answer 37

Psychogenic

Question 38

DIAGNOSTIC STUDIES OF Psychogenic?

Answer 38

Hyperventilation  to reproduce  the vertigo

Question 39

Cardiovascular  history; antihypertensive medications

Answer 39

Cardiovascular

Question 40

Orthostatic  blood  pressure;  dysrhythmias; carotid  or  temporal  bruits

Answer 40

Cardiovascular

Question 41

DIAGNOSTIC STUDIES OF Cardiovascular?

Answer 41

Depends  on  client condition  and symptoms

Question 42

Vertigo,  tinnitus,  fullness in  ears

Answer 42

Neurosyphilis

Question 43

Various  clinical  symptoms;  papilledema, aphasia,  monoplegia  or  hemiplegia, central  nervous  palsies,  pupillary  abnormalities,  Argyll  Robertson  pupil;  focal neurological  deficits

Answer 43

Neurosyphilis

Question 44

DIAGNOSTIC STUDIES OF Neurosyphilis?

Answer 44

Serology  for  syphilis

Question 45

Medication  history:  steroids, phenylbutazone,  ethacrynic acid,  aspirin,  streptomycin, gentamicin,  aminoglycosides,  furosemide, psychotropic  drugs

Answer 45

Ototoxic  and  salt- retaining  drugs

Question 46

Sensorineural  hearing  loss

Answer 46

 Ototoxic  and  salt- retaining  drugs

Question 47

DIAGNOSTIC STUDIES OF Ototoxic  and  salt- retaining  drugs?

Answer 47

Audiometry

Question 48

History  of  trauma  to  head or  ear

Answer 48

Trauma

Question 49

Depends  on  nature  and  location  of  injury; can  exhibit  peripheral  or  central symptoms

Answer 49

Trauma

Question 50

DIAGNOSTIC STUDIES OF Trauma?

Answer 50

MRI/CT