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Disorders of Equilibrium Flashcards

1
Q

True or false: dizziness may result from a disorder in any organ system

A

True

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2
Q

What are the four major organ systems that generally lead to the development of dizziness?

A
  • Brain
  • vestibular apparatus
  • CV
  • Endocrine system
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3
Q

True or false: dizziness may be physiologic

A

True

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4
Q

What is the definition of disequilibrium?

A

Altered sense of balance

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5
Q

What are the three major inputs for equilibrium?

A
  • Visual
  • Proprioceptive
  • Vestibular
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6
Q

What part of the spinal column is responsible for proprioception?

A

Dorsal columns

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7
Q

What are the three major organ systems that can produce vertigo?

A
  • Labyrinthine apparatus
  • Vestibular nerve
  • Brainstem
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8
Q

True or false: vertigo is always pathologic

A

false

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9
Q

How can you identify vertigo that is psychogenic in nature?

A

Absence of nystagmus

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10
Q

Psychogenic vertigo is usually seen in patients who have what conditions?

A

Panic disorder or agoraphobia

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11
Q

What is agoraphobia?

A

Afraid of open spaces/leaving their home

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12
Q

Can you have true vertigo without vestibular system involvement

A

no

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13
Q

Where can the lesions located with vestibular system disorders? (3)

A
  • Inner ear
  • Acoustic nerve
  • Brain
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14
Q

What are the receptors for vertical motion?

A

Saccule and utricle

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15
Q

What bone houses the vestibular apparatus?

A

temporal bone

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16
Q

What is the position sensing apparatus within the semicircular canals?

A

Cupula

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17
Q

What is the blood supply to the labyrinth?

A

internal auditory nerve

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18
Q

The endolymphatic fluid is high in what mineral? Low?

A

High in K

Low in Na

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19
Q

What is the pathway that transmits information from CN VIII?

A

Medial longitudinal fasciculus

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20
Q

What causes height vertigo?

A

Widening of the tiny saccular movements of the eyes d/t taller objects

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21
Q

What, generally, is physiologic vertigo?

A

Exaggerated response to normal phenomenon

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22
Q

What are the three HEENT exam bits that should always be obtained with a complaint of dizziness?

A
  • Otoscope exam
  • EOMs/Nystagmus
  • hearing exam
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23
Q

Which is usually pathologic and which is physiologic: jerk vs pendular nystagmus?

A
  • Physiologic=pendular

- Pathologic=jerk

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24
Q

How is the dix-hallpike maneuver performed?

A

Hold patient’s head at 45 degree angle (extended), and have them look to the right/left while turning their head.

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25
How can jerk nystagmus be brought about physiologically?
have eye move toward punctum so that no cornea is seen
26
How is nystagmus defined: by the fast or the slow phase?:
Fast phase
27
Is there nystagmus with pts in a coma?
No--controlled by the cerebral hemispheres
28
What are the characteristics of peripheral jerk nystagmus in terms of: - Latency - Vertigo - Positional adaptation - fatigue on repeat testing
- 2-20 second Latency - Associated Vertigo - Has Positional adaptation - Will fatigue on repeat testing
29
What are the characteristics of central jerk nystagmus in terms of: - Latency - Vertigo - Positional adaptation - fatigue on repeat testing
- No Latency - Variable Vertigo - No Positional adaptation - Little fatigue on repeat testing
30
Where do CN VIII nerves decussate?
In the pons
31
What, generally, is the BAER test?
Measuring the action potential of CN VIII as is traverses up the brain
32
What is the order of nerves/nuclei in the auditory pathway?
1. Acoustic nerve 2. Cochlear nerve 3. Superior olivary nucleus 4. Lateral lemniscus 5. Inferior colliculus 6. Medial geniculate 7. Auditory radiations (thalamocortical)
33
What are ENGs?
Electronystagmography--measuring the eye movement by detecting the changes in electrical activity whilst injecting cold water
34
What way does nystagmus occur with cold water injection in the ear?
Toward the side
35
Vertigo only with head movement = ?
Peripheral process
36
Jerk nystagmus at rest/exacerbated by movement = ?
Central process
37
Otologic s/sx associated with vertigo most likely indicates what?
Peripheral vertigo
38
What type of nystagmus is usually found with peripheral disorders?
Jerk
39
What is vestibular neuritis?
Inflammation of the vestibular nerve, usually of viral etiology
40
What is labyrinthitis?
Inflammation of the labyrinth, usually
41
What is Ramsey-Hunt syndrome?
Zoster infection of the labyrinth
42
What are the traumatic causes of peripheral vestibular disorders?
Perilymph fistulas | Cupulo-lithiasis
43
What is the classic sign of Ramsey-Hunt syndrome?
Vesicles in the ear canal
44
What is Meniere's syndrome?
Endolymph hydrops (too much fluid in the ear), which flows into other areas, causing damage
45
What is the classic triad of symptoms for Meniere's disease?
Vertigo Tinnitus Hearing loss
46
What is cholesteatoma?
Hyalinized epithelium of the middle ear
47
What is the bloody supply to CN VIII?
Internal auditory artery
48
What is the usual presentation of a labyrinthine infarction?
Sudden hearing loss
49
What are the associated symptoms of motion sickness?
Autonomic overtones (sweating, salivation, yawning)
50
What, generally, causes motion sickness?
Overstimulation of peripheral vestibular system
51
True or false: motion sickness may be induced by eye movements
True
52
Is BPV usually unilateral or bilateral?
Unilateral
53
What usually precipitates episodes of vertigo with BPV?
Movement of the head
54
What causes acoustic neuromas?
Schwannomas
55
Bilateral schwannomas = ?
NF2
56
Vertigo that comes on at rest or worse with position changes = ?
Central vertigo
57
What are the other, general, signs associated with central causes of vertigo?
CNS findings (e.g. diplopia, dysarthria, ataxia etc)
58
What is the arterial supply to the pons?
Basilar artery
59
What is the general medication class that is used to treat central vertigo?
Vestibular suppressants
60
What are the four major classes of drugs used to treat vertigo?
- Antihistamines - Benzos - Phenothiazines - Scopolamine
61
What is the goal with the Epley maneuvers?
Reposition the otoconia
62
How can you tell which ear is affected with BPV?
Nystagmus will go to the side of the lesion
63
How, generally, are the Epley maneuvers performed?
Lay head down towards the side of dysfunction

Neurology (23 decks)

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