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444-Oncology and Neurology > Dizziness > Flashcards

Dizziness Flashcards

1
Q

define dizziness

A

a feeling of spinning or light headedness, without loss of consciousness, and may or may not be associated with falls

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2
Q

what is the term describing a sensation of the environment

A

exteroception

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3
Q

what is proprioception

A

internal sense of body/ limb position

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4
Q

the utricle senses

A

horizontal acceleration

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5
Q

the saccule senses

A

vertical linear acceleration

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6
Q

canals and otolith organs are innervated by the

A

vestibular nerve

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7
Q

describe some PNS changes with age

A

degeneration of ampullae of the semicircular canals and otolith organs

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8
Q

describe CNS changes with age

A

decreased vestibular hair and nerve cells, loss of cerebellar purkinje cells

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9
Q

what are some disease related factors that cause somatosensory changes

A

arthritis
joint replacements
peripheral neuropathy

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10
Q

Sensation of motion when there is none (false sense of motion) or an exaggerated moving sensation to normal daily activities

A

vertigo

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11
Q

Feeling of unsteadiness, imbalance, or insecurity without rotation

A

disequilibrium

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12
Q

feeling of losing consciousness, impending fainting, blacking out

A

presyncope

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13
Q

Swimming, floating, giddy, or swaying sensation in the head or room
Vague sx- possibly feeling disconnected with the environment

A

lightheadedness

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14
Q

list some points of pt assessment to hit when assessing dizziness

A

clarify terms
what is the specific sensation
timing- onset/ pattern
triggers and progression
med and trauma hx
blood work
diagnostic imaging- CT, MRI head
physical exam to reproduce dizziness
med hx- ototoxic drugs? hypotensives?

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15
Q

what is the goal of the physical exam in dizziness? what is the specific maneuver to assess called?

A

to reproduce the dizziness
Dix-Hallpike Maneuver

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16
Q

3 approaches to treating dizziness

A

disease spec tx
symptomatic tx
rehab

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17
Q

match the following sx to central or peripheral vertigo
1. mild-mod
2. abrupt onset
3. chronic and continuous
4. more prominent movement illusions
5. gets worse with movement
6. has neurologic signs
7. hearing loss present
8. no N/V
9. severe imbalance

A
  1. mild-mod = central
  2. abrupt onset = peripheral
  3. chronic and continuous = central
  4. more prominent movement illusions = peripheral
  5. gets worse with movement = peripheral
  6. has neurologic signs = central
  7. hearing loss present = peripheral
  8. no N/V = central
  9. severe imbalance = central
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18
Q

list 3 central causes of dizziness

A

brainstem ischemia
cerebellar hemorrhage
normal pressure hydrocephalus
MS
space occupying lesions

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19
Q

3 approaches for treating central vertigo

A

manage/ reverse underlying condition
vestibular rehab
rehab with physio F3mths

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20
Q

describe presyncope clinical presentation

A

fainting or near fainting, seconds to minutes, can be accompanied by diaphoresis, nausea, blurred vision, pallor

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21
Q

presyncope is
1. red flag that requires assessment ASAP
2. may be accompanied by movement difficulties and hearing loss
3. may be managed by canalith repositioning
4. is most often caused by volume overload in the ear
5. often slower onset and lead up to syncope

A

1

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22
Q

causes/ origin of presyncope include

A

cardiac origin mostly/ decreased perf to brain- OH, volume depletion, carotid stenosis, arrhythmia, reflex, MI, autonomic failure

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23
Q

3 classes of medications that can cause presyncope/ syncope

A

cardiac- any antihypertensive or vasodilator
CNS- psychotropic drugs, anticonvulsants, dopaminergic, skeletal muscle relaxants
uroloogic drugs- anticholinergics, PDE5i

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24
Q

what is the guideline definition of orthostasis

A

SBP decrease of at least 20 mmHg or DCP decrease of at least 10 mmHg within 3 minutes of standing

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25
Q

what is a nonpharm tx for vertigo

A

pressure stockings

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26
Q

syncope/ presyncope pharm tx (list 3)

A

midodrine
fludrocortisone
caffeine
erythropoetin
desmopressin
pseudoephedrine

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27
Q

n disequilibrium, we are most concerned about
1. standing from sitting
2. standing to laying down
3. holding posture against gravity for long time
4. quick movements

A

4

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28
Q

disequilibrium can be assessed by

A

observing gait and full neuro exam

29
Q

3 caues of lightheadedness

A

psychiatric
hyperventilation
hypoxia

30
Q

how to manage light headedness

A

manage underlying conditions
optimize anxiety

31
Q

BPPV is a form of

A

peripheral vertigo

32
Q

BPPV onset is usually

A

50-70yrs old

33
Q

what is the clinical course of BPPV

A

sx resolve in 6-20d, up to 2mths in some cases

34
Q

describe the etiology of BPPV

A

debris from utricle circulate, otoliths (CaCO3) detach, settle in dependent portion of inner ear = tells brain the body is in a position it’s not in = disorientation

35
Q

BPPV is diagnosed with the

A

Dix Hallpike

36
Q

2 nonpharm tx for BPPPV

A

canalith repositioning
vestibular rehab

37
Q

which of the followign is false
1. canalith repositioning is up to 95% effective in BPPV
2. vestibular rehabilitation may be used in lightheadedness
3. vestibular rehab is usually a 3mth trial
4. vestibular suppressants are used in BPPV when nonpharm fails

A

2

38
Q

describe vestibular rehab

A

exercises that improve central compensation for peripheral deficit

39
Q

Maneuvers (Semont, Brandt-Daroff, Gans)- direct the otoconia back to the utricle where it is absorbed

A

canalith repositioning

40
Q

how long should vestibular suppressants be used for

A

3-7d

41
Q

why should the duration of vestibular suppressants be limited

A

inhibit the brains natural abiltiy to compensate for vertigo over time

42
Q

list the 3 classes of vestibular suppressants

A

anticholinergics
antihistamines
BZDs

43
Q

how do anticholinergics work in vertigo

A

suppresses firing in vestibular nucleus neurons

44
Q

how do BZDs work in vertigo

A

GABA modulators that act centrally to potentiate GABA and suppress vestibular responses

45
Q

which BZD is used in vertigo

A

lorazepam

46
Q

what is an alternative tx that directly suppresses vestibular activity in vertigo

A

flunarizine

47
Q

2 investigational tx in vertigo

A

vit D
calcium

48
Q

onset of meniere’s disease is usually

A

30-60yrs

49
Q

describe the presentation of meniere’s disease

A

No specific precipitant
Usually starts unilaterally, but over time both ears are affected
Symptoms remit and reoccur (episodic)
Episodes can last 20 min to few hours

50
Q

which of the following accurately describes Meniere’s disease
1. is caused by inflammation of endolymphatic system
2. has no specific precipitant
3. may be caused from external fluid entering ear
4. does not result in hearing loss

A

2

51
Q

4 classic sx of meniere’s disease

A

Aural fullness + pressure
Vertigo lasting minutes to hrs - often with N/V
Tinnitus
Hearing loss (unilateral at first)

52
Q

describe the pathophys of meniere’s disease

A

Dilation (ballooning) of the endolymphatic system
↑↑ production of endolymph
↓reabsorption

53
Q

acute tx of meniere’s disease

A

Vestibular suppressants (Ex- meclizine)
Antinauseants (Ex- prochlorperazine)
often resolves before med kicks in

54
Q

refractory intervention for meniere’s disease

A

intratympanic CS or gentamicin
vestibular neurectomy
labyrinthectomy

55
Q

name 3 prophylactics to use in meniere’s

A

changing diet: low salt, avoid caffeine, alcohol
diuretics: HCTZ, triamterene, acetazolamide
betahistine

56
Q

diet changes for meniere’s includes

A

low salt, avoid caffeine, alcohol

57
Q

which 3 diuretics are used in meniere’s?

A

HCTZ, triamterene, acetazolamide

58
Q

betahistine MOA

A

H1 agonist, strong H3 antagonist = vasodilation peripherally

3 sites of action: ↑ cochlear blood flow, ↑ CNS and vestibular histamine turnover, ↓ vestibular input in peripheral vestibular system

59
Q

T or F: evidence for betahistine use in meniere’s disease is strong

A

F- v weak

60
Q

CI for betahistine

A

PUD

61
Q

what might betahistine be used for

A

prophylactic tx for meniere’s

62
Q

presentation of vestibular neuritis

A

sudden/ severe vertigo, N/V
Auditory sx usually absent (no hearing loss)

63
Q

select all the following that have hearing loss
1. BPPV
2. vestibular neuritis
3. labryinthitis
4. meniere’s disease

A

3,4

64
Q

select all the following that are episodic
1. BPPV
2. vestibular neuritis
3. labryinthitis
4. meniere’s disease

A

1, 4

65
Q

tx for vestibular neuritis

A

bedrest
corticosteroids for 10 days if debilitating (methylprednisolone) then vestibular rehab after acute phase (2-3d after onset)

66
Q

3 causes of vestibular neuritis

A

viral infection
head injury
extreme stress

67
Q

what is the cause of labyrinthitis

A

inflammation of inner ear canals, may result from prior infections or ototoxic drugs

68
Q

labyrinthitis presentation

A

severe vertigo, hearing loss, N/v, fever

69
Q

labyrinthitis tx

A

hospitalization, IV antibiotics, possible surgical drainage and debridement

444-Oncology and Neurology (22 decks)

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