Dizziness

Question 1

all dizziness is vertgo true/false

Answer 1

False- not all dizziness is vertigo

Question 2

what is the problem with patients describing themselves as ‘dizzy’?

Answer 2

non- specific- ask more: did they faint?had they fallen

Question 3

what is vertigo?

Answer 3

sensation that they/the room is spinning

Question 4

what makes up the balance system? (5)

Answer 4

vestibular

eyesight

joint receptors

cardiac→ standign BP

brain→ stress/migraine

Question 5

what can affect your eyes causign dizziness?

Answer 5

cataracts

Question 6

what can affect your joint receptors casuign dizziness?

Answer 6

osteoarthritis

diabetes

Question 7

what can be doen in exmination of a dizzy patient?

Answer 7

otoscopy

balance test

audiometry

lying/standing BP

Question 8

what is BPPV?

Answer 8

Benign Paroxysmal Positional Vertigo

Question 9

define BPPV

Answer 9

dizziness when moving head position i.e rolling over in bed, bendign down (gardening), leaning back (reaching to cupboard)

Question 10

what is thought to be the cause of BPPV?

Answer 10

otilith material displaced from utricle into semicircular canals

Question 11

what test is used to diagnose BPPV?

Answer 11

Hallpikes test

Question 12

describe Hallpikes

Answer 12

patient lies back on couch

head at 45^o

keep eyes open

Question 13

what is the clincial sign seen in Hallpikes?

Answer 13

nystagmus

Question 14

what are the two manouvres used to treat BPPV?

Answer 14

Epley manouvre

Brandt- Daroff exercise

Question 15

what condition involces prolonged vertigo with symptoms of nausea and vomiting lasting for >3days?

Answer 15

vestibular neuritis

Question 16

tinnitus and hearing loss is associated with vestibular neuritis true/false

Answer 16

false- there is no assoc tinnitus or hearing loss with vestibular neuritis

Question 17

what codition is similar to vestibular neuritis but it does have assoc tinnitus and hearing loss?

Answer 17

labyrinthitis

Question 18

how does labyrinthitis present?

Answer 18

sudden onset that graudually gets better

Question 19

what is the treatment for vestibular neuritis and labyrinthitis?

Answer 19

supportive with vestibular sedatives

generally self limiting

Question 20

what can be given for pateitns with vestibular neuritis/labyrinthitis that are vomiting?

Answer 20

buccal meds (buccostem)

cyclozine

Question 21

what is menieres disease?

Answer 21

progressive deafness with tinnitus and vertigo

Question 22

what is th ecriteria to diagnose menieres?

Answer 22

room spinning + vomiting

usually tinnitus + LOH before episode

lasts around 30mins

[all have to vhange at same time]

Question 23

how does menieres affect you over time (years)?

Answer 23

destroys hearing and balance

Question 24

what investigation should always be carried out in suspicion of menieres?

Answer 24

MRI for intrancranial lesion of schwannoma

Question 25

what is the management of menieres?

Answer 25

buccostem during attack (vomiting)

hearing aids/therapy (tinnitus)

Question 26

what is thoughtto be the mechanism behind menieres?

Answer 26

thought that membrane between peri and endolymph is broken every attack and the two fluids mix

n.b- due to diff in salt conc of two fluids thought that salt restricted diet could be benificial

Question 27

what is a meniette?

Answer 27

device used in menieres that gives pulsed pressure into the ear canal- grommet insertion allows it to flow through

Question 28

how can gentamicin injection be useful in menieres?

Answer 28

giving gentamicin injection will result in you losing sense of balance- if you have no balance you cannot suffer from an attack