dizziness and syncope

Question 1

Causes of chronic dizziness

Answer 1

• central vestibular decompensation
• unilateral/bilateral vestibular failures
• medications
• middle ear infection

Question 2

Causes of acute dizziness

Answer 2

• vestibular neuronitis
• labyrinthitis
• benign positional vertigo
• meniere’s disease

Question 3

how does meniere’s disease present and how is it managed

Answer 3

• tinnitus, stuffy ear, hearing loss

management: salt restriction, diuretics, betahistine

Question 4

describe the Epley maneuver

Answer 4

• pt upright and examiner rotates head toward affectd ear
• pt lies down rapidly supine with neck extended over edge of bed
• slowly rotate head to the other side

Question 5

symptoms of vertigo

Answer 5

feeling of veering or pushed to the side
room spinning- often rotational
symptoms precipitated by head movement and associated with nausea and vomiting

Question 6

causes of central vertigo

Answer 6

• vertebrobasilar insufficiency
• cerebral infarction
• degenerative disease incl demyelination
• posterior fossa mass (tumour)

Question 7

causes of peripheral vertigo

Answer 7

• benign positional vertigo
• acute labyrinthitis
• meniere’s disease

Question 8

difference between central and peripheral vertigo

Answer 8

central- ataxia and neurological symptoms are common with slow compensation

peripheral: nausea and vomiting severe and hearing loss common, compensation rapid

Question 9

characteristics of disequilibrium

Answer 9

feeling of imminent fall
characterised by unsteadiness or imbalance
sx only when erect or moving, involves trunk or lower extremities- disappears when lying and sitting
trouble walking in the dark- poor vision

Question 10

characteristics of functional dizziness

Answer 10

feelings of woozy and heavy headed
often associated with anxiety, hyperventilation and depression
- recent stressors- mood, alcohol, nicotine, drugs
- constantly dizzy
- light-headed/swimmy
- breathing pattern changes

Question 11

what are the characteristics of presyncope

Answer 11

• feeling of impending faint
• more lightheaded than dizzy
• usually on standing and relieved by sitting
• dizzy when turning around or stooping
• palpitations and chest pain

Question 12

what is syncope

Answer 12

transient loss of consciousness with spontaneous recovery due to decrease in cerebral blood flow
- faint - blackout - pre-syncope

Question 13

3 categories of syncope

Answer 13

1. Reflex a) vasovagal b)situational c)carotid sinus hypersensitivity
2. orthostatic hypertension a) volume depletion b) drug-induced c) primary autonomic failure d) secondary autonomic failure
3. cardiac syncope a) arrhythmia b) structural disease

Question 14

what does the tilt table diagnose?

Answer 14

vasovagal syncope

Question 15

How is carotid sinus hypersensitivty diagnosed?

Answer 15

carotid sinus massage

Question 16

treatment of orthostatic hypotension

Answer 16

• review medications
• ted stockings
• fludrocortisone
• midodrine

Question 17

treatment of cardiac syncope

Answer 17

• treat arrhythmia- AF
• correct valve pathology
• medical management of angioplasty

Question 18

what is the romberg’s test based on i.e what senses are needed for balance

Answer 18

• propioception
• vestibular function
• vision

Question 19

in what conditions is the romberg’s test positive

Answer 19

• vitamin deficiencies e.g B12
• conditions affecting dorsal column e.g. neurosyphilis
• peripheral neuropathies
• meniere’s disease

Question 20

what does the timed get up and go test monitor?

Answer 20

determines fall risk and measures progress of balance, sit to stand and walking

Question 21

driving restriction after syncope

Answer 21

1 month- write to DVLA for them to confirm