Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Geriatrics 1 > Dizziness in Older Adults > Flashcards

Dizziness in Older Adults Flashcards

1
Q

Dizziness occurs in up to ____ of older adults

A

1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Prevalence of dizziness increases ___% for every 5 years of age

A

10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

___% of cases of dizziness have multiple causes

A

> 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Classification by symptoms: vertigo

A

Rotational “spinning” sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Classification by symptoms: presyncope

A

Sensation of impending faint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Classification by symptoms: disequilibrium

A

Feeling of imbalance on standing or walking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Most common types of dizziness presents with…..

A

Mixed symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is BPPV?

A

Episodic, inner ear disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What event precipitates BPPV?

A

Changes in position (e.g. turning, rolling over)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How long do episodes of BPPV last?

A

5-15 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pathophysiology of BPPV

A

Changes in endolymphatic pressure during head movements resulting from dislodged otoconia in semilunar canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is meniere disease?

A

Idiopathic inner ear disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical presentation of meniere disease:

A

Repeated episode of tinnitus
Functional hearing loss w/ sensation of fullness in ears
Severe vertigo
Progressive SNHL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Brain tumors are found in __% of dizzy patients

A

<1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most common tumor associated with dizziness

A

Acoustic neuroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Symptoms of acoustic neuroma

A

Unilateral tinnitus & HL predominate (not dizziness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Bilateral cochlear symptoms (tinnitus, hearing loss) in older persons usually represents

A

Presbycusis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is presyncope?

A

Sensation of near-fainting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cardiac causes of presyncope

A

Electrical -> tachy or bradyarrythmias

Structural -> aortic outflow obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Vascular causes of presyncope

A

Orthostatic hypotension

Vagal stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Postural causes of presyncope

A

+/- orthostatic hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is disequilibrium?

A

Sensation of being unsteady when standing or walking

23
Q

Factors that contribute to disequilibrium

A
  • Propioceptive disorder
  • Visual problems
  • MSK disorders
  • Gait disorders
24
Q

The term ___________ is reserved for patients who do not experience vertigo, presyncope or disequilibrium

A

Lightheadedness

25
Q

Two most prominent considerations in the context of lightheadedness

A 
Psychiatric causes (depression, anxiety, somatoform disorders) 
Idiopathic
26
Q

Use of >___ medications = dizziness risk factor

A

3

27
Q

Certain drugs frequently implicated in dizziness

A
  • Those that cause orthostasis or CNS effects
  • CV or anti-HTN drugs
  • Psychotropic medicaitons
  • AGs
  • NSAIDs
28
Q

Characteristics of dizziness in older adults

A
  • Resolves in days to several months
  • Chronic or recurrent
  • Multifactorial common
29
Q

4 important history elements

A
  1. If dizziness is characterized by spinning, fainting, falling
  2. If posture affects sx
  3. If there are other sx ass. w/ dizziness (esp. focal neurological)
  4. Medications
30
Q

Components of PE

A
  • Check orthostatics
  • Check hearing (gross first)
  • Perform provocative test of vestibular system (Head-thrust, Fukuda stepping, Dix-Hallpike)
  • Cardiac exam
  • Observe balance & gait (Get up & go)
31
Q

Head-thrust test

A

Pt. fixates on examiners nose, examiner rotates head rapidly about degrees to left or right
(-) = pt. eyes remain fixated on nose
(+) = pt. eyes move away from target along with head

32
Q

Fukuda stepping test

A

Pt. stands in circle on floor, asked to walk when blindfolded w/ outstretched arms, assessor determine s body sway
(+) = >30 degree sway to one side = unilateral vestibular lesion or acoustic neuroma

33
Q

Diagnostic evaluation of dizziness

A
  • Labs: HCT, CMP, vitamin B12, folic acid, TSH
  • Audiometry (esp. if cochlear sx present)
  • Vestibular testing (refer to ENT)
  • Neuroimaging (CT, MRI)
  • ECG - if cardiac cause suspected
  • Tilt-table test in select pt. w/ postural hypotension or syncope
34
Q

BPPV treatment

A

Epley’s maneuver

35
Q

Meniere disease treatment

A

Salt restriction, caffeine restriction, diuretics

Vestibular suppressants during acute attacks (e.g. Meclizine)

36
Q

Treatment of ototoxicity d/t medication

A

D/C med, substitute meds, reduce dosage

37
Q

Treatment of presyncope w/ cardiac cause

A

Treat CAUSE

  • Proper hydration
  • Slow rising from sitting/laying
  • PT/OT
  • Pharm therapy for orthostatic hypotension, autonomic dysfunction
38
Q

What med treats orthostatic hypotension?

A

Fludrocortisone

39
Q

What med treats autonomic dysfunction?

A

Midodrine

40
Q

Treatment of posprandial hypotension

A
  • Frequent small meals
  • Avoid exertion after meals
  • Slow rising from sitting position
  • Avoid anti-HTN @ or near mealtime
41
Q

Treatment of vertebrobasilar ischemia and/or cerebellar infarcts/hemorrhages

A

Low dose ASA, clopidogrel or ER dypyridamole; rehabilitation

42
Q

Treatment of acoustic neuroma

A

Surgery

43
Q

Treatment of PD

A

Drug therapy, rehab

44
Q

Treatment of peripheral neuropathy

A

Treat underlying disease

45
Q

Treatment of cervical spine degenerative arthritis, spondylosis

A

Cervical or vestibular rehabilitation; C collar; +/- surgery

46
Q

What is orthostatic hypotension?

A

Decrease is systolic BP of 20mmHG or decrease in diastolic BP of 10mmHG within 3 minutes of standing c/t sitting or supine

47
Q

It is normal for both systolic & diastolic BP to decrease __mmHG upon standing

A

~10

48
Q

Causes of orthostatic hypotension

A
  • Inadequate intravascular volume
  • ANS dysfunction
  • Decreased venous return
  • Inability to increase CO In response to postural changes
49
Q

Clinical presentation of orthostatic hypotension

A
  • Acute or chronic
  • Lightheadedness
  • Blurred vision
  • Dizziness
  • Weakness/fatigue
  • Syncope
50
Q

Indications for tilt table test

A
  • High probability of orthostatic hypotension despite an initial negative evaluation
  • Patients with motor impairment that can’t have vital signs taken while standing
  • Monitor course of autonomic disorder & its response to therapy
51
Q

Acute treatment of orthostatic hypotension

A

TX UNDERLYING CAUSE

e.g. transfuse, hydrate, D/C offending meds

52
Q

Chronic nonpharm treatment of orthostatic hypotension

A

EDUCATE, SET GOALS

  • Remove offending meds or take @ bedtime
  • Avoid large carb meals
  • Limit alcohol
  • Ensure adequate hydration, give water bolus if symptomatic
  • Supplement sodium (in those who can tolerate it)
  • LE compression stockings
  • Exercise & therapy
53
Q

Chronic pharm treatment of orthostatic hypotension

A

Fludrocortisone (1st line)
Midodrine
Pyridostigmine

Geriatrics 1 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions