Dizzy Patient

Question 1

dizziness is…

Answer 1

a non specific term- could indicate vertigo, pre-syncope, disequilibrium

Question 2

what are some words used by pt to discribe their vertigo-associated dizziness

Answer 2

spinning, falling, being pushed

Question 3

CV dizziness is usually more…

Answer 3

lightheadnedness, syncope, palpittaions

Question 4

blackouts, paraesthesia, speech/swallowing issues is more due to…

Answer 4

proprioceptive- DM, arthritis, neurology

Question 5

what is vertigo

Answer 5

spinning sensation

Question 6

T/F: males get it more than females

Answer 6

F: females more susceptible (3:1)

Question 7

causes of vertigo

Answer 7

BPPV, Meniere’s, Vestibular Neuritis/ Labrinthitis, migraine associated vertigo

Question 8

key hx for vertigo and its cause

Answer 8

BPPV: seconds, dizzy when rolling in bed/ standing up
meniere’s: hours, 1 ear feels full
Vestibular neuritis: days, 1st attack severe- nausea/vomiting
Migraine-asscoiated: comes on with migraine, light sensitivity

Question 9

associated symptoms of vertigo

Answer 9

hearing loss, tinnitus, aural pressure, migraines, nystagmus

Question 10

which cause of vertigo is the most common

Answer 10

BPPV

Question 11

aetiology of BPPV

Answer 11

idiopathic, head trauma, surgery

Question 12

pathophysiology of BPPV

Answer 12

the crystals move from the utricle to the SCC

Question 13

which SCC are crystals most commonly displaced to

Answer 13

posterior SCC

Question 14

s/s of BPPV

Answer 14

vertigo on looking up or moving head, turning in bed, first lying down/getting out of bed

Question 15

ix of BPPV

Answer 15

dix hallpike test +ve

Question 16

tx for BPPV

Answer 16

epley manœuvre, semont manœuvre, Brandt-daroff exercises

Question 17

what vertebrobasilar insufficiency

Answer 17

a ddx for BPPV- associated to other hypoperfusion symptoms of posterior brain (visual disturbance, weakness, numbness)

Question 18

vestibular neuritis is due to?

Answer 18

viral, ototoxicity

Question 19

s/s of vestibular neuritis

Answer 19

vertigo lasts DAYS, tinnitus

Question 20

how to differentiate between neuritis and labrynthitis

Answer 20

labirynthitis= hearing loss too

Question 21

mx of vestibular neuritis

Answer 21

supportive- vestibular sedatives, anti-emetics

rule of 3: 3 days in bed, 3 weeks off work, 3 months dizzy

Question 22

pathophysiology of Meniere’s

Answer 22

endolymphatic hydrops- high pressure in endolymph system of the inner ear

Question 23

s/s of Meniere’s

Answer 23

recurrent, spontaneous rotational vertigo with at least 2 episodes in <20mins, new tinnitus on affected side, aural fullness, sensorineural hearing loss

Question 24

audiogram for Meniere’s

Answer 24

2 separate lines that gradually join

Question 25

mx of Meniere’s

Answer 25

supportive tx during episodes, hearing support- hearing aids etc, reduce pressure (salt restriction, caffeine, alcohol)

Question 26

what are possible medications for meniere’s

Answer 26

ITS and ITG

Question 27

how many migraine sufferers also have vertigo

Answer 27

25%

Question 28

mx of migraine vertigo

Answer 28

lifestyle modification- avoid triggers

rx- abortive agents (triptans), prophylaxis (amitryptiline)

Question 29

what is a vestibular schwannoma

Answer 29

benign tumour of CN VII nerve sheath

Question 30

s/s of vestibular schwannoma

Answer 30

progressive imbalance, hearing loss + tinnitus

Question 31

ix for vest. schwan

Answer 31

MRI

Question 32

superior semi-circular cana dehiscence is…

Answer 32

thinning of bone over superior SCC, can hear noises in head (eyeballs moving etc)