Brainscape's Knowledge GenomeTM

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


See full index

clin med I exam II > ENT 3- vertigo > Flashcards

ENT 3- vertigo Flashcards

1
Q

otolith organs are responsible for…

A

linear motion

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

semicircular canals are responsible for…

A

angular motion

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

info from _____ is relayed via _____ portion of CN___ to _____, _____, _____

A

info from vestibular labyrinth relayed via vestibular portion of CN VII to cerebellum, ocular nuclei, spinal cord

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

utricle

A

horizontal plane

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

saccule

A

vertical plane

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

what is vertigo

A

illusory movement; swaying/tilting

symptom not diagnosis

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

what causes vertigo

A

damage or dysfunction in otolith organs, semicircular canals, CN 8, central brainstem/vestibular origin
causes asymmetrical signal to be sent

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

what is peripheral vertigo

A 
sudden onset
associated w tinnitus usually
hearing loss
\+/- horizontal nystagmus
most common = BPPV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

types of peripheral vertigo

A 
BPPV
vestibular neuritis (AKA labyrinthitis) 
meniere's disease
herpes zoster oticus (ramsey hunt)
acoustic neuroma (can be both but usually peripheral)
otitis media
aminoglycoside toxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is central vertigo

A

gradual onset

no associated auditory sx

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

types of central vertigo

A 
migraines
cerebral tumor on CNVIII
chiari malformation
brain ischemia- cerebellar infarct +hemorrhage 
TIA
MS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

other causes of vertigo

A 
antidepressants
anxiolytics
aminoglycosides
furosemide
amiodarone
ASA
NSAIDs
EtOH + cocaine
traumatic brain injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

dix-hallpike positioning test

A

clockwise, rotary nystagmus which is fatiguable w repetition when undergoing Dix-Hallpike positional testing
latency of 5-15sec btw supine positioning + onset nystagmus
induces vertigo/spinning in nystagmus

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

Dix hallpike findings in peripheral vertigo

A 
latent before nystagmus for 2-20sec
duration of nystagmus = <1min
fatiguing w repetition
direction of nystagmus- only one type, may change direction w gaze
severe vertigo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

dix hallpike findings in central vertigo

A 
no latent period before nystagmus
nystagmus lasts >1min
non-fatiguing
direction of nystagmus may change direction w given head position
less severe, sometimes no vertigo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what further tests (after dix hallpike) can be conducted

A

electronystagmography (records eye movements)

rule out other causes

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

tx for vertigo

A

symptomatic
often self-resolving w.i months

antihistamines
anti-emetics
benzos
scopolamine (PATCH)

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

when should a vertigo pt be referred to neuro

A

vestibular rehab- gaze stimulation exercises
repositioning maneuvers- epley maneuver
brant-daroff exercise

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

when should surgery be considered for vertigo pt?

A

only after 6mo

very rare

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

BPPV

A

benign paroxysmal positional vertigo

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

what is the most common cause of vertigo

A

BPPV (50%)

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

clinical presentation of BPPV

A

sudden onset of vertigo pecipitated by sudden head movements
N/V
short duration
No hearing loss, ear pain or tinnitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

nystagmus in BPPV

A

classic clockwise rotary
fatiguable in dix-hallpike
latency of 5-15secc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

who is most likely to get BPPV

A

> 60yrs, women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

vestibular neuritis (labyrinthitis) cause

A

viral or postviral inflam affecting vestibular portion of CN VIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are the two different types of vestibular neuritis

A

pure (no hearing loss)

labyrinthitis (vertigo w unilateral hearing loss)

27
Q

clinical presentation of vestibular neuritis

A 
rapid onset
severe, persistent vertigo 
N/V
gait instability
horizontal nystagmus suppressed by visual fixation
head thrust
unilateral hearing loss (labyrinthitis)
28
Q

imaging for vestibular neuritis

A

if concerned for lesion or stroke in cerebellum
MRI/MRA
CT if MRI/MRA isn’t available

29
Q

tx for vestibular neuritis

A

benign + self-limited (few days-1wk)
may have nonspecific dizziness/imbalance for months
corticosteroids may help
antihistamines
anti-emetics
vestibular rehab after acute sx subside w aggressive proprioception + balance exercises

30
Q

meiere’s dz cause

A

peripheral

excess endolymphatic fluid pressure causing episodic inner ear dysfunction

31
Q

what is in the labyrinth/inner ear

A

cochlea, semicircular canals, otolithic organs

32
Q

clinical presentation of menieres dz

A

vertigo + unilateral sensorineural hearing loss + tinnitus

fullness, pressure in ears
N/V
disabling imbalace
horizontal-torsional nystagmus during acute attack

33
Q

unpredictable episode of meniere’s

A

may last hours, recurring, followed by fatigue

34
Q

spontaneous episode of menieres

A

sx last 20min-24hrs

6-11 attacks a year

35
Q

vestibular testing for menieres

A

ENG abnormal on affected side
rotatory chair test
computerized dynamic posturography

36
Q

audiometry for menieres

A

if low freq hearing loss- helps confirm

not looking for conductive hearing loss!

37
Q

lab tests for menieres

A 
test for comorbid
ELEVATED  NA
RPR (rapid plasma reagin) for syphilis 
MRI to rule out lesions
controverial tests for endolymphatic hydrops (glycerine, urea or sorbitol stress test, electrocochleography)
38
Q

goals of tx for menieres

A

treat symptoms, improve QOL

prevent progression

39
Q

tx for acute sx of menieres

A 
antihistamines
antiemetics
benzos
anticholinergics (scopolamine)
lifestyle adjustment
salt restriction
limit caffeine + nicotine + alcohol
avoid excessive noise
diuretics
vestibular rehab
40
Q

nondestructive procedures for menieres

A

surgical (endolyphatic sac + sacculotomy)
intratympanic glucocorticoids
pressure pulse generator

41
Q

destructive procedures for menieres

A

intratympanic gentamicin injection
surgical labyrinthectomy
vestibular nerve resection

42
Q

what populations are at highest risk of menieres? other risk factors?

A

female > male
20s-40s

allergies, stress, viral

43
Q

what does the eustachian tube connect

A

middle ear to nasopharynx

44
Q

what is the purpose of eustachian tubes

A

provide ventilation + drainage for middle ear cleft

45
Q

when is eustachian tube open

A

usually closed

open during swallowing/yawning

46
Q

how is negative pressure created in the ear

A

when eustachian tube is comprimed, air is trapped in middle + gets absorbed -> TM retraction

47
Q

clinical presentation of eustachian tube dysfunction

A 
fullness in ear
mild/moderate hearing decrease
maybe popping sound when yawning/swallowing (only if partial blockage)
ear pain
retracted TM + decreased TM mobility
48
Q

dilatory eustachian tube dysfunction exam findings

A

effusion, scarring, thickening of TM
retractions, cholesteatomas, perforations, tympanosclerotic plaques
weber test- lateralization to affected ear (conductive hearing loss)

49
Q

patulous eustachian tube dysfunction exam findings

A 
AUTOPHONY (hear own voice)
sx fluctuate
worsened by exercise + prolonged speaking
ear fullness
varies in severity
breathing induces movements of TM
sensorineural hearing loss
50
Q

blockage of eustachian tube by ____ causes dysfunction

A 
allergic response
URI
sinusitis
chronic otitis media 
genetics
51
Q

what happens when there is impaired protective function of ET

A

reflux of nasopharyngeal pathogens into ET

52
Q

what happens when there is impaired clearance of ET

A

loss of mucociliary function contributing to inability to clear pathogens

53
Q

what is pressure dysregulation of the ET

A

fails to open to allow ventilation leading to ET dysfunction

54
Q

what happens due to dilatory dysfunction of ET

A

tube doesn’t dilate

leads to otitis media

55
Q

what happens in patulous dysfunction of ET

A

valve incompetency –> chronic patency (stuck open)

56
Q

tx of dilatory ET dysfunction

A 
tx underlying etiology
antihistamines
decongestants
nasal steroids
valsalva
57
Q

tx of patulous ET dysfunction

A

tx if severe sx >6wks

ventilation tubes in severe cases

58
Q

tx of ET dysfunction

A

refer to ENT
nasal endoscopy
audiology studies
CT or MRI w contrast if >3mo of unilateral sx or middle ear effusion -> increased risk of malignancy
surgery if mass found or continued otitis media w effusion
if 2/2 ET dysfunction –> tubes
balloon dilation

59
Q

what is tinnitus

A 
perception of sound w.o external source
can be unilateral or bilateral
around the head or distant noise
continuous or intermittent
buzzing, ringing, or hissing
60
Q

what should be accounted for in hx of pt w tinnitus

A

description (episodic/constant, pulsatile/nonpulsatile, rhythmicity, pitch, quality of sound)
previous ear dz, noise exposure, hearing status, head injury, TMJ syndrome sx
review meds, supplements
other conditions (HTN, atherosclerosis, neurologic illness, surgery)

61
Q

what is involved in the physical exam of pt w tinnitus

A

complete HEENT exam
cranial nerve exam
eval TM
auscultate neck, periauricular area, temple, orbit + mastoid
effects of position + vascular compression on involved side

62
Q

diagnosis of tinnitus

A

audiometry to R/O associated hearing loss

MRI if unilateral esp w hearing loss to R/O retrocochlear lesion (vestibular schwannoma)

63
Q

tx of tinnitus

A 
avoid noise, ototoxic drugs
correct comorbidities
tx underlying depression + insomnia
cochlear implants in severe sensorineural hearing loss
tinnitus retraining therapy
bio-feedback cognitive therapy (adjunct)
64
Q

epidemiology of tinnitus

A

increases w age

more likely in smokers

clin med I exam II (10 decks)

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