Exam 4 Vertigo

Question 1

Lightheaded is?

Answer 1

Vague, non-specific dizziness

Question 2

Vertigo is?

Answer 2

Sensation of abn mvmt: spinning, falling

Question 3

Vertigo caused by:

Peripheral?

Central?

Answer 3

Vestibular lesion

Central (brainstem) lesion

Question 4

Peripheral Vertigo presentation? (4)

Answer 4

Acute onset
Hearing loss/tinnitus
Nystagmus (horizontal or torsional)
No neural sxs

Question 5

Central Vertigo presentation? (5)

Answer 5

Gradual/progressive
Rarely ear sxs
Nystagmus in any direction (vertical)
Neuro sxs: diplopia, ataxia, dysarthria
P HA, N/V

Question 6

Disequilibrium is?

P contributing factors? (3)

Answer 6

Sense of imbalance/gait difficulty

Visual acuity
Peripheral neuropathy
Degenerative joint dz

Question 7

Approach to dizzy pt? (3)

Answer 7

Define dizziness
OLDCARTS
r/o cerebrovascular, MS, acoustic neuroma

Question 8

Approach to dizzy pt: Pertinent ROS? (12)

Answer 8

Pertinent ROS:
Meds/drugs/etoh
Allergies
Stress
N/V
Hearing
HA, aura
Vision
Seizure
Motor weak
Trauma
DM, HTN, migraines, URI
Psych hx

Question 9

Nystagmus is?

Answer 9

Slow drift in one direction followed by fast response in other direction

Question 10

Horizontal nystagmus caused by?

Answer 10

peripheral or metabolic

Question 11

Horizontal/torsional nystag caused by?

Answer 11

peripheral or positional

Question 12

Vertical nystag caused by?

Answer 12

CNS

Question 13

Hallpike maneuver is?

Answer 13

Sitting, turn head one direction, quickly lay
Supine w/ head turned same direction and head off table -> watch for nystag
Repeat on other side

Question 14

Hallpike results tell us?

Answer 14

Ear issue if:

1) Latency – delay of up to 20 seconds before onset
of nystagmus
2) Fatigueability – nystagmus fades if head held in provoking position
3) Habituation – repeating DH test produces less vigorous response

Otherwise CNS

Question 15

Audiometry is?

Tells us?

Answer 15

Test hearing

Sensory Neural vs Conduction loss

Question 16

Caloric Testing is?

Tells us?

Answer 16

Cold or warm H2O in ear

Normal response COWS: Cold Opposite, Warm Same.
Cold water = FAST phase of nystagmus to the side Opposite cold water
Warm water = FAST phase of nystagmus to the side Same as warm water

Impaired or absent fast nystag = labyrinth pathology on irrigated side

Question 17

Benign Paroxysmal Positional Vertigo (BPPV) is?

Answer 17

Most C inner ear cause of vertigo

Head position changes

Question 18

BPPV presentation? (2)

Caused by?

Answer 18

Transient (< 1 min) episodes
Self-limited (wks-months)
No hearing change
PE normal

U Prolonged bed rest or head trauma dislodging CaCO3

Question 19

BPPV test how?

Answer 19

Hallpike

Question 20

BPPV mgmt? (3)

Answer 20

Reassurance self-limited
OT
Anti-vertigo meds

Question 21

Vestibular Suppressants? (4)

Answer 21

Antichol
Antihist
Phenothiazines (phenergan)
BZs

Question 22

Vestibular Neurontitis is?

Presentation? (6)

Answer 22

Single attack of vertigo

Last 2-3 days
a/w Viral URI
Falling to affected side
N/V
P nystag
NO hearing changes

Question 23

Vestibular Neurontitis testing?

Answer 23

Audiogram = N

Caloric testing = +

Question 24

Vestibular Neurontitis tx?

Answer 24

Vest suppressants

Prednisone x 10 days

Question 25

Meniere’s Dz is?

Answer 25

Ruptured labyrinth causing paralysis of vest nn and degeneration of hair cells

Question 26

Meniere’s Dz presentation? (4)

Answer 26

Sudden attacks

Triad:
Episodic vertigo
Tinnitius
Fluctuating hearing loss (eventually irreversible)

Full ear
N/V

Question 27

Meniere’s Dz testing?

Answer 27

Audiogram = Sensory Neural loss (low tones then high)

Question 28

Meniere’s Dz tx: Acute? (3)

Prophy? (2)

Refractory? (3)

Answer 28

Rest
Antiemetics
Vest supp

Low salt
HCTZ diuretic

Endolymphatic shunt
Vest nn sectoning
Labyrinth ablation

Question 29

Perilymphatic Fistula is?

a/w?

Answer 29

Abn connection b/w perilymph and middle ear
Inner ear fluid leaks into middle ear

Sudden ∆ in middle ear pressure

Question 30

Perilymphatic Fistula presentation? (3)

Answer 30

Hearing loss
Tinnitus
P vertigo

Question 31

Perilymphatic Fistula testing?

Answer 31

pneumatic otoscopy = eye mvmt w/ pressure ∆

Question 32

Perilymphatic Fistula tx? (4)

Answer 32

Rest
Hydration
Sxs
Surgery