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Head And Neck > Final - Dizziness > Flashcards

Final - Dizziness Flashcards

1
Q

disordered se

A

Dizziness

A very common complaint: elderly patients and those with cervical spine/head injuries from MVAs (motor vehicle accidents)

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2
Q

What are he 4 categories of dizziness

A

Type I: Vertigo
Type II: Pre-Syncope
Type III: Dysequilibrium
Type IV: Vague Light-Headedness/Other

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3
Q

sensation of spinning or false sense of motion

Causes MAJORITY of cases of dizziness

A

Vertigo

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4
Q

Feeling faint or almost fainting

A

Presyncope

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5
Q

unsteadiness or feeling off-balance when walking

A

Dysequilibrium

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6
Q

ill defined, lacks

specific characteristics of the other 3 categories

A

Vague lightheadedness/ other

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7
Q

A detailed history will reveal the diagnosis in ___ out of ____ patients

A

3 out of 4

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8
Q

To ddx dizziness, you take a detailed history, Perform a simple, targeted physical exam, and get Additional testing (CT, MRI) if symptoms are severe and patient > ___ years old

A

50

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9
Q

What 6 things should you get it the history?

A
  1. Complete description of what the patient means by dizziness
  2. Timing
    > Setting & Circumstances?
  3. Duration
  4. Aggravating/alleviating factors
  5. Medication History
    > review list – common side effect
    > any recent changes to meds?
  6. PMHx (past medical history)
    > Heart disease, diabetes, history of TIA/stroke, ear conditions, alcohol and illicit drug use
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10
Q

What 5 things do you do in a physical exam for dizziness?

A
  1. Vital signs – specifically orthostatics
  2. Ear Exam – otoscopic exam and hearing test
  3. Heart Exam – auscultation, including carotids
  4. Neuro Exam – cranial nerves, nystagmus,cereb
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11
Q

What two types of vertigo are there? Which is more common?

A

Peripheral (more common)

Central

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12
Q

Is Benign Paroxysmal Positional Vertigo (BPPV) peripheral or central vertigo?

A

Peripheral

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13
Q

Is Meniere’s disease peripheral or central vertigo?

A

Peripheral

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14
Q

Is acute Labrinthitis (vestibular neuritis) peripheral or central vertigo?

A

Peripheral

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15
Q

Is drugs toxicity peripheral or central vertigo?

A

Peripheral

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16
Q

Is acoustic neuroma peripheral or central vertigo?

A

Peripheral

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17
Q

Is cervicogenic peripheral or central vertigo?

A

Peripheral

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18
Q

Is a TIA or Stroke (ischemic and hemorrhagic) peripheral or central vertigo?

A

Central

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19
Q

Is multiple sclerosis (MS) peripheral or central vertigo?

A

Central

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20
Q

Is posterior Fossa tumor peripheral or central vertigo?

A

Central

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21
Q

What is the most common recurrent vertigo that is thought to be due to otoconia in canals?

A

BPPV

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22
Q

BPPV most frequently occurs in the ______. What %?

A

posterior canal (>/= 80% of cases)

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23
Q

BPPV sudden onset of vertigo is provoke by what 3 head movement? How long does it last

A
  • turning head quickly
  • rolling over in bed
  • tilting head up

Lasts for seconds -> minutes (brief)

24
Q

What are the associated symptoms of BPPV?

A

Nausea/vomiting

*no tinnitus (ringing in the ears) or hearing loss

25
Q

What test do you perform for posterior canal BPPV? What are you looking for

A

Dix-Hallpike

- look for recurrence of dizziness and/or upbeat/torsional nystagmus (after brief latency)

26
Q

If they get +dix Hallpike, What is the treatment for posterior canal BPPV?

A

Epley’s Maneuver

27
Q

If Epley’s maneuver is successful, the ___ will have moved into the ____ and the patient will no longer be dizzy

A

Otoconia -> utricle

28
Q

Recurrent attacks of severe vertigo and hearing loss. Abrupt onset of vertigo that lasts hours (to 1-2 days)

A

Ménière’s disease

29
Q

What are the associated symptoms of Ménière’s disease? 3 things

A
  • N/V
  • Fullness, pressure and/or pain in the ear
  • ringing in the ears (tinnitus)
30
Q

What will you find on an exam of a patient with Meniere’s disease?

A

Sensorineural hearing loss (fluctuating initially but eventually progresses)

31
Q

What is the etiology of Meniere’s disease?

A

Thought to be due to excess fluid (endolymph) in the inner ear

32
Q

Would you refer a patient is Meniere’s disease to a ENT for further evaluation?

A

Yes

33
Q
  • a cause of peripheral vertigo
  • Sudden onset following a viral illness
    – Severe for 1-2 days, gradually resolves (on its own)
A

Acute labrynthitis/vestibular neuronitis

34
Q
  • a cause of peripheral vertigo
  • Vertigo is usually mild, slow onset
    – One-sided hearing loss
    – Tinnitus often present
A

Acoustic neuroma (CN VIII tumor)

35
Q

What can cause ototoxicity due to medications?

A
  • Antibiotics: gentamycin/neomycin
    – Loop diuretics
    – Aspirin/NSAIDs
36
Q

In a cervicogenic vertigo (whiplash), dizziness occurs in ________% of cases

A

41-48

37
Q

What physical exam findings will you find with a cervicogenic vertigo (whiplash)?

A

+ Swivel chair test and sore neck, otherwise no significant physical exam findings

38
Q

Possibly caused by injury to cervical proprioceptors

A

Cervicogenic vertigo (whiplash)

39
Q

What symptoms do these suggest?

  • Onset can be sudden or gradual
  • Variable duration (at least several minutes)
  • Intensity generally more vague
  • Not typically associated with head movement
  • +Neuro findings on exam
A

TIA or Stroke / Multiple Sclerosis (MS)/ Posterior Fossa Tumor/ migraine

40
Q

What are neuro findings with central vertigo? (7)

A
  • Gait ataxia (staggering)
  • Dysarthria (speech
    difficulties)
  • Diplopia (double vision)
  • Dysmetria (past pointing)
  • Numbness
  • Motor weakness
  • Gaze evoked/pure vertical nystagmus
41
Q

What is gaze-evoked nystagmus?

A

changes direction with gaze
OR
Spontaneous PURE vertical or torsional nystagmus looking straight ahead (fixed gaze)

42
Q

Is it peripheral or central vertigo?

normal neuro exam except hearing loss and nystagmus:

  • Unidirectional
  • Vertical/torsional components or horizontal
  • Suppressed by gaze fixation
A

Peripheral Vertigo

43
Q

Is this peripheral or central vertigo?

neuro exam abnormalities are common and nystagmus:

  • Changes direction with gaze
  • Any direction (horizontal, including purely torsional or vertical)
  • Not suppressed by gaze fixation (this can make it worse)
A

Central vertigo

44
Q

What is the difference between presyncope and syncope? What type of dizziness are they

A

Presyncope is feeling faint or almost fainting

Syncope is fainting, loss of consciousness

Type II

45
Q

What are three causes of presyncope?

A
  • vasovagal reaction (most common) dizziness often for minutes
46
Q

Vasovagal reaction is a vagal ______. Within minutes leads to wide-spread _______ (bradycardia, hypotension, the syncope)

A

Overreaction, vasodilation

47
Q

How long does it take fo vasovagal reaction to recover

A

Usually occurs after a few seconds

48
Q

What position can help someone with a vasovagal reaction?

A

Before and/or after syncope place patient in supine piston with legs elevated

49
Q

Orthostasis occurs for how long? Which age range is it most common in? What may is be related to?

A

Brief dizziness (seconds)

Elderly

  • dehydration, post-pyramidal hypotension, medications, autonomic dysfunction
50
Q

The prodrome for cardiogenic presyncope lasts _____ before syncope

A

<5 seconds or none at all

51
Q

What are the associated symptoms of cardiogenic presyncope? What is it usually due to

A

Palpitations

Usually do to arrhythmia

52
Q

Besides arrhythmias, what can cause cardiogenic syncope?

A
  • aortic stenosis
  • heart failure
  • pulmonary emboli
53
Q

What type of dizziness if dysequilibrium?

A

Type III

54
Q

Which dizziness has Multiple etiologies (medications, sensory deficits, motor abnormalities, orthopedic disorders) and may need physical therapy for balance training

A

Dysequilibrium

55
Q

With type IV dizziness, __________, symptoms are more vague, difficult to describe, and can be due to _______ or may remain without a definitive cause

A

Other lightheadedness

Psychiatric disorders: anxiety, depression

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