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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
What test do you perform for posterior canal BPPV? What are you looking for
Dix-Hallpike | - look for recurrence of dizziness and/or upbeat/torsional nystagmus (after brief latency)
26
If they get +dix Hallpike, What is the treatment for posterior canal BPPV?
Epley’s Maneuver
27
If Epley’s maneuver is successful, the ___ will have moved into the ____ and the patient will no longer be dizzy
Otoconia -> utricle
28
Recurrent attacks of severe vertigo and hearing loss. Abrupt onset of vertigo that lasts hours (to 1-2 days)
Ménière’s disease
29
What are the associated symptoms of Ménière’s disease? 3 things
- N/V - Fullness, pressure and/or pain in the ear - ringing in the ears (tinnitus)
30
What will you find on an exam of a patient with Meniere’s disease?
Sensorineural hearing loss (fluctuating initially but eventually progresses)
31
What is the etiology of Meniere’s disease?
Thought to be due to excess fluid (endolymph) in the inner ear
32
Would you refer a patient is Meniere’s disease to a ENT for further evaluation?
Yes
33
- a cause of peripheral vertigo - Sudden onset following a viral illness – Severe for 1-2 days, gradually resolves (on its own)
Acute labrynthitis/vestibular neuronitis
34
- a cause of peripheral vertigo - Vertigo is usually mild, slow onset – One-sided hearing loss – Tinnitus often present
Acoustic neuroma (CN VIII tumor)
35
What can cause ototoxicity due to medications?
- Antibiotics: gentamycin/neomycin – Loop diuretics – *Aspirin/NSAIDs*
36
In a cervicogenic vertigo (whiplash), dizziness occurs in ________% of cases
41-48
37
What physical exam findings will you find with a cervicogenic vertigo (whiplash)?
+ Swivel chair test and sore neck, otherwise no significant physical exam findings
38
Possibly caused by injury to cervical proprioceptors
Cervicogenic vertigo (whiplash)
39
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
TIA or Stroke / Multiple Sclerosis (MS)/ Posterior Fossa Tumor/ migraine
40
What are neuro findings with central vertigo? (7)
- Gait ataxia (staggering) - Dysarthria (speech difficulties) - Diplopia (double vision) - Dysmetria (past pointing) - Numbness - Motor weakness - Gaze evoked/pure vertical nystagmus
41
What is gaze-evoked nystagmus?
changes direction with gaze OR Spontaneous PURE vertical or torsional nystagmus looking straight ahead (fixed gaze)
42
Is it peripheral or central vertigo? normal neuro exam except hearing loss and nystagmus: - Unidirectional - Vertical/torsional components or horizontal - Suppressed by gaze fixation
Peripheral Vertigo
43
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)
Central vertigo
44
What is the difference between presyncope and syncope? What type of dizziness are they
Presyncope is feeling faint or almost fainting Syncope is fainting, loss of consciousness Type II
45
What are three causes of presyncope?
- vasovagal reaction (most common) dizziness often for minutes
46
Vasovagal reaction is a vagal ______. Within minutes leads to wide-spread _______ (bradycardia, hypotension, the syncope)
Overreaction, vasodilation
47
How long does it take fo vasovagal reaction to recover
Usually occurs after a few seconds
48
What position can help someone with a vasovagal reaction?
Before and/or after syncope place patient in supine piston with legs elevated
49
Orthostasis occurs for how long? Which age range is it most common in? What may is be related to?
Brief dizziness (seconds) Elderly - dehydration, post-pyramidal hypotension, medications, autonomic dysfunction
50
The prodrome for cardiogenic presyncope lasts _____ before syncope
<5 seconds or none at all
51
What are the associated symptoms of cardiogenic presyncope? What is it usually due to
Palpitations Usually do to arrhythmia
52
Besides arrhythmias, what can cause cardiogenic syncope?
- aortic stenosis - heart failure - pulmonary emboli
53
What type of dizziness if dysequilibrium?
Type III
54
Which dizziness has Multiple etiologies (medications, sensory deficits, motor abnormalities, orthopedic disorders) and may need physical therapy for balance training
Dysequilibrium
55
With type IV dizziness, __________, symptoms are more vague, difficult to describe, and can be due to _______ or may remain without a definitive cause
Other lightheadedness Psychiatric disorders: anxiety, depression

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