Brainscape's Knowledge GenomeTM

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


See full index

Clinical med > HEENT vertigo > Flashcards

HEENT vertigo Flashcards

1
Q

some differential diagnosis from the cochleovestibular system for vertigo

A

infection: serous otitis media, vestibular neuronitis, syphilis,

degenerative: aging

developmental: arnold-chiari malformation

tumor: cholesteaoma, acustic neuroma, glomus tumors,

vascular: infarction of labyrinthine artery, intralabyrinthine hemorrhage

ototoxins: aminoglycosides: loop diuretics

disorders of bone metabolisums

menieres disease

trauma: perilymph (labyrinthine) fistula, superior canal dehiscence

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

some differential diagnosis from the nervous system for vertigo

A

vascular: hyperventilation (anxiety) , migraine,

tumor: neoplasia, metastatic carinoma,

developmental: malformation of the base of the skull

peripheral neuropathy: DM, ethanol, B3/12 deficiency, Tabes dorsalis

infection: meningitis

seicure disorders: temporal lobe

dymyelinating disorders: MM sclerosis

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

some differential diagnosis from the cardiovascular system for vertigo

A

circulatory : hypovolemia, anemia, polycythemia, OTHORSTATIC HYPOTENSION

Great vessels: subclavian steal

cardiac: arrhythmias, valvular disease:

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

some differential diagnosis from the ocular system for vertigo

A

changes in fraction,

cataracts

glucoma

EMO neuropathy

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

some differential diagnosis from the allergy system for vertigo

A

inhalant

food

drug

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

some differential diagnosis from the autoimmune system for vertigo

A

autoimmune inner ear disease

collagen vascular disorder

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

old age syndrome (multisensory deficit) can cause vertigo… t/f

A

t

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

some differential diagnosis from the endocrine system for vertigo

A

DM

hypoglycemia

hyperlipidemia

hyperthyroidism

menstruations-pregnancy-menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

can chronic anxiety and hysteria cause vertigo?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is a genetic cause for vertigo?

A

usher syndrome

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

if the duration of vertigo is seconds and you hear auditory symptoms, then it can be

A

perilymphatic fistula :

refers to a hole or tear in one of the membranes that separate your middle ear and inner ear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

if the duration of vertigo is seconds and you CANT hear auditory symptoms, then it can be

A

BPPV

cervical vertigo

vertebrobasilar insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

if the duration of vertigo is hours and you hear auditory symptoms, then it can be

A

endolymphatic hydrops (Meniere’s disease)

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

if the duration of vertigo is hours and you CANT hear auditory symptoms, then it can be

A

Recurrent vestibulopathy,
Vestibular migraine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

if the duration of vertigo are DAYs and you CANT hear auditory symptoms, then it can be

A

vestibular neuronitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

if the duration of vertigo are days and you CAN hear auditory symptoms, then it can be

A

labyrinthitis,
labyrinthine concussion

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

if the duration of vertigo is months and you CANT hear auditory symptoms, then it can be

A

MS, cerebellar degeneration

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

if the duration of vertigo is months and you CAN hear auditory symptoms, then it can be

A

acoustic neuroma, ototoxicity

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

during the history, asking the pt. to describe their symptoms without using the word dizzy is important. t/f

A

T

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

during HPI, ask the pt if they feel or had

A

syncope

presyncope

light headedness

unsteadiness

disequilibrium

motion intolerance

floating sensation

drunk feeling

rocking on a boat

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

what is vertigo?

A

subtype of dizziness.

one will feel like they are moving or the environment is (cardinal symptom)

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

HPI : ask if onset and progression is slow or acute because …

A

slow = cns

acute = vestibular

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

HPI : ask if vertigo is continuous or ..

A

episodic

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

HPI : ask if their dizziness has other associated Sx. like

A

hearing loss

tinnitus

aural fullness

diaphoresis

nausea

emesis

(hearing fluctate: Meniere’s)

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

on HPI, ask if dizzy when turning their head (….), lying supine, or sitting upright

A

BPPV

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

asking the pt if they can ambulate during an acute episode of dizziness can help to see if it is

A

cerebellar problem if they cant move

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are some brainstem symptoms in a HPI for dizzy

A

diplopia

dyarthria (difficulty speaking)

facial paresthesia

extrem. numb / warm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

asking a pt if they feel their vertigo duriing nose blowing can help rule in

A

fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

asking a pt if they feel their vertigo with pressure or noise can help rule in

A

superior canal dehiscience (true vertigo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

asking a pt if they feel aura or warning signs before vertigo can help rule in

A

migraine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

asking a pt if they have visual symptoms with their vertigo can help rule in

A

scintillating scotoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

asking a pt if they feel vertigo with neck movement can help rule in ?

A

cervical vertigo

33
Q

asking a pt if they had head trauma that started their vertigo can help rule in

A

post traumatic hydrops

fistula

basilar skull fracture

labyrinthine concussion

34
Q

asking a pt if they had an URI or flu-like illness prior to their vertigo can help rule in?

A

vestibular neuronitis

35
Q

vestibular cause of vertigo will have the following history:

A

sudden onset

spinning

hearing loss

aural fullness

tinnitus

36
Q

non vestibular cause of vertigo will have the following history:

A

gradual onset

ill defined symptoms

passing out

cant ambulate

numbness/ weakness

37
Q

important past medical history you want to ask the pt who has vertigo is

A

headaches/ migraines

ear disease: chronic ear infections, cholesteatoma

anxiety/depression

diabetes

HTN

CV or cerebrovascular disease

Neurologic disease (MS)

38
Q

ask the pt with vertigo if they had any ear surgery because surgery for cholesteatoma may result in …

A

iatrogenic
or
acquired labyrinthine fistula

39
Q

ask the pt with vertigo if they had any ear surgery because surgery for otosclerosis or tympanosclerosis may result in …

A

vestibular symptoms bc of perilympathic fistula

40
Q

what FHx should you ask a pt with vertigo?

A

CV, peripheral vascular disease, migraine, otosclerosis, Meniere’s disease

41
Q

what Medication history should you ask a pt with vertigo?

A

new meds/ change in dose

OTC

herbal med

prescribed med

42
Q

what 3 things play a role in equilibrium

A

visual system

vestibular system

proprioceptive system

43
Q

what vital signs should you look at for someone with vertigo

A

orthostatic BP and pulse

44
Q

for vertigo, you will do the following physical exam

A

vital signs

CV exam - hear heart and cervical vessels

neurologic exam - reflexes, EOM, CN

neck exam: ROM / flexibility

ENT exam: middle ear or external infection? retracted or perforated TM? test hearing

45
Q

peripheral nystagmus is ….

pure vertical nystagmus is …

A

torsional (rotary)

sign of brainstem disease

46
Q

acquired nystagmus is caused by

A

manières disease

BPPV

labyrinthitis

vesitbular neuronitis

47
Q

which walking test will you do for vertigo pt

A

gait: watch out for staggering and leaning

romberg: standing heel to toe in front of each other w. eyes closed

tandem romberg: walk heal to toe with arms opened for balance

48
Q

which test will ID BPPV ?

A

dix-Hallpike maneuver

have pt sitting with head 45 degrees to one side, rapidly lay them supine —> vertigo & torsional rotary nystagmus once they lay,,,, lay for 1 min, then bring them to sit = goes away

49
Q

fistula test is

A

to see abnormal connection of the labyrinth and surrounding

apply pressure to pts ear canal (press the tragus) and observe eye movement

50
Q

fukada test is

A

stepping in place with your eyes closed for 100 steps and then measuring how much you turned during the test.

peripheral vestibular dysfunction likely consistent with the side to which the patient has rotated

51
Q

— Saccadic test
— Gaze test
— Pursuit eye movement test
— Optokinetic nystagmus test (OKN)
— Head-shake nystagmus test
— Positional nystagmus test
— Positioning nystagmus test (Dix Hallpike)
— Bithermal caloric tests

are all considered

A

electronystagmongraphy (ENG) testing

52
Q

— Vestibular autorotation testing (VAT)
— Computerized platform posturography
— Electrocochleography (Ecog)
— Auditory brainstem response (ABR)
— Vestibular evoked myogenic potentials (VEMP)

A

vestibular lab tests

53
Q

what diagnostic study will you do for vertigo?

A

MRI of the brain IAC with contrast
-pts younger than 50 = 1%

ct brain and temproal bones

lab test

54
Q

what home exercises can you give the pt to manage vertigo

A

cawthorne cooksey/ Brandt Daroff

55
Q

antihistamine for vertigo are

A

vestibular suppressant (should not be longterm)

Antivert (meclizine)
dramamine

56
Q

bezodiazephine for vertigo is

A

depresses CNS

Valium (diazepam)

57
Q

Phenothiazine for vertigo

A

treats emesis

promethazine (phenergan)
prochlorperazine (compazine)

58
Q

peripheral vertigo

DDx:
Onset:
Nystagmus:

A

labyrinthitis, menieres, BPPV, vestibular neuonitis

onset: slow

rotary

59
Q

central vertigo

DDx:
Onset:
Nystagmus:

A

DDx: acoustic neuroma, brainstem vascular disease, arteriovenous malformation, tumors of the brain stem or cerebellum, MS, vertiginous migraine

Onset: slower
Nystagmus: pure vertical = sign of brainstem disease

60
Q

benign paroxysmal positional vertigo (BPPV)

cause:
onset:
DDx:

A

cause: otolith debris floating in semicircular canals (canalithiasis) or to cupula (cupulolithiasis)
onset: spontaneous
DDx: vestibular neuronitis, manières disease/ head trauma (otoconia)

61
Q

does posterior canalithiasis happen 90% of the time in BPPV?

A

yes

62
Q

is canalithiasis worse than cupulolithiasis?

A

no, cupulolithiasis cause is worse in BPPV

63
Q

acute vertigo with episodes less than 1 minute due to changing head and body

no medication to help
resolves alone
to diagnosis: dix-hallpike (rotary nystagus)

is

A

BPPV

64
Q

how do you treat BPPV

A

epley manever: to reposition canalith out of semicircular canal
vestibular rehab

65
Q

severe vertigo that begins acutely after an URI

can last 24-28 hrs - unsteadiness for weeks

hearing is not affected

pt cant perform work

1/3 of ppl develope BPPV

A

vestibular neuronitis

66
Q

how do you treat vestibular neuronitis

A

medications, antiemetics, vestibular suppressants, corticosteroids

vestibular rehab

67
Q

acute onset of continuous, severe vertigo lasting several days

sudden hearing loss and tinnitus

hearing loss can be permanent

one or both ears

caused by bacteria or virus = inflammation of the labyrinth

A

Labyrinthitis

68
Q

how do you treat labyrinthitis

A

antimetic medications

vestibular supressant (meclizine/antivert)

steriods (oral/ intratympanic)

69
Q

meniere’s disease (endolymphatic hydrops) has four s/s …

A

fluctate, low frequency hearing loss in affected ear

tinnitus and fullness in affected ear

epis. of vertigo that lasts hours at a time

RULE syphilis: refer to ENT if negative for vestibular testing VNG/VEMP/ Electrocochelography

70
Q

cause of meniere’s disease and patho?

A

cause: unknown, head trauam

patho: over production or underabsorption of endolymph -> distention of the endolymphatic sac

71
Q

if menieres disease (endolymphatic hydrops) is untreated, it can lead to

A

unilateral SNHL

72
Q

treatment for menieres disease is

A

80% respond to salt restriction = less than 2 grams per day / ETHOL and Cafe

acute attacks = prednisone

diuretics (dyazide)

vestibular rehab

antiemetics and short term vestibular suppressants (meclinzine/antivert)

73
Q

perilymphatic fistula, is an abnormal connection due to a tear between the perilymph filled inner ear and the middle ear.

caused
s/s
diagnosis;

A

trauma induced (child birth, barotruama, weight lifting), idiopathic

s/s worsen with pressure changes, dizzy, tinnitus, hearing loss (treated surgically)

explore surgery after CT/MRI, vestibular testing, audtiogram, fistula test

74
Q

noise induced dizziness with perilympatic fistula is

A

tullio phenomenon

75
Q

Superior semicircular canal dehiscence (SSCD)

is:

s/s

cause:

diagnosis

treatment

A

no bone overlying the superior semicircular canal facing towards the dura of the middle cranial fossa

tullio phenomeno (noise induced vertigo) , pessure induced vertigo, fullness, CHL, flucatuating SNHL

congenital, head trauma, barotruama

audiogram, vestibular testing, noncontrast CT temporal bone, MRI

Tx: surgical

76
Q

central vertigo

is
cause

A

disease from CNS, brain stem/cerebellum

CNS tumor (acoustic neuroma)
migraines
MS
hemorrhaic or ischemic insults to cerebellum
tia
infection
drugs (anticonvulsants, aspirin, ETHOL)
seizures
psych disorder
vertebrobasilar circulation problems

77
Q

acoustic neuroma (vestibular schwannoma)
is:
s/s:
diagnosis:
Tx:

A

CN8 tumor -benign in the CPA (cerebopontine angle)

unilateral SHL, tinnitus/ vertigo (late s/s)

MRI with IAC with or without contrast

observation, gamma knife tx, srgical excision

78
Q

vestibular migraine
is:
affects:
s/s:
tx:

A

episodic vertigo lasting 5 min to 72 hrs
younger pt with hx of migraine

s: +/- headache, sensitivity to light/sound w. N/V
spinning, rocking, swaying, or disequilibirum

migraine medication

79
Q

cervical vertigo

is:
cause
s/s
tx/tests/diagnosis

A

veritgo or dizziness from cervical spine … moving head/neck

cause: close head or whiplash injuries/ migraines, cervical arterial issues, surgery

dizziness mins to hours

no test or Tx

diagnosis of exclusion

Clinical med (6 decks)

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