Lecture 6- Vertigo & Syncope

Question 1

gradual, progressive onset: sensation of motion, no ear symptoms, vertical nystagmus, neuro sx- ataxia, diplopia, dysarthria, assoc. w/ HA or N/V

Answer 1

central vertigo

Question 2

horizontal nystagmus is associated with? (2)

Answer 2

peripheral or metabolic vertigo

Question 3

horizontal/torsional nystagmus is assoc. w/ (2)

Answer 3

peripheral or positional vertigo

Question 4

vertical nystagmus is assoc. w/?

Answer 4

central vertigo

Question 5

electronystagmography assesses?

Answer 5

vestibular function

Question 6

impaired or absent thermally-induced fast nystagmus (vestibular paresis) indicates?

Answer 6

pathology of the labyrinth on the irrigated side

Question 7

most common inner ear cause of vertigo?

Answer 7

benign paroxysmal positional vertigo

Question 8

transient episodes of vertigo, assoc. w/ prolonged bed rest & head trauma

Answer 8

benign paroxysmal positional vertigo

Question 9

cause of BPPV?

Answer 9

secondary to dislodged otoliths in the semicircular canal (canalithiasis)

Question 10

diagnostic test for BPPV

Answer 10

Hallpike maneuver: reproduces vertigo & horizontal nystagmus

Question 11

1st line medications for BPPV? (2)

Answer 11

Anticholinergics: Scopalamine
Antihistamines: Meclizine, dimenhydrinate (Dramamine)

Question 12

single attack of vertigo, sx lasting 2-3 days
assoc. w/ viral URI, N/V
may see nystagmus, but no tinnitus or hearing loss

Answer 12

vestibular neuronitis

Question 13

vestibular neuronitis diagnostics? (2)

Answer 13

normal audiograms

caloric testing shows vestibular paresis

Question 14

vestibular neuronitis tx? (2)

Answer 14

bed rest- short-lived disorder

meds: dimenhydrinate, meclizine, scopalamine, diazepam, Anti-emetics PRN, prednisone taper over 10 days

Question 15

Meniere’s triad

Answer 15

episodic vertigo
tinnitus
fluctuating hearing loss

Question 16

Meniere’s disease cause

Answer 16

endolymphatic hydrops –> swelling & rupture of membranous labyrinth –> paralysis of vestibular nerve fibers & degeneration of cochlear hair cells

Question 17

Meniere’s disease hearing loss onset course (2) & diagnostic exam?

Answer 17

low tones lost first, then high tones
speech discrimination is preserved until late

audiogram shows sensorineural hearing loss

Question 18

Meniere’s disease acute attack tx?

Answer 18

bed rest
anti-emetics
vestibular suppression: anticholinergic, antihistamines

Question 19

Meniere’s disease prophylactic

Answer 19

low salt diet & HCTZ

Question 20

refractory Meniere’s disease tx (3)

Answer 20

endolymphatic shnt
vestibular nerve sectioning
ablation of the labyrinth (only w/ total hearing loss)

Question 21

condition assoc. w/ sudden change in middle ear pressure (head trauma, wt. lifting, scuba diving, flying, erosion)

Answer 21

perilymphatic fistula

Question 22

perilymphatic fistula connects?

Answer 22

perilymph & the middle ear

Question 23

perilymphatic fistula diagnostic?

Answer 23

pneumatic otoscopy: abn to see eye movements w/ pressure changes, may see nystagmus

Question 24

perilymphatic fistula tx (4)

Answer 24

bedrest
hydration
symptomatic treatment
surgery

Question 25

abnormal tilt table test results? what syncope does this provoke?

Answer 25

exaggerated decr. in BP with or without decr. HR associated w/ dizziness/lightheadedness

vasovagal sx

Question 26

carotid sinus massage indications?

and positive result?

Answer 26

recurrent episodes w/ negative workup, hx carotid sinus syncope

positive if symptoms reproduced & period of asystole > 3 seconds or drop in BP (>50 mmHg)

Question 27

bradyarrhythmias (3)

Answer 27

sick sinus syndrome
2nd degree type II AV block
complete heart block

Question 28

tachyarrythmias causing syncope (3)

Answer 28

SVT
WPW
V tach

Question 29

outflow obstructions causing syncope (2)

Answer 29

aortic dissection

aortic stenosis

Question 30

cardiac syncope cause assoc. w/ exertion

Answer 30

aortic stenosis

Question 31

carotid sinus syncope tx

Answer 31

cardiac pacemaker

Question 32

syncope assoc. w/ emotional lability, stress, pain, shock

& pathophysiology

Answer 32

vasovagal syncope

decr. sympathetic tone (or incr. parasymp. tone) –> vasodilation & bradycardia –> hypotension & syncope

Question 33

situational syncopes? (2)

Answer 33

micturition syncope

tussive syncope

Question 34

causes of vasomotor syncope/orthostatic hypotension (3)

Answer 34

anti-HTN meds
TCAs
volume depletion

Question 35

vasomotor syncope/orthostatic hypotension tx (3)

Answer 35

avoid volume depletion
Rx adjustment
behavior modification- slow position changes, exercises, stockings

Question 36

autonomic & peripheral neuropathies causing autonomic syncope (2)

Answer 36

diabetes

Parkinson’s

Question 37

debilitation causes of autonomic syncope (4)

Answer 37

malnutrition
anemia
blood loss
adrenal insufficiency

Question 38

syncope is a symptom of?

where do you need blood flow?

Answer 38

decr. cerebral blood flow

reticular activating system & at least 1 cerebral cortex

Question 39

diplopia, vertigo, dysarthria, pulse differences in UE, increased symptoms w/ exertion

Answer 39

subclavian steal syndrome

Question 40

indications for hospitalization w/ syncope (5)

Answer 40

> 70 y/o
organic heart disease
neuro symptoms
frequent or exertional syncope
moderate-severe orthostatic hypotension

Question 41

acute onset: sensation of motion, exaggerated sense of movement, hearing loss, tinnitus, horizontal or torsional nystagmus, absent neuro sx

Answer 41

peripheral vertigo