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Gerontology > Module 8 > Flashcards

Module 8 Flashcards

1
Q

The anterior and posterior semi circular canals are oriented

A

Vertically at right angles to each other

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2
Q

The horizontal semi circular canal is oriented at a

A

30 degree angle from horizontal plane

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3
Q

The macula of the utricle lies

A

Horizontally on the floor of the utricle

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4
Q

The otolithic membrane is above

A

The gelatinous layer that embeds the tips of hair cells

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5
Q

The otoloconia adds ___ to the otolithic membrane

A

Weight

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6
Q

The otoconia allows for increased sense of _____ and ___

A

Gravity and head orientation

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7
Q

The otoconia also increases the ability to detect ____, _____ and ______

A

Motion, inertia and horizontal acceleration

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8
Q

How is the utricle different from canal structures

A

It responds to linear motion instead of angular motion

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9
Q

The macula of the saccule lies in a

A

Vertical position

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10
Q

The macula of the saccule detects

A

Vertical linear acceleration

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11
Q

The weight otolithic membrane lags behind the

A

Stereocilia and kinocilium

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12
Q

Head orientation causes a combination of stimulation to ___ and ___ of ___ ears

A

Utricle and saccula of both ears

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13
Q

How does the brain interpret head orientation

A

Compare the inputs of the utricle and saccule to each other and the input form eyes and cervical stretch receptors

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14
Q

What is the ampulla

A

The localized dilation at one end of the semi circular duct

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15
Q

What is the crista

A

A patch of innervated hair cells found at the base of the ampulla

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16
Q

The hair cells in the crista are _____ oriented in a ___ direction

A

Stereo cilia, consistent

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17
Q

The stereocilia of the crista is embedded in a

A

Gelatinous cupula

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18
Q

During head rotation _____ in the semi circular ducts initially lags behind due to _____

A

Endolymph, inertia

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19
Q

What happens to the endolymph and cupula during head rotation

A

The cupula is deflected in the opposite direction of head movement and the endolymph fluid pushes the cupula - hair cells get stimulated and transmit corresponding signal

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20
Q

During head motion ____ acceleration of endolymph in the semicircular canals moves fluid back and forth in direction of ______ which stimulates vestibular receptors to ________

A

Angular, spinning, signal the brain that the head is moving

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21
Q

The vestibular ocular reflex involves how many pathways

A

3

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22
Q

The first neuronal pathway of the vestibulo ocular reflex is

A

Peripheral vestibular organs to the vestibular nuclei - lateral, medial, superior and inferior

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23
Q

The vestibulo ocular reflex second neuronal pathway

A

Oculomotor nuclei

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24
Q

The third neuronal pathway in the vestibulo ocular reflex

A

Extra ocular muscles

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25
Q

The vestibulo ocular reflex operates by

A

Generating eye movements at the same speed but in opposite direction to head movement

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26
Q

What is the function of the vestibulo ocular reflex

A

Stabilize the image on the fovea during head movement

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27
Q

The vestibulo occular reflex allows a person to

A

To see a sharp and clean image even during movement

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28
Q

What is impulsion

A

The sensation that the body is being hurled or pulled in space

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29
Q

What is oscillopsia

A

The visual illusion of a stationary object moving back and forth or up and down

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30
Q

Nystagmus is

A

Rhythmic oscillations of the eyes and is an abnormal response

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31
Q

What are the brain stem/cerebellar symptoms of central disorder

A

Diplopia, dysphagia, dysarthria, dysmetria

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32
Q

Acute vestibulopathy first manifests as an insidious onset of

A

Vertigo

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33
Q

Symptoms of acute vestibulopathy

A

Vertigo, visual disturbances, oscillopsia, nausea, vomiting, imbalance, brain fog and fatigue

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34
Q

What are the signs of acute vestibulopathy

A

Nystagmus, gaze instability, coordination deficits, gait ataxia

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35
Q

The prevalence of vestibulopathy in the 7th decade of life

A

49.4%

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36
Q

Prevalence of vestibulopathy in those in the 8th decade of life

A

68.7%

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37
Q

Prevalence of vestibulopathy in the 9th decade of life and over

A

84.8%

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38
Q

What is brain fog

A

Abnormality in regulation of overall level of consciousness that is mild and less severe than a delierium

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39
Q

What are the risk factors for vestibulopathy

A

Trauma/surgery to head or neck, allergies, exposure to ototoxic medications, migraine associated dizziness, cerebrovascular disease, cerebrovascular accident, central nervous system disease

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40
Q

Vertigo is commonly due to an imbalance of

A

Tonic vestibular signals

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41
Q

Typical areas associated with vertigo include

A

Inner ear, middle ear, brain stem, cerebellum

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42
Q

Vestibular hypo function is

A

Unilateral damage to the peripheral vestibular system

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43
Q

Causes of central lesions include

A

Ischemia of brain stem, cerebellar infarcts, infarct of medulla and MS

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44
Q

Signs of central lesions include

A

Impaired saccades, smooth pursuit, and optokinetic nystagmus

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45
Q

Central lesions or peripheral lesions have neurological signs

A

Central

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46
Q

Peripheral vestibulopathy does not have

A

Neurological signs

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47
Q

Peripheral vestibulopathy Often involves

A

Tinnitus and hearing loss

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48
Q

Symptoms in peripheral vestibulopathy are more severe when there is

A

Nausea and vomiting

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49
Q

Peripheral vestibulopathy develops acutely or chronically

A

Acutely - they are intermittent and short lasting

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50
Q

Cervical vertigo is similar to

A

BPPV

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51
Q

Cervical vertigo is triggered by

A

Head rotation relative to body while in upright posture

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52
Q

In postural hypotension systolic BP is below ___ and diastolic is below ___

A

20 and 10

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53
Q

Endolymphatic hydrops is

A

An abnormality in quantity, composition and or pressure of endolymph

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54
Q

Primary idiopathic endolymphatic hydrops is also called

A

Ménière’s disease

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55
Q

Ménière’s disease is characterized by

A

Episodic attacks of sustained vertigo, fluctuating hearing loss, a feeling of fullness or pressure in the ear and tinnitus

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56
Q

In Ménière’s disease the duration is typically ________ and more _____

A

Longer, Disabling

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57
Q

In Ménière’s disease there is protracted _____ and ____

A

Nausea and vomiting

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58
Q

How does semi circular canal orientation cause different canal stimulation

A

By head rotation in different planes

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59
Q

Inner ear infections causing vestibular neuritis or labyrinthitis are more commonly form

A

Viral not bacterial

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60
Q

Vestibular neuritis initially experience _____ of a ____ onset,

A

Vertigo, gradual

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61
Q

Difference in hearing between vestibular neuritis and labyrinthitis

A

No hearing loss in vestibular neuritis but there is hearing loss and tinnitus with labyrinthitis

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62
Q

Spontaneous nystagmus is present in vestibular neuritis or labyrinthitis

A

Vestibular neuritis

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63
Q

Symptoms happen _____ in labyrinthitis

A

Quickly

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64
Q

Oscillopsia is commonly seen in labyrinthitis true or false

A

True

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65
Q

Labyrinthitis may cause

A

Endolymphatic drops

66
Q

Most common vestibular disorder

A

BPPV

67
Q

BPPV is

A

A syndrome characterized by short episodes of vertigo in association with rapid changes in head position

68
Q

Prognosis for BPPV is

A

Good

69
Q

What type of BPPV is more common and why

A

Posterior canal on the right because people tend to sleep on their right

70
Q

Most common age of onset of BPPV

A

60

71
Q

Women to men ratio for BPPV

A

3:1

72
Q

In patients with chronic vestibular disorder __% had fell one or more times in the past year

A

53%

73
Q

Symptoms of BPPV occur when

A

Otoliths or fragmented endolymph particles migrate from area normally present into PC SCC

74
Q

BPPV - Trapped otoliths causes ___ changes in PC SCC

A

Intertial

75
Q

Most common form of PC BPPV

A

Canalolithiasis

76
Q

Intraoperatibe observation in Canalolithiasis showed

A

Free floating debris in endolymph of SCC

77
Q

In cupulolithiasis

A

Otoconia from the utricle are adherent to the cupula and deflect cupula inducing a gravitational effect on crista

78
Q

In cupulolithiasis position dependent movements (gravity) cause

A

Increased deflection of involved canal

79
Q

In cupulolithiasis increased stimulation remains as long as

A

Canal is in Gravity dependent position

80
Q

Nystagmus via stimulation of PC SCC Is of this type

A

Mixed torsional and vertical movement

81
Q

Nystagmus via stimulation of PC SCc is a ___ torsion

A

Up beating

82
Q

Upper pole of eye beats toward

A

Dependent ear

83
Q

Vertical component of nystagmus beats towards

A

Forehead

84
Q

Rate of nystagmus begins ___ increasing in ___ and then decreasing in ____

A

Gently, intensity, intensity

85
Q

Nystagmus up beating results in activated

A

Ipsa lateral superior oblique and contra lateral inferior rectus

86
Q

Nystagmus causes tonic _______ deviation of eyes with torsion in direction of _______

A

Downward, upper most ear

87
Q

Upper pole of eyes beats towards _____

A

Lower most ear

88
Q

In BPPV there is usually no ___ loss

A

Hearing

89
Q

Nystagmus in BPPV fatigues after __ seconds

A

60

90
Q

BPPV has the ___ duration : seconds

A

Shortest

91
Q

Is nausea present in BPPV

A

No

92
Q

Treatment of BPPV

A

Canal repositioning maneuver

93
Q

Treatment of vestibular neuritis

A

Symptomatic nausea treatment and steroids

94
Q

Treatment of labyrinthitis

A

Symptomatic nausea treatment and steroids

95
Q

Treatment of Ménière’s disease

A

Nausea treatment, salt restriction and diuretics

96
Q

How to asses orthostatic hypotension

A

Measure BP and hr after 5 minutes in supine, then again immediately standing and again after 3 minutes of standing

97
Q

Positive orthostatic hypotension readings

A

SBP lowers by 20 mmHg or DBP lowers 10 mmHg

98
Q

How do you perform the head impulse /thrust test

A

Head is rapidly turned to one side and then to other side while watching eyes for prescience or a scene of corrective movement

99
Q

Positive head thrust is when

A

When turned to effected side there is a corrective saccades to re fixate on visual target - VOR fails

100
Q

BPPV history that leads to diagnosis

A

Repeated episodes of vertigo with changes in head position

101
Q

Physical examination of BPPV (3)

A

Vertigo associated with nystagmus provoked Dix hallpike , latency period between completion of Dix hallpike and onset of vertigo and nystagmus is 5-20 seconds , provoked vertigo and nystagmus resolve in 60 seconds

102
Q

How to perform Dix hallpike

A

Start in long sitting, neck is extended 20 degrees and rotated 45 degrees to involved side, quickly moved to supine and observe for rotational nystagmus

103
Q

Alternate Dix hallpike

A

Seated at side of table. Head rotated 45 degrees away from involved ear, patient moved to side lying on the involved side

104
Q

The supine roll test is used to assess for

A

Lateral canal BPPV

105
Q

In lateral BPPV Dix hallpike will be

A

Negative

106
Q

Phenothiazine are used to control

A

Nausea and vomiting

107
Q

Anticholiniergics are used to

A

Prevent nausea, vomiting and motion sickness

108
Q

Benzodiazepines are a ______ used to treat

A

Central nervous system depressant, anxiety and chronic problems

109
Q

Three principles of vestibular rehabilitation training

A

Adaptation, substitution and habituation

110
Q

Vestibular adaptation involves

A

Readjusting gain of vestibulo ocular reflex or vestibulo spinal reflex

111
Q

Vestibular substitution uses

A

Alternative strategies to replace lost vestibular function , used to describe general recovery from unilateral vestibular deafferentiation syndrome

112
Q

Vestibular substitution is also called

A

Vestibular compensation

113
Q

Vestibular habituation

A

Decreases Symptoms via receptive symptom provoking head movements

114
Q

Adaptation exercises consist of

A

Repeated head movements while focusing on a target to develop compensatory saccadic eye movement

115
Q

Saccadic eye movement provide _____ for an impaired VOR

A

Motor substitution

116
Q

Two kinds of saccades

A

Insufficient amplitude and saccades back toward target

117
Q

In insufficient amplitude

A

Eyes drift to target

118
Q

In saccades back toward target

A

It is generated in the opposite direction to head rotation back toward target

119
Q

Ankle strategy involves upper and lower body moving in ____ direction

A

Same

120
Q

Hip strategy involves upper and lower body moving in

A

Opposite directions

121
Q

Falling is a consequence of

A

Bilateral vestibular hypo function

122
Q

Those over 65 with bilateral vestibular loss should

A

Use AD

123
Q

Adaptation implies a _____ where’s habituation Is an

A

Return to normal, attenuation of symptoms

124
Q

Habituation exercise example

A

Brandt - daroff

125
Q

Habituation exercises are inappropriate for patients with

A

Bilateral vestibular loss

126
Q

Habituation effect is s____ for older adults

A

Slower

127
Q

For habituation perform ___ per day

A

Less than or equal to 4 movements

128
Q

Symptoms should dissipate within ____ after each rep of habituation exercise

A

A minute

129
Q

Frequency of habituation exercises

A

2-3 times per day

130
Q

Habituation exercises may take _ weeks for symptoms to go away, continue for _ months and perform __ per day thereafter

A

4, 2-3, once

131
Q

Modified eply is used to treat

A

Posterior SCc and anterior SCC

132
Q

Canalith repositioning maneuver is also called

A

Particle releasing maneuver

133
Q

Mastoid vibration is no longer used true or false

A

True

134
Q

Crp is more effective than placebo with a ___ success after one session

A

80%

135
Q

What is the eply maneuver

A

Start from Dix hallpike test position, bring supine and turn head 90 degrees toward uneffected side, turn head and trunk 90 degrees in same direction and then move back up to sitting

136
Q

Maintain each position in eply maneuver for _ to _ minutes or until

A

1-2 , induced nystagmus and vertigo are resolved

137
Q

What is the clinical test for sensory interaction in balance (CTSIB)

A

Examines body sway for 20 seconds under six different sensory conditions

138
Q

The dizziness handicap inventory is a

A

25 question self assessment

139
Q

The dizziness handicap scale has a max score of

A

100

140
Q

The greater the score on the dizziness handicap inventory means

A

Greater perceived handicap

141
Q

What is the clinically significant change on the dizziness handicap inventory

A

18 points

142
Q

The BPPV reoccurrence rate is

A

15% per year up to as high as 50% at 5 years

143
Q

Bilateral PC SCc is more likely to be encountered after

A

Head trauma

144
Q

Vestibular compensation results from

A

Active neuronal changes in the cerebellum and brain stem in response to sensory conflicts produced by vestibular pathology

145
Q

VRT does not regenerate or treat the

A

Damaged vestibular end organ itself

146
Q

VRT focuses on the

A

Plasticity of the CNS

147
Q

Best stimulus for increasing the gain of vestibular response is

A

Error signal induced by retinal slip

148
Q

What is retinal slip

A

Image motion on retina during head motion

149
Q

Retinal slip is induced by

A

Horizontal or vertical head movements while maintaining visual fixation on a target

150
Q

Repeated periods of retinal slip induce

A

Vestibular adaptation

151
Q

In substitution for gaze stabilization the ____ reflex will substitute the VOR

A

Cervical ocular reflex

152
Q

The COR is

A

An ocular stabilization reflex that is elicited by rotation of the neck

153
Q

Cawthorne cooksey exercise for saccade

A

Moving only the eyes imagine two targets close enough together while looking directly at one, quickly switch looking between the two targets without moving the head

154
Q

Pursuit cawthorne cooksey is when

A

Put thumb out in front and move side to side not moving head w

155
Q

Enhancing gaze stability exercises are performed

A

4-5 x per day for 20-40 minutes per day including 20 minutes of balance and gait

156
Q

Central or peripheral lesion will cause prolonged period of therapy

A

Central

157
Q

Patients age does ___ effect the final level of recover

A

Not

158
Q

Age may ______ time required to receive max benefit

A

Prolong

159
Q

If on medications, outcome is the ___ but it takes ____

A

Same, longer

160
Q

Stage at which treatment is initiated should be

A

Earlier for better results

161
Q

Most common complication of BPPV is

A

Canal conversion or switch

Gerontology (12 decks)

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