Module 8 Flashcards
1
Q
The anterior and posterior semi circular canals are oriented
A
Vertically at right angles to each other
2
Q
The horizontal semi circular canal is oriented at a
A
30 degree angle from horizontal plane
3
Q
The macula of the utricle lies
A
Horizontally on the floor of the utricle
4
Q
The otolithic membrane is above
A
The gelatinous layer that embeds the tips of hair cells
5
Q
The otoloconia adds ___ to the otolithic membrane
A
Weight
6
Q
The otoconia allows for increased sense of _____ and ___
A
Gravity and head orientation
7
Q
The otoconia also increases the ability to detect ____, _____ and ______
A
Motion, inertia and horizontal acceleration
8
Q
How is the utricle different from canal structures
A
It responds to linear motion instead of angular motion
9
Q
The macula of the saccule lies in a
A
Vertical position
10
Q
The macula of the saccule detects
A
Vertical linear acceleration
11
Q
The weight otolithic membrane lags behind the
A
Stereocilia and kinocilium
12
Q
Head orientation causes a combination of stimulation to ___ and ___ of ___ ears
A
Utricle and saccula of both ears
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
14
Q
What is the ampulla
A
The localized dilation at one end of the semi circular duct
15
Q
What is the crista
A
A patch of innervated hair cells found at the base of the ampulla
16
Q
The hair cells in the crista are _____ oriented in a ___ direction
A
Stereo cilia, consistent
17
Q
The stereocilia of the crista is embedded in a
A
Gelatinous cupula
18
Q
During head rotation _____ in the semi circular ducts initially lags behind due to _____
A
Endolymph, inertia
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
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
21
Q
The vestibular ocular reflex involves how many pathways
A
3
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
23
Q
The vestibulo ocular reflex second neuronal pathway
A
Oculomotor nuclei
24
Q
The third neuronal pathway in the vestibulo ocular reflex
A
Extra ocular muscles
25
The vestibulo ocular reflex operates by
Generating eye movements at the same speed but in opposite direction to head movement
26
What is the function of the vestibulo ocular reflex
Stabilize the image on the fovea during head movement
27
The vestibulo occular reflex allows a person to
To see a sharp and clean image even during movement
28
What is impulsion
The sensation that the body is being hurled or pulled in space
29
What is oscillopsia
The visual illusion of a stationary object moving back and forth or up and down
30
Nystagmus is
Rhythmic oscillations of the eyes and is an abnormal response
31
What are the brain stem/cerebellar symptoms of central disorder
Diplopia, dysphagia, dysarthria, dysmetria
32
Acute vestibulopathy first manifests as an insidious onset of
Vertigo
33
Symptoms of acute vestibulopathy
Vertigo, visual disturbances, oscillopsia, nausea, vomiting, imbalance, brain fog and fatigue
34
What are the signs of acute vestibulopathy
Nystagmus, gaze instability, coordination deficits, gait ataxia
35
The prevalence of vestibulopathy in the 7th decade of life
49.4%
36
Prevalence of vestibulopathy in those in the 8th decade of life
68.7%
37
Prevalence of vestibulopathy in the 9th decade of life and over
84.8%
38
What is brain fog
Abnormality in regulation of overall level of consciousness that is mild and less severe than a delierium
39
What are the risk factors for vestibulopathy
Trauma/surgery to head or neck, allergies, exposure to ototoxic medications, migraine associated dizziness, cerebrovascular disease, cerebrovascular accident, central nervous system disease
40
Vertigo is commonly due to an imbalance of
Tonic vestibular signals
41
Typical areas associated with vertigo include
Inner ear, middle ear, brain stem, cerebellum
42
Vestibular hypo function is
Unilateral damage to the peripheral vestibular system
43
Causes of central lesions include
Ischemia of brain stem, cerebellar infarcts, infarct of medulla and MS
44
Signs of central lesions include
Impaired saccades, smooth pursuit, and optokinetic nystagmus
45
Central lesions or peripheral lesions have neurological signs
Central
46
Peripheral vestibulopathy does not have
Neurological signs
47
Peripheral vestibulopathy Often involves
Tinnitus and hearing loss
48
Symptoms in peripheral vestibulopathy are more severe when there is
Nausea and vomiting
49
Peripheral vestibulopathy develops acutely or chronically
Acutely - they are intermittent and short lasting
50
Cervical vertigo is similar to
BPPV
51
Cervical vertigo is triggered by
Head rotation relative to body while in upright posture
52
In postural hypotension systolic BP is below ___ and diastolic is below ___
20 and 10
53
Endolymphatic hydrops is
An abnormality in quantity, composition and or pressure of endolymph
54
Primary idiopathic endolymphatic hydrops is also called
Ménière's disease
55
Ménière's disease is characterized by
Episodic attacks of sustained vertigo, fluctuating hearing loss, a feeling of fullness or pressure in the ear and tinnitus
56
In Ménière's disease the duration is typically ________ and more _____
Longer, Disabling
57
In Ménière's disease there is protracted _____ and ____
Nausea and vomiting
58
How does semi circular canal orientation cause different canal stimulation
By head rotation in different planes
59
Inner ear infections causing vestibular neuritis or labyrinthitis are more commonly form
Viral not bacterial
60
Vestibular neuritis initially experience _____ of a ____ onset,
Vertigo, gradual
61
Difference in hearing between vestibular neuritis and labyrinthitis
No hearing loss in vestibular neuritis but there is hearing loss and tinnitus with labyrinthitis
62
Spontaneous nystagmus is present in vestibular neuritis or labyrinthitis
Vestibular neuritis
63
Symptoms happen _____ in labyrinthitis
Quickly
64
Oscillopsia is commonly seen in labyrinthitis true or false
True
65
Labyrinthitis may cause
Endolymphatic drops
66
Most common vestibular disorder
BPPV
67
BPPV is
A syndrome characterized by short episodes of vertigo in association with rapid changes in head position
68
Prognosis for BPPV is
Good
69
What type of BPPV is more common and why
Posterior canal on the right because people tend to sleep on their right
70
Most common age of onset of BPPV
60
71
Women to men ratio for BPPV
3:1
72
In patients with chronic vestibular disorder __% had fell one or more times in the past year
53%
73
Symptoms of BPPV occur when
Otoliths or fragmented endolymph particles migrate from area normally present into PC SCC
74
BPPV - Trapped otoliths causes ___ changes in PC SCC
Intertial
75
Most common form of PC BPPV
Canalolithiasis
76
Intraoperatibe observation in Canalolithiasis showed
Free floating debris in endolymph of SCC
77
In cupulolithiasis
Otoconia from the utricle are adherent to the cupula and deflect cupula inducing a gravitational effect on crista
78
In cupulolithiasis position dependent movements (gravity) cause
Increased deflection of involved canal
79
In cupulolithiasis increased stimulation remains as long as
Canal is in Gravity dependent position
80
Nystagmus via stimulation of PC SCC Is of this type
Mixed torsional and vertical movement
81
Nystagmus via stimulation of PC SCc is a ___ torsion
Up beating
82
Upper pole of eye beats toward
Dependent ear
83
Vertical component of nystagmus beats towards
Forehead
84
Rate of nystagmus begins ___ increasing in ___ and then decreasing in ____
Gently, intensity, intensity
85
Nystagmus up beating results in activated
Ipsa lateral superior oblique and contra lateral inferior rectus
86
Nystagmus causes tonic _______ deviation of eyes with torsion in direction of _______
Downward, upper most ear
87
Upper pole of eyes beats towards _____
Lower most ear
88
In BPPV there is usually no ___ loss
Hearing
89
Nystagmus in BPPV fatigues after __ seconds
60
90
BPPV has the ___ duration : seconds
Shortest
91
Is nausea present in BPPV
No
92
Treatment of BPPV
Canal repositioning maneuver
93
Treatment of vestibular neuritis
Symptomatic nausea treatment and steroids
94
Treatment of labyrinthitis
Symptomatic nausea treatment and steroids
95
Treatment of Ménière's disease
Nausea treatment, salt restriction and diuretics
96
How to asses orthostatic hypotension
Measure BP and hr after 5 minutes in supine, then again immediately standing and again after 3 minutes of standing
97
Positive orthostatic hypotension readings
SBP lowers by 20 mmHg or DBP lowers 10 mmHg
98
How do you perform the head impulse /thrust test
Head is rapidly turned to one side and then to other side while watching eyes for prescience or a scene of corrective movement
99
Positive head thrust is when
When turned to effected side there is a corrective saccades to re fixate on visual target - VOR fails
100
BPPV history that leads to diagnosis
Repeated episodes of vertigo with changes in head position
101
Physical examination of BPPV (3)
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
How to perform Dix hallpike
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
Alternate Dix hallpike
Seated at side of table. Head rotated 45 degrees away from involved ear, patient moved to side lying on the involved side
104
The supine roll test is used to assess for
Lateral canal BPPV
105
In lateral BPPV Dix hallpike will be
Negative
106
Phenothiazine are used to control
Nausea and vomiting
107
Anticholiniergics are used to
Prevent nausea, vomiting and motion sickness
108
Benzodiazepines are a ______ used to treat
Central nervous system depressant, anxiety and chronic problems
109
Three principles of vestibular rehabilitation training
Adaptation, substitution and habituation
110
Vestibular adaptation involves
Readjusting gain of vestibulo ocular reflex or vestibulo spinal reflex
111
Vestibular substitution uses
Alternative strategies to replace lost vestibular function , used to describe general recovery from unilateral vestibular deafferentiation syndrome
112
Vestibular substitution is also called
Vestibular compensation
113
Vestibular habituation
Decreases Symptoms via receptive symptom provoking head movements
114
Adaptation exercises consist of
Repeated head movements while focusing on a target to develop compensatory saccadic eye movement
115
Saccadic eye movement provide _____ for an impaired VOR
Motor substitution
116
Two kinds of saccades
Insufficient amplitude and saccades back toward target
117
In insufficient amplitude
Eyes drift to target
118
In saccades back toward target
It is generated in the opposite direction to head rotation back toward target
119
Ankle strategy involves upper and lower body moving in ____ direction
Same
120
Hip strategy involves upper and lower body moving in
Opposite directions
121
Falling is a consequence of
Bilateral vestibular hypo function
122
Those over 65 with bilateral vestibular loss should
Use AD
123
Adaptation implies a _____ where's habituation Is an
Return to normal, attenuation of symptoms
124
Habituation exercise example
Brandt - daroff
125
Habituation exercises are inappropriate for patients with
Bilateral vestibular loss
126
Habituation effect is s____ for older adults
Slower
127
For habituation perform ___ per day
Less than or equal to 4 movements
128
Symptoms should dissipate within ____ after each rep of habituation exercise
A minute
129
Frequency of habituation exercises
2-3 times per day
130
Habituation exercises may take _ weeks for symptoms to go away, continue for _ months and perform __ per day thereafter
4, 2-3, once
131
Modified eply is used to treat
Posterior SCc and anterior SCC
132
Canalith repositioning maneuver is also called
Particle releasing maneuver
133
Mastoid vibration is no longer used true or false
True
134
Crp is more effective than placebo with a ___ success after one session
80%
135
What is the eply maneuver
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
Maintain each position in eply maneuver for _ to _ minutes or until
1-2 , induced nystagmus and vertigo are resolved
137
What is the clinical test for sensory interaction in balance (CTSIB)
Examines body sway for 20 seconds under six different sensory conditions
138
The dizziness handicap inventory is a
25 question self assessment
139
The dizziness handicap scale has a max score of
100
140
The greater the score on the dizziness handicap inventory means
Greater perceived handicap
141
What is the clinically significant change on the dizziness handicap inventory
18 points
142
The BPPV reoccurrence rate is
15% per year up to as high as 50% at 5 years
143
Bilateral PC SCc is more likely to be encountered after
Head trauma
144
Vestibular compensation results from
Active neuronal changes in the cerebellum and brain stem in response to sensory conflicts produced by vestibular pathology
145
VRT does not regenerate or treat the
Damaged vestibular end organ itself
146
VRT focuses on the
Plasticity of the CNS
147
Best stimulus for increasing the gain of vestibular response is
Error signal induced by retinal slip
148
What is retinal slip
Image motion on retina during head motion
149
Retinal slip is induced by
Horizontal or vertical head movements while maintaining visual fixation on a target
150
Repeated periods of retinal slip induce
Vestibular adaptation
151
In substitution for gaze stabilization the ____ reflex will substitute the VOR
Cervical ocular reflex
152
The COR is
An ocular stabilization reflex that is elicited by rotation of the neck
153
Cawthorne cooksey exercise for saccade
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
Pursuit cawthorne cooksey is when
Put thumb out in front and move side to side not moving head w
155
Enhancing gaze stability exercises are performed
4-5 x per day for 20-40 minutes per day including 20 minutes of balance and gait
156
Central or peripheral lesion will cause prolonged period of therapy
Central
157
Patients age does ___ effect the final level of recover
Not
158
Age may ______ time required to receive max benefit
Prolong
159
If on medications, outcome is the ___ but it takes ____
Same, longer
160
Stage at which treatment is initiated should be
Earlier for better results
161
Most common complication of BPPV is
Canal conversion or switch
