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ENT SM > The Dizzy Patient > Flashcards

The Dizzy Patient Flashcards

1
Q

Define Vertigo

A

A sensation of movement, usually spinning

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2
Q

What are the 5 vestibular end organs

A

3 semi-circular canals:
Lateral, posterior and superior
2 otolith organs: utricle and saccule

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3
Q

What is the function of the utricle

A

It senses motion in the horizontal plane

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4
Q

What is the function of the saccule

A

It senses motion in the sagittal plane

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5
Q

What is the function of the semi-circular canals

A

They sense motion in an angular plane (head rotations)

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6
Q

What cochlear problems can result in an upset in the balance system

A

BPPV
Meniere’s
Vestibular neuronitis

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7
Q

What optic problems can result in an upset in the balance system

A

Cataracts

Diabetes Mellitus

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8
Q

What MSK problems can result in an upset in the balance system

A

Diabetes mellitus
Arthritis
Neurology

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9
Q

What cardiac problems can result in an upset in the balance system

A

Arrhythmias

postural hypotension

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10
Q

What neurological problems can result in an upset in the balance system

A

Stress
Migraine
SOL
MS

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11
Q

How can SCC be tested

A

Caloric tests

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12
Q

What is the supposed diagnosis if the vestibulo-ocular reflex is not working

A

Nystagmus

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13
Q

Where is the problem if the eye is pointing towards the left side of the nose nose

A

Right ear

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14
Q

What are some of the causes of Dizziness

A 
Cardiovascular 
Haematogological and metabolic 
Drug side - effects / interactions 
Migraines
otological 
trauma
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15
Q

What are some triggers of dizziness

A

Head movement

Sitting down or standing up

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16
Q

What are some possible associated symptoms with dizziness

A

Palpitations
fits
incontinence

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17
Q

What are some common alleviating factors

A

Eyes open or closed

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18
Q

What are some medications that can cause dizziness

A

Alcohol

Benzodiazipines

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19
Q

What examination should be carried out for dizziness

A 
Otoscopy - usually normal and regular 
Neurological - nystagmus at rest --> SOL
BP - lying and standing 
Balance system - stand up and close eyes and be prepared for falling 
Audiometry
20
Q

What are the 3 common causes of dizziness

A

Postural dizziness
Side effect of medication
Psychogenic and interaction with imbalance

21
Q

What are some underlying causes of postural dizziness

A

Hb, Na or BP lying and standing

22
Q

What medication can cause dizziness

A

Medication for anxiety or depression

23
Q

What are specific causes of dizziness

A 
Miner's disease
BPPV 
Vestibular neuronitis
Labyrinthitis 
Migrainous vertigo
24
Q

What is Meniere’s Disease

A

a disease of unknown cause affecting the membranous labyrinth of the ear, causing progressive deafness and attacks of tinnitus and vertigo

25
Q

Benign paroxysmal positional vertigo (BPPV)

A

is a disorder arising in the inner ear.

26
Q

What is the most common cause of vertigo

A

BPPV

27
Q

What are some causes of BPPV

A

Head trauma, ear surgery, idiopathic

28
Q

What is the pathophysiology of BPPV

A

Otolith material from utricle displaced into semicircular canals

29
Q

What is BPPV sometimes confused for

A

Vertebrobasilar insufficiency (VBI)

30
Q

How can we make a diagnosis of VBI

A

Other symptoms of impaired circulation in posterior brain associated with the vertigo
e.g. visual disturbance
Weakness
Numbness

31
Q

What are some of the common phrases a patient with BPPV would come out with

A 
Dizziness on:
looking up
turning in bed 
first lying down in bed at night 
first getting out of bed in the morning
bending forward
rising from bending
moving head quickly
32
Q

Is BPPV long lasting or brief episodes

A

Brief episodes

33
Q

What can be done to help BPPV

A

Hallpike’s test
Epley Manoeuvre
Semont Manoeuvre
Brandt- Daroff Exercises

34
Q

What is the purpose of the Epley Manoeuvre

A

To physically change the position of the calcium carbonate crystals within the SCC

35
Q

What is Vestibular neuronitis

A

Prolonged vertigo (days) with no associated tinnitus or hearing loss

36
Q

What is the underlying cause of vestibular neuritis

A

Inflammation of the vestibular nerve

37
Q

What is Labyrinthitis

A

Prolonged vertigo (days) that may be associated with tinnitus or hearing loss

38
Q

What is the main cause of labyrinths

A

Viral

39
Q

What is the treatment for both vestibular neuronitis / labyrinthitis

A

Supportive management with vestibular sedatives

40
Q

What are the main symptoms of Meniere’s disease

A

History of recurrent, spontaneous, rotational vertigo with t least 2 episodes >20 mins often lasting hours
Occurrence of or worsening of tinnitus on the affected side
occurrence of aural fulness on the affected side

41
Q

What is the treatment for Meniere’s disease

A 
supportive treatment during episodes 
tinnitus therapy 
hearing aids 
prevention:
salt restriction, Betahistine, caffeine, alcohol, stress
42
Q

What is the management for Meniere’s disease

A

Grommet insertion
Intratympanic Gentamicin / steroids
Surgery

43
Q

What is the issue with using gentamicin

A

It can destroy the hair cells and result in hearing loss

44
Q

What is the most common symptom of migraine

A

phonophobia (fear of loud sounds)

45
Q

What condition causes Aural Fullness

A

Meniere’s disease

46
Q

What condition causes a clear positional trigger

A

BPPV

47
Q

What conditions cause associtted HL or tinnitus

A

Meniere’s disease and labyrinthitis

ENT SM (19 decks)

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