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ENT > The Dizzy Patient > Flashcards

The Dizzy Patient Flashcards

1
Q

What is dizziness?

A

a non-specific term which may cover vertigo, pre-syncope,

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2
Q

What is vertigo?

A

a sensation of movement, usually spinning, usually in the horizontal plane

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3
Q

What semicircular canal is invovled in dizziness on a roundabout?

A

lateral (horizontal) canal

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4
Q

What are the organs involved in balance?

A

ear; eye; joints; heart; brain

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5
Q

Why would RA or OA affect balance?

A

joint receptors give information about where those joints are- proprioception- if RA or OA, these receptors could be affected

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6
Q

How could stress lead to vertigo?

A

if stressed and hperventilate

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7
Q

When does nystagmus occur?

A

when the semicircular canals are being stimulated while the head is not in motion- VOR is initiated

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8
Q

What does the direction of nystagmus depend on?

A

the canal being stimulated

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9
Q

What does nystagmus differentiate between in the causes of dizziness?

A

nystagmus will be observed in vestibular pathologies but not in non-vestibular

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10
Q

What are hte most common causes of diziness?

A

postural hypotension; side effect of medication and psychogenic

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11
Q

What are some associated symptoms of dizziness?

A

tinnitus; LOC; palpitations; incontinence

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12
Q

What is the commonest cause of vertigo on looking up?

A

benign positional paroxysmal vertigo

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13
Q

What are the causes of BPPV?

A

head trauma; ear surgery; idiopathic

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14
Q

What is the pathophysiology of BPPV?

A

otolith materal from utricle displaced into semicircular canals

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15
Q

What SCC is commonly affected in BPPV?

A

posterior

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16
Q

What may BPPV be confusedwith?

A

vertebrobasilar insufficienc

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17
Q

How can you differentiate between BPPV and vertebrobasilar insufficienct?

A

for VBI need other symptoms of impaired circulation in posterior brain eg visual disturbance; weakness; numbenss

18
Q

When do patients wtih BPPV get vertigo?

A

always on movement- looking up; turning in bed; moving head quiccklly; bending forward etc

19
Q

How long do BPPV episodes last?

A

seconds- minutes

20
Q

What are the associated symptoms of BPPV?

A

none- no tinnitus; hearing loss or aural fullness

21
Q

What is the diagnostic test for BPPV?

A

Hallpike’s test

22
Q

How is Hallpike’s test carried out?

A

sit on couch so that head will be off one end when pt lies back, turn head 45 to one side- to the side you want to test; warn pt NOT to close eyes if dizzy; lie back as quickly as possible ; hold in position and observe

23
Q

What is the limitation of Hallpike’s test?

A

only tests posterior and superior SCC- not the anterior

24
Q

How long must you wait for Hallpike’s test?

A

at least 30 seconds

25
Q

What does Hallpike’s test show?

A

Nystagmus

26
Q

What is the limitation of the test?

A

test fatigues- much reduced or absent response on repition- so if fails first time cannot do for a while

27
Q

What type of nystagmus does posterior SCC give?

A

torsional

28
Q

What is the purpose of the Epley manoeuvre?

A

move patient into different positions, wait 30s in each to move the crystals out of the SCC

29
Q

What is the Brandt-Daroff exercise?

A

similar idea to Epley manouevre but easier for patients who are very dizzy

30
Q

How long does vestibular neuronitis last?

A

days- throwing up continously

31
Q

What are the associated symptoms of vestibular neuronitis?

A

no associated tinnitus or hearing loss but may have other viral infection smptoms

32
Q

What causes vestibular neuronitis?

A

virus

33
Q

What is the difference between vestibular neuronitis and labyrinthitis?

A

labyrinthitis involves the whole labyrinth, not just the vestibular nerve so may have associated tinnitus or hearing loss

34
Q

What is the treatment for vestibular neuronitis/ labyrinthitis?

A

supportive with vestibular sedatives- self-limitin

35
Q

What is the pathophysiology of Menieres?

A

pressure of endolymph is greater than perilymph so perilymph is smaller- ?salt balance

36
Q

What is seen on history of Menieres?

A

hx of recurrent, spontaneous, rotational vertigo with at least 2 eps >20 mins (often lasting hours0
worsening tinnitus on affected side
aural fullness on affected side
SNHL

37
Q

What is the managemnt of menieres?

A

supportive; tinnitus therpay; hearing aids-pts will eventuall get HL; prevention- salt restriction (diuretics?); bethistine; caffeine; alcohol; stress; frommet insertion; intratympanic gent/steroids

38
Q

What is important to do in the diagnosis of Menieres?

A

exclude other causes eg vestibular schwannoma- do MRI”

39
Q

How does intratympanic gentamicin work in menieres?

A

poisons vestibular apparatus so dont get vertigo- will also destroy hearing

40
Q

What is ataxia?

A

loss of control over body movements

41
Q

What is the most common auditory symptom with migraine?

A

phonophobia

42
Q

what other symptoms do pts with migraines get?

A

vertigo and ataxia and motion sickness

ENT (13 decks)

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