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2 ENT > The Dizzy Patient > Flashcards

The Dizzy Patient Flashcards

1
Q

what type of dizziness is all ear related dizziness

A

vertigo (spinning)

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2
Q

what can cause dizziness

A
  • cardiovascular problems
  • haematological and metabolic diseases
  • anxiety
  • neurological conditions
  • drug side effects/interactions
  • migraine
  • otological
  • trauma
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3
Q

what questions should you ask in a vertigo history

A

-duration of episodes

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4
Q

what does v short episodes of vertigo suggest (seconds)

A

benign paroxysmal positional vertigo

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5
Q

what does hour long episodes of vertigo suggest

A

Menieres

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6
Q

what do day long episodes of vertigo suggest

A

vestibular neuritis

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7
Q

what causes variable lengths of vertigo

A

migraine related vertigo

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8
Q

what are the balance systems

A

visual
cardiovascular
proprioceptive
vestibular

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9
Q

what are vestibular causes of dizziness

A

benign paroxysmal positional vertigo

meniere’s disease

vestibular neuronitis

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10
Q

visual causes of dizziness

A

cataracts

diabetes

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11
Q

proprioceptive causes of dizziness

A

diabetes
arthritis
neurology

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12
Q

cardiovascular causes of dizziness

A

arrhythmias

postural hypotension

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13
Q

what are central pathway causes of dizziness

A

migraine
stress
space occupying lesion
MS

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14
Q

what type of vertigo makes you dizzy rolling over in bed

A

BPPV

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15
Q

first attack severe, lasting house with nausea and vomiting

A

vestibular neuritis

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16
Q

light sensitive during dizzy spells

A

vestibular migraine

17
Q

one ear feels full or hearing loss before or during the dizzy spells

A

Meniere’s disease

18
Q

what examinations are done for dizziness

A 
otoscope 
neurological 
blood pressure (lying/standing)
balance system 
audiometry
19
Q

what is the vestibulo-occular reflex

A

ears sense the head rotating which causes the eyes to move in the other direction

20
Q

what happens to the vestibule ocular reflex in right vestibular neuritis

A

the right side of the ear can’t sense balance so doesn’t cause the eye to move in the opposite direction

21
Q

which ear does the eye twitch to with a nystagmus

A

the ear with the problem

if they’re going both ways its a central region (same for vertical nystagmus)

22
Q

how do you test vestibuloocular reflex

A

head impulse test

23
Q

what is benign paroxysmal postural vertigo (BPPV)

A

very common cause of vertigo caused by otolith material (crystals) from the utricle being displaced into the semi-circular canals (most commonly the posterior SSC)

24
Q

when do you get vertigo with BPPV

A
  • looking up
  • turning in bed
  • first lying down in bed at night
  • first getting out of bed in the morning
  • bending forwards
  • rising from bending
  • moving head quickly - often in one direction
25
Q

what tests can be done for BPPV

A

Dix Hhallpike test

26
Q

how is BPPV treated

A

Epely manoeuvre
Semont manoeuvre
Brandt-daroff exercises

(involve movement of the head to dislodge the crystals)

27
Q

symptoms of vestibular neuritis

A

prolonged vertigo (days)
no associated tinnitus or hearing loss
probably viral

28
Q

symptoms of labrynthitis

A

prolonged vertigo (days)
may be associated tinnitus or hearing loss
probably viral

29
Q

how do you treat vestibular neuritis and labrynthitis

A

supportive management
vestibular sedatives
self limiting

30
Q

what is the suspected cause of meniere’s disease

A

Endolymphatic hydrops

the high pressure inside the endolymph system can cause membranes to swell and the endolymph system rupturing

this leads to endolymph and perilymph mixing

though that the membranes heal over and it goes away

31
Q

signs/symptoms of Meniere’s

A

hearing loss
profound vertigo (>20 mins)
often happens in clusters
tinnitus (worsening on affected side)
feeling of aural fullness on effective side
sensorineural hearing loss on at least one occasion

32
Q

management of meniere’s

A 
supportive treatment during episodes 
tinnitus therapy 
hearing aids (if loss is constant) 
life style preventions 
grommet insertion 
intratympanic steroids/gentamycin 
surgery
33
Q

what can trigger a Meniere’s flare up

A

salt
caffeine
alcohol
stress

2 ENT (15 decks)

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