The Dizzy Patient

Question 1

what type of dizziness is all ear related dizziness

Answer 1

vertigo (spinning)

Question 2

what can cause dizziness

Answer 2

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

Question 3

what questions should you ask in a vertigo history

Answer 3

-duration of episodes

Question 4

what does v short episodes of vertigo suggest (seconds)

Answer 4

benign paroxysmal positional vertigo

Question 5

what does hour long episodes of vertigo suggest

Answer 5

Menieres

Question 6

what do day long episodes of vertigo suggest

Answer 6

vestibular neuritis

Question 7

what causes variable lengths of vertigo

Answer 7

migraine related vertigo

Question 8

what are the balance systems

Answer 8

visual
cardiovascular
proprioceptive
vestibular

Question 9

what are vestibular causes of dizziness

Answer 9

benign paroxysmal positional vertigo

meniere’s disease

vestibular neuronitis

Question 10

visual causes of dizziness

Answer 10

cataracts

diabetes

Question 11

proprioceptive causes of dizziness

Answer 11

diabetes
arthritis
neurology

Question 12

cardiovascular causes of dizziness

Answer 12

arrhythmias

postural hypotension

Question 13

what are central pathway causes of dizziness

Answer 13

migraine
stress
space occupying lesion
MS

Question 14

what type of vertigo makes you dizzy rolling over in bed

Answer 14

BPPV

Question 15

first attack severe, lasting house with nausea and vomiting

Answer 15

vestibular neuritis

Question 16

light sensitive during dizzy spells

Answer 16

vestibular migraine

Question 17

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

Answer 17

Meniere’s disease

Question 18

what examinations are done for dizziness

Answer 18

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

Question 19

what is the vestibulo-occular reflex

Answer 19

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

Question 20

what happens to the vestibule ocular reflex in right vestibular neuritis

Answer 20

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

Question 21

which ear does the eye twitch to with a nystagmus

Answer 21

the ear with the problem

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

Question 22

how do you test vestibuloocular reflex

Answer 22

head impulse test

Question 23

what is benign paroxysmal postural vertigo (BPPV)

Answer 23

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)

Question 24

when do you get vertigo with BPPV

Answer 24

• 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

Question 25

what tests can be done for BPPV

Answer 25

Dix Hhallpike test

Question 26

how is BPPV treated

Answer 26

Epely manoeuvre Semont manoeuvre Brandt-daroff exercises (involve movement of the head to dislodge the crystals)

Question 27

symptoms of vestibular neuritis

Answer 27

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

Question 28

symptoms of labrynthitis

Answer 28

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

Question 29

how do you treat vestibular neuritis and labrynthitis

Answer 29

supportive management vestibular sedatives self limiting

Question 30

what is the suspected cause of meniere's disease

Answer 30

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

Question 31

signs/symptoms of Meniere's

Answer 31

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

Question 32

management of meniere's

Answer 32

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

Question 33

what can trigger a Meniere's flare up

Answer 33

salt caffeine alcohol stress