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Ear - Clinical Medicine IV > Vertigo > Flashcards

Vertigo Flashcards

1
Q

What is vertigo?

A

feeling of motion when not moving or exaggerated response to movement

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2
Q

What are the peripheral causes of vestibular dysfunction?

A

labryinthitis, benign paroxysmal positional vertigo, endolymphatic hydrops (Meniere’s), vestibular neuritis, head injury

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3
Q

What are the causes of central vertigo?

A

brainstem vascular disease, arteriovenous malformations, tumors, MS, vertebrobasilar migrane

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4
Q

What is the presentation of peripheral vertigo?

A

ACUTE, tinnitus, hearing loss, horizontal nystagmus

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5
Q

What is the presentation of central vertigo?

A

gradual, no auditory symptoms, vertical nystagmus

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6
Q

What are some drugs that can cause vertigo?

A 
ABX - doxy, metro, aminogly
Anticonvulsants - phenytoin
Hypnotics - diazepam
Analgesics - ASA
Traquilizing drugs & ETOH
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7
Q

What is benign paroxysmal positional vertigo?

A

triggered by head change position, clusters for several days, last few seconds, can treat via habiutation

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8
Q

When vertigo last seconds, think?

A

benign paroxysmal positional vertigo

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9
Q

When vertigo last minutes to hours, think?

A

meniere disease, migrane associated, otic symphilis, cogan syndrome

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10
Q

When vertigo last days to weeks, think?

A

vestibular neuritis

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11
Q

When vertigo constant, think?

A

central cause

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12
Q

What is the most common cause of peripheral vertigo?

A

BPPV

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13
Q

What age is the onset of BPPV and who?

A

40-50 yo, women

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14
Q

What manuver is used to dx BPPV?

A

Dix-Hallpike - pt lies back on exam table and head turned 45 degree one way, if normal do the same thing but turning to the opposite side, if still normal eye response, then repeat but extend the head off the exam table

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15
Q

What is the treatment for BPPV?

A

epley maneuver

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16
Q

What causes BPPV?

A

canalithiasis of posterior semicircular cancal

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17
Q

What do you need to observe nystagmus?

A

Frenzel goggles

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18
Q

What presents with sudden severe vertigo + vegetative symptoms?

A

vestibular neuritis

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19
Q

Does vestibular neuritis include hearing loss?

A

no

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20
Q

What are the symptoms of meniere’s disease?

A

episodic vertigo, SNHL, tinnitus, unilat aural fullness

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21
Q

When does meniere’s disease have its onset?

A

40-50 yo, whites

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22
Q

What is the hallmark of meniere’s disease?

A

endolymphatic hydrops

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23
Q

What is the triad of meniere’s disease?

A

vertigo, hearing loss, tinnitus

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24
Q

What is the treatment for meniere disease?

A

low salt diet and diuretics

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25
Q

Contiguous vertigo + hearing loss =

A

labrinthitis

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26
Q

Contiguous vertigo + no hearing loss =

A

vestibular neuritis

27
Q

What is the treatment for vestibular neuritis and labrynthitis?

A

steroids first line

28
Q

What is a false sensation of mvmt associated with difficulty in balance or gait?

A

vertigo

29
Q

What is the perceived motion in vertigo?

A

rotary

30
Q

What is the first step in dx vertigo?

A

get info on what it actually feels like - dizziness or vertigo
dizziness - light headed
vertigo - room is spinning

31
Q

What causes peripheral vertigo?

A

secondary to disorders of inner ear or 8th CN

32
Q

What causes central vertigo?

A

CNS disorder, vestibular nuclei and pathway

33
Q

What is the presentation of peripheral vertigo?

A

sudden, intermittent with severe symptoms, affected by head position and mvmt. N/V, motor function intact

34
Q

What is the presentation of central vertigo?

A

gradual, constant, milder, unaffected by head position, N/V less likely, motor function issues

35
Q

What do you see in cerebellar stroke?

A

bilat or vertical nystagmus, limb ataxia, gait disturbance, CAN NOT stand w/o support

36
Q

What are some urgent considerations?

A

cerebellar stroke, CV disease, Vestibular neuritis and labrynthitis

37
Q

What do you get if you suspect urgent causes?

A

CT or MRI w/ internal auditory canals

38
Q

What are the possible causes of central vertigo?

A

cerebellar bleeds, infarcts and tumors, lesion of brainstem, MS. cerebellopontain angle tumors

39
Q

When do you admit a vertigo pt?

A

neuro deficits or cardiac issues, if unable to walk despite max tx, protracted vomiting, significant co morbid, concern of central vertigo

40
Q

What is the motion of nystagmus in central?

A

vertical

41
Q

What is the motion of nystagmus in peripheral?

A

horizontal, rotary or absent

42
Q

Can you fatigue a central nystagmus?

A

NOPE

43
Q

When is an abnormal time you can observe horizontal nystagmus?

A

cerebellar infarction

44
Q

What are the steps to hallpike maneuver?

A

lie back and neck extended, sit back up and lay down again, turn head to one side, repeat and have them turn head to other side

45
Q

What is a nystagmus with hallpike that is unidirection, latent and fatigues?

A

peripheral origin

46
Q

What do you use to alleviate symptoms of vertigo?

A

Antihistamines
Meclizine 12.5-25mg every 8 hours PRN vertigo
Benadryl 25-50mg every 4-6 hours PRN
Anticholinergics
scopolamine – transdermal patch, apply q72 hours

47
Q

What antiemetic/anti nausea do you use?

A

ondansetron (Zofran) 4 mg q 4-6 hr PRN

Phenothiazines - prochlorperazine, promethazine

48
Q

What are the common causes of peripheral vertigo?

A

benign paroxysmal persitional vertigo, Meds, Head injury, vestibular neuronitis, labryrinthitis, meniere’s disease, pressure on vestibular nerve

49
Q

What are the crystals in BPPV?

A

otoconia

50
Q

Where do otoconia sit?

A

basement but can get moved during activities

51
Q

What is the most common cause of peripheral vertigo?

A

BPPV

52
Q

When are symptoms worse in BPPV?

A

in the morning

53
Q

How do you dx BPPV?

A

hallpike

54
Q

How do you tx BPPV?

A

epley, meds for symptoms, rarely surgery

55
Q

What do you have to do after eply?

A

sleep sitting up 2 nights, dont bend head a lot for 1 wk

56
Q

When does BPPV pt come back?

A

2 wks later

57
Q

What is the treatment for labryrinthitis?

A

diazepam or benzodiazepines - vestiblular suppressant
Short course of steroids
Antiviral therapy - acyclovir, famciclovir, valacyclovir

58
Q

Is hearing affected in vestibular neuronitis?

A

no

59
Q

What is vestibular neuronitis due to?

A

HSV type 1 in vestibular ganglia

60
Q

How do you treat vestibular neuronitis?

A

steroids, antivirals

61
Q

How do you distinguish labrynrinthisi from vestibular neuronitis?

A

labrynthrinthis - hearing loss

Steroid and antiviral

62
Q

What happens in meniere’s diseae?

A

increase in fluid of endolymphatic system

63
Q

What happens in menieres when endolymph swells?

A

microruptures - mixing of perilymph and endolymph

64
Q

What is the quadrad of meniere’s disease?

A

vertigo - 2 episodes 20 min w/ nystagmus
tinnitus,
sensation of aural fullness,
hearing loss - lower 20-25 than unaffected side

Ear - Clinical Medicine IV (15 decks)

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