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Clin Med III Disease Key Notes > Vertigo & Syncope (Exam #4) > Flashcards

Vertigo & Syncope (Exam #4) Flashcards

1
Q

What definition involves sensation of abnormal motion; nystagmus, postural instability?

A

Vertigo

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2
Q

What type of lesion is likely present with Peripheral Vertigo?

A

Vestibular lesion

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3
Q

What type of lesion is likely present with Central Vertigo?

A

Brain lesion

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4
Q

What condition involves sudden/acute, horizontal/torsional nystagmus, NO neuro sxs?

A

Peripheral Vertigo

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5
Q

What condition involves gradual/progressive, vertical and non-fatigable nystagmus, neuro sxs?

A

Central Vertigo

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6
Q

What type of nystagmus is present with Peripheral Vertigo (2)? What about with Central Vertigo (2)?

A
  • Peripheral = horizontal/torsional

- Central = vertical and non-fatigable

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7
Q

What is the general onset of Peripheral Vertigo? What about with Central Vertigo?

A
  • Peripheral = sudden/acute

- Central = gradual/progressive

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8
Q

What three conditions should always be R/O with a presentation of dizziness?

A
  • CVA
  • MS
  • Acoustic Neuroma
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9
Q

What three associated sxs often present with dizziness?

A
  • N
  • V
  • Hearing loss
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10
Q

What three changes constitute as orthostasis?

A
  • Drop in SBP of 20+
  • Drop in DBP of 10+
  • Drop in HR of 20+
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11
Q

What is nystagmus? How do you classify it?

A

Slow drift one direction → fast response in opposite direction
- Direction of nystagmus is the direction of the fast response

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12
Q

What does Caloric Testing test, and what is it used to differentiate?

A

Caloric Testing: tests vestibulo-ocular reflex

- Peripheral (vestibular) vs. Central (brainstem)

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13
Q

What does a normal Caloric Test looks like?

A

Normal = COWS

  • Cold water = opposite nystagmus
  • Warm water = same side nystagmus
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14
Q

If the Caloric Testing is abnormal, what is this called and what might this indicate?

A

Vestibular paresis = Peripheral Vertigo

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15
Q

What two drug classes are considered vestibular suppressants, and what is an example med for each?

A

Anticholinergics
- Scopolamine

Antihistamines

  • Meclizine
  • Dimenhydrinate
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16
Q

What is the MOST common cause of vertigo?

A

Benign Paroxysmal Positional Vertigo (BPPV)

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17
Q

What are two possible etiologies of Benign Paroxysmal Positional Vertigo (BPPV)?

A
  • Prolonged bedrest

- Head trauma

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18
Q

What condition involves brief vertigo episodes (<1 minute)?

A

Benign Paroxysmal Positional Vertigo (BPPV)

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19
Q

What might induce Benign Paroxysmal Positional Vertigo (BPPV)?

A

Changes in head position

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20
Q

What dx test can confirm Benign Paroxysmal Positional Vertigo (BPPV), and how?

A

Dix-Hallpike Maneuver

- Reproduce vertigo and horizontal nystagmus

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21
Q

What is the tx for Benign Paroxysmal Positional Vertigo (BPPV)?

A

Self-limiting

  • Education/reassurance
  • Positioning maneuvers
  • Vestibular rehab
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22
Q

What condition involves single attack of severe vertigo lasting days/weeks?

A

Vestibular Neuritis

- AKA Vestibular Neuronitis, Labyrinthitis

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23
Q

What age group does Benign Paroxysmal Positional Vertigo (BPPV) present in (2)?

A
  • 50s

- 70s

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24
Q

What age group does Vestibular Neuritis present in?

A

Young/middle-aged adults

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25
Q

How can you differentiate Vestibular Neuritis from Labyrinthitis?

A
  • Vestibular Neuritis: no hearing sxs

- Labyrinthitis: hearing sxs present

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26
Q

How can you differentiate Benign Paroxysmal Positional Vertigo (BPPV) from Vestibular Neuritis?

What sxs is NOT seen with either?

A
  • BPPV = brief vertigo (<1 minute),
  • Vestibular Neuritis = severe vertigo lasting days/weeks

NO hearing sxs in either

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27
Q

What condition is secondary to endolymphatic hydrops? What two conditions/events may precipitate this?

A

Meniere Disease

- Possible precipitating Syphilis or head trauma

28
Q

What condition involves TRIAD of episodic vertigo, tinnitus, fluctuating hearing loss?

A

Meniere Disease

29
Q

What is the TRIAD associated with Meniere Disease?

A
  • Episodic vertigo
  • Tinnitus
  • Fluctuating hearing loss
30
Q

What two dx tests are positive with Vestibular Neuritis?

A
  • +Head Thrust Test

- Abnormal Caloric Testing shows vestibular paresis

31
Q

What is the tx for Vestibular Neuritis (2)?

A

Self-limiting

- Supportive care (bed rest, vestibular suppressants, anti-emetics, Prednisone taper?)

32
Q

How does the fluctuating hearing loss with Meniere Disease typically progress? How does this effect the vertigo sxs?

A

Gradually progressive → eventually irreversible

- Vertigo sxs stop when deafness is complete

33
Q

How do the episodic vertigo attacks differ for BPPV, Meniere Disease or Vestibular Neuritis?

A
  • BPPV: brief, <1 minute
  • Meniere Disease: sudden, last 20 minutes to 24 hours
  • Vestibular Neuritis: severe, lasts days/weeks
34
Q

What finding is seen on audiogram with Meniere Disease?

A

Sensorineural hearing loss

35
Q

What is the acute tx for Meniere Disease? What is the prophylactic tx (2)?

A
  • Acute = supportive

- Prophylactic = low salt diet; limit caffeine/nicotine/alcohol/MSG

36
Q

What condition involves an abnormal connection between perilymph and middle ear?

A

Perilymphatic Fistula

37
Q

What two sxs may present with Perilymphatic Fistula?

A
  • Hearing loss

- Tinnitus

38
Q

What is pneumatic otoscopy, and what condition can it present with?

A

Eye movement w/ pressure change

- Seen with Perilymphatic Fistula

39
Q

With what two conditions are hearing sxs present?

With what two conditions are hearing sxs NOT present?

A

Present = Perilymphatic Fistula, Meniere Disease

NOT present = BPPV, Vestibular Neuritis

40
Q

What condition involves sudden, transient LOC with spontaneous recovery?

A

Syncope

41
Q

What three sxs present with the prodrome of Vasovagal Syncope?

A
  • Pallor
  • Diaphoresis
  • Nausea
42
Q

What dx test can be used to evaluate recurrent episodes of unexplained syncope OR vasovagal syncope?

A

Tilt Table Test

43
Q

What two conditions can be diagnosed with a Tilt Table Test, and what is an abnormal result?

What is a normal result?

A
  • Recurrent episodes of unexplained syncope
  • Vasovagal syncope

Abnormal = exaggerated drop in BP (+/- change in HR)
- Normal = mild drop in BP AND increase in HR

44
Q

What two tests can be used to evaluate Syncope?

A
  • Tilt Table Test

- Carotid Sinus Massage

45
Q

What two conditions can be diagnosed with a Carotid Sinus Massage?

A
  • Recurrent episodes of unexplained syncope

- Hx of carotid sinus syncope

46
Q

What is an abnormal result of the Carotid Sinus Massage test (__ AND __OR__)?

A

Abnormal = sxs reproduced and period of asystole for 3-5 seconds OR drop in BP (50+ mmHg)

47
Q

What are two major CIs associated with the Carotid Sinus Massage test?

A
  • Prior TIA/CVA WITHIN 3 months

- Carotid bruits present

48
Q

What are four RF associated with Cardiac Syncope?

A
  • Abnormal EKG
  • Hx of ventricular arrhythmias
  • Hx of CHF
  • Age 45+ years
49
Q

How does Cardiac Syncope differ from other types of syncope?

A

Cardiac = NO prodrome

50
Q

What is the most common cause of OBSTRUCTIVE Cardiac Syncope?

A

Aortic stenosis

51
Q

What are the three types of Reflex Syncope? Which is most common?

A
  • Vasovagal = most common
  • Carotid Sinus
  • Situational
52
Q

What type of Syncope involves prodrome of pallor, diaphoresis and nausea?

A

Vasovagal Syncope

53
Q

What type of Syncope is neurally-mediated, and what does this mean?

A

Reflex Syncope

- Loss of SNS tone → vasodilation, bradycardia → hypotension, syncope

54
Q

What is the recommended tx for Carotid Sinus Syncope?

A

Cardiac pacemaker

55
Q

What population most often presents with Carotid Sinus Syncope?

A

Male with atherosclerosis

56
Q

What are the two types of Situational Syncope? Describe each

A
  • Micturition Syncope = after emptying distended bladder

- Tussive Syncope = with severe coughing

57
Q

What two populations most often present with Tussive Syncope?

A
  • COPD

- Children with asthma

58
Q

What often presents with Orthostatic (Postural) Hypotension (2)?

A
  • Autonomic Neuropathies

- Peripheral Neuropathies

59
Q

What are three txs for Orthostatic (Postural) Hypotension?

A
  • Avoid volume depletion
  • Med adjustment
  • Behavior modification
60
Q

What two sxs present with Subclavian Steal Syndrome?

What makes these sxs worse?

A
  • Vertigo
  • Syncope

Worse with arm exertion

61
Q

What sign often presents with Subclavian Steal Syndrome?

A

Difference in pulses of BUE

62
Q

What definition involves sense of imbalance (losing balance without sensation of movement)?

A

Disequilibrium

63
Q

What definition involves vague and nonspecific dizziness?

A

Lightheadedness

64
Q

What definition involves feeling impending faint or LOC? What is often the etiology of this?

A

Presyncope

- Often cardiac etiology

65
Q

With Cardiac Syncope, what are two examples of bradycarrhythmias? What are three tachycarrhythmias?

A

Brady

  • 2nd Degree AV Block, Type II
  • 3rd Degree AV Block (Complete Heart Block)

Tachy

  • WPW
  • SVT
  • VT
66
Q

What are two common findings seen with Syncope that are NOT seen with seizures?

A
  • Relation to posture

- Cardiac signs

Clin Med III Disease Key Notes (18 decks)

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