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Adult Neuro One > vestibular > Flashcards

vestibular Flashcards

1
Q

semicircular canals

A

fluid filled loops which detect angular acceleration and head rotation

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2
Q

how many semicircular canals are there?

A

3 (anterior, posterior, horizontal)

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3
Q

otoliths

A

detect translation, linear acceleration, and head position relative to gravity

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4
Q

what are the two otoliths?

A

utricle and saccule

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5
Q

saccule detects _______ translation and utricle detects ______ translation

A

vertical
horizontal
(katie remembers by the horizontal cross on the t in utricle)

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6
Q

stereocilia

A

mechanosensing organelles of hair cells

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7
Q

stereocilia are oriented in rows of ___ heights to the tallest _______

A

ascending kinocilium

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8
Q

as you turn your head to the right, your ______ horizontal canal is excited and the _______ horizontal canal is inhibited

A

right
left

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9
Q

what is the resting firing rate of hair cells

A

90 spikes per sec

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10
Q

depolarization occurs with deflection _____ the kinocilium

A

toward

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11
Q

push pull mechanism of canals

A

as one canal increases firing rate and depolarizes, its pair decreases its firing rate and hyperpolarizes

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12
Q

vestibulo-ocular reflex is driven by the…

A

semicircular canals

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13
Q

what does the VOR do?

A

generates eye movement to match head movement to allow clear vision during head motion

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14
Q

how many vestibular nuclei are there?

A

four (superior, medial, lateral, and inferior)

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15
Q

the vestibular nuclei connect to the ______

A

cerebellum

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16
Q

what system do humans typically rely on for posture control in a stable, well-lit environment

A

somatosensory

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17
Q

vertigo

A

the sensation of movement

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18
Q

dizziness

A

can be used to describe anything from feeling faint, lightheaded, or unsteady

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19
Q

T or F: vertigo and dizziness are diagnoses

A

F

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20
Q

T or F: dizziness is one of the most common reasons adults visit their doctor

A

T

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21
Q

3 important components of subjective history for dizziness

A

1 - tempo: how long has it been going on, duration of spells?
2 - symptoms: lightheadedness, rocking, motion sickness, floating, vertigo?
3 - circumstances - spontaneous, with eye movement, after sitting up?

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22
Q

what are some red flags that you may see with dizziness?

A
  • cranial nerve involvement
  • diplopia, dysphagia, dysarthria, dysmetria
  • asymmetric weakness
  • numbness
  • clonus
  • severe HA
  • vertical nystagmus w/o torsion
  • spontaneous nystagmus in room light after two weeks
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23
Q

nystagmus

A

repetitive to and fro movement of the eyes that are initiated by slow phases

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24
Q

3 ways to induce physiologic nystagmus

A

1 - vestibular (rotational)
2 - visually induced
3 - extreme end point

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25
Q

2 types of pathologic nystagmus

A

spontaneous and positional

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26
Q

what tests should you do for oculomotor system with there are c/o dizziness? (8)

A

1 - spontaneous nystagmus
2 - gaze holding nystagmus
3 - smooth pursuit
4 - convergence
5 - saccades
6 - slow VOR
7 - VOR cancellation
8 - head thrust test

27
Q

spontaneous nystagmus

A

observe for nystagmus while they are looking straight ahead

28
Q

gaze holding nystagmus

A

have them follow tip of your finger with eyes only (H pattern) pause in each position to observe for nystagmus

29
Q

smooth pursuits

A

have patient follow your finger horizontally and up and down look for smooth movement

30
Q

saccades

A

hold your finger about 15 degrees to one side of your nose
have pt look at your nose then at your finger
repeat center to left, right, up and down

31
Q

convergence

A

have pt focus on the tip of your finger as you bring it towards their nose. have them tell you when they see double

32
Q

Pts should be able to converge ___ cm from tip of nose

A

6
*older adults typically have trouble with this

33
Q

slow VOR

A
  • grasp pts head firmly on both sides
  • tip it down 30 degrees and then rotate it side to side about 30 degrees
  • have pt look at your nose while doing this
34
Q

VOR cancellation

A

test is performed the same as slow VOR but now, you move in the same direction as you move the pt’s head
* watch for saccadic eye movements

35
Q

VOR rapid head thrust

A
  • grasp pts head firmly on both sides
  • tilt head down 30 degrees and have them look at your nose
  • move head slowly side to side and then quickly rotate their head (small range) to one side and hold it there *look for corrective saccade to refixate on your nose
36
Q

with peripheral causes of vestibular dysfunction fixation ________ nystagmus

A

decreases

37
Q

with central causes of vestibular dysfunction fixation ______ nystagmus

A

either does not change or increases

38
Q

typically, what direction is the nystagmus with peripheral causes? what about central?

A

peripheral = mixed plane (horizontal and torsional)
central = single plane

39
Q

with peripheral causes of vestibular dysfunction nystagmus increases with gaze ____- direction of quick phase. with central it ________ direction.

A

peripheral = toward
central = does not change or reverses

40
Q

benign paroxysmal positional vertigo (BPPV)

A

brief episode of vertigo when head is in certain positions

41
Q

what is the cause of BPPV?

A

otoconia from the utricle enter the semicircular canal. movement of the otoconia results in movement of the endolymph which pulls on the cupula and changes the firing rate in that canal

42
Q

two types of BPPV

A

canalithiasis
cupulolithiasis

43
Q

canalithiasis

A

otoconia are free moving within the semicircular canals

44
Q

cupulolithiasis

A

otoconia adhere to the cupula itself

45
Q

which type of BPPV is usually move difficult to treat

A

cupulolithiasis

46
Q

test for BPPV (anterior and posterior canals)

A

Dix-Hallpike

47
Q

Dix-Hallpike test

A

rotate head 45 degrees horizontally in long sitting position and have them lie down with head hanging over edge of bed about 30 degrees.
look for nystagmus

48
Q

which ear is being tested in dix-hallpike

A

anterior and posterior canal of the downward ear

49
Q

if a patient cannot lie supine or extend the head 30 degrees for dix-hallpike, what could you do?

A

do it in side lying

50
Q

how long do you hold dix-hallpike?

A

at least 60 seconds (unless you see nystagmus and it subsides in a quicker time period)

51
Q

test for BPPV (horizontal canals)

A

roll test

52
Q

roll test

A

pt supine with head flexed 20 degrees. roll head quickly to one side, back to midline, and then to the other side

53
Q

with dix-hallpike, if the anterior canal is affected you will see ________ beating while if the posterior canal is affected you will see ______ beating

A

ant = downbeating
post = upbeating

54
Q

you perform dix-hallpike on the right and observe upbeating right torsion. where is the pathology?

A

right posterior SCC

55
Q

you perform dix - hallpike on the right and observe downbeating left torsion. where is the pathology?

A

left anterior SCC

56
Q

you perform dix-hallpike on the left and observe upbeating left torsion. where is the pathology?

A

left posterior SCC

57
Q

you perform dix-hallpike on the left and observe downbeating right torsion. where is the pathology?

A

right anterior SCC

58
Q

you perform the roll test and observe geotropic nystagmus that is stronger on the right. where is the pathology?

A

right horizontal canal

59
Q

you perform the roll test and observe ageotropic nystagmus that is stronger on the right. where is the pathology?

A

left horizontal canal

60
Q

horizontal canal BPPV due to canalithiasis is _________ while cupulolithasis is _______

A

geotropic
ageotropic

61
Q

with cupulolithiasis, nystagmus lasts ______ than 60 seconds while with canalithiasis it lasts _______ than 60 seconds

A

greater
less

62
Q

T or F: with cupulolithiasis and central BPPV, you will see latency with the nystagmus

A

F: but you will with canalithiasis

63
Q

T or F: peripheral BPPV will have vertigo with nystagmus

A

T: but vertigo not always present with central

64
Q

T or F: central nystagmus fatigues

A

F: but peripheral does with repeated maneuvers

Adult Neuro One (10 decks)

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