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Clinical Medicine Me > Vestibular > Flashcards

Vestibular Flashcards

1
Q

MEDICAL CAUSES of Vertigo

A

● CARDIOVASCULAR
● HYPOTENSION
● CARDIAC ARRYTHMIA
● CAD
● HYPERTENSION
● INFECTION
● HYPOGLYCEMIA

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2
Q

Causes of vertigo

A

Medical

  • Cardiac
  • Metabolic

Neurological

  • TBA
  • CVA

Vestibular

  • Peripheral
  • Central
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3
Q

NEUROLOGICAL CAUSES vertigo

A

● STROKE AND TIA
● VERTIBROBASILAR MIGRAINE
● BASAL GANGLIA DYSFUNCTION
● CEREBELLAR
● SEIZURE

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4
Q

OTOLOGIC CAUSES vertigo

A

● BPPV
● MENIERES DISEASE
● UNILATERAL VESTIBULAR DYSFUNCTION
● BILATERAL VESTIBULAR DYSFUNCTION
● MIDDLE EAR DYSFUNCTION
● FISTULA

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5
Q

Vertigo

A

● OVER 5 MILLION MD VISITS PER YEAR IN U.S.
● OVER 75 YEARS OF AGE
● MOST COMMON REASON TO SEE MD

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6
Q

CAUSES OF DIZZINESS

A

ETIOLOGY

PSYCHOGENIC
CERVICAL
METABOLIC
CENTRAL VESTIBULAR
PERIPHERAL VESTIBULAR
CARDIOVASCULAR

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7
Q

OTHER CAUSES OF VERTIGO

A

● A - alcohol
● E - epilepsy or exposure (heat stroke, hypothermia)

● I - insulin (diabetic emergency)

● O - overdose or oxygen deficiency (shortness of breath, hyperventilation)
● U - uremia (toxins due to kidney failure)

● T - trauma (head injury or shock)

● I - infection

● P - poisoning or psychosis

● S - stroke

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8
Q

PERIPHERAL VESTIBULAR PROBLEMS - UNILATERAL

A

● BPPV

● ACUTE UNILATERAL VESTIBULAR DEAFFERENTATION
● VESTIBULAR NEURITIS

● VESTIBULAR LABYRINTHITIS

● PERILYMPHATIC FISTULA

● ENDOLYMPHATIC HYDROPS

● MENIERES DISEASE

● ACOUSTIC NEUROMA

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9
Q

PERIPHERAL VESTIBULAR PROBLEMS - BILATERAL

A

● OTOTOXICITY

● INFECTION

● ACOUSTIC NEUROMA

● INNER EAR AUTOIMMUNE DISEASE

● MENIERES

● BPPV

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10
Q

BPPV THEORIES (2)

A

● CUPULOLITHIASIS
● CANALITHIASIS

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11
Q

CUPULOLITHIASIS

A

● DEBRIS FROM UTRICULAR MACULA SETTLES BY GRAVITY ON TO THE CUPULA OF THE SEMICIRCULAR CANAL

● CUPULA THUS OBTAINS A HIGHER SPECIFIC GRAVITY THAN THE ENDOLYMPH AND BECOMES SENSITIVE TO GRAVITY DURING CHANGES IN HEAD POSITION

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12
Q

Symptoms of Canalithiasis

A

BRIEF EPISODES OF VERTIGO INDUCED BY CHANGE IN HEAD POSITION

●USUALLY INVOLVES THE POSTERIOR SCC

● CONSISTENT TYPICAL CHARACTERISTICS

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13
Q

CHARACTERISTICS of Canalithiasis

A
  1. POSITIONALLY INDUCED
  2. LATENCY IN THE ONSET OF SYMPTOMS
  3. MOST COMMONLY TORSIONAL NYSTAGMUS WITH THE SUPERIOR ASPECT OF THE EYE BEATING TOWARD THE AFFECTED EAR WHICH APPEARS WITH THE SAME LATENCY AS THE COMPLAINTS OF VERTIGO
  4. A CRESCENDO AND DECRESCENDO OF THE VERTIGO AND NYSTAGMUS WITH LASTS LESS THAN 60 SECONDS
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14
Q

MOVEMENT TOWARD THE__________ IS EXCITATORY IN THE HORIZONTAL CANALS, BUT IN THE __________& _____ CANALS, MOVEMENT AWAY FROM THE ________IS EXCITATORY

A

AMPULLA

ANTERIOR

POSTERIOR

AMPULLA

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15
Q

Syptoms of Canalithiasis

A
  • SHOULD IMPLY A LONGER DURATION OF POSITIONAL NYSTAGMUS
  • SIMILAR EVENT OCCURS WITH ETOH
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16
Q

What is Canalithiasis?

A

● LOOSE PARTICLES DISPLACED INTO SCC WHICH WOULD INDUCE A MOVEMENT AWAY FROM THE AMPULLA, PULLS ON THE CUPULA AND EXCITES THE NEURONS
● SHORT DURATION OF NYSTAGMUS WHEN SCC PLACED IN THE SAME PLANE WITH GRAVITY

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17
Q

SURGERY for BPPV

A
  • LABYRINTHECTOMY
  • CHEMICAL LABYRINTHECTOMY
  • VESTIBULAR NERVE SECTION
  • PERILYMPHATIC FISTULA REPAIR
  • POSTERIOR CANAL PARTITIONING
  • ACOUSTIC NEUROMA REMOVAL
  • CHOLESTEATOMA REMOVAL
  • ENDOLYMPHATIC SAC DECOMPRESSION PROCEEDURES
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18
Q

VESTIBULAR NEURITIS

A
  • USUALLY VIRAL
  • DURING OR FOLLOWING AN UPPER RESPIRATORY INFECTION
  • PEAK OF CASES IN WOMEN IN THE 4TH DECADE, MEN IN THEIR 60’S
  • DIZZINESS NAUSEA AND VOMITING
  • CALORIC TESTS IPSILATERAL HYPORESPONSIVENESS
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19
Q

ACUTE VESTIBULAR DEAFFERENTATION

A

● AFTER SURGICAL ABLATION

● ACUTE PHASE OF VESTIBULAR NEURITIS

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20
Q

What is the acute phas of vestibular neutitis called?

A

Vestibular Deafferentation

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21
Q

PERIYMPHATIC FISTULA MOE

A
  • HEAD TRAUMA
  • BAROTRAUMA
  • SURGERY
  • PENETRATING INJURY
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22
Q

Perilympathic Fistula S&S

A
  • LOUD POPPING SOUND
  • SEVERE VERTIGO
  • HEARING LOSS
  • TINNITUS
  • TULIO’S PHENOMENON
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23
Q

PERILYMPHATIC FISTULA location

A

BETWEEN THE MIDDLE EAR AND THE PERILYMPH

24
Q

Perilympathic fistula agg factors

A
  • SNEEZING,
  • COUGHING
  • STRAINING
  • NOSE BLOWING WILL REPRODUCE THE SYMPTOMS
25
Q

Treatment for Perilympathic Fistula

A
  • Bed rest
  • REQUIRES IMMEDIATE SURGERY IF SNHL IS PRESENT
26
Q

BAROTRAUMA - causes

A
  • Implosion on descent
  • Explosion on ascent

● USUALLY INVOLVES RUPTURE OF UTRICLE AND SACCULE

27
Q

ENDOLYMPHATIC HYDROPS

A
  • INNER EAR FLUID CHEMISTRY SHOULD REMAIN CONSTANT
  • MALFUNCTION OF THE MECHANISMS WHICH MAINTAINS PRESSURE AND COMPOSITION CONSTANT
  • NERVE ENDINGS BECOME ABNORMALLY STIMULATED
28
Q

S&S of Endolympathic Hydrops

A
  • AURAL FULLNESS
  • TINNUTUS
  • HEARING LOSS
  • VERTIGO
29
Q

MENIERES DISEASE

A
  • IDEOPATHIC SYNDROME OF ENDOLYMPHATIC HYDROPS
  • MALFUNCTION OF RESORPTIVE FUNCTION OF ENDOLYMPHATIC SAc
30
Q

S&S of Menieres Disease

A
  • AURAL FULLNESS
  • DECREASED HEARING LOSS
  • TINNITUS
  • SEVERE VERTIGO AND DYSEQUILIBRIUM 30 MIN TO 24 HOURS
31
Q

Coservative treatment for Minieres Disease

A
  • Salt reduced diet
  • Dieuretic / Betaserc
  • Pressure chamber
  • Treatment with local overpressure
32
Q

Surgical and / destructive treatment for Minieres

A
  • Surgery of endolympathic sac
  • Gentamyacin injection
  • Vestibular nerve section
  • Complete destruction of inner ear
33
Q

IDEOPATHIC VESTIBULAR DEGENERATION

A
  • OCCURS WITH AGING
  • COMMON IN PATIENTS WITH EARLY BALDING OR GRAYING
  • ESPECIALLY IS GRAYING OCCURRED BEFORE AGE 30
34
Q

Acoustic Neuroma -cause

A
  • MAY BE INHERITED TENDENCY
  • TUMOR ON ACOUSTIC NERVE
35
Q

S&S of Acoustic Neuroma

A
  • PROGRESSIVE HEARING LOSS
  • TINNITUS IN ONE EAR
  • VESTIBULAR BRANCH COMPRESSION
  • IMBALANCE
  • VERTIGO
  • MAY BE SLOW GROWING
36
Q

CHOLESTEATOMA

A
  • CYST LIKE GROWTH
  • COMMONLY FORMS IN Pts WITH CHRONIC MID EAR INFECTION OR PERFORATED EAR DRUM
  • BENIGN TUMOR OF MIDDLE EAR
  • ERODES THE BONE OF THE INNER EAR
37
Q

SS of Cholesteatoma

A
  • HEARING LOSS
  • VERTIGO
  • FOUL DRAINAGE FROM THE EAR
38
Q

Causes of Bilateral Vestibular Loss

A
  • OTOTOXIC DRUGS
  • BILATATERAL MENIERES DISEASE
  • AUTOIMMUNE DISEASE SJORGRENS
  • SYPHILLIS
  • BILATERAL ACOUSTIC NEUROMA
  • INFECTION
  • OTOSCLOSIS
  • PAGETS DISEASE
39
Q

BILATERAL VESTIBULAR LOSS impairments

A
  • SEVERE OSCILLOPSCIA
  • GAIT SEVERELY IMPAIRED WITH HEAD MOVEMENT
  • UNABLE TO DO TANDEM STANCE WITH EYES OPEN
  • POOR OUTCOME ON FUKUDA STEP TEST
40
Q

BILATERAL VESTIBULAR LOSS SS

A
  • IF EQUAL ON BOTH SIDES NO VERTIGO NYSTAGMUS OR SKEW DEVIATION
  • NO GAZE STABILIZATION WITH HEAD MOVEMENT
  • SEVERELY IMPAIRED GAIT
  • VISUALLY AND PROPRIOCEPTIVELY DEPENDENT
41
Q

Ototoxic drugs - Antibiotics

A
  • AMINOGLYCOSIDES
  • STREPTOMYCIN
  • NEOMYCIN
  • GENTAMICIN
  • TOBRAMYCIN

OTHER ANTIBIOTICS

  • ERYTHROMYCIN
  • VANCOMYCON
  • CAPREOMYCIN
42
Q

Ototoxic Drugs- Anti Neoplastic Drugs

A
  • Cispatin
  • Carboplatin
  • Vincristin
  • Bleomycin
43
Q

Ototoxic Drugs- Loop Dieuretics

A

● Furosemide
● Ethacrynic Acid
● Bumetanide

44
Q

Ototoxic Drugs- Anti-Inflammatory Drugs

A
  • SALICYLATES
  • INDOMETHACINN
  • IBUPROPHEN
  • PIROXICAM (FELDANE)
45
Q

Ototoxic Drugs- Anti-Malaria Drugs

A

● QUININE
● CHOLOQUINE

46
Q

Ototoxic Drugs- Miscellaneous

A
  • HEAVY METALS
  • INDUSTRIAL CHEMICALS
  • ARSENICALS
  • LEAD
  • CARBON MONOXIDE
  • MERCURY
47
Q

VERTIBROBASILAR INSUFFICIENCY

A
  • COMMON CAUSE OF VERTIGO IN THE ELDERLY
  • OCCURS SUDDENLY NO WARNING
  • LASTS SEVERAL MINUTES
  • OFTEN WITH NAUSEA AND VOMITING
  • HEADACHE IMPAIRED VISION CAN ALSO OCCUR
48
Q

Common cause of vertigo in elderly

A

Vertibrobasalar insufficiency

49
Q

Etilogy of Dizziness- Timing

A
  • SUDDEN ONSET USUALLY PERIPHERAL
  • GRADUAL ONSET USUALLY CNS
  • INTERMITTENT USUALLY PERIPHERAL
  • CONTINUOUS USUALLY CNS
50
Q

Etiology of Dizziness- Associated Symptoms

A
  • NUMBNESS
  • DYSARTHRIA
  • CHANGE IN LOC
  • LINKED TO INJURY
  • LINKED TO RESPIRATORY ILLNESS
  • SCUBA ● RELATED TO POSITION
51
Q

Etiology of Dizziness- Peripheral

A
  • Neuritis
  • Menieres
  • BPPV
  • Barotrauma
  • Ototoxia
  • Surgery
  • Trauma
  • Acoustic Neuroma
  • Otosclerosis
52
Q

Etiology of Dizziness- Central

A
  • VERTIBROBASILAR INSUFFIENCY
  • MIGRAINE
  • LABYRININE
  • CEREBELLAR
  • BRAINSTEM INFARCTION
  • TIA
  • STROKE
53
Q

Ethiology of Dizziness- Medical

A
  • HYPOTENSION
  • HYPERTENSION
  • CARDIAC ARRYTHMIA
  • CORONARY ARTERY DISEASE
  • INFECTION
  • MEDICATION
  • HYPOGLYCEMIA
54
Q

Etiology of Dizziness- Phychophysiologic

A
  • ACUTE ANXIETY
  • CHRONIC ANXIETY
  • PANIC ATTACKS
  • SECONDARY GAIN
55
Q
A

Clinical Medicine Me (3 decks)

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