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Semester 5 PMNM Exam 8 > Vestibular Exam > Flashcards

Vestibular Exam Flashcards

1
Q

Reflex System - VOR is what

A

Gaze stabilization with head movement

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2
Q

Reflex System - Gain is measuring what

A

Movement of they eye relative to the movement of the head - it should be 1.0 (where eye magnitude equals head movement magnitude)
Relationship of eye velocity to head velocity

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3
Q

Reflex System - COR

A

Cervical Ocular Reflex
Signals head movement relative to body position - Body rotates on stool while head remains stationary - common with whiplash

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4
Q

Reflex System - OOR

A

Oto ocular reflex
Controls vertical and horizontal eye movement via the linear VOR
Gaze stabilization with head tilt

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5
Q

Reflex System - VSR

A

Input from otoliths and canals

Stabilizes head and erect stance - output to antigravity muscles

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6
Q

Peripheral vs. Central imbalance

A

Peripheral - moderate

Central - severe

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7
Q

Peripheral vs. Central nausea

A

Peripheral - severe

Central - minimal

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8
Q

Peripheral vs. Central auditory

A

Peripheral - auditory problems

Central - rare

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9
Q

Peripheral vs. Central neuro symptoms

A

Peripheral - rare (no problems with coordination)

Central - Common

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10
Q

Peripheral vs. Central compensation

A

Peripheral - rapid (good recovery time)

Central - slow (months to years)

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11
Q

Peripheral vs. Central onset of symptoms

A

Peripheral - sudden onset of vertigo

Central - gradual worsening of symptoms

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12
Q

Peripheral vs. Central oscillopsia

A

Peripheral - mild unless bilateral

Central - severe

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13
Q

Peripheral Nystagmus - Spontaneous

A

Occurring when just sitting there
Combined movements
Well attenuate

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14
Q

Peripheral Nystagmus - Positional

A

Change position of head
Torsional upbeat
Latency is common
It will fatigue

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15
Q

Central Nystagmus - Spontaneous

A

Purely unidirectional
Won’t decrease with fixation
It will not stop

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16
Q

Central Nystagmus - Positional

A

Vertical upbeat (immediate)
Latency is uncommon
Usually will not fatigue - it will just keep going

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17
Q

Things to consider in vertigo

A

Define dizzy

Medications

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18
Q

Things to consider in vertigo - Define dizziness

A

Symptoms
Tempo
Circumstances - how long does it last, what makes it better/worse

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19
Q

Things to consider in vertigo - Medications

A 
Alcohol
Tranquilizers
Antihypertensives
Anticonvulsants
Amnoglycosides/Antibiotic
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20
Q

Acute unilateral vestibular loss - 9% of clinic visits with c/o dizziness are dx as ___ or ___

A

Neuritis

Labryinthitis

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21
Q

Acute unilateral vestibular loss - Neuritis

A

Sudden onset, vertigo, nausea, severe 3-4 days, worse in first 24 hours
Inflammation of the vestibular nerve

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22
Q

Acute unilateral vestibular loss - Labyrinthitis

A

Viral or bacterial infections
Inflammation of the SC canals
Linked to cochlea and hearing loss

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23
Q

Acute unilateral vestibular loss - head injury

A

Inner ear concussion
Fx to temporal bone
Increase in ICP leading to periplymph fistula

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24
Q

Episodic Unilateral Vestibular Loss - Meniere’s Disease

A

Increase in endolymph volume causing membranous labyrinthine distension and rupture

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25
Q

Episodic Unilateral Vestibular Loss - Perilymphatic Fistula

A

Caused by disruption of labyrinth membranes, creating a passage between perilymph and the middle ear

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26
Q

Episodic Unilateral Vestibular Loss - perilymphatic fistula - events

A

Head injury
Barotrauma
Penetrating injury to tympanic membrane

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27
Q

Progressive Unilateral Vestibular Loss - Acoustic Neuroma

A

Usually around CN 8 at cbm/pontne
Evident on MRI
Slow onset

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28
Q

Progessive Unilateral Vestibular Loss - Acoustic Neuroma S/S

A

Progressive unilateral hearing loss
Tinnitus
Mild disequilbrium

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29
Q

Peripheral Bilateral Vestibular loss - incidence

A

11%

Irreversible so not a healing or recovering process

30
Q

Peripheral Bilateral Vestibular loss - causes

A 
Meningitis 
Polyneuropathy (diabetes) 
Neurofibromatosis 
Acoustic neuroma
Congenital malformation
Ototoxic drugs
31
Q

Peripheral Bilateral Vestibular loss - Impact

A

44% change their driving habits
55% limit social activities and have problems with ADLs
31% increase in fall risk

32
Q

Central Vertigo - Causes

A

CVA, HI
Unable to retrain if cbm is involved
Long term rehab

33
Q

Central Vertigo - Symptoms

A 
Dizziness not related to activity or position 
Falls/Disequilibrium 
Lightheaded (full/foggy) 
Spontaneous nystagmus 
Directional nystagmus 
Poor smooth pursuit
34
Q

Non vestibular - dizziness and imbalance - Vestibular balance and rehabilitation therapy (VBRT)

A

Beneficial to people with a non vestibular dysfunction

35
Q

Non vestibular - dizziness and imbalance – people with symptoms that were provoked with head or visual motion (more of a motion sensitivity)

A

Improve with vestibular exercise/gaze stabilization and balance training

36
Q

Non vestibular - dizziness and imbalance - Mal de Debarquement

A

Typically after cruise and they still feel like they are on boat
Some people can persist for weeks or months

37
Q

Non vestibular - dizziness and imbalance - Migraine associated dizziness

A

Can be with migraine or can be atypical migraine where it is just the symptoms of the migraine without the headache

38
Q

Non vestibular - dizziness and imbalance - Primary anxiety and panic

A

Can make symptoms worse

39
Q

Examination

A 
Hx
Medications
Orientation 
ROM
Sensory 
Strength 
Coordination 
Balance
Gait
40
Q

Medications - Meclizine

A

Prevent and rx nausea and motion sickness

Side effects - drowsiness, hypotension

41
Q

Medications - Diazepam

A

For anxiety

Side effects - drowsy, ataxia, confusion, fatigue, respiratory depression

42
Q

Medications - Meds to control nausea and vomiting

A 
Trimethobenzamide
Prochlorperazine
Scopalamine
Droperidol
Side effects - Drowsy, Parkinsonism, blurred vision, confusion, changes in BP
43
Q

Medications - often given for what reason

A

Hopes of decreasing the symptoms or to stop the level of discomfort
Most of them will dampen the CNS system

44
Q

Medical and Lab Examinations - Test for Labyrinthine, Vestibular Nerve

A

Caloric Test
Rotary Chair Testing
Quantified Dynamic Visual Activity

45
Q

Medical and Lab Examinations - Test for Labyrinthine, Vestibular Nerve - Caloric Test

A

Hot/warm in the ear to test to identify which ear is impacted

46
Q

Medical and Lab Examinations - Test for Labyrinthine, Vestibular Nerve - Rotary chair testing

A

Sit in a chair that spins n a dark room - measuring nystagmus to differentiate diagnosis

47
Q

Medical and Lab Examinations - Test for Labyrinthine, Vestibular Nerve, Otolith

A

Vestibular evoked myogenic potential test (VEMP)

Subjective visual vertical test

48
Q

Outcome measures - body structure

A 
Dynamic visual acuity 
Sharpened romberg
Sensory orientation test
CTSIB
Visual analog scale 
Motion sensitivity quotient
49
Q

Outcome measures - activity and participation

A 
5XSTS
Functional reach
Gait velocity
Mini BESTest
Berg
DGI/FGA
4 square step test
Single leg stance
TUG
50
Q

Outcome measures - questionnaires

A

Dizziness Handicap Inventory
Activities Specific Balance Confidence Scale
Vestibular Activities of Daily Living
Modified Fast Evaluation of Mobility, Balance, and Fear Baseline Questionnaire

51
Q

Vestibular Exam

A 
VOR deficiency: 
Spontaneous nystagmus
Gaze holding nystagmus
Smooth pursuit 
Saccadic eye movement
VOR cancellation
Slow VOR
Rapid VOR
Head thrust (Halmagyi) 
Optokinetic nystagmus
Static dynamic visual acuity 
Post head shaking nystagmus
52
Q

VOR 1

A

Eyes stationary

Head turning

53
Q

VOR 2

A

Eyes and object turning in opposite directons focusing on an object

54
Q

Vestibular exam - motion intolerance

A

Hallpike
Motion sensitivity test
Generally hallpike is gold standard for BPPV

55
Q

Vestibular exam - disequilibrium

A

Motion specific
Sensory condition
Functional task specific

56
Q

Differential Diagnosis/Red Flags - Lightheadedness

A

Can be from a lot of things

57
Q

Differential Diagnosis/ Red Flags - Dysequilibrium without dizziness and no dx

A

Undiagnosed central cause

Need to refer

58
Q

Differential/Red Flags - Sudden onset of hearing loss

A

Acoustic neuroma

Refer to neurologist

59
Q

Differential/Red Flags- Drop attacks

A

Cardiopulm or neuro

Need to refer

60
Q

Differential/Red Flags - Neck pain/instability

A

Cervical ligament instability

61
Q

Differential/Red Flags - No tx effect after 30 days

A

Acoustic neuroma

Refer to neurologist or PCP

62
Q

Differential/Red Flags - Facial numbness

A

Acoustic neuroma

Undx CNS disease

63
Q

Differential/Red Flags - Vertigo with vertical nystagmus and downward gaze

A

Red flag to refer

64
Q

Differential/Red Flags - Urgent referrals to physician

A 
Unexplained unilateral hearing loss
Orthostatic hypotension
Unexplained drop attacks
Suspected vertebrobasilar insufficency 
Unexplained neuro or CN dysfunction
Vertigo with vertical nystagmus
65
Q

Goals and interventions

A

Decrease dizziness symptoms during functional activities
Improve balance
Understanding HEP that they will do 3 or 4 times a day

66
Q

Clinical practice guidelines for peripheral vestibular hypofunction - Vestibular PT is effective for

A 
Acute, sub acute, and chronic unilateral vestibular hypofunction (UVH)
Bilateral hypofunction (BVH)
67
Q

Clinical practice guidelines for peripheral vestibular hypofunction - exercise is effective for improved

A

functional goals with dosage of minimum TID for total of 20 minutes - moderate evidence (min of three sessions per day)

68
Q

Clinical practice guidelines for peripheral vestibular hypofunction - PT supervise vestibular rehab

A

Moderated evidence

Don’t necessarily have to see them ongoing - is more of supervision

69
Q

Clinical practice guidelines for peripheral vestibular hypofunction - saccades and smooth pursuit alone for UVH or BVH

A

DO NOT DO SACCADES OR SMOOTH PURSUIT ALONE!!!

70
Q

Four primary exercise components

A

Exercise to promote gaze stability
Habituation
Balance and Gait Training
Walking program

71
Q

Four primary exercise components - Exercise to promote gaze stability

A 
VOR adaptation 
VOR substitution
VOR 1 
VOR 2
Eyes to target and then head to target
72
Q

Four primary exercise components - Habitutation exercises

A

Optokinetic stimuli (moving pattern)
Virtual reality
Bath address visual vertigo or motion difficulty

Semester 5 PMNM Exam 8 (8 decks)

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