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Neurology > Vestibular System > Flashcards

Vestibular System Flashcards

1
Q

Thin elastic cartilage covered by skin that collects air vibration

A

Auricle

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2
Q

Curved tube from the auricle to eardrum

A

External Auditory Meatus

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3
Q

Length of EAM

A

1 inch

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4
Q

Outer 1/3 of EAM

A

Elastic Cartilage

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5
Q

Inner 1/3 of EAM

A

Bony Cartilage

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6
Q

A narrow oblique slit-like cavity in the ear

A

Middle Ear

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7
Q

Another name of Middle Ear

A

Tympanic Cavity

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8
Q

Wall of the ear: Fenestra Vestibuli

A

Medial Wall

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9
Q

Wall of the ear: Canal of Tensor Tympani

A

Anterior Wall

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10
Q

Wall of the ear: Tympanic Membrane

A

Lateral Wall

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11
Q

Wall of the ear: Pyramid

A

Posterior Wall

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12
Q

Wall of the internal ear

A

Fenestra Vestibuli

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13
Q

Muscle located at the pyramid

A

Stapedius

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14
Q

Another name of the tympanic membrane

A

Eardrum

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15
Q

Shape of Eardrum

A

Concave Laterally

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16
Q

Innervation of outer tympanic membrane

A

CN 5 and 10

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17
Q

Innervation of the inner tympanic membrane

A

CN 9

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18
Q

Three auditory ossicles of the ear

A

Malleus, Incus, Stapes

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19
Q

Largest auditory ossicles

A

Malleus

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20
Q

Shape of Malleus

A

Hammer

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21
Q

Shape of Incus

A

Anvil

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22
Q

Shape of Stapes

A

Stirrup

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23
Q

Attachment of Malleus

A

Long process = ear drum; Head = incus

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24
Q

Attachment of Incus

A

Body = malleus; Long process = stapes

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25
Q

Attachment of Stapes

A

Head = incus; Base = fenestra vestibuli

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26
Q

Two movements of air in the ear

A

Medially and laterally

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27
Q

Movement of Eardrum + LP of the Malleus

A

Medially

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28
Q

Movement of LP of incus + Head of Stapes

A

Medially

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29
Q

Movement of Head of Malleus + Body of Stapes

A

Laterally

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30
Q

Two muscles of the ear

A

Tensor Tympani and Stapedius

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31
Q

Origin of Tensor Tympani

A

Own Canal

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32
Q

Insertion of Tensor Tympani

A

Handle of Malleus

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33
Q

Nerve of Tensor Tympani

A

CN 5

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34
Q

Action of Tensor Tympani

A

Dampens vibration

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35
Q

Origin of Stapedius

A

Pyramid

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36
Q

Insertion of Stapedius

A

Neck of Stapes

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37
Q

Nerve of Stapedius

A

CN 7

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38
Q

Action of Stapedius

A

Dampens vibration

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39
Q

“Labyrinth”

A

Internal Ear

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40
Q

Two major components of Internal Ear

A

Bony and Membranous Labyrinth

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41
Q

Series of cavities in the internal ear

A

Bony Labyrinth

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42
Q

The fluid that fills the Bony Labyrinth

A

Perilymph

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43
Q

Three parts of Bony Labyrinth

A

Vestibule, Semi-circular canals and Cochlea

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44
Q

Central part of the bony labyrinth

A

Vestibule

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45
Q

What is contained inside the Vestibule?

A

Otolith organs

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46
Q

Posterior part of the bony labyrinth

A

Semi-circular canals

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47
Q

What is contained inside the Semi-circular canals?

A

Semi-circular ducts

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48
Q

Three Semi-circular canals

A

Superior or Anterior, Inferior or Posterior, Lateral or Horizontal

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49
Q

Hollow bony tube making 2 1/2 spiral turns

A

Cochlea

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50
Q

What does cochlea resemble?

A

Snail shell

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51
Q

Orientation of the base of the cochlea

A

Posteromedial

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52
Q

Orientation of the apex of the cochlea

A

Anterolateral

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53
Q

What is contained inside the cochlea?

A

Duct of cochlea

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54
Q

What is lodged within the bony labyrinth?

A

Membranous Labyrinth

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55
Q

What surrounds the membranous labyrinth?

A

Perilymph

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56
Q

The fluid that fills the Membranous Labyrinth

A

Endolymph

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57
Q

What is the description of endolymph?

A

Higher density than water

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58
Q

Two parts of Membranous Labyrinth

A

Cochlear System and Vestibular System

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59
Q

What composes the cochlear system

A

Duct of Cochlea

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60
Q

Forms of spinal organ of corti

A

Duct of Cochlea

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61
Q

Receptor for hearing

A

Spinal Organ of Corti

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62
Q

3 canals at the cochlear system

A

Scala Vestibuli, Scala Media, Scala Tympani

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63
Q

Canals at the cochlear system: Oval Window

A

Scala Vestibuli

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64
Q

“Oval window”

A

Fenestra Vestibuli

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65
Q

Canals at the cochlear system: Round window

A

Scala Tympani

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66
Q

Canals at the cochlear system: Duct of Cochlea

A

Scala Media

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67
Q

What prevent scatter of vibration

A

Scala Tympani

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68
Q

What pitch is the anterior canals of the cochlear system?

A

High pitch

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69
Q

What pitch is the posterior canals of the cochlear system?

A

Low pitch

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70
Q

Three primary functions of the peripheral vestibular system

A

(1) Stabilizes visual image during head motion; (2) Maintains postural stability; (3) Provides information about spatial orientation

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71
Q

5 neural structures in each labyrinth

A

3 SCC and 2 otolith organs

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72
Q

Responsible for angular rotation

A

SCC

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73
Q

Responsible for linear rotation

A

Otolith Organs

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74
Q

What structure at the end of SCC?

A

Ampula

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75
Q

What is the gel-like structure contained in the ampulla?

A

Cupula

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76
Q

What is contained in the cupula?

A

Hair cells

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77
Q

Two types of hair cells in the cupula

A

Kinocilia and Stereocilia

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78
Q

Where do the hair cells sit in the cupula?

A

Crista ampularis

79
Q

Sensory organ for angular motion

A

Crista ampularis

80
Q

Responsible for horizontal linear acceleration

A

Utricle

81
Q

Responsible for vertical linear acceleration

A

Saccule

82
Q

Crystals in the otolith organs

A

Otoconia

83
Q

The nerve that branched out in the hair cells of SCC and otolith organs

A

CN 8

84
Q

Where does CN 8 bring the signals to the brainstem?

A

Vestibular Nuclei

85
Q

4 places where signals from vestibular nuclei send off to

A

CN 346, Thalamus, SC, and Cerebellum

86
Q

What is the function of the signals sent in CN 3,4,6?

A

For Visual Image

87
Q

What is the function of the signals sent in the Cerebellum?

A

For Balance

88
Q

What is the function of the signals sent in SC?

A

For Postural Stability

89
Q

What is the function of the signals sent in the Thalamus to the cortex?

A

For Spatial Orientation

90
Q

3 principles of the vestibular system

A

Tonic Firing Rate, Push-pull mechanism, Vestibulo-ocular reflex

91
Q

“Brain detects head motion and direction through comparison of inputs between 2 vestibular system”

A

Push-pull mechanism

92
Q

“Vestibular system can detect head motion through excitation and inhibition”

A

Tonic Firing Rate

93
Q

“Stabilizes visual image in the retina by generating compensatory eye motions in the direction opposite to head motion”

A

Vestibulo-ocular reflex

94
Q

Resting Firing Rate

A

70-100 spikes/sec

95
Q

VOR when the head rotates to the right

A

MR of Right and LR of left

96
Q

Eye movement when looking at the right

A

LR of Right and MR of Left

97
Q

Eye movement when the head rotates right and down

A

Right IO and Left SR

98
Q

Eye movement when the head rotates right and up

A

Right SO and Left IR

99
Q

True or False: Head motion is C/L with eye motion

A

True

100
Q

5 signs and symptoms saw in patients with Vestibular conditions

A

Vertigo, Lightheadedness, Dysequilibrium, Oscillopsia, Nystagmus

101
Q

The only s/sx cannot be seen in patients with pure vestibular pathology

A

Lightheadedness

102
Q

“Out-of-balance”

A

Dysequilibrium

103
Q

Primary diagnostic indicator for most central and peripheral pathology

A

Nystagmus

104
Q

Illusion of movement

A

Vertigo

105
Q

“Fainting is about to occur”

A

Lightheadedness

106
Q

The motion of objects that are known to be stationary

A

Oscillopsia

107
Q

Possible causes of vertigo

A

BPPV, UVH, Central Lesion

108
Q

Possible causes of lightheadedness

A

HOPA: Hypoglycemia, OH, Panic attack, Anxiety

109
Q

Possible causes of dysequilibrium

A

BVH, UVH, Central lesion

110
Q

Possible cause of oscillopsia

A

Vestibular Hypofunction

111
Q

Nystagmus is slow and fast movement

A

Jerk Nystagmus

112
Q

Nystagmus that are equal in movement

A

Pendular Nystagmus

113
Q

Three peripheral vestibular pathologies

A

BPPV, UVH, BVH

114
Q

Most common vestibular pathology

A

Benign Paroxysmal Postural Vertigo (BPPV)

115
Q

BPPV is secondary to _______?

A

Biomechanical disorder

116
Q

Two biomechanical disorder that causes BPPV

A

Canalithiasis and Cupulolithiasis

117
Q

Otoconia adhered to the cupula

A

Cupulolithiasis

118
Q

Otoconia are found in SCC

A

Canalithiasis

119
Q

Signs and symptoms of BPPV

A

Vertigo and Nystagmus

120
Q

Vestibula condition due to asymmetric firing rate

A

Unilateral Vestibular Hypofunction (UVH)

121
Q

Possible causes of UVH

A

Viral insults, vascular events, trauma

122
Q

4 signs and symptoms of UVH

A

Vertigo, Oscillopsia, Dysequilibrium, Nystagmus

123
Q

Vestibula condition due to otoxicity

A

Bilateral Vestibular Hypofunction (BVH)

124
Q

The antibiotic that causes ototoxicity in BVH

A

Aminoglycosides

125
Q

Primary complaints by the patients with BVH

A

Dysequilibrium

126
Q

Do patients experience nystagmus and vertigo in BVH?

A

Usually NO

127
Q

When do patients experience nystagmus and vertigo in BVH?

A

Unless there is an asymmetry in firing rate

128
Q

4 CNS injuries that may affect the vestibular system

A

Vertebral Artery damage, TBI, TIA, MS

129
Q

What is the structure affected in Vertebral Artery damage?

A

Cerebellum

130
Q

What is the vestibular s/sx of Vertebral Artery damage?

A

Mimics vestibular pathologies

131
Q

What is the vestibular s/sx of TBI and TIA?

A

Vertigo

132
Q

What is the structure affected in MS?

A

Cranial nerve 8

133
Q

What is the vestibular s/sx of MS?

A

Identical to UVH

134
Q

Central or Peripheral: Severe Ataxia

A

Central

135
Q

Central or Peripheral: Nystagmus that can be suppressed by visual fixation

A

Peripheral

136
Q

Central or Peripheral: Mild Ataxia

A

Peripheral

137
Q

Central or Peripheral: (+) Vertigo

A

Both

138
Q

Central or Peripheral: (+) Diplopia

A

Central

139
Q

Central or Peripheral: (-) Hearing Loss

A

Central

140
Q

Central or Peripheral: (+) Hearing Loss

A

Peripheral

141
Q

Central or Peripheral: (+) Nystagmus

A

Both

142
Q

Central or Peripheral: Nystagmus that cannot be suppressed by visual fixation

A

Central

143
Q

Central or Peripheral: Altered Consciousness

A

Central

144
Q

Central or Peripheral: Tinnitus

A

Peripheral

145
Q

Central or Peripheral: Lateropulsion

A

Central

146
Q

Central or Peripheral: Fullness of Ear

A

Peripheral

147
Q

Nystagmus seen in Peripheral Vestibular Pathology

A

Horizontal and Jerky

148
Q

Nystagmus seen in Central Vestibular Pathology

A

Vertical and Pendular

149
Q

Two examinations for Eye Movements

A

Dix-Hallpike and Head-Shaking Induced Nystagmus

150
Q

The most common cause of vertigo

A

BPPV

151
Q

The most common positional test for BPPV

A

Dix-hallpike Test

152
Q

What is the tested ear in the Dix-hallpike test?

A

The ear that is pointed to the ground or rotation of the head

153
Q

5 steps in the Procedure of Dix-Hallpike Test

A

(1) Long Sitting (2) Rotate head any side (3) Supine (4) Extension of head or neck (5) Check for nystagmus

154
Q

A positive sign of Dix-Hallpike Test

A

(+) Nystagmus

155
Q

Condition tested in Dix-Hallpike Test

A

BPPV

156
Q

5 steps in the Procedure of Head-Shaking Induced Nystagmus Test

A

(1) EC (2) Flexion of head or neck (3) Oscillate head HORIZONTALLY (20 cycles) (4) EO (5) Check for Nystagmus

157
Q

A positive sign of Head-Shaking Induced Nystagmus Test

A

(+) Nystagmus

158
Q

Condition tested in Head-Shaking Induced Nystagmus Test

A

UVH

159
Q

Three assessments used for vestibular function

A

Rotation Chair Test, Caloric Test, Vestibular Evoked Myogenic Potential (VEMP)

160
Q

Two test used to check of SCC function

A

Rotation Chair Test, Caloric Test

161
Q

SCC: Administration of infusing warm/cold air or water in the auditory canal

A

Caloric Test

162
Q

Condition tested in Caloric Test

A

UVH

163
Q

SCC: Patient is rotated in the darkroom

A

Rotation Chair Test

164
Q

Condition tested in Rotation Chair Test

A

BVH

165
Q

The assessment used to check the function of otolith organs

A

Vestibular Evoked Myogenic Potential (VEMP)

166
Q

Two subtypes of VEMP

A

Ocular and Cervical VEMP

167
Q

The muscle tested in Ocular VEMP

A

Inferior Oblique

168
Q

The muscle tested in cervical VEMP

A

SCM

169
Q

How many decibels are exposed to the patient while administering the VEMP?

A

95 decibels

170
Q

Procedure of VEMP

A

The patient is exposed to loud clicks

171
Q

Interpretation of VEMP

A

If VEMP is absent = (+) UVH

172
Q

Two exercises used to treat patients with UVH

A

Gaze Stability Exercise and Habituation Exercise

173
Q

UVH exercise to improve VOR

A

Gaze Stability Exercise

174
Q

UVH exercise to improve motion sensitivity

A

Habituation Exercise

175
Q

What item is used in Gaze Stability Exercise?

A

Card

176
Q

3 steps in Gaze Stability Exercise

A

(1) Focus on card, (2) Rotate head to 1 side (3) Move card to opposite direction

177
Q

3 steps in Habituation exercise

A

(1) Determine provoking position, (2) Maintain provoking position (3) Repetition: 3-5x

178
Q

Habituation exercise is done how many seconds per position?

A

30 secs per position

179
Q

Four exercises used to treat patients with BVH

A

Tai Chi, Balance Exercise, Pool Exercise, Exercise to improve central programming movements

180
Q

What item is used in Exercise to improve central programming movements?

A

Cards

181
Q

4 step procedure of exercise to improve central programming movements using 2 cards

A

(1) Arrange cards horizontally, (2) focus on card A then B, (3) Arrange cards vertically, (4) focus on card A then B

182
Q

5 step procedure of exercise to improve central programming movements using 1 card

A

(1) Focus on the card, (2) EC, (3) Rotate head to one side (imagine that you are looking at card), (4) EO, (5) Focus on the card

183
Q

Three exercises used to treat patients with BPPV

A

Canalith Repositioning Maneuver (CRM), Brandt-Daroff Exercise, Liberatory Semont Maneuver

184
Q

Position of the patient in CRM: Anterior & Posterior SCC

A

Sitting

185
Q

Position of the patient in CRM: Horizontal SCC

A

Supine

186
Q

6 step procedure of CRM: Anterior & Posterior SCC

A

(1) Sitting (2) Rotate head to affected side (3) Supine with head/neck extension (4) Rotate head to unaffected side (5) Roll to shoulder (unaffected) (6) Assist to sitting (fit with collar)

187
Q

5 step procedure of CRM: Horizontal SCC

A

(1) Supine (2) Rotate head to affected side (3) Rotate head to the unaffected side; wait for few seconds 2x (4) Roll to prone (unaffected) (5) wait for the symptoms to stop

188
Q

What SCC does Brandt-Daroff Exercise use to improve?

A

Posterior SCC

189
Q

5 step procedure of Brandt-Daroff Exercise

A

(1) SItting (2) Rotate head to 1 side (3) Side-lying to opposite side (4) Sitting (5) Repeat to another side

190
Q

What SCC does Liberatory Semont Maneuver use to improve?

A

Posterior SCC

191
Q

4 step procedure of Liberatory Semont Maneuver

A

(1) Sitting (2) Rotate head to unaffected side (3) Sidelying on the affected side (4) from 1 side-lying to opposite side-lying (180 degrees turn to unaffected side)

192
Q

2 exercise of central lesions

A

Balance and Gait exercises

193
Q

Purpose of Central Pathology exercise

A

For safety

194
Q

Important Patient education

A

Without head motion, the vestibular system will not improve maximally

Neurology (14 decks)

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