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AUD fall 2019 vestib > Week 2 > Flashcards

Week 2 Flashcards

1
Q

brief overview of central vestibular pathology symptoms talked about in case history

A

milder in nature with gradual onset

*often associated with headache, visual changes or neurological deficits

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2
Q

brief overview of peripheral vestibular pathology symptoms talked about in case history

A

tends to be sudden onset, decreases with visual fixation, often accompanied by otologic symptoms (aural fullness, fluctuation on hearing, tinnitus)
*more likely to report nausea and vomiting

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3
Q

nystagmus with peripheral lesion

A

horizontal and torsional
inhibited by fixation
doesnt change with gaze

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4
Q

nystagmus with central lesion

A

purely vertical or horizontal
nor inhibited by fixation
direction changing with gaze

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5
Q

otologic symptoms with peripheral lesion?

A

hearing loss and tinnitus common

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6
Q

otologic symptoms with central lesion?

A

uncommon

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7
Q

latency after provocation with peripheral lesion

A

longer (>15 seconds)

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8
Q

latency after provocation with central lesion

A

short

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9
Q

fatigibility of peripheral lesion

A

yes

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10
Q

fatigability of central lesion

A

no

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11
Q

duration with peripheral lesion

A

variable

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12
Q

duration with central lesion

A

long

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13
Q

neurologic symptoms with peripheral lesion

A

no

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14
Q

neurologic symptoms with central lesion

A

yes

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15
Q

loss of consciousness with peripheral lesion

A

no

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16
Q

loss of consciousness with central lesion

A

possible

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17
Q

vertigo

A

an illusionary sense of movement or rotation

*can be pt spinning or the world spinning around them

18
Q

presyncope

A

lightheadedness just prior to falling

  • often pts report feeling like they are going to faint, but don’t actually
  • *if they faint, its not a disorder of the ear
  • need to look at heart, blood pressure, carotid artery blockage and do so quickly
19
Q

orthostatic hypotension

A
  • common cause of presyncope
  • this is when someone either stands up too quickly or sits up too quickly from the supine position
  • this happens in the young and old populations but see an increase with age (inadequate vascular supply, reduced reflex compensation)
20
Q

how to diagnose orthostatic hypotension

A

blood pressure is taken laying, sitting, and standing

*if a sig changes (>20 systolic pressure) is notes then it is orthostatic hypotension

21
Q

treating orthostatic hypotension

A

medication management: what medications could be causing the issue?
*counseling: pts should be urged to move slowly to allow the change in blood pressure to equalize

22
Q

vasovagal attacks

A
  • reduction of cardiac output by decreasing blood pressure and pulse rate
  • maybe w/ sight of blood, or a frightening event, heat exposure, bowel movement
  • dizziness, pallor, sweating, tingling hands, nausea
  • pts may pass out
  • EKG and medical eval often negative
  • tilt table is important
23
Q

treating vasovagal attacks

A

reevaluation of meds
education
counseling to reduce frusteration and anxiety

24
Q

heart disorders (leading to dizziness)

A
  • arrythmias
  • heart disease acquired or congenital
  • coronary artery disease
25
Q

psychological disequilibrium

A
  • anxiety induced, associated with panic attacks
  • usually lasting 10-15 minutes
  • accompanied by palpitations, parethesias, sweating, shortness or breath and dizziness
  • hyperventilation
26
Q

ocular disequilibrium

A
  • visual abnormalities send incorrect messages to the brain about spacial positioning
  • very common after changes in corrective lenses, or eye surgery
  • pts will have to adjust to the change by returning to life and allowing compensation of the VOR
  • motion sickness falls in this category
27
Q

motion sickness

A
  • occurs when there is a mismatch between vestib and visual systems
  • this is also why reading a book in a car can make some people really sick
  • Dramamine reduces the input of the vestib system and reduces conflicting message
28
Q

pathologies that have short length dizziness

A
  • BPPV
  • perilymph fistula
  • SSCD
  • vascular insufficiency
  • Chiari malformation
  • Iatrogenic
29
Q

pathologies that have a medium length dizziness

A
  • meniere’s disease
  • migraine
  • metabolic
  • syphilis
  • panic attacks
  • TIA
  • Iatrogenic
30
Q

pathologies that have a long length dizziness

A
  • labyrinthitis
  • temporal bone trauma
  • stroke
  • multiple sclerosis
  • Iatrogenic (caused by medical treatment)
  • autoimmune inner ear disease
31
Q

static evaluation (bedside eval)

A
  • assess for spontaneous nystagmus
  • have pt look straight, right, left, up, and down with and without fixation (Fenzels lenses) look at eyes fro spontaneous or gaze nystagmus
  • results:
  • –horizontal nystagmus that is conjugate and without fixation= peripheral
  • –vertical or torsional (rotary) and may be stronger in one eye than the other and with fixation= central
32
Q

headshake test (bedside exam)

A
  • a test of the VOR. have pt shake head back and forth in horizontal plane for 20-30 seconds. have stop abruptly and open eyes with frenzel’s lenses or infra red goggles
  • Results:
  • –horizontal nystagmus beats away from the lesion or beats towards the healthy ear (usually)
  • –horizontal nystagmus beats toward the lesion after a delay or after the initial nystagmus sops
33
Q

head thrust (bedside exam)

A
  • a test of the VOR. the pt is asked to gaze steadily at a target in the room. move the pts head from side to side gently and then move briskly from one side to the other and hold while observing eyes position
  • results:
  • –eyes remain fixed on the target=normal
  • –eyes make a compensatory movement after the head is stopped to fixate on the target=abnormal
  • this test can indicate if the output of one or both labyrinths is depressed
34
Q

dynamic visual acuity (bedside exam)

A
  • a test of the VOR. have patient read a Snellen eye chart and establish visual acuity or static acuity. then rotate the pts head at 1-2 Hz horizontally and have them read the chart again
  • results:
  • –loss of one or two lines=normal
  • –loss of three lines indicated a VOR deficit
35
Q

saccades (bedside exam)

A
  • have pt rapidly shift gaze from nose to finger or wiggle fingers on each side at varying distances
  • results:
  • –grossly abnormal responses can indicate cerebellar dysfunction
  • –poor eyesight, unable to focus the fovea onto the target
36
Q

smooth pursuit (tracking) (beside exam)

A
  • have pt follow your finger as it moves slowly through their visual field
  • results:
  • –grossly abnormal responses can indicate cerebellar dysfunction
  • –again, interpret with caution
37
Q

Rhomberg (bedside exam)

A
  • have the pt stand with feet together, eyes open and arms to the side or across the chest. then have pt close their eyes
  • sharpened Rhomberg= have pt stand heel to toe with 1 foot in front and close eyes with arms at side or across chest, then close eyes
  • results:
  • -excessive sway (eyes closed)-peripheral lesion (usually to the side they lean)
  • -excessive sway (eyes pen)- proprioceptive weakness
38
Q

gait/tandem gait (beside exam)

A
  • have pt walk heal-to-toe in a straight line
  • tandem gait test- have patient walk heal-to-toe in a tight circle or figure eight
  • results:
  • –pt staggers or consistently leans to one side or the other=likely central
39
Q

fakuda stepping (bedside exam)

A
  • pt is asked to step (march) in place with eyes closed for 100 steps
  • results:
  • –rotation of the pt= peripheral lesion
  • –less than a 45 degree rotation= normal
40
Q

fistula test (beside exam)

A
  • manual setting of temp or pneumatic otoscopy

* nystagmus and dizziness is indicative of a fistula

41
Q

dysduadichokinesis (bedside exam)

A
  • rapid alternating movements such as tapping foot to floor of touching thumb to each finger rapidly
  • poor coordination of movements-cerebellar dysfunction
42
Q

hyperventilating syndrome tsting

A

*have pt over breathe for 90 seconds and see if they can reproduce their symptoms

AUD fall 2019 vestib (16 decks)

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