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RRCCPA Clin Med Exam 4 > Hall dizziness lecture > Flashcards

Hall dizziness lecture Flashcards

1
Q

Sensation of motion when no motion is occuring

A

Vertigo

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2
Q

Sensation of disturbed spatial orientation

A

Dizziness

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3
Q

you have a patient that is sitting in front of you and you notice that their eyes are moving horizontally seemingly involuntarily, this is called?

A

Nystagmus

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4
Q

The oscillations of ones visual surroundings usually secondary to nystagmus is called

A

Oscillopsia

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5
Q

central vertigo originates in the ______. This can include a lesion of CN______

A

central vertigo originates in the CNS. This can include a lesion of CNVIII

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6
Q

a vertigo that is due to a disease that affects the labyrinth of the inner ear or the vestibular branch of CN VIII can is called _____

A

Peripheral vertigo

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7
Q

in contrast to peripheral vertigo central vertigo comes on ____

A

Slowly

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8
Q

Central vertigo may be ________ where peripheral may be _______ (referring to frequency)

A

Central: constant and progressive
Peripheral: episodic and recurrent

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9
Q

Your patient states that their vertigo is triggered if they turn their to the side and is relieved with motionlessness. From this description it is safe to assume that their veritgo is ______ in nature

A

Peripheral

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10
Q

Shit, your patients eyes are moving up and down vertically. This is bad. and idicative of what kind of vertigo

A

Central

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11
Q

a vertigo that is associated with tinnitus and nausea is _____

A

Peripheral

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12
Q

nystagmus associated with Central vertigo is _______ where peripheral is ______ (fatigable or not?)

A

Central: not fatigable
Peripheral: fatigable

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13
Q

What can cause both central and peripheral vertigo

A

trauma

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14
Q

vertigo associated with migraines is _______(central or periph?)

A

peripheral

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15
Q 
Match the pathology with central or peripheral assocaited vertigo:
CNS tumor 
Infection 
Vestibular neuritis 
Menieres disease 
BPPV
acoustice neuroma 
MS
A

CNS tumor: C
Infection: C
Vestibular neuritis: P (think the vestibular part of the vestibularcochlear nerve)
Menieres disease: P
BPPV: P
Acoustic neuroma: C (think the cochlear part of the vestibularcochlear nerve)
MS: C

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16
Q

vertigo is often a benign complaint but these are some dangerous causes:

A 
arrhythmia
vascular pathology 
MI 
Hypoxemia 
Hypoglycemia 
AVM 
CVA
17
Q

You’re at the grocery store and the 65 year old gentleman in front of you starts shouting ahhhhhhhhh! everything is spinning suddenly! instead of pretending to know nothing about medicine, you jump into action knowing that…..

A

usually sudden onset of sponaneous vertigo is coming from a dangerous cause especially for those over 60, may the odds be ever in his favor

18
Q

though nystagmus is not always present with central vertigo, _______ and _______nystamus is indicative of a central cause

A

Direction changing, down beat

19
Q

______ is the gold standard of dx for posterior canal BPPV

A

Dix hallpikes manuever

20
Q

______ is the gold standard of dx for posterior canal BPPV

A

Dix hallpikes manuever (yes its on here twice, he was really stressing it!)
but do not perform if someone has spontaneus nystagmus

21
Q

This test is 100 percent sensitive for the presence of a central lesion

A

HINTS:
HI: head impulse
N: nystagmus
TS: test of skew

22
Q

Work up for a vertigo complaint

A

Labs: CMP CBC ESR
Imaging: CT, CTA (head and neck), MRI/ MRA
Other: EKG, Audiologic eval, ENG, VNG, Caloric testing (COWS)

23
Q

Caloric testing

A

Cold or warm water into the ear canal. When cold water or cold air enters that ear and changes temp it will cause nystagmus

24
Q

ENG (electronystagmogram)

A

measures nystagmus nad normal eye movements

25
Q

VNG: Videonystagmography

A

documents a personal ability to follow visual objects

26
Q

Meds for the treatment of vertigo itself (obviously tx underlying cause)

A 
Antihistamines
Anticholinergics
Benzos 
Sympathomimetics 
epley manuever (for BPPV specifically)
27
Q

Your patient presents with vertigo that she says lasts 30 minutes to two hours. this happens every couple of days. She also has some hearing loss and ringing in her ears. She states that there is some pressure feeling in her right ear from time to time. What is the most likely dx for this patient and what is the cause?

A

Menieres disease,

cause is unknown

28
Q

how would you treat menieres dz

A

Low salt diet
diuretics (acetazolamine)
Meclizine or valium

29
Q

your patient comes to the urgent care in very apparent discomfort. She has some gait ataxia and says she has been very very dizzy for about a week. This is following a URI the week prior to that. she has some tinnitus but that discomfort is nothing compared to her vertigo, what is the dx?

A

Viral labrynthitis. Sorry lady we cant do much for you, want some meclizine or diazepam?

30
Q

vertigo lasting for only 1- several seconds, but happens multiple times per day.
It is caused by a vasculpression of the vestibular nerve., similar to trigeminal neuralgia and is similarly treated with carbamazepine. Nystagmus is provoked by hyperventilation

A

Vestibular paroxysmia

31
Q

as many as _____ percent of migraine patients experience dizziness with their migraines.

A

50

32
Q

The four criteria for a patient to meet for a vestibular migraine

A
  1. meet criteria set forth by the International headache society
  2. Episodic or fluctuating symptoms suggestive of a balance disorder
  3. no other neuro-otologic diagnosis
  4. Experience migraine symptoms during periods of vertigo or imbalace
33
Q

you have a 76 year old patient present with symptoms that SEEM like BPPV. He has no nystagmus with dix-hallpike. Should you get a CT?

A

YAS! that mofo had an aortic dissection caught on CT of head and neck

34
Q

The mortality of a type 1 debakey aortic dissection increases _____% per hour

A

6 percent

35
Q

which of the following is a characteristic of central vertigo?
A. Symptoms are not triggered by motion/ head postion
B. Symptoms are triggered by motion/ head position
C. Nystagmus us fatiguable and horizontal
symptoms are sudden and episodic

A

A

36
Q

At what degree of rotation do you hold the patients head during the dix-hallpike’s manuever?

A

45 degrees

37
Q

What is a positive dix-halpike

a. patient has relief of symptoms
b. patient exhibits torsional fatiguable nystagmus
c. patient experiences no change in symptoms
d. provider feels audible crack in the patients cervical spine

A

B.

38
Q 
Which of the following is most likely to produce central vertigo symptoms over peripheral vertigo symptoms?
A. Meniers 
b. vestibular neuritis 
c. migrainous vertigo 
d. acoustic neuroma
A

D

RRCCPA Clin Med Exam 4 (20 decks)

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