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DPT 520 > Exam 3 > Flashcards

Exam 3 Flashcards

Huntington's to cranial nerves

1
Q

what is the series of events involved in auditory conduction?

A

sound wave strike ear drum

ossicles move, causing vibration of the membrane at the opening of the upper chamber

movements of the fluid in the upper chamber

vibration of the basilar membrane and attached hair cells

hairs bend bc the tips are embedded in the immobile tectorial membrane, hair cells depolarize

cochlear nerve endings activated

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2
Q

what is the pathway for auditory info from the cochlear nuclei?

A

medial geniculate body–> primary auditory cortex (A1)

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3
Q

what is the inferior colliculus responsible for?

A

auditory info integrated from both ears

detection of the location of sounds

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4
Q

t/f: the inf colliculus elicits eye movement towards the sound via sup olive

A

true

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5
Q

t/f: the reticular formation is responsible for the activating affect of sounds on the CNS

A

true

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6
Q

what is the primary auditory cortex (A1) responsible for?

A

conscious awareness of the intensity of sounds

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7
Q

t/f: the primary auditory cortex has a map of where sound is processed depending on the frequency of sound

A

true

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8
Q

what is the secondary auditory cortex (A2) responsible for?

A

compares w/memories of other sounds

categorizes sounds (music, speech, calling you etc)

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9
Q

where is Wernicke’s area located?

A

posterior portion of the secondary auditory cortex

only in the L hemisphere, no BL

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10
Q

what is Wernicke’s area responsible for?

A

comprehension of spoken language

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11
Q

can someone with a lesion to Wernicke’s area still read and speak?

A

yes!

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12
Q

what is conductive hearing loss?

A

transmission of vibration is limited from the outer/middle ear to the inner ear

limited transmission of vibration/sound

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13
Q

what is the most common cause of conductive hearing loss?

A

excessive earwax

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14
Q

what kind of hearing loss is caused by otitis media?

A

conductive hearing loss

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15
Q

what is otitis media?

A

inflammation of the middle ear causing restricted ossicles

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16
Q

what is sensorineural hearing loss?

A

damage to the receptors cells of the cochlear nerve causes hearing loss

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17
Q

is sensorineural or conductive hearing loss more common?

A

conductive hearing loss

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18
Q

what can cause sensorineural hearing loss?

A

acoustic trauma

ototoxic drugs

Meniere’s disease

acoustic neuroma

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19
Q

what is acoustic trauma?

A

ear exposed to repetitive noise for prolonged period of time (ie working in a loud environment for whole life)

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20
Q

what are ototixic drugs?

A

drugs that are toxic to the auditory system

high dose aspirin or acetaminophen

one of the most commonly used diuretics

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21
Q

what is an acoustic neuroma?

A

benign tumor of the Schwann cells surrounding CN 8

tumor on the acoustic nerve that can grow and wipe out vestibular nerve

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22
Q

t/f: surgery to remove an acoustic neuroma improves symptoms of the vestibulocochlear system

A

false, the surgery leaves lingering symptoms in the vestibular system

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23
Q

what is tinnitus?

A

ringing in the ears

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24
Q

when is tinnitus normal?

A

when sitting in complete silence and the ringing lasts only a couple of seconds

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25
Q

what can cause tinnitis?

A

meds, stimulation of auditory receptors, or central sensitization following deafferentation

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26
Q

when someone has unilateral hearing loss, do we expect them to be able to clearly locate sounds?

A

no

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27
Q

what is Ramsey-Hunt syndrome?

A

CN 7 and 8 disease caused by varicella zoster infection (shingles)

acute facial paralysis w/ear p! and blisters/rash

balance issues, gaze stability impairment, vertigo, hearing impairment, and gait issues

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28
Q

what age group is typically affected by Ramsey Hunt syndrome?

A

> 60 years old

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29
Q

can pts recover from Ramsey-Hunt syndrome?

A

in mild-moderate cases they can fully recover

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30
Q

what is the special sensory fxn of the glossopharyngeal nerve (CN 9)? what is the associated nucleus?

A

afferents for taste from the post 1/3 of the tongue

spinal trigeminal nucleus

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31
Q

what is the somatosensory fxn of the glossopharyngeal nerve (CN 9)? what is the associated nucleus?

A

afferents fom soft palate, pharynx, and post 1/3 of the tongue, middle ear, and post external ear canal

spinal trigeminal nucleus

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32
Q

what is the motor fxn of the glossopharyngeal nerve (CN 9)? what is the associated nucleus?

A

efferent to one one muscle (stylopharyngeus) in the pharynx

nucleus ambiguus (in the medulla)

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33
Q

what is the parasympathetic fxn of the glossopharyngeal nerve (CN 9)? what is the associated nucleus?

A

efferent to parotid gland

inf salivatory nucleus

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34
Q

what is the reflex fxn of the glossopharyngeal nerve (CN 9)? what is the associated nucleus?

A

afferent limb of the gag and swallowing reflexes

solitary nucleus

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35
Q

what does the stylopharyngeus do?

A

elevation of the larynx and pharynx for speech production and swallowing

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36
Q

what CN is the efferent of the reflex to the parotid gland?

A

CN 10

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37
Q

what CN is the afferent of the reflex to the parotid gland?

A

CN 9

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38
Q

what are the consequences of CN 9 dysfxn?

A

reduced sensation over the post 1/3 tongue, palate, and pharynx

impaired gustation (taste) over post 1/3 tongue and palate

dysphagia

loss of carotid sinus reflex

absent gag reflex

parotid gland dysfxn

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39
Q

what is the somatosensory fxn of the vagus nerve (CN 10)? what is the associated nucleus?

A

afferents from pharynx, larynx, and skin in center of external ear

spinal trigeminal nucleus

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40
Q

what is the motor fxn of the vagus nerve (CN 10)? what is the associated nucleus?

A

efferents to muscles of the pharynx and larynx

nucleus ambiguus

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41
Q

what is the autonomic fxn of the vagus nerve (CN 10)? what is the associated nucleus?

A

afferent from pharynx, larynx, thorax, and abdomen

sup solitary nucleus

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42
Q

what is the parasympathetic fxn of the vagus nerve (CN 10)? what is the associated nucleus?

A

efferents to smooth muscles and glands in the pharynx, larynx, thorax, and abdomen

nucleus ambiguus

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43
Q

what is the reflex fxn of the vagus nerve (CN 10)? what is the associated nucleus?

A

efferent limb of gag and swallowing reflexes

dorsal motor nucleus

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44
Q

does the vagus nerve speed up or slow down the HR and contractility of the heart?

A

slows it down

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45
Q

what is the gag reflex?

A

touching of the pharynx elicits contraction of the pharyngeal muscles

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46
Q

what is the afferent limb of the gag reflex?

A

glossopharyngeal nerve (CN 9)

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47
Q

what is the efferent limb of the gag reflex?

A

vagus nerve (CN 10)

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48
Q

what is the swallowing reflex?

A

food touching the entrance of the pharynx elicits movement of the soft palate and contraction of the pharyngeal muscles

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49
Q

what is the afferent limb of the swallowing reflex?

A

glossopharyngeal nerve (CN 9)

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50
Q

what is the efferent limb of the swallowing reflex?

A

vagus nerve (CN 10)

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51
Q

what are the consequences of CN 10 dysfxn?

A

dysarthria

dysphagia

poor digestion

assymetric elevation of the palate

hoarseness

loss of gag and swallowing reflexes

uvula deviation

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52
Q

why is there poor digestion in CN 10 dysnfxn?

A

the efferent CN 10 facilitates digestion

decreased digestive enzymes and peristalsis

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53
Q

why does the uvula deviate in CN 10 dysfxn?

A

CN 10 participates in palate elevation

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54
Q

in CN 10 dysnfxn, uvula deviation is ___ to the lesion

A

contralateral

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55
Q

in CN 10 dysnfxn, soft palate depression is ___ to the lesion

A

ipsilateral (lower palate of the affected side)

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56
Q

what does a LMN lesion of CN 11 (spinal accessory) result in?

A

flaccid paralysis of SCM an straps ipsilateral to the lesion

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57
Q

what does an UMN lesion (corticobrainstem lesion) of CN 11 (spinal accessory) result in?

A

paresis due to bilateral cortical innervation

hypertonicity of the SCM and traps

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58
Q

what is the normal fxn of CN 12?

A

sticking tongue straight out

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59
Q

what does dysfxn of CN 12 result in?

A

atrophy of tongue and deviation to the weaker side

difficulty speaking and swallowing

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60
Q

t/f: CN 12 innervates intrinsic and extrinsic muscles of the tongue

A

true

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61
Q

what would result from an UMN lesion (corticobrainstem lesion) of CN 12?

A

tongue deviates to the side contralateral to the lesion

weakness is contralateral

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62
Q

with a L UMN lesion of CN 12, which side would be weak? which way would the tongue deviate?

A

R sided weakness
R tongue deviation

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63
Q

t/f: the corticobrainstem tract for CN 12 is bilateral

A

false, it only projects contralaterally

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64
Q

what would result from a LMN lesion of CN 12?

A

tongue deviates to the side ipsilateral to the lesion

ipsilateral weakness

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65
Q

with a L LMN lesion of CN 12, which side would be weak? which way would the tongue deviate?

A

L sided weakness
L tongue deviation

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66
Q

t/f: both UMN and LMN lesions of CN 12 will cause the tongue to deviate towards the side of weakness

A

true, the weakness will just be on different sides

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67
Q

can CN 12 dysfxn result in tongue atrophy, fasciculation, or tremors?

A

yes

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68
Q

what disorder commonly has fasciculation and atrophy of the tongue?

A

ALS

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69
Q

what disorders commonly have tremors of the tongue muscles?

A

PD and alcoholism

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70
Q

what are the 3 chronological stages of swallowing?

A

1) oral
2) pharyngeal/laryngeal
3) esophageal

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71
Q

what is involved in the oral stage of swallowing?

A

food in the mouth, lips closed

jaw, cheek, and tongue movements manipulate food

tongue moves food to the pharynx entrance

larynx closes

swallowing reflex triggered

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72
Q

what CN is involved in or oral phase when food is in the mouth with lips closed?

A

CN 7

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73
Q

what CNs are involved in the oral phase when the jaw, cheek, and tongue movements manipulate food?

A

CN 5, 7, 12

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74
Q

what CN is involved in the oral phase when the tongue moves food to the pharynx entrance?

A

CN 12

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75
Q

what CN is involved in the oral phase when the larynx closes?

A

CN 10

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76
Q

what CN is involved in the oral phase when the swallow reflex is triggered?

A

CN 9

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77
Q

what happens in the pharyngeal/laryngeal phase of swallowing?

A

food moves into the pharynx

soft palate rises to block food from the nasal cavity

epiglottis covers the trachea to prevent food from entering the lungs

peristalsis moves food to the entrance of the esophagus, sphincter opens, food moves into the esophagus

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78
Q

what CN is involved in the pharyngeal/laryngeal phase when food moves into the pharynx?

A

CN 9

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79
Q

what CN is involved in the pharyngeal/laryngeal phase when the soft palate rises to block food from the nasal cavity?

A

CN 10

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80
Q

what CN is involved in the pharyngeal/laryngeal phase when the epiglottis covers the trachea to prevent food from entering the lungs?

A

CN 10

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81
Q

what CN is involved in the pharyngeal/laryngeal phase when when peristalsis moves food to the entrance of the esophagus, sphincter opens, and food moves into the esophagus?

A

CN 10

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82
Q

what happens during the esophageal phase of swallowing?

A

peristalsis moves food into the stomach

83
Q

what CN is involved in the esophageal phase of swallowing when peristalsis moves food into the stomach?

A

CN 10

84
Q

the following are signs of what?

frequent aspiration, choking, lack of awareness of food in one side of the mouth

A

dysphagia

85
Q

dysphagia results from dysfxn of what CNs?

A

5, 7, 9, 10, or 12

86
Q

t/f: motor generation of sounds and articulation of words requires coordination of multiple CNs

A

true

87
Q

dysarthria can result from a LMN of what CNs?

A

5, 7, 10, 12

88
Q

what is spastic dysarthria and what does it result from?

A

hypertonicity of speech muscles resulting from an UMN lesion

89
Q

which CNs are responsible for articulation of sound?

A

CN 5 (jaw)

CN 7 (lips)

CN 10 (soft palate and larynx)

CN 12 (tongue)

90
Q

which CN is responsible for the generation of sounds?

A

CN 10 (larynx)

91
Q

what are the peripheral causes of pathologic nystagmus?

A

vestibular apparatus or vestibular nerve

92
Q

what are the central causes of pathologic nystagmus?

A

vestibular nuclei or vestibular cerebellum

93
Q

what are the peripheral vestibular receptor disorders?

A

BPPV

unilateral vestibular disorders

bilateral vestibular disorders

Meniere’s disease

labyrinthine concussion (trauma)

perilymphatic fistula (hole)

sup canal dehiscence (SCD)

94
Q

what is BPPV (benign paroxysmal positional vertigo)?

A

mechanical disorder caused by otoconia displacement from the macula of the utricle (where it should be) to the SCC (where it shouldn’t be) and becomes sensitive to gravity

95
Q

what is the most common peripheral vestibular receptor disorder?

A

BPPV

96
Q

where can particles be displaced in BPPV?

A

the posterior, horizontal, or anterior canals

attached to the cupula or sensory receptor

97
Q

where is the most common place for particles to move to in BPPV?

A

posterior canals

98
Q

which is more common, canalithiasis or cupulolithiasis?

A

canalithiasis

99
Q

what is canalithiasis?

A

when the particles displace into the post, hor, or ant canals in BPPV

100
Q

what is cupulolitiasis?

A

when the particles attach to the cupula or sensory receptor in BPPV

101
Q

when do symptoms appear in BPPV?

A

when lying down or getting up

during movement as the crystals are moving

no symptoms once the crystals stop moving

102
Q

how long does it typically take for the crystals to stop moving and symptoms to dissipate in BPPV?

A

less than 1 minute

103
Q

what is the typical pt presentation in BPPV?

A

true spinning vertigo

triggered by lying down, rolling over, looking up, or bending over (pitch plane vs rolling movements)

short <1 minute attacks that start out light, get really bad b4 fading away (crescendo>descrescendo)

recent flu/cold, blow to the head

104
Q

t/f: the odds of getting BPPV go up substantially w/w a blow to the head

A

true

105
Q

how is BPPV diagnosed?

A

Dix Hallpike test (rotate the head 45 deg and quickly lie back of head off the table)

106
Q

t/f: BPPV is very specific and easy to treat

A

true

107
Q

what is the second most common location of BPPV?

A

horizontal canals (diagnosed with supine roll test)

108
Q

what is a positive test for BPPV?

A

nystagmus provoked in the position that stimulates a given canal pair

109
Q

what is the treatment for BPPV?

A

canalith repositioning maneuvers (Epley is one)

110
Q

what are the unilateral peripheral disorders?

A

vestibular neuritis/labyrinthitis

Meniere’s disease

Ramsey Hunt

acoustic neuroma

3rd window (fistula, SCD)

labyrinthine concussion

111
Q

does an acoustic neuroma cause hearing loss?

A

yes

112
Q

what is the treatment for an acoustic neuroma?

A

taking out the tumor which leaves damage where the tumor was and can cause spinning following surgery as the brain adapts to the loss on that side

113
Q

what is the typical presentation of a pt with a unilateral peripheral disorder?

A

outpt reports being “dizzy” and off balance w/blurry vision and some nausea

severe bout of consant acute vertigo following the flu

no vertigo now

114
Q

what provoked unilateral peripheral disorders?

A

movement

115
Q

what is the frequency of unilateral peripheral disorders?

A

episodic

116
Q

what is the duration of symptoms in unilateral peripheral disorders?

A

only when moving

117
Q

what is the intensity of symptoms in unilateral peripheral disorders?

A

mild

118
Q

what unilateral peripheral vestibular condition is explained by EPISODIC acute condition, TRIAD of symptoms, unique TRIGGERS and DURATION (hrs to days)?

A

Meniere’s disease

119
Q

what are the triad of symptoms in Meniere’s disease?

A

tinnitus, fluctuating hearing loss, aural fullness

120
Q

what is the treatment for aural fullness?

A

diuretics to get rid of the excess fluid

121
Q

what are the bilateral peripheral disorders?

A

sequential vestibular neuronitis

ototoxicity/vestibular ablation

autoimmune disorders/syphilis

122
Q

t/f: new onset hearing loss is a red flag

A

true

123
Q

what generally causes ototoxicity?

A

‘mycin drugs’

124
Q

t/f: sepsis treated with antibiotics can save a pts life but wipe out the ear

A

true

125
Q

what are the central processing or projection disorders?

A

MAV/MAD (migraine associated vertigo/dizziness

chronic dizziness (persistent perceptual postural dizziness-PPPD)

infarcts (ant vestibular aa, PICA, labyrinthine aa, AICA)

TIAs

CNS (MS, Chiari)

trauma (head injury, concussion)

126
Q

do peripheral or central vestibular disorders generally result in milder continuous symptoms?

A

central

127
Q

does the presence of any brainstem signs along with vertigo, nystagmus, or unsteadiness suggest a central or peripheral vestibular disorder?

A

central

128
Q

what are some additional s/s of central vestibular disorder?

A

motor/sensory loss

Horner’s syndrome

pure vertical/direction changing nystagmus

diploplia

ataxia

dysarthria

129
Q

does head tilt with anteropulsion and poor vertical orientation suggest a lesion where?

A

in the vestibular nuclei or above the sup vestibular nuclei

130
Q

t/f: lateropulsion can be associated with Wallenburg’s syndrome or lesions of the spinocerebellar tracts

A

true

131
Q

abnormal perception of vertical w/o vertigo is suggestive of what?

A

involvement of vestibulothalamocortical pathway or vestibular cortex

132
Q

what is postural vertical?

A

the alignment of the body relative to gravity (fxn of the otoliths)

133
Q

what are the 2 ways that otoliths contribute to postural vertical?

A

1) perception
2) postural reflexes

134
Q

what pathway is responsible for perception of postural vertical?

A

otolith–> thalamus–> vestibular cortex

vestibulothalamocortical pathway

135
Q

what pathway is responsible for postural reflexes?

A

otolith–> vestibulospinal and vestibulocollic tracts

136
Q

is subjective visual vertical disorder central or peripheral?

A

peripheral

137
Q

is postural vertical disorder central or peripheral?

A

central

138
Q

what is lateropulsion?

A

pushing to the side

139
Q

what is anteropulsion?

A

pushing forward

140
Q

what is retropulsion?

A

pushing backward

141
Q

what is postural vertical disorder?

A

central disorder where there is a misperception of postural vertical causing misalignment of the body relative to gravity

142
Q

does otolith dysfxn impair subjective visual vertical or postural vertical?

A

subjective visual vertical

143
Q

what is the triad of signs associated with otolith disorder?

A

1) lateral head tilt
2) skew deviation of the eyes
3) ocular tilt and rotation

144
Q

what are nonvestibular causes of vestibular symptoms?

A

orthostatic hypotension (rare)

panic/anxiety attacks

dysequilibrium of aging

presbyastasis (inner ear weakness/couch potato ear)

145
Q

t/f: nonvestibular causes of vertigo are harder to treat

A

true

146
Q

what are nonorganic causes of vertigo?

A

aphysiologic or secondary gain (making it up)

147
Q

describe the diagnostic process for vestibular disorders

A

hx taking

description of symptoms w/o using the word “dizzy”

description of symptoms, triggers, duration, severity, and timing

acute vs chronic

TTTH (timing, type, triggers, and hearing involvement)

148
Q

how long do acute symptoms last?

A

<3 months

149
Q

how long do chronic symptoms last?

A

> 3 months

150
Q

if symptoms are worsened by linear acceleration such as elevators, escalators, or riding in the car, what should we suspect?

A

otolith dysfxn

151
Q

if symptoms are worsened by angular acceleration such a as bending forward/backward, rolling over, or quick head movements, what should we suspect?

A

SCC dysfxn

152
Q

if symptoms include blurry/bounding vision especially with movement, walking, or reading, what should we suspect?

A

VOR dysfxn, poor gaze stability

153
Q

if a pt has difficulty looking from one object to another, tracking targets, or converging/diverging, what should we suspect?

A

oculomotor dysfxn

154
Q

if a pt has increased imbalance in visual environment or activity, what should we suspect?

A

the pt has visual dependence for balance

155
Q

what is the #1 cause of dizziness?

A

orthostatic hypotension

156
Q

what is the #1 cause of vertigo?

A

BPPV

157
Q

what does the central and peripheral diagnostic exam test?

A

smooth pursuits and end gaze nystagmus

cover cross test

head impulse test of the VOR

158
Q

is the HINTS exam or an MRI more sensitive to central vs peripheral early on?

A

HINTS

159
Q

is spontaneous nystagmus present with central or peripheral disorder?

A

central disorder and ACUTE peripheral disorder

160
Q

what does the oculomotor and HINTS exam look for?

A

spontaneous nystagmus

nystagmus in eccentric gaze

central involvement (cover cross cover test)

head impulse test for the VOR

161
Q

what does HINTS stand for?

A

Head Impulse Nystagmus Test of Skew

162
Q

what does INFARCT stand for?

A

Impulse normal

Fast phase Alternating (look R, nystagmus R)

Refixation of Cover Test

163
Q

what is a positive reorientation of Cover Test mean?

A

when you cover pt’s one eye and focus on your nose if the covered eye has to reorient to the nose

164
Q

what results would indicate a benign HINTS exam?

A

abnormal HIT

fixed direction nystagmus

absent skew

165
Q

what results would indicate dangerous HINTS exam?

A

any ONE of the following:

  • normal HIT
  • direction changing horizontal nystagmus present/untestable
  • skew deviation present/untestable
166
Q

what is measured in vestibular fxn testing?

A

eye movement

eye/neck muscle response

167
Q

what is involved in vestibular fxn testing?

A

caloric testing

rotary testing

vestibular autorotation testing

C-VEMP

O-VEMP

168
Q

how does electronystagmography measure nystagmus?

A

use of electrodes placed to record and measure each eye muscle response

169
Q

how does videonystagmography measure nystagmus?

A

use of video infrared recordings to observe, record, and measure eye muscle responses

170
Q

t/f: ENG and VNG record eye movement in response to a stimulus delivered to each vestibular apparatus

A

true

171
Q

what is caloric testing?

A

a way to measure nystagmus using cold and warm water/air in each ear and measuring output of the eyes

172
Q

what are normal results of caloric testing?

A

nystagmus in both eyes

173
Q

when cold water/air is irrigated into the ears, what happens to the eyes?

A

the eyes move (horizontal nystagmus) away from the side of the stimulus

174
Q

when warm water/air is irrigated into the ear, what happens to the eyes?

A

the eyes move towards the side of the stimulus

175
Q

what does absent/reduced reactive eye movements suggest in caloric testing?

A

vestibular weakness (UVL) of the horizontal SCC of the side being stimulated

176
Q

<__% difference bw the eyes is considered normal in caloric testing

A

25

177
Q

increased responses in caloric testing usually signify what?

A

cerebellar disease

178
Q

what results of caloric testing would indicate unilateral vestibular lesion?

A

decreased intensity of response in one ear of >25%

179
Q

what results of caloric testing would indicate bilateral vestibular lesion?

A

no response/very weak response in both ears

180
Q

what is the rotational chair test?

A

pt is rotated in a chair int he dark w/the eyes open and eye activity is recorded with ENG/VNG recording

measures phase and GAIN (ratio) of head:eye movements

181
Q

what does reduced gain in rotational chair testing indicate?

A

decreased vestibular sensitivity

bilateral loss of vestibular fxn

182
Q

what does abnormally large gain in rotational chair testing indicate?

A

central dysfxn

183
Q

what are the indications for rotational chair testing?

A

suspected BL

pediatrics

can’t tolerate caloric testing

suspected to be aphysiologic

184
Q

is ENG or rotational chair testing better for suspected BL involvement?

A

rotational chair testing

185
Q

what is a vestibular autorotational test (VAT)

A

test performed in room light where the subject wears an accelerometer device on their head

subject asked to focus on target and move head at speeds greater than 2 Hz

records head and eye velocities

calculates VOR gains and phases

186
Q

what is a VEMP?

A

Vestibular Evoked Myogenic Potentials

high intensity sounds stimulate the vestibular system in the absence of head movement

evaluates otolithic organs separate from the SCC

187
Q

what is the anatomical difference be the otolith organs?

A

the UTRICLE supplies the ipsilateral superior oblique, superior rectus, medial rectus and control of the inf oblique and inf rectus via the sup vestibular nerve

the SACCULE supplies the ipsilateral SCM muscle via the inf vestibular nerve

188
Q

what is the fxnal dif bw the otolith organs?

A

the UTRICLE is principally related to eye movement

the SACCULE plays a major role in control of postural adjustments

189
Q

what is C-VEMP?

A

series of “clicks” used to stim each ear–>stim saccule–>inhibits SCM on ipsilateral side

the firing rate of the ipsilateral SCM is recorded using EMG

responses are compared bilaterally

190
Q

what C-VEMP results indicate an abnormal test?

A

1) one side is 2x larger than the other
2) low amplitude
OR
3) absent

191
Q

what does an abnormal C-VEMP indicate?

A

the saccule, inf vestibular nerve, integrity of the descending vestibular pathway for postural responses are abnormal

192
Q

what is an O-VEMP?

A

series of “clicks” used to stim each ear–>stim utricle–>inhibits contralateral oblique

firing rate of the contralateral oblique is recorded using EMG

responses are compared bilaterally

193
Q

what O-VEMP results indicate an abnormal test?

A

1) low amplitude
OR
2) absent

194
Q

what does an abnormal O-VEMP indicate?

A

the integrity of the ascending VOR pathways, sup vestibular nerve, and utricle

195
Q

how is subjective vertical tested?

A

pt asked to orient a rod to gravity (vertical) when in total darkness

the degree of off-axis tilt represents the torsion of the eye common in acute unilateral vestibular lesions

196
Q

how are/should pts with BPPV be treated?

A

PT

197
Q

how are/should pts with vestibular labyrinthitis/neuronitis, or Ramsey Hunt be treated?

A

with meds in acute case

with PT is uncompensated in chronic cases

198
Q

how are/should pts with Meniere’s disease be treated?

A

diuretics and lifestyle changes

PT later and bw attacks

199
Q

how are/should pts with vestibular migraines be treated?

A

with meds

200
Q

how are/should pts with acoustic neuroma, fistula, or sup canal dehiscence be treated?

A

surgical removal/repair

PT after medical management

201
Q

how are/should pts post-concussion/labyrinthine concussion be treated?

A

PT

neuro-opthamology (vision therapy)

medications

202
Q

how are/should pts with central vestibular disorders (MS, stroke) be treated?

A

medical management

medications

PT

203
Q

t/f: pts with Meniere’s disease, migraine, and infection must be treated b4 PT

A

true

DPT 520 (13 decks)

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