4: Dizzy patient

Question 1

Is dizziness the same as vertigo?

Answer 1

Dizziness is the patient’s word for how they feel

Vertigo is the sensation of spinning

Question 2

When a patient says they’re dizzy, what might they mean?

Answer 2

Vertigo

Pre-syncope

Seizures

Question 3

What is vertigo?

Answer 3

Sensation of spinning

Question 4

Vertigo has a good chance of being related to which organ?

Answer 4

Ear

Question 5

Which structures do the vestibular nerves supply?

Answer 5

Semicircular canals

Urticle

Saccule

Question 6

Which vestibular structures detect

a) head movements
b) horizontal motion
c) vertical motion?

Answer 6

a) Semicircular canals

b) Urticle

c) Saccule

Question 7

What systems control balance?

Answer 7

Ear

Eyes

Joints (proprioception)

Heart

Question 8

What eye conditions upset balance?

Answer 8

Anything causing vision loss (cataracts, diabetic retinopathy, glaucoma, macular degeneration…)

Question 9

What diseases can affect joint sensation, which itself affects balance?

Answer 9

Arthritis

Neurological disorders

Question 10

Which cardio conditions affect balance?

Answer 10

Arrythmias

Postural hypotension

Question 11

What brain disorders can cause balance problems?

Answer 11

Migraine

Space-occupying lesions

Multiple sclerosis

Question 12

What is the vestibulocular reflex?

Answer 12

Ability to keep focused on an object when your head is moving

Question 13

What are the sensory organs of rotation found in the semicircular canals?

Answer 13

Crista ampullaris

Question 14

What eye sign is caused by an impaired vestibulo-ocular reflex?

Answer 14

Nystagmus

Question 15

Which eye sign indicates a vestibular problem?

Answer 15

Nystagmus

Question 16

What is the most common GP presenting complaint in people over 75?

Answer 16

Dizziness

Question 17

What questions should you ask when taking a history from someone with dizziness?

Answer 17

Triggers?

Duration?

Associated symptoms? pain, hearing loss, vision, cardio

Alleviating factors?

Medication?

Question 18

What should be examined in someone who is dizzy?

Answer 18

Ear exam

Neuro exam

Blood pressure (lying/standing)

Question 19

What is the most common ENT cause of dizziness?

Answer 19

Benign positional paroxysmal vertigo (BPPV)

Question 20

What is the symptom of BPPV?

Answer 20

Veritgo on changing position, looking up

Question 21

What is the most common cause of BPPV?

Answer 21

Idiopathic

Question 22

What is the pathophysiology of BPPV?

Answer 22

Movement of otolith (calcium carbonate crystals) from urticle into semicircular canals, causing sensation of motion

Question 23

How long do episodes of BPPV last?

Answer 23

Never more than 30s

Question 24

Does BPPV have any associated symptoms?

Answer 24

No

Question 25

What test is used to detect BPPV?

Answer 25

**Hallpike test**

Question 26

What is the Hallpike test used to detect? How do you do it? What are you looking for?

Answer 26

**BPPV** Lie head over end of couch, turn head 45 to one side then return as quickly as possible, EYES OPEN **Nystagmus**

Question 27

What do you need to **see** on performing a Hallpike test to diagnose BPPV?

Answer 27

**Nystagmus** patient saying they're dizzy isn't enough

Question 28

Why must you wait 30s before finishing a Hallpike test?

Answer 28

**Nystagmus can be delayed by up to 30s**

Question 29

Which **manoeuvre** can be used to alleviate BPPV?

Answer 29

**Epley manoeuvre**

Question 30

How are patients with BPPV advised to sleep?

Answer 30

**Sitting up slightly**

Question 31

What is **vestibular neuronitis**?

Answer 31

**Prolonged vertigo** associated with **vomiting** No other associated symptoms

Question 32

What is a condition causing **prolonged vertigo** AND **tinnitus, hearing loss?**

Answer 32

**Labyrinthitis**

Question 33

How are **vestibular neuronitis** and **labyrinthitis** managed?

Answer 33

**Supportive** (sedatives, anti-emetics)

Question 34

How long do **vestibular neuronitis** and **labyrinthitis** last?

Answer 34

Days - Weeks

Question 35

What is a disease causing **recurrent rotational vertigo** lasting **2**+ **hours?**

Answer 35

**Meniere's disease**

Question 36

What are the symptoms required to diagnose Meniere's disease?

Answer 36

**Recurrent, prolonged rotational vertigo attacks** **Worsening of hearing \> hearing loss** **Aural fullness** all on one side

Question 37

What type of hearing loss is seen in **Meniere's disease**?

Answer 37

**Sensorineural hearing loss**

Question 38

What type of anti-emetic is used in vertigo?

Answer 38

**Buccastem** buccal administration

Question 39

How is **Meniere's disease** treated?

Answer 39

**Supportive** **Tinnitus therapy** **Hearing aids** **Restrict triggers**

Question 40

What are some possible **triggers** of **Meniere's disease**?

Answer 40

**Caffeine** **Alcohol** **Stress**

Question 41

Which antibiotic can be used to intentionally destroy residual balance function to stop vertigo in Meniere's disease?

Answer 41

**Gentamicin**

Question 42

Which common condition, causing headache, can also cause balance problems?

Answer 42

**Migraine**

Question 43

\_\_\_ and **vertigo** often go together.

Answer 43

**Migraine**