14. Vertigo

Question 1

What is the caloric reflex test?

Answer 1

Cold water: endolymph sinks in horizontal canal –> patient feels head turning to opposite side –> Eyes turn towards ipsi ear with CONTRA NYSTAGMUS
Hot water: endolymph rises –> patient feels head is turning to SAME side –> eyes turn CONTRA ear with IPSI nystagmus

Question 2

What is the number one complaint of persons over the age of 70

Answer 2

dizziness

Question 3

What is BPPV?

Answer 3

benign paroxysmal positional vertigo –> otoliths break off membrane and become lodged elsewhere –> false signals

Question 4

What is the leading cause of accidental deaths in persons +65

Answer 4

Falls

Question 5

Does have a reported fear of falling increase, decrease, or no change in the correlation with predicting a future fall

Answer 5

Fear of falling –> inc change of falling

Question 6

Having how many risk of falling indicators are necessary to have a 100% chance of falling?

Answer 6

3 or more

Question 7

What are the three reflexes associated with equilibrium?

Answer 7

Vestibuloocular (VOR)
Vestibulospinal
Vestibulocolic

Question 8

Which semilunar canal is important in BPPV? Which is important in caloric testing?

Answer 8

BPPV: posterior semilunar canal

Caloric testing: horizontal semilunar canal

Question 9

Which direction does nystagmus occur in BPPV?

Answer 9

Initially torsional (rotary) –> vertical

Question 10

VOR does what

Answer 10

Gaze stabilization

Question 11

VSR

Answer 11

Uses visual, proprioceptive information to coordinate balance and movement
Can still balance with 2/3 systems with training
CANNOT BALANCE WITH 1/3 SYSTEMS

Question 12

VCR

Answer 12

Postural control. Acts on muscles in neck to stabilize the head
Uses utricle and saccule

Question 13

Differentiate what happens with symmetric vs assymetric impulses

Answer 13

Symmetric = normal
Assymetric = interpreted as vertigo

Question 14

What is the vestibular clamp?

Answer 14

Inhibitory signal sent by cerebellum to vestibular nucleus when it sends assymetric impulses, but these are not strong

Question 15

What artery supplies blood to the labyrinth and cochlea

Answer 15

AICA

Question 16

When is the labyrinth formed during gestation?

Answer 16

47th day of gestation

Question 17

Is nystagmus present with vertigo or dizziness?

Answer 17

Vertigo. Dizziness is any disturbed sense of relationship to space whereas vertigo is a sensation of the person spinning

Question 18

Central vs peripheral vertigo

Answer 18

Peripheral vertigo is more severe, concerns the labyrinth or vestibular nuc
Central is generally associated with neurologic symptoms (diplopia, weakness, numbness, incoordination)

Question 19

Meniere’s Disease - what is it?

Answer 19

Idiopathic distention of membranous labyrinth and cochlear duct

Question 20

Meniere’s Disease triad

Answer 20

Hearing loss
Tinnitus
Vertigo

Question 21

What is an important etiologic basis for meniere’s disease?

Answer 21

food sensitivity&raquo_space; food allergy

Question 22

How do you dx Meniere’s disease?

Answer 22

MRI

Question 23

Tx for Meniere’s disease?

Answer 23

Benzodiazepines - VALIUM

Question 24

What is something very important that you need to be concerned about when prescribing streptomycin IM?

Answer 24

It’s ototoxic; must be stopped to prevent hearing loss

Question 25

What is something very important that you need to be concerned about when prescribing garamycin?

Answer 25

Can cause chemical labrynthectomy

Question 26

What is acute labyrinthitis?

Answer 26

Inflammatory process occurring within labyrinth w/ bacterial or viral etiology

Question 27

Bacterial mediated acute labyrinthitis

Answer 27

Children: Acute otitis media; must give abx
Adults: serous form occurs with bacterial toxins

Question 28

Virus mediated acute labyrinthitis, tx

Answer 28

Seen during summertime
Severe vertigo, cochlear dysfunction
Tx: IV valium (must reduce it)