Sachen-High Yield Review

Question 1

Describe the signs and symptoms of Meniere’s disease

Answer 1

Recurrent episodes of spontaneous VERTIGO

LOW FREQUENCY HEARING LOSS

TINNITUS

AURAL FULLNESS

Question 2

What are some drug-induced causes of hearing loss?

Answer 2

• GENTAMICIN (Big one) –> Aminoglycoside abx
• EtOH
• Salicylate’s
• Anti-epileptics
• Abx
• Diuretics
• Chemotherapeutic

Question 3

What are some obligatory features (present 100% of the time) in Friedrichs ataxia?

Answer 3

• Onset before age 20 (young persons disease)
• Gait ataxia
• Progression of ataxia to involve all 4 limbs
• Dysarthria
• Impaired position/vibratory sense in legs
• Muscle weakness
• Absent tendon reflexes in legs (hyporeflexia)

Question 4

What is often the cause of death in Friedrichs ataxia?

Answer 4

Cardiomyopathy

Question 5

What is the mean age of death in Friedrichs ataxia?

Answer 5

35 years

Question 6

If you pour cold water in the right ear and get no response then pour cold water in the left ear and get a normal intact response (look to the left), what is the abnormality?

Answer 6

Left brainstem is intact, abnormality in brainstem at the level of the pons on the right

Question 7

The caloric (oculovestibular) reflex tests which part of the brainstem?

Answer 7

Lower pons

Question 8

In cold water irrigation with intact brainstem, the eyes deviate to which side in unilateral irrigation?

Answer 8

Eyes deviate to irrigated side if unilateral irrigation

Question 9

In an uncal transtentorial herniation, herniation of the uncus under the edge of the tentorium causes?

Answer 9

• Compression of CN III—> ipsilateral dilated pupil, poor EOM, ptosis
• Contralateral brainstem –> ipsilateral hemiparesis
• respiratory abnormalities, posturing, fixed pupils, and death

Question 10

What are some signs/symptoms in someone with Liver dysfunction (diffuse/metabolic)?

Answer 10

• Pupillary rxns are usually preserved
• Cross eyed
• Asterixis –> tremor of the hand when the wrist is extended (start to flap)
• Icteric sclera and maybe icteric skin
• Uremia

Question 11

Describe a positive romberg sign:

Answer 11

• Stumble when eyes closed, problem with proprioception (dorsal columns)
• Fall toward side of lesion

Question 12

What side will a Horners syndrome be with a lateral medullary syndrome?

Answer 12

Ipsilateral

Question 13

In a pt with Labyrinthine deficits (peripheral), what is the direction of nystagmus?

Answer 13

• Fixed

- Horizontal/diagonal