Clinical Approach to Disorders of Equilibrium (Hon)

Question 1

Balance and awareness of body position in relation to surroundings requires input from two of the following three systems:

Answer 1

1) Visual (to judge distance)
2) Labyrinthine (to judge acceleration and position change)
3) Proprioceptive (to judge posture)

Question 2

The Romberg test is assessing what system?

Answer 2

Proprioceptive

Question 3

What is characterized by illusion of movement of oneself or objects around self may be vestibular or neurologic in origin?

Answer 3

Vertigo

Question 4

What may be caused by vertigo but is usually a nonvertiginous state of altered static or dynamic balance?

Answer 4

Disequilibrium

Question 5

What is characterized by lightheadedness or send of impending loss of consciousness often due to orthostasis, arrhythmia, hyperventilation and aggravated by high temp?

Answer 5

Presyncope

Question 6

Vertigo is due to disturbance in?

Answer 6

Vestibular dysfunction (semicircular canals/otoliths)

Question 7

What is the most common cause of recurrent vertigo?

Answer 7

Benign Positional Vertigo

Question 8

Benign Positional Vertigo is triggered by?

Answer 8

Changes in head position with respect to gravity

Question 9

Which semicircular canal is most commonly affected by BPV?

Answer 9

Posterior

Question 10

BPV is confirmed by?

Answer 10

Dix-Hallpike position testing

Question 11

What is characterized by spontaneous attack of vertigo that does not involve hearing loss or tinnitus and is not characteristically positional?

Answer 11

Vestibular Neuronitis

Question 12

How doe Vestibular Neuronitis differ from BPV?

Answer 12

Vestibular Neuronitis is not triggered by positional changes

Question 13

What is the range of onset for Meniere’s disease?

Which sex is it more common in?

Answer 13

1) 20-50

2) Females

Question 14

Meniere’s disease is due to?

Answer 14

Increase in the volume of labyrinthine endolymph because of poor absorption (endolymphatic hydrops)

Question 15

What are the symptoms of Meniere’s disease?

Answer 15

1) Vertigo
2) Low frequency hearing loss
3) Tinnitus
4) Aural fullness

Question 16

What is the treatment plan for Meniere’s Disease?

Answer 16

1) Sodium restriction

2) Diuretics

Question 17

If vertigo symptoms are less than 24 hours, is it BPV or Vestibular Neuronitis?

If it lasts for about 3 months?

Answer 17

1) Vestibular Neuronitis

2) BPV

Question 18

What is an autosomal recessive disorder due to a mutation on chromosome 9?

What is the onset?

Answer 18

1) Friedrich’s Ataxia

2) Before age 20

Question 19

What symptoms are associated with Friedrich’s Ataxia?

Answer 19

1) Gait ataxia
2) Dysarthria
3) Impaired position/vibratory sense in legs
4) Muscle weakness
5) Absent tendon reflexes in legs

Question 20

What is often the cause of death in patients with Friedrich’s Ataxia?

Answer 20

Cardiomyopathy

Question 21

What is an autosomal recessive disorder due to a mutation on chromosome 11?

Answer 21

Ataxia-Telangiectasia

Question 22

Ataxia-Telangiectasia is characterized by?

Answer 22

1) Progressive ataxia
2) Oculocutaneous telangiectasia
3) Immunologic deficiency

Question 23

Around what age does the oculocutaneous telangiectasia usually appear?

Answer 23

Teen years

Question 24

What Igs are decreased with Ataxia-Telangiectasia?

The immunological impairment becomes evident later in childhood and is manifested by?

Answer 24

1) IgA and IgE

2) Recurrent sinopulmonary infections

Question 25

Deficiency of what vitamin can cause vague fatigue, gait and balance problems, distal sensory loss, Babinski and Romberg sign?

Answer 25

Vit B12

Question 26

Vit B12 Deficiency causes degeneration of?

Answer 26

Posterior columns and lateral corticospinal

Question 27

What levels of are increased with Vit B12 Deficiency?

Answer 27

1) Homocysteine

2) Methylmalonic acid