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Flashcards in Disorders of Equilibrium Deck (63)
1

True or false: dizziness may result from a disorder in any organ system

True

2

What are the four major organ systems that generally lead to the development of dizziness?

-Brain
-vestibular apparatus
-CV
-Endocrine system

3

True or false: dizziness may be physiologic

True

4

What is the definition of disequilibrium?

Altered sense of balance

5

What are the three major inputs for equilibrium?

-Visual
-Proprioceptive
-Vestibular

6

What part of the spinal column is responsible for proprioception?

Dorsal columns

7

What are the three major organ systems that can produce vertigo?

-Labyrinthine apparatus
-Vestibular nerve
-Brainstem

8

True or false: vertigo is always pathologic

false

9

How can you identify vertigo that is psychogenic in nature?

Absence of nystagmus

10

Psychogenic vertigo is usually seen in patients who have what conditions?

Panic disorder or agoraphobia

11

What is agoraphobia?

Afraid of open spaces/leaving their home

12

Can you have true vertigo without vestibular system involvement

no

13

Where can the lesions located with vestibular system disorders? (3)

-Inner ear
-Acoustic nerve
-Brain

14

What are the receptors for vertical motion?

Saccule and utricle

15

What bone houses the vestibular apparatus?

temporal bone

16

What is the position sensing apparatus within the semicircular canals?

Cupula

17

What is the blood supply to the labyrinth?

internal auditory nerve

18

The endolymphatic fluid is high in what mineral? Low?

High in K
Low in Na

19

What is the pathway that transmits information from CN VIII?

Medial longitudinal fasciculus

20

What causes height vertigo?

Widening of the tiny saccular movements of the eyes d/t taller objects

21

What, generally, is physiologic vertigo?

Exaggerated response to normal phenomenon

22

What are the three HEENT exam bits that should always be obtained with a complaint of dizziness?

-Otoscope exam
-EOMs/Nystagmus
-hearing exam

23

Which is usually pathologic and which is physiologic: jerk vs pendular nystagmus?

-Physiologic=pendular
-Pathologic=jerk

24

How is the dix-hallpike maneuver performed?

Hold patient's head at 45 degree angle (extended), and have them look to the right/left while turning their head.

25

How can jerk nystagmus be brought about physiologically?

have eye move toward punctum so that no cornea is seen

26

How is nystagmus defined: by the fast or the slow phase?:

Fast phase

27

Is there nystagmus with pts in a coma?

No--controlled by the cerebral hemispheres

28

What are the characteristics of peripheral jerk nystagmus in terms of:
-Latency
-Vertigo
-Positional adaptation
-fatigue on repeat testing

-2-20 second Latency
-Associated Vertigo
-Has Positional adaptation
-Will fatigue on repeat testing

29

What are the characteristics of central jerk nystagmus in terms of:
-Latency
-Vertigo
-Positional adaptation
-fatigue on repeat testing

-No Latency
-Variable Vertigo
-No Positional adaptation
-Little fatigue on repeat testing

30

Where do CN VIII nerves decussate?

In the pons

31

What, generally, is the BAER test?

Measuring the action potential of CN VIII as is traverses up the brain

32

What is the order of nerves/nuclei in the auditory pathway?

1. Acoustic nerve
2. Cochlear nerve
3. Superior olivary nucleus
4. Lateral lemniscus
5. Inferior colliculus
6. Medial geniculate
7. Auditory radiations (thalamocortical)

33

What are ENGs?

Electronystagmography--measuring the eye movement by detecting the changes in electrical activity whilst injecting cold water

34

What way does nystagmus occur with cold water injection in the ear?

Toward the side

35

Vertigo only with head movement = ?

Peripheral process

36

Jerk nystagmus at rest/exacerbated by movement = ?

Central process

37

Otologic s/sx associated with vertigo most likely indicates what?

Peripheral vertigo

38

What type of nystagmus is usually found with peripheral disorders?

Jerk

39

What is vestibular neuritis?

Inflammation of the vestibular nerve, usually of viral etiology

40

What is labyrinthitis?

Inflammation of the labyrinth, usually

41

What is Ramsey-Hunt syndrome?

Zoster infection of the labyrinth

42

What are the traumatic causes of peripheral vestibular disorders?

Perilymph fistulas
Cupulo-lithiasis

43

What is the classic sign of Ramsey-Hunt syndrome?

Vesicles in the ear canal

44

What is Meniere's syndrome?

Endolymph hydrops (too much fluid in the ear), which flows into other areas, causing damage

45

What is the classic triad of symptoms for Meniere's disease?

Vertigo
Tinnitus
Hearing loss

46

What is cholesteatoma?

Hyalinized epithelium of the middle ear

47

What is the bloody supply to CN VIII?

Internal auditory artery

48

What is the usual presentation of a labyrinthine infarction?

Sudden hearing loss

49

What are the associated symptoms of motion sickness?

Autonomic overtones (sweating, salivation, yawning)

50

What, generally, causes motion sickness?

Overstimulation of peripheral vestibular system

51

True or false: motion sickness may be induced by eye movements

True

52

Is BPV usually unilateral or bilateral?

Unilateral

53

What usually precipitates episodes of vertigo with BPV?

Movement of the head

54

What causes acoustic neuromas?

Schwannomas

55

Bilateral schwannomas = ?

NF2

56

Vertigo that comes on at rest or worse with position changes = ?

Central vertigo

57

What are the other, general, signs associated with central causes of vertigo?

CNS findings (e.g. diplopia, dysarthria, ataxia etc)

58

What is the arterial supply to the pons?

Basilar artery

59

What is the general medication class that is used to treat central vertigo?

Vestibular suppressants

60

What are the four major classes of drugs used to treat vertigo?

-Antihistamines
-Benzos
-Phenothiazines
-Scopolamine

61

What is the goal with the Epley maneuvers?

Reposition the otoconia

62

How can you tell which ear is affected with BPV?

Nystagmus will go to the side of the lesion

63

How, generally, are the Epley maneuvers performed?

Lay head down towards the side of dysfunction