Dizziness

Question 1

is menieres common

Answer 1

no

Question 2

what are the different causes of dizziness

Answer 2

cardio problems 
haematological and metabolic 
anxiety 
neurological conditions 
drugs side effects/ interactions 
migraine
otological 
trauma

Question 3

what is dizziness

Answer 3

non-specific term, covers vertigo, pre-syncope (state before fainting), disequilibrium

Question 4

what is vertigo

Answer 4

sensation of movement, usually spinning

Question 5

what conditions that causes dizziness affect the vestibular contribution to the central pathway

Answer 5

BPPV
menieres
venstibular neuronitis

Question 6

what conditions that causes dizziness affect the cardiovascular contribution to the central pathway

Answer 6

arrhythmias

postural hypotension

Question 7

what conditions that causes dizziness affect the visual contribution to the central pathway

Answer 7

cataracts

DM

Question 8

what conditions that causes dizziness affect the proprioceptive contribution to the central pathway

Answer 8

DM, arthritis, neurology

Question 9

what conditions that causes dizziness affect the central pathways

Answer 9

stress
migraine
space occupying lesion
MS

Question 10

what are the signs of a cardiac dizziness

Answer 10

lightheadedness, syncope, palpitation

Question 11

what are the features of a neuro dizziness

Answer 11

blackouts, visual disturbance, paraesthesia, weakness, speech and swallow problems

Question 12

what are the vestibular causes of dizziness

Answer 12

vertigo; feeling of spinning, falling or being pushed

Question 13

what dizziness lasts seconds

Answer 13

BPPV

Question 14

what dizziness lasts hours

Answer 14

menieres

Question 15

what dizziness lasts days

Answer 15

vestibular neuritis/ labyrinthitis

Question 16

what causes of dizziness are variable in length

Answer 16

migraine associated vertigo

Question 17

what are the symptoms of a vestibular migraine

Answer 17

dizziness, variable duration, mostly occur without headaches, nausea, vomiting, sweating, flushing, diarrhoea, visual changes (blurring), flashing lights, difficulty focusing
bright light and loud sounds are uncomfortable, most feel need to sleep

Question 18

what does dizziness with hearing loss, tinnitus and aural pressure suggest

Answer 18

inner ear problems- meineres

Question 19

quick diagnosis:

gets dizzy rolling over in bed

Answer 19

BPPV

Question 20

quick diagnosis:

first attack was severe, lasting hours with nausea and vomiting

Answer 20

vestibular neuritis

Question 21

quick diagnosis:

get light sensitive during the dizzy spells

Answer 21

vestibular migraines

Question 22

quick diagnosis:

one ear feels full/ get hearing loss before/ during the dizzy spell

Answer 22

menieres

Question 23

what should you include in an exam of a dizzy patient

Answer 23

otoscopy 
neurological 
BP when lying and standing 
balance system 
audiometry 
dix hallpike test

Question 24

what causes of dizziness need an urgent referral

Answer 24

AOM or cholesteatoma

Question 25

what are the vestibular end organs

Answer 25

ampullae of lateral, posterior and superior canals (swelling containing cupulas) maculae of the urticle and saccule (respond to changes in the head position with respect to gravity)

Question 26

when turning right the cupula on which side will be most excited

Answer 26

the right side

Question 27

in a nystagmus caused by a dead ear is the fast phase away from or towards the affected side

Answer 27

away from- slow to affected side, fast away from

Question 28

where is the lesion in a bi directional nystagmus

Answer 28

central

Question 29

where is the lesion in a vertical nystagmus

Answer 29

central, can be stroke

Question 30

what investigations into someone with postural dizziness

Answer 30

Hb, Na, BP lying + standing

Question 31

is BPPV common

Answer 31

yes very

Question 32

what is BPPV

Answer 32

benign positional paroxysmal vertigo | the commonest cause of vertigo when looking up

Question 33

what causes BPPV

Answer 33

head trauma, ear surgery, idiopathic happens with otolith material (crystals) from urticle are displaced into semicircular canals (most commonly posterior SCC) causing perceived movement

Question 34

what can BPPV be confused with

Answer 34

vertebrobasilar insufficiency (when bending head back blocks off the arteries)

Question 35

what are the features of vertebrobasilar isufficiency

Answer 35

visual disturbance weakness numbess vertigo

Question 36

when do you get vertigo in BPPV

Answer 36

``` looking up turning in bed laying down at night first getting up in morning bending forward rising from bending moving head quickly ```

Question 37

what is the dix hallpike test

Answer 37

sit up, eyes open turn head 45 degrees to the right lay down, doesnt have to be fast short delay (wait up to ten seconds) and looking for symptoms and nsytagmus eyes tell you which canal the crystals are in in BPPV eye will bounce up and down and there will be twisting patient will feel dizzy and might be sick

Question 38

in BPPV how can you tell what canal the crystal is in

Answer 38

eye twisting towards the ground (geotrophic) | 9/10 times BPPV will be in the posterior canal

Question 39

how do you treat BPPV

Answer 39

epley manoeurve or semont manoeuvre if the patient cant tolerate epley brandt-daroff exercises

Question 40

what do the posterior and superior semicircular canals join to form

Answer 40

crus commune

Question 41

where do you want to get the crystals to end up after the epley manoeuvre

Answer 41

out of the semicircular canals

Question 42

what is vestibular neuronitis

Answer 42

``` prolonged vertigo (days) with no associated tinnitus or hearing loss caused by an infection of the vestibular nerve within the inner ear (probably viral) ```

Question 43

what is labryinthitis

Answer 43

another name for vestibular neuronitis

Question 44

what is the treatment for vestibular neuronitis

Answer 44

supportive management with vestibular sedatives generally self limiting if prolonged may need exercises(looking at thumb and moving head will improve VOR)/ further investigation

Question 45

what is menieres disease

Answer 45

endo lymphatic hydrops = high pressure within the endolymph system

Question 46

what are the symptoms of menieres

Answer 46

episodic sudden onset of vertigo, sensorineural hearing loss (low frequency), tinnitus, and sensation of fullness in the affected ear, at least two episodes >20 mins (often lasting hours)

Question 47

what is the management of menieres

Answer 47

supportive treatment during episodes (intratympanic steroids or gentamicin) tinnitus therapy hearing aids prevention (salt restriction, betahistine, caffeine, acohol, stress) grommet insertion surgery

Question 48

what is the most common auditory symptom of migraine

Answer 48

phonophobia

Question 49

what is a migraine

Answer 49

abnormal electrical activity

Question 50

what causes of dizzyness have associated hearing loss or tinnitus

Answer 50

menieres disease, labyrinthitis

Question 51

what causes of dizzyness has aural fullness

Answer 51

menieres

Question 52

what tumour can cause dizzyness

Answer 52

vestibular schwannoma

Question 53

describe the nystagmus in BPPV

Answer 53

rotary nystagmus in posterior canal BPPV. Purely horizontal nystagmus suggests horizontal canal BPPV. A short latency period of a few seconds should be expected. Nystagmus (fast component) will be upbeat and in the direction of the affected ear. This has a limited duration, lasting <30 seconds (adaption). On sitting, there is more vertigo, experienced as the room spinning in the opposite direction (with reversal of the nystagmus).

Question 54

is BPPV is nystagmus towards or away from the affected ear

Answer 54

the fast phase is towards the affected ear