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13 ENT > Dizziness > Flashcards

Dizziness Flashcards

(55 cards)

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1
Q

a distinct immediate and sometime incapacitating alteration of sensory experience characterized by a feeling of movement of oneself or environment

A

vertigo

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2
Q

unsteadiness or current tendency to stumble or fall, lacks a clear disturbance of sensorium of vertigo and related to ambulation

A

imbalance/disequilibrium

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3
Q

a floating feeling, mild unsteadiness or depersonalization

A

lightheadedness, can be replicated by hyperventilation

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4
Q

feeling faint or losing consciousness

A

presyncope

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5
Q

mechanics of the balance system

A

input from vestibular (angular and linear), proprioceptive, and visual -> cns -> eye and joints -> vestibulooccular reflex and vestibularspinal reflex

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6
Q

t/f dizziness occurs when there is any dysfunction in the visual, vestibular, or somatic (proprioceptive) system

A

true

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7
Q

non-vestibular causes of dizziness

A

cardiovascular, endocrine, neurologic, drugs

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8
Q

vestibular causes of dizziness

A

disruption in the afferent vestibular pathway or in the equilibrium reflexes mentioned earlier

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9
Q

how to diagnose dizziness

A
  1. ascertain if it’s truly vertigo
  2. elicit triggers, timing, duration, and intensity (detailed hx)
  3. detect associated symptoms (neuro pe)
  4. determine if vestibular or not
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10
Q

the first thing to do with a dizzy patient is __

A

determine if this is a neuro event (sudden onset headache and neurologic signs = urgent refer)

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11
Q

peripheral vs central vertigo

A

peripheral: membranous labyrinth/vestibular apparatus and vestibular nerve
central: nuclei and fiber tracts in cns

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12
Q

nystagmus in peripheral vertigo

A
  • horizontal and torsional
  • inhibited by fixating eyes
  • fades after few days
  • does not change direction with gaze
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13
Q

nystagmus in central vertigo

A
  • purely vertical, horizontal or torsional
  • not inhibited by fixation
  • may last weeks to months
  • may change direction with gaze towards fast phase
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14
Q

imbalance in peripheral and central vertigo

A

p: mild to moderate, can walk
c: severe, cannot walk or stand still

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15
Q

nausea/vomiting in p and c vertigo

A

p: severe
c: varies

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16
Q

hearing loss and tinnitus in p and c vertigo

A

p: common
c: rare

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17
Q

non-auditory neuro symptoms in p and c vertigo

A

p: rare
c: common

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18
Q

latency following provocation in p and c vertigo

A

p: longer (20 s)
c: shorter (5 s)

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19
Q

a conjugated, coordinated eye movement about a certain axis which can be divided into rhythmically alternating slow and fast phases

A

nystagmus

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20
Q

pathology in nystagmus

A

when only one vestibular system is sending inputs to the cns

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21
Q

kinds of movement in nystagmus

A
  • horizontal
  • vertical
  • rotary
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22
Q

slow vs fast phase

A

slow: tonic eye movement induced physiologically or pathologically by vestibular stimulus
fast: saccade like re-fixation movement induced by oculomotor system

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23
Q

direction of the nystagmus is defined by the ____

Study These Flashcards
A

fast component

24
Q

pure tone audiometry

Study These Flashcards
A
  • confirms peripheral vertigo

- abnormal = mri

25
gold standard for diagnosis of retrocochlear pathology
mri
26
t/f the use of audiometric brainstem response is recommended for retrocochlear pathology
false, hx and pe enough
27
inflammation of the vestibular nerve
vestibular neuronitis/neuritis
28
pathophysio of vestibular neuritis
- sudden impairment of peripheral vestibular system of one side - usually superior vestibular nerve
29
manifestation of vestibular neuritis
- 2 wks after urti - sudden severe attack of rotary vertigo with no apparent cause - horizontal symtpoms
30
vestibular neuritis pertinent negatives
no ear pain, hearing loss, or tinnitus no other neuro impairments no headache
31
in vestibular neuritis, nystagmus is heightened when ___ and decreased when ___
heightened when looking toward fast phase decreased when looking toward slow phase (injured side)
32
ddx for vestibular neuritis
central infarction of cerebellum vascular lesions cns space occupying lesion
33
treatment for vestibular neuritis
supportive: bed rest, iv fluids, anti-vertigo meds, corticosteroids, vestibular rehabilitation after acute phase
34
prognosis of vestibular neuritis
good with complete recovery but elderly can have residual disequilibrium
35
most common cause of dizziness
benign paroxysmal positional vertigo
36
pathophysio of bppv
- caused by particles floating in endolymph of semicircular canal - particles cause an unphysiologic deflection of cupula in scc (usually posterior scc)
37
manifestations of bppv
- brief episodic transient vertigo induced by rapid change in head movement - vertigo and nystagmus <30 s - bppv temporarily becomes less intense and disappears with repeated positioning
38
pertinent negatives in bppv
no ear pain, hearing loss or tinnitus | no other neuro impairments
39
diagnostics of bppv
dix haplike test: rotatory nystagmus after latent period of 10 s and lasts for a minute pta-st and calorics normal
40
treatment for bppv
canalith repositioning maneuvers (epley's maneuver and semont's maneuver)
41
pathophysio of meniere's disease
- hx: narrow vestibular aqueduct or previous hx of ear trauma - oversecretion of endolymph = distention of cochlear duct and displacement of reissner's membrane towards scala vestibuli - rupture of reissner's membrane = mixing of perilymph and endolymph = inc potassium in perilymph
42
clinical triad of meniere's disease
fluctuating hearing loss, tinnitus, and vertigo - tinnitus becomes louder, hearing becomes poorer - vertigo ~20 mins
43
manifestation of meniere's disease
- ear fullness - hearing improves after attack but dysequilibrium persists - pta: low tone sensorineural hearing loss - vestibular testing: hypo- or hyperfunction and eventually hypofunction
44
treatment for meniere's disease
- symptom control and decreasing fluid - diuretics, ccb, histamine analogs - anti-emetics - salt restriction - sedatives - intratympanic injection of gentamicin or dexamethasone in serve cases
45
prognosis for meniere's diesease
good but recurrent, hearing loss may become permanent
46
manifestation of migraine associated vertigo
- hx of migraine - mimics bppv, meniere's, or TIA - diagnosis by exclusion
47
manifestations of cervicogenic vertigo
- headache - syncope, tinnitus, nausea and vomiting, hearing loss, flashing lights - elicited by cervical range of motion maneuvers
48
pathophysio of cervicogenic vertigo
- trigger: head/neck assumes a certain position or change in position - misalignment causes abnormal information on orientation of head and neck - brain mis-corrects based on wrong info = dizziness
49
diagnostics of cervicogenic vertigo
pta-st and caloric tests normal | neck ap-l: cervical spondylosis, degenerative change, straightening of normal cervical lordosis
50
treatment for cervicogenic vertigo
symptom control, rehab for cervical neck spine problem
51
examples for vestibular neuritis drugs
steroids: prednisone
52
examples of meniere's drugs
diruetics: hydrochlorthiazide histamine: betahistine ccb: flunarizine, cinnarizine
53
examples of bppv drugs
histamine: betahistine ccb: cinnarizine
54
examples of vestibular sedatives
benzodiazepines: diazepam, lorazepam antihistamines, anticholinergic: meclizine, dimenhydrinate anticholinergics: scopolamine
55
examples of antiemetics
metoclopramide: prochlorperazine others: gingko biloba

13 ENT (18 decks)

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