Dizzy Patient

Question 1

____ is very common and __________ disease is very uncommon

Answer 1

BPPV is very common and MÉNIÈRE’S disease is very uncommon

Question 2

non-specific term, which may cover vertigo, pre-syncope, disequilibrium, etc. defines what?

Answer 2

dizziness

Question 3

define vertigo

Answer 3

a sensation of movement, usually spinning

Question 4

visual
cardiovascular
proprioceptive
vestibular
vestibulospinal tract
vestibule-ocular reflex

all contribute to what?

Answer 4

balance

Question 5

the following conditions are under what umbrella contributing to balance:

BPPV
Ménière’s
vestibular neuronitis

Answer 5

vestibular

Question 6

the following conditions are under what umbrella contributing to balance:

cataracts
DM

Answer 6

visual

Question 7

the following conditions are under what umbrella contributing to balance:

DM
arthritis
neurology

Answer 7

proprioceptive

Question 8

the following conditions are under what umbrella contributing to balance:

arrhythmias
postural hypertension

Answer 8

cardiovascular

Question 9

the following conditions are under what 2 umbrellas contributing to balance:

stress
migrane
SOL
MS

Answer 9

vestibulospinal tract

vestibule-ocular reflex

Question 10

a duration of vertigo lasting seconds

diagnosis?

Answer 10

BPPV

Question 11

a duration of vertigo lasting hours

diagnosis?

Answer 11

Ménière’s

Question 12

a duration of vertigo lasting days

diagnosis?

Answer 12

vestibular neuritis or labyrinthitis

Question 13

a duration of vertigo lasting variable duration

diagnosis?

Answer 13

migrane associated vertigo

Question 14

Do you get dizzy rolling over in bed?

if the answer was yes…

diagnosis?

Answer 14

BPPV

Question 15

Was your first attack severe, lasting hours with nausea & vomiting?

if the answer was yes…

diagnosis?

Answer 15

vestibular neuritis

Question 16

Do you get light-sensitive during the dizzy spells?

if the answer was yes…

diagnosis?

Answer 16

vestibular migraine

Question 17

Does one ear feel full or do you get hearing loss before or during the dizzy spell?

the answer was yes…

diagnosis?

Answer 17

Ménière’s

Question 18

name the 2 unusual but urgent referals of dizziness when you look in the ear

Answer 18

AOM

cholesteatoma

Question 19

BPPV is the commonest cause of vertigo when looking in what direction?

Answer 19

up

Question 20

what are the 3 causes of BPPV?

Answer 20

head trauma
ear surgery
idiopathic

Question 21

BPPV pathophysiology?

Answer 21

otolith material from utricle displaced into semicircular canals

most commonly in posterior SCC

Question 22

BPPV can be confused with vertebrobasilar insufficiency. for a diagnosis of VBI, what other symptom is needed?

Answer 22

visual disturbance
weakness
numbness

Question 23

vertigo on:

looking up
turning in bed - often worse to one side
first lying down in bed at night
on first getting out of bed in the morning
bending forward
rising from bending
moving head quickly – often only in one direction

diagnosis?

Answer 23

BPPV

Question 24

name the test and manœuvre performed in BPPV

Answer 24

dix hallpike test and epley manœuvre

Question 25

is there associated tinnitus or hearing loss in vestibular neuronitis?

Answer 25

no

Question 26

is there associated tinnitus or hearing loss in labyrinthitis?

Answer 26

yes

Question 27

vestibular neuronitis/labyrinthitis treatment?

Answer 27

self limiting | supportive with vestibular sedatives

Question 28

what rule is associated with vestibular neuronitis/labyrinthitis?

Answer 28

rule of 3: 3 days in bed 3 weeks of work 3 months off balance

Question 29

history of recurrent, spontaneous, rotational vertigo with at least two episodes >20mins (often lasting hours) occurrence of or worsening of tinnitus on the affected side ocurrence of aural fullness on the affected side documented SNHL on at least one occasion diagnosis?

Answer 29

Ménière's disease

Question 30

is high or low frequencies that is lost in Ménière's disease?

Answer 30

low frequencies

Question 31

Ménière's disease management?

Answer 31

supportive tinnitus therapy hearing aids salt restriction ITS - injected steroid to middle ear ITG - injected gentamicin grommet surgery

Question 32

is there a clear positional trigger in BPPV?

Answer 32

yes

Question 33

in what condition is there aural fullness?

Answer 33

Ménière's disease

Question 34

in what 2 conditions is there associated hearing loss or tinnitus?

Answer 34

Ménière's disease and labyrinthitis

Question 35

rare, benign tumour of VIII nerve sheath causes progressive imbalance and HL with tinnitus diagnosis?

Answer 35

vestibular schwannoma

Question 36

what is the gold standard to investigate the dizzy patient?

Answer 36

MRI

Question 37

BPPV duration?

Answer 37

minutes

Question 38

Ménière's disease duration?

Answer 38

hours

Question 39

labyrinthitis and vestibular neuronitis duration?

Answer 39

days-weeks

Question 40

vestibular schwannoma presses against what nerve?

Answer 40

CN VIII