"The Dizzy Patient"

Question 1

Is meniere’s disease common?

Answer 1

No

Question 2

Is benign positional paroxysmal vertigo common?

Answer 2

Yes (v common)

easily treated

Question 3

What is “dizziness”?

Answer 3

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

Question 4

What is “vertigo”?

Answer 4

a sensation of movement, usually spinning

Question 5

What is the name of the complex structure in the inner ear?

Answer 5

Labyrinth

Question 6

Is all dizziness “vertigo”?

Answer 6

no

Question 7

Is all dizziness otogenic?

Answer 7

no

Question 8

What does BPPV stand for?

Answer 8

Benign Positional Paroxysmal Vertigo

Question 9

BPPV, Meniere’s and Vestibular Neuronitis are issues due to what component of the balance system?

Answer 9

The inner ear

Question 10

Diabetes Mellitus affects what components of the balance system?

Answer 10

The eye, the joints

Question 11

Arrhythmias and postural hypotension affect what component of the balance system?

Answer 11

The heart

Question 12

Stress, migraine, SOL and MS affect what components of the balance system?

Answer 12

The brain

Question 13

What is the christa ampullaris?

Answer 13

The sensory organ of rotation

Question 14

What is the name of the sensory organ of rotation?

Answer 14

The christa ampullaris

Question 15

What is nystagmus?

Answer 15

rapid involuntary movements of the eyes

Question 16

What is the word for rapid involuntary movements of the eyes?

Answer 16

Nystagmus

Question 17

Is nystagmus observed in vestibular pathologies?

Answer 17

Yes

Question 18

What is the commonest cause of vertigo on looking up?

Answer 18

Benign Positional Paroxysmal Vertigo

Question 19

Name (3) causes of bening positional paroxysmal vertigo:

Answer 19

Head trauma
Ear surgery
Idiopathic

Question 20

Pathophysiology of BPPV:

Answer 20

Otolith material from utricle displaced into semicircular canals. Most commonly in posterior SCC.

Question 21

What insufficiency may BPPV be confused with?

Answer 21

May be confused with Vertebrobasilar insufficiency.

For a diagnosis of VBI need other symptoms of impaired circulation in posterior brain associated with the vertigo:
e.g. visual disturbance
weakness
numbness

Question 22

Benign Positional Paroxysmal Vertigo is vertigo on:

Answer 22

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

Question 23

Does BPPV have associated tinnitus or hearing loss?

Answer 23

No

Question 24

What exercises are used for treatment of BPPV?

Answer 24

Brandt-Daroff Exercises

Question 25

Which (2) manouvre's are used to manage BPPV?

Answer 25

Epley Manoeuvre and Semont Manoeuvre

Question 26

What does the Dix–Hallpike test/manoeuvre test for?

Answer 26

BPPV

Question 27

What manouvevre is a diagnostic test for BPPV?

Answer 27

Hallpike's Test

Question 28

What hapens in the Dix-hallpike test?

Answer 28

``` Sit on couch so that head will be off end when lies back Turn head 45º to one side Warn patient not to close eyes if dizzy Lie back as quickly as comfortable Hold in position and observe Usually delay of approx. 30 seconds Classical nystagmus Test fatigues - much reduced or absent response on repetition Condition may be bilateral ```

Question 29

What is the name of this test: ``` Sit on couch so that head will be off end when lies back Turn head 45º to one side Warn patient not to close eyes if dizzy Lie back as quickly as comfortable Hold in position and observe Usually delay of approx. 30 seconds Classical nystagmus Test fatigues - much reduced or absent response on repetition Condition may be bilateral ```

Answer 29

The Dix-hallpike test

Question 30

What is the Brandt-daroff exercise?

Answer 30

Start in an upright, seated position. Move into the lying position on one side with your nose pointed up at about a 45-degree angle. Remain in this position for about 30 seconds (or until the vertigo subsides, whichever is longer). ... Repeat on the other side.

Question 31

How do you do the Eppley Manoeuvre?

Answer 31

start sitting on a bed and turn your head 45° to the right. Place a pillow behind you so that on lying back it will be under your shoulders. Lie back quickly with shoulders on the pillow and head reclined onto the bed. Wait for 30 seconds. Turn your head 90° to the left (without raising it) and wait again for 30 seconds. Turn your body and head another 90° to the left and wait for another 30 seconds. Sit up on the left side.

Question 32

Vestibular neuronitis: | 4

Answer 32

Prolonged vertigo (days) No associated tinnitus or hearing loss Probable viral aetiology May be viral prodromal symptoms

Question 33

What is Labyrinthitis?

Answer 33

inflammation of the labyrinth or inner ear.

Question 34

Management of labyrinthitis:

Answer 34

Supportive management with vestibular sedatives Generally self-limiting (if prolonged or atypical may require further investigation) May be helped by rehabilitation exercises if prolonged

Question 35

What is the cause of Meniere's Disease?

Answer 35

Unknown | lol, trick question

Question 36

Is meniere's disease common?

Answer 36

No 50-200/100,000

Question 37

History of Meniere's Disease:

Answer 37

Recurrent, spontaneous, rotational vertigo with at least two episodes >20mins (often lasting hours) Occurrence of or worsening of tinnitus on the affected side Occurrence of aural fullness on the affected side Documented sensorineural hearing loss on at least one occasion Other causes excluded

Question 38

Management of Meniere's disease:

Answer 38

Supportive treatment during episodes Tinnitus therapy Hearing Aids Prevention Grommet insertion/Meniette Intratympanic Gentamicin/ Steroids Surgery

Question 39

What are the preventative measures agaisnt menieres disease?

Answer 39

``` Salt restriction Betahistine (used to ease symptoms) Caffeine Alcohol Stress ```

Question 40

What does betahistine ease symptoms of?

Answer 40

Meniere's disease

Question 41

Does meniere's disease cause hearing loss?

Answer 41

Yes

Question 42

Migranous vertigo =

Answer 42

Episodic vestibular symptoms of at least moderate severity (interfere but not impede daily activities) Migraine according to International Headache Society criteria At least 1 of the following during at least 2 attacks: Migrainous symptoms during vertigo, migraine-specific precipitants of vertigo, response to anti-migrainous drugs Other causes ruled out

Question 43

PROBABLE migrainous vertigo:

Answer 43

Episodic vestibular symptoms of at least moderate severity (interfere but not impede daily activities) At least 1 of: Migrainous headache, photophobia, phonophobia, visual or other aura Other causes ruled out

Question 44

BPPV lasts for: | minutes/hours/days-weeks

Answer 44

Minutes

Question 45

Meniere's disease lasts for: | minutes/hours/days-weeks

Answer 45

Hours

Question 46

Labrinthitis lasts for: | minutes/hours/days-weeks

Answer 46

Days-Weeks

Question 47

Vestibular Neuronitis lasts for: | minutes/hours/days-weeks

Answer 47

Days-weeks

Question 48

Is there an associated hearing loss or tinnitus with BPPV?

Answer 48

No

Question 49

Is there an associated hearing loss or tinnitus with Meniere's Disease?

Answer 49

Yes

Question 50

Is there an associated hearing loss or tinnitus with Labyrinthitis?

Answer 50

Yes

Question 51

Is there an associated hearing loss or tinnitus with Vestibular Neuronitis?

Answer 51

No

Question 52

Do patients get "aural fullness" with BPPV?

Answer 52

No

Question 53

Do patients get "aural fullness" with Meniiere's Disease?

Answer 53

Yes

Question 54

Do patients get "aural fullness" with Labyrinthitis?

Answer 54

No

Question 55

Do patients get "aural fullness" with vestibular neuronitis?

Answer 55

No

Question 56

Does BPPV have a clear positional trigger?

Answer 56

Yes

Question 57

Does Meniere's have a clear positional trigger?

Answer 57

No

Question 58

Does Labrynthitis have a clear positional trigger?

Answer 58

No

Question 59

Does Vestibular neuronitis have a clear positional trigger?

Answer 59

No