The Dizzy Patient

Question 1

how will a patient explain vertigo?

Answer 1

room is spinning

they are spinning

Question 2

most common form of vertigo?

Answer 2

benign positional paroxysmal vertigo

Question 3

meniere’s disease is uncommon T or F

Answer 3

T

Question 4

what part of the semicircular canals is classed as a vestibular end organ

Answer 4

their ampullae

Question 5

what parts of the utricle and saccule are considered to be vestibular end organs?

Answer 5

maculae

Question 6

what parts of the brain control movement?

Answer 6

cerebellum

brainstem

Question 7

what brain conditions/symptoms can affect balance?

Answer 7

MS
SOL
stress
migraine

Question 8

how is a patient with dizziness examined?

Answer 8

otoscopy
neurological exam
blood pressure
balance system eg hallpike's test
audiometry

Question 9

common causes of dizziness?

Answer 9

medication

postural hypotension

Question 10

specific causes of dizziness?

Answer 10

meniere's disease
benign positional paroxysmal vertigo
vestibular neuronitis
labrynthitis
migrainous vertigo

Question 11

causes of benign positional paroxysmal vertigo?

Answer 11

head trauma
ear surgery
idiopathic

Question 12

pathophysiology of BPPV

Answer 12

otolith displaced into the semicircular canals, particularly the posterior SCC

Question 13

most common area for otoliths to deposit and why?

Answer 13

posterior semicircular canal

is the lowest so gravity causes it

Question 14

what should otoliths be attached to?

Answer 14

otolithic membrane of the utricle and saccule

Question 15

another name for otoliths?

Answer 15

calcium carbonate crystals

Question 16

how long does true vertigo last?

Answer 16

30 secs-1 min

Question 17

presentation of BPPV?

Answer 17

vertigo on looking up, turning in bed, lying down, bending forward etc

Question 18

the eyes are facing what direction in fast nystagmus?

Answer 18

down (towards floor)

Question 19

there is associated tinnitus and hearing loss in BPPV T or F

Answer 19

F, none of these

Question 20

what test can be used to check for BPPV?

Answer 20

hallpike’s test

Question 21

how is hallpike’s test done?

Answer 21

lie on couch with head hanging off the end
eyes open even if dizzy
turn head 45 degrees to one side
look for nystagmus

Question 22

what exercise can patients do themselves to help with vertigo?

Answer 22

brandt-daroff exercise

Question 23

prolonged vertigo with no associated ear symptoms?

Answer 23

vestibular neuronitis

Question 24

aetiology of vestibular neuronitis?

Answer 24

viral

Question 25

prolonged vertigo with associated tinnitus and hearing loss?

Answer 25

labyrinthitis

Question 26

what does the epley manoeuvre hope to achieve?

Answer 26

the otoliths go back into the otolith organs

Question 27

aetiology of labyrinthitis?

Answer 27

viral

Question 28

Tx of vestibular neuronitis?

Answer 28

self limiting | support with vestibular sedatives and exercises

Question 29

Tx of labyrinthitis?

Answer 29

self limiting | support with vestibular sedatives and exercises

Question 30

presentation of menieres disease?

Answer 30

Hx of recurrent, spontaneous rotational vertigo that lasts hours

Question 31

what are the other ear symptoms experienced in tinnitus other than vertigo?

Answer 31

aural fullness and worsening of tinnitus on affected side

Question 32

Tx of menieres?

Answer 32

``` supportive grommet insertion gentamicin/steroids intratympanically tinnitus therapy hearing aids reduction of caffeine and alcohol ```

Question 33

how do you test for menieres?

Answer 33

you can't, it is a diagnosis of exclusion

Question 34

how common is vertigo in migraine sufferers?

Answer 34

1/4 get it