Vertigo

Question 1

Dizzy when rolling over in bed

Answer 1

BPPV

Question 2

First attack severe, lasting hours and associated with N+V

Answer 2

Vestibular neuritis

Question 3

Light sensitive during dizzy spells

Answer 3

Vestibular migraine

Question 4

Feeling of fullness in one ear and difference in hearing around the time of the dizzy spell

Answer 4

Ménière’s disease

Question 5

What is dizziness

Answer 5

Non-specific term used to describe a sensation of unsteadiness, lightheadedness, or a feeling of spinning or imbalance

Question 6

What is vertigo

Answer 6

A sensation of motion

Question 7

How might people describe vertigo

Answer 7

Spinning, falling, feeling of being pushed

Question 8

Vertigo that lasts seconds

Answer 8

BPPV

Question 9

Vertigo that lasts hours

Answer 9

Meniere’s

Question 10

Vertigo that lasts days

Answer 10

Vestibular neuritis

Question 11

Vertigo that lasts for variable amounts of time

Answer 11

Migraine associated vertigo

Question 12

Name some associated symptoms of vertigo

Answer 12

Hearing loss, tinnitus, aural pressure
Migraines or sensory sensitivity
Sound or pressure induced symptoms

Question 13

How might we investigate vertigo

Answer 13

Otoscopy
Blood pressure
Neurological exam
Test balance systems
Audiometry

Question 14

What is BPPV

Answer 14

Benign positional paroxysmal vertigo

Question 15

What causes BPPV

Answer 15

Otoconia from the utricle is displaced into the semi-circular canals

Question 16

What are otoconia

Answer 16

Calcium carbonate crystals

Question 17

Where is otoconia most commonly displaced to

Answer 17

Posterior semi-circular canals

Question 18

Name 3 things that can cause BPPV

Answer 18

Head trauma
Ear surgery
Idiopathic

Question 19

How does BPPV present

Answer 19

Vertigo when looking up, movement in bed, bending forward, moving head quickly

Question 20

Other associated symptoms of BPPV

Answer 20

N+V

Question 21

Diagnostic examination for BPPV

Answer 21

Dix-hallpike manoeuvre

Question 22

Positive test for Dix-hallpike manoeuvre

Answer 22

Will invoke symptoms and cause geotropic, torsional nystagmus

Question 23

What is nystagmus

Answer 23

Uncontrolled repetitive movements of the eyes

Question 24

What is used to treat BPPV

Answer 24

Repositioning manoeuvres

Question 25

Name 3 repositioning manoeuvres used to treat BPPV

Answer 25

Epley manoeuvre Selmont manoeuvre Brandt-daroff exercises

Question 26

What is the epley manoeuvre

Answer 26

A series of head and body movements designed to reposition displaced otoliths in the inner ear

Question 27

How often should a patient do Brandt-daroff exercises

Answer 27

10 reps 3x a day, usually for a week

Question 28

What is vertebrobasilar insufficiency

Answer 28

Describes a temporary set of symptoms due to ischaemia in the posterior circulation of the brain

Question 29

What is the most common cause of vertebrobasilar insufficiency

Answer 29

Atherosclerosis

Question 30

Clinical presentation of VBI

Answer 30

Causes vertigo on looking up

Question 31

What is VBI

Answer 31

vertebrobasilar insufficiency

Question 32

What is needed for a diagnosis of VBI

Answer 32

Vertigo + symptoms of impaired circulation in the posterior brain

Question 33

Give examples of symptoms that suggest impaired circulation in the posterior brain

Answer 33

Visual disturbance Weakness Numbness

Question 34

What is labyrinthitis

Answer 34

Inflammation of the labyrinth of the inner ear

Question 35

What is vestibular neuritis

Answer 35

Inflammation of the vestibular nerve

Question 36

What is the probable cause of labyrinthitis and vestibular neuritis

Answer 36

Viral infection

Question 37

What symptoms are associated with labyrinthitis

Answer 37

Tinnitus or hearing loss

Question 38

Clinical presentation of vestibular neuritis and labyrinthitis

Answer 38

Prolonged vertigo First attack severe, lasting hours with N+V

Question 39

What is the management of vestibular neuritis and labyrinthitis

Answer 39

Supportive- vestibular sedatives Rehabilitation exercises if prolonged

Question 40

What is Ménière’s disease

Answer 40

An idiopathic disorder causing vertigo

Question 41

What is Ménière’s disease thought to be caused by

Answer 41

Excess of endolymph within the membranous labyrinth caused by dysfunctioning sodium channels Causes increase in pressure

Question 42

Clinical presentation of Ménière’s disease

Answer 42

Triad of severe paroxysmal vertigo, sensorineural hearing loss and tinnitus on the affected side Sensation of ear being full

Question 43

Investigation for Ménière’s disease

Answer 43

Audiology

Question 44

Positive testing for Ménière’s disease shows…

Answer 44

Low frequency sensorineural hearing loss

Question 45

Management of Ménière’s disease

Answer 45

Supportive Tinnitus therapy Hearing aids

Question 46

Lifestyle prevention of Ménière’s disease

Answer 46

Reduce salt, avoid chocolate and caffeine, avoid stress

Question 47

What is a vestibular migraine

Answer 47

Episode of vertigo in someone who has a history of migraines

Question 48

Clinical presentation of vestibular migraine

Answer 48

Light sensitive during dizzy spells Fluctuating hearing loss Phonophobia

Question 49

Lifestyle management of vestibular migraines

Answer 49

Avoid: alcohol, caffeine, chocolate, citrus fruits, lack of sleep

Question 50

Pharm management of vestibular migraines

Answer 50

Abortive agents e.g. triptans Prophylaxis e.g. propranolol, amitriptyline

Question 51

Which way does nystagmus occur

Answer 51

Away from the damaged side