vestibular

Question 1

is diplopia (double vision) a central or peripheral sign?

Answer 1

central

Question 2

what is labyrinthitis and what are some sx?

Answer 2

inflammation of the labyrinth
sudden onset of vertigo, nausea, vom
(+) head impulse test
lasts days to weeks
HEARING LOSS, TINNITUS

Question 3

in anterior canal BPPV, which way does the nystagmus beat?

Answer 3

downbeating torsional

Question 4

in posterior canal BPPV, which way does the nystagmus beat?

Answer 4

upbeating torsional

PUP

Question 5

how do you treat right cupulolithiasis?

Answer 5

Semont/Liberatory maneuver

1. head rotated 45* to L side
2. pt is moved from sitting to R sidelying and stays here for 1 min
3. pt is rapidly moved 180* to L sidelying
4. after 1 min, return pt to sitting

Question 6

how long does dizziness last in canalithiasis?

Answer 6

<1 min

Question 7

what is vestibular neuritis and what are some sx?

Answer 7

inflammation of the nerve
sudden onset of vertigo, nausea, vom
(+) head impulse test
lasts days to weeks
no hearing loss

Question 8

what are the two types of BPPV?

Answer 8

canalithiasis
cupulolithiasis

Question 9

what should you do if you suspect a central vestibular pathology?

Answer 9

refer to physician

Question 10

is horizontal nystagmus a peripheral or central pathology?

Answer 10

peripheral

Question 11

how can you assess oculomotor?

Answer 11

smooth pursuits and saccades

Question 12

will you see ataxia in central or peripheral vestibular disorders?

Answer 12

central (cerebellum could be affected)

Question 13

does geotropic nystagmus indicated canalithiasis or cupulolithiasis?

Answer 13

canal, ageotropic is cupulo

Question 14

is VOR intact in BPPV?

Answer 14

YES

Question 15

what is a slow growing tumor that develops from the balance and hearing nerves supplying the inner ear?

Answer 15

acoustic neuroma/vestibular schwannoma (also want to refer to dr)

will also have tinnitus and hearing issues and LOB/ataxia

Question 16

for geotropic nystagmus, will the affected side have stronger or weaker sx?

Answer 16

stronger

Question 17

what are the two otolith organs

Answer 17

saccule
utricle

Question 18

how can you treat unilateral vestibular hypofunction?

Answer 18

VOR x1 and VOR x2 exercises
postural stability and balance
habituation

Question 19

what is VOR responsible for?

Answer 19

maintaining focus on an image during rapid head movements

Question 20

supine roll is a ____, BBQ roll is a _______

Answer 20

test, treatment for horizontal canal (head turned to affected side)

Question 21

how to treat horizontal canal BPPV?

Answer 21

CRM

position head to affected side

Question 22

can BPPV be bilateral?

Answer 22

yes

Question 23

oscillopsia, loss of gaze stabilization, spontaneous nystagmus that can be suppressed with visual fixation, disequilibrium, and ataxia are all signs of what?

Answer 23

acute unilateral vestibular hypofunction (UVH)

Question 24

BPPV, vestibular neuritis, labyrinthitis, and acoustic neuroma are all types of _____ vestibular pathologies?

Answer 24

peripheral, labyrinth related

Question 25

can BPPV happen in any canal?

Answer 25

Yes, but most commonly posterior anterior is very rare and they prob won't ask about it

Question 26

what is the most common disorder resulting in dizziness in older populations?

Answer 26

BPPV

Question 27

will you see hearing loss in central or peripheral vestibular disorders?

Answer 27

peripheral

Question 28

will visual fixation help central or peripheral disorders?

Answer 28

peripheral

Question 29

how do you treat bilateral vestibular hypofunction

Answer 29

VOR x1 imaginary targets walkig

Question 30

which way does a ageotropic nystagmus beat?

Answer 30

away from the ground

Question 31

will you have hearing loss with labyrinthitis or vestibular neuritis?

Answer 31

labyrinthitis

Question 32

you are doing a head impulse test on a pt. when you turn their head right and then quickly to the center, their eyes lag and take longer to catch up to center, what does this indicate?

Answer 32

R sided hypofunction/R VOR affected/+ head impulse

Question 33

while the exact cause of BPPV is not really known, they think it can be because of...

Answer 33

infection head trauma vestibular weakness advancing age

Question 34

what neurological condition would be related to central vestibular pathology?

Answer 34

MS, UMN disorder

Question 35

how will I treat someone with posterior canalithiasis BPPV?

Answer 35

Epley/canalith repositioning maneuver (CRM)

Question 36

which way does a geotropic nystagmus beat?

Answer 36

to the ground (geo)

Question 37

if pt can't tolerate the CRM, what can you do instead?

Answer 37

brandt daroff same as semont basically except you have a head turn before you do the 180 to the other side you will do both sides

Question 38

what cranial nerve can be affected by acoustic neuroma?

Answer 38

facial nerve, resulting in facial numbness

Question 39

will you see vertical nystagmus in central or peripheral?

Answer 39

central

Question 40

describe the epley maneuver

Answer 40

1. 45* to symptomatic side and 30* below horizontal (dix-hallpike position) 2. rorate 45* to the otherside maintaining the 30* of extension 3. roll to sidelying (uninvolved side) with nose down 4. slowly sit up, maintaining head position flexed and rotated slowly return the head to upright and remain sitting 3-4 min then repeat until no sx are seen maintain each position for 1-2 minutes or until the vertigo and nystagmus has stopped

Question 41

what kind of nystagmus will you see in peripheral disroders?

Answer 41

jerk (slow and fast phases)

Question 42

what disease is described as an overproduction of fluid within the inner ear, causing increased pressure and vertigo?

Answer 42

meniere's pts may have hearing loss, tinnitus, aural fullness, and it can last min to hours rec a diet lower in salt to decrease water content

Question 43

what the larger part of the canal called that crystals sometimes get stuck in?

Answer 43

cupula

Question 44

is smooth pursuit and saccades normal in central or peripheral vestibular disorders?

Answer 44

they are normal in peripheral

Question 45

what test assesses BPPV? explain the steps

Answer 45

dix-hallpike pt's head is turned 45 degrees to affected ear pt moved quickly into a supine position with head extended 20-30 degrees (maintaining 45 deg rotation)

Question 46

the labyrinth is made up of what two things?

Answer 46

semicircular canals and otolith organs

Question 47

what test is used for horizontal canal BPPV?

Answer 47

supine roll pt supine, cervical spine flexed to 20*. head quickly turned 90* to one side, check for nystagmus or vertigo. head is then turned gently to the neutral staring position. they you repeat on other side

Question 48

for ageotropic nystagmus, will the affected side have stronger or weaker sx?

Answer 48

weaker

Question 49

what kind of nystagmus will you see in central vestibular disorders?

Answer 49

pendular (eyes oscillate at equal speeds)

Question 50

how long does dizziness last in cupulolithiasis?

Answer 50

>1 min, "cupulo" is longer than "canal"

Question 51

describe what happens in BPPV?

Answer 51

calcium carbonate crystals, or otoconia, are normally in the utricle but then they get dislodged and float inside canals or cupula causing dizziness

Question 52

whats the biggest symptom in BPPV (that you'd see in the clinic, not in the history)?

Answer 52

nystagmus