wk 10 key

Question 1

4 types of dizziness

Answer 1

1. vertigo (illusion of movement of oneself or envo)
2. presyncope (feel like going to faint)
3. dysequilibrium (impaired walk)
4. light headed/ non specific

Question 2

central vs peripheral causes of vertigo causing a dysfunction in vestibular system

Answer 2

peripheral: BPPV, Menieres, vestibular neuritis

central: vestibular migraine, cerebrovascular disease (stroke, VBI)

Question 3

TiTrATE dx for dizziness

Answer 3

Timing of sx

Triggers the provoke sx

And a Targeted Exam

Question 4

flow chart on slide 9

Question 5

BPPV

Answer 5

episodic vertigo triggered by head motion or change in body position

from migration of ear otoliths in semicircular canal

Question 6

assess BPPV

Answer 6

dix hallpike

Question 7

tx for BPPV

Answer 7

vestibular rehab
-epley maneuver to reposition canalith

avoid meds that suppress vestibular ie. benzes or antihistamines

Question 8

orthostatic hypotension

Answer 8

dizzy when stand up after lying or sitting (decreased cerebral perfusion)

BP drops 20 systolic or 10 diastolic when stand up after sitting

causes: hypovolemia, meds, autonomic insufficiency

Question 9

Menieres disease

Answer 9

end-lymphatic hydrops; excess fluid pressure in inner ear

unilateral sensorineuronal hearing loss w episodes of vertigo

unidirectional, horizontal torsional nystagmus w vertigo

Question 10

tx for menieres

Answer 10

salt restrict, caffeine and alcohol restrict, no diuretics, rehab, surgery

Question 11

vestibular migraines

Answer 11

vertigo plus migraine sx: N/V, photo or phonophobia, visual aura

Question 12

tx vestibular migraines

Answer 12

avoid triggers, stress, sleep and exercise, vestibular suppressant meds…

Question 13

psychogenic dizziness

Answer 13

from psychiatric i.e. anxiety, depress

physical findings:
* Moment-to-moment fluctuations in impairment
* Excessive slowness or hesitation
* Exaggerated sway on Romberg, improved by distraction
* Sudden buckling of knee, typically without falling
* A cautious “walking on ice” pattern

DO: SSRI, CBT

Question 14

barotrauma

Answer 14

vertigo from alterations in pressure (i.e scuba dive, fly)

Question 15

medication induced dizziness

Answer 15

alcohol, antiparkinsona, antifunal, antihistamines, antihypertensive, narcotics, anticholinergic, hypoglycemics,…..

Question 16

HINTS

Answer 16

Head Impulse-Nystagmus-Test for Skew

HI
peripheral; saccade
central; normal

nystagmus
peripheral; unidirectional
central; bidirectional

skew
peripheral; normal
central; skew vertical

Question 17

vestibular neuritis

Answer 17

inflamed vestibular nerve; usually viral

sx: episodic vertigo, no trigger w N/V, oscillopsia, unsteady gait

horizontal or torsional nystagmus

hearing OK

tx: vestibular suppressants

Question 18

Vertebrobasilar Insufficiency (VBI) or
Vertebrobasilar Ischemia

Answer 18

RED FLAG

inadequate blood flow to brain

can lead to TIA or stroke

neuro sx: diplopia, dysphonia, ataxia, numb or weak

Question 19

acute labyrinthitis

Answer 19

viral infection i.e. otits media or meningitis

hearing loss, tinnitus, vertigo

tx; antibiotics

Question 20

Herpes Zoster Oticus (Ramsay Hunt
Syndrome)

Answer 20

inflamed vestibulocochlea nerve

causes dizziness

possible facial paralyssi

Question 21

cholesteatoma

Answer 21

growth in middle ear; cyst with keratin

Question 22

otosclerosis

Answer 22

abnormal bone growth in inner ear

conductive hearing loss, tinnitus, vertigo

Question 23

perilymphatic fistula

Answer 23

seconds of vertigo with sensorineural hearing loss

leak perilymphatic fluid into tympanic or round window

usually from physical trauma

Question 24

Tumours Arising from the
Cerebellopontine Angle

what are their names

Answer 24

red flag

i.e. schwannoma, meningioma

sensorineural hearing loss and vertigo

Question 25

Multiple Sclerosis

Answer 25

associated with BPPV or other causes of vertigo

Question 26

further testing in dizziness

Answer 26

if suspect central lesion and risk for stroke MRI, MRA

Question 27

A 55-year-old woman with a history of migraines presents with a 2-day history of severe, continuous dizziness and imbalance. She denies headache, visual changes, or weakness. Her vitals are stable, but the neurological examination reveals nystagmus and difficulty with heel-to-toe walking. She has no other focal neurological deficits. Given her history and presentation, which of the following is the most appropriate initial diagnostic approach? Question 2 Answer a. Vestibular rehabilitation therapy b. Treatment with migraine medication and observation for symptom resolution c. Magnetic Resonance Imaging (MRI) of the brain d. Dix-Hallpike maneuver to diagnose benign paroxysmal positional vertigo (BPPV)

Answer 27

c. Magnetic Resonance Imaging (MRI) of the brain

Question 28

A naturopathic doctor is informing their patient about the prognosis for their vestibular neuronitis. Which of the following represents the most accurate prognostic information? Question 3 Answer a. A sensation of disequilibrium is likely to persist for years because of bilaterally impaired vestibular function b. The prognosis for this condition is good, but BPPV tends to develop afterwards, occurring in approximately 50% of patients c. As vestibular compensation occurs, the patient's vertigo is likely to resolve slowly over a few days d. Unfortunately, in 80% of patients, the underlying nerve damage takes three months or longer to resolve

Answer 28

c. As vestibular compensation occurs, the patient's vertigo is likely to resolve slowly over a few days