ENT EXAM 2: HIGH-YIELD REVIEW AND KEY
TOPICS
vertigo is a ________ not a diagnosis
symptom
recurrent positionally triggered vertigo attacks
BPPV
positional vertigo is also known as
benign paroxysmal positional vertigo (BPPV)
All vertigo is made worse by...
moving the head
* if head motion does not worsen the feeling, it is probably another type of dizziness
Physical exam should consist of (3) when pt complains of disequilibrium
1. inquire about sx's of neurologic/gait disorder
2. watch patients walk
3. cerebellar functions exam
Nonspecific dizziness has a wide differential diagnosis including (2)
1. medication side effects (antidepressants, anticholinergics)
2. metabolic derangements (hypoglycemia)
arises because of asymmetry in vestibular system d/t damage to or dysfunction of labrynth, vestibular
neve, or central vestibular structures in the brainstem
vertigo
* described as sense of swaying, tilting, spinning
,T/F: Vertigo never has a life-threatening etiology
FALSE
* large range of diagnoses from benign to immediately life threatening
T/F: a pt's description of a "spinning" sensation likely indicates an abnormality of semicircular canals
or the CNS structures that process signals from the semicircular canals
TRUE
* CNS receives signals from both R & L labyrinths and compares these signals with one another
Peripheral vs. central causes of vertigo
Know this chart **
Peripheral vertigo has a paroxysmal & intermittent pattern while central causes are ________.
constant
Nystagmus pattern peripheral vertigo
horizontal and unidirectional
Nystagmus pattern central vertigo
vertical and/or multidirectional
T/F: Central vertigo has fatigue of symptoms/signs
FALSE
* peripheral !!
T/F: CNS signs/symptoms are absent in peripheral vertigo and usually present in central
TRUE
Peripheral vertigo makes up ______ % of vertigo cases. Included are BPPV, vestibular neuritis,
Meniere's disease
80
When obtaining PMH, prior hx of migraine suggests...
migrainous vertigo
Stroke factors (HTN, DM, smoking) suggest...
vertebrobasilar ischemia
Past head trauma is a common antecedent to...
, BPPV
* less commonly, head trauma/barotrauma can cause perilymphatic fistula
- occurs in acute unilateral vestibular lesions (both central and peripheral)
- rhythmic oscillation of the eyes d/t pathologic asymmetry in vestibular activity
- drift of eyes away from target in one direction followed by fast corrective movement in reverse
direction
nystagmus
Vestibular neuritis causes the fast phase to move...
toward the good ear
BPPV causes the fast phase to move...
toward the affected ear
- vertical or torsional nystagmus
- lack of suppression with visual fixation
- bidirectional (change in fast-phase direction when pt looks left vs right)
central lesion
- horizontal nystagmus
- suppresses with visual fixation
- unidirectional (no change in fast-phase direction when pt looks left vs right)
peripheral lesion
- type (horizontal, vertical, torsional)
- tendency to suppress with visual fixation
- does direction alter with gaze?
how to distinguish central vs. peripheral cause of nystagmus
unilateral sensorineural hearing loss suggests a _________ .
peripheral lesion
* audiometry required for confirmation
- most useful test to confirm dx of BPPV
- tests for canalithiasis of posterior semicircular canal (MCC of BPPV)
Dix-Hallpike maneuver
The most common cause of BPPV is...
canalithiasis of the posterior semicircular canal
TOPICS
vertigo is a ________ not a diagnosis
symptom
recurrent positionally triggered vertigo attacks
BPPV
positional vertigo is also known as
benign paroxysmal positional vertigo (BPPV)
All vertigo is made worse by...
moving the head
* if head motion does not worsen the feeling, it is probably another type of dizziness
Physical exam should consist of (3) when pt complains of disequilibrium
1. inquire about sx's of neurologic/gait disorder
2. watch patients walk
3. cerebellar functions exam
Nonspecific dizziness has a wide differential diagnosis including (2)
1. medication side effects (antidepressants, anticholinergics)
2. metabolic derangements (hypoglycemia)
arises because of asymmetry in vestibular system d/t damage to or dysfunction of labrynth, vestibular
neve, or central vestibular structures in the brainstem
vertigo
* described as sense of swaying, tilting, spinning
,T/F: Vertigo never has a life-threatening etiology
FALSE
* large range of diagnoses from benign to immediately life threatening
T/F: a pt's description of a "spinning" sensation likely indicates an abnormality of semicircular canals
or the CNS structures that process signals from the semicircular canals
TRUE
* CNS receives signals from both R & L labyrinths and compares these signals with one another
Peripheral vs. central causes of vertigo
Know this chart **
Peripheral vertigo has a paroxysmal & intermittent pattern while central causes are ________.
constant
Nystagmus pattern peripheral vertigo
horizontal and unidirectional
Nystagmus pattern central vertigo
vertical and/or multidirectional
T/F: Central vertigo has fatigue of symptoms/signs
FALSE
* peripheral !!
T/F: CNS signs/symptoms are absent in peripheral vertigo and usually present in central
TRUE
Peripheral vertigo makes up ______ % of vertigo cases. Included are BPPV, vestibular neuritis,
Meniere's disease
80
When obtaining PMH, prior hx of migraine suggests...
migrainous vertigo
Stroke factors (HTN, DM, smoking) suggest...
vertebrobasilar ischemia
Past head trauma is a common antecedent to...
, BPPV
* less commonly, head trauma/barotrauma can cause perilymphatic fistula
- occurs in acute unilateral vestibular lesions (both central and peripheral)
- rhythmic oscillation of the eyes d/t pathologic asymmetry in vestibular activity
- drift of eyes away from target in one direction followed by fast corrective movement in reverse
direction
nystagmus
Vestibular neuritis causes the fast phase to move...
toward the good ear
BPPV causes the fast phase to move...
toward the affected ear
- vertical or torsional nystagmus
- lack of suppression with visual fixation
- bidirectional (change in fast-phase direction when pt looks left vs right)
central lesion
- horizontal nystagmus
- suppresses with visual fixation
- unidirectional (no change in fast-phase direction when pt looks left vs right)
peripheral lesion
- type (horizontal, vertical, torsional)
- tendency to suppress with visual fixation
- does direction alter with gaze?
how to distinguish central vs. peripheral cause of nystagmus
unilateral sensorineural hearing loss suggests a _________ .
peripheral lesion
* audiometry required for confirmation
- most useful test to confirm dx of BPPV
- tests for canalithiasis of posterior semicircular canal (MCC of BPPV)
Dix-Hallpike maneuver
The most common cause of BPPV is...
canalithiasis of the posterior semicircular canal
