NM703 EXAM 4 (FINAL) MOD 8 & 9 QUESTIONS AND
ANSWERS WITH COMPLETE SOLUTIONS
dizziness.
vague term used to describe lightheaded or pre-syncope
vertigo.
perception that the person or the environment is spinning
disequilibrium.
Sense of insecurity or imbalance, and/or unsteadiness in walking
What is Peripheral vertigo:
related to inner ear conditions, it is position related
What is Central vertigo:
spontaneous and not position related
What are some common causes of peripheral vertigo?
- BPP
- vestibular neuronitis
- acute labyrinthitis
- menieres
- ototoxicity
What are the signs and symptoms of BPP (benign paroxysmal positional)
vertigo?
Intermittent Sensation of spinning or whirling of oneself or the environment, nystagmus
,What history is needed with a patient suspected of having benign paroxysmal
positional vertigo?
- brought on by sudden position change of the head
- Sx occur intermittently
What will the CNM/WHNP find on examination of a patient with benign
paroxysmal positional vertigo?
Dizziness and vertigo with affected ear lying down, Hallpike-Dix maneuver shows
nystagmus characteristic of vertigo
How is the Hallpike-dix maneuver performed?
Check the patient for spontaneous nystagmus while seated; bring pt quickly to a
recumbent or supine position w/head extended 30-45 over the end and tilted 30-45 to
one side; repeat previous step 2 times once w/head tilted to left and then w/tilted to
right; observe for latency, duration, direction, and fatigability of nystagmus
What is the patient education needed with benign paroxysmal positional vertigo?
Education regarding evaluation, prognosis, and treatment options; educate that the
most effective tx may initially increase symptoms at first but treatment must continue;
use caution when driving if symptoms occur when turning head
What is the management of benign paroxysmal positional vertigo?
Sometimes no tx as it resolves in a few days/wks on own; canalith repositioning
procedure; meclizine; Epley maneuver;
What is the follow up needed with benign paroxysmal positional vertigo?
3-6 weeks
What are the complications with benign paroxysmal positional vertigo?
,Risk of falling; self-imposed decreased mobility; safety with driving
What are the signs and symptoms of meningitis?
- Fever, headache, stiff neck (meningismus), N/V, photophobia
- purpura & petchiae = rapidly progressing
- ICP (late signs) altered LOC, seizures, HTN, resp depression, bradycardia, posturing,
hyperreflexia, spasiticity, seizures
What history is needed with a patient suspected of having meningitis?
Hx basilar skull fracture or neurosurgery, sickle cell disease, complement deficiency,
asplenia, alcoholism, immunodeficiency, travel to an endemic area, exposure to
community outbreak,
What will the CNM/WHNP find on examination of a patient with meningitis?
Jolt sensitivity (increase in headache when moving head twice horizontally), purpura
and petechia
How do you test for Kernig sign?
Patient in supine position resists passive knee extension while hip is fully flexed on the
abdomen
How do you test for Brudzinski sign?
Patient in the supine position actively flexes hips when the neck is passively flexed
What is the management for bacterial meningitis?
- Immediate empirical bactericidal therapy -> w/in 6 hrs
- Vanc plus 3rd generation Cephalosporin (Cefotaxime or Ceftriaxone) IV
- dexamethasone IV -> q 6 hr x 4 days
, - Monitor ICP and initiate measures to decrease it (elevate HOB, mannitol)
- resp isolation for 24 hrs
What is the management of bacterial meningitis in post-traumatic, neurosurgical
or CSF shunt patients?
Ceftazidime 2 gm every 8 hr; Vanomycin 1-2 gm every 12; CSF analysis if pt has not
responded to antibiotics after 48 hrs; dexamethasone 10 mg IV every 6 hr X 4 days
What is the dosage of Vancomycin given for bacterial meningitis?
15-20 mg/kg IV every 8-12 hrs max dose 2g at once or 60 mg/kg/day
What is the dosage of Cefotaxime given for bacterial meningitis?
2 gm every 4 hrs
What is the dosage of Ceftriaxone given for bacterial meningitis?
2 gm every 12 IV
What is the etiology of Bell's Palsy?
Idiopathic but thought to be caused by factors such as viral infections and autoimmune
pathomechanism. Also thought to possibly be genetic, vascular, caused by nerve
compression or metabolic changes. *CN 7
What conditions are thought to cause Bell's palsy?
Herpes simplex virus type 1 and types 2, varicella zoster, Lyme disease
What history does the CNM/WHNP need to obtain for a pt w/suspected Bell's
Palsy?
Any recent infections; any chronic illnesses such as DM, HTN, hypothyroidism; any
recent insect bites, rashes or lesions; any facial trauma
What are the signs and symptoms of Bell's Palsy?
ANSWERS WITH COMPLETE SOLUTIONS
dizziness.
vague term used to describe lightheaded or pre-syncope
vertigo.
perception that the person or the environment is spinning
disequilibrium.
Sense of insecurity or imbalance, and/or unsteadiness in walking
What is Peripheral vertigo:
related to inner ear conditions, it is position related
What is Central vertigo:
spontaneous and not position related
What are some common causes of peripheral vertigo?
- BPP
- vestibular neuronitis
- acute labyrinthitis
- menieres
- ototoxicity
What are the signs and symptoms of BPP (benign paroxysmal positional)
vertigo?
Intermittent Sensation of spinning or whirling of oneself or the environment, nystagmus
,What history is needed with a patient suspected of having benign paroxysmal
positional vertigo?
- brought on by sudden position change of the head
- Sx occur intermittently
What will the CNM/WHNP find on examination of a patient with benign
paroxysmal positional vertigo?
Dizziness and vertigo with affected ear lying down, Hallpike-Dix maneuver shows
nystagmus characteristic of vertigo
How is the Hallpike-dix maneuver performed?
Check the patient for spontaneous nystagmus while seated; bring pt quickly to a
recumbent or supine position w/head extended 30-45 over the end and tilted 30-45 to
one side; repeat previous step 2 times once w/head tilted to left and then w/tilted to
right; observe for latency, duration, direction, and fatigability of nystagmus
What is the patient education needed with benign paroxysmal positional vertigo?
Education regarding evaluation, prognosis, and treatment options; educate that the
most effective tx may initially increase symptoms at first but treatment must continue;
use caution when driving if symptoms occur when turning head
What is the management of benign paroxysmal positional vertigo?
Sometimes no tx as it resolves in a few days/wks on own; canalith repositioning
procedure; meclizine; Epley maneuver;
What is the follow up needed with benign paroxysmal positional vertigo?
3-6 weeks
What are the complications with benign paroxysmal positional vertigo?
,Risk of falling; self-imposed decreased mobility; safety with driving
What are the signs and symptoms of meningitis?
- Fever, headache, stiff neck (meningismus), N/V, photophobia
- purpura & petchiae = rapidly progressing
- ICP (late signs) altered LOC, seizures, HTN, resp depression, bradycardia, posturing,
hyperreflexia, spasiticity, seizures
What history is needed with a patient suspected of having meningitis?
Hx basilar skull fracture or neurosurgery, sickle cell disease, complement deficiency,
asplenia, alcoholism, immunodeficiency, travel to an endemic area, exposure to
community outbreak,
What will the CNM/WHNP find on examination of a patient with meningitis?
Jolt sensitivity (increase in headache when moving head twice horizontally), purpura
and petechia
How do you test for Kernig sign?
Patient in supine position resists passive knee extension while hip is fully flexed on the
abdomen
How do you test for Brudzinski sign?
Patient in the supine position actively flexes hips when the neck is passively flexed
What is the management for bacterial meningitis?
- Immediate empirical bactericidal therapy -> w/in 6 hrs
- Vanc plus 3rd generation Cephalosporin (Cefotaxime or Ceftriaxone) IV
- dexamethasone IV -> q 6 hr x 4 days
, - Monitor ICP and initiate measures to decrease it (elevate HOB, mannitol)
- resp isolation for 24 hrs
What is the management of bacterial meningitis in post-traumatic, neurosurgical
or CSF shunt patients?
Ceftazidime 2 gm every 8 hr; Vanomycin 1-2 gm every 12; CSF analysis if pt has not
responded to antibiotics after 48 hrs; dexamethasone 10 mg IV every 6 hr X 4 days
What is the dosage of Vancomycin given for bacterial meningitis?
15-20 mg/kg IV every 8-12 hrs max dose 2g at once or 60 mg/kg/day
What is the dosage of Cefotaxime given for bacterial meningitis?
2 gm every 4 hrs
What is the dosage of Ceftriaxone given for bacterial meningitis?
2 gm every 12 IV
What is the etiology of Bell's Palsy?
Idiopathic but thought to be caused by factors such as viral infections and autoimmune
pathomechanism. Also thought to possibly be genetic, vascular, caused by nerve
compression or metabolic changes. *CN 7
What conditions are thought to cause Bell's palsy?
Herpes simplex virus type 1 and types 2, varicella zoster, Lyme disease
What history does the CNM/WHNP need to obtain for a pt w/suspected Bell's
Palsy?
Any recent infections; any chronic illnesses such as DM, HTN, hypothyroidism; any
recent insect bites, rashes or lesions; any facial trauma
What are the signs and symptoms of Bell's Palsy?
