Vertigo

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Which of the following is true about BPPV (Benign Paroxysmal Positional Vertigo)?

The nystagmus is not horizontal in classic BPPV. Tinnitus is not a feature and as the name suggests the symptoms and signs occur on movement.

Nystagmus is very often at rest.

It is often associated with tinnitus.

It generally causes horizontal nystagmus.

It can be diagnosed by a Hallpike manouevre.

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Which of the following is TRUE about the crystals that cause BPPV (Benign Paroxysmal Positional Vertigo)?

They are formed from calcium carbonate and alter the flow of endolymph in a vestibular canal when dislodged from their normal position in the utricle and saccule.

They end up blocking all 3 canals of the vestibular apparatus.

They are called otoconia.

They are caused by uric acid.

A strict diet, known as the "no spin" diet can prevent their formation.

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What manouevre is shown in the video?

The Hallpike manouevre is used to diagnose BPPV (Benign Paroxysmal Positional Vertigo). Note the characteristic nystagmus. You need to do it on both sides (only 1 shown). Also it is better to sit at the end of the bed and hold their head in your hands.

Heimlich manouevre.

Epley manouevre.

Hallpike manouevre.

McRoberts manouevre.

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What symptoms best describe an attack of Meniere's disease?

Meniere's disease is from excessive endolymph in the semi circular canals. The cause is uncertain but some attacks are thought viral in origin. Tends to be recurrent and progressive and can cause severe hearing loss. Meniere was a French doctor who died in 1862.

Vertigo, tinnitus, headache, photophobia.

Vertigo, hemiparesis, hyperacousis.

Vertigo, hyperacousis, headache, tinnitus.

Vertigo, hearing loss, tinnitus, feeling of fullness in the ear.

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Only one of the following is TRUE about the movie "Vertigo". Which is it?

Directed by Alfred Hitchcock apparently it is Martin Scorsese's favourite movie. It starred Kim Novak and James Stewart. One of the cast has acrophobia--a fear of heights. Worth a look.

It was directed by Martin Scorsese.

It has an approval rating of 93% on "Rotten Tomatoes".

It stars Grace Kelly.

One of the characters has agoraphobia.

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Which of the following findings is NOT typical of vestibular neuritis?

Epley's only works to shift otoconia crystals in BPPV. Vestibular neuronitis may be treated by steroids. The video shows characteristic horizontal nystagmus which is unidirectional usually away from the affected side.

Continuous vertigo not specifically on movement.

Horizontal unidirectional nystagmus.

May be fixed by Epley's manouevre.

Onset over hours, resolves over days.

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What of the following is NEVER found in a patient with a "central"cause for their vertigo?

A positive Hallpike occurs in patients with BPPV which is a peripheral cause of vertigo. Central causes include cerebellar bleeds, posterior circulation infarctions, multiple sclerosis and vestibular migraine.

Nystagmus may be vertical.

May have other neurological findings.

Severe headache.

A positive Hallpike manouevre.

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What is HINTs testing used for when it comes to looking for a cause of vertigo?

HINTs is a group of testing that is used mainly in patients who you think have vestibular neuritis (peripheral cause of vertigo). If the 4 components all show a peripheral result like vestibular neuritis then you do not have to chase a central cause with CTs/ MRIs etc.

Made up of Head impulse, Nystagmus, Test of Skew and Hearing.

Look up Peter Johns and vertigo for very good videos showing HINTs testing.

The link below is also a very good overview.

https://youtu.be/yEikmd5Y6ME

Helps you determine external ear vs middle ear causes.

Helps determine whether the vertigo is peripheral or central in cause.

Helps you know whether the vertigo is likely to resolve in 24hrs or less.

Helps you know whether Meniere's disease is the likely cause.

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What can cause vertigo if you syringe out ear wax with water?

The water should be body temperature. If it is too cold or too hot it causes stimulation of the vestibular nerve.

If you use too much pressure.

If you only syringe out one ear canal and not the other.

If you use water that is cool or cold.

If you do not aim upwards in the canal to cause a circular stream of water.

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Which of the following combinations of people and their phobias is INCORRECT?

Matthew McConaghy has a fear of revolving doors. The rest are correct.

Matthew McConaghy and his fear of closed doors.

Nicole Kidman and her fear of butterflies.

Gustaf Eiffel and his fear of heights.

Julius Caesar and his fear of cats.

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