vertigo

Question 1

head impulse test - expected finding in central vertigo

Answer 1

negative ie vertigo not triggered by head movement

Question 2

head impulse test - expected finding in peripheral vertigo

Answer 2

positive ie vertigo triggered by head movement

Question 3

head impulse test

- what reflex is tested

Answer 3

vestibulo-ocular reflex

Question 4

head impulse test

• how to perform the test
• interpretation

Answer 4

1. get patient to focus on your nose
2. slowly move patient’s head away from centre
3. rapid movement 5 degrees in opposite direction
4. if eyes fail to track = peripheral lesion
5. the direction of sudden turn = side where lesion is present

Question 5

test of skew

• how to perform the test
• interpretation

Answer 5

cover 1 eye, then uncover it

if the eye has to wander back into position = central vertigo

Question 6

vertigo triggered by movement

- ddx (5)

Answer 6

BPPV
vestibular neuronitis
labyrinthitis
acoustic neuroma
acoustic neuroma

Question 7

vertigo triggered by vertical movement suggests what dx

Answer 7

BPPV

Question 8

vertigo triggered by horizontal movement suggests what dx (2)

Answer 8

vestibular neuronitis, acute labyrinthitis

Question 9

difference in presenting symptoms for vestibular neuronitis vs labyrinthitis

Answer 9

labyrinthitis has hearing loss

Question 10

peripheral vertigo + hearing loss

- ddx (3)

Answer 10

labyrinthitis
meniere’s disease
acoustic neuroma

Question 11

vertigo

- indications for MRI (4)

Answer 11

• you think its central
• CVA risk factors
• associated neuro signs
• vertigo with headache

Question 12

nonmedical management of peripheral vertigo

• lifestyle (3)
• allied health (1)

Answer 12

restrict
- salt
- etoh
- caffeine
vestibular rehabilitation via physiotherapy

Question 13

medical management of peripheral vertigo

• nausea
• nausea + vomiting
• meniere’s disease

Answer 13

stemetil 5-10mg PO TDS

stemetil IM 12.5mg stat, then PO 5-10mg in 6/24

hydrochlorothiazide 25mg PO OD