GNRS 5669 Exam 3
Lab evaluation in patients with delirium: - ✔️✔️electrolytes
creatinine
glucose
calcium
CBC
urinalysis and urine culture
Vertigo: - ✔️✔️sensation of spinning or motion
Prescyncopal lightheadedness: - ✔️✔️sensation of impending faint
Disequilibrium: - ✔️✔️sensation of unsteadiness
Continuous dizzy symptoms: - ✔️✔️stroke
Episodic or brief dizziness: - ✔️✔️BPPV, labryinthitis
Hours or days of dizziness: - ✔️✔️menieres disease
Dix-Hallpike maneuver: - ✔️✔️-help differentiate benign vertigo vs. vertigo from a CNS
lesion
-expect vomiting
-BPPV treatment
-CNS lesion: longer duration nystagmus, continues with each repetition of hallpike, does
not decrease in intensity
-benign vertigo: rotation nystagmus during head rotation, resolves quickly and cannot
be reproduced after 2-3 repetitions of hallpike
BPPV: - ✔️✔️-episodic w/ no vertigo
-N/V, worse with movement
-positive dix-hallpike maneuver
-using anti-emetics may prolong BPPV course
Labyrinthitis: - ✔️✔️-ABRUPT onset of dizziness
-sometimes occurs with viral URI
Postural hypotension: - ✔️✔️-20mm drop in SBP, 10mm drop in DBP without pulse
change
-wait 2 min after standing from lying position
, Diseased vestibular nerve: - ✔️✔️Menieres disease
-loss of low frequencies
-dizzy, N/V, diaphoresis, difficulty with balance, vertigo, tinnitus, fluctuating hearing loss,
feeling of pressure in the ear, diplopia
Basilar CVA: - ✔️✔️facial numbness, hemiparesis, diplopia, dysarthria, HA, N/V
Veterbrobasilar stroke syndromes: - ✔️✔️nausea, vertigo, facial numbness, hearing
loss
Cerebellar infaction: - ✔️✔️severe vomiting, vertigo, ataxia
Tx of dizziness: - ✔️✔️-antihistamines- meclizine, benadryl, phenergan
-take medication for a week and then taper to PRN
-antiemetics- for n/v
-sedation precautions!
S/S of bells palsy: - ✔️✔️-50% max paralysis within in 48hrs
-pain behind or in ear
-smooth forhead
-widened palpebral fissure
-flattened nasolabial fold
-asymmetrical smile
-altered taste (dysgeusia)
-increased hearing sensitivity (hyperacusis)
-bell phenomenon: upward diversion of the eye with attempted closure of the lid
Management of bells palsy: - ✔️✔️-CBC, lyme titer, HCG, blood sugar
-protection of the eye with tears, methylcellulose gtts, taping shut
-within 3 days: prednisone 60-80 mg qday x7 days
-if severe facial paralysis- add valvyclovir 1g tid x 7days
Partial seizures: simple - ✔️✔️SINGLE hemisphere
no LOC, tonic clonic movements of 1 leg/arm, deja vu
auditory, olfactory, visual
Partial seizures: complex - ✔️✔️altered consciousness, automatisms
Partial seizures: secondary generalized - ✔️✔️starts as simple or complex, evolves to
generalized
Generalized seizure: non convulsive - ✔️✔️BOTH hemispheres
Absence- "petit mal", staring
atonic- drop attacks
Lab evaluation in patients with delirium: - ✔️✔️electrolytes
creatinine
glucose
calcium
CBC
urinalysis and urine culture
Vertigo: - ✔️✔️sensation of spinning or motion
Prescyncopal lightheadedness: - ✔️✔️sensation of impending faint
Disequilibrium: - ✔️✔️sensation of unsteadiness
Continuous dizzy symptoms: - ✔️✔️stroke
Episodic or brief dizziness: - ✔️✔️BPPV, labryinthitis
Hours or days of dizziness: - ✔️✔️menieres disease
Dix-Hallpike maneuver: - ✔️✔️-help differentiate benign vertigo vs. vertigo from a CNS
lesion
-expect vomiting
-BPPV treatment
-CNS lesion: longer duration nystagmus, continues with each repetition of hallpike, does
not decrease in intensity
-benign vertigo: rotation nystagmus during head rotation, resolves quickly and cannot
be reproduced after 2-3 repetitions of hallpike
BPPV: - ✔️✔️-episodic w/ no vertigo
-N/V, worse with movement
-positive dix-hallpike maneuver
-using anti-emetics may prolong BPPV course
Labyrinthitis: - ✔️✔️-ABRUPT onset of dizziness
-sometimes occurs with viral URI
Postural hypotension: - ✔️✔️-20mm drop in SBP, 10mm drop in DBP without pulse
change
-wait 2 min after standing from lying position
, Diseased vestibular nerve: - ✔️✔️Menieres disease
-loss of low frequencies
-dizzy, N/V, diaphoresis, difficulty with balance, vertigo, tinnitus, fluctuating hearing loss,
feeling of pressure in the ear, diplopia
Basilar CVA: - ✔️✔️facial numbness, hemiparesis, diplopia, dysarthria, HA, N/V
Veterbrobasilar stroke syndromes: - ✔️✔️nausea, vertigo, facial numbness, hearing
loss
Cerebellar infaction: - ✔️✔️severe vomiting, vertigo, ataxia
Tx of dizziness: - ✔️✔️-antihistamines- meclizine, benadryl, phenergan
-take medication for a week and then taper to PRN
-antiemetics- for n/v
-sedation precautions!
S/S of bells palsy: - ✔️✔️-50% max paralysis within in 48hrs
-pain behind or in ear
-smooth forhead
-widened palpebral fissure
-flattened nasolabial fold
-asymmetrical smile
-altered taste (dysgeusia)
-increased hearing sensitivity (hyperacusis)
-bell phenomenon: upward diversion of the eye with attempted closure of the lid
Management of bells palsy: - ✔️✔️-CBC, lyme titer, HCG, blood sugar
-protection of the eye with tears, methylcellulose gtts, taping shut
-within 3 days: prednisone 60-80 mg qday x7 days
-if severe facial paralysis- add valvyclovir 1g tid x 7days
Partial seizures: simple - ✔️✔️SINGLE hemisphere
no LOC, tonic clonic movements of 1 leg/arm, deja vu
auditory, olfactory, visual
Partial seizures: complex - ✔️✔️altered consciousness, automatisms
Partial seizures: secondary generalized - ✔️✔️starts as simple or complex, evolves to
generalized
Generalized seizure: non convulsive - ✔️✔️BOTH hemispheres
Absence- "petit mal", staring
atonic- drop attacks
