NR 603 2023/2024 CORRECT ANSWER

NR 603 2023/2024 CORRECT ANSWER Vestibular neuritis/labyrinthitis - CORRECT ANSWER-Acute unilateral labryinthine dysfunction Sx: severe vertigo, nausea, vomiting and disequilibrium lasting few days, unbalance with rapid head movement; lasts weeks to months; probs w/ walking/balance Causes: by viral infection in vestibular nerve, otitis media sometimes another cause; HSV-1 of vestibular ganglia Assessment: -Thorough ear, nose throat exam -Neuro exam (including balance testing with Romberg) -Hearing screen should be normal -Abnormal neuro exam should suggest a central cause and referred to Neuro Diagnostics: Labs: CBC with diff Imaging: MRI or CT Differential dx: -BPPV -Meniere disease -Migranous vertigo -Vascular d/o -Trauma -Toxins -Demyelinating disease (MS) -Ramsay Hunt Syndrome -Cerebellar disorder -Tumors Tx: -Symptom relief - use only for 3 days (more than that can just mask sx): anticholinergics (first line), antihistamines(first line), long acting benzos (reserved for pts who cant take anticholinergics) or antiemetics (added to relieve vomiting) -Acute treatment: Methylpredisone taper (100mg every 3 days) Meniere's disease - CORRECT ANSWER-Excessive fluid and pressure in labyrinth of inner ear; autoimmune process Sx: Vertigo that last min to hours, a/w nausea and vomiting, accompanied by pressure in ear; low-pitched = unilateral hearing loss; hearing loss is constant in later stages Assessment: -Head and neck exam to exclude acute otitits media -Neuro exam -Weber test - sound will laterlize to unaffected ear -Rinne test - air conduction bone conduction Diagnostics: -Initial: Audiogram -Labs- TSH, serum glucose, RPR, lyme serologies -Imaging: MRI (rule out neuroma) Differential: -BPPV -Vestibular neuritis -Vertebrobasilar insufficiency -Acoustic neuroma -Migraine HA -Head Trauma -Thyroid dysfunction -Anemia -Diabetes -MS -Cerebellar tumor -Cogan syndrome Tx: Refer to otolaryngologist, there is no cure -Symptomatic relief: meclizine and antiemetics (Phenergan) Tinnitus - CORRECT ANSWER-Ringing or buzzing in ears High pitched, ocntinous sounds: a/w sensorineural loss Low pitched: idiopathic tinnitus or Meniere disease Pulsing or rushing: vascular Ocean: eustachian tube dysfunction Clicking: somatic, maybe TMJ or spasms of muscles or middle ear structures Diagnostics: -Initial: Audiology -Labs: lyme serologies, RPR, CBC with diff, ESR, Serum glucose, TSH -Imaging: MRI or CT scan Tx:Intermittent tinnitus not serious, but unilateral a/w vestibular schwannoma (get MRI or CT) Pulsatile also serious-- refer otoryngologist or neurologist Vertigo (dizziness) - CORRECT ANSWER-Illusion of movement of either oneself or the environment - spinning, tilting or moving back and forth. Can be related to peripheral or central disorder. Peripheral causes may include BPPV, vestibular neuronitis, acute labyrinthitis, Meniere diseaese, ototoxicity and head trauma. Result of inner ear problems or cranial nerve VIII. Central causes include brainstem or cerebellar ischemia or hemorrhage, tumors, MS or migranous syndrome. Hallmarks include associated neurologic findings and vertigo/nausea that are not positional related Caused by an imbalance in vestibular system that may result from lesions in inner ear, vestibular nerve, brainstem or cerebellum. Less commonly, vertigo may result from lesions in subjective sensory pathways of thalamus or cortex or stretch receptors in the neck BPPV - CORRECT ANSWER-inner ear condiition Characterized by a sensation of spinning, whirling or tilting with position change Pathophysiology: otoconia refers to debris in inner ear made up of small crystals of calcium carbonate. Chrystals shift with position gchanges and disperse within the semicurcular canal seending false signals to the brain Symptoms: preceipitated by change in head position Nystagmus a/w BPPV is characteristic; any deviation from the typical profiles should suggest a central lesion. Nystagmus observed by Hallpike-Dix maneuver. If vertical or torsional in nature and lasts less than 30 secs, it is consistent with posterior semicircular canal variant. If nystagmus is direction changing and horizontal (beating toward the ground and lasts about 1 min, it is consistent with a horizontal canal variant. Parkinson disease - CORRECT ANSWER-neurodegenerative disease with cardinal features of assymetric resting tremor, bradykinesia, and rigidity, commonly with postural changes PD develops with depletion of dopamine resulting in increased inhibition of thalamus and reduce excitatory input to motor cortex, which results in cardinal fatures of PD: tremor at rest, rigidity, bradykinesia, postural instability Sx: rest tremor in PD present at rest, usually unilateral at first and characteristically disappears with action, rigidity, bradykinesia, with freezing, flex posture (bowed head, trunk bent forward), shuffling gait with decrease in arm swing