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13 Cards in this Set

  • Front
  • Back
In regards to Vertigo, which is correct?
A. CT is 45% sensitive for acute stroke.
B. between 10-12% of patients presenting to ED with isolated vertigo have cerebellar infarction.
C. The 2 Clinical signs that indicate cerebellar infarction are severe ataxia and vomiting.
D. Cerebellar infarction makes up 2% of strokes overall.
D.

A. 26%
B. 0.3 -7.0%
C. Severe ataxia and gaze evoked nystagmus
In regards to vertigo, which is incorrect?
A. 17% patients with vertigo do not report the Classical 'rotational vertigo"-rather episodic imbalance / dizziness.
B. BPPV is caused by an otolith in the anterior semicircular canal.
C. The Dix-Hallpike Test is positive if it provokes symptoms and nystagmus.
D. Even without a Positive dix-Hallpike Test, BPPV patients can be differentiated from cerebellar infarction by their "episodic and positional symptoms".
B. Otolith in the POSTERIOR semicircular canal.
Which is incorrect regarding vertigo and cerebellar infarction?
A. Factors in the history suggesting cerebellar infarction include vascular risk factors (e.g.. HTN)
B. 10% of cerebellar infarcts present with ISOLATED VERTIGO.
C. Gaze-evoked nystagmus = "multidirectional " or "direction-changing" nystagmus.
D. CT is only 10% sensitive for acute cerebellar stroke in patients presenting with vertigo.
D. 26%
Which is incorrect regarding Vertigo?
A. Peripheral vertigo can tinnitus and partial hearing loss.
B. All vertigo is made worse with positional changes.
C. The Dix-Hallpike manoeuvre is performed in all vertigo presentations.
D. The nystagmus of peripheral vertigo is suppressed with fixation.
C. It is reserved only for those in whom BPPV is being considered.
What are the 5 "D's" of Centrally mediated vertigo?
1. Diplopia
2. Dysarthria
3. Dysphagia
4. Dysphonia
5. Dysmetria
Which is not a feature of BPPV?
A. Vertigo lasting for periods of 20-30 seconds
B. The nystagmus can be purely vertical.
C. Precipitated by sudden head movements.
D. It has nystagmus that is vertical and torsional towards downward ear.
B. Typical of cerebellar / brainstem lesion.
Which is not a feature of centrally mediated vertigo?
A. Diplopia
B. Sudden onset vertigo
C. Ataxic gait
D. vertical nystagmus with torsional component.
D. Nystagmus is usually vertical or gaze evoked.
What type of nystagmus does Ketamine produce?
Gaze-evoked (all directions of gaze)
Which is not a feature of Acute Vestibular neuritis?
A. Preceding viral illness
B. Gradual onset vertigo
C. relapsing remitting , short duration vertigo
D. Mild ataxia- improved with gait adjustment.
C. Duration usually hours
Which is incorrect regarding Acute Vestibular syndrome (Vestibular neuritis)and vertigo?
A. It has prominent autonomic symptoms.
B. It can have a positive head impulse test - a "catch-up, re-fixation" saccade on the affected side.
C. Acute vestibular neuritis has a gradual onset, persistent and ongoing vertigo- with characteristic positional exacerbations.
D. The fast phase of nystagmus is toward the affected ear.
D. It is :
- Unidirectional
- horizontal and torsional
- OPPOSITE the affected ear.
In regards to the HINTS examination, which of the following is correct?
A. A 'normal' vestibular-ocular reflex suggests a peripheral vertigo.
B. With the Head impulse test. the presence of no refutation "catch-up" saccade has a likelihood ratio of 10 for a central vertigo.
C. Gaze evoked nystagmus is highly sensitive, but poorly specific.
D. Vertical ocular misalignement when performing a test of skew, is 30% sensitive BUT 98% specific for a central vertigo.
D.

A = central
B = LR of 18.4
C = Poorly sensitive ( 38%) highly specific (92%)
In regards to the HINTS examination, which of the following is incorrect?
A. Abnormal skew deviation is highly suggestive of a central vertigo.
B. Gaze-evoked nystagmus = central cause
C. The presence of a refixation "catch-up" saccade suggests a central cause.
D. Both gaze evoked nystagmus and an abnormal test of skew have a specificity for central vertigo of > 95% if positive.
C. peripheral
In regards to the "infarct" acronym, which is incorrect?
A. It has a sensitivity of 80 % for a central cause , if any of the criteria are abnormal.
B. It stands for Impulse Normal, Fast-phase Alternating, Refixation on Cover Test.
C. It has a 96% specificity for central vertigo if any 1 of the 3 are abnormal.
D. Fast-phase alternating = gaze-evoked nystagmus.
A. = 100%