Dizzy Quiz - Test Your Knowledge of Vestibular Disorders

Below is the last Dizzy Quiz from 2012.  If you are looking for the first ONLINE Dizzy Quiz for 2013, click here.


Congratulations to the latest winner, Dr. John Tuttle, of Witham Health Services!

Our knowledge and technology in the evaluation and treatment of the 'dizzy' patient has changed so much over the past two decades.  On a quarterly basis, BalanceMD is sending out a "Dizzy Quiz" to medical practitioners in the Indianapolis area in order to determine deficiencies in knowledge in this area, so as to focus future CME seminars to address any knowledge gaps.  Two questions are posed in multiple choice format and those that answer both questions correctly are placed into a drawing for an iPod Shuffle.  Below to the left are the questions posed and below to the right are the correct answers with detailed explanations and the percentage of medical practitioners answering the questions correctly.
Questions:

1.  Which of the following might produce vertigo in certain head positions?

A.  Migraine-associated Vertigo
B.  BPPV
C.  Brain Tumor
D.  Vestibular Neuritis
E.  All the above


2.  The best way to help a patient completely recover from vestibular neuritis includes

A.  Indefinite meclizine treatment
B.  Stop all vestibular suppressant medication(s)
C.  Vestibular rehabilitation therapy (PT)
D.  They'll just have to learn to live with it
E.  Both B and C
Answers:

1.  E. All the above listed conditions might produce vertigo which changes in head position.  There is a common misconception that if vertigo occurs with a change in head position it must represent benign paroxysmal positional vertigo (BPPV), aka, the inner ear "crystal" problem.  However, while BPPV typically elicits vertigo with changes in head position, there are many other conditions which may cause positional vertigo symptoms.  This highlights the importance of proper diagnosis of of the condition causing the "positional vertigo" symptoms, as all conditions listed have quite different treatments.

2.  E. Both B and C.  Vestibular neuritis is a condition which causes damage to cranial nerve VIII, the vestibular or "balance" portion.  The brain is capable of adjusting or compensating for the damaged nerve.  However, the brain has difficulty adjusting in the present of vestibular suppressant medications, such as meclizine or Antivert as well as other medications.  Therefore, the best treatment for vestibular neuritis involves stopping all vestibular system suppressant medications and proceeding with a form of physical therapy (PT) know as vestibular rehabilitation therapy (VRT).  The Cawthorne-Cooksey or Brandt-Daroff exercises are generic vestibular exercises that may be helpful, however, we now have more specific exercises available for specific vestibular system diseases, such as vestibular neuritis.
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