24.2 ๐ ๅ่็๏ผ้ซๅธซๅ่ / PGY OSCE๏ผ
M6 / PGY ๅ่่กๅบใ
24.2.0.1 ๐ ไธ้ ้้ปๆด็ (Cram Sheet)
24.2.0.1.1 ๐ฅ ้ซ yield 10 ๆข
- ใ้ ญๆใ4 ้ก๏ผvertigo / presyncope / disequilibrium / lightheadedness
- Vertigo ๅจ้ vs ไธญๆจ = ๆ ธๅฟ้ๅฅ
- HINTS exam ๆฏๆฉๆ MRI ๆๆ for cerebellar stroke
- BPPV 90% ๅพ็ฎก + Dix-Hallpike + Epley
- Mรฉniรจre ไธ่ฏ๏ผvertigo + hearing loss + tinnitus๏ผ+ ear fullness๏ผ
- Vestibular neuritis๏ผviral๏ผsingle episode lasting days
- Cerebellar stroke ๆฉๆ MRI DWI ๅฏ่ฝ negative (< 24h)
- HCS = HINTS Central Signs๏ผHead impulse normal / nystagmus direction-changing or vertical / skew +
- BZD ็ญๆ OK๏ผ< 3 ๅคฉ๏ผ๏ผ้ทๆ้ป compensation
- ไธญๆจ vertigo ๅฟ ๆฅ brain MRI + ่ก็ฎกๅฝฑๅ
24.2.0.1.2 ๐ข ๅฟ ่ๆธๅญ
| ้ ็ฎ | ๆธๅญ |
|---|---|
| BPPV ๅพ็ฎกๆฏไพ | ~90% |
| BPPV ็ญๆซ็ฉๆ | < 60 ็ง |
| Dix-Hallpike nystagmus ๆ็บ | 5-60 ็ง |
| Epley ๆๅ็ | 70-90% |
| Mรฉniรจre hearing loss frequency | low-frequency |
| Mรฉniรจre diet | < 2 g/d sodium |
| Vestibular neuritis duration | days-week |
| Cerebellar stroke ้ขจ้ช swelling | 48-72 hr |
| MRI DWI sensitivity early stroke | < 24h ๅฏ่ฝ negative |
| HINTS test sens for stroke | > MRI within 24h |
24.2.0.2 โญ ้ซ yield ๆ่ฆ
24.2.0.2.1 4 ้ก้ ญๆ
| ้กๅฅ | ็ ไบบๆ่ฟฐ | ็ ๅ |
|---|---|---|
| Vertigo | ๆ่ฝใๅคฉ่ฑๆฟ่ฝ | ๅๅบญ็ณป็ตฑ |
| Presyncope | ๅฟซๆๅใ็ผๅ้ป | ๅฟ่ก็ฎก |
| Disequilibrium | ็ซไธ็ฉฉใ่ตฐไธ็ด | ็ฅ็ถ / ่ๅ |
| Lightheadedness | ้งใ้ ญ้ | ็ฆๆ ฎ / metabolic |
24.2.0.2.2 Peripheral vs Central Vertigo
| Peripheral | Central | |
|---|---|---|
| ่ตทๅง | ็ช็ผ | ็ช็ผ / ๆผธ้ฒ |
| ๅผทๅบฆ | ๅด้ | ่ผ-ไธญ |
| Nystagmus | ๅฎๅใhorizontal | ้ๅ / ๅ็ด |
| Hearing loss | + (Mรฉniรจre) | โ |
| Neuro deficit | โ | + |
| Walking | ๅฏ๏ผไธ็ฉฉ๏ผ | ็กๆณ / ๅๅด |
| HINTS | peripheral | central |
| Etiology | BPPV, vestibular neuritis, Mรฉniรจre | Stroke, MS, tumor |
24.2.0.2.3 HINTS๏ผๅฟ ๆ๏ผ
| Test | Peripheral | Central |
|---|---|---|
| Head impulse | abnormal (catch-up saccade) | normal |
| INystagmus | unidirectional, horizontal | direction-changing, vertical |
| Test of skew | absent | present |
โ ไปปไธ central โ MRI brain + vessel imaging
24.2.0.2.4 BPPV
- ๆฉ่ฝ๏ผotoconia ็งปไฝ
- 90% ๅพ็ฎก
- ็นๅพต๏ผposition-induced, < 60s, ๅ่ฆ
- Dix-Hallpike: torsional + upbeat nystagmus, latency 5-10s, duration 10-60s
- Epley maneuver therapeutic๏ผ70-90% success๏ผ
- Brandt-Daroff ่ชๆๅพฉไฝ
- ๅพฉ็ผ็๏ผ~30% / yr
24.2.0.2.5 Mรฉniรจreโs Disease
- Triad + 1: vertigo + hearing loss + tinnitus + ear fullness
- ๆฉ่ฝ๏ผendolymphatic hydrops
- Audiogram: low-frequency sensorineural HL
- ๆฒป็๏ผ
- Low-salt < 2 g/d, avoid caffeine/alcohol
- HCTZ + triamterene
- ๆฅๆง: meclizine + antiemetic
- Refractory: intratympanic steroid / gentamicin / surgery
24.2.0.2.6 Vestibular Neuritis
- Acute single episode, lasting days
- Post-viral
- No hearing loss (unlike labyrinthitis)
- ๆฒป็๏ผsteroid (early), antihistamine for symptoms; vestibular rehab
24.2.0.2.7 Labyrinthitis
- Vestibular neuritis + hearing loss
- ๅ vestibular neuritis ่็ + audiogram
24.2.0.3 ๐ ๆๆททๆทๅฐ็ ง
24.2.0.4 ๐ ้ๅป่้ก้กๅ
24.2.0.5 ๐ฏ ่ชๆๆชขๆธฌ
Q๏ผHINTS ไธ้ central ๆจกๅผ๏ผ A๏ผHead impulse normal / direction-changing or vertical nystagmus / skew +
Q๏ผBPPV 90% ๅจๅชๅ canal๏ผ A๏ผPosterior canal
Q๏ผMรฉniรจre triad๏ผ A๏ผVertigo + hearing loss + tinnitus๏ผ+ ear fullness๏ผ
Q๏ผDix-Hallpike + ๅพๅไป้บผ๏ผ A๏ผEpley maneuver
Q๏ผVestibular neuritis vs labyrinthitis ๅทฎๅฅ๏ผ A๏ผLabyrinthitis ๅ hearing loss
Q๏ผCerebellar stroke ๆฉๆ MRI ๅฏ่ฝๆๆจฃ๏ผ A๏ผDWI < 24h ๅฏ่ฝ negative๏ผrely on HINTS๏ผ
Q๏ผBZD for vertigo ๅคไน ๏ผ A๏ผ็ญๆ < 3 ๅคฉ๏ผ้ทๆ้ป compensation๏ผ
Q๏ผMรฉniรจre ้ฃฒ้ฃ๏ผ A๏ผSodium < 2 g/d
Q๏ผHCTZ + triamterene ็จๆผ๏ผ A๏ผMรฉniรจre prophylaxis
Q๏ผAcoustic neuroma ๅจๅช CN๏ผ A๏ผCN VIII๏ผvestibular schwannoma๏ผ
24.2.0.6 ๐ ๆณๆทฑๅ ฅ่ซ็
- ้ซๅญธ็ โ Ch 24 medstudent.md
- ๅ งๅฐ โ Ch 24 specialist.md
- Syncope โ Ch 23
- Stroke โ Ch 439
- ๅๆ โ Ch 24
โ ๏ธ AI ่็จฟใ