LAB - Vest. Exam

Question 1

What should you expect to find with the Weber and Rinne test if vestibular-related
auditory loss is present?

Answer 1

Weber: louder in unaffected ear
Rinne: no BC or AC

Question 2

Why does it matter whether your patient has taken anti-vertigo medications prior to your session?

Answer 2

Difficult to evaluate nystagmus

Question 3

What are the two ways that we will observe nystagmus during a clinical examination?

Answer 3

Spontaneous or gaze evoked

Question 4

Peripheral Vestibular Nystagmus:
- Effect of fixation
- Direction of fast phase
- Effect of gaze

Answer 4

Unidirectional nystagmus
Fixation: nystagmus decreases
Fast Phase: Mixed (horizontal + torsional)
Gaze: increased toward gaze direction of quick phase (away from involved ear)
Acute > chronic

Question 5

Central Vestibular Nystagmus:
- Effect of fixation
- Direction of fast phase
- Effect of gaze

Answer 5

Multidirection nystagmus
Fixation: nystagmus increases or stays the same
Fast Phase: Single-plane (torsional or vertical)
Gaze: does not change or reverses direction
Acute or chronic

Question 6

Explain Alexander’s Law and its clinical relevance.

Answer 6

Describes how to classify peripheral vestibular nystagmus.

Question 7

1st degree nystagmus

Answer 7

only present when gaze directed towards fast phase

Question 8

2nd degree nystagmus

Answer 8

present in primary gaze < directed toward fast phase (strongest)

Question 9

3rd degree nystagmus

Answer 9

present in all 3 gazes, strongest when gaze directed towards fast phase

Question 10

What is the purpose of visual fixation blockers?

Answer 10

Take away the ability to fixate

Question 11

In which of the following scenarios could you NOT use visual fixation blockers?
- Assessing for spontaneous nystagmus
- Assessing VOR with a head impulse test
- Assessing VOR with the head-shaking test
- Assessing eye movements elicited during BPPV maneuvers

Answer 11

• Assessing VOR with a head impulse test

Question 12

What is an abnormal responses for the Head Impulse Test?

Answer 12

• Corrective saccade +/- post-thrust nystagmus (PNS)
• Normal w/vertigo (CNS)

Question 13

How can sensitivity be improved with the Head Impulse Test?

Answer 13

• Unpredicted Head Thrusts
• Frequency (2Hz) and velocity >180 deg/sec
• Maintaining appropriate head positioning (30º below neutral)

Question 14

What is an abnormal responses for the Head Shake Test?

Answer 14

PVD: >3 beats nystagmus
CVD: vertical nystagmus

Question 15

What does the Dynamic Visual Acuity test investigate?

Answer 15

functional challenge to VOR, better for subacute/chronic cases

Question 16

What is the abnormal response to the Dynamic Visual Acuity Test?

Answer 16

3 or more line degradation

Question 17

What is the functional relevance of optokinetic nystagmus?

Answer 17

Works synergistically with VOR to maintain gaze stability

Question 18

What is an abnormal response during optokinetic testing?

Answer 18

Asymmetrical response

Question 19

What do smooth pursuit and saccades test for?

Answer 19

Central vestibular disorders

Question 20

What would be an abnormal response to smooth pursuit and saccades tests?

Answer 20

Slow, inaccruate, hypo/hypermetric

Question 21

What does Skew Deviation test for?

Answer 21

Central vestibular involvement

Question 22

What is an abnormal response to the Skew Deviation test?

Answer 22

Deviation of one eye while the other is being covered, followed refixation after uncovering it.

Question 23

What does VOR Cancellation test for?

Answer 23

cerebellar control with regards to modulation of VOR

Question 24

What is an abnormal response to the VOR Cancellation test?

Answer 24

corrective saccades ipsilaeral to cerebellar lesion

Question 25

What is the HINTS test and when is it performed?

Answer 25

**H**ead **I**mpulse, **N**ystagmus observation, **T**est of **S**kew Performed when CNS is suspected.

Question 26

What results on the HINTS create concern for CNS diagnosis?

Answer 26

INFARCT **I**mpulse = **N**ormal **F**ast phase nystagmus **A**lternating **R**efixation during **C**over **T**est

Question 27

What is the purpose of the Motion Sensitivity Quotient?

Answer 27

position dependent clinical exam that evaluated symptoms response.

Question 28

What cutoff scores are available for the the Motion Sensitivity Quotient?

Answer 28

Mild VD: 0-10 Mod VD: 11-30 Severe VD: 31-100

Question 29

What is the purpose of the Dizziness Handicap Inventory?

Answer 29

evaluates self-perceived hanicap from dizziness (physical, emotional, functional)

Question 30

What are the cuttoff scores and MCID for the Dizziness Handicap Inventory?

Answer 30

Mild 0-30 Mod 31-60 Severe 60-100 MCID = 18

Question 31

Clinical Test of Sensory Organization and Balance

Answer 31

"Foam + Dome" 6 conditions that assesses sensory contributions to postural control.

Question 32

What is the Mini-BESTest and the MCID?

Answer 32

test observing anticipatory and reactive control, sensory organization and dynamic gait. MCID: 4 points

Question 33

What is the Balance Error Scoring System Test and the MCID?

Answer 33

Measures # of errors in six balance positions (max 10/condition) MCID = 3 points

Question 34

What is the vestibular cut off score for the four square step test? What does it indicate?

Answer 34

>12 sec, risk for falls

Question 35

When performing the Romber, Sharpened Romberg, and Timed unipedal stance test, what is an abnormal finding?

Answer 35

Unable to maintain balance, typically fall toward the side of injury

Question 36

What is the computerized posturography sensory organization testing?

Answer 36

Assessment/intervention tool that manipulates different balance inputs to identify how a patient weights each modality.