Vestbular Exam

Question 1

Subjective Exam

Answer 1

-Quality of s/s
-Frequency
-Duration
-Agg/Eas
-Other s/s

Question 2

Quality: Vertigo

Answer 2

-Illusion of movement
-spinning, rocking, swaying, falling

Question 3

Quality: Disequibrium

Answer 3

-sense of being off balance
-unsteady, wobbly, drunk, tilted

Question 4

Quality: Gaze-Instability

Answer 4

-foggy headed
-heady-headed
-light headed
-motion sickness

Question 5

Quality: Cardiovascular

Answer 5

-dec bloodflow
-light headed
-pre-syncope
-tunnel vision

Question 6

Quality: Anxiety

Answer 6

-floating
-swimming
-rocking

Question 7

Quality: Visual

Answer 7

-diplopia
-oscillopsia (visual jumping)

Question 8

Frequency and Duration: Vestibular Neuritis

Answer 8

-Sudden onset
-lasts days

Question 9

Frequency and Duration: BPPV

Answer 9

Short Spells: Canal
Long Spells: Cup

-recurring

Question 10

Frequency and Duration: Bilateral Hypofunction

Answer 10

-gradual onse
-constant/chronic

Question 11

Frequency and Duration: Mennniere’s or Vestib Migraine

Answer 11

-Sudden
-Recurrent spells (hours/days)

Question 12

Frequency and Duration: Orthostatic Hypotension

Answer 12

-short spells
-Recurring

Question 13

Frequency and Duration: PPPD of MDDS

Answer 13

-Constant
-Chronic

Question 14

Aggs and Eases: BPPV

Answer 14

Ag: changing positions or lying or rolling
Eas: holding still for time

Question 15

Aggs and Eases: Gaze Instability

Answer 15

Ag: head movement
Eas: holding still and closing eyes

Question 16

Aggs and Eases: Vestibular Neuritis

Answer 16

Ag: Spontaneous made worse by head movement
Eas: Holding still, closing eyes, meds

Question 17

Aggs and Eases: Vestibular Migraine or Meniere’s

Answer 17

Ag: Spontanous made worse by head movement
Eas: Holding still, closing eyes, meds

Question 18

Other Associated S/s

Answer 18

-Illness
-Allergies
-Headache
-Syncope
-N/t

Question 19

Components of a Vestibular Screen

Answer 19

1. Subjective
2. Systems Review
3. Observe for Nystagmus
4. Oculomotor Tests (CNS)
5. VOR Screen (Peripheral)
6. HINTS
7. Postural Control (Balance)
8. Position Provocation Testing

Question 20

Cervical Screen

Answer 20

1. Contraindications
2. Cervical AROM
3. Seated Ext/ROT Test
4. Alar, Transverse leg and VBAI Test

Question 21

Cervical Screen: Contraindications

Answer 21

Ask about Hx of
-neck surgery
-recent trauma
-severe RA, AA or OA instability
-Cervical meylopathy/Radiculopathy
-Carotid sinus syncope
-Chiari malformation
-Vascular dissection

Question 22

Cervical Screen: Cervical AROM

Answer 22

-flx/ext/SB/ROT (Ds and Ns)
-Rot head and ext head and count back from 10

no overpressure

Question 23

Cervical Lig and ABI Testing

Answer 23

-verbalize

“I have checked the transverse and alar ligaments as well as the vertebral basilar artery for insufficiency”

Question 24

BPPV Exam Order

Answer 24

1. Subjective
2. Perform Dix-Hallpike (only if cleared)
3. Roll Test (if -)
4. Side-Lying Test (if -)
5. Determine side and canal/cup

Question 25

non-BPPV Determinants

Answer 25

1. Vestibular or not
2. Central or peripheral
3. Acute or chronic
4. Unilateral or Bilateral

Question 26

non-BPPV Exam Order

Answer 26

1. Observe Spontaneous Nystagmus
2. Observe Oculomotor Issues
3. Oculomotor Tests
4. VOR Tests
5. HINTS Exam
6. Balance Screen