Vestibular

Question 1

Which vestibular structure registers linear acceleration and deceleration and has a maximum response with bending forward?

Answer 1

Utricular macula

Question 2

Which vestibular structure is oriented vertically and has a maximal response to moving from sidelying to standing?

Answer 2

Sacular macula

Question 3

What is the response to movement of endolymph toward the kinocilium?

Answer 3

Excitatory

Question 4

What is the response to movement of endolymph away from the kinocilium?

Answer 4

Inhibitory

Question 5

Symptom: mild oscillopsia

Which is more likely: Central or Peripheral?

Answer 5

Peripheral vestibular disorder

Question 6

Symptom: tinnitus/decreased hearing

Which is more likely: Central or Peripheral?

Answer 6

Peripheral vestibular disorder

Question 7

Symptom: vertical nystagmus

Which is more likely: Central or Peripheral?

Answer 7

Central vestibular disorder

Question 8

Symptom: mild nausea/vomiting

Which is more likely: Central or Peripheral?

Answer 8

Central vestibular disorder

Question 9

Symptom: severe nausea/vomiting

Which is more likely: Central or Peripheral?

Answer 9

Peripheral vestibular disorder

Question 10

Symptom: sensorimotor deficits

Which is more likely: Central or Peripheral?

Answer 10

Central vestibular disorder

Question 11

Symptom: dysarthria

Which is more likely: Central or Peripheral?

Answer 11

Central vestibular disorder

Question 12

Symptom: absence of brainstem region signs

Which is more likely: Central or Peripheral?

Answer 12

Peripheral vestibular disorder

Question 13

Symptoms: provoked by changes in head position, acute onset, subsides < 2 minutes

What is the most likely vestibular disorder?

Answer 13

Benign Paroxysmal Positional Vertigo (BPPV)

Question 14

Symptoms: disequilibrium, spontaneous nystagmus, nausea, hearing unaffected, vertigo present when still, no UMN signs present

What is the most likely vestibular disorder?

Answer 14

Vestibular neuritis

Question 15

Symptoms: tinnitus, hearing loss, severe acute vertigo with duration >30 minutes, nausea/vomiting, sensation of fullness in the ear,

What is the most likely vestibular disorder?

Answer 15

Meniere’s disease

Question 16

Symptoms: vertigo, possible history of head trauma, exacerbated by changes in air pressure (i.e. flying at altitude or ascending in elevator), sensitive hearing/hearing loss, sense of ear fullness, tinnitus, no UMN signs

What is the most likely vestibular disorder?

Answer 16

Perilymph fistula

Question 17

Symptoms: mild vertigo with nausea/vomiting lasting >3 days, sensorimotor loss, diplopia, dysarthria

What is the most likely vestibular disorder?

Answer 17

Central vestibular disorder

(could be a number of causes including vertebrobasilar ischemia, brainstem tumor, MS, Arnold-Chiari malformation, etc.)

Question 18

Based on the indicated patterns of excitation/inhibition, what is the direction of head movement?

Answer 18

Down and to the left

Question 19

Based on the indicated patterns of excitation/inhibition, what is the direction of head movement?

Answer 19

Up and to the left

Question 20

Based on the indicated patterns of excitation/inhibition, what is the direction of head movement?

Answer 20

Rotating toward the left

Question 21

Based on the indicated patterns of excitation/inhibition, what is the direction of head movement?

Answer 21

Turning to look down with face in midline