vestibular assessment

Question 1

2 otolith organs

Answer 1

utricle and saccule

Question 2

saccule detects _____ translation and utricle detects _____

Answer 2

vertical
horizontal

Question 3

what is the resting firing rate of hair cells

Answer 3

90 spikes/sec

Question 4

With ____ hair cells are deflected towards kinocilium and with ______- they are deflected away from kinocilium

Answer 4

depolarization
hyperpolarization

Question 5

T or F: as one canal depolarizes, its pair hyperpolarizes

Answer 5

T: this is the push pull mechanism

Question 6

vestibular occular reflex

Answer 6

• responds to brief angular and linear head movement
• compensates for high frequency head movements

Question 7

vestibular nuclei

Answer 7

superior, lateral, medial, inferior

Question 8

where are the vestibular nuclei

Answer 8

rostral medulla and caudal pons

Question 9

what nuclei to the semicircular canals project to

Answer 9

superior and medial

Question 10

what nuclei do the otoliths project to?

Answer 10

lateral, medial, and inferior

Question 11

what do the vestibular nuclei do

Answer 11

distribute info about direction and speed of head movement and the position of the head with respect to gravity to main regions of the brain

Question 12

what is the only sensory organ that sends direct primary afferent projections to the cerebellar cortex and nuclei

Answer 12

vestibular labyrinth

Question 13

what has reciprocal connections with the vestibular nuclei

Answer 13

cerebellum
- this allows for regulatory mechanisms for control of eye movements, head movements, and posture

Question 14

what musculature does the lateral vestibulospinal tract control? what about medial corticospinal

Answer 14

lateral = primarily LEs
medial = neck muscles

Question 15

what does the vestibular thalamus do

Answer 15

cognitive perceptions of motion and spatial orientation

Question 16

vestibular cortex

Answer 16

• supramarginal and supratemporal gyrus
• sensory integration for balance control

Question 17

3 subjective history elements that help with vestibular diagnosis

Answer 17

1 - tempo: how long
2 - symptoms: what does it feel like
3 - circumstances: when/how does it happen

Question 18

the cover/uncover test tests for _______ while the alternate cover test tests for ______-

Answer 18

tropia
phoria

Question 19

cover/uncover test

Answer 19

• have pt look at target
• cover one eye
• observe uncovered eye
• uncover covered eye

Question 20

alternate cover test

Answer 20

• cover each eye alternately
• watch covered eye just after it is uncovered

Question 21

in sitting position, geotropic beats towards _______ ear and apogeotropic beats towards ________ ear

Answer 21

healthy
affected

Question 22

in bow position, geotropic beats toward ________ ear and apogeotropic beats toward _______ ear

Answer 22

affected
healthy

Question 23

in lean position, geotropic beats towards __________ ear and apogeotropic beats toward __________ ear

Answer 23

healthy
affected

Question 24

in sit to supine test, geotropic beats towards _______ ear and apogeotropic beats toward ________ ear

Answer 24

healthy
affected

Question 25

is there latency with cupulolithiasis? what about canalithiasis

Answer 25

cupulo = none canal = 0-15 secs

Question 26

for cupulolithiasis, the duration is ______ than 60 seconds while with canalithiasis it is _______ than 60 seconds

Answer 26

greater less

Question 27

T or F: with central vertigo nystagmus is persistent and does not decrease

Answer 27

T

Question 28

T or F: BPPV is pure torsional or vertical nystagmus

Answer 28

F: that's central! BPPV is vertical with a torsional component for anterior/posterior canals or horizontal for horizontal canal

Question 29

how do you get reversal of nystagmus with anterior or posterior canal BPPV

Answer 29

sitting up

Question 30

how do you get reversal of nystagmus with horizontal canal BPPV

Answer 30

head turned to opposite side

Question 31

T or F: Fukuda test (50 marches with eyes closed) is recommended for vestibular diagnosis

Answer 31

F

Question 32

electronystagmography

Answer 32

records horizontal and vertical eye movements through electrodes attached to the face *there's also a video version that uses goggles instead

Question 33

what is the gold standard for identifying peripheral unilateral vestibular hypofunction

Answer 33

caloric test (water in ear)

Question 34

what is the gold standard for bilateral vestibular hypofunction

Answer 34

rotational chair testing

Question 35

what are 4 s/s of central vestibular dysfunction

Answer 35

1 - gait ataxia 2 - dizziness vertigo 3 - head tilt to one side 4 - negative head thrust test

Question 36

is direction changing nystagmus a sign of central or peripheral vertigo

Answer 36

central

Question 37

S/S of acute unilateral peripheral vestibular loss or hypofunction

Answer 37

- N/V - dizziness - vertigo - off balance but they can walk - spontaneous nystagmus

Question 38

HINTS exam to rule out stroke

Answer 38

head impulse - positive nystagmus - unidirectional test of skew - negative *if all 3 of these are true then stroke is ruled out

Question 39

chronic unilateral vestibular hypofunction may not have a positive head thrust test. why?

Answer 39

b/c it's chronic and their system may compensate

Question 40

S/S bilateral vestibular disease

Answer 40

- oscillopsia - ataxia - falls - no vertigo

Question 41

s/s of menieres disease

Answer 41

- ear pressure - hearing loss - N/V - tinnitus - spontaneous attacks

Question 42

s/s of BPPV

Answer 42

- vertigo <1 min - sx with change in head position - no ear pain or hearing loss

Question 43

In _______ canal BPPV the nystagmus is upbeating and in _______ canal it is downbeating

Answer 43

posterior anterior (rare)