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Neuromsk 2 > Vestibular Exam > Flashcards

Vestibular Exam Flashcards

1
Q

Vestib exam flow

A

Subjective

Vestibular screen and systems review

HINTS test if they present with ongoing vertigo and with spontaneous nystagmus

Ask contraindications and perform cervical clearing test

Perform cervical ligament testing in supine

Test less affected side first

Dix Hallpike test

Roll test

Side lying test

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2
Q

You only want to do a BPPV exam if the nystagmus presented how?

A

If the nystagmus and vertigo are only provoked by positional head changes

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3
Q

Why is it important to find out if your patient is on vestibular suppressant medication

A

Can cause tests to not be sensitive due to masking symptoms

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4
Q

How do we rule out the cardiovascular system

A

Take vitals

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5
Q

How do we clear the cervical spine/circulation during the systems review?

A

First ask contras

ROM in all planes, Ask about 5Ds and 3Ns while patient performs.

Next have pt actively rotate to one side then look back behind shoulder and count backward from 10, observe again for 5Ds and 3Ns

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6
Q

What is vertical skew and what does it mean

A

When the patients head position is not inline with the rest of their body from a vertical standpoint

It is a sign of a central problem

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7
Q

The head thrust test tests for what

How do you perform it?

A

Tests for peripheral problems

You quickly turn a patients head to one side and watch for the VOR reflex to work normally

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8
Q

What is the HINTS exam?

A

Head impulse nystagmus test of skew

Tests if the nystagmus is vertical/horizontal and or unidirectional/bidirectional

Good for ruling in a stroke

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9
Q

What are contraindications to doing cervical provocation testing

A

Hx of neck surgery

Recent neck trauma

Severe RA, upper cervical instability

Cervical myelopathy/radiculopathy

Carotid sinus syncope

Chiari malformation

Vascular dissection syndromes

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10
Q

When conducting the cervical vascular clearing sequence what are we asking our patients if they’re feeling

A

Dizziness diplopia, dysarthria. Dysphagia, drop attacks

Nystagmus , nausea, numbness and tingling

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11
Q

Which side should you test first first in a vestib exam

A

Unaffected or less effected side

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12
Q

which portion of the vestib exam would you skip if the cervical screen was not clear?

A

Definitely don’t do dix-hallpike, may still be able to do roll test and sidelying test

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13
Q

How will nystagmus from cupulolithiasis present during test?

A

immediate onset of vertigo and nystagmus

Constant intensity as long as they’re in provoking position

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14
Q

How will nystagmus from canalithiasis present during test

A

Delayed/latent onset of vertigo,nystagmus

symptoms gradually intensify and then subside

lasts for a few seconds to a minute

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15
Q

In what order do you perform the BPPV tests and which canals do they test

A

Dix-hallpike - Anterior and Posterior (most common)

Roll test- Horizontal

Sidelying test- Posterior and Anterior

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16
Q

What is the patient’s position at the start of the dix-hallpike test

what about at the end?

A

Longsitting, head turned 45 degrees to one side

Supine, head still 45 degrees to one side but now with 30 degrees of ext aswell

17
Q

What is the head position to start the roll test?

A

Pt with head flexed to 30 degrees

18
Q

During the BPPV tests, Ewalds 1st law states that eye movements are __________________

A

within the plane of the canal being stimulated

19
Q

If you see an upbeat (fast phase) with right torsion during a dix-hallpike this indicates which canal

A

Right posterior

20
Q

If you see a down-beat (fast phase) with a right torsion during the dix-hallpike this indicates what canal

A

RIght anterior

21
Q

If you see an upbeat with a left torsion during the dix-hallpike, what canal?

A

left posterior

22
Q

How will a left-anterior canal’s nystagmus present during the dix-hallpike test

A

left torsional w/ down-beat

23
Q

What is Ewald’s 3rd law?

A

Deflection of the cupula towards the canal
(endolymph moving toward the canal from the cupula) creates a stronger response than deflection away from the canal

24
Q

When going into the test position for dix-hallpike, is the endolymph defecting the cupula towards or away from the canal

A

towards the canal (stronger excitation according to ewalds law)

25
Q

When a person complete’s dix-hallpike and returns to sitting, they now have a downbeating nystagmus with L torsional, what does this mean?

A

R posterior canal

(it’s the opposite of what you’ll see during the dix-hallpike test position)

26
Q

When a patient with suspected L anterior canalithiasis returns to sitting after the dix-hallpike maneuver, what will you see?

A

upbeat and R torsional

27
Q

What goes geotropic nystagmus mean

Apogeotropic?

A

Geotropic - nystagmus beating towards earth during roll test

apogeotropic - nystagmus beating away from earth during roll test

28
Q

How long does the patient hold the test-position in a dix-hallpike

A

1 minute

or until dizziness subsides + 30 seconds

29
Q

How is the horizontal canal positioned?

A

30 degrees off of true horizontal

30
Q

When performing the roll test for HSC BPV, how do you know which side is the involved side

A

The side that is worst is the involved side

31
Q

How do you perform the roll test for HSC BPV?

A

Pt is supine w/ head at 30 degrees flexion

You quickly turn their head 90 degrees and hold the position for 1 minute, then bring their head slowily back to midline and quickly turn to the other side 90 degrees, hold 1 minute again

32
Q

What is a positive horizontal roll test?

A

vertigo and nystagmus occur bilaterally w/ one side worse than the other

33
Q

During the horizontal roll test,

geotropic nystagmus on the more involved side Right side means what

A

R sided horizontal canal BPPV

When nystagmus is geotropic, the stronger side has canalithiasis

*picture example is for opposite side

34
Q

During the horizontal roll test towards the R , if you see Apogeotropic nystagmus that is stronger than on the L, what does this tell you

A

L cupulolithiasis

When nystagmus is apogeotropic, the weaker side has cupulolithiasis

*picture example is for opposite side

35
Q

how do you perform the sidelying test for PSC or ASC?

A

have pt turn head 45 degrees to one side, then quickly lay down on side

36
Q

Can the sidelying test determine the difference between cupulolithiasis and canalithiasis

A

No, you must first determine this through subjective before the test

37
Q

If a patient has upbeat nystagmus and rotary component towards down ear in the side lying test, what canal is this?

A

BPV of downside PSC

Same as in dix-hallpike the PSC is upbeat and ASC is downbeat

38
Q

If a patient has downbeat nystagmus with rotary component towards down ear, what does this mean?

A

anterior canal of downside

Same as in dix-hallpike the PSC is upbeat and ASC is downbeat

Neuromsk 2 (9 decks)

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