Vestibular Exam pt. 2

Question 1

dizziness

Answer 1

non specific term
feelings of imbalance, spinning, lightheadedness

Question 2

vertigo

what is it due to?

Answer 2

room is spinning
rotational or linear

imbalance of tonic neural activity to vestibular cortex
caused by peripheral or central damage

Question 3

what is oscillopsia

Answer 3

just bouncy

gaze instability - illusionary sensation that stationary visual world is moving

only when eyes open

Question 4

when can oscillopsia be seen

Answer 4

bilateral > unilateral
central vestibular dysfunction

Question 5

what is disequilibrium

Answer 5

imbalance or unsteadiness while standing or walking

Question 6

causes of disequilibrium

Answer 6

visual changes, vestibular dysfunction, proprioceptive deficits

neuromotor deficits, joint pain, psychological factors

Question 7

lightheadedness

Answer 7

pre-syncope

brief decrease in blood flow to brain

Question 8

motion sickness

Answer 8

induced passive locomotion OR motion in visual surroundings while standing still

episodic dizziness, tiredness, pallor, diaphoresis, salivation, N/V

Question 9

what is motion sickness caused by

Answer 9

sensory mismatch between visual and vestibular systems

Question 10

what is motion sickness common with

Answer 10

migraine disorders (60%)

Question 11

red flags noted during subjective history:

Answer 11

severe HA
rapid hearing decline
dysarthria
incoordination
diplopia
decreased mentation
urinary incontinence
acute weakness
decreased consciousness
additional CN dysfunction

Question 12

motion sensitivity quotient

Answer 12

position dependent clinical examination that evaluates symptom response

Question 13

what are the S&S provoked in the motion sensitivity quotient

Answer 13

episodic dizziness, pallor, diaphoresis, tiredness, salivation, nausea, vomiting, imbalance, vertigo, disorientation

Question 14

motion sensitivity quotient: mild vestibular dysfunction

Answer 14

0-10

Question 15

motion sensitivity quotient: mod vestibular dysfunction

Answer 15

11-30

Question 16

motion sensitivity quotient: severe vestibular dysfunction

Answer 16

31-100

Question 17

dizziness handicap inventory

Answer 17

self assessment inventory designed to evaluate self-perceived handicap from dizziness

physical, emotional, functional

Question 18

DHI cut offs
mild:
mod:
severe:

Answer 18

0-30
31-60
61-100

Question 19

DHI MCID

Answer 19

18

Question 20

smooth pursuit

Answer 20

voluntary
slow following a target
1-2Hz

Question 21

saccades

Answer 21

voluntary
rapid repositioning of target

Question 22

VOR

Answer 22

involuntary
eye position in relation to head movement

Question 23

optokinetic

Answer 23

involuntary
perceives motion in visual field
supplements VOR to stabilize vision

Question 24

nystagmus

Answer 24

abnormal visual finding

Question 25

spontaneous nystagmus

Answer 25

peripheral vestibular imbalance nystagmus
congenital
central

nystagmus during nothing

Question 26

gaze evoked nystagmus

Answer 26

has a trigger

head shaking, optokinetic, positional, calroic, pressure induced, sound induced

Question 27

non-pathological nystagmus

Answer 27

end range nystagmus

Question 28

does central nystagmus get worse with lights on

Answer 28

yes - too much info

Question 29

does peripheral nystagmus get worse with lights on

Answer 29

no - lights off
can’t correct

Question 30

effect of fixation on peripheral nystagmus

Answer 30

decreases

Question 31

direction of gaze with peripheral nystagmus

Answer 31

usually mixed plane - horizontal and torsional

Question 32

effect of gaze on peripheral nystagmus

Answer 32

increases with gaze directed towards quick phase

Question 33

effect of fixation on central nystagmus

Answer 33

does not change or it increases

Question 34

direction of gaze with central nystagmus

Answer 34

usually single plane horizontal - torsional or vertical

Question 35

effect of gaze with central nystagmus

Answer 35

does not change or reverses direction

Question 36

when do u use frenzel lenses or video infrared camera?

Answer 36

spontaneous nystagmus
head shaking test
eye movements during maneuvers

Question 37

when do u not use frenzel lenses or video infrared camera?

Answer 37

dynamic visual activity
head impuse test
looking for skew deviations
examine visual tracking and saccades
examine stance and gait