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VESTIBULAR CERTIFICATION EXAM QUESTIONS WITH 100% DETAILED VERIFIED ANSWERS, Exams of Health sciences

VESTIBULAR CERTIFICATION EXAM QUESTIONS WITH 100% DETAILED VERIFIED ANSWERS

Typology: Exams

2024/2025

Available from 11/26/2024

Wanjiruesther
Wanjiruesther 🇰🇪

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Download VESTIBULAR CERTIFICATION EXAM QUESTIONS WITH 100% DETAILED VERIFIED ANSWERS and more Exams Health sciences in PDF only on Docsity!

VESTIBULAR CERTIFICATION

EXAM QUESTIONS WITH 100%

DETAILED VERIFIED ANSWERS

Vestibular sedatives are most likely to be helpful with addressing what kind of symptoms:

  1. Vertigo Sedative such as Diazepam (Valium) and Meclizine (Antivert) are helpful in reducing acute vertigo. Valium is typically utilized for severe vertigo, followed by Meclizine.
  2. Nausea and emesis Sedatives have an anti-emetic property which can increase patient comfort while suffering from acute vertigo. With acute peripheral vestibular loss, patients may struggle with nausea and emesis for several days to one week. When would it be pointless for a patient to start taking vestibular suppressants after an acute vestibular event? With acute peripheral vestibular loss, use of agents (Benzodiazipines and Antihistimines) is only helpful for approximately one week. Typically after one week, central nervous system compensation has sufficiently reduced spontaneous vertigo. Antihistamines are sometimes prescribed for chronic vertigo and motion sickness as well. ***** Vestibular neuritis typically presents with ___________ because it typically damages the ________________. Which of the following structures are likely to be involved?**
  3. Horizontal, Anterior canal, and Utricle deficits such as ***
  4. superior vestibular nerve List all possible positive tests for a Central NS vestibular dysfunction.
  1. Smooth pursuit
  2. Saccades
  3. Vergence
  4. Pure torsional or downbeating nystagmus (cerebellar)
  5. Nystagmus that changes direction based on gaze position is suggestive of central nervous system dysfunction.

Diagnose the Case: 72 year old female c/o dizziness for 2 months. PMH: osteoporosis, atrial fib, CAD, HTN, hypercholesterolemia, and lumbar spinal stenosis. MVA with mild head trauma which preceded the dizziness by 3 days. Sx: A sense of imbalance with the majority of the episodes, occasionally experiences a sense of vertigo, with the following activities: supine to sit transitions, lying in bed, rolling from right to left in bed, stooping and pitching her head back. The episodes last less than a minute. BPPV Notes:

  • Elderly patients with BPPV frequently do not report a sense of vertigo. Frequently patients complain of non-rotary imbalance with BPPV. This is more common in patients with chronic BPPV or the patient with diminished vestibular sensitivity.
  • BPPV can be active for varying periods of time. The natural course can vary highly from a day to over a year. Duration for canalithiasis vs cupulolithiasis Canal: Nystagmus lasting up to 15 seconds with associated vertigo. Otoconia freely migrating within the semicircular canal (canalithiasis) should settle within seconds. With cupulolithiasis, the debris is adherent to the cupula and the nystagmus will last greater than one minute.

What type of nystagmus is seen with BPPV Geotrophic nystagmus Geotropic nystagmus involves nystagmus with the fast phase directed toward the earth. This finding would suggest likely involvement of the horizontal canal (canalithiasis-type). Roll testing should be completed to determine the affected side. Diagnose the case:

**- 70 yo male

  • 3 week history of dizziness.
  • Acute spontaneous episode of vertigo with nausea/emesis and imbalance at onset lasting approximately 4 days.
  • Residually c/o gait instability and head motion related unsteadiness.
  • Denies any preceding upper respiratory or GI infection.
  • Denies any h/o sign dizziness prior to the current episode.
  • Denies associated hearing loss or tinnitus.
  • Denies diplopia, limb incoordination, severe headache, dysarthria, dysphagia or falls with the dizziness. PMH: HTN, afib, hypercholesterolemia, DM type 2, and TIA. Patient smokes cigarettes 1.5 ppd for the last 50 years.** Anterior vestibular artery ischemia The patient's history is suggestive of an acute loss of peripheral vestibular hypofunction. Anterior vestibular artery ischemia is more common in patients with vascular risk factors, several of which are present with this patient (DM-2, HTN, atrial fibrillation, hypercholesterolemia, and tobacco use). Additionally supportive of an ischemic origin is the patient's prior history of TIAs. ***** List some key differences between labrynthitis and vestibular neuritis** Labrynthitis: a key element of labyrinthitis is associated unilateral hearing loss or tinnitus Vestibular neuritis: Many patients with vestibular neuritis report a preceding infection. Vestibular neuritis is speculated to be mediated by immune system hypersensitivity triggered by viral exposure. What is a significant caloric test?

Caloric testing provides a comparative measure of vestibular function bilaterally. Cold irrigations suppress tonic vestibular activity, warm irrigations stimulate increased vestibular activity. Testing measures the velocity of vestibular ocular reflex activity. Asymmetries of greater than 25% are considered significant. ***** Testing: Head thrust test**

  • Loss of target and corrective saccade. If positive, suggests a deficit in the ipsilateral side as the test. Dx: Suggests a vestibular hypofunction on the side the test is + With Meniere's disease, pts tend to _______ ________hearing loss. Episodes of dizziness typically last _______. The best treatment for active meniere's is ______ experience gradual (initially in the low frequencies, is common. The hearing loss is unilateral.) The duration of vertiginous episodes is more commonly within a range of 20 minutes to 24 hours, not days. The episodes occur spontaneously and may be preceded by tinnitus and fullness in the affected ear. Vestibular sedative and anti-emetics. The use of medications can be helpful during attacks in increase patient comfort and reduce nausea / emesis. These agents should not be utilized for chronic unsteadiness or to prevent an attack.
  • Vestibular rehabilitation is not effective in preventing recurrent attacks of vertigo and is not helpful in the management of active Meniere's disease. Rehabilitation may be helpful following an ablative procedure (trans-tympanic gentamycin injections / vestibular nerve section / labyrinthectomy). **For a patient with a current vestibular schwannoma, what are her best treatment options?

  1. Surgery then vestibular rehabilitation

Gamma knife treatment is utilized when open surgery is too risky due to the patient's poor health or tumor size / location. Gamma knife treatment does not typically completely ablate the tumor. Vestibular

rehabilitation may be trialed, however the vestibular loss may not be stable which may limit rehab potential. Why do pts with vestibular issues have visual vertigo? Over-reliance on visual cues for information about movement


What dysfunction would you expect cochlear complaints as well as vestibular complaints?** Meniere's disease Cupula detects ____ acceleration and Otoliths detect ___ acceleration. Why? Cupula detects angular acceleration because the membrane with the embeded hair cells have the same specific gravity as the endolymph Otolith membrane have calcium particles on top of them so they can sense gravity. Why to patients discover oscillopsia? Gaze is unstable due to loss of VOR. Hall mark sign of bilateral vestibular loss. How to do Head thrust of the following canals/structures:

**- Utricle

  • Horizontal
  • Posterior And which nerves are you testing with each?** 180deg/sec of >2 Hz, unpredictably Utricle: Lateral shift or "Heave test"
  • Sup vestibular nerve (anterior canal also does sup nerve) Horizontal: Rotation
  • superior vestibular nerve

Posterior: (R canal): Rotate 45deg to the R your hand on L forehead and R under ear and push back pure saggital plane. (Start in flexion in go into neutral extension)

  • also looks at the inferior vestibular nerve What does a hyper-reflexive HTT indicate? Central dysfunction HTT corrective saccades are in the same position as the direction your tunring their head. TOO much VOR What would the following finding suggest? Nystagmus changing direction based on the direction of gaze Nystagmus from peripheral vestibular loss is unidirectional and enhanced with fixation denied. Nystagmus that changes direction based on gaze position is suggestive of central nervous system dysfunction. You find a pt with h/o upper respiratory illness, followed by acute onset of dizziness. She was able to schedule an evaluation for PT a couple days later. Should you treat, refer, or treat and refer? Steroids (anti-inflammatory) may be helpful in acute vestibular neuritis. Additionally, use of a prednisone taper is more likely to be helpful when given during the acute phase of the illness (within one week of onset). Taylor is a young person with an unidentified vestibular disorder. His symptoms are consistent with vestibular impairment, but the etiology of his symptoms is unclear. You are evaluating him to determine whether his impairment is central or peripheral. What central oculomotor tests would you perform to establish baseline of oculomotor function? Saccades, smooth pursuit, and VOR suppression An Acoustic Neuroma would have what other Sx besides hearing and vestibular issues? CN 5 and 7 problems Nystagmus decreased with fixation means that the conditions is most likely... Peripheral in nature

Which remarkable findings do not help you in determining a central vs peripheral involvement? Spontaneous nystagmus Gaze holding nystagmus Name tests that would be consistent with positive Central dysfunction vestibular system Saccades with smooth Pursuit or with switching between a Target 15 degrees Impaired extraocular movements (or CN346) Vergence (or CN3) Impaired VOR cancellation What does a positive head thrust test indicate This is a test for the vestibular ocular reflex VOR indicates a peripheral vestibular dysfunction Describe a remarkable finding for dynamic visual Acuity test and what this indicates Inability to read within two lines of the stable head visual accuracy at 2 Hertz suggested of peripheral dysfunction Describe the recovery-based exercises for vestibular training Adaptation some habituation in the acute phase and functional training Describe the compensatory based exercises for vestibular rehab Substitution habituation functional training Who would be appropriate for adaptation exercises and vestibular rehab Exercises such as VOR 1 and VOR 2 are appropriate for:

  • chronic bppv
  • late-stage Meniere's disease
  • vestibular hypofunction such as post acoustic neuroma resection neuritis or labyrinthitis

Who would be appropriate for substitution exercises in vestibular rehab Bilateral vestibular loss Central vestibular disorders elderly faller patient with acute symptoms who cannot tolerate adaptation exercises Who would you use habituation exercises with in vestibular rehab Patients with specific movements or positions that cause symptoms (but should not have active bppv) Patients who have difficulty coordinating adaptation or substitution exercises Patients who are acutely presenting with symptoms and can't tolerate other gaze stabilization exercises