Vestibular Quiz

When performing the Dix Hallpike maneuver, the examiner should turn the patients head in which manner?

• Towards the good ear

• Towards the bad ear

• Slight lateral flexion

• Slight extension

Answer explanation

The head should be turned towards the ear that is illiciting the symptoms aka "bad ear."

This can be identified by asking the patient subjective questions about positions that illicit symptoms and the "good ear," side can be tested initially to desensitixe patient to quick movement and decrease likelihood for symptoms of nausea or vomiting.

Which of the following is the assessment tool for identifying a horizontal canal BPPV?

• BBQ Roll

• Supine Roll

• Epley Maneuver

• Dix-Hallpike

Answer explanation

Supine roll test is the best test to use to identify BPPV that is affecting the horizontal canal (lateral canal).

The dix-hallpike is a test that is used to identify pathology in the posterior canal.

BBQ roll and Epley maneuver are both canalith repositioning maneuvers that are used to treat vertigo and move crystals out of the semicircular canal.

A 38-year-old school teacher reports that she has had approximately 10 attacks of spinning vertigo in the past 12 months, usually lasting several hours each. She has also noted hearing loss, tinnitus, and full-ness in the left ear. Audiological testing reveals a 40-dB low-frequency hearing deficit in the left ear. What is the probable diagnosis?

• Meniere's Disease

• Central vestibular disorder

• BPPV

• UVH

Answer explanation

Meniere's disease is a chronic inner ear disorder that causes balance issues and hearing loss. It's characterized by episodes of vertigo (dizziness), tinnitus (ringing in the ears), hearing loss, and a feeling of fullness in the ear.

A 44-year-old colleague of yours sustains a mild TBI in a bicycle accident. The next morning, they report spinning vertigo while turning over in bed with symptoms going away at rest. They report nausea/vomiting, attacks are triggered by turning over to the left, and last 30 seconds. Clinical examination is normal. What is the diagnosis?

• Vertebral Artery Dissection

• Meniere's Disease

• Orthostatic dizziness

• BPPV

Answer explanation

BPPV is a common disorder of the inner ear with symptoms including dizziness, vertigo, unsteadiness and nausea. It is the most common form of vertigo.

Dizziness and vertigo that comes on within 1-5 seconds of a movement but that is short in duration (< 1 min) most closely represents which condition?

• Canalithiasis

• Cupolithiasis

• Meniere’s disease

• BPPV

Answer explanation

Dizziness and vertigo that comes on within 1-5 seconds of a movement but that is short in duration (less than 1 min) is the result of Canalithiasis. Crystals are floating freely in the canals and mess with the cupula before settling. This is what causes the temporary dizziness.

Cupolalithiasis nystagmus occurs immediately when moved into position and lasts for longer than 1 minute.

Which result would indicate a posterior canal issue when performing the Dix Hallpike maneuver?

• Upbeating torsional nystagmus to side of rotation

• Downbeating nontorsional nystagmus to side of rotation

• Upbeating non torsional nystagmus

• Downbeating torsional nystagmus away from side of rotation

Answer explanation

Typical posterior canal BPPV, the most frequent form of BPPV, is characterized by a paroxysmal nystagmus evoked through the Dix-Hallpike test; the nystagmus is torsional and clockwise for the left side, counter-clockwise for the right side, with a vertical up-beating component.

What is the difference between the Dix-Hallpike and the Epley?

• Dix Hallpike to diagnose, Epley to treat.

• Epley to diagnose, Dix Hallpike to treat.

• Dix Hallpike to treat cupolithiasis, Epley to treat canalithiasis.

• Dix Hallpike to identify BPPV, Epley to identify direction of nystagmus.

Answer explanation

The dix-hallpike is a test to rule in/out benign positional paroxysmal vertigo while the Epley maneuver is a treatment that involves positions that a patient can get themselves into to move the crystals and clear the symptoms when they come on.

Which of the following best identifies the test seen in this picture?

• Dix-Hallpike

• Supine Roll

• BBQ roll

• Epley Maneuver

Answer explanation

BBQ roll and epley maneuver are not vestibular tests. They are interventions used to treat positonal nystagmus. The dix hallpike starts off with the patient sitting and then is carried to a quick position change with the examiner. The supine roll test is seen in the picture. The examiner will perform quick head turns while patient is in supine.

All of the following are clinical findings that may warrant a possible diagnosis of Ankylosing Spondylitis, except?

• Morning stiffness lasting > 30 min

• Waking up at night due to pain that eases with arising

• Pain and stiffness increase with activity and improve with exercise

• Age of onset > 45 years of age

Answer explanation

Consider diagnosis of AS if two or more of following present. Presence of four or more considered diagnostic:

• - Age of onset < 45 years (less than 45 years of age), more likely to be something else if diagnosed in later ages.

• - Duration > 3 months

• - Morning stiffness lasting > 30 minutes

• - Waking up second half of night due to pain, eases with arising

• - Pain and stiffness increases with inactivity and improve with exercise

 (These symptoms are characteristic of inflammatory back pain.)