Vestibular Testing — MCQs
A person presenting to the outpatient department with complaints of rotational vertigo and nausea in the morning, which worsens with changes in head position. What is your diagnosis?
Hallpike test is done for
Cervical Vestibular Evoked Myogenic Potential (cVEMP) detects lesion of -
Following are the laboratory tests for the diagnosis of vestibular dysfunction except -
At what angle is the caloric test performed?
Hallpike maneuver is done for:
Which of the following test is being performed on the patient?
A patient with cholesteatoma has lateral semicircular canal fistula. The most specific sign is:
All are true about vestibular neuritis EXCEPT:
Meniere's disease is characterized by which triad of symptoms?
Vestibular Testing Indian Medical PG Practice Questions and MCQs
Question 1: A person presenting to the outpatient department with complaints of rotational vertigo and nausea in the morning, which worsens with changes in head position. What is your diagnosis?
- A. Labyrinthitis
- B. BPPV (Correct Answer)
- C. Vestibular neuronitis
- D. Meniere's disease
Explanation: ***BPPV (Benign Paroxysmal Positional Vertigo)*** - **Rotational vertigo** that is triggered by specific **head position changes** and often noticed upon waking or turning in bed is highly characteristic of BPPV. - The symptoms are typically brief, intense, and associated with **nausea**, resolving within seconds to minutes. *Labyrinthitis* - Labyrinthitis presents with **continuous vertigo** and often includes **hearing loss** and **tinnitus**, which are not mentioned in the patient's symptoms. - The vertigo in labyrinthitis is usually constant, not positional, and is caused by inflammation of the inner ear. *Vestibular neuronitis* - Vestibular neuronitis is characterized by **sudden, severe, and persistent vertigo** without hearing loss, often following a viral infection. - Unlike BPPV, the vertigo does not primarily worsen with specific head position changes but is more constant. *Meniere's disease* - Meniere's disease involves a classic triad of **recurrent episodes of vertigo**, **tinnitus**, and **fluctuating sensorineural hearing loss**, often accompanied by aural fullness. - The vertigo attacks are typically severe and last for hours, which is longer than the brief episodes seen in BPPV.
Question 2: Hallpike test is done for
- A. Vestibular function (Correct Answer)
- B. Cochlear function
- C. Audiometry
- D. Eustachian tube function
Explanation: ***Vestibular function*** - The **Dix-Hallpike maneuver** is a diagnostic test used to identify **benign paroxysmal positional vertigo (BPPV)**, a disorder of the vestibular system. - It involves specific head and body movements to provoke dizziness and **nystagmus**, indicating otolith displacement in the semicircular canals. *Cochlear function* - **Cochlear function** relates to hearing, which is evaluated by tests like **audiometry** or **otoacoustic emissions**. - The Hallpike test does not assess the ability to perceive sound or the health of the cochlea. *Audiometry* - **Audiometry** is a hearing test that measures a person's ability to hear sounds at different frequencies and intensities, assessing the **degree and type of hearing loss**. - It is unrelated to assessing vertigo or balance disorders caused by semicircular canal pathology. *Eustachian tube function* - **Eustachian tube function** is assessed by tests like **tympanometry** or the **Valsalva maneuver**, which evaluate middle ear pressure equalization. - The Hallpike test does not assess Eustachian tube patency or function.
Question 3: Cervical Vestibular Evoked Myogenic Potential (cVEMP) detects lesion of -
- A. Inferior Vestibular Nerve (Correct Answer)
- B. Cochlear Nerve
- C. Facial Nerve
- D. Superior Vestibular Nerve
Explanation: ***Inferior Vestibular Nerve*** - **cVEMP** primarily assesses the function of the **saccule** and its neural pathway via the **inferior vestibular nerve (IVN)**. - The saccule is sensitive to **vertical head movements and linear acceleration** and transmits signals through the IVN to the vestibulospinal pathway. - cVEMP is recorded from the **sternocleidomastoid muscle** and reflects the **vestibulocollic reflex**. *Cochlear Nerve* - The **cochlear nerve** is responsible for **auditory processing** and is assessed by tests like audiometry and ABR, not VEMPs. - While it's part of the vestibulocochlear nerve (CN VIII), its function is distinct from vestibular assessment. *Facial Nerve* - The **facial nerve (CN VII)** controls **facial muscles** and taste sensation, with no direct role in vestibular function. - Lesions are detected through facial movement assessment and electrophysiological tests like electroneuronography (ENoG). *Superior Vestibular Nerve* - The **superior vestibular nerve (SVN)** primarily innervates the **anterior and horizontal semicircular canals** and the **utricle**. - Its function is assessed by **oVEMP (ocular VEMP)**, **caloric reflex test**, or **head impulse test**, rather than cVEMP.
Question 4: Following are the laboratory tests for the diagnosis of vestibular dysfunction except -
- A. Galvanic test
- B. Electronystagmography
- C. Gelle's test (Correct Answer)
- D. Optokinetic test
Explanation: ***Gelle's test*** - **Gelle's test** is used to evaluate the mobility of the **tympanic membrane** and the integrity of the **ossicular chain**, primarily in the diagnosis of **otosclerosis**. - It does not directly assess the function of the **vestibular system** or its pathways. *Galvanic test* - The Galvanic test involves applying an electrical current to the mastoid process to stimulate the **vestibular nerve** directly. - It assesses the function of the **semicircular canals** and their connections to the brainstem. *Electronystagmography* - **Electronystagmography (ENG)** records eye movements during various maneuvers to evaluate the function of the **vestibular-ocular reflex (VOR)**. - It helps detect nystagmus and other eye movement abnormalities indicative of **vestibular dysfunction**. *Optokinetic test* - The **optokinetic test** assesses the ability of the eyes to follow moving targets, evaluating the **central vestibular pathways** and their interaction with the visual system. - It can help differentiate between peripheral and central **vestibular disorders**.
Question 5: At what angle is the caloric test performed?
- A. 45
- B. 15
- C. 60
- D. 30 (Correct Answer)
Explanation: ***30*** - The **caloric test** is performed with the patient's head elevated at a **30-degree angle** from the horizontal. - This specific head position places the **horizontal semicircular canal** in a **vertical plane**, making it most sensitive to thermal stimulation and generating a caloric response. *45* - A **45-degree angle** is not the standard head position for isolating the horizontal semicircular canal during the caloric test. - Positioning the head at this angle would not optimally align the **horizontal canal** for testing. *15* - A **15-degree angle** is too shallow to effectively position the **horizontal semicircular canal** in the optimal vertical plane. - This would result in a suboptimal or absent caloric response due to inadequate thermal stimulation of the canal. *60* - Elevating the head to a **60-degree angle** would position the **horizontal semicircular canal** beyond the optimal vertical plane required for the caloric test. - This non-optimal positioning would reduce the effectiveness of thermal stimulation and potentially lead to inaccurate test results.
Question 6: Hallpike maneuver is done for:
- A. Vestibular function (Correct Answer)
- B. Cochlear function
- C. Audiometry
- D. Corneal test
Explanation: ***Vestibular function*** - The **Dix-Hallpike maneuver** is a diagnostic test used to identify **benign paroxysmal positional vertigo (BPPV)**, which is a common cause of dizziness originating from the **vestibular system**. - It involves specific head and body movements to provoke dizziness and observe characteristic eye movements (**nystagmus**) indicative of otolith displacement within the semicircular canals. *Cochlear function* - **Cochlear function** relates to hearing and sound perception, which is assessed by tests like **audiometry** or otoacoustic emissions. - The Hallpike maneuver does not directly evaluate the function of the **cochlea**. *Audiometry* - **Audiometry** is a test used to assess a person's **hearing sensitivity** by measuring their ability to hear sounds of different frequencies and intensities. - It is distinct from the Hallpike maneuver, which focuses on **balance** and **vestibular dysfunction**. *Corneal test* - The **corneal reflex test** evaluates the integrity of the **trigeminal (CN V)** and **facial (CN VII)** nerves by observing an involuntary blink response to corneal stimulation. - This test is unrelated to vertigo or the **vestibular system**, which the Hallpike maneuver addresses.
Question 7: Which of the following test is being performed on the patient?
- A. Caloric stimulation test
- B. Doll's eye reflex
- C. Dix-Hallpike test (Correct Answer)
- D. Frenzel maneuver
Explanation: ***Dix-Hallpike test*** - The image depicts a patient being moved from an upright sitting position to a supine position with the head turned to one side and extended, which is characteristic of the **Dix-Hallpike maneuver**. - This test is used to diagnose **benign paroxysmal positional vertigo (BPPV)** by provoking vertigo and nystagmus as a result of otoconia displacement in the semicircular canals. *Caloric stimulation test* - This test involves introducing **warm or cold water/air into the ear canal** to induce nystagmus, assessing the vestibular system. - It's typically performed with the patient lying supine with their head elevated at 30 degrees, not involving the specific positional changes shown in the image. *Doll's eye reflex* - Also known as the **oculocephalic reflex**, it assesses brainstem function by rapidly turning the patient's head while observing eye movement. - This reflex is primarily used to evaluate comatose patients and does not involve the complex body and head positioning seen in the image. *Frenzel maneuver* - The Frenzel maneuver is performed during **otoscopy** to check for nystagmus by having the patient gaze through high plus lenses in a dark room. - It is often used to suppress visual fixation and enhance nystagmus, but it does not involve the specific body or head movements depicted.
Question 8: A patient with cholesteatoma has lateral semicircular canal fistula. The most specific sign is:
- A. Head thrust test
- B. Fistula test (Correct Answer)
- C. Hennebert's sign
- D. Dix-Hallpike test
Explanation: ***Fistula test*** - The **fistula test** (Positive pressure test or Hennebert's test) directly assesses for a communication between the middle ear and the labyrinth by applying positive or negative pressure to the external auditory canal. - A positive result, indicated by **nystagmus** or **vertigo** induced by pressure changes, is the **most specific sign** for a **labyrinthine fistula** in the context of **cholesteatoma**. - The lateral semicircular canal is the most commonly affected site in cholesteatoma-related fistulae. *Hennebert's sign* - **Hennebert's sign** refers to **nystagmus** or **vertigo** induced by pressure changes in the external auditory canal **in the absence of an actual fistula**. - It represents a **false positive fistula test** and is classically associated with **congenital syphilis**, **Meniere's disease**, or other conditions causing increased labyrinthine membrane mobility. - In this case with a **confirmed fistula**, the positive pressure test would be called a **positive fistula test**, not Hennebert's sign. *Head thrust test* - The **head thrust test** evaluates the function of the **vestibulo-ocular reflex (VOR)** and is used to detect **peripheral vestibular hypofunction**. - While cholesteatoma can affect vestibular function, this test is **not specific** for identifying a **labyrinthine fistula**. *Dix-Hallpike test* - The **Dix-Hallpike test** is used to diagnose **Benign Paroxysmal Positional Vertigo (BPPV)** by identifying nystagmus and vertigo triggered by specific head positions. - This test detects **otoconia displacement** in the semicircular canals and is **not relevant** for identifying a **labyrinthine fistula**.
Question 9: All are true about vestibular neuritis EXCEPT:
- A. Horizontal nystagmus
- B. Positive head thrust
- C. Vertical nystagmus (Correct Answer)
- D. Normal hearing
Explanation: ***Vertical nystagmus*** - **Vestibular neuritis** primarily affects the **horizontal semicircular canal** and superior vestibular nerve, leading to **horizontal or rotational nystagmus**, not vertical. - **Vertical nystagmus** is often indicative of a **central lesion** rather than a peripheral vestibular disorder like neuritis. *Horizontal nystagmus* - This is a characteristic finding in **vestibular neuritis**, where the **nystagmus is usually horizontal or rotatory** and beats away from the affected side. - The nystagmus typically **increases in intensity** when looking in the direction of the fast phase. *Positive head thrust* - A **positive head thrust test** (or **head impulse test**) is a hallmark of **peripheral vestibular dysfunction**, including vestibular neuritis. - It demonstrates a **saccadic corrective eye movement** when the head is quickly turned towards the affected side, indicating impaired vestibulo-ocular reflex. *Normal hearing* - **Vestibular neuritis** specifically involves inflammation of the **vestibular nerve**, sparing the cochlear nerve. - Therefore, patients with vestibular neuritis typically **maintain normal hearing**, differentiating it from labyrinthitis.
Question 10: Meniere's disease is characterized by which triad of symptoms?
- A. Conductive hearing loss and tinnitus
- B. Vertigo, ear discharge, tinnitus, and headache
- C. Vertigo, tinnitus, hearing loss, and headache
- D. Vertigo, tinnitus, and hearing loss (Correct Answer)
Explanation: **Explanation** Meniere’s disease (Endolymphatic Hydrops) is a disorder of the inner ear characterized by an abnormal accumulation of endolymph within the membranous labyrinth. The classic clinical triad consists of: 1. **Episodic Vertigo:** Sudden, rotatory vertigo lasting 20 minutes to several hours, often accompanied by nausea and vomiting. 2. **Sensorineural Hearing Loss (SNHL):** Characteristically fluctuating and low-frequency in the early stages. 3. **Tinnitus:** Often described as a low-pitched "roaring" or "seashell" sound. *(Note: Many authorities include a fourth symptom—**Aural Fullness**—making it a tetrad).* **Analysis of Options:** * **Option A:** Incorrect. Meniere’s causes **Sensorineural** hearing loss, not conductive. Conductive loss suggests pathology in the external or middle ear (e.g., ASOM, Otosclerosis). * **Option B:** Incorrect. **Ear discharge (Otorrhea)** is a hallmark of middle ear infections (CSOM) and is never seen in Meniere’s, which is an inner ear pathology with an intact tympanic membrane. * **Option C:** Incorrect. While headache can occur, it is not a defining component of the diagnostic triad. Its presence might instead suggest Vestibular Migraine. * **Option D:** **Correct.** This captures the classic diagnostic triad essential for NEET-PG. **Clinical Pearls for NEET-PG:** * **Pathology:** Distension of the endolymphatic system (Reissner’s membrane bulges into the scala vestibuli). * **Lermoyez Syndrome:** A variant where hearing improves during a vertigo attack ("the phenomenon of reverse symptoms"). * **Tuning Fork Tests:** Rinne positive (SNHL) and Weber lateralized to the better ear. * **Audiometry:** Shows a "rising curve" in early stages (low-frequency loss). * **Glycerol Test:** Used for diagnosis; oral glycerol (osmotic diuretic) temporarily improves hearing by reducing endolymphatic pressure. * **Management:** Low salt diet, Betahistine (drug of choice), and diuretics. Intratympanic Gentamicin is used for refractory cases.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free