NM III Exam I Questions and answers, rated A+ 2022 update.

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NM III Exam I Questions and answers, rated A+ 2022 update. T or F: The vestibular system is sensory only. - ✔✔False. The vestibular system is sensory and motor system. What reflex control... s gaze stabilization? a. vestibular ocular reflex b. vestibular spinal reflex - ✔✔a. vestibular ocular reflex What reflex controls postural control? a. vestibular ocular reflex b. vestibular spinal reflex - ✔✔b. vestibular spinal reflex Reflex that allows you to focus on what your looking at while your head is moving (vision is not blurred). a. vestibular ocular reflex b. vestibular spinal reflex - ✔✔a. vestibular ocular reflex -provides sensory input regarding position and motion of the head -role in controlling position of the body's COM -role in stabilizing and orienting the head with respect to gravity/vertical a. vestibular ocular reflex b. vestibular spinal reflex - ✔✔b. vestibular spinal reflex ____ ear infections are common and can occasionally get into the inner ear/vestibular system leading to a hypofunction. a. external b. middle c. internal - ✔✔b. middle ____ semicircular canals on each side. a. 1 b. 2 c. 3 - ✔✔c. 3 Anterior and posterior semicircular canals connect to the utricle via an opening called ______. a. ordinary crus b. common crus c. middle crus - ✔✔b. common crus ____ is significant for the treatment of BPPV and removal of the otoconia. - ✔✔common crus The opening b/w utricle and posterior canal is gravity _____. a. eliminated b. assisted c. dependent - ✔✔c. dependent When otoconia break away from the macula, they drop down into ____ canal most often. a. anterior b. posterior c. horizontal - ✔✔b. posterior The semicircular movements are most sensitive to ___ movements. a. fast b. slow - ✔✔a. fast Canals are oriented ___ degrees to each other. a. 25 b. 45 c. 60 d. 90 - ✔✔d. 90 The horizontal canal is tilted up ____ degrees from the transverse plane. a. 0 b. 30 c. 60 d. 90 - ✔✔b. 30 The anterior and posterior canals are oriented vertically at ___ degree angle to the midline. a. 0 b. 45 c. 60 d. 90 - ✔✔b. 45 Hair cells are located in each _____. a. ampulla b. semicircular canals c. middle ear - ✔✔a. ampulla What all does the ampulla house? - ✔✔-crista -cupula -hair cells Swelling off of each semicircular canal. a. ampulla b. cupula - ✔✔a. ampulla Gelatinous mass, hair cells, and hairs are embedded in the cupula and bend with head rotation. a. ampulla b. cupula - ✔✔b. cupula For motion detection which information from is sent off to the brain; sends messages to the brain via CN VIII. a. motor hair cells b. sensory hair cells - ✔✔b. sensory hair cells Short hairs. a. stereocilia b. kinocilia - ✔✔a. sterociliar Tall hairs. a. stereocilia b. kinocilia - ✔✔b. kinocilia Bending towards the kinocilia leads to ____ of CN VIII. a. excitation b. inhibition - ✔✔a. excitation Bending away from kinocilia leads to _____ of CN VIII. a. excitation b. inhibition - ✔✔b. inhibition The bony labryinth is filled with ____. a. perilymph b. endolymph - ✔✔a. perilymph The membranous labryinth is filled with _____. a. perilymph b. endolymph - ✔✔b. endolymph What is the resting (tonic) firing rate? a. 40 pulses/sec b. 60 pulses/sec c. 80 pulses/sec d. 100 pulses/sec - ✔✔c. 80 pulses/sec When the head rotates to the right, ___ horizontal canal increases firing, ____ horizontal canal decreases firing. a. R, L b. L, R - ✔✔a. R, L Endolymph flow moves in the ____ direction to the head rotation. a. same b. opposite - ✔✔b. opposite What 2 parts are the otolith made of? - ✔✔saccule and utricle Which hair cell is responsive to vertical linear acceleration? a. saccule b. utricle - ✔✔a. saccule Which hair cell is responsive to horizontal acceleration? a. saccule b. utricle - ✔✔b. utricle What is the sensory receptor of the otolith? - ✔✔macula Calcium carbonate crystals (Gravity sensitive); small heavy sand like crystals - ✔✔Otoconia Most vestibular nuclei are at the level of the _____. a. pons b. medulla - ✔✔a. pons some extend inferior into the medulla Superior and medial nuclei are involved in... a. vestibular ocular reflex (Gaze stability) b. vestibular spinal reflex (postural control) c. reticular formation (vegetative) - ✔✔a. vestibular ocular reflex Lateral and medial nuclei are involved in... a. vestibular ocular reflex (Gaze stability) b. vestibular spinal reflex (postural control) c. reticular formation (vegetative) - ✔✔b. vestibular spinal reflex Inferior nuclei are involved in... a. vestibular ocular reflex (Gaze stability) b. vestibular spinal reflex (postural control) c. reticular formation (vegetative) - ✔✔c. reticular formation Adjusts and maintains the gain of the VOR (1:1 - equal and opposite direction). - ✔✔cerebellum (flocculonodular lobe) Cancels the VOR (Eyes and head move in SAME direction; turn to look at the person beside you) - ✔✔cerebellum (flocculondoular lobe) Peripheral lesions promote ___ compensatory recovery when there is a peripheral change. a. central b. peripheral - ✔✔a. central Output for VOR for gaze stability (pick all that apply) a. ocular motor nuclei (CN 3, 4, and 6) b. medial and lateral vestibulospinal tracts, reticulospinal tracts c. postural reactions/postural tone - ✔✔a. ocular motor nuclei (CN 3, 4, and 6) Output for VSR a. ocular motor nuclei (CN 3, 4, and 6) b. medial and lateral vestibulospinal tracts, reticulospinal tracts c. postural reactions/postural tone - ✔✔b and c Head movement on the left causes an equal and ___ eye movement to the ____. a. opposite; right b. same; left - ✔✔a. opposite; right Discuss what motor nuclei are active due to the horizontal canal (Example: turn head to right). - ✔✔(+) R ipsilateral medial rectus (-) R ipsilateral lateral rectus (+) contralateral (left) lateral rectus (-) contralateral (left) medial rectus Discuss what motor nuclei are active due to the posterior canal (example: tip head back and to the right) - ✔✔(+) R ipsilateral superior oblique (-) R ipsilateral inferior oblique (+) contralateral (left) inferior rectus (-) contralateral (left) superior rectus Discuss what motor nuclei are active due to the anterior canal (example: tip forward and to the left) - ✔✔(+) ipsilateral superior rectus (-) ipsilateral inferior rectus (+ contralateral inferior oblique (_) contralateral . superior oblique What is the MOST common cause of vertigo and nystagmus? a. labyrinthitis b. neuronitis c. acoustic neuroma d. BPPV - ✔✔d. BPPV Which canal is affected when there is an upward torsional beating to the affected side? a. posterior canal b. anterior canal - ✔✔a. posterior canal 80% of BPPV is from what canal? a. posterior b. anterior - ✔✔a. posterior Which canal has a downward torsional beat? a. posterior b. anterior - ✔✔b. anterior Which is the rarest canal to be affected from BPPV? a. posterior b. anterior c. horizontal - ✔✔b. anterior Which canal does not have a torsional aspect during BPPV? a. posterior b. anterior c. horizontal - ✔✔c. horizontal Ageotropic a. cupulolithiasis b. canalithiasis - ✔✔a. cupulolithiasis Geotropic a. cupulolithiasis b. canalithiasis - ✔✔b. canalithiasis ____ canal BPPV usually has a longer duration of symptoms and the patient is more sick. a. anterior b. posterior c. horizontal - ✔✔c. horizontal Free floating otoconia. a. canalithiasis b. cupulolithiasis - ✔✔a. canalithiasis Otoconia stuck onto the cupula. a. canalithiasis b. cupulolithiasis - ✔✔b. cupulolithiasis <60 seconds with short delay in onset (up to 10 seconds) a. canalithiasis b. cupulolithiasis - ✔✔a. canalithiasis >60 seconds with immediate onset of nystagmus. a. canalithiasis b. cupulolithiasis - ✔✔b. cupulolithiasis In BPPV, the vertigo ____ even if provoking position is maintained. a. remains b. goes away - ✔✔b. goes away T/F: In BPPV, there are complaints of aura fullness, hearing loss, or tinnutus. - ✔✔False. T/F: You may see imbalance and gait ataxia in BPPV. - ✔✔True T/F: BPPV is self limiting. - ✔✔True. Resolves spontaneously in 6-12 months. BPPV has ____% effectiveness with positional manuever in one session. a. 50-60% b. 60-70% c. 70-80% d. 80-90% - ✔✔d. 80-90% What is the second most common cause of vertigo? a. BPPV b. neuronitis/labryinthitis c. acoustic neuroma - ✔✔b. neuronitis/labyrinthitis T/F: Acoustic neuroma is the most common cause of hypofunction. - ✔✔False. Infection is. T/F: In acute vestibular crisis (i.e. infection), spontaneous nystagmus is present. - ✔✔True. It may last days. What will not be present with neuronitis/labryinthitis? a. nystagmus b. difficulty with balance c. hearing impairments - ✔✔c. hearing impainrments What drug is given during acute vestibular crisis but must be stopped off for the central system to compensate? - ✔✔antivert Benign tumor in the internal auditory canal. - ✔✔acoustic neuroma What is the first symptom of the acoustic neuroma? - ✔✔impaired hearing What condition occurs secondary to meningitis, sequential vestibular neuronitis, and oxotoxic drugs? a. acoustic neuroma b. labyrinthitis c. bilateral vestibular hypofunction - ✔✔c. bilateral vestibular hypofunction Antibiotics in the ____ family can affect the hair cells in the otoconia. - ✔✔myosin family T/F: If loss in bilateral vestibular hypofunction is symmetrical, there will be no vertigo or spontaneous nystagmus. - ✔✔True List the symptoms of bilateral vestibular hypofunction. - ✔✔-if loss is symmetrical, there will be no vertigo or spontaneous nystagmus -oscillopsia -ataxic gait and impaired balance -fluctuating hearing loss -fluctuating tinnitus -fluctuating vertigo (30 min to 24 hours) -imbalance, fullness of the ear - ✔✔Meniere's Disease T/F: Meniere's disease is curable. - ✔✔False, it is a progressive disease that will result in deafness. What are some steps to reducing the effects of meniere's disease? - ✔✔-restricting sodium intake -avoidance of alcohol and caffeine -nicotine T/F: Physical therapy is helpful for Meniere's disease. - ✔✔False. It's not helpful because it is fluctuating. What condition is caused by barotrauma, middle ear tumor, or head trauma? - ✔✔Perilymphatic fistula What are the symptoms of perilymphatic fistula? - ✔✔-hearing loss -positional vertigo -oscillopsia -skew deviation What conditions can you suspect if the patient complains of hearing loss? Select all that apply. a. perilymphatic fistula c. BPPV d. Meniere's - ✔✔a. perilymphatic fistula d. Meniere's T/F: Oscillopsia is more common with peripheral vestibular problems. - ✔✔False. More common with central vestibular problems. Which vestibular disorder is described by the following attributes: -severe N/V -mild imbalance -common hearing loss -mild oscillopsia -rare neuro symptoms -rapid compensation a. peripheral b. central - ✔✔a. peripheral Which vestibular disorder is described by the following attributes: -moderate N/V -severe imbalance -rare hearing loss -severe oscillopsia -common neuro symptoms -slow compensation a. peripheral b. central - ✔✔b. central Which vestibular disorder involves semicircular canals, CN 8, or the otolith and respond quickly and well to PT? a. peripheral b. central - ✔✔a. peripheral Which vestibular disorder involves vestibular nuclei or cerebellum and has slow compensation and minimal effects of PT? a. peripheral b. central - ✔✔b. central Little electrodes are placed on the eye and record eye movements and measure motor activity of the ocular muscles and the speed of the nystagmus. - ✔✔Electronystagmography Insertion of cold or warm air into each air. - ✔✔Calorics Cold is ____, thus fast-phased nystagmus beats away from stimulated ear. a. inhibitory b. facilitatory - ✔✔a. inhibitory Warm air is ____, thus fast-phased nystagmus beats toward the stimulated ear. a. inhibitory b. facilitatory - ✔✔b. facilitatory If hypofunction is present, you will have _____ response to the stimulated ear in calorics. a. increased. b. decreased. - ✔✔b. decreased T/F: Hypofunction conditions have hearing loss. - ✔✔False. What does the rotary chair do? - ✔✔-measures VOR during sinusoidal or step rotations of the chair -more specific than caloric test Rotary chair may be inaccurate if what has occurred? - ✔✔Central compensation What are the indications for the rotary chair test? - ✔✔-when vestibular hypofunction is suspected but caloric testing not definitive -assists in determining if patient has had a central compensation from a hypofunction T/F: Sensory organization test cannot differentiate between peripheral or central problems. - ✔✔True Upon viewing ocular alignment, if CN 6 palsy is there, the eye will deviate ____. a. upward b. downward c. inward d. outward - ✔✔c. inward -fatigues -acutely will see spontaneous nystagmus in room light (quickly suppressed with visual fixation) -often delay with positional vertigo a. peripheral nystagmus b. central nystagmus - ✔✔a. peripheral nystagmus -persists -will be spontaneous even in room light -changes direction with gaze changes -often vertical or "pure" rotational or "pure" horizontal (not combined with any torsion) -will be immediate onset with positional vertigo a. peripheral nystagmus b. central nystagmus - ✔✔b. central nystagmus Most common diagnostic test for BPPV of posterior and anterior canal or cupula. - ✔✔Hallpike-Dix Maneuver Diagnostic test for horizontal canal BPPV. - ✔✔Supine roll test T/F: Epley Manuever is successful in treating anterior canal BPPV. - ✔✔False. We should refer out for anterior. What condition is Epley Maneuver indicated to treat? a. posterior canalithisasis b. anterior canalithiasis c. posterior cupulolithiasis d. anterior cupulolithiasis - ✔✔a. posterior canalithiasis What condition is the Liberatory Maneuver indicated for? a. posterior canalithisasis b. anterior canalithiasis c. posterior cupulolithiasis d. anterior cupulolithiasis - ✔✔c. posterior cupulolithiasis d. anterior cupulolithiasis If you are treating a RIGHT posterior cupulolithiasis, describe how you would perform the Liberatory manuever. - ✔✔Turn head away from affected side (to the left) 45 degrees. Move to affected side (right) nose up (right SL). Hold for 5 minutes on each SL position don't stop in sitting. In one quick maneuver patient will go from R SL to L SL. wait another 5 minutes then go into short sitting. When are Brandt-Daroff Habituation exercises typically used? - ✔✔stubborn cases of BPPV or HEP What is the 2nd most common cause of vertigo? a. BPPV b. unilateral hypofunction c. bilateral hypofunction - ✔✔b. unilateral hypofunction How does an individual recovery from unilateral hypofunction? - ✔✔Adaptation via vestibular system. -spontaneous reestablishment of the tonic-firing rate -exercise can facilitate faster recovery -habituation Which oculomotor exercise involves the head moving and target being stationary? a. x1 b. x2 - ✔✔a. x1 Which oculomotor exercise involves the head and target moving in opposite directions? a. x1 b. x2 - ✔✔b. x2 What does the treatment for the complete loss of vestibular function look like? - ✔✔-substitution (increase patient's reliance on somatosensation and vision) -slow head movements What is used to replace the VOR in individuals with complete loss of vestibular function? - ✔✔cervical spine proprioception (cervical ocular reflex) Which of the following vestibular disorders is NOT considered a hypofunction? a. neuronitis b. BPPV c. acoustic neuroma d. labyrinthitis - ✔✔b. BPPV T/F: In peripheral vestibular disorders, neurological symptoms are common. - ✔✔false Which of the following disorders is characterized by fluctuating hearing loss, tinnitus, and vertigo lasting 30 minutes to 24 hours. a. meniere's disease b. concussion c. bilateral vestibular hypofunction d. perilymphatic fistula - ✔✔a. meniere's disease Which of the following is true of peripheral nystagmus? a. often pure vertical b. fatigues c. changes direction with gaze changes d. unable to be suppressed - ✔✔b. fatigues Which of the following works to maintain head and body posture? a. VOR b. VSR c. CN VIII d. push-pull relationship - ✔✔b. VSR A (+) head thrust (head impulse test) is indicative of? a. BPPV cupulolithiasis b. central involvement c. BPPV canalithiasis d. hypofunction - ✔✔d. hypofunction Which of the following interventions is indicated for cupulolithiasis? a. liberatory maneuver b. gaze stabilization exercise c. habituation exercises d. canal repositioning maneuver - ✔✔a. liberatory maneuver The Hallpike-Dix maneuver is used to assess: a. posterior canal b. anterior canal c. posterior cupula d. anterior cupula e. all of the above - ✔✔e. all of the above The vestibular system is only a sensory system. a. true b. false - ✔✔b. false Which structure is made up of the utricle and saccule? a. crista b. ampulla c. macula d. otolith - ✔✔d. otolith What are the 3 components of the HINTS exam? - ✔✔-nystagmus -head impulse -test of skew (Vertical) What is used to diagnose vestibular neuritis vs stroke in patients with hours or days of ongoing vertigo and nystagmus? - ✔✔HINTS exam The head impulse test will be (normal/abnormal) if you have vestibular neuritis. - ✔✔Abnormal. If you have acute vertigo and nystagmus with NORMAL head impulse, it indicates something is wrong with the brain. What percentage of people with concussion will spontaneously recover on their own? a. 50-60% b. 60-70% c. 80-90% d. 90-100% - ✔✔c. 80-90% The adult window of concussion recovery is ____. a. 5-7 days b. 7-10 days c. 10-12 days d. 3 weeks - ✔✔b. 7-10 days The youth window of concussion recovery is ____. a. 5-7 days b. 7-10 days c. 10-12 days d. 3 weeks - ✔✔d. 3 weeks > 10 days of persistent symptoms (Adults) > 3 weeks of persistent symptoms (high school atheletes/youth) - ✔✔Post concussion syndrome. Persistent symptoms are reported in ___% of concussions. a. 5-10% b. 10-15% c. 15-20% d. 20-25% - ✔✔b. 10-15% PCS is diagnosed when a patient develops at least 3 of 8 symptoms within 4 weeks. List the 8 symptoms. - ✔✔-headaches -dizziness -fatigue -irritability -impaired sleep -impaired concentration -impaired memory -impaired tolerance for stress, emotional situations, or alcohol use T/F: PCS symptoms are predominantly psychological, whereas acute concussion has more physical symptoms. - ✔✔True T/F: an individual who experiences a concussion with a LOC lasting > 1 min does not need to seek medical consultation. - ✔✔False T/F: Initial s/s of dizziness and fogginess predict prolonged recovery. - ✔✔True Which of the following does not predict longer recovery from concussion: a. h/o migraines (personal or family) b. h/o prior concussion c. h/o learning disorders d. h/o visual impairment e. sport/workplace/recreation risks and cognitive demands f. all of the above predict longer recovery from concussion - ✔✔f. all of the above predict longer recovery from concussion According to the Rivermead Post-Concussion Symptoms Questionnaire, ____ on the field is the number 1 predictor of protracted recovery. a. lightheadedness b. headaches c. dizziness d. strabismus - ✔✔c. dizziness What is the most common systems reporting questionnaire? a. rivermead post concussion symptoms b. post concussion symptom scale c. graded symptom checklist d. British Columbia Post-Concussion Symptom Inventory - ✔✔a. Rivermead Post Concussion Symptoms Which system reporting questionnaire is military specific? a. Post Concussion symptom scale b. graded symptom checklist c. Rivemread post concussion symptoms d. Neurobehavior Symptom Inventory - ✔✔d. Neurobehavioral Symptom Inventory If a patient describes their dizziness as the room spinning/swaying, what is the issue? a. vestibular overlay b. cervicogenic dizziness c. ocular d. motion sensitivity e. syncope - ✔✔a. vestibular overlay If a patient describes their dizziness as a floating sensation, what is the issue? a. vestibular overlay b. cervicogenic dizziness c. ocular d. motion sensitivity e. syncope - ✔✔b. cervicogenic dizziness Vestibular overlay is associated with: a. BPPV, hypofunction, perilymphatic fistula b. whiplash - ✔✔a. BPPV, hypofunction, perilymphatic fistula Cervicogenic dizziness is associated with: a. BPPV, hypofunction, perilymphatic fistula b. whiplash - ✔✔b. whiplasth If a patient describes their dizziness as blurred/double vision, what is the issue? a. vestibular overlay b. cervicogenic dizziness c. ocular [Show More]

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