Vestibular NCS Exam Questions with
Correct Answers
Cilia- what is i? where is it? what does it do? - ANSWER-Embedded in the
membrane called the cupula, they help detect angular acceleration/deceleration
Cupula - ANSWER-a gelatinous mass found in the ampulla of the semicircular
canals; moves in response to the flow of the fluid in the canals, the cilia are
embedded in this
Kinocilium - ANSWER-The tallest hair cell
Moving towards the kinocilium - ANSWER-Excitatory
Moving away from the kinocilium - ANSWER-Inhibitory
Otolith organs
What are they?
What do they detect?
What plane do they sit in? - ANSWER-Utricle and Saccule
Detect linear acceleration/deceleration
Otoliths ARE gravity sensitive (SCCs are NOT gravity sensitive)
Utricle sits in the horizontal plane (can detect a car accelerating quickly)
Saccule sits in the vertical plane (can detect elevator motion going up and down)
Hair cells in the Otolith Organs
Where are they?
What is on top of them?
What does this help detect? - ANSWER-Embedded in the Otolithic Membrane
Overlying this membrane are the Otoconia
Otoliths sense where the head is in space (tilt in relation to upright and gravity)
Dark Cells - ANSWER-Maintain homeostasis within the endolymph
Potassium and Calcium homeostasis
Might help degrade loose otoconia - can help with resolution of BPPV
Meneire's Disease has a reduction of Dark Cells - this is likely why BPPV is more
common in this population
,Labyrinthitis - also a loss of Dark Cells - BPPV is also more common in this
population
Nystagmus - what is it named by? - ANSWER-The direction of the FAST movement
of the eyes
The fast phase beats towards the more intact/active side, slow phase beats towards
the impaired or hypoactive side
Postural control
Control by Vestibular Mechanisms vs
Control by Somatosensory Cues - ANSWER-Vestibular mechanism control neck,
trunk and hip muscles to stabilize the head. Vestibular mechanisms control more
proximal things. So Vestibular does more hip strategies
Somatosensory cues are more responsible for activation of distal muscles.
Somatosensory does more ankle strategies
Meds for Vestibular Issues
Types?
Categories?
Purpose?
Names?
When are they indicated? - ANSWER-Benzodiazepines:
Diazepam- Valium
Lorazepam- Ativan
Indicated for acute or severe vertigo
Antihistamines:
Meclizine- Antivert
Indicated for chronic vertigo
Antiemetics:
Zofran
Scopolamine
Indicated to reduce emesis
Acute Unilateral Peripheral Vestibulopathy-
Signs and symptoms?
Onset?
How long does it last?
How and why does it go away?
Medication indication?
What speeds up recovery?
Prognosis? - ANSWER-Spontaneous onset
Continuous vertigo
, Vertigo lasts 1 day to 1 week, NOT longer than 1 week
Nausea, emesis, oscillopsia, nystagmus, imbalance, lateropulsion, all worse with
head movements
Residual symptoms after acute symptoms pass- head motion induced imbalance
and oscillopsia
CNS compensates for unilateral dysfunction by inhibiting the healthy side to balance
it out bilaterally. So this is why the acute symptoms pass. Chronic symptoms are
from residual hypofunction that CNS is compensating for
Prolonged use of sedatives can prolong recovery
Vestibular adaptation exercises appear to speed up recovery
Excellent prognosis for vestibular compensation with good recovery predicted
Vestibular Neuritis-
What is it?
What is it caused by? Preceded by?
Recurrence?
What structures are involved?
Treatments? - ANSWER-Most common cause of acute unilateral vestibular loss
Most often caused by Herpes Simplex Virus (HSV-1)
Preceded by upper respiratory or GI infection
Recurrence is NOT common, usually a 1 time attack with residual symptoms
It is inflammation of the superior vestibular nerve (innervates the anterior canal,
horizontal canal and utricle). So it's a partial vestibular loss
Steroids (Prednisone) can help and might help lead to LESS residual deficits
Antibiotics are not helpful (it's usually viral and not bacterial)
Superior Vestibular Nerve - ANSWER-Innervates anterior canal, horizontal canal,
utricle
Anterior Vestibular Artery Ischemia-
What is it?
What blood supply supplies the vestibular system?
How does this present?
Comorbidities?
Treatments?
Prognosis? - ANSWER-Occlusion of the anterior vestibular artery
Correct Answers
Cilia- what is i? where is it? what does it do? - ANSWER-Embedded in the
membrane called the cupula, they help detect angular acceleration/deceleration
Cupula - ANSWER-a gelatinous mass found in the ampulla of the semicircular
canals; moves in response to the flow of the fluid in the canals, the cilia are
embedded in this
Kinocilium - ANSWER-The tallest hair cell
Moving towards the kinocilium - ANSWER-Excitatory
Moving away from the kinocilium - ANSWER-Inhibitory
Otolith organs
What are they?
What do they detect?
What plane do they sit in? - ANSWER-Utricle and Saccule
Detect linear acceleration/deceleration
Otoliths ARE gravity sensitive (SCCs are NOT gravity sensitive)
Utricle sits in the horizontal plane (can detect a car accelerating quickly)
Saccule sits in the vertical plane (can detect elevator motion going up and down)
Hair cells in the Otolith Organs
Where are they?
What is on top of them?
What does this help detect? - ANSWER-Embedded in the Otolithic Membrane
Overlying this membrane are the Otoconia
Otoliths sense where the head is in space (tilt in relation to upright and gravity)
Dark Cells - ANSWER-Maintain homeostasis within the endolymph
Potassium and Calcium homeostasis
Might help degrade loose otoconia - can help with resolution of BPPV
Meneire's Disease has a reduction of Dark Cells - this is likely why BPPV is more
common in this population
,Labyrinthitis - also a loss of Dark Cells - BPPV is also more common in this
population
Nystagmus - what is it named by? - ANSWER-The direction of the FAST movement
of the eyes
The fast phase beats towards the more intact/active side, slow phase beats towards
the impaired or hypoactive side
Postural control
Control by Vestibular Mechanisms vs
Control by Somatosensory Cues - ANSWER-Vestibular mechanism control neck,
trunk and hip muscles to stabilize the head. Vestibular mechanisms control more
proximal things. So Vestibular does more hip strategies
Somatosensory cues are more responsible for activation of distal muscles.
Somatosensory does more ankle strategies
Meds for Vestibular Issues
Types?
Categories?
Purpose?
Names?
When are they indicated? - ANSWER-Benzodiazepines:
Diazepam- Valium
Lorazepam- Ativan
Indicated for acute or severe vertigo
Antihistamines:
Meclizine- Antivert
Indicated for chronic vertigo
Antiemetics:
Zofran
Scopolamine
Indicated to reduce emesis
Acute Unilateral Peripheral Vestibulopathy-
Signs and symptoms?
Onset?
How long does it last?
How and why does it go away?
Medication indication?
What speeds up recovery?
Prognosis? - ANSWER-Spontaneous onset
Continuous vertigo
, Vertigo lasts 1 day to 1 week, NOT longer than 1 week
Nausea, emesis, oscillopsia, nystagmus, imbalance, lateropulsion, all worse with
head movements
Residual symptoms after acute symptoms pass- head motion induced imbalance
and oscillopsia
CNS compensates for unilateral dysfunction by inhibiting the healthy side to balance
it out bilaterally. So this is why the acute symptoms pass. Chronic symptoms are
from residual hypofunction that CNS is compensating for
Prolonged use of sedatives can prolong recovery
Vestibular adaptation exercises appear to speed up recovery
Excellent prognosis for vestibular compensation with good recovery predicted
Vestibular Neuritis-
What is it?
What is it caused by? Preceded by?
Recurrence?
What structures are involved?
Treatments? - ANSWER-Most common cause of acute unilateral vestibular loss
Most often caused by Herpes Simplex Virus (HSV-1)
Preceded by upper respiratory or GI infection
Recurrence is NOT common, usually a 1 time attack with residual symptoms
It is inflammation of the superior vestibular nerve (innervates the anterior canal,
horizontal canal and utricle). So it's a partial vestibular loss
Steroids (Prednisone) can help and might help lead to LESS residual deficits
Antibiotics are not helpful (it's usually viral and not bacterial)
Superior Vestibular Nerve - ANSWER-Innervates anterior canal, horizontal canal,
utricle
Anterior Vestibular Artery Ischemia-
What is it?
What blood supply supplies the vestibular system?
How does this present?
Comorbidities?
Treatments?
Prognosis? - ANSWER-Occlusion of the anterior vestibular artery
