NM ES-3 EXAM 2026 EXAM SCRIPT
COMPLETE QUESTIONS AND SOLUTIONS
◉ A patient reports that the room begins to spin a few seconds after
she turns to her left side in bed. You perform a left Dix Hallpike and
find downbeating nystagmus that only lasts for a couple of seconds.
This is most indicative of:
a. right posterior cupulolithiasis
b. left anterior canalithiasis
c. right anterior canalithiasis
d. right posterior canalithiasis. Answer: b. left anterior canalithiasis
◉ You are performing a right Dix Hallpike. After some delay your
patient's symptoms arise and you notice upbeating nystagmus. The
patient's symptoms subside after 30 seconds. This is most indicative
of:
a. right posterior canalithiasis
b. left posterior canalithiasis
c. right anterior canalithiasis
d. right posterior cupulolithiaisis. Answer: a. right posterior
canalithiasis
,◉ you perform the dix hallpike test and notice your patient has
UPBEATING nystagmus towards the L. Symptoms last less than 1
minute and it has a delayed onset. What is your diagnosis?
a. right posterior canalithiasis
b. left posterior canalithiasis
c. right anterior canalithiasis
d. right posterior cupulolithiaisis. Answer: b. left posterior
canalithiasis
◉ you perform the dix hallpike test and notice your patient has
UPBEATING nystagmus towards the R. Symptoms last greater than 1
minute and there is an immediate onset. What is your diagnosis?
a. right posterior canalithiasis
b. left posterior canalithiasis
c. right anterior canalithiasis
d. right posterior cupulolithiaisis. Answer: d. right posterior
cupulolithiaisis
◉ A positive head impulse test when turning the head to the left is
most indicative of:
,a. left-sided hypofunction
b. right-sided hypofunction
c. left horizontal canalithiasis
d. right horizontal canalithiasis. Answer: a. left-sided hypofunction
◉ You are performing the left Dix Hallpike maneuver on a 62 yo. She
complains of immediate onset vertigo and her symptoms last longer
than a minute. During the maneuver you see downbeating, which of
the following interventions would be most appropriate?
a. Liberatory maneuver (Semont), head turned right bringing her
into left sidelying first
b. Liberatory maneuver (Semont), head turned left bringing her into
left sidelying first
c. Liberatory maneuver (Semont), head turned right bringing her
into right sidelying first
d. Liberatory maneuver (Semont), head turned left bringing her into
right sidelying first. Answer: c. Liberatory maneuver (Semont), head
turned right bringing her into right sidelying first
, for L Anterior Cupulolithiasis you would
perform Rotation of head 45º towards unaffected side (R) w/
sidelying on unaffected side (R) ((nose down)) then move into
affected side sidelying (L) ((nose up))
◉ You are performing the right Dix Hallpike maneuver on a 55 yo
male. He complains of delayed onset vertigo with symptoms lasting
less than a minute. During the maneuver you notice downbeating
nystagmus. Which of the following is most likely the cause?
a. left anterior canalithiasis
b. left anterior cupulolithiasis
c. right anterior canalithiasis
d.. right posterior cupulolithiasis. Answer: c. right anterior
canalithiasis
◉ During a dix hallpike test, the eyes will beat towards the ____ side
a. unaffected
b. affected
c. unaffected and affected. Answer: b. affected
rotation/torsion toward affected side
COMPLETE QUESTIONS AND SOLUTIONS
◉ A patient reports that the room begins to spin a few seconds after
she turns to her left side in bed. You perform a left Dix Hallpike and
find downbeating nystagmus that only lasts for a couple of seconds.
This is most indicative of:
a. right posterior cupulolithiasis
b. left anterior canalithiasis
c. right anterior canalithiasis
d. right posterior canalithiasis. Answer: b. left anterior canalithiasis
◉ You are performing a right Dix Hallpike. After some delay your
patient's symptoms arise and you notice upbeating nystagmus. The
patient's symptoms subside after 30 seconds. This is most indicative
of:
a. right posterior canalithiasis
b. left posterior canalithiasis
c. right anterior canalithiasis
d. right posterior cupulolithiaisis. Answer: a. right posterior
canalithiasis
,◉ you perform the dix hallpike test and notice your patient has
UPBEATING nystagmus towards the L. Symptoms last less than 1
minute and it has a delayed onset. What is your diagnosis?
a. right posterior canalithiasis
b. left posterior canalithiasis
c. right anterior canalithiasis
d. right posterior cupulolithiaisis. Answer: b. left posterior
canalithiasis
◉ you perform the dix hallpike test and notice your patient has
UPBEATING nystagmus towards the R. Symptoms last greater than 1
minute and there is an immediate onset. What is your diagnosis?
a. right posterior canalithiasis
b. left posterior canalithiasis
c. right anterior canalithiasis
d. right posterior cupulolithiaisis. Answer: d. right posterior
cupulolithiaisis
◉ A positive head impulse test when turning the head to the left is
most indicative of:
,a. left-sided hypofunction
b. right-sided hypofunction
c. left horizontal canalithiasis
d. right horizontal canalithiasis. Answer: a. left-sided hypofunction
◉ You are performing the left Dix Hallpike maneuver on a 62 yo. She
complains of immediate onset vertigo and her symptoms last longer
than a minute. During the maneuver you see downbeating, which of
the following interventions would be most appropriate?
a. Liberatory maneuver (Semont), head turned right bringing her
into left sidelying first
b. Liberatory maneuver (Semont), head turned left bringing her into
left sidelying first
c. Liberatory maneuver (Semont), head turned right bringing her
into right sidelying first
d. Liberatory maneuver (Semont), head turned left bringing her into
right sidelying first. Answer: c. Liberatory maneuver (Semont), head
turned right bringing her into right sidelying first
, for L Anterior Cupulolithiasis you would
perform Rotation of head 45º towards unaffected side (R) w/
sidelying on unaffected side (R) ((nose down)) then move into
affected side sidelying (L) ((nose up))
◉ You are performing the right Dix Hallpike maneuver on a 55 yo
male. He complains of delayed onset vertigo with symptoms lasting
less than a minute. During the maneuver you notice downbeating
nystagmus. Which of the following is most likely the cause?
a. left anterior canalithiasis
b. left anterior cupulolithiasis
c. right anterior canalithiasis
d.. right posterior cupulolithiasis. Answer: c. right anterior
canalithiasis
◉ During a dix hallpike test, the eyes will beat towards the ____ side
a. unaffected
b. affected
c. unaffected and affected. Answer: b. affected
rotation/torsion toward affected side
