Vertigo and Balance — Advanced (VEMP, Videonystagmography, Central vs Peripheral) MCQs

ENT · 45 free questions with answers & explanations.

1. A 40-year-old patient undergoes vestibular evoked myogenic potential (VEMP) testing. Cervical VEMP (cVEMP) tests which structure's function, and what is the stimulus used?
2. On videonystagmography (VNG), a patient demonstrates direction-changing nystagmus that increases in amplitude with gaze in that direction. This pattern is consistent with which type of nystagmus?
3. Superior semicircular canal dehiscence (SSCD) presents with which of the following characteristic symptom combination?
4. Video head impulse test (vHIT) is abnormal with catch-up saccades noted for horizontal head impulses to the RIGHT. Which structure is most likely dysfunctional?
5. The Epley canalith repositioning maneuver for posterior canal BPPV sequentially moves the patient through which positions to reposition otoconia from the posterior canal into the utricle?
6. Cervical vestibular evoked myogenic potential (cVEMP) tests the integrity of which vestibular end organ and neural pathway?
7. During videonystagmography (VNG) caloric testing, a 'directional preponderance' to the right (using Jongkees formula) indicates:
8. A 38-year-old woman presents with episodic vertigo lasting 20 minutes, triggered by loud sounds (Tullio phenomenon) and straining (Valsalva). She also reports autophony (hearing her own heartbeat). CT temporal bone shows thinning/absence of bone over the superior semicircular canal. The diagnosis is:
9. A patient with suspected otolith dysfunction undergoes cervical vestibular evoked myogenic potential (cVEMP) testing. cVEMP assesses the integrity of which end organ and nerve pathway?
10. On videonystagmography (VNG) caloric testing, a patient shows 70% canal paresis on the right side with 30% directional preponderance to the left. This pattern most suggests:
11. A patient presents with episodic vertigo lasting 20–30 minutes, ipsilateral ear fullness, and low-frequency SNHL fluctuating in severity. Pure-tone audiogram shows a rising configuration (better high-frequency hearing). The most specific electrophysiological test to confirm endolymphatic hydrops in this condition is:
12. A patient presents with acute severe vertigo, vomiting, inability to walk, and nystagmus that does NOT suppress with visual fixation. Direction of nystagmus changes on gaze direction (gaze-evoked nystagmus). The HEAD IMPULSE TEST is normal (no corrective saccade). This presentation most strongly suggests:
13. Cervical VEMP (cVEMP) is performed in a patient suspected of superior canal dehiscence syndrome (SCDS). What response pattern is expected in SCDS compared to normal?
14. A 40-year-old patient with sudden onset severe vertigo, horizontal nystagmus beating to the right, and inability to walk is evaluated. Video head impulse test (vHIT) shows normal VOR gain bilaterally. Which of the following diagnoses is most consistent with these findings?
15. On videonystagmography (VNG) caloric testing, a patient shows 40% reduced caloric response on the right side compared to the left. This finding is termed canal paresis (CP). At what percentage of asymmetry is this considered clinically significant using Jongkee's formula?
16. A patient presents with episodic vertigo lasting seconds, triggered by lying down and rolling to the right. Dix-Hallpike test on the right produces upbeat-torsional geotropic nystagmus with a latency of 5 seconds that fatigues after 30 seconds. The canal most likely involved and the mechanism are:
17. Cervical VEMP (cVEMP) tests the integrity of the saccule and which nerve pathway?
18. On videonystagmography (VNG), a patient with acute vertigo shows spontaneous horizontal nystagmus that is suppressed by visual fixation, beats away from the affected ear, and is direction-fixed. These features indicate:
19. A 68-year-old presents with episodic vertigo triggered by head position changes. Dix-Hallpike test shows a latency of 2–3 seconds before onset of upbeat-torsional nystagmus beating toward the lower ear, lasting 15–30 seconds, and fatiguing with repeated testing. This pattern localizes the pathology to:
20. In Meniere's disease, the electrocochleography (EcochG) finding that supports endolymphatic hydrops is:
21. A patient with Meniere's disease undergoes cervical VEMP (cVEMP) testing. In this test, a large P1-N1 amplitude on the affected side compared to the normal side is most consistent with:
22. On videonystagmography (VNG), a patient shows spontaneous nystagmus that increases in darkness, direction-fixed, and normal caloric responses bilaterally. This pattern is most consistent with:
23. The ocular VEMP (oVEMP) test primarily assesses which structure of the peripheral vestibular system?
24. A 40-year-old woman has recurrent episodes of vertigo lasting 30–60 minutes with ipsilateral low-frequency sensorineural hearing loss and aural fullness. Cervical VEMP (cVEMP) shows absent responses on the left side. The most likely diagnosis and significance of the VEMP finding are:
25. On videonystagmography (VNG), a patient with right peripheral vestibular lesion would be expected to show:
26. The Ocular VEMP (oVEMP) tests the function of which vestibular end-organ?
27. A 65-year-old hypertensive male presents with acute onset vertigo, vomiting, inability to stand, dysarthria and diplopia. There is no hearing loss. Nystagmus is direction-changing and not suppressed by fixation. The most likely diagnosis is:
28. Cervical vestibular evoked myogenic potentials (cVEMPs) are recorded from the sternocleidomastoid muscle and assess the integrity of which vestibular end-organ?
29. On videonystagmography (VNG), a patient shows unidirectional horizontal nystagmus that increases with gaze in the direction of fast phase (Alexander's Law) and is inhibited by visual fixation. This pattern suggests:
30. A 55-year-old woman presents with episodic vertigo lasting 20–30 minutes, fluctuating low-frequency sensorineural hearing loss, tinnitus, and aural fullness. The vestibular function test most likely to show enhanced amplitude is:
31. The Dix-Hallpike test is positive with upbeat-torsional nystagmus (upper pole of eye beating toward the ground when the ear is down). This is diagnostic of BPPV involving:
32. Cervical VEMP (cVEMP) tests the integrity of the saccule and inferior vestibular nerve. In a patient with superior semicircular canal dehiscence (SCCD), the expected cVEMP finding is:
33. On video head impulse test (vHIT), a patient shows normal gain but corrective saccades (covert saccades) after rapid head rotation toward the left. This finding indicates:
34. The Dix-Hallpike manoeuvre elicits a geotropic torsional nystagmus with latency of 5 seconds and duration of 15 seconds which fatigues on repeated testing. This is most consistent with:
35. A patient with acute vertigo, ipsilateral hearing loss, and tinnitus has caloric testing showing canal paresis of 45% on the right. The most appropriate initial pharmacological treatment for the acute vertigo is:
36. Cervical Vestibular Evoked Myogenic Potential (cVEMP) assesses the function of which vestibular end organ?
37. A 45-year-old woman presents with episodic vertigo lasting 20–30 minutes, unilateral tinnitus, aural fullness, and fluctuating low-frequency sensorineural hearing loss. Glycerol dehydration test shows >15 dB improvement in thresholds. The pathophysiology involves:
38. On videonystagmography (VNG), a patient shows a direction-changing gaze-evoked nystagmus that reverses with gaze direction and is suppressed with visual fixation. This pattern is most consistent with:
39. A 50-year-old man develops sudden severe vertigo with nausea, unable to stand, with no hearing loss and no neurological deficit. Head impulse test (HIT) shows a corrective saccade when the head is thrust towards the left. The most likely diagnosis is:
40. The Epley canalith repositioning manoeuvre is most effective for which variant of BPPV?
41. Cervical VEMP (cVEMP) tests the integrity of which vestibular structure?
42. A 35-year-old patient has unidirectional horizontal nystagmus increasing on gaze toward the fast phase, direction-changing nystagmus on positional testing, and a positive Fukuda stepping test. These findings are MOST consistent with:
43. Videonystagmography (VNG) caloric test showing a canal paresis (unilateral weakness) of >25% on Jongkees formula indicates:
44. In superior semicircular canal dehiscence (SSCD) syndrome, which combination of findings is PATHOGNOMONIC?
45. The HINTS examination (Head Impulse, Nystagmus, Test of Skew) is used to differentiate acute vestibular neuritis from posterior circulation stroke. Which combination is indicative of a CENTRAL cause?