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A Recipe for Success in the Vestibular Clinic – Clinical Decision Analysis for Vestibular Testing

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1.  Patient symptoms of vertigo triggered with position changes that lasts seconds to minutes would warrant starting with which vestibular measure to determine cause of symptoms? Caloric irrigations Video head impulse testing Dix-Hallpike maneuver Fistula testing

2.  Patient symptoms of unsteadiness when walking or standing, increased symptoms in darkness and on uneven surfaces, oscillopsia, and lack of symptoms when at rest warrant further vestibular testing to rule out which of the following conditions? Unilateral vestibular impairment Bilateral vestibular impairment Third window effect Benign paroxysmal positional vertigo

3.  Which of the following best describes a series negative protocol? If the first test in a protocol is positive no further testing is needed. If the first test in a protocol is positive go on to perform the next test in the series If the first test in a protocol is negative, no further testing is needed. None of the above

4.  Which objective vestibular test evaluates angular vestibulo-ocular reflex function in the 2-5 Hz range? Video head impulse testing Caloric irrigations Rotational chair testing Cervical Vestibular Evoked Myogenic Potentials

5.  Clinical signs of unilateral vestibular impairment include all of the following except: Caloric unilateral weakness>25% Direction fixed horizontal and torsional nystagmus enhanced with fixation removed Vestibular dysfunction pattern on postural control testing Reduced rotational chair VOR gain across all test frequencies.