CVT Patient Safety & Clinical Decision-Making 2 — Questions and Answers
Question 1: A patient with acute unilateral vestibular neuritis reports sudden worsening of vertigo when lying flat. What is the most appropriate immediate action?
- Proceed with canalith repositioning maneuver
- Reassess for central nervous system pathology before continuing treatment (Correct answer)
- Increase vestibular suppression medication dosage
- Begin aggressive gaze stabilization exercises immediately
Correct answer: Reassess for central nervous system pathology before continuing treatment
Sudden worsening of vertigo in a patient with presumed peripheral vestibular disorder warrants reassessment for central pathology such as cerebellar stroke before proceeding.
Question 2: Which fall risk screening tool is most validated for use in vestibular rehabilitation patients?
- Berg Balance Scale
- Timed Up and Go (TUG) test
- Dizziness Handicap Inventory
- Dynamic Gait Index (DGI) (Correct answer)
Correct answer: Dynamic Gait Index (DGI)
The Dynamic Gait Index (DGI) is specifically validated to predict fall risk in individuals with vestibular disorders and assesses gait under varied task demands.
Question 3: A 78-year-old patient with BPPV is taking an anticoagulant and has severe osteoporosis. Which precaution is MOST critical when performing the Epley maneuver?
- Avoid neck rotation beyond 30 degrees
- Monitor blood pressure before and after each position change
- Perform the maneuver with extreme head movement caution to prevent falls (Correct answer)
- Use a hydraulic treatment table to minimize cervical stress
Correct answer: Perform the maneuver with extreme head movement caution to prevent falls
Severe osteoporosis increases fracture risk with falls; supporting the patient carefully through position changes is the primary safety concern during the Epley maneuver.
Question 4: During gaze stabilization exercises, a patient reports sudden onset of diplopia and perioral numbness. What should the clinician do FIRST?
- Stop the exercise and document the symptoms for the next visit
- Reduce the speed of head movements during the exercise
- Discontinue treatment and urgently refer for neurological evaluation (Correct answer)
- Administer vestibular suppressant medication
Correct answer: Discontinue treatment and urgently refer for neurological evaluation
Diplopia and perioral numbness are brainstem warning signs that require immediate discontinuation of treatment and urgent neurological referral.
Question 5: A patient is referred for vestibular rehabilitation after acoustic neuroma surgery. Which outcome measure best captures functional limitations specific to vestibular dysfunction?
- SF-36 Health Survey
- Dizziness Handicap Inventory (DHI) (Correct answer)
- Numeric Pain Rating Scale
- Oswestry Disability Index
Correct answer: Dizziness Handicap Inventory (DHI)
The Dizziness Handicap Inventory (DHI) is specifically designed and validated to measure the functional, emotional, and physical impact of vestibular disorders.
Question 6: Which clinical finding most strongly indicates that a patient's dizziness is of central rather than peripheral origin?
- Nystagmus that suppresses with visual fixation
- Direction-changing nystagmus in the same head position (Correct answer)
- Positive Dix-Hallpike test with 10-second latency
- Unilateral sensorineural hearing loss with tinnitus
Correct answer: Direction-changing nystagmus in the same head position
Direction-changing nystagmus in the same head position is a central sign because peripheral nystagmus is always unidirectional from a given test position.
Question 7: A patient with Meniere's disease reports a drop attack (otolithic crisis of Tumarkin) during a therapy session. What is the PRIORITY action?
- Perform the Semont liberatory maneuver to reposition otoliths
- Ensure patient safety, keep them supine, and contact emergency services if injury occurred (Correct answer)
- Increase the frequency of vestibular exercises to compensate
- Administer oral antihistamine from the clinic's emergency kit
Correct answer: Ensure patient safety, keep them supine, and contact emergency services if injury occurred
Drop attacks are sudden and unpredictable; ensuring the patient is safe, assessing for injury, and activating emergency services if needed is the immediate priority.
CVT Patient Safety & Clinical Decision-Making 2
A patient with acute unilateral vestibular neuritis reports sudden worsening of vertigo when lying flat.
What is the most appropriate immediate action?