CVT Patient Safety & Clinical Decision-Making 3

Question 1

Before initiating cervical BPPV maneuvers, which pre-screening test helps identify vertebrobasilar insufficiency risk?

Accepted Answer

Cervical arterial insufficiency screen (Hautant's/VBI testing)

Answer

Cervical arterial insufficiency screening (e.g., Hautant's test or sustained rotation/extension positions) helps identify patients at risk for vertebrobasilar compromise during repositioning maneuvers.

Question 2

A patient on vestibular rehabilitation is also taking meclizine daily. The therapist should anticipate which effect on treatment outcomes?

Accepted Answer

Reduced central nervous system plasticity potentially slowing compensation

Answer

Meclizine is a vestibular suppressant that reduces central compensation mechanisms, potentially slowing the neuroplasticity-dependent recovery process in vestibular rehabilitation.

Question 3

During the modified HINTS exam (Head Impulse, Nystagmus, Test of Skew), which combination is most reassuring for a BENIGN peripheral cause of acute vestibular syndrome?

Accepted Answer

Abnormal head impulse, unidirectional nystagmus, no skew deviation

Answer

In peripheral vestibular neuritis, the head impulse test is abnormal (catch-up saccade), nystagmus is unidirectional and suppressed by fixation, and skew deviation is absent.

Question 4

A therapist notices a patient's Romberg test is significantly worse with foam padding than on firm surface. What does this most likely indicate?

Accepted Answer

Primarily somatosensory system compensation for vestibular loss

Answer

Marked worsening on foam (which reduces somatosensory input) compared to firm surface indicates the patient is relying heavily on somatosensory cues to compensate for vestibular deficits.

Question 5

Which scenario requires IMMEDIATE discontinuation of vestibular exercises and physician notification?

Accepted Answer

New onset of severe headache, vomiting, and ataxia during treatment

Answer

Severe headache, vomiting, and ataxia during treatment are red flags for a posterior fossa event such as cerebellar hemorrhage requiring emergency evaluation.

(CVT) Certified Vestibular Therapist Practice Test

(CVT) Certified Vestibular Therapist Practice Test

CVT Patient Safety & Clinical Decision-Making 3