Q.1 Which of the following is the most common cause of peripheral vertigo?
Benign paroxysmal positional vertigo (BPPV)
Meniere's disease
Vestibular migraine
Acoustic neuroma
Explanation - BPPV is the most common cause of peripheral vertigo and is caused by displaced otoliths in the semicircular canals.
Correct answer is: Benign paroxysmal positional vertigo (BPPV)
Q.2 Which maneuver is most commonly used to diagnose BPPV of the posterior semicircular canal?
Romberg test
Dix-Hallpike maneuver
Fukuda stepping test
Head impulse test
Explanation - The Dix-Hallpike maneuver is the standard test to elicit vertigo and nystagmus in posterior canal BPPV.
Correct answer is: Dix-Hallpike maneuver
Q.3 Meniere's disease is classically associated with which triad of symptoms?
Vertigo, tinnitus, hearing loss
Vertigo, diplopia, ataxia
Hearing loss, otalgia, fever
Tinnitus, headache, nausea
Explanation - Meniere's disease presents with episodic vertigo, fluctuating sensorineural hearing loss, and tinnitus due to endolymphatic hydrops.
Correct answer is: Vertigo, tinnitus, hearing loss
Q.4 Which test evaluates the function of the vestibulo-ocular reflex (VOR)?
Caloric test
Audiometry
Tympanometry
Weber test
Explanation - The caloric test stimulates the semicircular canals with warm or cold water/air to assess VOR function.
Correct answer is: Caloric test
Q.5 Central vertigo is more likely to present with which of the following?
Gradual onset, severe nausea
Sudden onset, auditory symptoms
Gait instability, diplopia, dysarthria
Short episodes triggered by head movement
Explanation - Central vertigo, caused by brainstem or cerebellar lesions, often has neurological deficits such as diplopia, dysarthria, and ataxia.
Correct answer is: Gait instability, diplopia, dysarthria
Q.6 Which structure in the inner ear detects linear acceleration and gravity?
Semicircular canals
Utricle and saccule
Cochlea
External auditory canal
Explanation - The utricle and saccule contain otolith organs that sense linear acceleration and head position relative to gravity.
Correct answer is: Utricle and saccule
Q.7 Which drug class is often used for symptomatic treatment of acute vertigo?
Antihistamines
Beta-blockers
ACE inhibitors
Proton pump inhibitors
Explanation - Antihistamines like meclizine reduce vertigo symptoms by suppressing vestibular activity.
Correct answer is: Antihistamines
Q.8 The HINTS exam is useful for differentiating which two types of vertigo?
Peripheral vs central vertigo
Meniere's vs BPPV
Acoustic neuroma vs vestibular neuritis
Labyrinthitis vs otitis media
Explanation - HINTS (Head Impulse, Nystagmus, Test of Skew) helps distinguish central from peripheral causes in acute vestibular syndrome.
Correct answer is: Peripheral vs central vertigo
Q.9 Which condition is characterized by recurrent, brief episodes of vertigo triggered by head position changes?
BPPV
Meniere's disease
Vestibular neuritis
Labyrinthitis
Explanation - BPPV causes short, positional vertigo episodes due to dislodged otoliths in the semicircular canals.
Correct answer is: BPPV
Q.10 Which imaging modality is preferred if a central cause of vertigo is suspected?
MRI of the brain
X-ray of the temporal bone
CT of the sinuses
Ultrasound of the inner ear
Explanation - MRI is sensitive for detecting brainstem or cerebellar lesions causing central vertigo.
Correct answer is: MRI of the brain
Q.11 Vestibular neuritis primarily affects which cranial nerve?
Cranial nerve VIII
Cranial nerve VII
Cranial nerve V
Cranial nerve IX
Explanation - Vestibular neuritis is inflammation of the vestibular portion of cranial nerve VIII, leading to acute vertigo without hearing loss.
Correct answer is: Cranial nerve VIII
Q.12 Which type of nystagmus is typically seen in peripheral vertigo?
Unidirectional horizontal
Vertical
Rotatory without direction change
Purely torsional
Explanation - Peripheral vertigo usually causes horizontal nystagmus that beats away from the affected ear and suppresses with visual fixation.
Correct answer is: Unidirectional horizontal
Q.13 Which maneuver is commonly used to treat posterior canal BPPV?
Epley maneuver
Brandt-Daroff exercises
Semont maneuver
Fukuda stepping test
Explanation - The Epley maneuver repositions displaced otoliths in the posterior semicircular canal to relieve vertigo.
Correct answer is: Epley maneuver
Q.14 Labyrinthitis differs from vestibular neuritis primarily by the presence of:
Hearing loss
Vertigo
Nausea
Imbalance
Explanation - Labyrinthitis affects both vestibular and cochlear components, causing vertigo and sensorineural hearing loss, unlike vestibular neuritis.
Correct answer is: Hearing loss
Q.15 Which electrolyte imbalance may exacerbate vertigo in Meniere's disease?
Low sodium
High potassium
Low calcium
High magnesium
Explanation - Dietary sodium restriction is recommended in Meniere's disease because high sodium can worsen endolymphatic hydrops and vertigo episodes.
Correct answer is: Low sodium
Q.16 Vestibular migraine often presents with vertigo episodes that are:
Associated with headache and light sensitivity
Triggered by loud noises
Accompanied by hearing loss
Always lasting several hours
Explanation - Vestibular migraine features episodic vertigo with migraine symptoms such as headache, photophobia, or phonophobia.
Correct answer is: Associated with headache and light sensitivity
Q.17 Which postural test helps assess balance in vertigo patients?
Romberg test
Weber test
Rinne test
Caloric test
Explanation - The Romberg test evaluates proprioception and vestibular function by observing swaying when standing with eyes closed.
Correct answer is: Romberg test
Q.18 Which of the following is a hallmark of central vertigo on nystagmus examination?
Direction-changing nystagmus
Suppressible by visual fixation
Horizontal unidirectional nystagmus
Torsional nystagmus only when lying down
Explanation - Central lesions often produce nystagmus that changes direction with gaze, unlike peripheral vertigo which is usually unidirectional.
Correct answer is: Direction-changing nystagmus
Q.19 Which vestibular test involves stepping in place with eyes closed to detect unilateral vestibular loss?
Fukuda stepping test
Dix-Hallpike maneuver
Romberg test
Epley maneuver
Explanation - The Fukuda stepping test detects lateral deviation in patients with unilateral vestibular deficits.
Correct answer is: Fukuda stepping test
Q.20 Which viral infection is most commonly associated with vestibular neuritis?
Herpes simplex virus
Influenza virus
Epstein-Barr virus
Varicella-zoster virus
Explanation - Vestibular neuritis is often linked to reactivation of latent herpes simplex virus in the vestibular ganglion.
Correct answer is: Herpes simplex virus
Q.21 Which symptom is more indicative of peripheral than central vertigo?
Severe imbalance without other neurological deficits
Diplopia and dysarthria
Direction-changing nystagmus
Vertigo with gradual onset over days
Explanation - Peripheral vertigo often presents with acute imbalance and vertigo but lacks other neurological deficits seen in central causes.
Correct answer is: Severe imbalance without other neurological deficits
Q.22 Which of the following drugs may be used for prophylaxis in vestibular migraine?
Beta-blockers
Antihistamines
Loop diuretics
ACE inhibitors
Explanation - Beta-blockers like propranolol are effective in reducing the frequency of vestibular migraine attacks.
Correct answer is: Beta-blockers
Q.23 Which feature distinguishes BPPV from Meniere's disease?
Short, positional episodes
Associated tinnitus and hearing loss
Spontaneous vertigo lasting hours
Vestibular hypofunction on caloric testing
Explanation - BPPV typically causes brief vertigo episodes triggered by head position, unlike Meniere's which has longer-lasting spontaneous attacks with auditory symptoms.
Correct answer is: Short, positional episodes
Q.24 Which rehabilitation approach is used for chronic vestibular dysfunction?
Vestibular rehabilitation therapy (VRT)
Epley maneuver
Dix-Hallpike maneuver
Caloric testing
Explanation - VRT uses exercises to promote central compensation for vestibular deficits in patients with chronic imbalance.
Correct answer is: Vestibular rehabilitation therapy (VRT)