Patient Safety & Clinical Decision-Making Flashcards

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

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

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.

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

Answer: Reduced central nervous system plasticity potentially slowing compensation

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

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?

Answer: Abnormal head impulse, unidirectional nystagmus, no skew deviation

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.

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

Answer: Primarily somatosensory system compensation for vestibular loss

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.

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

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

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

A patient with bilateral vestibular hypofunction asks about return to driving. Which objective assessment most directly informs this clinical decision?

Answer: Dynamic Visual Acuity testing showing less than 2-line loss

Dynamic Visual Acuity testing directly measures the ability to maintain clear vision during head movement, which is the key vestibular function required for safe driving.

When documenting informed consent for vestibular rehabilitation, which element is MOST important to include for a patient with cervical spondylosis?

Answer: Risks of cervical manipulation techniques and alternatives discussed

Patients with cervical spondylosis face elevated risk with cervical mobilization; documenting that risks were discussed and alternatives offered is a critical medico-legal requirement.