Vestibular disorders: ageotropic horizontal canal BPPV: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Vestibular disorders: ageotropic horizontal canal BPPV

Sample item

On the supine roll test, a patient has horizontal nystagmus beating away from the ground (ageotropic) on turning to either side, with vertigo. What does this indicate?

ASuperior canal dehiscenceBPosterior canal canalolithiasisCDebris adherent to the cupula of the horizontal canalDFree-floating debris in the long arm of the horizontal canal

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Debris adherent to the cupula of the horizontal canal

Ageotropic horizontal nystagmus indicates cupulolithiasis of the horizontal canal (or debris in the anterior arm near the cupula). Geotropic nystagmus indicates free debris in the long arm. The ageotropic form is often converted to the geotropic form by manoeuvres such as the Gufoni manoeuvre before repositioning.

Option by option

A. Superior canal dehiscence
Superior canal dehiscence causes sound-induced vertigo, not roll-test nystagmus.
B. Posterior canal canalolithiasis
Posterior canal BPPV gives upbeating torsional nystagmus on Dix-Hallpike testing.
C. Debris adherent to the cupula of the horizontal canal (correct)
Correct. Ageotropic nystagmus indicates debris stuck to the cupula.
D. Free-floating debris in the long arm of the horizontal canal
Free canalolithiasis in the long arm produces geotropic nystagmus.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this ENT question

What is the answer to this ENT question?

The best answer is C, Debris adherent to the cupula of the horizontal canal. Ageotropic horizontal nystagmus indicates cupulolithiasis of the horizontal canal (or debris in the anterior arm near the cupula).

Why is "Superior canal dehiscence" not the answer?

Superior canal dehiscence causes sound-induced vertigo, not roll-test nystagmus.

Why is "Posterior canal canalolithiasis" not the answer?

Posterior canal BPPV gives upbeating torsional nystagmus on Dix-Hallpike testing.

Why is "Free-floating debris in the long arm of the horizontal canal" not the answer?

Free canalolithiasis in the long arm produces geotropic nystagmus.

What concept does this question test?

It tests Vestibular disorders: ageotropic horizontal canal BPPV in ENT. Geotropic nystagmus indicates free debris in the long arm. The ageotropic form is often converted to the geotropic form by manoeuvres such as the Gufoni manoeuvre before repositioning.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Vestibular disorders: ageotropic horizontal canal BPPV?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.