Vestibular disorders: anterior 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: anterior canal BPPV

Sample item

On Dix-Hallpike testing a patient has brief downbeating nystagmus with a torsional component after a short latency, which fatigues on repetition. There are no other neurological signs. Which part of the labyrinth is involved?

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

The answer and the reasoning

A. Anterior (superior) semicircular canal

Debris in the anterior (superior) canal produces downbeating nystagmus with a torsional component on Dix-Hallpike testing. Posterior canal BPPV, the commonest form, gives upbeating torsional nystagmus. A lateral canal lesion gives horizontal nystagmus on the supine roll test. Features of latency and fatigability favour a peripheral cause rather than a central one.

Option by option

  • A. Anterior (superior) semicircular canal (correct)

    Correct. Downbeating torsional nystagmus with latency and fatigue localises to the anterior canal.

  • B. Utricular macula

    The utricular macula senses linear acceleration and is not tested by provoking canal nystagmus on Dix-Hallpike.

  • C. Lateral semicircular canal

    Lateral canal BPPV gives horizontal geotropic or apogeotropic nystagmus on the supine roll test.

  • D. Posterior semicircular canal

    Posterior canal BPPV gives upbeating torsional nystagmus, not downbeating.

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.

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Questions about this ENT question

What is the answer to this ENT question?

The best answer is A, Anterior (superior) semicircular canal. Debris in the anterior (superior) canal produces downbeating nystagmus with a torsional component on Dix-Hallpike testing.

Why is "Utricular macula" not the answer?

The utricular macula senses linear acceleration and is not tested by provoking canal nystagmus on Dix-Hallpike.

Why is "Lateral semicircular canal" not the answer?

Lateral canal BPPV gives horizontal geotropic or apogeotropic nystagmus on the supine roll test.

Why is "Posterior semicircular canal" not the answer?

Posterior canal BPPV gives upbeating torsional nystagmus, not downbeating.

What concept does this question test?

It tests Vestibular disorders: anterior canal BPPV in ENT. Posterior canal BPPV, the commonest form, gives upbeating torsional nystagmus. A lateral canal lesion gives horizontal nystagmus on the supine roll test. Features of latency and fatigability favour a peripheral cause rather than a central one.

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: anterior 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.