Vertigo: central signs: 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 · Vertigo: central signs

Sample item

Which finding in a patient with acute vertigo suggests a central cause such as cerebellar stroke?

ADirection-changing or purely vertical nystagmus with a normal head impulse testBHorizontal-rotatory nystagmus suppressed by fixationCAbnormal head impulse test toward the lesionDAssociated unilateral hearing loss in a young person

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

The answer and the reasoning

A. Direction-changing or purely vertical nystagmus with a normal head impulse test

In the HINTS approach, a normal head impulse test, direction-changing nystagmus or skew deviation indicate a central cause. Peripheral nystagmus is unidirectional, horizontal-rotatory and suppressed by visual fixation.

Option by option

A. Direction-changing or purely vertical nystagmus with a normal head impulse test (correct)
Correct. Direction-changing or vertical nystagmus with a normal head impulse test is central.
B. Horizontal-rotatory nystagmus suppressed by fixation
Fixation-suppressed horizontal-rotatory nystagmus is peripheral.
C. Abnormal head impulse test toward the lesion
An abnormal head impulse test indicates a peripheral lesion.
D. Associated unilateral hearing loss in a young person
Hearing loss in a young person does not by itself indicate a central cause.

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 A, Direction-changing or purely vertical nystagmus with a normal head impulse test. In the HINTS approach, a normal head impulse test, direction-changing nystagmus or skew deviation indicate a central cause.

Why is "Horizontal-rotatory nystagmus suppressed by fixation" not the answer?

Fixation-suppressed horizontal-rotatory nystagmus is peripheral.

Why is "Abnormal head impulse test toward the lesion" not the answer?

An abnormal head impulse test indicates a peripheral lesion.

Why is "Associated unilateral hearing loss in a young person" not the answer?

Hearing loss in a young person does not by itself indicate a central cause.

What concept does this question test?

It tests Vertigo: central signs in ENT. Peripheral nystagmus is unidirectional, horizontal-rotatory and suppressed by visual fixation.

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 Vertigo: central signs?

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.