Vestibular Disorders Practice Questions

Q: COWS mnemonic is related to which of the following tests?

Caloric test. **Explanation:** The **COWS mnemonic** is a fundamental clinical tool used to interpret the results of the **Caloric Test** (part of the Electronystagmography battery). The test involves irrigating the external auditory canal with water or air that is either warmer or cooler than body temperature to induce convection currents in the endolymph of the lateral semicircular canal. The mnemonic stands for: * **C**old – **O**pposite * **W**arm – **S**ame This describes the direction of the **fast component of nystagmus**: cold water irrigation induces nystagmus with the fast phase beating toward the opposite ear, while warm water induces nystagmus beating toward the same (irrigated) ear. **Analysis of Incorrect Options:** * **Romberg test:** A test of postural stability used to differentiate between sensory and cerebellar ataxia; it does not involve thermal stimulation or the COWS mnemonic. * **Fistula test:** Used to identify a labyrinthine fistula (usually in the lateral canal). A positive result (Hennebert’s sign) is nystagmus/vertigo induced by pressure changes in the EAC. * **Hallpike positional test:** The gold standard for diagnosing Benign Paroxysmal Positional Vertigo (BPPV) by eliciting characteristic geotropic nystagmus. **Clinical Pearls for NEET-PG:** * **Fitzgerald-Hallpike Technique:** The standard caloric test using water at 30°C (Cold) and 44°C (Warm). * **Canal Paresis:** A reduced response on one side (calculated using Jongkees’ formula), indicating a peripheral vestibular lesion. * **Dead Labyrinth:** No response to both cold and warm irrigation. * **Directional Preponderance:** Nystagmus in one direction is stronger than the other.

Q: Episodic vertigo, tinnitus, and normal hearing are characteristic features of which condition?

Meniere's disease. ### Explanation **Meniere’s Disease (Endolymphatic Hydrops)** is characterized by a classic triad of episodic vertigo, tinnitus, and sensorineural hearing loss (SNHL). While the question mentions "normal hearing," it is a high-yield clinical fact that in the **early stages** of Meniere’s disease, hearing often returns to normal between episodes. The vertigo is spontaneous, lasting 20 minutes to several hours, and is typically associated with a feeling of aural fullness. #### Analysis of Options: * **Meniere’s Disease (Correct):** It is the most likely diagnosis for episodic vertigo and tinnitus. Although SNHL is a hallmark, it is characteristically fluctuating and may not be persistent in early presentations. * **Acoustic Neuroma:** This presents with **progressive**, unilateral SNHL and persistent tinnitus. Vertigo is rarely episodic; instead, patients experience gradual imbalance due to central compensation as the tumor grows slowly. * **Vestibular Neuritis:** This involves a sudden, severe attack of vertigo lasting days. Crucially, there are **no auditory symptoms** (no tinnitus, no hearing loss), as the pathology is limited to the vestibular nerve. #### NEET-PG High-Yield Pearls: * **Pathophysiology:** Distension of the endolymphatic system (Endolymphatic hydrops) due to increased pressure. * **Hearing Loss Pattern:** Early Meniere’s typically shows **low-frequency SNHL** (rising curve on audiometry). * **Lermoyez Syndrome:** A variant where hearing improves during a vertigo attack. * **Tullio Phenomenon:** Vertigo induced by loud sounds (also seen in Superior Semicircular Canal Dehiscence). * **Management:** Low-salt diet and diuretics are first-line; Betahistine is used for prophylaxis.

Question 1

COWS mnemonic is related to which of the following tests?

Accepted Answer

Caloric test

Answer

Romberg test

Answer

Fistula test

Answer

Hallpike positional test

Question 2

Which of the following is NOT typically seen in Meniere's disease?

Accepted Answer

Loss of consciousness

Answer

Tinnitus

Answer

Hearing loss

Answer

Vertigo

Question 3

Episodic vertigo, tinnitus, and normal hearing are characteristic features of which condition?

Accepted Answer

Meniere's disease

Answer

Acoustic neuroma

Answer

Vestibular neuritis

Answer

All of the above

Question 4

A 55-year-old woman presents with ear pain, tinnitus, dizziness, and vertigo. Radiographic examination suggests Meniere's disease. Which of the following structures is most likely affected by the edema associated with Meniere's disease?

Accepted Answer

Endolymphatic sac

Answer

Middle ear

Answer

Semicircular canals

Answer

Cochlea

Question 5

In which type of nystagmus does the abnormality manifest when the patient looks straight ahead?

Accepted Answer

Optokinetic nystagmus

Answer

Latent nystagmus

Answer

Positional nystagmus

Answer

Central nystagmus

Vestibular Disorders — MCQs

Vestibular Disorders — MCQs

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