Vestibular Disorders Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Vestibular Disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Vestibular Disorders Indian Medical PG Question 1: A 25-year-old woman presents with episodes of dizziness, tinnitus, and hearing loss in the right ear. What is the most likely diagnosis?
- A. Labyrinthitis
- B. Ménière's disease (Correct Answer)
- C. Acoustic neuroma
- D. Benign paroxysmal positional vertigo
Vestibular Disorders Explanation: ***Ménière's disease***
- This condition is characterized by a classic triad of **episodic vertigo (dizziness)**, fluctuating **sensorineural hearing loss**, and **tinnitus**, often accompanied by aural fullness, typically affecting one ear.
- The symptoms arise from an accumulation of **endolymph** in the inner ear, leading to increased pressure and dysfunction.
*Labyrinthitis*
- **Labyrinthitis** is an inflammation of the inner ear, usually viral, causing sudden, severe **vertigo** potentially with hearing loss and tinnitus.
- Unlike Meniere's disease, **hearing loss** and **tinnitus** in labyrinthitis are usually constant rather than episodic or fluctuating.
*Acoustic neuroma*
- An **acoustic neuroma** (vestibular schwannoma) is a benign tumor on the eighth cranial nerve, often causing **gradual, progressive unilateral hearing loss**, tinnitus, and **balance issues**, but typically not episodic severe dizziness.
- While it can cause hearing loss and tinnitus, the **episodic nature of vertigo** is less common than in Ménière's disease.
*Benign paroxysmal positional vertigo*
- **BPPV** is characterized by sudden, **brief episodes of vertigo** triggered by specific head movements, caused by dislodged **otoconia** in the semicircular canals.
- Critically, BPPV does **not** typically cause associated **hearing loss or tinnitus**, which are prominent symptoms in the presented case.
Vestibular Disorders Indian Medical PG Question 2: A 65-year-old woman complains of recurrent episodes of sudden-onset dizziness and nausea. She notices an abrupt onset of a spinning sensation when rolling over or sitting up in bed. The symptoms last for 30 seconds and then completely resolve. She has no hearing change or other neurologic symptoms, and her physical examination is completely normal. A Dix-Hallpike maneuver reproduces her symptoms. Which of the following findings on vestibular testing favors the diagnosis of benign paroxysmal positional vertigo (BPPV) over central positional vertigo?
- A. habituation occurs (Correct Answer)
- B. absence of a latency period
- C. moderate vertigo
- D. absence of fatigability
Vestibular Disorders Explanation: The phenomenon of **habituation**, where symptoms lessen with repeated positional changes, is characteristic of **BPPV** due to canalith dissolution or movement away from the cupula. In central positional vertigo, habituation typically does not occur, and the nystagmus may be persistent. **BPPV** typically presents with a **latency period** of a few seconds (usually 2-20 seconds) between the provocative maneuver and the onset of nystagmus and vertigo. The absence of a latency period is a characteristic more consistent with **central positional vertigo**. The severity of vertigo (moderate vs. severe) is not a reliable differentiating factor between BPPV and central positional vertigo, as both can cause significant discomfort. While BPPV often causes **severe vertigo with nystagmus**, central causes can also present with varying intensities of dizziness. **Fatigability**, meaning the nystagmus and vertigo decrease in intensity with repeated maneuvers, is a hallmark of **BPPV**. The **absence of fatigability** suggests a central cause, where nystagmus often persists or even increases with repeated testing.
Vestibular Disorders Indian Medical PG Question 3: Identify the maneuver shown in the image.
- A. Brandt-Daroff
- B. Epley (Correct Answer)
- C. Foster
- D. Semont
Vestibular Disorders Explanation: ***Epley***
- The image displays the classic sequence of head and body movements characteristic of the **Epley maneuver**, designed to reposition otoconia from the semicircular canals back into the utricle.
- This maneuver involves a series of specific head turns and body positions, often starting in an upright seated position, then lying down while turning the head, and rotating the body, as depicted.
*Brandt daroff*
- The **Brandt-Daroff exercises** involve rapid, self-administered movements between sitting and lying on one side, then sitting up and lying on the other side.
- These exercises are typically performed multiple times a day and differ in their sequence from the repositioning maneuvers shown.
*Foster*
- The **Foster maneuver**, also known as the "half-somersault maneuver," is a self-administered variant used for posterior canal BPPV, particularly when the Epley maneuver is difficult to perform.
- It involves beginning in a kneeling position, looking up, placing the head on the floor, and tucking the chin, which is distinct from the sequence shown.
*Semont*
- The **Semont maneuver** involves rapid movement from a sitting position to lying on one side with the head turned up, then rapidly moving to lie on the opposite side with the head turned down.
- While it is a repositioning maneuver for BPPV, its specific rapid movements and head orientations differ from those illustrated in the image.
Vestibular Disorders Indian Medical PG Question 4: Which of the following is not true regarding Vestibular neuroma
- A. Nystagmus
- B. High frequency sensorineural deafness
- C. Absence of caloric response
- D. Normal Corneal reflex (Correct Answer)
Vestibular Disorders Explanation: ***Absence of caloric response***
- A **vestibular schwannoma** (acoustic neuroma) typically arises from the **vestibular nerve**, causing early impairment of **vestibular function**.
- This often manifests as a **reduced or absent caloric response** in the affected ear, indicating damage to the peripheral vestibular system.
*Normal Corneal reflex*
- The **corneal reflex** tests the integrity of the **trigeminal nerve (CN V)** for the afferent limb and the **facial nerve (CN VII)** for the efferent limb.
- While a large vestibular schwannoma can compress the trigeminal nerve and cause a diminished corneal reflex, early-stage tumors, or smaller tumors less commonly lead to this finding.
*Nystagmus*
- **Nystagmus** is an involuntary rhythmic eye movement and can be a sign of **vestibular dysfunction**, which is characteristic of a vestibular schwannoma.
- It often presents as a **vestibular nystagmus**, which can be spontaneous or provoked, particularly in the early stages as the tumor affects balance pathways.
*High frequency sensorineural deafness*
- **Sensorineural hearing loss** is a classic and often the earliest symptom of a vestibular schwannoma, as the tumor compresses the **cochlear nerve**.
- The hearing loss typically affects **higher frequencies** first and is progressive and unilateral.
Vestibular Disorders Indian Medical PG Question 5: Best surgery to relieve intractable vertigo in a Meniere's disease patient with profound hearing loss is?
- A. Vestibular neurectomy
- B. Endolymphatic sac decompression
- C. Cochleosacculotomy
- D. Surgical Labyrinthectomy (Correct Answer)
Vestibular Disorders Explanation: **Surgical Labyrinthectomy**
* **Labyrinthectomy** is the most effective surgical option for intractable vertigo in Meniere's disease when the affected ear also has **profound hearing loss**, as it completely ablates the vestibular function of the inner ear.
* Since the patient already has profound hearing loss, the loss of residual hearing from this procedure is not a significant concern, making it an ideal choice for **vertigo control**.
*Vestibular neurectomy*
* **Vestibular neurectomy** is a highly effective procedure for intractable vertigo, as it aims to selectively cut the vestibular nerve while preserving hearing.
* However, it is a more complex surgical approach compared to labyrinthectomy and is typically reserved for patients with **serviceable hearing** that they wish to preserve.
*Endolymphatic sac decompression*
* **Endolymphatic sac decompression** is a surgical procedure designed to improve the reabsorption of endolymph, thereby reducing the pressure and symptoms of Meniere's disease, including vertigo and hearing loss.
* While it may improve vertigo symptoms, it is less consistently effective than ablative procedures for intractable vertigo and its primary benefit is to **preserve hearing**, which is not a priority in a patient with profound hearing loss.
*Cochleosacculotomy*
* **Cochleosacculotomy** involves making a small opening in the labyrinth to drain endolymph, aiming to reduce endolymphatic hydrops and alleviate vertigo.
* Though it can help with vertigo, it carries a high risk of causing complete hearing loss in the operated ear and offers less reliable vertigo control compared to a labyrinthectomy, especially when profound hearing loss is already present.
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