NR 603 exam with complete solutions
2024/2025
Vestibular neuritis/labyrinthitis - ANSWER-Acute unilateral labyrinthine
dysfunction
Sx: severe vertigo, nausea, vomiting and disequilibrium lasting few days,
unbalance with rapid head movement; lasts weeks to months; probs w/
walking/balance
Causes: by viral infection in vestibular nerve, otitis media sometimes another
cause; HSV-1 of vestibular ganglia
Assessment:
-Thorough ear, nose throat exam
-Neuro exam (including balance testing with Romberg)
-Hearing screen should be normal
-Abnormal neuro exam should suggest a central cause and referred to Neuro
Diagnostics:
Labs: CBC with diff
Imaging: MRI or CT
Differential dx:
-BPPV
-Meniere disease
-Migrainous vertigo
-Vascular d/o
, -Trauma
-Toxins
-Demyelinating disease (MS)
-Ramsay Hunt Syndrome
-Cerebellar disorder
-Tumors
Tx:
-Symptom relief - use only for 3 days (more than that can just mask sx):
anticholinergics (first line), antihistamines(first line), long acting benzos
(reserved for pts who cant take anticholinergics) or antiemetics (added to relieve
vomiting)
-Acute treatment: Methylprednisolone taper (100mg every 3 days)
Meniere's disease - ANSWER-Excessive fluid and pressure in labyrinth of inner
ear; autoimmune process
Sx: Vertigo that last min to hours, a/w nausea and vomiting, accompanied by
pressure in ear; low-pitched = unilateral hearing loss; hearing loss is constant in
later stages
Assessment:
-Head and neck exam to exclude acute otitis media
-Neuro exam
-Weber test - sound will lateralized to unaffected ear
-Rinne test - air conduction > bone conduction
Diagnostics:
-Initial: Audiogram
-Labs- TSH, serum glucose, RPR, lyme serologies
-Imaging: MRI (rule out neuroma)
Differential:
-BPPV
-Vestibular neuritis
2024/2025
Vestibular neuritis/labyrinthitis - ANSWER-Acute unilateral labyrinthine
dysfunction
Sx: severe vertigo, nausea, vomiting and disequilibrium lasting few days,
unbalance with rapid head movement; lasts weeks to months; probs w/
walking/balance
Causes: by viral infection in vestibular nerve, otitis media sometimes another
cause; HSV-1 of vestibular ganglia
Assessment:
-Thorough ear, nose throat exam
-Neuro exam (including balance testing with Romberg)
-Hearing screen should be normal
-Abnormal neuro exam should suggest a central cause and referred to Neuro
Diagnostics:
Labs: CBC with diff
Imaging: MRI or CT
Differential dx:
-BPPV
-Meniere disease
-Migrainous vertigo
-Vascular d/o
, -Trauma
-Toxins
-Demyelinating disease (MS)
-Ramsay Hunt Syndrome
-Cerebellar disorder
-Tumors
Tx:
-Symptom relief - use only for 3 days (more than that can just mask sx):
anticholinergics (first line), antihistamines(first line), long acting benzos
(reserved for pts who cant take anticholinergics) or antiemetics (added to relieve
vomiting)
-Acute treatment: Methylprednisolone taper (100mg every 3 days)
Meniere's disease - ANSWER-Excessive fluid and pressure in labyrinth of inner
ear; autoimmune process
Sx: Vertigo that last min to hours, a/w nausea and vomiting, accompanied by
pressure in ear; low-pitched = unilateral hearing loss; hearing loss is constant in
later stages
Assessment:
-Head and neck exam to exclude acute otitis media
-Neuro exam
-Weber test - sound will lateralized to unaffected ear
-Rinne test - air conduction > bone conduction
Diagnostics:
-Initial: Audiogram
-Labs- TSH, serum glucose, RPR, lyme serologies
-Imaging: MRI (rule out neuroma)
Differential:
-BPPV
-Vestibular neuritis
