cirus
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[left]A 49-year-old woman comes to your clinic complaining of new-onset rotational vertigo. It began approximately 2 months before and occurs several times per day without obvious provoking factors. She describes the sensation as “things flying around in circles,” requiring her to sit down or lean against something for balance. She has nausea with a few episodes of vomiting that accompany these dizzy spells and has had increased problems with hearing lately. She denies any other changes in her vision, cognition,memory, motor strength, or sensation. She has a past medical history of highly symptomatic menopause, anxiety,and uterine fibroids. She takes paroxetine, 50 mg once/day, and estrogen replacement therapy. A Hallpike test causes no change in her pattern of dizziness. Her hearing is slightly diminished bilaterally but worse on the left. The rest of her neurologic examination is normal.Over the course of the next several years, this patient most likely will experience which of the following?
A) Complete loss of her vestibular sensation of balance
B) Complete resolution of her symptoms
C) A continued increase in the frequency and severity of her vertigo symptoms
D) Development of refractory tinnitus
E) Resolution of her vertigo but continued hearing loss
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| kashdoc21
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it is meinner's d's ..is it ?
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| doc_clotaire
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B) Complete resolution of her symptoms
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| dr in trouble
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can someone explain it???
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| Justice
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E) Resolution of her vertigo but continued hearing loss
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| cirus
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Justice wrote:
E) Resolution of her vertigo but continued hearing loss
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| cirus
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The correct answer is
A. Administering glucose to a patient who is deficient in thiamin may precipitate Wernicke-Korsakoff syndrome, which is a combination of confusion, ataxia, ophthalmoplegia, anterograde and retrograde amnesia, and confabulation. It is therefore imperative to administer IV thiamin prior to glucose-containing IV fluids.
Niacin (choice B) is an essential component of the coenzymes involved in oxidation-reduction reactions. Profound deficiency in niacin causes the classic triad of pellagra: dermatitis, diarrhea, and dementia.
Vitamin B12 deficiency (choice C) may lead to megaloblastic anemia, neurologic complications, and dementia.
Vitamin C deficiency (choice D) may lead to difficulty with wound healing and scurvy.
Vitamin K (choice E) is essential for the production of selected clotting factors. Although alcoholics may be deficient in all the vitamins mentioned in the answer choices, only deficits in thiamin are associated with harmful effects if glucose is administered without replenishment.
[left]induce neuropathic changes in the vestibulocochlear
[/left] [left]nerve and more central auditory nuclei. This can make the tinnitus refractory even to ablation of the vestibulocochlear
[/left]
nerve (central tinnitus).
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| Justice
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Hey cirus,
what is the correct answer? Is it D or E? My wife is ENT and she says it must be D
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| kashdoc21
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diagnosis is ?
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| cirus
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sorry guys, i posted a wrong explanation:
[left]The correct answer is E. [/left]
[left]This patient suffers fromMénière disease, an idiopathic, episodic cause of vertigo and hearing loss. Multiple medications have proven ineffective in treating this, and it is usually very difficult to distinguish the natural waxing and waning of disease severity from a treatment response. [/left]
[left]Complete loss of vestibular sensation of balance (choice A) is a very rare disorder that requires extensive damage to the vestibular apparatus (the utricle, saccule, and semicircular canals). This is seen most commonly in oto/vestibulotoxicity secondary to aminoglycoside antibiotics or to loop diuretics.[/left]
[left]Experiencing complete resolution of symptoms (choice B) occurs occasionally in Ménière disease, especially if it is associated with an acute viral infection (labyrinthitis). If they truly had a case of chronic Ménière disease, though, only a minority has complete resolution. [/left]
[left]Experiencing a continued increase in the frequency and severity of vertigo symptoms (choice C) occurs only rarely in patients with Ménière disease. Observational studies have found that this occurs in only approximately10% of patients. [/left]
[left]Development of refractory tinnitus (choice D) is an uncommon complication of Ménière disease. As with other manifestations, it stems from permanent damage to the cochlear hair cells. Over the long term it can even[/left]
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| cirus
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Justice wrote:
Hey cirus,
what is the correct answer? Is it D or E? My wife is ENT and she says it must be D
That was my ans too
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