Meniere's Disease and Vestibular Disorders MCQs

ENT · 44 free questions with answers & explanations.

1. A 45-year-old woman has episodic attacks of vertigo lasting 2–6 hours, fluctuating low-frequency sensorineural hearing loss, tinnitus, and a sensation of aural fullness in the left ear. Between attacks, hearing returns to near-normal. The most likely diagnosis and its underlying pathology are:
2. The Dix-Hallpike manoeuvre is used to diagnose which type of benign paroxysmal positional vertigo (BPPV), and which canal is most commonly involved?
3. Electrocochleography (ECoG) in Meniere's disease shows an elevated summating potential to action potential (SP/AP) ratio. What threshold ratio is considered abnormal?
4. Vestibular neuritis characteristically spares which branch of the vestibular nerve, and what does this produce clinically?
5. A patient with disabling unilateral Meniere's disease refractory to medical therapy is offered intratympanic gentamicin. The intended mechanism and the major risk of this treatment are:
6. Endolymphatic hydrops is the pathophysiological hallmark of Menière's disease. The current leading theory for its mechanism involves:
7. In the Dix-Hallpike test for posterior canal BPPV (PC-BPPV), the characteristic nystagmus evoked is:
8. A 65-year-old presents with sudden severe vertigo, nausea, inability to walk, and ipsilateral limb ataxia. There is no hearing loss. The HiNTs (Head Impulse, Nystagmus, Test of Skew) examination shows a NORMAL (negative) head impulse test and skew deviation. What does this suggest?
9. The 2020 AAO-HNS criteria for a 'definite' Meniere's disease diagnosis requires all of the following EXCEPT:
10. In BPPV (benign paroxysmal positional vertigo), the most common variant involves the posterior semicircular canal with canalolithiasis. The Dix-Hallpike manoeuvre triggers a characteristic nystagmus. Which of the following correctly describes the nystagmus direction in posterior canal canalolithiasis (right posterior canal BPPV)?
11. Vestibular neuritis affects which part of the vestibular system most commonly, and which diagnostic test can help distinguish it from acute cerebellar stroke?
12. In intractable Meniere's disease failing conservative treatment, intratympanic gentamicin ablation works by:
13. The pathophysiological basis of Meniere's disease is endolymphatic hydrops. The most accepted mechanism by which endolymphatic sac dysfunction leads to episodic attacks involves:
14. A 55-year-old presents with recurrent episodic vertigo lasting 20-30 minutes, low-pitched tinnitus, and hearing loss predominantly in the lower frequencies (250-1000 Hz). Glycerol dehydration test shows >15 dB improvement in hearing threshold. The MOST appropriate initial medical therapy targeting the underlying pathophysiology is:
15. Benign Paroxysmal Positional Vertigo (BPPV) most commonly affects the posterior semicircular canal and is treated with the Epley canalith repositioning maneuver. In horizontal canal BPPV (HC-BPPV), the Dix-Hallpike test is NEGATIVE and the diagnosis is made by the supine roll (Pagnini-McClure) test. Which direction of geotropic nystagmus on the roll test indicates which ear is affected?
16. In Meniere's disease, the diagnostic criteria per the 2015 Barany Society guidelines require which of the following for a definite diagnosis (as opposed to probable)?
17. In benign paroxysmal positional vertigo (BPPV), the most common subtype involves the posterior semicircular canal. The pathophysiology is canalithiasis — free-floating otoliths in the endolymph. The Dix-Hallpike test provokes geotropic torsional nystagmus. The Epley canalith repositioning maneuver moves debris toward which structure for reabsorption?
18. A 40-year-old pilot develops severe vertigo during a flight landing, with inability to stand, vomiting, and horizontal nystagmus fast component beating toward the right ear. Caloric testing during recovery shows canal paresis on the left (>25% asymmetry). The diagnosis is vestibular neuritis. The primary mechanism of damage is thought to be:
19. A patient with long-standing Meniere's disease presents with sudden falls without loss of consciousness or vertigo. These episodes are called:
20. Transtympanic intratympanic gentamicin injection for Meniere's disease works by which targeted mechanism?
21. A 60-year-old presents with sudden severe vertigo, nausea, and vomiting lasting 2-3 days, with no hearing loss or tinnitus. He can walk with support. Which diagnosis is MOST consistent?
22. In the Epley maneuver for posterior canal BPPV, the treatment works by:
23. The AAO-HNS 2020 diagnostic criteria for DEFINITE Meniere's disease require which combination?
24. The Epley canalith repositioning manoeuvre for posterior canal BPPV achieves its effect by:
25. The key distinguishing feature between vestibular neuritis and labyrinthitis is:
26. A patient with refractory Meniere's disease is being considered for intratympanic gentamicin injection. What is the SPECIFIC mechanism by which this treatment controls vertigo, and what is its main risk?
27. Benign paroxysmal positional vertigo (BPPV) most commonly involves the posterior semicircular canal. In canalithiasis of the posterior canal, the Dix-Hallpike test produces a characteristic nystagmus. Which of the following ACCURATELY describes the expected nystagmus in right posterior canal canalithiasis on right Dix-Hallpike?
28. A 50-year-old woman presents with sudden onset severe vertigo, nausea, horizontal nystagmus (fast phase toward the left), past-pointing to the right, and positive Romberg (falls to right). There is no hearing loss. Which is the MOST likely diagnosis and the expected caloric test finding?
29. A patient with Meniere's disease has failed dietary restriction and diuretics. The ENT surgeon considers intratympanic gentamicin therapy. The primary mechanism of action of intratympanic gentamicin in Meniere's disease is:
30. Intratympanic gentamicin injection for Meniere's disease primarily works by:
31. Lermoyez syndrome is a variant of Meniere's disease characterized by:
32. A patient with definite Meniere's disease has failed medical management (betahistine, diuretics, low-salt diet). She has good serviceable hearing (PTA 35 dB, speech discrimination 70%). Which surgical intervention has the best hearing-preservation outcome for vertigo control?
33. A patient with definite Meniere's disease has failed dietary sodium restriction, betahistine, and diuretics. The next treatment step that reduces vertigo attacks without sacrificing hearing is:
34. Intratympanic gentamicin therapy is used for refractory Meniere's disease. Which semicircular canal function is most impaired first, and what is the mechanism of action?
35. A patient with Meniere's disease refractory to conservative treatment (low-sodium diet, diuretics, betahistine) is being considered for intratympanic gentamicin therapy. The primary mechanism of action of this treatment is:
36. Superior semicircular canal dehiscence (SSCD) syndrome presents with which characteristic combination of symptoms?
37. The pathological basis of Meniere's disease is:
38. Endolymphatic sac decompression surgery in Meniere's disease aims to control which symptom primarily?
39. Electrocochleography (ECochG) in Meniere's disease classically shows elevation of which ratio, and what does this indicate?
40. A patient meets the 2015 Barany Society criteria for definite Meniere's disease. Which intervention is considered the most evidence-based ablative procedure for refractory Meniere's disease that preserves hearing?
41. Which finding on the 2015 Barany Society criteria is essential to diagnose 'definite Meniere's disease' (as opposed to probable Meniere's)?
42. A 45-year-old woman presents with episodic vertigo lasting 20-30 minutes, fluctuating low-frequency sensorineural hearing loss, aural fullness, and tinnitus over 2 years. Electrocochleography (ECochG) is performed. The diagnostic finding most supportive of endolymphatic hydrops is:
43. A patient with definite Meniere's disease (fulfilling AAO-HNS 1995 criteria) has been treated with dietary salt restriction, diuretics and betahistine for 18 months but continues to have disabling vertigo attacks. The next most appropriate interventional option is:
44. In benign paroxysmal positional vertigo (BPPV) of the posterior semicircular canal, the Epley canalith repositioning manoeuvre works by: