NR 603 QUESTIONS AND 100% CORRECT ANSWERS 2024

NR 603 QUESTIONS AND 100%
CORRECT ANSWERS 2024
Vestibular neuritis/labyrinthitis - ANSWER Acute unilateral labryinthine dysfunction
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Sx: severe vertigo, nausea, vomiting and disequilibrium lasting few days, unbalance with rapid head mov
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ement; lasts weeks to months; probs w/ walking/balance
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Causes: by viral infection in vestibular nerve, otitis media sometimes another cause; HSV-
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1 of vestibular ganglia
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Assessment: U




-Thorough ear, nose throat exam U U U U




-Neuro exam (including balance testing with Romberg)
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-Hearing screen should be normal
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-Abnormal neuro exam should suggest a central cause and referred to Neuro
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Diagnostics: U




Labs: CBC with diff
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Imaging: MRI or CT U U U




Differential dx: U




-BPPV

-Meniere disease U




-Migranous vertigo U




-Vascular d/o U




-Trauma

-Toxins

-Demyelinating disease (MS) U U




-Ramsay Hunt Syndrome U U

, -Cerebellar disorder U




-Tumors



Tx: U




-Symptom relief - U U


Uuse only for 3 days (more than that can just mask sx): anticholinergics (first line), antihistamines(first lin
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e), long acting benzos (reserved for pts who cant take anticholinergics) or antiemetics (added to relieve v
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omiting)

-Acute treatment: Methylpredisone taper (100mg every 3 days)
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Meniere's disease - ANSWER Excessive fluid and pressure in labyrinth of inner ear; autoimmune process
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Sx: Vertigo that last min to hours, a/w nausea and vomiting, accompanied by pressure in ear; low-
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pitched = unilateral hearing loss; hearing loss is constant in later stages
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Assessment:

-Head and neck exam to exclude acute otitits media
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-Neuro exam U




-Weber test - sound will laterlize to unaffected ear
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-Rinne test - air conduction > bone conduction
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Diagnostics:

-Initial: Audiogram
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-Labs- TSH, serum glucose, RPR, lyme serologies
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-Imaging: MRI (rule out neuroma)
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Differential:

-BPPV

-Vestibular neuritis U




-Vertebrobasilar insufficiency U