A 55-Year-Old Woman Is Brought to the Emergency Department Due

question 18

Multiple Choice

A 55-year-old woman is brought to the emergency department due to severe dizziness and unsteadiness.  Two days ago, she awoke with a spinning sensation accompanied by severe nausea and vomiting and a feeling of pressure in the right ear.  The episode lasted an hour.  Over the next 48 hours, the patient had similar events while in bed.  She had no tinnitus, headache, blurry or double vision, dysphasia, dysarthria, falls, or focal weakness during the episodes.  The patient has no history of neck or head trauma.  She was evaluated for similar symptoms 2 months ago, and no medication was prescribed.
Medical history is notable for type 2 diabetes mellitus, which was diagnosed 15 years ago and is complicated by peripheral neuropathy and gastroparesis.  The patient also has hypertension, hypothyroidism, and hyperlipidemia.  Family history is notable for stroke and heart disease.
Temperature is 37 C (98.6 F) , supine blood pressure is 130/85 mm Hg, and supine pulse is 88/min and regular.  Weber test shows lateralization to the left ear.  Rinne test shows diminished air and bone conduction on the right and normal findings on the left.  Sensory examination reveals a length-dependent reduction in pain, temperature, vibratory, and proprioceptive perception in the lower extremities up to the knees and in the upper extremities up to the elbows.  Reflexes are absent in the lower extremities and 1+ in the upper extremities, with mute plantar responses.  Coordination testing is normal.  A bedside Dix-Hallpike maneuver does not elicit nystagmus.
Which of the following is most likely to prevent further symptoms in this patient?

• A)Canalith repositioning maneuvers
• B)Low-dose aspirin
• C)Midodrine
• D)Oral methylprednisolone
• E)Salt-restricted diet and diuretics

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