MSRA High-Yield MCQs: Vestibular Neuronitis & Vertigo Differentials (ENT-Neurology Integration)
- examiner mla
- Jul 1
- 3 min read
Updated: Jul 2
A 42-year-old man presents with sudden onset severe vertigo, nausea, and vomiting. Symptoms started on waking and have been constant for the past 24 hours. He veers to the right while walking. Examination shows fine horizontal-torsional nystagmus with fast phase to the left, no hearing loss, and a positive head-impulse test to the right. There are no other neurological signs.
What is the most likely diagnosis?
Choose the correct answer
A) Benign paroxysmal positional vertigo (BPPV)
B) Meniere’s disease
C) Vestibular migraine
D) Vestibular neuronitis
Answer: D – Vestibular neuronitis 🔑 Sudden continuous severe vertigo, no hearing loss, positive HIT to affected side.
Which of the following is true regarding vestibular neuronitis?
Choose the correct answer
A) Vertigo episodes last a few seconds and are positional
B) Hearing loss is a common feature
C) Head-Impulse Test is normal
D) Vertigo is continuous for days and worsened by head movem
Answer: D
🔑 Continuous vertigo for 2–3 days, worsened by head movement. HIT is abnormal. No routine steroids.
A 50-year-old woman presents with vertigo and unsteadiness. Examination shows vertical nystagmus, normal head-impulse test, and dysarthria with limb ataxia.
What is the most likely cause?
Choose the correct answer
A) Vestibular neuronitis
B) Labyrinthitis
C) Posterior circulation stroke
D) BPPV
Answer: C
🔑 Vertical nystagmus + normal HIT + neuro signs → central cause (stroke).
In vestibular neuronitis, why should vestibular suppressants be discontinued after ≤3 days?
Choose the correct answer
A) They cause irreversible vestibular damage
B) They worsen hearing loss
C) They delay central compensation needed for recovery
D) They increase the risk of seizures
Answer: C 🔑 Prolonged use delays brain adaptation (central compensation) → prolonged imbalance.
Which of the following findings on the HINTS exam suggests a central cause of vertigo?
(HINTS stands for:
🔹 Head-Impulse test
🔹 Nystagmus assessment
🔹 Test of Skew)
Choose the correct answer
A) Abnormal head-impulse test
B) Unidirectional nystagmus suppressed by fixation
C) Normal head-impulse test with direction-changing nystagmu
D) No skew deviation
Answer: C 🔑 Normal HIT + direction-changing nystagmus → central lesion (e.g. stroke).
A patient presents with recurrent vertigo episodes lasting hours, associated with fluctuating low-frequency hearing loss and tinnitus. What is the most likely diagnosis?
Choose the correct answer
A) Vestibular neuronitis
B) BPPV
C) Meniere’s disease
D) Labyrinthitis
Answer: C
🔑 Meniere’s: episodic vertigo (minutes–hours) + hearing loss + tinnitus.
Which of the following is not recommended in vestibular neuronitis management?
Choose the correct answer
A) Oral prochlorperazine for severe vertigo
B) Early mobilisation
C) Routine use of antivirals
D) Safety advice to prevent falls
Answer: C
🔑 No evidence for antivirals; management is symptomatic + mobilisation.
A patient with suspected vestibular neuronitis presents with facial palsy and vesicles in the external auditory canal. What is the most appropriate next step?
Choose the correct answer
A) Start prochlorperazine alone
B) Start acyclovir and corticosteroids
C) Reassure and mobilise only
D) Arrange MRI brain urgently
Answer: B 🔑 This is Ramsay Hunt syndrome (VZV reactivation) → requires antivirals + steroids.
Which vestibular disorder is characterised by brief vertigo lasting seconds triggered by head position changes?
Choose the correct answer
A) Vestibular neuronitis
B) Labyrinthitis
C) BPPV
D) Meniere’s disease
Answer: C 🔑 BPPV = positional, brief (seconds) vertigo.
In vestibular neuronitis, what is the typical prognosis?
Choose the correct answer
A) Permanent severe vertigo
B) Recovery only with surgery
C) Near-complete recovery over weeks via central compensatio
D) Requires long-term vestibular suppressants
Answer: C
🔑 Central compensation restores balance over weeks.
A 35-year-old man presents with severe sudden onset vertigo, nausea, and vomiting. Examination reveals unidirectional horizontal-torsional nystagmus suppressed by visual fixation, veering to the left on walking, and positive head-impulse test to the left. There is no hearing loss or tinnitus.
Which finding would suggest a central rather than peripheral cause in this patient?
Choose the correct answer
A) Positive head-impulse test
B) Nystagmus suppressed by fixation
C) Direction-changing nystagmus
D) No hearing loss
Answer: C
🔑 Direction-changing or vertical nystagmus suggests central cause.
Which of the following is true regarding the Head-Impulse Test (HIT)?
Choose the correct answer
A) A positive test indicates intact vestibulo-ocular reflex
B) It assesses cerebellar function
C) A corrective saccade indicates peripheral vestibular hypo
D) It is diagnostic for BPPV
Answer: C 🔑 Corrective saccade = abnormal HIT = peripheral vestibular lesion (e.g. neuronitis).
A patient with acute vestibular syndrome has the following HINTS findings:
Normal head-impulse test
Direction-changing nystagmus
Positive skew deviation
What is the most likely cause?
Choose the correct answer
A) Vestibular neuronitis
B) BPPV
C) Posterior circulation stroke
D) Labyrinthitis
Answer: C
🔑 HINTS central pattern (normal HIT, direction-changing nystagmus, positive skew) → stroke.
Which of the following medications should be avoided in the routine management of vestibular neuronitis?
Choose the correct answer
A) Cyclizine
B) Prochlorperazine
C) Cinnarizine
D) Diazepam
Answer: D 🔑 Benzodiazepines (e.g. diazepam) suppress central compensation and cause sedation.
A 40-year-old woman with vestibular neuronitis asks why she feels unsteady and tends to fall to the left.
Which explanation is most accurate?
Choose the correct answer
A) Damage to the cerebellum causes truncal ataxia
B) Hearing loss on the left causes imbalance
C) Left vestibular loss causes veering to that side.
D) The unaffected side is overactive, pushing her left
Answer: C 🔑 Veering towards lesion side due to asymmetrical vestibular input.
Which of the following features is characteristic of Meniere’s disease?
Choose the correct answer
A) Continuous vertigo for days with no hearing loss
B) Prolonged vertigo with low-frequency hearing and tinnitus
C) Vertigo lasting seconds triggered by positional change
D) Sudden permanent hearing loss and vertigo
Answer: B 🔑 Meniere’s triad: episodic vertigo, fluctuating hearing loss, tinnitus ± aural fullness.
A patient with vertigo, hearing loss, and vesicles in the ear canal most likely has which condition?C) Ramsay Hunt syndrome
Choose the correct answer
A) Vestibular neuronitis
B) Labyrinthitis
C) Ramsay Hunt syndrome
D) Meniere’s disease
Answer: C
🔑 Ramsay Hunt = VZV reactivation → vertigo + facial palsy + vesicles + hearing loss.
What is the main mechanism of recovery in vestibular neuronitis?
Choose the correct answer
A) Regeneration of vestibular nerve
B) Resolution of viral infection
C) Central compensation by the brain
D) Increased visual input alone
Answer: C
🔑 Recovery occurs via central compensation (brain adaptation).
Which statement is true about antivirals in vestibular neuronitis?
Choose the correct answer
A) They should be given within 48 hours
B) They accelerate vestibular nerve recovery
C) They prevent recurrent episodes
D) They are not recommended as they have no proven benefit
Answer: D
🔑 Antivirals have no role in vestibular neuronitis unless Ramsay Hunt is suspected.
A patient has vertigo with vertical nystagmus, normal HIT, and ataxia. Which investigation is most appropriate?
Choose the correct answer
A) No investigations needed
B) Dix-Hallpike manoeuvre
C) Urgent MRI brain
D) ENT referral for Epley manoeuvre
Answer: C
🔑 Central features → urgent imaging to rule out stroke or cerebellar lesion.
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