{"id":2769,"date":"2022-09-28T13:13:00","date_gmt":"2022-09-28T13:13:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=2769"},"modified":"2025-10-01T11:40:33","modified_gmt":"2025-10-01T19:40:33","slug":"usmle-step-1-question-of-the-day-meniere-disease","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-meniere-disease","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Meniere Disease"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-meniere-disease\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-meniere-disease\/#C_Meniere_disease\" >C. Meniere disease&nbsp;<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-meniere-disease\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-meniere-disease\/#A_Benign_paroxysmal_positional_vertigo\" >A. Benign paroxysmal positional vertigo<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-meniere-disease\/#B_Otosclerosis\" >B. Otosclerosis<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-meniere-disease\/#D_Labrynthitis\" >D. Labrynthitis<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-meniere-disease\/#E_Presbycusis\" >E. Presbycusis<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-meniere-disease\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-meniere-disease\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-meniere-disease\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;<\/em><\/strong><strong><em>Today&#8217;s case focuses on a 37-year-old woman who has had multiple episodes of dizziness lasting between 20 minutes to several hours. These episodes are associated with ringing in the left ear.&nbsp;<\/em><\/strong><strong><em>Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 37-year-old woman comes to her primary care physician for evaluation of dizziness and hearing loss. The patient has had multiple episodes of dizziness lasting between 20 minutes to several hours. These episodes are associated with ringing in the left ear. The patient states, \u201cThese episodes are so debilitating I have to lie in bed until they are over. Sometimes the spinning sensation is so intense that I vomit.\u201d Past medical history is noncontributory. She has not had any recent bacterial or viral infections. Vital signs are within normal limits, and physical examination reveals no significant findings. Audiometric testing demonstrates low-mid frequency hearing loss in the left ear. Hearing in the right ear is normal. Which of the following is the most likely diagnosis?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Benign paroxysmal positional vertigo<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Otosclerosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Meniere disease<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Labrynthitis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Presbycusis<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\/do?source_cta=navbar\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/lets-get-visual-banner.png?w=700\" alt=\"\" class=\"wp-image-263\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/lets-get-visual-banner.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/lets-get-visual-banner.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Meniere_disease\"><\/span>C. Meniere disease&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Benign_paroxysmal_positional_vertigo\"><\/span>A. Benign paroxysmal positional vertigo<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Benign paroxysmal positional vertigo arises from calcium crystals, known as otoconia or otoliths, that become dislodged from their usual position within the utricle. Over time, the otoliths migrate into the semicircular canals and can cause vertigo triggered by changes in position. However, the condition would not lead to hearing loss.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Otosclerosis\"><\/span>B. Otosclerosis<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Otosclerosis is characterized by bony remodeling and overgrowth of the middle ear ossicles. The footplate of the stapes is most commonly affected. The condition presents with low-frequency conductive hearing loss. Otosclerosis would not typically present with the vertigo experienced by this patient.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Labrynthitis\"><\/span>D. Labrynthitis<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Labrynthitis, also known as vestibular neuritis, is caused by inflammation of the inner ear structures. The condition manifests with intermittent vertigo, hearing loss, and loss of coordination. However, labrynthitis typically occurs in the setting of an active or recent upper respiratory tract infection.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Presbycusis\"><\/span>E. Presbycusis<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Presbycusis is an age-related condition characterized by bilateral, high-frequency sensorineural hearing loss. However, presbycusis would not account for the episodes of vertigo experienced by this patient.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents with episodes of vertigo, tinnitus, and low-mid frequency hearing loss. These findings are most consistent with Meniere disease.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Meniere disease is an inner ear disorder characterized by episodic attacks of vertigo, tinnitus, ear fullness, and hearing loss. Individual episodes can last anywhere from twenty minutes to 24 hours. The disease typically occurs in adults between the ages of 30 and 60. Meniere disease arises due to impaired reabsorption of endolymph fluid. Overtime, the fluid accumulates and causes distention of the semicircular canals; this phenomenon is termed endolymphatic hydrops.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ultimately, these changes impair proper signaling through the labyrinthine system, causing disequilibrium, vertigo, sensorineural hearing loss, tinnitus, as well as a sensation of ear fullness. Meniere disease is primarily a clinical diagnosis. Patients should also undergo audiometric testing to evaluate for low-mid frequency sensorineural hearing loss.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Treatment of Meniere disease aims to decrease the volume of the endolymphatic fluid. This can be done by limiting the intake of salt, caffeine, alcohol, and nicotine. If symptoms persist, diuretics (e.g., hydrochlorothiazide, acetazolamide) can be used. In severe, disabling cases, surgical options (e.g., labyrinthectomy, vestibular neurectomy) can be considered.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Meniere disease is due to impaired reabsorption of endolymph fluid. The condition can manifest with vertigo, sensorineural hearing loss, and tinnitus. Treatment options include dietary modifications, diuretics, and in severe cases, surgery.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span><strong>References<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Espinosa-Sanchez, J.M., Lopez-Escamez, J.A. (2016)&nbsp;<em>Meniere&#8217;s disease. Handbook of Clinical Neurology<\/em>. 137, 257-277. Doi: 10.1016\/B978-0-444-63437-5.00019-4.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Sajjadi, H., Paparella, M.M. (2008)&nbsp;<em>Meniere&#8217;s disease. Lancet.&nbsp;<\/em>372(9636), 406-414. Doi: 10.1016\/S0140-6736(08)61161-7.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 37-year-old woman who has had multiple episodes of dizziness lasting between 20 minutes to several hours. These episodes are associated with ringing in the left ear.&nbsp;Can you figure it out? A 37-year-old woman [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":2770,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,20,1369,44],"tags":[],"class_list":["post-2769","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-1-questions","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Meniere Disease - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-meniere-disease\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Meniere Disease - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 37-year-old woman who has had multiple episodes of dizziness lasting between 20 minutes to several hours. These episodes are associated with ringing in the left ear.&nbsp;Can you figure it out? 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