Management of Patient With Vestibular Neuronitis (VN)

Management of Patient With Vestibular Neuronitis (VN) Stephen Chiang (21209166) Rural GP Case 2GP CLINIC Presenting complaint TW is a 22 year old woman who was presented with a 3 day history of dizziness and light-headedness. History of presenting complaint Patient first experienced dizziness and light-headedness after returning from her holiday in Sydney. History of viral URTI 4 weeks ago which has been resolved. Describes the dizziness as â€Å"walking on air† and feeling unstable on her feet. Patient denies any sensation of vertigo – â€Å"head spinning† or â€Å"everything spinning†. Associated with a right- sided headache that worsens the day after. Also associated with nausea, malaise and myalgia. Denies any vomiting. Symptoms are exacerbated by changing position – getting out from bed and standing up from sitting position. Relieved by resting in a dark, quiet room. Patient denies any visual symptoms (flashes), tinnitus or deafness. No recent head injury or ingestion of any drugs – alcohol marijuana Pt went to see a physiotherapist ?vertigo but no abnormalities was detected by the physiotherapist. No nystagmus. Patient admits dizziness improved slightly with the hall-pike manoeuvre. Past Medical History Nil Medications Estelle-35 ED tablets2mg/35mcgdaily No known drug allergies Family History Nil remarkable Social History TW works as a hair stylist. Lives with her parents and siblings. Non-smoker and occasional ETOH consumption 2-3 standard drinks a week. Diet consists of take outs and fast food. Moderate physical activities. Examinations Pleasant looking young woman. Not in any obvious pain or distress. Vitals – BP 118/80, HR 80, RR 18, afebrile, no signs of anaemia. ENT – NAD on otoscope examination, no redness, swelling or discharge. Weber and Rinne test grossly intact. Optic – visual acuity 6/6 on L and R eye. No evidence of nystagmus on examination. Cardiovascular – Dual heart sound noted, nil added. No postural drop of blood pressure. Cranial nerves – olfactory sensation intact. Visual field and pupillary light reflex normal. Nil ptosis, diplopia and good accommodation. Light touch on the cheeks and forehead grossly intact. Power of muscle of mastication 5/5. Facial nerve intact and NAD. No deviations and fasciculation of tongue and uvula. Accessory muscles 5/5. Cerebellum – Normal gait, good coordination, negative dysdiadochokinesia and negative rhomberg test. Normal reflexes and no past pointing. Negative Hallpike manoeuvre. Investigations Ordered Nil Murtagh’s Diagnostic Model Management Plan 1. Viral vestibular neuronitis Reassurance and careful explanation to patient about nature of disease. Symptomatic treatment of nausea, prochlorperazine prescribed. Supportive treatment at home, bed rest and special vestibular exercises – explained by GP. Avoid movement or position that exacerbates symptoms. Return to GP if no resolution of symptoms. Follow up Patient did not represent to GP practice during my placement. Preventative Health Activities 1. Nutrition – education and advice on healthy diet plan 2. Alcohol – education on appropriate alcohol intake, early recognition or drinking problem 3. Sexual health – education for prevention of sexually transmitted infection and contraception. 4. Physical activity – encourage importance of physical activities. Clinical Evidence Base In the management of patient with vestibular neuronitis (VN), is the usage of pharmacological treatment (glucocorticoid) more effective in terms of recovery compared to supportive treatment alone. Vestibular neuronitis is defined as the dysfunction of the peripheral vestibular system with associated vertigo, nausea and vomiting.5 Hearing symptoms such as deafness and tinnitus are rarely associated with vestibular neuronitis.3 Up to today, the cause of vestibular neuronitis remains unknown hence, the main treatment options remain unclear limiting it to corticosteroids, antiviral therapy and vestibular exercises.1,4 The OneSearch UWA library database was searched and keywords used were â€Å"acute†, â€Å"vestibular neuronitis†, â€Å"corticosteroid†, â€Å"conservative treatment† and â€Å"head manoeuvre†. Other related terms were also included in the search. One study was identified, â€Å"Corticosteroid and vestibular exercises in vestibular neuronitis† by John K. Goudakos, MSc; Konstantinos D. Markou, George Psillas, Victor Vital, Miltiadis Tsaligopoulos.1 The study is single-blind randomised clinical trial measuring the recovery of 40 patients with vestibular neuronitis by using vestibular exercises vs corticosteroid at 1, 6 and 12 months.1 The 40 patients were randomised into 2 groups where one received corticosteroid therapy and the other underwent vestibular exercises for 3 weeks.1 Recovery was measured by monitoring the scores on the European Evaluation of Vertigo scale (EEV), Dizziness Handicap Inventory (DHI) and vestibular evoked myogenic potentials (VEMPs).1 Patient included in the study were: Aged 18-80 presenting with history of acute onset associated with vertigo, nausea, vomiting, postural imbalance, no hearing loss, no central lesion on neurological examination, horizontal nystagmus with rotational component, ipsilateral deficit on the head thrust test and unilateral reduced calorie response on the electronystagmography(ENG).1 Patient excluded from the study were: glaucoma, recent infection, signs of central vestibular dysfunction, history of chronic vestibular dysfunction, hearing loss and patients that are contraindicated for steroid use.1 Results: At 1 month, the EEV in both group showed an improvement with a score of 3.75 in the vestibular exercise group and 4.17 in the corticosteroid group. However (P>0.05) hence there is not significant difference between the two groups.1 At the 6 months follow up, 35% of the patient in the corticosteroid group had a complete disease resolution compared to 5% in the vestibular exercise group, (P1 At the 12 months follow up for disease resolution, 50% of patient in the corticosteroid group showed complete disease resolution and 45% of the patient in the vestibular exercise group showed disease resolution however (P>0.05) hence there was no significant difference.1 Strength and Weaknesses This study is level II based on the NHMRC. Methods of measuring outcome were clearly explained. Inclusion and exclusion criteria were well defined. Single-blinded study. No statistically significant difference in age, sex and disease onset between both groups. Small sample size of 40 patients. Method of randomisation was not defined, may include bias. Measurement of recovery did not include other factors. Tools of measurement such as VEMPs are good for diagnostic clarification but not measurement of disease. Measurement did not include clinical improvement. Application – This study showed that there is a quicker resolution of vestibular neuronitis in the short term within 6 months of corticosteroid therapy. However in the long term follow up, (12 months) the efficacy of corticosteroid therapy is similar to vestibular exercises. Further studies should be performed combining vestibular exercises with corticosteroid therapy with a larger sample size to measure efficacy. In this case, my GP did not offer corticosteroid therapy to the patient but educated the patient on vestibular exercises which corresponds to the finding above because corticosteroid therapy does not offer additional long term benefits. References 1. John K. Goudakos, MD, MSc; Konstantinos D. Markou, MD, PhD; George Psillas, MD, PhD; Victor Vital, MD, PhD; Miltiadis Tsaligopoulos, MD, PhD. Corticosteroids and Vestibular Exercises in Vestibular Neuritis Single-blind Randomized Clinical Trial.JAMA Otolaryngol Head Neck SurgeryPublished online March 6, 2014.; 140(5) pages 434-440 2. Mikael L.-Ã…. Karlberg and Mà ¥ns Magnusson. Treatment of Acute Vestibular Neuronitis With Glucocorticoids.Otology Neurotology2011; 32 pages 1140-1143 3. Keith A Marill, MD.Vestibular Neuronitis. http://emedicine.medscape.com/article/794489-overview#a5 (accessed 18 June 2015) 4. John Murtagh AM.Murtaghs General Practise, Fifth edition ed. Published in Australia: McGraw-Hill Australia Pty Ltd; This fifth edition published 2011 5. John C. Goddard MD and Jose N. Fayad MD. Vestibular Neuritis.Otolaryngologic Clinics of North America2011; 44(2)pages 361-365

The Common Theme in the Songs of Good Charlotte :: Good Charlotte Music Bands Essays

The Common Theme in the Songs of Good Charlotte There are three specific songs sung by Good Charlotte that all have a common theme. The songs are called Wondering, Emotionless, and Predictable. In all of these songs the common theme of relationships is reoccurring. There are successful and failed relationships as well as relationships with family members and girlfriends. In the song Wondering, by Good Charlotte a boy is happy that he found somebody that he can trust and wants to be around. He tells her that he is willing to wait for her and wants to be with her forever. Emotionless, is about a boy who is writing to his father who abandoned his family during his childhood. He asks him why he was never around, how they struggled to survive and that he misses him. In the song Predictable, it’s about a boy’s relationship with a girl who he loved and she turned out to break his heart. This boy becomes broken because he knew the girl was so predictable. The main theme in the three songs is having or being in a relationship. Each song is talking about a relationship with either a family member or a girlfriend. Most songs these days are written about relationships and this usually makes the song more interesting to listen to. When people write songs they usually write about their feelings or personal experiences that they have had. All of these songs were written about things that had happened to certain people in the past. Songwriters find it easier to write songs about what may be going on in there life or what may have happened in the past. To them it’s a way of expressing themselves and maybe releasing stress. Two of the songs deal with relationships with a girlfriend. In Predictable, it’s more about a girl that left a boy (this isn’t the first time, that you left me waiting. Sad excuses and false hopes high, I saw this coming, still I don’t know why, I let you in).

Gimpel the Fool Essay

Technology essay – Advantages and disadvantages of technological advances Technology has been progressing at an astonishingly rapid rhythm, and it has been changing our lives in a scaring way. In the future, our lives might change even more, with several benefits and dangers of technological advances. Everything evolves around 3 concepts: technology, science and future. So now arises the question: will this technology advance make society better or worse off? On the one hand, several benefits will make society better off. For example, advances in cosmetic surgery will lead to people being highly satisfied with their personal appearance and happiness among society will be increased. For example, people that feel ugly and can’t find a couple will now be able do it with facial metamorphosis, and they won’t be depressed anymore. In conclusion, society’s welfare and happiness will be increased by cosmetic surgery. Another example is genetically modified food. The ability to modify the food’s gens will allow crops to grow faster. This will lead to higher amounts of food being produced at lower prices. As a consequence, world’s hunger rates will be dramatically reduced, with higher nutrition rates taking place. In conclusion, genetically modified food will affect positively human hunger and nutrition rates. Lastly, human lives will also be benefited by another important technological advancement: animal clonation. Species extinction will be reduced or even stopped, as well as hunger rates to the increase in supply of food. To sum up, animal clonation will solve some of the key issues which are actually part of the world’s daily agenda. Overall, human life will be changed in a very positive way by advancements such as the mentioned before and some actual key issues won’t exist anymore. However, technology might also bring severe dangers to human life, being society’s welfare not maximized and in a very extreme case, humans might be extinct. An example of this situation is life expectancy increased to 120/130 years old. Besides this might be seen as a positive fact because we will be able to have a higher quality and longer life, increasing the life expectancy to that range of years will make more profound an actual worldwide issue: overpopulation. If humans start living until 120/130 years old and the birth rates remain constant, then overpopulation will take place, global warming will increase at a higher rate and human life will be seriously threated. In conclusion, increase life expectancy might be a danger to human life if it’s not applied properly. Another example, which is less â€Å"catastrophic† than the previous one mentioned is online education. If we look at a â€Å"hardware and internet connection timeline†, we will be able to notice that internet connection has been doubling its speed every 5 years, and hardware per capita (ie: the amount of computer/s owned by each person all over the world† has been increasing at a constant rate of 25%. This is a good fact, which also implies that online education will take place in the short term future. But isn’t this good? Research have shown that if online education would take place, students would suffer the syndrome of social isolation, which means that mental disorders would be suffered by students as a consequence of a lack of social interaction, as well as decreased happiness and welfare in society due to the unsocial students. In conclusion, besides it might increase individual productivity as students can adopt their own working patterns and practices, it represents a big problem to society. To finish off, another example is technological advancements in internet resulting in a loss of privacy. This is because there will be higher software’s available to spy other people and get into their private life, as well as the fact that the increased availability of internet in society would make all of us more interrelated. As an example, software’s will be available to steal our Facebook account or any other social network password, or if any photo is uploaded to Facebook then people might be able to see it without the publisher of the photo even knowing. In conclusion, it might be considered as a minor issue in society, but as internet and globalization has been having a remarkable growth, this danger will be more noticeable in the long term and will definitely need to be treated. In conclusion, technological advancements are always seen as a good thing but however, they might represent a real danger to society, even threatening human life to extinction. This is not because of the nature of the technological advancements, but because of its over use or misuse by society, and all the dangers these advancements generate could be easily reduced or removed with government intervention and a market that would automatically stop or reduce its consumption because it brings dangers among its consumers.

You Are The Boss. Mian Mao. Mian Mao Is A Senior Majoring

You are the Boss Mian Mao Mian Mao is a senior majoring in Interior Design, and now part-time working in College of Business as a peer recruiter for 19 hours per week. Mian’s major jobs are leading tours consisting with 3 to 10 forthcoming new students around Austin Hall and especial dormitories for COB students, and inserting data into the computer and sorting materials into files. According to Mian’s description, Mian enjoys and satisfies her working environment and atmosphere as friendly coworkers and accommodating supervisor. The reason of choosing this job for Mian is that there are opportunities to communicate with different people and to improve her oral ability, which accords with Goal Setting Theory. In addition, the motivation†¦show more content†¦Mian said that once she did not finish the work of that day, she must take the job back to home and catch up the whole progress. Lastly, Mian has already reached her goal commitment for both job characteristic and work perfo rmance. Niggy Lee Niggy Lee is now working in ErnestYoung as an audit, one of the â€Å"Big Four† audit firms. Actually, audit is one of my dream jobs, and Niggy shares her career experience and advices to me. Niggy now is a senior manager who works with 10 people in the team. As Niggy’s description, she always works more than 75 hours per week in the peak season. The busy and massive work often frustrates her to intend resign for several times. At the same time, this job provides Niggy satisfied income and opportunities to achieve her primary objective. Niggy explains that she continues to work in Ernest Young as result of straightforward promotion mechanism which motives her greatly. Niggy’s major in college was engineering. During the vacation, Niggy worked in a bank as an intern and began to be interested in finance. After she got bachelor degree, she worked in a technology startup company as an entry-level employee, and then she lacked interest in this occupational area. Moreover, Niggy’s parents perused her to work in a stable and promising field and company. Hence, Niggy decided to study accountancy in the master program. Because of Niggy’s own expectation and self-efficacy, she can exert a high