<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 59-year-old man comes to your clinic accompanied by his wife complaining of nausea and dizziness. He reports that he is unsure when his symptoms started, but they have been affecting him for a while. It began as episodes of unsteadiness and progressed to a feeling of spinning. He cannot tell if his symptoms change with position, but reports that if he does not lie down he will become nauseous. When asked about other symptoms, his wife reports that she has also noticed the patient has worsening hearing loss. She complains that she is constantly repeating herself, especially if she speaks on his right side. The patient denies this and says that she just speaks too softly. The patients past medical history is significant for hypertension, alcoholism, and chronic obstructive pulmonary disease. His medications include aspirin, amlodipine, and fluticasone-salmeterol. He reports he drinks a glass of red wine every night with dinner and smokes a cigar on the weekends. Examination shows delayed horizontal nystagmus. Which of the following is the first-line treatment?? A: Epley maneuver, B: Low-salt diet, C: Meclizine, D: Thiamine, E: CN VIII ablation,  <response>: This is a question about treating a patient with symptoms of dizziness, nausea, and worsening hearing loss. The key details in the stem are the delayed horizontal nystagmus on exam, history of alcoholism, and worsening hearing loss. This suggests a diagnosis of Menieres disease. The first-line treatment for Menieres disease is reducing salt intake to decrease fluid accumulation in the inner ear. Meclizine can help with symptomatic relief of vertigo but does not treat the underlying cause. Epley maneuver is for treating benign paroxysmal positional vertigo. Thiamine deficiency could cause these symptoms but is less likely given the normal diet. Ablating the vestibulocochlear nerve would not be first-line.B: Low-salt diet 