Vertigo in the ED

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Question 1 of 10

1. Question
Which of these statements best describes vertigo?
- Sensation of body tipping
- Sensation of body rocking
- Sensation of the room spinning
- Sensation of body somersaulting
- All of the above
Question 2 of 10

2. Question
Concerning the pathophysiology of vertigo, which is the most accurate statement?
- Benign paroxysmal positional vertigo (BPPV) is most commonly due to the presence of canaliths in the anterior semicircular canal, and can be treated with the Epley manoeuvre
- Vestibular neuritis is often associated with post-viral hearing loss, or tinnitus
- Vertigo is an early feature of acoustic neuroma (vestibular schwannoma) because of the dysfunction of the vestibular nerve and expansion in the cerebellar pontine angle
- Isolated vertigo is a feature of central cerebellar infarction and can be a presenting feature of multiple sclerosis
- Meniere’s disease is caused by endolymphatic hydrops (dilated labyrinth) and results in slowly-progressive, unilateral hearing loss
Question 3 of 10

3. Question
A patient presents to the ED with vertigo. You consider central and peripheral causes of the vertigo. Which one of the following clinical features most favours a peripheral cause for the patient’s symptoms?
- Insidious onset of symptoms
- The presence of vertical nystagmus
- Profound nausea and vomiting
- Fatiguable nystagmus
- Limb ataxia
Question 4 of 10

4. Question
In a patient presenting with attacks of vertigo that become worse when the patient moves, which one of the following features would most favour a diagnosis of benign paroxysmal positional vertigo?
- Gradual onset and prolonged attacks of vertigo
- Witnessed nystagmus is typically bilateral and vertical
- Worse when turning in bed
- Persistent nystagmus precipitated by the Dix-Hallpike manoeuvre and relieved on sitting back up
- Inability to walk during attacks
Question 5 of 10

5. Question
Regarding the diagnosis and investigation of vertigo, which of the following statements is most accurate?
- In BPPV, symptoms are most likely with the Dix-Hallpike manoeuvre when the head is turned away from the affected side
- Mild vertigo, tinnitus and the absence of a corneal reflex favours a diagnosis of acoustic neuroma
- Attacks of vertigo from vestibular neuritis typically last for a few hours
- Stroke will be the diagnosis in 2-4% of patients over the age of 45 presenting with isolated dizziness or vertigo
- Suspected central causes of hearing loss and vertigo are best investigated with an audiogram and CT
Question 6 of 10

6. Question
A patient with BPPV is treated with the Epley (canalith repositioning) manoeuvre. Regarding this treatment, which of the following is false?
- The procedure is curative in more than 50% of patients
- The procedure works best in patients with a positive Dix-Hallpike test
- The procedure is less effective than conventional drug therapy
- The procedure may be more effective if repeated
- The procedure should start with the affected ear down most
Question 7 of 10

7. Question
Regarding treatments for vertigo, which statement is most accurate:
- Diazepam may be used as an alternative to Prochlorperazine
- There is no proven benefit from the use of corticosteroids in patients with vestibular neuritis
- Vestibular rehabilitation therapies have yet to be proven in randomised clinical trials
- Bed rest should be advised until symptoms have largely settled
- Vestibular suppressants may be required for some weeks to treat labyrinthitis
Question 8 of 10

8. Question
Concerning advice on the recovery from vertigo, which is the most accurate statement?
- Vestibular exercises are an old but effective approach for treating chronic vertigo
- Vestibular-suppressant drugs are effective for chronic vertigo
- Specialist physical therapy is required for vestibular rehabilitation
- Betahistine has been shown in trials to reduce the rate of hearing loss in Meniere’s disease
- Antiviral agents are of benefit in patients with post-viral vestibular neuritis
Question 9 of 10

9. Question
Concerning the misdiagnosis of vertigo, which of the following is the least accurate statement?
- Most cases of dizziness are not due to vertigo
- Central Cerebellar infarction may be diagnosed as vestibular neuritis
- Vertigo, due to brainstem infarction, is difficult to diagnose and high-risk patients should undergo CT before considering discharge
- Acute attacks of vertigo from vestibular neuritis usually last only a few days
- Head injury may be the cause of BPPV
Question 10 of 10

10. Question
When suspecting a central cause of vertigo, which of the statements is true?
- Isolated vertigo without ataxia does not occur with cerebellar infarction
- Vertigo occurs in the majority of patients with multiple sclerosis due to CNS demyelination
- Vertigo is not familial
- Brainstem infarction may be associated with vertigo and contralateral loss of truncal pain and temperature sensation
- Lateral medullary (Wallenberg’s) syndrome is not seen following neck trauma

Vertigo in the ED

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