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
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Sensation of body rocking
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Sensation of the room spinning
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Sensation of body somersaulting
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All of the above
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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.
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Vestibular neuritis is often associated with post-viral hearing loss, or tinnitus.
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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.
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Isolated vertigo can be a feature of central cerebellar infarction and can be a presenting feature of multiple sclerosis.
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Meniere’s disease is caused by endolymphatic hydrops (dilated labyrinth) and results in slowly-progressive, unilateral hearing loss.
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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
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The presence of vertical nystagmus
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Profound nausea and vomiting
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Fatiguable nystagmus
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Limb ataxia
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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
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Witnessed nystagmus is typically bilateral and vertical
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Worse when turning in bed
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Persistent nystagmus precipitated by the Dix-Hallpike manoeuvre and relieved on sitting back up
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Inability to walk during attacks
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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
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Mild vertigo, tinnitus and the absence of a corneal reflex favours a diagnosis of acoustic neuroma
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Attacks of vertigo from vestibular neuritis typically last for a few hours
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Stroke will be the diagnosis in 2-4% of patients over the age of 45 presenting with isolated dizziness or vertigo
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Suspected central causes of hearing loss and vertigo are best investigated with an audiogram and CT
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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
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The procedure works best in patients with a positive Dix-Hallpike test
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The procedure is less effective than conventional drug therapy
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The procedure may be more effective if repeated
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The procedure should start with the affected ear down most
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Question 7 of 10

7. Question

Regarding treatments for vertigo, which statement is most accurate:

Diazepam is less effective for treatment of acute vertigo than antihistamines.
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There is no proven benefit from the use of corticosteroids in patients with vestibular neuritis.
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Vestibular rehabilitation therapies have yet to be proven in randomised clinical trials.
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Bed rest should be advised until symptoms have largely settled.
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Vestibular suppressants may be required for some weeks to treat labyrinthitis.
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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
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Vestibular-suppressant drugs are effective for chronic vertigo
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Specialist physical therapy is required for vestibular rehabilitation
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Betahistine has been shown in trials to reduce the rate of hearing loss in Meniere’s disease
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Antiviral agents are of benefit in patients with post-viral vestibular neuritis
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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.
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Central Cerebellar infarction may be diagnosed as vestibular neuritis.
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Vertigo, due to brainstem infarction, is difficult to diagnose and high-risk patients should undergo neuroimaging..
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Acute attacks of vertigo from vestibular neuritis usually last only a few days.
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Head injury may be the cause of BPPV.
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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
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Vertigo occurs in the majority of patients with multiple sclerosis due to CNS demyelination
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Vertigo is not familial
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Brainstem infarction may be associated with vertigo and contralateral loss of truncal pain and temperature sensation
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Lateral medullary (Wallenberg’s) syndrome is not seen following neck trauma
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