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BPPV — RACP Adult Medicine MCQ

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EasyNeurologyBPPVRACP Adult Medicine

A 50-year-old man presents with brief episodes (seconds) of vertigo triggered by rolling over in bed or looking up. Dix-Hallpike test is positive on the right with rotatory upbeat nystagmus with latency, crescendo-decrescendo pattern, and fatiguability. No hearing loss. What is the most likely diagnosis?

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Correct answer: B — Benign paroxysmal positional vertigo

Brief positional vertigo triggered by specific head positions with classic positive Dix-Hallpike (latency, crescendo-decrescendo, fatiguability, rotatory nystagmus) is posterior canal BPPV. Caused by otoconia displacement into the semicircular canal. Treatment is the Epley manoeuvre (canalith repositioning), which is curative in >80% with a single treatment.

Reference: eTG Neurology – 2024 – BPPV; AAN 2024 BPPV Guidelines