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Benign paroxysmal positional vertigo — MCCQE Part 1 MCQ

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ModerateDizziness/VertigoBenign paroxysmal positional vertigoMCCQE Part 1

A 58-year-old woman has brief spinning vertigo triggered by rolling over in bed. Dix-Hallpike manoeuvre produces delayed torsional nystagmus lasting 20 seconds; neurological examination is normal. Which of the following is the most appropriate management?

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Correct answer: A — Perform canalith repositioning manoeuvre such as the Epley manoeuvre

Brief positional vertigo with fatigable torsional nystagmus is posterior canal BPPV, best treated with canalith repositioning. Vestibular suppressants may worsen compensation and are not definitive. Stroke assessment is needed for central signs, but this vignette has classic peripheral features.

Reference: Canadian primary care vertigo pathways; Choosing Wisely Canada otolaryngology