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Benign paroxysmal positional vertigo — MCCQE Part 1 MCQ

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ModerateDizziness/VertigoBenign paroxysmal positional vertigoMCCQE Part 1

60-year-old woman presents with brief spinning vertigo when rolling in bed. Dix-Hallpike provokes torsional nystagmus lasting under a minute. Which of the following is the most appropriate next step?

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Correct answer: E — Perform canalith repositioning manoeuvre

Perform canalith repositioning manoeuvre is best because positional brief vertigo with fatigable torsional nystagmus is posterior-canal BPPV. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Vestibular suppressants do not correct BPPV and may prolong imbalance.

Reference: Canadian otolaryngology guidance