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Benign paroxysmal positional vertigo — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareBenign paroxysmal positional vertigoUSMLE Step 3

A 63-year-old woman has brief episodes of vertigo when rolling over in bed. Each episode lasts less than 1 minute and is associated with nausea but no hearing loss, headache, weakness, or diplopia. Dix-Hallpike testing provokes vertigo with torsional nystagmus. Which of the following is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Perform a canalith repositioning maneuver

Posterior canal BPPV is treated with canalith repositioning; neuroimaging is reserved for central neurologic signs.

Reference: American Academy of Otolaryngology BPPV guideline: https://www.entnet.org/