Dizziness SBA ENT 15 Single Best Answer (SBA)
1. A 60-year-old woman presents with sudden onset vertigo lasting a few seconds, triggered when she turns her head to the right while lying in bed. She describes a spinning sensation that resolves within a minute. There is no hearing loss or tinnitus. What is the most likely diagnosis?
Answer: A. Benign paroxysmal positional vertigo (BPPV)
Explanation: BPPV is characterised by brief episodes of vertigo triggered by changes in head position due to dislodged otoliths in the semicircular canals.
2. A 45-year-old man experiences recurrent episodes of vertigo lasting several hours, accompanied by tinnitus and hearing loss in his left ear. What is the most likely diagnosis?
Answer: A. Ménière's disease
Explanation: Ménière's disease presents with episodes of vertigo lasting minutes to hours, along with fluctuating sensorineural hearing loss and tinnitus.
3. A patient presents with acute onset of severe vertigo, nausea, and vomiting that started suddenly two days ago and has been persistent since. There is no hearing loss or tinnitus. Examination reveals unidirectional horizontal nystagmus. What is the most likely diagnosis?
Answer: A. Vestibular neuronitis
Explanation: Vestibular neuronitis is an inflammation of the vestibular nerve, causing acute vertigo without auditory symptoms.
4. A 35-year-old woman develops sudden vertigo, nausea, vomiting, and right-sided hearing loss following an upper respiratory tract infection. What is the most likely diagnosis?
Answer: A. Labyrinthitis
Explanation: Labyrinthitis involves inflammation of the labyrinth, leading to vertigo with associated hearing loss after viral infections.
5. Which of the following features is more suggestive of central vertigo rather than peripheral vertigo?
Answer: A. Vertical nystagmus not suppressed by visual fixation
Explanation: Central vertigo often presents with vertical or multidirectional nystagmus that is not suppressed by visual fixation, indicating a central nervous system lesion.
6. A 55-year-old man with hypertension and atrial fibrillation presents with sudden onset dizziness, unsteady gait, and difficulty speaking. Examination reveals dysmetria and nystagmus. What is the most likely diagnosis?
Answer: A. Cerebellar stroke
Explanation: Cerebellar stroke causes dizziness, ataxia, dysarthria, and nystagmus, often in patients with vascular risk factors like hypertension and atrial fibrillation.
7. A 65-year-old woman experiences episodes of dizziness and unsteadiness when turning her head, associated with blurred vision. She has a history of cervical spondylosis. What is the most likely diagnosis?
Answer: A. Vertebrobasilar insufficiency
Explanation: Vertebrobasilar insufficiency is due to decreased blood flow in the vertebrobasilar circulation, causing dizziness when head movements compromise arterial flow.
8. A 28-year-old woman with a history of migraine presents with episodes of vertigo lasting several hours, accompanied by headache, photophobia, and phonophobia, but no hearing loss. What is the most likely diagnosis?
Answer: A. Vestibular migraine
Explanation: Vestibular migraine involves episodes of vertigo associated with migraine symptoms, without auditory symptoms like hearing loss.
9. A 70-year-old man feels dizzy and lightheaded upon standing up from a seated position. His blood pressure drops significantly on standing. Which of the following is the most likely cause?
Answer: A. Orthostatic hypotension
Explanation: Orthostatic hypotension is characterised by a drop in blood pressure upon standing, leading to dizziness and lightheadedness.
10. A 50-year-old woman reports a sensation of unsteadiness and dizziness described as "feeling like she's on a boat." The symptoms have persisted for months and worsen with stress. Neurological examination is normal. What is the most likely diagnosis?
Answer: A. Psychogenic dizziness
Explanation: Psychogenic dizziness presents with chronic, non-specific dizziness without neurological findings, often associated with anxiety or stress.
11. Which of the following is the first-line treatment for benign paroxysmal positional vertigo (BPPV)?
Answer: A. Epley manoeuvre
Explanation: The Epley manoeuvre is a repositioning technique to treat BPPV by moving dislodged otoliths out of the semicircular canals.
12. A patient experiences vertigo, tinnitus, and hearing loss following barotrauma during scuba diving. Which condition is most likely?
Answer: A. Perilymph fistula
Explanation: A perilymph fistula is an abnormal connection between the inner ear and middle ear, often caused by barotrauma, leading to vertigo and hearing loss.
13. Which of the following medications is most likely to cause ototoxicity leading to dizziness?
Answer: A. Gentamicin
Explanation: Aminoglycoside antibiotics like gentamicin are known to be ototoxic, affecting the vestibular apparatus and causing dizziness.
14. A 30-year-old man presents with sudden onset of vertigo, diplopia, dysarthria, and weakness on the left side of his body. MRI reveals demyelinating lesions in the brainstem. What is the most likely diagnosis?
Answer: A. Multiple sclerosis
Explanation: Multiple sclerosis can cause brainstem lesions leading to vertigo and other neurological symptoms due to demyelination.
15. Which of the following is a key differentiating feature of peripheral vertigo compared to central vertigo?
Answer: A. Hearing loss
Explanation: Peripheral vertigo is often associated with auditory symptoms like hearing loss and tinnitus, whereas central vertigo may present with severe imbalance and neurological deficits.
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