CONFIDENTIAL

PART 1

15 minutes

A 65-year-old woman presents with a chief complaint of dizziness. She describes it as a sudden and
severe spinning sensation precipitated by rolling over in bed onto her right side.
(a) Enumerate four possible (4) differential diagnosis for dizziness.
1. _________________________________________________________________________
2. _________________________________________________________________________
3. _________________________________________________________________________
4. _________________________________________________________________________
(b) Enumerate four (4) differential diagnosis. [4 marks]
1. _________________________________________________________________________
2. _________________________________________________________________________
3. _________________________________________________________________________
4. _________________________________________________________________________
(c) Enumerate eight (8) additional history that you would like to elicit from this patient. [8 marks]
History

Justifications

1
2
3
4
5
6
7
8

PART 2

10 minutes

A 65-year-old woman presents with a chief complaint of dizziness. She describes it as a sudden and
severe spinning sensation precipitated by rolling over in bed onto her right side. Symptoms typically
last <30 seconds. They have occurred nightly over the last month and occasionally during the day
when she tilts her head back to look upwards. She describes no precipitating event prior to onset and
no associated hearing loss, tinnitus, or other neurological symptoms.
(d) Complete the Table 1 below tabulating the differences between peripheral or central vertigo?

Turn overleaf]

CONFIDENTIAL
[5 marks]
(e) The following are the differential diagnosis of peripheral vertigo. Explain briefly the
pathophysiology of each of the diagnosis stated below.
Cause

Pathophysiology

BPPV
VN/L
Meniere disease
Posttraumatic vertigo
Perilymph fistula
Acoustic neuroma
[6 marks]

PART C

6 minutes

(f) Otological and neurological examinations are normal except for the Dix-Hallpike manoeuvre,
which is negative on the left but strongly positive on the right side.

Turn overleaf]

CONFIDENTIAL

Figure 1
With the aid of the diagram above, describe in detail how you would perform Dix-Hallpike
manoeuvre and the reasons behind each step. [5 marks]
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
PART D

10 minutes

(g) State four (4) expected findings on the Dix-Hallpike Test in Patients with Benign Paroxysmal
Positional Vertigo.
1. _________________________________________________________________________

Turn overleaf]

CONFIDENTIAL
2. _________________________________________________________________________
3. _________________________________________________________________________
4. _________________________________________________________________________
(h) A repositioning manoeuvre as shown in Figure 2 was done. What is the manoeuvre shown
below? Explain in detail how is this manoeuvre is carried out.

Name of manoeuvre: __________________________________________________________

Procedure
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
[5 marks]

PART E

7 minutes

(i) The diagnosis of BPPV is confirmed. What further investigation would you like to carry out
in this patient. Justify.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Turn overleaf]

CONFIDENTIAL
___________________________________________________________________________
___________________________________________________________________________
[3 marks]
(j) Describe the principles of management in this patient?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
[5 marks]
(k) Enumerate five (5) causes of central vertigo.
1. _________________________________________________________________________
2. _________________________________________________________________________
3. _________________________________________________________________________
4. _________________________________________________________________________
5. _________________________________________________________________________
[5 marks]
END OF QUESTION PAPER

Turn overleaf]