Peripheral Vertigo

1. A 32-year-old lady presents withepisodes of vertigo that come on at random. These 'dizzy spells' last for a fewminutes to hours, and during this time she also experiences difficulty hearingand ringing in her ear. What is the most likely diagnosis?

2. Which one of the following medicationsis most useful for helping to prevent attacks of Meniere's disease?

3.A 34-year-old woman presents to the emergency department with two days of sudden onset, severe vertigo. She has a productive cough, sore throat,bilateral rhinorrhoea, as well as nausea, vomiting and loss of appetite.Although her hearing is unaffected, she feels generally weak and has passed minimal urine in the past 12 hours.She has a history of migraines and recurrent urinary tract infections.Three weeks ago, she returned from a holiday in Jamaica.On examination, she appears generally unwell, has weak peripheral pulses, bilateral cervical lymphadenopathy, and nystagmus. Basic observations are temperature 38ºC, heart rate 119 beats per minute and respiratory rate 23 breaths per minute.What is the most likely diagnosis?

4. Which one of the following isleast recognised in patients with Meniere's disease

5. A 35-year-old man presents to the GP with episodes of dizziness which started 2 weeks ago. These episodes come about at random, however, they are exacerbated when he changes the position of his head. His last episode of dizziness was particularly uncomfortable as it lasted longer than a day. He also reports nausea and vomiting. Following a cranial nerve examination, the GP notes horizontal nystagmus. The patient denies any aural symptoms such as tinnitus. When asked about his general health, the patient reports that he had a viral upper respiratory tract infection last week.

6. A 55-year-old man presents to his general practitioner with reports of recurrent episodes of the room spinning. He has no past medical history. He denies hearing loss or aural fullness. The patient experiences this commonly when he is in bed and each episode lasts 10-20 seconds. This has been ongoing for months and was preceded by an upper respiratory tract infection. He is well in between episodes.The examination is unremarkable.What is the likely diagnosis?

7.A 38-year-old woman presents to her GP with severe dizziness. She experienced nausea and vomited three times over the past 24 hours. She also had a mild viral infection last week which has since resolved. When asked, the patient reported no associated tinnitus or hearing loss.What is the first-line option to manage her dizziness?

8.A 55-year-old woman presents with a 3-day history of continuous double-vision and vertigo. Her symptoms began with a severe episode of the room spinning followed by associated nausea and vomiting. Recently, she has also noticed left, high-pitched ringing. Her only past medical history includes an upper respiratory tract infection 1 week ago and migraines. She denies any headaches,numbness, or weakness.Weber's test lateralises to the right ear, and Rinne's test is positive(air conduction louder than bone conduction) in both ears. Horizontal nystagmus is seen in both eyes.What is the most likely diagnosis?

9.A 59-year-old man presents with recurrent attacks of vertigo and dizziness.These attacks are often precipitated by a change in head position and typically last around half a minute. Examination of the cranial nerves and ears is unremarkable. His blood pressure is 120/78 mmHg sitting and 116/76 mmHg standing. Given the likely diagnosis, what is the most appropriate next step to help confirm the diagnosis?

10.A 57-year-old man presents to the GP with sudden-onset dizziness which has now lasted for 2 days. He is also experiencing nausea and vomiting and nothing has seemed to relieve the dizziness so far. On further questioning, he does mention feeling unwell with a cold last week. He denies any changes to his hearing. On examination, you note horizontal nystagmus. He has a past medical history of type 2 diabetes mellitus and hypercholesterolemia and takes metformin, empagliflozin, and atorvastatin. What test could be used to rule out a more concerning underlying diagnosis?