WBR1080

Author	PageAuthor::Chetan Lokhande
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Head and Neck, SubCategory::Neurology
Prompt	[[Prompt::A 50-year-old man comes to your office with complaints of dizziness only while turning his head left or right. He noticed that it happens when he is looking on the sides while driving. It stays only for 10 seconds and disappears when he looks again in the front. The patient reports no hearing loss, tinnitus and ataxia. What maneuver fixes this condition ?]]
Answer A	AnswerA::Cold caloric
Answer A Explanation	AnswerAExp::Cold caloric is commonly used by physicians, audiologists and other trained professionals to validate a diagnosis of asymmetric function in the peripheral vestibular system. It provides no relief in patients of BPPV.
Answer B	AnswerB::Dix hallpike
Answer B Explanation	[[AnswerBExp::Dix hallpike maneuver is the test used to diagnose BPPV. The Dix–Hallpike test is performed with the patient sitting upright with the legs extended. The patient's head is then rotated by approximately 45 degrees. The clinician helps the patient to lie down backwards quickly with the head held in approximately 20 degrees of extension. This extension may either be achieved by having the clinician supporting the head as it hangs off the table or by placing a pillow under their upper back. The patient's eyes are then observed for about 45 seconds as there is a characteristic 5–10 second period of latency prior to the onset of nystagmus. If rotational nystagmus occurs then the test is considered positive for benign positional vertigo. During a positive test, the fast phase of the rotatory nystagmus is toward the affected ear, which is the ear closest to the ground. The direction of the fast phase is defined by the rotation of the top of the eye, either clockwise or counter-clockwise. Home devices are available to assist in the performance of the Dix–Hallpike Maneuver for patients with a diagnosis of BPPV.]]
Answer C	AnswerC::Cold then Hot calorie
Answer C Explanation	AnswerCExp::Cold and Hot calorie are commonly used by physicians, audiologists and other trained professionals to validate a diagnosis of asymmetric function in the peripheral vestibular system . It is used to diagnose nystagmus.
Answer D	AnswerD::Epley
Answer D Explanation	[[AnswerDExp::The Epley maneuver or repositioning maneuver is a maneuver used to treat benign paroxysmal positional vertigo (BPPV) of the posterior or anterior canals. Free floating particles from the affected semicircular canal are relocated, using gravity, back into the utricle, where they can no longer stimulate the cupula, therefore relieving the patient of bothersome vertigo. It is often performed by a medical doctor, doctor of chiropractic, occupational therapist, audiologist or physical therapist, after confirmation of a diagnosis of BPPV using the Dix-Hallpike test and has a reported success rate of between 90–95%. This maneuver was developed by Dr. John Epley and first described in 1980. Physiotherapists and some chiropractors now use a version of the maneuver called the "modified" Epley that does not include vibrations of the mastoid process originally indicated by Epley, as they have since been shown not to improve the efficacy of the treatment.]]
Answer E	AnswerE::Barlow’s
Answer E Explanation	[[AnswerEExp::The Barlow maneuver is a physical examination performed on infants to screen for developmental dysplasia of the hip. It is named for T. G. Barlow, an English pediatrician, who devised this test; it was clinically tested during 1957–1962 at Hope Hospital Salford, Manchester.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::The treatment of choice for this condition is the Epley canalith repositional maneuver which is effective in approximately 80% of patients. The treatment employs gravity to move the calcium build-up that causes the condition). The particle repositioning maneuver (Epley Maneuver) can be performed during a clinic visit by specially trained otolaryngologists, neurologists, chiropractors, physical therapists, or audiologists. The maneuver is relatively simple but few general health practitioners know how to perform it. Treatment may also be achieved with the use of a device such as "The DizzyFIX", a device that enables patients and health practitioners to guide themselves through the particle repositioning maneuver. The maneuver can be conducted at home and repeated as often as needed. Other devices, such as a head over heels "rotational chair", are also available at some tertiary care centers .The Epley maneuver (particle repositioning) does not address the actual presence of the particles (otoconia), rather it changes their location. The maneuver moves these particles from areas in the inner ear which cause symptoms, such as vertigo, and repositions them into areas where they do not cause these problems. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Epley, WBRKeyword::Dix hallpike, WBRKeyword::BPPV
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::