Family Nurse Practitioner Exam

What finding would support a diagnosis of benign paroxysmal positional vertigo?

1. Tinnitus

2. Horizontal nystagmus with rapid head movement

3. New onset of hearing loss

4. Duration of greater than 2 years

The correct answer is: Horizontal nystagmus with rapid head movement

The finding that supports a diagnosis of benign paroxysmal positional vertigo (BPPV) is the presence of horizontal nystagmus with rapid head movement. In BPPV, the characteristic symptom is episodic vertigo triggered by changes in head position relative to gravity, such as rolling over in bed or looking up. When the healthcare provider performs the Dix-Hallpike maneuver or similar positional tests, they may observe horizontal or torsional nystagmus occurring rapidly in response to head movements. This nystagmus typically fatigues with repetition, further confirming the diagnosis. The other options do not align with the typical presentation of BPPV. Tinnitus, commonly associated with inner ear problems but not exclusively indicative of BPPV, suggests other vestibular or auditory disorders. New onset of hearing loss is more suggestive of conditions like Meniere's disease or acoustic neuroma, rather than BPPV, which is primarily characterized by vertigo without hearing impairment. A duration of greater than 2 years would be atypical for BPPV, as the episodes are usually short-lived and episodic, with most patients reporting symptoms for less than a year.