Mastering the Dizzy Patient: iHuman Virtual Encounter
with Sheila Davis (68 y/o). Comprehensive Guide to
Differential Diagnosis, Orthostatic Hypotension
Assessment, and Epley Maneuver Execution for Posterior
Canal BPPV | 2026/2027
,
, TABLE OF CONTENTS
1. Case Overview & Problem Statement
2. Patient Demographics & Vitals
3. Chief Complaint & History of Presenting Illness (HPI)
4. OLD CARTS Framework – Complete HPI Analysis
5. Recommended Interview Questions & Rationale
6. Past Medical History (PMH)
7. Past Surgical History
8. Medications
9. Allergies
10. Family History
11. Social History
12. Review of Systems (ROS)
13. Physical Examination
14. Neurological Examination
15. Vestibular & Positional Testing – Dix-Hallpike Maneuver
16. HINTS Examination
17. Diagnostic Workup & Laboratory Interpretation
18. Differential Diagnosis
19. Peripheral vs. Central Causes of Dizziness – Comparative Table
20. Final Diagnosis
21. Pathophysiology of BPPV
22. Treatment & Management Plan
23. Epley Maneuver – Step-by-Step Procedure
24. Patient Education & Counseling
25. Follow-Up & Monitoring Plan
, 26. SOAP Note (Complete)
27. Clinical Reasoning & Decision-Making
28. Geriatric Considerations in Dizziness
29. Red Flags & Emergency Signs
30. Pharmacology Considerations
31. Common Pitfalls & Misdiagnosis
32. Evidence-Based Practice Guidelines
33. Practice Questions & Answers
34. Key Takeaways
35. References
SECTION 1: CASE OVERVIEW & PROBLEM STATEMENT
Patient: Sheila Davis, 68-year-old female
Reason for Encounter: Dizziness
Setting: Outpatient clinic with laboratory capabilities
Clinical Problem: Sheila presents with a new episode of dizziness. In an older adult,
dizziness requires a structured assessment because it may result from a benign vestibular
disorder, medication effect, dehydration, orthostatic hypotension, cardiovascular disease,
metabolic abnormalities, or a potentially serious neurologic process.
The first clinical task is to characterize what the patient means by "dizziness":
• Vertigo: Sensation of spinning or movement
• Presyncope: Sensation of impending fainting
• Disequilibrium: Sensation of unsteadiness or imbalance
• Lightheadedness: Nonspecific feeling of being "woozy"
Key Pattern Recognition: The dizziness is triggered + positional + brief + spinning.
This pattern strongly raises suspicion for a peripheral vestibular cause, particularly Benign
Paroxysmal Positional Vertigo (BPPV).
Main Problem (1–2 clear sentences): Differential diagnosis of complex geriatric
dizziness involving vestibular, cardiovascular, and neurological etiologies. Misdiagnosis
risks catastrophic falls and unmanaged systemic pathology.
SECTION 2: PATIENT DEMOGRAPHICS & VITALS
with Sheila Davis (68 y/o). Comprehensive Guide to
Differential Diagnosis, Orthostatic Hypotension
Assessment, and Epley Maneuver Execution for Posterior
Canal BPPV | 2026/2027
,
, TABLE OF CONTENTS
1. Case Overview & Problem Statement
2. Patient Demographics & Vitals
3. Chief Complaint & History of Presenting Illness (HPI)
4. OLD CARTS Framework – Complete HPI Analysis
5. Recommended Interview Questions & Rationale
6. Past Medical History (PMH)
7. Past Surgical History
8. Medications
9. Allergies
10. Family History
11. Social History
12. Review of Systems (ROS)
13. Physical Examination
14. Neurological Examination
15. Vestibular & Positional Testing – Dix-Hallpike Maneuver
16. HINTS Examination
17. Diagnostic Workup & Laboratory Interpretation
18. Differential Diagnosis
19. Peripheral vs. Central Causes of Dizziness – Comparative Table
20. Final Diagnosis
21. Pathophysiology of BPPV
22. Treatment & Management Plan
23. Epley Maneuver – Step-by-Step Procedure
24. Patient Education & Counseling
25. Follow-Up & Monitoring Plan
, 26. SOAP Note (Complete)
27. Clinical Reasoning & Decision-Making
28. Geriatric Considerations in Dizziness
29. Red Flags & Emergency Signs
30. Pharmacology Considerations
31. Common Pitfalls & Misdiagnosis
32. Evidence-Based Practice Guidelines
33. Practice Questions & Answers
34. Key Takeaways
35. References
SECTION 1: CASE OVERVIEW & PROBLEM STATEMENT
Patient: Sheila Davis, 68-year-old female
Reason for Encounter: Dizziness
Setting: Outpatient clinic with laboratory capabilities
Clinical Problem: Sheila presents with a new episode of dizziness. In an older adult,
dizziness requires a structured assessment because it may result from a benign vestibular
disorder, medication effect, dehydration, orthostatic hypotension, cardiovascular disease,
metabolic abnormalities, or a potentially serious neurologic process.
The first clinical task is to characterize what the patient means by "dizziness":
• Vertigo: Sensation of spinning or movement
• Presyncope: Sensation of impending fainting
• Disequilibrium: Sensation of unsteadiness or imbalance
• Lightheadedness: Nonspecific feeling of being "woozy"
Key Pattern Recognition: The dizziness is triggered + positional + brief + spinning.
This pattern strongly raises suspicion for a peripheral vestibular cause, particularly Benign
Paroxysmal Positional Vertigo (BPPV).
Main Problem (1–2 clear sentences): Differential diagnosis of complex geriatric
dizziness involving vestibular, cardiovascular, and neurological etiologies. Misdiagnosis
risks catastrophic falls and unmanaged systemic pathology.
SECTION 2: PATIENT DEMOGRAPHICS & VITALS
