ACTUAL IHUMAN CASE STUDY. SHEILA DAVIS, 68-YEAR-OLD.
REASON FOR ENCOUNTER: DIZZINESS. EXAM STUDY GUIDE.
GRADED A+. LATEST 2026/2027 UPDATE.
, 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. Past Medical History (PMH)
6. Past Surgical History
7. Medications
8. Allergies
9. Family History
10. Social History
11. Review of Systems (ROS)
12. Physical Examination
13. Neurological Examination
14. Vestibular & Positional Testing – Dix-Hallpike Maneuver
15. Diagnostic Workup & Laboratory Interpretation
16. Differential Diagnosis
17. Peripheral vs. Central Causes of Dizziness – Comparative Table
18. Final Diagnosis
19. Pathophysiology of BPPV
20. Treatment & Management Plan
21. Epley Maneuver – Step-by-Step Procedure
22. Patient Education & Counseling
23. Follow-Up & Monitoring Plan
24. SOAP Note (Complete)
25. Clinical Reasoning & Decision-Making
26. Geriatric Considerations in Dizziness
27. Red Flags & Emergency Signs
28. Pharmacology Considerations
29. Common Pitfalls & Misdiagnosis
30. Evidence-Based Practice Guidelines
31. Practice Questions & Answers
32. Key Takeaways
33. 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
Attribute Details
Patient Name Sheila Davis
Age 68 years
Gender Female
Race Caucasian
Occupation Retired school teacher (retired 3 years ago)
Height 5'2" (157 cm)
Weight 150.0 lb (68.2 kg)
BMI 27.4 kg/m² (overweight)
Setting Outpatient clinic with laboratory capabilities
REASON FOR ENCOUNTER: DIZZINESS. EXAM STUDY GUIDE.
GRADED A+. LATEST 2026/2027 UPDATE.
, 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. Past Medical History (PMH)
6. Past Surgical History
7. Medications
8. Allergies
9. Family History
10. Social History
11. Review of Systems (ROS)
12. Physical Examination
13. Neurological Examination
14. Vestibular & Positional Testing – Dix-Hallpike Maneuver
15. Diagnostic Workup & Laboratory Interpretation
16. Differential Diagnosis
17. Peripheral vs. Central Causes of Dizziness – Comparative Table
18. Final Diagnosis
19. Pathophysiology of BPPV
20. Treatment & Management Plan
21. Epley Maneuver – Step-by-Step Procedure
22. Patient Education & Counseling
23. Follow-Up & Monitoring Plan
24. SOAP Note (Complete)
25. Clinical Reasoning & Decision-Making
26. Geriatric Considerations in Dizziness
27. Red Flags & Emergency Signs
28. Pharmacology Considerations
29. Common Pitfalls & Misdiagnosis
30. Evidence-Based Practice Guidelines
31. Practice Questions & Answers
32. Key Takeaways
33. 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
Attribute Details
Patient Name Sheila Davis
Age 68 years
Gender Female
Race Caucasian
Occupation Retired school teacher (retired 3 years ago)
Height 5'2" (157 cm)
Weight 150.0 lb (68.2 kg)
BMI 27.4 kg/m² (overweight)
Setting Outpatient clinic with laboratory capabilities
