The Ultimate iHuman Clinical Simulation & Study Guide: Sheila
Davis (68 y/o) – A Step-by-Step Approach to Dizziness
Evaluation, Differentiating Peripheral vs. Central Vertigo, and
Performing the Epley Maneuver for BPPV | Graded A+
,TABLE OF CONTENTS
Section Title Page
1 Case Overview & Clinical Problem Statement 1
,2 Patient Demographics & Vital Signs 2
3 Chief Complaint & History of Presenting Illness (HPI) 3
4 OLD CARTS Framework – Complete HPI Analysis 4
5 Recommended Interview Questions & Clinical Rationale 5
6 Past Medical History (PMH) 6
7 Past Surgical History 7
8 Medications & Over-the-Counter Use 8
9 Allergies & Adverse Reactions 9
10 Family History 10
11 Social History & Functional Status 11
12 Review of Systems (ROS) – Complete 12
13 Physical Examination – General & Vital Signs 13
14 Physical Examination – System-Specific Findings 14
15 Neurological Examination – Mental Status & Cranial Nerves 15
16 Neurological Examination – Motor, Sensory, Cerebellar & Reflexes 16
17 Vestibular & Positional Testing – Dix-Hallpike Maneuver (Technique) 17
18 Dix-Hallpike Maneuver – Findings & Interpretation 18
19 HINTS Examination – Head Impulse, Nystagmus, Test of Skew 19
20 Diagnostic Workup & Laboratory Interpretation 20
21 Comprehensive Differential Diagnosis (Ranked by Likelihood) 21
22 Peripheral vs. Central Causes of Dizziness – Comparative Table 22
23 Final Diagnosis with Diagnostic Criteria 23
24 Pathophysiology of BPPV – Canalithiasis Theory Explained 24
25 Treatment & Management Plan – Overview 25
26 Epley Maneuver – Step-by-Step Procedure 26
27 Alternative Repositioning Maneuvers (Semont & Brandt-Daroff) 27
28 Patient Education & Counseling – Script & Handout Content 28
29 Follow-Up & Monitoring Plan (1 Week, 1 Month, 3-6 Months) 29
30 Complete SOAP Note (Subjective, Objective, Assessment, Plan) 30
31 Clinical Reasoning & Decision-Making Algorithms 31
32 Geriatric Considerations & Fall Prevention Strategies 32
, 33 Red Flags, Emergency Signs & Referral Criteria 33
34 Common Pitfalls, Misdiagnosis & Pharmacology Pearls 34
35 Evidence-Based Guidelines, Practice Questions & References 35
SECTION 1: CASE OVERVIEW & CLINICAL PROBLEM STATEMENT
Patient: Sheila Davis, 68-year-old female
Reason for Encounter: Dizziness
Setting: Outpatient clinic with laboratory capabilities
Clinical Problem: Sheila Davis presents with a 2-week history of episodic dizziness that has progressively
interfered with her daily activities, sleep, and emotional well-being. In a 68-year-old patient, dizziness
demands a systematic, multi-system evaluation due to the broad differential, which ranges from benign
peripheral vestibular disorders to life-threatening cerebrovascular events, cardiac arrhythmias, or
metabolic derangements.
The First Clinical Task – Characterize the Dizziness:
The term "dizziness" is non-specific and requires categorization:
Category Definition Sheila's Presentation
Vertigo Illusion of movement (spinning, rocking, tilting) Yes – "room spins," "merry-go-round"
Presyncope Sensation of impending faint or lightheadedness Yes – "wooziness" upon standing
Disequilibrium Feeling of unsteadiness or imbalance while walking Mild – between episodes,
slightly unsteady
Lightheadedness Non-specific "floating" or "head-in-a-fog" feeling Yes – lingering between
episodes
Key Pattern Recognition: The dizziness is triggered (positional) + episodic (brief) + spinning (vertigo) +
reproducible. This constellation strongly points toward a peripheral vestibular etiology, most commonly
Benign Paroxysmal Positional Vertigo (BPPV). However, the presence of mild orthostatic lightheadedness
and a recent increase in antihypertensive medication introduces a contributing vascular component that
must be addressed concurrently.
Main Problem Statement: This case involves the differential diagnosis of complex geriatric dizziness with
both vestibular and cardiovascular contributions. Misdiagnosis or incomplete management could lead to
Davis (68 y/o) – A Step-by-Step Approach to Dizziness
Evaluation, Differentiating Peripheral vs. Central Vertigo, and
Performing the Epley Maneuver for BPPV | Graded A+
,TABLE OF CONTENTS
Section Title Page
1 Case Overview & Clinical Problem Statement 1
,2 Patient Demographics & Vital Signs 2
3 Chief Complaint & History of Presenting Illness (HPI) 3
4 OLD CARTS Framework – Complete HPI Analysis 4
5 Recommended Interview Questions & Clinical Rationale 5
6 Past Medical History (PMH) 6
7 Past Surgical History 7
8 Medications & Over-the-Counter Use 8
9 Allergies & Adverse Reactions 9
10 Family History 10
11 Social History & Functional Status 11
12 Review of Systems (ROS) – Complete 12
13 Physical Examination – General & Vital Signs 13
14 Physical Examination – System-Specific Findings 14
15 Neurological Examination – Mental Status & Cranial Nerves 15
16 Neurological Examination – Motor, Sensory, Cerebellar & Reflexes 16
17 Vestibular & Positional Testing – Dix-Hallpike Maneuver (Technique) 17
18 Dix-Hallpike Maneuver – Findings & Interpretation 18
19 HINTS Examination – Head Impulse, Nystagmus, Test of Skew 19
20 Diagnostic Workup & Laboratory Interpretation 20
21 Comprehensive Differential Diagnosis (Ranked by Likelihood) 21
22 Peripheral vs. Central Causes of Dizziness – Comparative Table 22
23 Final Diagnosis with Diagnostic Criteria 23
24 Pathophysiology of BPPV – Canalithiasis Theory Explained 24
25 Treatment & Management Plan – Overview 25
26 Epley Maneuver – Step-by-Step Procedure 26
27 Alternative Repositioning Maneuvers (Semont & Brandt-Daroff) 27
28 Patient Education & Counseling – Script & Handout Content 28
29 Follow-Up & Monitoring Plan (1 Week, 1 Month, 3-6 Months) 29
30 Complete SOAP Note (Subjective, Objective, Assessment, Plan) 30
31 Clinical Reasoning & Decision-Making Algorithms 31
32 Geriatric Considerations & Fall Prevention Strategies 32
, 33 Red Flags, Emergency Signs & Referral Criteria 33
34 Common Pitfalls, Misdiagnosis & Pharmacology Pearls 34
35 Evidence-Based Guidelines, Practice Questions & References 35
SECTION 1: CASE OVERVIEW & CLINICAL PROBLEM STATEMENT
Patient: Sheila Davis, 68-year-old female
Reason for Encounter: Dizziness
Setting: Outpatient clinic with laboratory capabilities
Clinical Problem: Sheila Davis presents with a 2-week history of episodic dizziness that has progressively
interfered with her daily activities, sleep, and emotional well-being. In a 68-year-old patient, dizziness
demands a systematic, multi-system evaluation due to the broad differential, which ranges from benign
peripheral vestibular disorders to life-threatening cerebrovascular events, cardiac arrhythmias, or
metabolic derangements.
The First Clinical Task – Characterize the Dizziness:
The term "dizziness" is non-specific and requires categorization:
Category Definition Sheila's Presentation
Vertigo Illusion of movement (spinning, rocking, tilting) Yes – "room spins," "merry-go-round"
Presyncope Sensation of impending faint or lightheadedness Yes – "wooziness" upon standing
Disequilibrium Feeling of unsteadiness or imbalance while walking Mild – between episodes,
slightly unsteady
Lightheadedness Non-specific "floating" or "head-in-a-fog" feeling Yes – lingering between
episodes
Key Pattern Recognition: The dizziness is triggered (positional) + episodic (brief) + spinning (vertigo) +
reproducible. This constellation strongly points toward a peripheral vestibular etiology, most commonly
Benign Paroxysmal Positional Vertigo (BPPV). However, the presence of mild orthostatic lightheadedness
and a recent increase in antihypertensive medication introduces a contributing vascular component that
must be addressed concurrently.
Main Problem Statement: This case involves the differential diagnosis of complex geriatric dizziness with
both vestibular and cardiovascular contributions. Misdiagnosis or incomplete management could lead to
