Dizziness History Taking | OSCE Tips

Dizziness history taking is a crucial skill that is frequently tested in OSCEs. This tutorial offers a methodical way to collect a dizziness history during an OSCE.

Presenting complaint (PC):

What brought you here today?

Can you tell me more about your dizziness?

History presenting complaint (HPC):

You can adapt SOCRATES to explore skin problems too: Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/Relieving factors and Severity.

Site: where do you feel dizzy?

Onset: when did the dizziness start? suddenly or gradually?

Character: can you describe to me how it feels. Is it a spinning sensation, feeling of unsteadiness or lightheadedness?

Radiation: n/a

Associate symptoms:

nausea / vomiting
visual disturbance
head trauma
hearing loss
recent ear infection/ respiratory infections

Timing: are the symptoms getting worse or better? how long does the dizziness last for?

Exacerbating/Relieving factors: does anything make it better or worse? is it worse on head movements?

Severity: from a scale from 1 to 10. with 10 being the worse, how severe is the dizziness?

Ideas, Concerns & Expectations (ICE):

Now is a good idea to ask Ideas, Concerns & Expectations (ICE): do you have an idea what might be causing your symptoms? is there anything that particularly concern you? what were expecting to achieve in this consultation?

Medical history (MH):

Do you have a history of high blood pressure, heart conditions, diabetes?

Past medical history (PMH):

Ask about any previous episodes of dizziness or treatment or investigations?

Drug history (DH):

Are you taking any medication (prescribed or over-the-counter (OTC)? If so, any side effects.

Any recent use of medications that might have caused the dizziness?

Note: the following medications might cause dizziness. Antihypertensives, antidepressants/antipsychotics, sedatives, some antibiotics.

Allergies:

Are you allergic to any medications?

Family history (FMH):

Is there any family members who have similar symptoms?

Social History (SH):

Ask about living condition, occupation and social support.

Do you smoker? alcohol? recreational drug use?

System review:

Review each body system to check for any other symptoms that might be causing the bleeding.

Possible differential diagnosis:

Benign paroxysmal positional vertigo (BPPV): causes a spinning sensation which is often triggered by sudden head movements.
Labyrinthitis: Inner ear inflammation that can cause vertigo, hearing loss, and ringing in the ears, frequently preceded by a viral or bacterial infection.
Meniere's disease.
Orthostatic hypotension: dizziness caused by a drop in blood pressure.
Heart arrhythmia.
Neurological causes such as stroke, multiple sclerosis (MS), parkinson’s disease.