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:

1. Benign paroxysmal positional vertigo (BPPV): causes a spinning sensation which is often triggered by sudden head movements.

2. Labyrinthitis: Inner ear inflammation that can cause vertigo, hearing loss, and ringing in the ears, frequently preceded by a viral or bacterial infection.

3. Meniere's disease.

4. Orthostatic hypotension: dizziness caused by a drop in blood pressure.

5. Heart arrhythmia.

6. Neurological causes such as stroke, multiple sclerosis (MS), parkinson’s disease.

Summaries your findings.

Investigation: 

• Bloods: full blood count (FBC), Urea and electrolytes (U&E), Hba1c, thyroid function test (TFT).

• ECG and 24hr ECG.

• Echocardiogram.

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