Hx taking Case 1: BPPV Drug Hx

Patient Details No long-term drugs

Ms Mary Chan 30y C F Allergic to penicillin -> causes a rash
S1234567A No TCM/Supplement

HOPC PMHx/Sx Hx
Vertiginous giddiness x 2 weeks No PMHx/Sx
Episodic, 2-3 times per day, each episode lasting 1 min
Worse with head movement Fam Hx
Worse when turning in bed No significant Fam Hx

Significant Negatives/Ruling out differentials Social Hx

No headache, focal neurological deficit Non-smoker
No hearing loss Non-drinker
No tinnitus, aural fullness
No otalgia, otorrhea ICE
Ideas: Don’t know
Systemic Review Concern: Quite annoying
No fever Ex: Wants it resolved
No LOW/LOA
Negative systemic review
Hx taking Case 2: Labyrinthitis Drug Hx
Patient Details No long-term drugs
Mr Teo See Meng 45y C M No drug allergies
S1234567A No TCM/Supplements

HOPC PMHx/Sx Hx
Vertiginous giddiness x 1 day No PMHx/Sx
Non-episodic, constant throughout the past day
Sudden onset Fam Hx
No triggers, nothing makes it better No significant Fam Hx

Hearing loss in L ear x 1 day Social Hx

Same onset as above Smoker half-pack/day for 20 years (10 pack-years)
Non-drinker
Recent URTI last week, resolved without meds Job: Taxi driver -> affecting driving ability

Significant Negatives/Ruling out differentials ICE

No headache, focal neurological deficit Ideas: Due to fatigue
No tinnitus, aural fullness Concern: Will it go away, affecting his job
No otalgia, otorrhea Ex: For doctor to help with the problem
Not worse when turning in bed

Systemic Review
Some mild nausea, no vomiting
No fever
No LOW/LOA
Negative systemic review
Hx taking Case 3: Vestibular migraine Drug Hx
Patient Details Tried Paracet for headache (but doesn’t help vertigo)
Mr Albert Tan 35y C M No long-term drugs
S1234567A No drug allergies
No TCM/Supplements
HOPC
Vertiginous giddiness x 1 month PMHx/Sx Hx
Episodic, 2-3 times per week, each episode 3-4 hours No PMHx/Sx
Gradual, worsening onset
Worse with head movement Fam Hx
Worse with bright lights and loud sounds No significant Fam Hx
Worse after drinking coffee/alcohol
Under a lot of stress and lack of sleep recently due to new job Social Hx
Social smoker
Unilateral headache x 1 month Drinker - few glasses of liquor 2-3x per week
Episodic, each time lasting at least 4 hours Job: finance manager -> long hours, high stress, drinking with clients
Vertigo comes on together with headache
ICE
Significant Negatives/Ruling out differentials Ideas: Thinks due to lack of sleep
No generalised headache, focal neurological deficit Concern: Affecting job, unable to concentrate
No hearing loss Ex: Medication to relieve the dizziness
No tinnitus, aural fullness
No otalgia, otorrhea

Systemic Review
No fever
No LOW/LOA
Negative systemic review
Hx taking Case 4: Posterior circulation stroke Drug Hx
Patient Details Metformin, Glipizide
Mr Tan Bee See 65y C M Amlodipine, Enalapril
S1234567A Atorvastatin
No drug allergies
HOPC No TCM/Supplements
Vertiginous giddiness x 1 day
No previous episodes PMHx/Sx Hx
Sudden onset when showering, initially dropped to ground T2DM past 10 years HbA1C 9%
Constant, progressively better, can walk now Hypertension well controlled
Not worse with head movement Hyperlipidemia
Not better when keeping still Previous AMI 3 years ago s/p PCI

Previous episodes of unilateral facial weakness and dysarthria Fam Hx

Fully recovered since No significant Fam Hx

Significant Negatives/Ruling out differentials Social Hx

No generalised headache Smoker 1 pack 40 years
No focal neurological deficit (facial/limb weakness, numbness, diplopia, Non drinker
dysarthria, dysphagia) Taxi driver
No hearing loss
No tinnitus, aural fullness ICE
No otalgia, otorrhea Ideas: Thinks due to lack of sleep
Concern: Cannot drive currently
Systemic Review Ex: Medication to relieve the dizziness
No fever
No LOW/LOA
Negative systemic review
Presentation Case 1: Drug History
Patient Details No long-term drugs
Ms Jamie Lim 18y C F No drug allergies
S1234567A No TCM/Supplements

History of Presenting Complaint Past Medical History/Surgical History

Vertiginous giddiness lasting for 2 weeks No significant history
Episodic, 2-3 times per week, each episode 6 hours
Gradual, worsening onset Family History
Worse when turning head No significant family history
Worse with bright lights and loud sounds
Social History
Significant Negatives Non-smoker
No generalised headache, weakness or numbness in arms and legs Non-drinker
No hearing loss JC2 student studying for A-levels, under a lot of stress
No tinnitus, aural fullness
No otalgia, otorrhea

Systemic Review
No fever
No loss of weight or loss of appetite
Negative systemic review
Presentation Case 2: Drug History
Patient Details Amlodipine
Mr John Tan 60y C M No drug allergies
S1234567A No TCM/Supplement

History of presenting complaint Past Medical History/Surgical History

Vertiginous giddiness lasting for 1 week Hypertension – well controlled 130/85
Episodic, 1-2 times per day, each episode lasting 1 min
Worse with head turning Family History
Worse when turning around when sleeping No significant family history

Significant Negatives Social History

No headache, weakness and numbness in arms and legs Smoker 1 pack per day for 30 years
No hearing loss Non-drinker
No tinnitus, aural fullness
No otalgia, otorrhea

Systemic Review
No fever
No loss of weight or loss of appetite
Negative systemic review
Presentation Case 3: Drug History
Patient details No long-term drugs
Mdm Chen Mei Mei 50y C F No drug allergies
S1234567A No TCM/Supplements

HOPC Past Medical History/Surgical History

Vertiginous giddiness that started yesterday morning No significant history
Non-episodic, constant throughout the past day
Sudden onset Family History
No triggers No significant family history

Hearing loss in left ear Social Hx

Started the same time as the dizziness Non-smoker
Non-drinker
Had some cough and runny nose last week
Saw a GP, resolved after taking some medications

Significant negatives/Ruling out differentials

No headache, focal neurological deficit
No tinnitus, aural fullness
No otalgia, otorrhea
Not worse when turning in bed

Systemic review
No fever
No loss of weight or loss of appetite
Negative systemic review