Station - Instructions for candidate
You are an intern on the acute medical ward.
Trevor Fraser is an 84-year-old man with moderate dementia admitted 12 hours ago after falling at home. He was getting out of bed when he felt dizzy and fell. He has been on enalapril 10 mg daily for 15 years; his GP escalated amlodipine to 10 mg two weeks ago for persistent hypertension. The nursing notes report he is notably more confused than his baseline and has only mobilised once since admission, at which point he was unsteady and required assistance. His wife is at the bedside and concerned about what caused the fall.
| Baseline observations (patient at rest, supine) | HR 78 bpm regular, BP 156/92 mmHg, RR 16, SpO2 98% on room air, temperature 36.9C |
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Your tasks are to:
- Perform a focused examination of gait and balance, postural blood pressure, and lower limb neuromuscular function. Describe to the examiner what you would like to examine and the relevant findings will be provided to you.
- State your most likely diagnosis and two or three differentials to the examiner, with brief justification for each.
- Outline your initial management plan, including any immediate medication changes and key referrals for preventing further falls.
- Summarise your key findings and your clinical reasoning to the examiner.
- You are not required to take a detailed history; the patient's baseline cognitive impairment limits reliability.
- Please verbalise each examination step to the examiner.
- Findings will be provided by the examiner when you specify the examination component.
This is a 10-minute station, with 2 minutes of reading time.