Medicine · Examination

Fall in an older adult with confusion - Hospital ward

HardYear 5 · Curtin style · 10 min + 2 min reading · 3 tasks

2 min reading · 10 min station · reminders at 2 min

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.

Your tasks are to:

  1. Perform a focused examination.
  2. Summarise your findings to the examiner with your most likely diagnosis and differential diagnoses.
  3. Outline your initial management plan to the examiner.
  • You are not required to take a detailed history; the patient's baseline cognitive impairment limits reliability.
  • Please verbalise your examination to the examiner; findings will be provided on request.

This is a 10-minute station, with 2 minutes of reading time.

Ask the examiner

Say what you would examine or request, the way you would in the station. Nothing is named until you ask for it.

Whatever the examiner recognises is revealed below. Or pick a numbered item to reveal it blind.

Investigations

Ask for a category the way you would in the station: “Can I have the obs and a set of bloods?”

Examination

Say what you would examine and how; the examiner reports what you would find.