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Orthostatic hypotension — DGM MCQ

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EasyFallsOrthostatic hypotensionDGM

A 79-year-old man has fallen twice when getting out of bed. He describes light-headedness rather than vertigo or chest pain. Blood pressure is 142/76 mmHg lying and 108/62 mmHg after standing for one minute. Current medicines include ramipril, tamsulosin and furosemide. What is the most likely diagnosis?

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Correct answer: C — Orthostatic hypotension

The marked fall in systolic blood pressure after standing with postural symptoms is most consistent with orthostatic hypotension. BPPV causes brief positional vertigo, carotid sinus hypersensitivity is often related to neck movement, hypoglycaemia needs biochemical support, and vestibular neuritis causes sustained vertigo. Lying and standing blood pressure is a high-yield assessment after unexplained falls.

Reference: NICE NG249