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Postural hypotension from autonomic failure — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsPostural hypotension from autonomic failureSCE Acute Medicine

A 76-year-old woman is assessed on the acute medical unit. She has recurrent falls on standing. Lying blood pressure is 158/84 mmHg and standing blood pressure after 3 minutes is 104/62 mmHg with little pulse rise. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: B — Neurogenic orthostatic hypotension

Neurogenic orthostatic hypotension is the best answer because a marked postural blood pressure fall without compensatory tachycardia suggests autonomic failure rather than simple volume depletion. Subarachnoid haemorrhage is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Measure lying and standing blood pressure properly in unexplained falls.

Reference: https://cks.nice.org.uk/#acute-medicine-order-60-1