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Recurrent falls from orthostatic hypotension and medicines — RACP Adult Medicine MCQ

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HardGeriatricsRecurrent falls from orthostatic hypotension and medicinesRACP Adult Medicine

An 82-year-old man has three falls in 2 months, usually after standing from bed. He takes prazosin, temazepam and frusemide. Examination shows postural blood pressure drop from 142/80 to 104/62 mmHg with dizziness. Neurological examination is otherwise normal. What is the most appropriate investigation?

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Correct answer: A — Medication review with lying and standing blood pressure assessment documented

Falls after standing with a clear postural drop and high-risk medicines require orthostatic assessment and medication review as key evaluation steps. CT brain alone is low yield without focal neurology or head injury concern. Carotid Doppler, tumour markers and EEG do not address the demonstrated mechanism.

Reference: RACGP falls prevention guidance; AMH