Repeated falls in an older woman
PLAB 2 practice station

The task

You are a doctor in a GP surgery. Mrs Maureen Doyle, aged 79, has come to see you after she fell at home for the third time in two months. She is alone. Take a focused history. Then explain to her what you think is going on and what needs to happen next, answering her questions, and tell her what to do if things change. There is no need to examine her. The examiner will not take part in the conversation.

What this station tests

• Recurrent falls need a structured assessment: circumstances, medicines, vision, feet, cardiovascular and home factors.
• Review medicines first; diuretics, antihypertensives and sedatives commonly contribute.
• Measure lying and standing blood pressure in older people who fall.
• Ask about head strike and time on the floor.
• Address fear of losing independence to engage the patient in the plan.

Sources for the clinical content

• NICE NG249: Falls: assessment and prevention in older people and in people 50 and over at higher risk
• NICE NG5: Medicines optimisation: the safe and effective use of medicines
• NICE NG232: Head injury: assessment and early management

An original practice scenario with invented patients. Not an exam question.

Practise next

• Severe headache since yesterday
• Chest tightness that comes and goes
• Breathlessness and cough in a long-term smoker
• Lower abdominal pain in a young woman
• Low mood and poor sleep