86 year old female presents to the Emergency Department following a fall. She is usually cared for at home with TDS package of care.

She is found by the morning carer at 9:00 am near to her commode. She lives alone and the fall was unwitnessed. She is currently disorientated and unable to provide significant history. PMHx includes: hypertension, glaucoma and osteoarthritis. Drug Hx: Amlodipine, Latanoprost, Timolol, Simvastatin, Paracetamol, Lansoprazole and Ibuprofen. She has no known drug allergies. She is a non-smoker and drinks only occasional alcohol.

On Examination

  • Obs: HR 122, BP 128/74, RR 18, Temp 36.7 and SpO2 99% on air

  • CVS: Nil remarkable bar observations

  • Resp: Mild creps heard bilaterally

  • Abdominal: Dry mucus membranes in the mouth, mild abdominal tenderness supra-pubically but no guarding or peritonism.

  • Neuro: GCS 14/15, but no focal neurological deficit identified and pupils equal and reactive to light. Obvious laceration to scalp.

  • MSK: No focal bony tenderness and able to move all four limbs, but she says they ache and feel weak.

  • U+E's: Urea 12.2 and Creatinine 280

Questions

Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

  1. In an ideal patient who is able to provide history, what further questions would you need to ask?

  2. What significant differentials would you consider as a cause for this fall given this case history?

  3. What significant consequences should you consider following a fall in an elderly patient?

  4. What investigations would you consider in the Emergency Department?

  5. What are the differentials for this patient’s abnormal renal function and what test would you like to add on to this sample?

  6. Given the most likely diagnosis, what is the pathophysiology of this condition?

  7. How would you manage this patient (assume a CT head is normal)?

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