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Home / Station 22: Recurrent falls and dizziness

NAC OSCE preparation

Station 22: Recurrent falls and dizziness

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Recurrent falls and dizziness

11 minutes

Discipline: Geriatric Medicine
Station type: Focused history + multifactorial plan
Setting: Family medicine clinic

Your task

Take a focused history from the patient and explain your assessment and plan.

Information available at entry

Seated BP 136/74 mm Hg, HR 68/minStanding at 1 min BP 108/62 mm Hg, HR 70/minStanding at 3 min BP 106/60 mm HgGlucose 4.2 mmol/L

Coach prompt: Identify orthostatic hypotension, medication effects and modifiable fall risks.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 22 of 30

Standardized-patient profile

NameMr. Samuel Patel

Age78

Pronounshe/him

RolePatient

Demeanour: Pleasant, worried about losing independence.

Opening statement: “I have fallen three times in two months, usually when I stand up or go to the bathroom at night.”

History and standardized-patient responses

Fall characterization

Candidate explores	Standardized-patient response
Events	Light-headed after standing; legs give way; no spinning sensation.
Syncope/seizure	No complete loss of consciousness, tongue bite or postictal confusion.
Injury	Bruised hip; no head injury.
Timing	Often after morning medications or overnight toileting.

Medical contributors

Candidate explores	Standardized-patient response
Cardiac	No exertional chest pain or palpitations.
Neurologic	No focal weakness; chronic distal numbness from diabetes.
Vision/hearing	Needs new glasses; no recent eye exam.
Continence	Urgency and nocturia.

Medication and environment

Candidate explores	Standardized-patient response
Medications	Ramipril, hydrochlorothiazide, tamsulosin, glyburide and zopiclone.
Hydration	Restricts fluids to avoid nocturia.
Home	Loose rugs, dim hallway and no grab bars.
Mobility	Uses furniture for support; no gait aid.

Physical findings

Orthostatic BP drop with minimal heart-rate response.
Reduced vibration at toes; broad-based cautious gait.
Timed Up and Go is slow and unsteady.
No focal neurologic deficit or acute injury.

Examiner prompts

Main diagnosis?

Multifactorial falls with symptomatic orthostatic hypotension, medication burden, hypoglycemia risk, neuropathy, nocturia and environmental hazards.

Investigations?

Targeted testing guided by history/exam—CBC, electrolytes/renal function, glucose/A1c, ECG; vision and gait assessment.

Management?

Medication reconciliation/deprescribing, hydration, slow position changes, strength/balance training, home safety and appropriate mobility aid.

Differential diagnosis

Orthostatic hypotension
Medication-related fall
Hypoglycemia
Peripheral neuropathy
Arrhythmia
Vestibular disorder

Investigations

CBC and electrolytes/renal function
Glucose/A1c and hypoglycemia review
ECG
Vision assessment
Gait/balance and footwear review
Further cardiac/neurologic testing only when indicated

Management

Review need/doses of diuretic, alpha-blocker, glyburide and zopiclone
Hydration and gradual position changes
Physiotherapy for strength/balance
Occupational therapy/home safety assessment
Night lighting, remove rugs and install grab bars
Mobility aid and footwear
Bone health and injury prevention

Communication behaviours

Emphasize preserving independence
Use shared decision-making for deprescribing
Involve family with permission

Critical safety actions

Treat unexplained syncope or focal deficits urgently
Reduce hypoglycemia and sedative exposure
Assess injuries after every fall

Model closing summary

Mr. Patel's falls are multifactorial, with symptomatic orthostatic hypotension and several medication and environmental contributors. I would review and rationalize his diuretic, alpha-blocker, glyburide and sedative, improve hydration, assess gait, vision and neuropathy, arrange strength and balance therapy and a home-safety review, and provide urgent precautions for true syncope, chest symptoms, focal deficits or head injury.

Common pitfalls

Calling all falls mechanical
Ordering neuroimaging without indication
Telling the patient simply to be careful
Abruptly stopping necessary drugs without a plan

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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