Orthostatic Hypotension: ABFM practice questions

4 board-style questions on orthostatic hypotension in the PulseMD family medicine question bank, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.

Sample question 1

An 81-year-old man with hypertension, type 2 diabetes, peripheral neuropathy, and bilateral cataracts presents after his third fall in 4 months. His medications include amlodipine 10 mg daily, metformin 1000 mg twice daily, gabapentin 300 mg three times daily, tamsulosin 0.4 mg at bedtime, and a daily multivitamin. Orthostatic vitals show a supine BP of 138/78 mmHg and a standing BP of 112/64 mmHg after 3 minutes. His Timed Up and Go test is 18 seconds. Which combination of interventions is most appropriate?

  1. Address orthostatic hypotension by adjusting amlodipine and tamsulosin, refer for cataract evaluation, start physical therapy for balance training, and supplement vitamin D
  2. Discontinue all antihypertensives, refer to ophthalmology, and prescribe a cane
  3. Admit to the hospital for comprehensive inpatient fall evaluation and telemetry monitoring
  4. Start meclizine for dizziness, increase gabapentin for neuropathic pain, and order physical therapy

Sample question 2

An 80-year-old man with hypertension, type 2 diabetes, insomnia, osteoarthritis, and benign prostatic hyperplasia presents after his third fall in 6 months. His current medications include: amlodipine 10 mg daily, metformin 1000 mg twice daily, temazepam 15 mg at bedtime, ibuprofen 400 mg as needed, and tamsulosin 0.4 mg daily. Orthostatic blood pressure testing reveals a 25 mmHg systolic drop upon standing. Which combination of medication changes would most effectively reduce his fall risk?

  1. Discontinue ibuprofen and add acetaminophen; increase amlodipine to improve blood pressure control
  2. Discontinue temazepam and tamsulosin; reassess need for amlodipine given orthostatic hypotension
  3. Switch temazepam to trazodone 50 mg and add a vitamin D supplement
  4. Discontinue metformin to reduce hypoglycemia risk and add a thiazide diuretic for blood pressure

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