MLA Domain 5 · Presentation

Falls

10 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 5

Fractures & pathological fractures

Open fracture (wound communicating with bone) → IV antibiotics, tetanus, photograph + cover, urgent orthoplastics

Joint dislocation & subluxation

Neurovascular injury (axillary nerve in shoulder; sciatic nerve / AVN risk in hip) → assess before and after reduction

Obstructive sleep apnoea

Falling asleep while driving/at work; resistant hypertension; pulmonary hypertension/cor pulmonale; a sleepy driver must

Parkinson-plus syndromes (PSP, MSA, CBD)

Early falls, early autonomic failure, vertical gaze palsy, or a poor levodopa response = atypical parkinsonism (Parkinso

Pericardial effusion & cardiac tamponade

Cardiac tamponade (shock + raised JVP + muffled sounds, pulsus paradoxus) → emergency echo-guided pericardiocentesis

recognised feature · 2

Lewy body dementia

NEUROLEPTIC SENSITIVITY — antipsychotics can cause severe rigidity/irreversible deterioration; recurrent falls

Urinary tract infection

Fever, loin pain, rigors or systemic upset → pyelonephritis/urosepsis → escalate (see pyelonephritis)

differential of the above · 3

Hypothyroidism

Myxoedema coma (hypothermia, bradycardia, reduced consciousness, hyponatraemia) → emergency

Pulmonary embolism

Massive PE with haemodynamic instability (hypotension/shock) → thrombolysis (or embolectomy)

Tension pneumothorax

Haemodynamic collapse — this is a clinical diagnosis; decompress immediately without imaging