Manual blood pressure measurement including postural readings
PLAB 2 & PRES 3 · practical skills / geriatrics · medium · 8 minutes
Candidate brief
You are an FY2 doctor in a GP surgery. Mrs Rose Donnelly, 81, has been brought in by her daughter after a fall at home last week. She describes feeling dizzy when she stands up. Her repeat prescription includes amlodipine, indapamide and sertraline (the sertraline was started three weeks ago). Please measure her blood pressure manually, including postural (lying and standing) readings, and explain your findings and plan. Verbalise your technique as you perform it.
What examiners look for
Blood pressure is a measurement before it is a number: cuff size, bare arm, supported at heart level, rested patient, no talking. Each breach skews the result in a predictable direction, and a candidate who recites the setup is telling the examiner the reading can be trusted. Postural readings have a protocol, not a vibe: supine after at least five minutes' rest, then standing measurements at 1 and 3 minutes. The 3-minute value catches the slower drops — and the definition (a fall of at least 20 systolic and/or 10 diastolic within 3 minutes) is applied to those readings, not to a single paired comparison. Symptoms during the test are data. Her dizziness arriving exactly as the cuff shows 110/68 ties cause to effect far more convincingly than any number alone — record the symptoms alongside the readings. Medication review is where this diagnosis is treated: antihypertensives, diuretics, antidepressants (SSRIs included), alpha-blockers and dopaminergic drugs head the list of culprits. The timing clue — three weeks since sertraline started, six weeks of dizziness — is the history doing diagnostic work. But the remedy is a prescriber's review, staged and monitored, never the patient's own abrupt cessation. A fall at 81 is never just a fall: it triggers falls-risk assessment, home-hazard review, bone-health thinking and a driving conversation. The blood pressure station quietly tests whether the candidate manages the whole problem or only the sphygmomanometer. And technique protects the patient physically as well as diagnostically: she is being asked to stand still for three minutes while symptomatic and posturally hypotensive. Standing within arm's reach, chair behind her, ready to sit her down — that is part of the procedure, not bedside decoration.
Guideline references
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