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The woman in question 1 has no orthostatic drop in her blood pressures, and her clinical exam does not reveal a cause for her fall (no focal neurological findings, normal heart, lung, abdominal and musculoskeletal exam). The most appropriate next step is:
A. A timed Get Up and Go Test
B. A referral to physical therapy
C. A referral to occupational therapy
D. Home safety evaluation
Annotated answer: A. A Timed Get Up and Go test (TGUAG) is a simple test that can be performed quickly in a clinical setting. A patient is asked to sit on a standard non-wheeled chair, to fold his/her arms, rise, walk 3 meters, turn around, and sit back down. This test evaluates lower extremity and trunk muscle function, balance, gait speed, and neurological function. A time of <20 seconds is adequate for independent transfers and mobility. A time of >30 seconds suggests a higher risk of falls and functional dependence. Gait examination is a must in a faller. The other measures may be appropriate, pending the gait assessment.