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M&M Test 4 > B6-075 CBCL Geriatric Fall-Pelvic Fracture > Flashcards

B6-075 CBCL Geriatric Fall-Pelvic Fracture Flashcards

1
Q

DEATTH pneumonic for ADLs required for independent living

A

Dressing
Eating (actually feeding self)
Ambulating
Transfers
Toileting
Hygiene (don’t have to do this to live on your own, you can have someone help)

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2
Q

SHAFTTT pneumonic for IADLs

A

Shopping
Housekeeping
Accounting
Food prep
Telephone
Transportation
Taking medications

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3
Q

advanced ADLs

A

working
recreational activity

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4
Q

functional assessment AGING GAMES pneumonic

A

Audiovisual
Gait/mobility
Insomnia
Nutrition
GI

GU
ADLs/advance directive
Mood/memory
Environment/everyday activities
Sexuality

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5
Q

ultimate goal of inter-professional geriatric care

A

maximize independence

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6
Q

biggest risk factors for falls [2]

A

history of falls
fear of falling (causes gait disorders, less leaving house, anxiety, etc)

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7
Q

types of medications that can cause increased risk of fall [5]

A

blood pressure (orthostatic hypotension)
diabetes (hypoglycemia)
benzodiazepines
SSRIs
anticholinergics

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8
Q

fall history should make sure to include

A

near falls

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9
Q

timed get up and go <10 s is

A

normal

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10
Q

timed get up and go >14 s is indicative of

A

increased risk of fall

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11
Q

timed get up and go >20 s is indicative of

A

more severe gait impairment

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12
Q

less than […] on function reach test is highly predictive of falls

A

7 inches

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13
Q

BLAST pneumonic for gait assessment

A

Base
Length of stride
Arm swing
Stance
Turn

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14
Q

[type of gait]
limited ROM, limping
slow short steps
unable to bear full weight

A

antalgic gait

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15
Q

[type of gait]
pain worsening with movement and weight bearing

A

antalgic gait

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16
Q

[type of gait]
caused by degenerative joint disease or trauma

A

antalgic gait

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17
Q

[type of gait]
staggering, wide-base

A

cerebellar ataxia

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18
Q

[type of gait]
dysarthia, tremor, Romberg sign

A

cerebellar ataxia

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19
Q

[type of gait]
caused by cerebellar degeneration, MS, stroke

A

cerebellar ataxia

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20
Q

[type of gait]
short stepped, shuffling
hips knees and spine flexed
festination, en bloc turns

A

parkinsonian

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21
Q

[type of gait]
absences of objective neurologic signs
give-way weakness

A

parkinsonian

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22
Q

[type of gait]
caused by Parkinson’s disease

A

parkinsonian

:)

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23
Q

[type of gait]
results from foot drop
excessive flexion of hips/knees when walking
short strides
slapping quality
tripping

A

steppage

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24
Q

[type of gait]
atrophy of distal leg muscles
distal sensory loss and weakness
footdrop
loss of ankle jerk

A

steppage

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25
Q

[type of gait]
caused by motor neuropathy or sensory ataxia

A

steppage

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26
Q

[type of gait]
wacky, wobbly, wet due to sensory ataxia

A

normal pressure hydrocephalus

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27
Q

keys to fall prevention [2]

A
  1. multifactorial risk assessment and intervention
  2. anticipatory guidance
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28
Q

describe patient presentation with hip fracture

A

groin pain
unable to bear weight
displaced: shortened leg, external rotation, abduction
+ log roll
rarely bruising

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29
Q

initial imaging for hip fracture

A

lateral and AP pelvis Xray

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30
Q

if Xray is negative but the pain persists, what imaging modality should be used?

A

MRI

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31
Q

types of extracapsular fracture [2]

A

intertrochanteric
subtrochanteric

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32
Q

types of intracapsular fracture [2]

A

femoral head
femoral neck

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33
Q

most important initial treatment for hip fracture

A

analgesia

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34
Q

hips fractures should be treated within […] to increase chances of improved mobility

A

24-48 hrs

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35
Q

treatment of intertrochanteric fractures

A

ORIF or arthroplasty

36
Q

fx occurring in cancellous bone with good blood supply, but has a high rate of failure due to being a high stress area

A

subtrochanteric

37
Q

treatment of subtrochanteric fractures

A

IM rod/nail

38
Q

fx associated with higher risk of AVN or nonunion due to poor blood supply

A

femoral head and neck fractures

39
Q

treatment of femoral head/neck fracture

A

ORIF vs arthroplasty

ORIF: lower mortality, less blood loss, fewer infections
arthroplasty: lower re-operation rates, less AVN/malunion, earlier recovery

40
Q

components of gait assessment [2]

A

timed get up and go
functional reach

41
Q

how is treatment of a hip fracture decided? [3]

A

location of fracture
patient’s co-morbid conditions
risk vs benefit ratio

42
Q

some interventions for a person at risk of falls

A

physical/occupational therapy
walkers, other DME
daily exercise
Tai Chi

43
Q

what is used to avoid pulmonary embolism after surgery?

A

anticoagulation therapy
SCDs

44
Q

what techniques are used to avoid delirium after surgery?

A

minimal medications
keeping home schedule
frequent orientation

45
Q

[…] is key to retaining mobility post-operatively

A

early ambulation with PT

46
Q

what long term medications should be considered post-operatively to decrease the risk of subsequent fractures?

A

calcium
vitamin D
bisphophonates

47
Q
A

:)

48
Q

patients with function decline due to frailty most commonly loose their ADLs in what order?

A

Hygiene
Dress or Toilet
Walk
Feed

**dress/toilet is inconsistent

49
Q

the only ADL that a person can need help with and still live in their own home alone is

A

hygiene

50
Q

goals of functional assessment

A

optimize independence by identifying and treating impairments early

51
Q

biggest risk factor for falling

A

history of falls

52
Q

second biggest risk factor for falling

A

fear of falling

53
Q

most comprehensive evaluation for gait assessment

A

timed get up and go

54
Q

pain that worsens with extension (going up stairs) and improves with flexion is characteristic of

A

spinal stenosis

55
Q

confused
gait instability
urinary incontinence

is characteristic of

A

normal pressure hydrocephalus

**wacky, wobbly, wet

56
Q

festinating gait is associated with

A

parkinsonism

57
Q

in a confused patient with acutely altered gait, what should you consider?

A

vision impairment (apparently 🙄)

58
Q

near-falling upon waking up is likely due to

A

orthostatic hypertension

59
Q

gait test useful for ataxia and imbalance

A

Romberg

60
Q

if the patient has a normal gait, what gait test is most appropriate?

A

Tandem walk

61
Q

gait indicative of pain/trauma

A

antalgic

62
Q

gait associated with osteoarthritis

A

antalgic

63
Q

best initial step for a person with antalgic gait

A

referral to PT

associated with degenerative disease

64
Q

most modifiable risk factor for preventing falls using a multifactorial approach

A

balance impairment

65
Q

SSRIs considered to be safe in older adults [3]

A

sertaline
citalopram
escitalopram

66
Q

SSRIs that increase fall risk significantly [2]

A

fluoxetine
paroxetine

**they are anticholingeric and have multiple drug interactions

67
Q

sedative/hypnotic medication used for insomnia

A

zolpidem

68
Q

strongly anticholinergic agent that effects balance and cognition
should almost never be used in older adults

A

diphenhydramine

69
Q

best next step following abnormal timed get up and go test

A

multifactorial risk assessment with intervention

70
Q

interventions shown to decrease fall risk in low-risk patients without fall history [3]

A

Tai Chi/exercise
environmental modifications if the patient is severely visually impaired
vitamin D supplementation

71
Q

[…]% of hip fracture patients recover their ADLs

A

50%

72
Q

[…]% of hip fracture patients walk independently again

A

50

73
Q

[…]% of hip fracture patients move into long term care after

A

20

74
Q

if she asks how you should respond to a patient, use […]

A

wish/worry statements

75
Q

if initial Xray is negative but patient has ongoing hip pain following fall, what is the next best step?

A

MRI

or bone scan

76
Q

in a hip fracture patient, surgery should be done within […] to speed functional recovery

A

24-48 hrs

77
Q

treatment for isolated trochanteric avulsion fracture

A

non-weight bearing for 3-4weeks
follow up with Xrays to assess for displacement/healing

78
Q

following trochanteric avulsion fracture, patients can usually resume full activity at

A

3-4 months

79
Q

LMWH should be started […] hours prior to surgery

A

12

80
Q

given preoperatively to reduce the risk of bleeding and prevent DVT formation

A

LMWH

81
Q

[…] should be given following treatment of hip fracture, regardless of bone density

A

bisphosphonates

82
Q

[…] should be given 1-2 hours prior to surgery

A

antibiotics (cefazolin)

**vancomycin if the patient is allergic to cephalosporins

83
Q

[…] should be given every 8 hours for 24 hours after surgery to prevent infection

A

antibiotics (cefazolin)

**vancomycin if the patient is allergic to cephalosporins

84
Q

safest assistive device following hip fracture

A

roller walker

85
Q

first ADL typically lost

A

bathing

86
Q

last ADL typically lost

A

feeding

M&M Test 4 (14 decks)

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