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YEAR 1: CSI > Case 6: Falls > Flashcards

Case 6: Falls Flashcards

1
Q

What are the non- modifiable risk factors for falls?

A
  • Age
  • Gender
  • History of falls
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2
Q

What are the neurological risk factors for falls?

A
  • Cognitive impairment or Dementia
  • Confusion/delirium
  • Depression
  • Poor vision
  • Poor balance (arthritis, parkinson’s)
  • Poor co-ordination
  • Anxiety about falling
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3
Q

What are the environmental risk factors for falls?

A
  • Home hazards
  • Inappropriate footwear
  • Insufficient home modification
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4
Q

What are the chemical risk factors for falls?

A
  • Polypharmacy
  • Drug culprits (e.g. corticosteroids)
  • Alcohol
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5
Q

What are the cardiovascular risk factors for falls?

A
  • Orthostatic hypotension (low blood pressure upon standing up)
  • Arrhythmias
  • Syncope (temporary drop in blood to the brain that causes fainting)
  • Anaemia
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6
Q

What is collateral history?

A

Taking history of a patient from an onlooker or relatives.

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7
Q

How can you prevent falls?

A
  • Clean up/declutter the environment
  • Better feedback
  • Do regular strength and balance activities (physiotherapy)
  • Eyesight checks (optician’s)
  • Reduce alcohol intake
  • Correct low BP
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8
Q

What is delirium?

A

A worsening or change in person’s mental state that happens suddenly, over 1-2 days.

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9
Q

What are the 3 different types of delirium?

A
  • Hyperactive
  • Hypoactive
  • Mixed
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10
Q

What are the symptoms of hyperactive delirium?

A
  • Restlessness
  • Agitation
  • Delusions
  • Hallucinations
  • Disorientation
  • Paranoia
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11
Q

What are the symptoms of hypoactive delirium?

A
  • Withdrawn mood
  • Drowsiness
  • Unable to focus
  • Less mobile
  • Somnolent
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12
Q

What are the risk factors of delirium?

A
  • Age
  • Underlying cognitive impairment
  • Social isolation
  • Pain from fall
  • Renal impairment
  • Poor mobility (previous falls)
  • Visual/hearing problems
  • Alcohol
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13
Q

What are the triggers of delirium?

A
  • Pain
  • Infection
  • Nutrition (deficiencies like Vit B12, folate, thiamine, Vit D)
  • Constipation
  • Hydration
  • Medication (drug culprits)
  • Electrolytes
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14
Q

What is the treatment of delirium?

A

1) Address the medical problem that caused it (correct glucose levels, stop medication that may be causing it, give antibiotics).
2) Ensure a supportive + calm environment for patient

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15
Q

What tests are carried out for a patient that’s had a fall and is delirious?

A
  • ECG
  • Blood tests
  • Chest X-ray
  • Urine sample (to test for UTIs)
  • Hip X-ray
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16
Q

What are fragility fractures?

A

Fractures that result from mechanical forces that would not ordinarily result in a fracture (equivalent to falling from standing height).

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17
Q

What are the most common causes of fragility fractures?

A
  • Osteoporosis
  • Advancing age
  • Other bone disorders (OI, acromegaly)
  • Poor muscle strength
18
Q

What is osteoporosis?

A

Reduction in the density of bone: bone is more porous because osteoclast activity > osteoblast activity. There is sequential trabeculae loss.

19
Q

What are the risk factors for osteoporosis?

A
  • Age: reduced Ca2+ / Vitamin D metabolism

- Female gender: loss of oestrogen means less inhibition of osteoclasts and less stimulation of osteoblasts

20
Q

How is osteoporosis diagnosed?

A
  • T score
21
Q

What is the mechanostat theory?

A

Bone structure is influenced by mechanical loading. If there is a change in load, bone mass + structure will change.

22
Q

If a patient is on bedrest, what will happen to their bones and muscle according to the mechanostat theory?

A
  • Decrease in bone density (osteopenia initially)

- Atrophy of muscle due to disuse (sarcopenia)

23
Q

What is sarcopenia?

A
  • Progressive loss of muscle strength

- Usually comes with osteopenia

24
Q

What are the most common sites for a fragility fracture?

A
  • Vertebrae
  • Hip (NOF)
  • Wrist (Scaphoid bone)
25
Q

What are the risk factors for fragility fractures?

A
  • Age
  • Female gender
  • Ethnicity
  • FHx of hip fractures (family history)
  • Fall history
  • BMI
  • Smoking
  • High alcohol intake (reduced oestrogen)
26
Q

What are the 2 classes of hip fractures?

A
  • Intracapsular (the head of the femur)

- Extracapsular

27
Q

What can the extracapsular fractures be divided into?

A
  • intertrochanteric

- subtrochanteric

28
Q

What are the 4 classifications of intracapsular fractures?

A
  • Garden I (non-displaced, partial)
  • Garden II (non-displaced, complete)
  • Garden III (partially displaced, complete)
  • Garden IV (displaced, complete)
29
Q

How are extracapsular NOF fractures treated?

A
  • Dynamic hip screw (intertrochanteric)

- Intramedullary nail/ femoral nail (subtrochanteric)

30
Q

Describe the blood supply to the femoral head

A
  • Blood supply in femoral head is retrograde (goes from distal -> proximal)
  • Medial circumflex artery supplies the head
31
Q

Why are intracapsular fractures more dangerous than extracapsular fractures?

A

Blood supply is more likely to be disrupted causing AVASCULAR NECROSIS

32
Q

How are non-displaced intracapsular fractures (Garden I + II) treated?

A

Dynamic Hip screw

33
Q

How are displaced intracapsular fractures (Garden III + IV) treated?

A
  • Total Hip replacement (both the head and the acetabulum are replaced)
  • Hemi-arthroplasty (where only the head is replaced)
34
Q

Even though THR have better post-operative outcomes, why are hemi-arthroplasties still performed?

A

THR have an added risk of hip dislocation for older patients with cognitive impairment. In HA, there is also…

  • less blood loss
  • shorter operative time
  • quicker recovery.
35
Q

What are the first line medications for people with osteoporosis, that have just had a fragility fracture?

A

Bisphosphonates -> these inhibit osteoclast activity

36
Q

Which bisphosphonate would be given to the patient to take home?

A

Alendronic Acid (it can be taken orally unlike Zoledronic Acid which is given through IV infusion)

37
Q

What medication can be given to menopausal women?

A

Raloxifene (Oestradoil receptor agonist)

38
Q

Other than bisphosphonates, what other medications could be given?

A
  • Vitamin D (cholecalciferol)

- Ca2+

39
Q

What clinic would a patient that has suffered a fall be referred to?

A

Falls clinic -> occupational therapist

40
Q

Would a Bone scan be needed to diagnose osteoporosis?

A

No- bone scans are where radioactive isotopes are injected into bone to look for bone infections/ cancers

41
Q

What are the signs (what the doctor sees) of a hip fracture?

A
  • Bony tenderness at hip/ groin

- Externally rotated hip

42
Q

What are the symptoms (what the patient experiences) of a hip fracture?

A
  • Hip/knee pain

- Unable to weight bear

YEAR 1: CSI (9 decks)

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