Discuss the presentation, initial investigation, key differential diagnosis and initial management of falls

Question 1

How do you perform the ‘get up and go test’?

Answer 1

1. ask the patient to stand up from a sitting position
2. walk 3 meters
3. turn and go back to the chair
4. normal performance takes less than 12 seconds

Question 2

Which 2 medications precipitate falls?

Answer 2

1. psychotropic
2. hypotensive agent

Question 3

How can a patient with falls be managed in the MDT? (3)

Answer 3

1. balance and strength
2. cataract extraction
3. podiatry

Question 4

True or False?

Calcium and vitamin D₃ is beneficial in preventing falls in the elderly

Answer 4

False

it is only beneficial in the frailest (i.e institutionalised)

Question 5

What adjustments to medication should you consider if your patient is having recurrent falls?

Answer 5

1. rationalising psychotropic medication
2. reducing or stopping hypotensive drugs

Question 6

How may falls that are due to frailty present?

Answer 6

recurrent falls

Question 7

What 4 acute illnesses may cause falls?

Answer 7

1. infection
2. stroke
3. metabolic disturbance
4. heart failure

Question 8

How may falls that are due to syncopal episode present?

Answer 8

loss of consciousness

Question 9

What 3 general investigations should be carried out if a patient presents with falls that started recently?

Answer 9

1. thorough examination and investigation for acute illness
2. establish whether any drug that precipitates falls has been started recently
3. calculation of fracture risk (FRAX) and DEXA scan

Question 10

How may falls that are due to acute illness present

Answer 10

falls that have suddenly occurred over a few days

Question 11

What are 3 common causes of recurrent dizzy spells?

Answer 11

1. lightheadedness
2. vertigo
3. unsteadiness/poor balance

Question 12

What are 3 common causes of acute dizziness?

Answer 12

1. hypotension (due to arrhythmia, myocardial infarction, GI bleed, PE)
2. posterior fossa stroke onset
3. vestibular neuronitis

Question 13

What are the key differential diagnoses for falls?

Answer 13

1. acute illness
2. synoptic episode
3. mechanical and recurrent falls

Question 14

What does the ‘get up and go test’ assess?

Answer 14

gait and balance