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Medical Specialties > Elderly - falls and immobility > Flashcards

Elderly - falls and immobility Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the main causes of falls?

A 
MSK causes
Drugs
Neurological
Sensory
CVS
Generally unwell
Incontinence
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2
Q

What MSK causes lead to falls?

A

Arthritis of weight bearing joints
Sarocopenia
Deformities of feet

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3
Q

What are neurological causes of falls?

A 
Stroke - old or new
Parkinsonism
Dementia
Delirium
Ataxia
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4
Q

What are sensory causes of falls?

A

Visual impairment

Inattention

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5
Q

What are CVS causes of falls?

A

Postural hypotension
Arrythmia
Heart failure
Aortic stenosis

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6
Q

Why does incontinence lead to falls?

A

Rushing to the toilet

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7
Q

What drugs cause falls?

A 
Anti-hypertensives
Sedatives
Alcohol
Beta blockers
Anticholinergics
Opioids
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8
Q

Why do drugs cause falls?

A 
Decrease blood pressure
Decrease heart rate
Decrease awareness
Increase urine output
Increase sedation
Increase hallucinations
Increase dizziness
Increase QTc interval
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9
Q

How are patients likely to be after a fall in the falls clinic?

A

Likely to be well with a difficult and multifactorial fall

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10
Q

How are patients likely to be in A&E after a fall?

A

More likely to be acutely unwell

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11
Q

How are inpatients who have fallen in hospital likely to be?

A

Very likely to be acutely unwell, significant injury possible

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12
Q

What roles does the nurse have in the falls clinic?

A

Eye test
ECG
Lying and standing BP
Incontinence questionaire

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13
Q

What is the role of the physiotherapist in the fall clinic?

A

Full assessment of gait and balance

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14
Q

What is the role of the doctor in the falls clinic?

A

Thorough history and examination

Consider bone health and osteoporosis screening

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15
Q

What details should be found in the history of a fall?

A

If they remember the fall - syncope or cognition
Clear history of the trip
Palpitations preceding fall?
On turning? - postural instability
Any ‘near misses?’ - unsteady on standing
Syncope on exertion?

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16
Q

What should be asked about in systematic enquiry?

A

Memory
Urinary symptoms - might not tell you if you dont ask
Has walking changed recently?

17
Q

What should be found in drug history other than the common causes?

A

Antihistamines

18
Q

What neurological signs should be examined?

A

Cranial nerves except olfactory
Check for neglect
Cerebellar signs
Bradykinesia, rigidity

19
Q

What non-neurological signs should be examined?

A 
Pulse
BP
Heart sounds
Kyphosis
Abdominal examination
20
Q

What should be examined in the legs?

A 
Feet - footwear and toenails
Sensation, vibration sense, proprioception
Co-ordination
Romberg's test
Gait
21
Q

What pathology would cause ataxic gait?

A

Cerebellar damage

22
Q

What pathology would cause arthralgic gait?

A

Arthritis

23
Q

What pathology would cause hemiplegic gait?

A

Stroke

24
Q

What pathology would cause gait with shuffling small steps?

A

Parkinsonism

25
Q

What pathology would cause high stepping gait?

A

Peripheral neuropathy

26
Q

What are typical features of falls patients in A&E?

A 
Tired
Injured
In pain
Unable to stand due to injury - gait is difficult to assess
Systemically unwell
Will need MDT assessment later
27
Q

What should be found in the history in A&E?

A 
ABCDE assessment
How did they fall - trip?
Any other falls
Assess cognition
Incontinence?
Syncope?
Features of seizure?
Drunk?
Talk to relatives
28
Q

What should be done in examination in A&E?

A

Neuro exam
Look at legs and try to assess gait
Full set of obs

29
Q

What investigations should be done in A&E?

A

ECG
Bloods - B12, Folate, CK, TFTs
Check for delirium using 4AT
Consider CT head

30
Q

What needs to be considered about a patient going home after a fall?

A

Can they go to the toilet on their own?
Can they get themselves food and drink between carer visits
Can they walk in A&E?
Could they summon help if they fell?

31
Q

What immediate assessments are done for serious injuries?

A 
Head injury and extradural haematoma
Seizure
C-spine injury
Abdo injury
Flail chest
Pelvic injury
Limb fracture
32
Q

What would indicate immediate CT head?

A 
GCS<13
Still confused after 2 hours
Focal neurology
Signs of skull fracture
Seizure
Vomiting
Anti-coagulation
33
Q

When should a joint be X-rayed?

A

If pain on moving joint

No deformity but pain on weight bearing

34
Q

What can cause falls in inpatients?

A 
Postural hypotension
New medication
Low blood glucose
Getting more ill
Delirium
De-conditioning
35
Q

What could lead to a patient lying for a long time after a fall?

A

Call bell out of reach

36
Q

What do the nurses do after an inpatient falls?

A

Repeat risk assessment
Datix
Call family
Try and prevent further fall

Medical Specialties (23 decks)

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