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MB3 Medicine Elderly > Falls > Flashcards

Falls Flashcards

1
Q

intrinsic factors leading to falls

A 
age related changes in gait and muscle strength, reflexes 
acute illness
diabetes
arthritis 
parkinsons 
stroke 
cognition 
incontinence 
impaired vision or hearing 
fear of falling
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2
Q

extrinsic medications that may increase falls risks

A 
diuretics 
antihypertensives 
sedatives 
anticholinergics 
hypoglycaemics
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3
Q

extrinsic environmental factors that may increase falls risk

A 
stairs 
rug 
furniture 
inadequate lighting 
inappropriate footwear 
inappropriate walking aids
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4
Q

how can diabetes increase falls risk

A

diabetic retinopathy may lead to poorer vision

diabetic neuropathy may lead to altered proprioception

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5
Q

how can incontinence lead to increase in falls risk

A

rush to toilet esp night

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6
Q

how can fear of falling lead to increase in falls risk

A

paradoxical increase in risk due to cautious gait

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7
Q

what % of those with cognitive impairment suffer falls

A

80%

do a 4AT ± MOCA/MMSE

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8
Q

true/false - antidepressants increase falls risk

A

true

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9
Q

what antidepressants and antipsychotics can lead to orthostatic hypotension

A

venlafaxine
duloxetine
risperidone
haloperidol

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10
Q

what anticonvulsant may lead to permanent cerebellar damage and ataxia in toxic levels in the blood

A

phenytoin

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11
Q

systolic BP of ___ leads to increase falls risk

A

<110 mmHg

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12
Q

what antihypertensives increase risk of falls, what cardiac medicines have a survival benefit

A

alpha blockers - prostatism
nitrates, CCB
survival benefit in ACEI and BB

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13
Q

what aspects of gait should be examined in an elderly patient who has suspected disturbance

A 
joint swelling 
muscle wasting 
shortening/foot drop 
peripheral neuropathy 
abnormalities of the feet 
assess gait/rombergs
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14
Q

what is the most common neurological condition leading to ataxia in the elderly

A

peripheral neuropathy

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15
Q

possible causes of peripheral neuropathy

A

diabetes
B12 deficiency
hypothyroid

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16
Q

when is peripheral neuropathy functionally significant in falls patients

A

lost heel reflexes
decreased vibration improving proximal
imapired position sense at great toe
cannot maintain unipedal stance for 10s in 3 attempts

17
Q

management of peripheral neuropathy in falls pts

A

correct walking aid use
decent shoes and orthotics
balance and strength exercise

18
Q

causes of orthostatic hypotension

A 
decreased autonomic buffering due to age  
volume depletion 
prolonged bed rest 
alpha blockers or diuretics 
neurogenic orthostatic hypotension 
arrhythmia 
carotid sinus sensitivity 
seizure
19
Q

what may cause neurogenic orthostatic hypotension

A

diabetes
amyloidosis
DLB
parkinsons disease

20
Q

conservative management of orthostatic hypotension

A 
stop possible drugs 
avoid sudden movement change 
water load 
increase salt 
compression stockings
elevate legs 
calf muscle exercises when standing for long periods
21
Q

medical management of orthostatic hypotension

A

fludrocortisone

midodrine

22
Q

what is a drop attack

A

sudden collapse with no preceding symptoms and without apparent LOC

23
Q

aspects of history to ask in falls?

A 
where did it occur 
preceding/during/after
any LOC 
any injury or head injury 
could you get up
how long lying
past falls 
was it different 
fear of falling
24
Q

examinations to conduct in falls?

A 
observations 
injuries - head, pelvis, hip, vertebrae 
cardiac - BP, murmur 
neuro - vision, peripheral neuropathy, gait, stroke 
4AMT ±MOCA/MMSE 
HINTS 
dix hallpike
25
Q

investigations to conduct in falls?

A 
ECG ± telemetry 
blood glucose 
postural BP 
timed up and go 
consider echo 
CT head 
ambulatory ECG 
tilt table test 
carotid sinus massage 
inflammatory markers and U&E
26
Q

when is an urgent plain head CT indicated

A 
GCS <13 
GCS< 15 after 2 hours injury 
suspected depressed or open skull fracture 
suspected basal skull fracture 
post traumatic seizure 
new focal neuro 
>2 episodes vomiting
27
Q

when is a plain head CT indicated within 8 hours

A

LOC or amnesia since injury and >65, or >30 mins retrograde amnesia, or on anticoagulation, or dangerous injury mechanism

28
Q

signs of a base of skull fracture?

A

haemotympanum
panda eyes
battles sign
CSF leak from nose or ears

29
Q

HTN target for >80yrs

A

<150/90

30
Q

what is carotid sinus syndrome

A

abnormal activation of carotid sinus baroreceptors leading to peripheral vasodilation and reduced HR, leading to cerebral hypoperfusion

31
Q

positive findings on carotid sinus massage suggesting CSS

A

cardioinhibition - paused HR >3s
vasopressor - drop in SBP 50mmHg
or both

32
Q

contraindication to carotid sinus massage

A

MI/CVA in 3m
Hx VT
carotid artery stenosis

33
Q

risks associated with carotid sinus massage

A

stroke or TIA

MB3 Medicine Elderly (7 decks)

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