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OPIC > Falls > Flashcards

Falls Flashcards

1
Q

What questions would you ask regarding when did you fall ?

A
  • What time of day ?
  • What were they doing at the time ? (Looking upwards - vertebrobasilar insufficiency, getting up from the bed - postural hypotension)
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2
Q

What questions would you ask regarding where did you fall ?

A
  • In the house or outside?
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3
Q

What questions would you ask regarding what happened before/ during/ after the fall ?

A
  • Before: any warning, was there any dizziness/ chest pain/ palpitations
  • During: was there any incontinence or tongue biting ? Was there any loss of consciousness? Was the patient pale/flushed? Did the patient injure themselves? What part of the body had the first contact with the floor?
  • After: what happened after the fall ? Was the patient able to get themselves up off the floor? How long did it take them ? Was the patients able to resume normal activity afterwards? Was there any confusion after the event ? Was there any weakness or speech difficulty after the event ?
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4
Q

What questions should be asked regarding why?

A
  • Why did you think you may have fallen
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5
Q

What questions should be asked regarding how?

A
  • how many times have you fallen over the last 6 months
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6
Q

What questions would you ask for a general systems review?

A
  • Fatigue
  • Weight loss
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7
Q

What questions would you ask for a CVS systems review?

A
  • Chest pain
  • Palpitations
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8
Q

What questions would you ask for a Respiratory systems review?

A
  • SOB
  • Cough
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9
Q

What questions would you ask for a Neurological systems review?

A
  • Loss of consciousness
  • Seizures
  • Motor/ sensory disturbances
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10
Q

What question would you ask for a GI systems review?

A
  • Abdominal pain
  • Diarrhoea
  • Constipation
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11
Q

What questions would you ask for a Urology systems review?

A
  • Incontinence
  • Urgency
  • Dysuria
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12
Q

What questions would you ask for a MSK systems review?

A
  • Joint pain
  • Muscle weakness
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13
Q

What is significant in the Past Medical History for Falls?

A
  • Visual/ Hearing impairment
  • Diabetes
  • Anaemia
  • CVS disease
  • Arrhythmias
  • COPD
  • Parkinson’s disease
  • Peripheral neuropathy
  • Stroke
  • Dementia
  • Recurrent UTI
  • Incontinence
  • Diverticulitis
  • Chronic diarrhoea
  • Alcoholic liver disease
  • Arthritis
  • Chronic pain
  • Fractures
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14
Q

What is important to establish from the social history for falls?

A
  • Alcohol intake
  • support at home = friends/ family and carers
  • mobility - use of mobility aids
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15
Q

What should you assess during clinical examination of a falls patient?

A
  • Is the Patient orientated/ alert? Can the patient perform the timed up and go test? (getting up walking 3 meters and returning?
  • Pulse/ BP? Bruits- carotids? Murmurs?
  • Increased work of breathing? Coarse crackles (pneumonia)? Dullness on percussion (pleural effusion)
  • Cranial nerve examination
  • Power weakness (stroke)? Tone changes (stroke)? Reflexes (reduced = diabetic neuropathy, increased = UMN lesions)? Sensation reduced (UMN/LMN lesions)? Co-ordination impaired (Chronic alcohol misuse or cerebellar degeneration)?
  • Abdominal tenderness? Organomegaly?
  • Injuries associated with falls?
  • Ear wax? tympanic membranes intact?
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16
Q

What Investigations would you do for Falls?

A
  • Bedside: BP/HR/RR/Spo2/Temp
  • Lying and Standing BP (orthostatic hypotension)
  • Urine dipstick: infection, rhabdomyolysis
  • ECG: Bradycardia, Arrhythmias
  • Cognitive Screening: AMT - Cognitive Impairment
  • Blood Glucose: Hypoglycaemia
  • Bloods: FBC
  • U+E: Dehydration, electrolyte abnormalities, rhabdomyolysis
  • LFTs: Chronic Alcohol Use
  • Bone Profile: Calcium abnormalities in malignancy, over-supplementation of Calcium
  • Imaging: CXR, CT head (stroke, bleeds), ECHO (valvular heart disease - Aortic stenosis)
  • Specialist - Tilt Table Test (Orthostatic hypotension), Dix-Hallpike test (BPPV), Cardiac Monitioring (48 hour tape)
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16
Q

What Investigations would you do for Falls?

A
  • Bedside: BP/HR/RR/Spo2/Temp
  • Lying and Standing BP (orthostatic hypotension)
  • Urine dipstick: infection, rhabdomyolysis
  • ECG: Bradycardia, Arrhythmias
  • Cognitive Screening: AMT - Cognitive Impairment
  • Blood Glucose: Hypoglycaemia
  • Bloods: FBC
  • U+E: Dehydration, electrolyte abnormalities, rhabdomyolysis
  • LFTs: Chronic Alcohol Use
  • Bone Profile: Calcium abnormalities in malignancy, over-supplementation of Calcium
  • Imaging: CXR, CT head (stroke, bleeds), ECHO (valvular heart disease - Aortic stenosis)
  • Specialist - Tilt Table Test (Orthostatic hypotension), Dix-Hallpike test (BPPV), Cardiac Monitioring (48 hour tape)
17
Q

What are some of the Differential Diagnosis for falls?

A
  • General: Mechanical (poor footwear/ visual impairments, Polypharmacy)
  • CVS: Arrhythmias, orthostatic hypotension, bradycardia, valvular heart disease
  • Neurological: Stroke, Peripheral Neuropathy
  • Genitourinary: Incontinence, UTI
  • Endocrine: Hypoglycaemia
  • MSK: Arthritis, Disuse Atrophy
  • ENT: BPPV, Ear wax
18
Q

What is the Management for Gait Issues with falls?

A
  • Physiotherapy
19
Q

What is the managment for Visual Problems with Falls?

A
  • Eye tests
  • Ensures glasses are worn
20
Q

What is the managment for Hearing Difficulties with Falls?

A
  • Remove Earwax
  • Hearing Assessment
21
Q

What is the managment for Medication Reviews with Falls?

A
  • Cut down any unnecessary medications
22
Q

What is the managment for Alcohol intake regarding Falls?

A
  • Alcohol cessation advice
  • Alcohol service referral
23
Q

What is the managment for Cognitive Impairment for Falls?

A
  • Psychiatric team
24
Q

What is the managment for Postural Hypotension for Falls?

A
  • Review Medication
  • Improve Hydration
25
Q

What is the managment for Continence in Falls?

A
  • Treat/ rule out infections
  • Continence assessment
26
Q

What is the managment for Footwear in Falls?

A
  • Ensure good fitting footwear
27
Q

What is the managment for Environmental Hazards in Falls?

A
  • Turn on Lights
  • Take up Rugs
28
Q

What is the managment options for Falls?

A
  1. Gait
  2. Visual Problems
  3. Hearing Difficulties
  4. Medications Review
  5. Alcohol Intake
  6. Cognitive Impairment
  7. Postural Hypotension
  8. Continence
  9. Footwear
  10. Environmental Hazards
29
Q

What are the three Fall Risk Assessment Tools?

A
  • FRAT (falls risk assessment tool)
  • Timed Up and Go test ( Time the person getting up from a chair without using their arms walking 3 metres, turning around, returning to their chair and sitting down)
  • Time 180 test ( Ask the person to stand up and step around until they are facing the opposite direction)
30
Q

What are the three Fall Risk Assessment Tools?

A
  • FRAT (falls risk assessment tool)
  • Timed Up and Go test ( Time the person getting up from a chair without using their arms walking 3 metres, turning around, returning to their chair and sitting down)
  • Time 180 test ( Ask the person to stand up and step around until they are facing the opposite direction)
31
Q

What is Osteoporosis?

A
  • Osteoporosis is a condition where there is a reduction in the density of the bones
32
Q

What are the risk factors of Osteoporosis?

A
  • Older Age
  • Female
  • Reduced Mobility and Activity
  • Low BMI
  • RA
  • Alcohol and Smoking
  • Long term corticosteroids
  • Other Medications: SSRI, PPIs, Anti-epileptics and Anti-oestrogens
  • Post-menopausal women
  • Oestrogen is protective against osteoporosis
33
Q

What is the FRAX tool?

A
  • Frax tool gives a prediction of the risk fo fragility fracture over the next 10 years.
  • Looks at age, BMI, co-morbidities, smoking, alcohol and family history
  • It gives results as a percentage 10-year probability of a: Major osteoporotic fracture and hip fracture
34
Q

What is Bone Mineral Density?

A
  • BMD is measured using a DEXA scan ( Dual-energy xray absorptiometry)
  • Gives you a T score
  • This forms the basis for the WHO classification of the level of osteoporosis
35
Q

What is the WHO classification Score?

A
  • More than -1 = Normal
  • -1 to -2.5 = Osteopenia
  • Less than -2.5 = Osteoporosis
  • Less than -2.5 plus a fracture = severe osteoporosis
36
Q

How would you go about assessing for osteoporosis?

A

Perform a Frax assessment on:
1. Women aged >65
2. Men aged >75
3. Younger Patients with risk factors such as previous fragility fractures, history of falls, low BMI, long term steroids, endocrine disorders and RA

After Frax assessment perform a BMD:
- low risk = reassure
- intermediate risk = offer DEXA scan and recalculate the risk with the results
- high risk = offer treatment

Frax outcome with BMD:
1. Treat
2. Lifestyle advice and Reassure

37
Q

What is the Managment for Osteoporosis?

A
  • Activity and Exercise
  • Maintain a Healthy weight
  • Adequate calcium + Vit D intake ( Calchichew- D3 = 1000mg of calcium and 800 units of Vit D)
  • Avoiding Falls
  • Stop Smoking
  • Reduce Alcohol Consumption
38
Q

What are some examples of Bisphosphonates?

A
  • Alendronate 70mg
  • Risedronate 35mg
  • Zoledronic Acid 5mg
39
Q

What are some of the side effects of Bisphosphonates?

A
  1. Reflux and oesophageal erosions - taken on empty stomach sitting upright for 30 minutes before moving or eating
  2. Atypical fractures
  3. Osteonecrosis of the jaw
  4. Osteonecrosis of the external auditory canal
40
Q

What are some other medical options if bisphosphonates are contraindicated?

A
  • Denosumab = monoclonal antibody which works by blocking the activity of the osteoclasts
  • Strontium Ranelate = stimulate osteoblasts and blocks osteoclasts, but increases the risk of DVT, PE and MI
  • Raloxifene = used as secondary prevention only. It is a SERM that stimulates oetrogen receptors on the bone but blocks them in the breast and uterus
  • HRT = considered in women who go through menopause early
41
Q

What is the Follow Up for Patients who have Osteoporosis?

A
  • Low risk patients only given lifestyle advice should be followed up within 5 years
  • Patients on Bisphosphonates should have a repeat FRAX and DEXA scan after 3-5 years and a treatment holiday should be considered if there BMD has improved

OPIC (18 decks)

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