FALLS

Question 1

why is fall risk the number one mortality

Answer 1

you’re in the hospital and you get sick

Question 2

two trajectories for ddx

Answer 2

commonality

red flag

Question 3

Common DiagnosesLeading to Gait Disorders

Answer 3

Degenerative Joint Disease
Sensory Impairment
Neurological Diseases
Stroke
Parkinson's
Postural Hypotension/Rx induced
Fear of Falling

Question 4

number one thing that pertains to gait problems

Answer 4

degenerative joint disease

arthritis

Question 5

normal pressure hydrocephalus gait looks like what

Answer 5

cortical gait disorder

short shuffling and scraping
hip adducts so that the knee cross in front

Question 6

Trendelenburg gait causes

Answer 6

Drop in pelvis/weight to unaffected side

Cause: hip abductor weakness, eg: gluteus medius minimus piriformis, QL

Question 7

Drop in pelvis/weight to unaffected side

Answer 7

Trendelenburg:

Question 8

Gluteus Maximus Lurch

Answer 8

hip extensor weakness eg gluteus maximus

Question 9

Backward trunk lurch persists to maintain center of balance

Answer 9

Gluteus Maximus Lurch:

Question 10

Excess hip flexion to clear foot

Answer 10

Steppage:

Question 11

Steppage gait caused by

Answer 11

foot drop

Question 12

foot drop is high risk

Answer 12

high risk for femoral nerve damage

Question 13

drunk gait

Answer 13

ataxic gait

Question 14

Antalagic gait means

Answer 14

secondary to pain

Question 15

weakness in gluteus maximus leads to what kind of gait

Answer 15

Trendelenburg

Question 16

when the gluteus maximus muscle is weak the trunk moves in which direction

Answer 16

backwards

Question 17

foot drop is the inability to raise the front part of the foot due to weakness or paralysis of what muscle

Answer 17

tibialis anterior

Question 18

foot drop is usually the result of injury to what nerve

Answer 18

peroneal (deep peroneal)

this nerve is responsible for dorsiflexion of this muscle

Question 19

peroneal nerve begins where and joins what

Answer 19

begins from L4 L5 S1 and S2 to join the tibial and form the sciatic nerve

Question 20

what type of conditions can cause foot drop

Answer 20

injury to the knee

can be a late finding in compartment syndrom

Question 21

tx of foot drop

Answer 21

tx of herniated disk

need nerve studies

Question 22

most common causes of falls

Answer 22

Accident/environment (mechanical) 	31%
Gait/balance dis(mechanical)	                 17%
Dizziness					      13%
Drop Attack (syncope)	         10%
Confusion					      4%
Postural Hypotension			      3%
Impaired Vision				      3%

Question 23

how many geriatrics pts sustain injury in a fall

Answer 23

50% sustain injury
2% hip fracture
5% other fracture

Question 24

risk factors for falls

Answer 24

Hx of fall
if pts are falling more than once the likelihood that is is a mechanical fall goes down

Gait Deficit
Balance Deficit
Strength Deficit
RESTRAINTS
Arthritis
Uses assistive devices
Impaired ADLs
Depression
Cognitive Impairment
Postural Hypotension

Question 25

RESTRAINTS

Answer 25

ARE A RISK FACTOR FOR FALLS NOT INTUITIVE but people who are restrained are more likely to fight that shit and fall

Question 26

Checklist for Patients who Fall:Past Medical History

Answer 26

``` History of Injuries, Accidents Falls within the Last 12 Months History of Diseases and Surgeries History of Orthopedic Procedures Hospitalizations MEDICATIONS ```

Question 27

REFLAGS

Answer 27

Chest pain of shortness of breath acute coronary event DON'T miss this stroke--> DON'T MISS THIS chronic neurological thing?

Question 28

evaluating stroke risk?

Answer 28

weakness slurred confusion? poor balance

Question 29

incontinence with fall suggests

Answer 29

a seizure

Question 30

reoccurring falls suggestive of

Answer 30

Parkinsonism dementia heart failure

Question 31

were you going to the bathroom?

Answer 31

vasalsalva valva maneuver causes people to lose consciousness During the strain, venous return to the heart is decreased and peripheral venous pressures become increased.

Question 32

trauma check

Answer 32

should be able to check bony protuberances

Question 33

no obvious fractures after palpation | poor historian

Answer 33

CT: stokre EKG: arrhythmia labs: dehydrated, electrolyte abnormality, anemia, infection UA: UTI if nothing is wrong with them and they live at home alone you have a bigger issue and you need to make sure someone is going to check on them do they need a assisted device? if they can't self change their foley they may need to be admitted to the hospital. Build your argument

Question 34

syncope CM symptoms

Answer 34

HTN tachycardia bruits carotid sinus massage causing dizziness or weakness

Question 35

what causes impaired oxygenation

Answer 35

COPD | CHF

Question 36

peripheral vasodilation is caused by

Answer 36

CHF

Question 37

diminished venous tone leading to pooling of blood in the LE sx of

Answer 37

CHF

Question 38

what increases venous return

Answer 38

muscles squeezing diaphragm pumping on IVC and valves wearing stockings

Question 39

negative ekg

Answer 39

could still be mI paroxysmal ``` look at blood pressure tachycardia pulso ox murmurs skipped heart beats --> irregularly irregular ``` EDMA

Question 40

peripheral

Answer 40

numbness in fingers full range of motion should be able to rattle off neurological symptoms be able to think backwards

Question 41

subjective

Answer 41

SXS

Question 42

objective

Answer 42

PE

Question 43

positive carotid massage

Answer 43

if blood pressure dorps

Question 44

test for orthostasis

Answer 44

lie sit stand bp check

Question 45

criteria that warrants hospitlization

Answer 45

``` syncope while supine syncope during exertion palpitations prior to sync Fhx of sudden cardiac death Hx of previous myocardial infarction low EF signs of heart failure --> worsening edema!! abnormal ECG systolic blood pressure <90 ```

Question 46

red flags in dizziness

Answer 46

onset sudden?

Question 47

BPPV

Answer 47

benign postural positional vertigo not seen with positive dick's hallpike all the time balance in ear effected ---> natural dizziness nystagmus seen

Question 48

what could you have if you don't have nystagmus with dizziness with dick's hallpike

Answer 48

central nervous lesion but could still be BPPV

Question 49

how do you write a note that says dizziness is not a stroke

Answer 49

NO NEURAL DEFFICITS

Question 50

how do you write a note that says dizziness is not a stroke

Answer 50

NO NEURAL DEFFICITS make sure all CN nerve and cerberall tests are neg for CVA

Question 51

what are the first questions you need to ask a pt with dizziness

Answer 51

have you had any changes in vision or hearing | shortness of breath?