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Geriatrics > FALLS > Flashcards

FALLS Flashcards

1
Q

why is fall risk the number one mortality

A

you’re in the hospital and you get sick

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2
Q

two trajectories for ddx

A

commonality

red flag

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3
Q

Common DiagnosesLeading to Gait Disorders

A 
Degenerative Joint Disease
Sensory Impairment
Neurological Diseases
Stroke
Parkinson's
Postural Hypotension/Rx induced
Fear of Falling
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4
Q

number one thing that pertains to gait problems

A

degenerative joint disease

arthritis

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5
Q

normal pressure hydrocephalus gait looks like what

A

cortical gait disorder

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

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6
Q

Trendelenburg gait causes

A

Drop in pelvis/weight to unaffected side

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

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7
Q

Drop in pelvis/weight to unaffected side

A

Trendelenburg:

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8
Q

Gluteus Maximus Lurch

A

hip extensor weakness eg gluteus maximus

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9
Q

Backward trunk lurch persists to maintain center of balance

A

Gluteus Maximus Lurch:

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10
Q

Excess hip flexion to clear foot

A

Steppage:

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11
Q

Steppage gait caused by

A

foot drop

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12
Q

foot drop is high risk

A

high risk for femoral nerve damage

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13
Q

drunk gait

A

ataxic gait

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14
Q

Antalagic gait means

A

secondary to pain

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15
Q

weakness in gluteus maximus leads to what kind of gait

A

Trendelenburg

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16
Q

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

A

backwards

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17
Q

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

A

tibialis anterior

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18
Q

foot drop is usually the result of injury to what nerve

A

peroneal (deep peroneal)

this nerve is responsible for dorsiflexion of this muscle

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19
Q

peroneal nerve begins where and joins what

A

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

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20
Q

what type of conditions can cause foot drop

A

injury to the knee

can be a late finding in compartment syndrom

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21
Q

tx of foot drop

A

tx of herniated disk

need nerve studies

22
Q

most common causes of falls

A 
Accident/environment (mechanical) 	31%
Gait/balance dis(mechanical)	                 17%
Dizziness					      13%
Drop Attack (syncope)	         10%
Confusion					      4%
Postural Hypotension			      3%
Impaired Vision				      3%
23
Q

how many geriatrics pts sustain injury in a fall

A

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

24
Q

risk factors for falls

A

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
25
Q

RESTRAINTS

A

ARE A RISK FACTOR FOR FALLS

NOT INTUITIVE but people who are restrained are more likely to fight that shit and fall

26
Q

Checklist for Patients who Fall:Past Medical History

A 
History of Injuries, Accidents
Falls within the Last 12 Months
History of Diseases and Surgeries
History of Orthopedic Procedures
Hospitalizations
MEDICATIONS
27
Q

REFLAGS

A

Chest pain of shortness of breath

acute coronary event
DON’T miss this

stroke–> DON’T MISS THIS

chronic neurological thing?

28
Q

evaluating stroke risk?

A

weakness
slurred
confusion?
poor balance

29
Q

incontinence with fall suggests

A

a seizure

30
Q

reoccurring falls suggestive of

A

Parkinsonism
dementia
heart failure

31
Q

were you going to the bathroom?

A

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

32
Q

trauma check

A

should be able to check bony protuberances

33
Q

no obvious fractures after palpation

poor historian

A

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

34
Q

syncope CM symptoms

A

HTN
tachycardia
bruits
carotid sinus massage causing dizziness or weakness

35
Q

what causes impaired oxygenation

A

COPD

CHF

36
Q

peripheral vasodilation is caused by

A

CHF

37
Q

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

A

CHF

38
Q

what increases venous return

A

muscles squeezing
diaphragm pumping on IVC
and valves
wearing stockings

39
Q

negative ekg

A

could still be mI paroxysmal

look at blood pressure
tachycardia
pulso ox
murmurs 
skipped heart beats --> irregularly irregular

EDMA

40
Q

peripheral

A

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

be able to think backwards

41
Q

subjective

A

SXS

42
Q

objective

A

PE

43
Q

positive carotid massage

A

if blood pressure dorps

44
Q

test for orthostasis

A

lie
sit
stand

bp check

45
Q

criteria that warrants hospitlization

A 
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
46
Q

red flags in dizziness

A

onset sudden?

47
Q

BPPV

A

benign postural positional vertigo

not seen with positive dick’s hallpike all the time

balance in ear effected —> natural dizziness

nystagmus seen

48
Q

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

A

central nervous lesion

but could still be BPPV

49
Q

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

A

NO NEURAL DEFFICITS

50
Q

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

A

NO NEURAL DEFFICITS

make sure all CN nerve and cerberall tests are neg for CVA

51
Q

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

A

have you had any changes in vision or hearing

shortness of breath?

Geriatrics (12 decks)

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