Falls

Question 1

morbidities caused by a long lie on the floor after a fall

Answer 1

hypothermia
dehydration -> AKI
rhabdomyolysis -> AKI
DVT
pneumonia
pressure sore

Question 2

what kind of patients are at highest risk of falls?

Answer 2

patients with delirium or cognitive impairment

Question 3

what happens to vision as we get older?

Answer 3

smaller pupils

thicker lens so less light gets in

Question 4

why do reaction times change as you get older?

Answer 4

central processing and cognition are worse

Question 5

why is standing from a chair difficult in old people?

Answer 5

less muscle mass from sarcopenia so less quadriceps bulk

Question 6

cardiovascular causes of falls

Answer 6

syncope
arrythmias
vascular eg postural hypotension or stroke (NOT TIA)

Question 7

visual causes of falls

Answer 7

wet ARMD
glaucoma
cataracts

Question 8

“i just go down…”

Answer 8

syncope

Question 9

why should you look at clothes in someone who has fallen?

Answer 9

gives you an idea of the time/day that they fell eg pyjamas would mean it was at night

Question 10

causes of syncope

Answer 10

arrhythmias eg heart block

postural hypotension

Question 11

another term for postural hypotension

Answer 11

orthostatic hypotension

Question 12

test for postural hypotension?

Answer 12

sit-stand BP

Question 13

what would someone with aortic stenosis have before a fall?

Answer 13

chest pain

breathlessness

Question 14

most common valvular cause of falls

Answer 14

aortic stenosis

Question 15

postural HT is defined as a fall in __mmHg SBP and __mmHg DBP

Answer 15

> 20

>10

Question 16

how would you do a sit-stand BP

Answer 16

take lying BP (lie for 5 mins)

take BP immediately when standing PLUS 3 mins after

Question 17

why do old people get postural hypotension

Answer 17

skeletal muscle pumps less effective so less venous return
medication eg BP drugs
possible slowing of the ANS eg MS

Question 18

“high-stepping gait”

Answer 18

cervical myelopathy

Question 19

3 causes of a wide based gait

Answer 19

peripheral neuropathy
cerebellar ataxia
lumbar stenosis

Question 20

patients with parkinsons get postural hypotension T or F

Answer 20

T

Question 21

BPPV is confirmed by what manoeuvre?

Answer 21

dix -hallpike

Question 22

“brown tinge to vision”

Answer 22

cataracts

Question 23

what class of antiarrythmics cause falls?

Answer 23

class 1A

Question 24

3 history questions to screen for falls?

Answer 24

1. have you had 2 or more falls in the last year
2. have you presented acutely with a fall
3. do you have problems with walking and balance

Question 25

what do you want to get from a fall history

Answer 25

what happened before and after
impact/consequence of it
account from a witness
medication list

Question 26

what examinations would you want to do in a patient with falls?

Answer 26

GALS
neurological exam
CVS exam
visual acuity
incontinence assessment
look at shoes

Question 27

how would you screen for fracture risk?

Answer 27

do a qFRACTURE score

check vitamin D levels

Question 28

being on over _ medications is a risk factor for falls

Answer 28

4