Falls Flashcards

1
Q

what ages should males and females be assessed for fracture risk?

A

females - 65 years
males - 75 years

consider between these ages and 50 years old in the presence of the following risk factors

  • previous fragility fracture
  • current or frequent use of glucocorticoids
  • history of falls
  • family history of hip fracture
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2
Q

how is the 10 year probability of a fragility fracture calculated?

A

using FRAX or QFracture risk tools

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3
Q

when should oral bisphosphonates be commenced relating to 10 years probability of fragility fractures?

A

10 year probability is at least 1%

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4
Q

when should IV bisphosphonates be commenced?

A

when 10-year probability of fragility fractures is at least 10%
or if a patient can not tolerate oral ones

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5
Q

name 2 medications as alternatives if a post menopausal women can not take bisphosphonates

A
- DENOSUMAB 
or 
- RALOXIFENE
or 
- RANELATE
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6
Q

Mechanism of action of Raloxifene?

A

selective oestrogen receptor modulator

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7
Q

mechanism of action of strontium ranelate

A

increases deposition of new bone by osteoblasts ansd reduces the resorption of bone by inhibiting osteoclasts

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8
Q

mechanism of action of denosumab

A

human monoclonal antibody that inhibits RANK ligand which in turn inhibits the maturation of osteoclasts

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9
Q

name a contraindication of taking oral bisphosphonates?

A

swallowing problems or pre existing oesophageal disease e.g. barrets oesophagus

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10
Q

what is sarcopaenia?

A

reduction in muscle mass

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11
Q

by what mechanism does postural hypotension arise from?

A

reduced baroreceptor sensitivity with ageing

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12
Q

1st line investigations in a patient presenting with falls?

A
  • blood glucose
  • lying and standing blood pressure
  • gain assessment
  • ECG
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13
Q

history of intermittent vertigo, precipitated by change in head position

A

BPPV

benign, paroxysmal positional vertigo

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14
Q

Interventions (2) that have been shown to reduce both risk and rate of falls?

A
  • exercise programmes; containing strength and balance training
  • home hazard assessment
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15
Q

most common side effects of bisphosphonates?

A

heartburn and indigestion

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16
Q

when should oral bisphosphonate therapy be reviews?

A

3-5 years time

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17
Q

what is the pnuemonic DAME for and what does it stand for

A
  • causes of falls in the elderly
  • Drugs
  • Ageing related
  • Medical causes
  • Environment
18
Q

Drug causes of falls in the elderly?

A
  • polypharmacy
  • antihypertensives
  • sedatives
  • opioids
  • psychotropics
19
Q

Ageing related causes of falls in the elderly?

A
  • visual changes
  • OA
  • decreased muscle bulk
  • gait abnormalities: increased postural sway
  • cognitive decline
20
Q

Medical causes of falls in the elderly? (3)

A
  • Neurological: neuropathy, strokes, parkinsons
  • Cataracts
  • Cardiac: arrhythmias
21
Q

Environmental causes of falls in the elderly?

A
  • walking aids
  • footwear
  • fear of falling
  • wrong length walking stick
22
Q

history questions to ask relating to prior to the fall?

A
  • time of day
  • where were they
  • any pattern to recurrent falls
  • prior symptoms
  • why do they think they fell
23
Q

history questions to ask relating to during the fall?

A
  • loss of consciousness

- injuries

24
Q

history questions to ask relating to after the fall?

A
  • did you get help
  • were you able to get up yourself
  • any complications e.g. head injury, fracture, hypothermia, pneumonia, dehydration, pressure sores
25
name 3 causes of vertigo (peripheral)
1) BPPV 2) Vestibular neuronitis 3) Meniere's disease
26
what are the 3 patterns dizziness comes in?
- light headedness - vertigo - feeling fuzzy all the time
27
what symptoms does a patient with BPPV experience?
sudden onset of dizziness and vertigo triggered by changes in head position, e.g. looking one way/turning round in bed or gazing upwards
28
name 4 causes of central vertigo
- multiple sclerosis - brainstem ischaemia - cerebellar stroke - migraine
29
how long do episodes of BPPV last?
10-20 seconds
30
symptomatic relief for BPPV?
- Epley maneuvre - Vestibular rehabilitation exercises - Betahistine
31
how is postural hypotension diagnosed?
lying and standing blood pressure
32
how is lying and standing blood pressure measured?
Patient is asked to lie down for 5 minutes, after which blood pressure is measured followed by standing up and standing blood pressure measured within 1 minute, another BP measurement after standing up for 3 minutes
33
What is a positive postural hypotension lying and standing blood pressure measurement in relation to the systolic BP
drop in sysolic more than or equal to 20 mmHg
34
What is a positive postural hypotension lying and standing blood pressure measurement in relation to the diastolic BP
Drop in diastolic of 10 mmHg with symptoms
35
what is a psychogenic cause of falls?
- common, fear of falling with confidence loss
36
how does baroreceptor sensitivity change with ageing
decreases
37
list the ways a physiotherapist helps to manage a patient with falls?
- 6 weeks falls class for balance training and strength retraining - training can include showing ways to get up if fall over in the future - either in a group or individual classes
38
podiatrist role in managing a patient with falls?
footwear advice for more supportive shoes
39
pharmacist role in managing patient with falls
prescription review and omit certain medications such as antihypertensives
40
role of occupational therapy for managing a patient with falls
home visit to assess environment; lighting, panic alarm system, environmental hazards, home adaptations