Falls Flashcards

Question

What structural cardiac disease can cause falls

Answer 1

``` Valve e.g. AS IHD Acute MI Obstructive cardiomyopathy Pericardial disease / tamponade PE Subclavian steal Dissection ```

Answer 2

``` Exertional syncope or supine FH sudden death HF Recent MI New SOB Murmur Presence of ehart disease Palpitation Abnormal ECG ```

Answer 3

Bradycardia Long or short QT T wav einversion

Answer 4

Stroke / TIA - hemiparesis | Subclavian steal

Answer 5

``` When, where, why, previous falls RF for falls Before - Any Sx e.g. dizzy Any trigger / concurrent illness - why do they think During Recovery quick or slow - vasovagal quick Sx - LOC / dizzy / vertigo / amnesia / headache or injury / vomit / After - any long lie Alcohol DM Thick each system Cardiac - SOB or palpitation or pain Neuro - Weakness - Seizure ``` Background - How many falls last 6 month ``` PMH DH SH - ADL / carers / independence - Smoking / alcohol FH sudden cardiac death ```

Answer 6

``` Vital signs / NEWS ALWAYS document fluid status Lying and standing BP CVS / chest Neuro - Asymmetry - Power / tone - Cerebellar - Gait - Balance MSK Vision / hearing Abdo exam Feet exam for neuropathy / DM AMTS Injuries - X-Ray / CT ```

Answer 7

>65 + fall or on anti-coagulant = within 8 hours Risk of subdural Diff criteria if younger

Answer 8

``` Postural BP + CT = main Cardiac evaluation ECHO EEG MRI Cardiac stress Holter test for unknown - 24 hour cardiac monitor to pick up arrythmia Tilt table test Asses gait / balance - clinic ```

Answer 9

No cardaic cause or cardiac disease but defo not cause Possibly exercise induced See if change in position or HR causes

Answer 10

Carotid sinus massage (massage internal carotid) | If +Ve i.e. 3s block = hypersensitivity

Answer 11

Carotid sinus massage If +ve = hypersensitvity If -ve = holter

Answer 12

``` Seizure has 1+ of Bitten tongue Head turning No memory of abnormal behaviouro Unusual posture Prolonged limb - jerk Fast tonic clonic fall May be rigid CYanosis Confused after / prolonged post-octal Prodromal deja vu / aura ```

Answer 13

``` Prodromal vision / N+V / sweat / tinnitus / light-headed - abolished if sit dwon Trigger Prolonged standing precipitates Slow fall Bradycardia Lumpness Return of consciousness quick and no post-octal Secondary anoxic seizure is possbile ```

Answer 14

Limited cerebral reserve Hypoxia = impaired balance Infection / dehydration Often delerium on top

Answer 15

Dementia Deleirum Depression

Answer 16

``` Impaired judgement Abnormal gait Visual - spacial perception Can't recognise hazard Immobility ```

Answer 17

Anti-hypertensive Diuretic Benzodiazepine . anxiolytic Anti-cholinergic

Answer 18

Found on floor

Answer 19

Immoblity Immbolity = sarcopenia Falls = loss of confidence / injury / immbolity

Answer 20

Low muscle mass Degenerative loss of muscle mass Associated with frailty

Answer 21

``` DM Elderly Chronic disease Lack of use Inflammation Nutritional deficinecy Endocrine causes ```

Answer 22

Impairment - due to strctural / functional change e.g. hemiparesis due to infarct Activity restriction - relearn skills / SLT / neuropsychology Participation restriction - modify environment to not restrict Set goals and tackle all 3

Answer 23

Cardiac - MI / arrythmia / hypersensitivity Brain - haemorrhage ./ tumour Sepsis Poisin - new drug?

Answer 24

``` History Check for injury Assess cognition with 4AT and capaciy CT ECG Bloods Drug review ```

Answer 25

``` Postural BP Urine dip 4AT ECG Bloods CXR / urine if +Ve Drug review ```

Answer 26

Drug induced hyponatramia UTI Cancer / ulcer = GI bleed = anaemia = fall

Answer 27

Delerium Subdural haemorrhage Hip fracture Dehydration

Answer 28

``` Injury - haemorrhage / fracture Rhabdomyolysis = AKI Pneumonia Immobility Loss of confidence Carer stress Social isolation Terminal deline ```

Answer 29

Differentiate between vertigo / dizzy / syncope

Answer 30

Important to do to look for postural drop | Not if unwell as will be dehydrated / unable to stand

Answer 31

Probably BP | If no BP meds think Addison and do cortisol

Answer 32

``` CK if long lie hbA1c Haematenincs - b12, folate, ferritn Malabsorption screen e.g. coeliac if anaemia Vit D ```

Answer 33

``` FRAX score calculated Bone screen - Vit D, Ca, phosphate, PTH, ALP - Mg may be important - Myeloma screen ```