Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CSI > Falls > Flashcards

Falls Flashcards

1
Q

What is ‘hyperactive’ delirium?

A

Abnormally alert
Restless
Agitated
Possibly aggressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define hip fracture

A

Bony injury of the proximal femur typically occurring in the elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can people with delirium be supported?

A 
Review medications
Pain free
Properly hydrated
Well nourished
Oxygenated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How much do hip fractures cost the NHS a year?

A

£1 billion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What % of people with hip fractures cannot live independently afterwards?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How would you treat Garden II, undisplaced,intra-articular, intra-capsular fracture?

A

Dynamic hip screw

Cannulated hip screw

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What surgery is recommended for minimally displaced intra-capsular fracture gardens I/II?

A

2-3 cannulated hip screws

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the risks of fragility fractures?

A 
Age
Female
Low body mass/ Anorexia nervosa
Parental history 
Corticosteroid therapy
Cushing's
3+ units a day
Smoking
Ethnicity- caucasian higher risk
 OI/Acromegaly
Visual impairment 
Cognitive impairment
Sedative meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What effects can be seen post-delirium?

A

Distressing memories
Rapid worsening of a person’s mental abilities
Later diagnosis of dementia
Higher risk of death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What % of them die within a year?

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is sarcopenia?

A

Progressive and generalised loss of skeletal muscle and strength
Risk factors: age, gender, levels of physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why is vitamin D important in bone health?

A

Involved in calcium absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is unique about the proximal femur?

A

Largest bone in the human body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the mechanostat theory?

A

Suggests that external forces influence the mass and architecture of the bone
Adapts strength to resist/cope with habitual loads

Regulatory mechanism in bone that senses changes in the mechanical demands placed on it and stimulates adjustment in its architecture

Below a certain threshold of mechanical use bone is reabsorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does intra-capsular mean?

A

Above the inter-trochanteric line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is teriparatide?

A

Recombinant fragment of parathyroid hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How can a fragility factor occur without a fall?

A

Coughing
Heavy lifting
Banging into things

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Aside from clinical consequences what can a fall result in?

A

Loss of confidence
Become withdrawn
Loss of independence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What percentage of older people in hospital have dementia?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does PTH do?

A

Increases calcium reabsorption

Action of osteoclasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is ‘hypoactive’ delirium?

A

Causes patients to become withdrawn and sleepy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How might a hip fracture be caused in a younger person?

A

Trauma
Gait disturbance e.g. MS
Prolonger steroid use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is type I?

A

Incomplete

Impacted in valgus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What role do stem cells in the bone marrow have in osteoporosis?

A

Stem cells become adipocytes rather than osteoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What should you observe on an X-ray?

A

Shenton’s line should be continuous and smooth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What hormone level will rise in response to low calcium?

A

Parathyroid hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How many fractures does osteoporosis cause?

A

200,000 annually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is type II?

A

Complete

Undisplaced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are secondary causes of osteoporosis?

A 
Rheumatoid arthritis
Very sedentary lifestyle 
Hypogonadism
Hyperparathyroidism
Hyperthyroidism
Post-transplantation
Chronic kidney disease
GI e.g. Crohn's, coeliac
Premature menopause
T1DM and T2DM
Chronic liver disease
COPD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What do you check for when a patient suffers delirium?

A

Infection
Electrolyte abnormalities
Metabolic abnormalities
Intracerebral pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Why might an elderly person be vitamin D deficient?

A

Not going out as frequently
Diet
Poor kidney and liver function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the inter-trochanteric line?

A

Line that lies of the anterior surface of the femoral neck running between trochanters
Demarcates the inferior attachments of the hip capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What can compression fractures cause?

A 
Pain 
Morbidity associated with high analgesia doses
Loss of height 
Difficulty breathing
Loss of mobility 
GI symptoms 
Difficulty sleeping 
Symptoms of depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Why might they die within a year?

A 
Co-morbidities 
Infection 
Hospital acquired infections
Heart failure 
Poor mobility- blood clots, bed sores
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What factors might have contributed to Mrs Wilkins delirium?

A 
Age
Dehydration
Change in environment 
Medications- change, new, not taking 
Painkillers
Bladder and bowel problems
Head trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Why are older people more susceptible to falls?

A 
Balance problems
Muscle weakness
Poor vision
Long term health conditions e.g. hearing disease
Can lead to dizziness and a brief loss of conciousness
Reduced bone mineral density  
Bones deficient in elastic reserve
Medications e.g. beta blockers 
Low blood pressure (postural/orthostatic hypotension)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What makes you more susceptible to osteoporosis?

A

Smoking
Excessive alcohol consumption
Steroid medication
Family history of hip fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What T-score represents osteoporosis?

A

Less than 2.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What should you do if you fall?

A

Keep calm
Don’t get up too quickly
Roll on your hands and knees
Look for a stable piece of furniture e.g. chair or bed
Hold with both hands
Rest before carrying on with daily activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is osteoporosis characterised by?

A

Low bone mass
Micro architectural disruption
Skeletal fragility
Decreased bone strength and increased risk of fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the effects of delirium?

A 
Easily distracted
More confused 
Changes in alertness
Disorientation
Rambling speech
Disturbed patterns of sleep 
Prone to mood swings
Hallucinations
Abnormal/Paranoid beliefs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How do you divide care for patients with neck of femur fractures?

A

Pre op
Op
Post op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is raloxifene?

A

Selective oestrogen receptor modulator
Inhibits bone reabsorption
Reduces vertebral fracture risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How can hip fractures be classified?

A

intra- or extra- capsular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What post op components can be used?

A 
Pain control 
Antibiotic prophylaxis
FBC monitoring
Routine examinations 
Cognitive function assessment 
Prevention and management of pressure sores 
Nutritional status monitoring 
Monitoring of renal/bowel/bladder function 
Wound care
Early mobilisation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How can low BMD be treated?

A

Adequate vit D and calcium intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What % of people with hip fractures die within in month?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are risk factors for fragility fractures?

A 
Osteoporosis
Advancing age
Acromegaly
Osteogenesis imperfecta
Poor balance
Poor muscle strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Which type of dementia is delirium most similar to?

A

Lewy body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Why may HRT be used?

A

Option in younger perimenopausal women who also need treatment for symptoms of menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What are common sites for fragility fractures?

A

Vertebrae
Proximal femur
Distal radius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is strontium ranelate?

A

Only used for severe osteoporosis

or patients for whom other treatments are not possible due to increased risk of myocardial infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Why are elderly females at particular risk for osteoporosis?

A

Low oestrogen levels after menopause

54
Q

What should you know about your patients?

A

Medical co-morbidities
How mobile there were before their fall
Social history

55
Q

What explains Mrs. Wilkins’ current mental state?

A

Acute confusional state- delirium

56
Q

What is teriparatide?

A

Competitive inhibitor for PTH

Used to treat osteoporosis

57
Q

What imaging can be done?

A

CXR pre-op
Plain films
MRI/CT if plain films are inconclusive
Cardiac echo

58
Q

What is a fragility fracture?

A

Result from mechanical forces (low energy)
Equivalent to a fall from standing height or less
Can happen without a fall

59
Q

When might surgery not be an option?

A

Significant co-morbidities

60
Q

In what % of people at risk can delirium be prevented?

A

30%

61
Q

Rarely what conservative measures could be used?

A

Traction
Bed rest
Restricted mobilisation
Outcomes are often very poor

62
Q

Give examples of measures that can help prevent falls

A 
Using non-slip mats in the bathroom
Mopping up spills 
Ensuring good lighting 
Removing clutter 
Getting help moving or lifting heavy items
63
Q

What should you supplement after a fragility fracture?

A

Calcium and cholecalciferol

64
Q

What bedside investigations can be carried out?

A

Observations
Urine dip
ECG

65
Q

How can the environment be adapted?

A

24 hour clock
Hearing aids and glasses properly worn
Avoid unnecessary noise t night
Not moving person between wards

66
Q

What might a GP recommend to reduce the risk of falls?

A 
Sight test
ECG 
Blood pressure check
Request a home hazard assessment 
Doing exercises to improve strength and balance
67
Q

What is the 1 year mortality for hip fractures?

A

40%

68
Q

What is type III?

A

Complete

Partially displaced

69
Q

What surgery is recommended for displaced intra-capsular fracture gardens III/IV?

A

THR
Total hip replacement for fit patients

Hemi-arthoplasty for patients with significant comorbidity

70
Q

What does the type of fracture determine?

A

Likelihood of disruption to the blood supply fo the femoral head
Intra = higher risk

71
Q

What does prognosis depend upon?

A

Age
Comorbidity
Fracture site
Personal circumstances

72
Q

What is type IV?

A

Complete

Completely displaced

73
Q

Who is involved in post-op management?

A 
Orthopaedic surgeon
Geriatric physician 
Nurses
Occupational therapist
Social workers
Physiotherapists
74
Q

What is a major risk factor for fragility fracture?

A

Reduced bone mineral density

75
Q

What are the metaphyseal vessels?

A

After skeletal maturity the contribute blood to the femoral head

76
Q

What can prolonged bed rest lead to?

A 
Thromboembolism
UTIs
Pneumonia
Pressure sores
Loss of muscle
77
Q

How many hip fractures are there a year in the UK?

A

65,000

78
Q

How do patients with hip fractures typically present?

A

Inability to bear weight
Pain in the affected side
Reduced range of movement
Bony tenderness

79
Q

How can bisphosphantes be used to treat osteoprosis?

A

Helps replenish minerals within bone

Inhibit osteoclasts

80
Q

What comprises the proximal femur?

A 
Head
Neck
Greater trochanter
Lesser trochanter
Shaft
81
Q

What is the mean age for hip fractures?

A

80

82
Q

How would you treat intra-capsular, Garden IV, displaced fracture?

A

Hip replacement

Total- also replaces that acetabulum

83
Q

What can a GP do to reduce the risk of falls?

A

Simple balance checks

Review of medication for side effects that may increase risk

84
Q

What are the risk factors for hip fractures?

A 
Increasing age
Osteoporosis 
Low muscle mass
Steroids
Smoking
Excess alcohol intake
85
Q

What is the difference between dementia and delirium?

A

Delirium starts suddenly

Delirium symptoms will vary greatly during the day

86
Q

What environmental factors make a fall more likely to happen?

A 
Floors are wet e.g. bathroom or recently polished
Dim lighting
Not properly secured rugs or carpets
Person is reaching for storage areas
Wires
Person is going down the stairs
Person is rushing to go to the toilet 
Carrying out maintenance work on a ladder
87
Q

What do NICE recommend?

A

Surgery to be performed on the day of or the day after admission
Aim to allow patients to fully weight bear in the immediate post-op period

88
Q

What makes someone more likely to have a fall?

A

Age due to natural ageing process

Long term health condition

89
Q

What is hypoactive delirium often confused with?

A

Depression

90
Q

What does extra-capsular mean?

A

Below the inter-trochanteric line

91
Q

What does the hip capsule contain?

A

Reticular vessels

92
Q

What scan do we use for diagnosis of osteoporosis?

A

DEXA Scan

T-score

93
Q

What drugs can cause bleeding?

A

Warfarin

Low molecular weight heparin

94
Q

How are acute injuries managed?

A 
Chest X-ray
ECG
FBC
Renal function
Glucose 
Assessment of cognitive function
95
Q

What does oestrogen do in bones?

A

Inhibits osteoclasts activity

Increases osteoblasts activity

96
Q

Where can you refer a patient after they suffer a fragility fracture?

A

Falls clinic

97
Q

What is key in ideal management of neck of femur fractures?

A

Early diagnosis

Early surgery within 36 hours of presentation

98
Q

What is the relationship between osteoporosis and hip fractures to age and gender?

A

Risk increases with age in men and women

More so in women

99
Q

How much do they cost the NHS?

A

£1.7 Billion

100
Q

What proportion of adults over 65 living at home will have a fall at least once a year?

A

1 in 3

101
Q

Why are older women more at risk of osteoporosis?

A

Often associated with hormonal changes during menopause

102
Q

What is denosumab?

A

Monoclonal antibody that reduces osteoclast activity

103
Q

What should you look for on an X-ray?

A

Intra/extra capsular

Displaced/undisplaced

104
Q

How are hip fractures diagnosed?

A

Radiologically

May be suspected clinically

105
Q

How are intra-capsular fractures sub-classified?

A

According to garden’s classification

Type I-IV

106
Q

What should you do if you are hurt and unable to get up?

A 
Call out for help
Bang on wall or floor
Use aid call button
Call 999 
Try to reach something warm e.g. blanket/dressing gown to keep over you particularly legs and feet
Keep as comfortable as possible
107
Q

How can delirium be combated in a hospital setting?

A 
Familiar objects
Continuity of care
Relatives
Rehydration
Mealtime buddies
Red tray- signals they need help when eating
108
Q

What is mixed delirium?

A

Alternating between hypo/hyper active delirium

109
Q

What is shenton’s line?

A

Imaginary curved line drawn along the inferior border of the superior ramus
Along the inferomedial border of the proximal femur

110
Q

What medication should you start after a fragility fracture?

A

Alandronic acid
First line treatment of osteoporosis
Oral

111
Q

How can you categorise risks of falls?

A

Neurological e.g. confusion, cognitive impairment
Unmodifiable e.g. age, female
Environmental
Chemical
Cardiovascular
Neuromuscular
Other e.g. fear of falling, incontinence, fragility

112
Q

What occurs in a falls clinic?

A 
Rehabilitation 
Occupational therapy 
Physiotherapist 
MDT approach 
Medications review
113
Q

How often should you change your position if you have fallen?

A

Every half and hour roughly

114
Q

Why would you only do a hemi-arthroplasty?

A

Lesser operation

Less risk of post-op complications

115
Q

How can delirium be diagnosed?

A

Clinical history
Underlying health
Current mental state
Speaking to loved ones

116
Q

How are most hip fractures treated?

A

Surgically

117
Q

How many times more common are hip fractures in women?

A

4x

118
Q

How would you treat a extra-capsular, displaced, intertrochanteric fracture?

A

Intra-medullary nail

119
Q

What is sarcopenia correlated with?

A

Physical disability
Falls
Low BMD
Poor quality of life

120
Q

Why may falls in older people be particularly problematic?

A

Osteoporosis

121
Q

What bloods should be done?

A 
FBC
U&E
CRP
Clotting
Group & Save x2
122
Q

What is the foveal artery?

A

Supplies the epiphysis with a small amount of blood during skeletal development

123
Q

What are the neuromuscular risk factors for falls?

A

Muscle weakness

Gait disorder: Parkinson’s, hemiplegia, cerebellar disease, antalgic, normal pressure hydrocephalus eat.c

124
Q

What are the reticular vessels?

A

Main blood supply to the femoral head
Originates from the extra-capsular arterial ring
Supplied by the medial and lateral circumflex vessels

125
Q

What can delirium result from?

A 
Brains reaction to underlying medical problem:
Chest infection
UTI
Severe illness
Surgery
Pain
Dehydration
Constipation
Poor nutrition
Change in medication
126
Q

What surgery is recommended for extra-capsular fractures?

A

Dynamic hip screw: Promotes bone healing

Intramedullary nail

127
Q

Who is at risk of delirium?

A 
Dementia
Over 65
Frailty
Multiple co-morbidities 
Poor hearing/vision
Multiple medications
128
Q

Falls are the most common cause of injury related deaths in what population?

A

People over the age of 75

129
Q

What is an osteoporotic fracture?

A

Fragility fracture caused by osteoporosis

130
Q

Where the hip capsule attached?

A

Proximally to margins of acetabulum and transverse acetabular ligament

Distally to the inter-trochanteric line

Posteriorly to the bases of the trochanters and the femoral neck

131
Q

What are contraindications for alendronic acid?

A

Acid reflux

GI issues

CSI (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions