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Geriatrics > Falls, Dizziness And Syncope > Flashcards

Falls, Dizziness And Syncope Flashcards

1
Q

Why do elderly fall

A

SITUATIONAL
risk taking

INTRINSIC
Failure to maintain
postural control

EXTRINSIC
environmental

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2
Q

How to maintain balance

A

SENSORY INPUTS
• peripheral nerve
• vision
• vestibular

CENTRAL
PROCESSING
• global cerebral failure
• motor cortex + connections
• basal ganglia/extrapyramidal
• cerebellum
• spinal cord

NEUROMUSCULAR OUTPUT
• peripheral nerve
• muscles
• skeleton and joints

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3
Q

How to manage falls

A

PREVENTION
1. Deconditioning of postural reflexes + muscle strength
prevented by exercise - Tai-Chee, Rekei, Calinetics
combined with walking (> 30 minutes 3x a week)
2. Professional advice on the use of walking aids
3. Advice on sensible footwear and care of feet

MINIMIZE RISKS OF FRACTURE
1. Prevent and treat osteoporosis

COMPREHENSIVE ASSESSMENT IF HIGH RISK
• 1 x fall with injury
• 2 x fall in 12 months
• 1 x fall with abnormal gait

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4
Q

Assessing a patient with falls

A

METHOD
1. Identify contributory environmental and situational
factors
2. Clinical evaluation of patient to identify intrinsic
factors
3. Multidisciplinary intervention including medical,
environmental adaptation by occupational therapist
and strength and balance training + walking aids by
physiotherapist

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5
Q

Intrinsic factors that causes a fall

A
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6
Q

Medications that might cause a fall

A

• Psychotropics – hypnotics, antipsychotics, antidepressants
• Cardiac/antihypertensive drugs – postural hypotension, arrhythmias
• Anticholinergic side effects (NB tricyclic antidepressants and older
neuroleptic antipsychotics + clozapine)

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7
Q

Gait and balance assessment

A
  1. Get-up-and-go
  2. Sternal nudge
  3. Romberg
  4. One-legged-stance
  5. Tandem walk
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8
Q

Get up and go test

A
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9
Q

Romberg test

A

Ask patient to stand with feet together and arms at the sides then
close eyes for at least 10 seconds
• Staggering and having to take a step to prevent falling
= peripheral sensory neuropathy
• Swaying back and forth
= slow postural reflexes with increased falls risk
(may be abnormal in cerebral or vestibular disease but then there should be
symptoms or abnormal cerebellar signs present)

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10
Q

Sternal nodge

A

Ask patient to stand with feet together and eyes open then nudge
with 2 fingers on sternum with arm behind patient to catch them if
they lose balance (as hard enough as to move 1kg block 5 cm)
• Swaying or staggering = poor postural control

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11
Q

Lab investigations for falls

A

B12 and TSH

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12
Q

Plan with a patient with falls

A
  1. Physiotherapy for strength and balance training,
    assessment for assistive devices and to address
    fear of falling
  2. Manage contributory medical problems
  3. Rationalize medication
  4. Occupational therapy to modify environment to
    minimize risks and educate.
  5. Behavior modification – situational factors usually
    addressed by physio and OT; remember alcohol
    and self medication
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13
Q

Syncope vs dizziness

A

SYNCOPE
Transient loss of consciousness
accompanied by loss of postural tone

DIZZINESS
Abnormal sensation resulting in a feeling of
impaired balance or postural control

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14
Q

Dizziness with no loss of consciousness types

A

Light headed
Disequilibrium
Vertigo

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15
Q

Vertigo causes

A

GENERALIZED ANXIENTY DISORDER
VESTIBULAR+/- DEAFNESS
BRAINSTEM+ CNS SIGNS
VERTEBROBASILAR INSUFFICIENCY
Cardiac presyncope

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16
Q

Vertigo test

A
17
Q

Peripheral vertigo causes

A

• BPPV (Benign Paroxysmal Positional
Vertigo)
• Meniere’s
• Vestibular Neuronitis
• Progressive pathology

18
Q

Central vertigo causes

A

Focal neurological signs or symptoms related to brainstem or cerebellar pathology

19
Q

Episodic vertigo causes

A

BPPV
Meniere
TIA

20
Q

BPPV(Benign paroxysmal positional vertigo)

A

• 1 – 2 minutes of intense vertigo on turning head

Diagnosis
• Dix-Hallpike manoeuvre

Treatment
• Epley’s manoeuvre

21
Q

Menieres disease

A
22
Q

Diagram to classify vertigo

A
23
Q

Postural hypotension

A

> 20 mmHg ↓ systolic BP +/- 10 mmHg ↓ diastolic BP
within 3 minutes of standing + symptoms

24
Q

Postural hypotension pathophysiology

A

Causes: - inadequate vasoconstriction +/- ↑ HR
- ↓ intravascular volume

Symptoms
-dizzy on standing, NB if vasodilated
- getting out of warm bed/ bath
- after big meal or alcohol
- standing in hot place

25
Q

Automatic nervous systems dysfunction that leads to postural hypotension

A

CENTRAL: Age related slowing of reflexes
- 1• - Multisystem Atrophy

PERIPHERAL: afferent – Guillain-Barré
efferent – Diabetes mellitus

DRUGS: α + β blockers
Vasodilators –ACE inhibitors, Calcium channel blockers, Nitrates
Anticholinergics – Antidepressants, antipsychotics, Opiods

26
Q

Reasons for intravascular volume depletion postural hypotension

A

Diuretics. ↓ cortisol. Or acute blood loss/dehydration

27
Q

Cardiac syncope

A

Last a few minutes
Oriented and awake afterwards
No warning

28
Q

Generalized seizure

A

Last half an hour
Post ictal confusion
With or without tonic clonic movement
With or without aura and incontinence

29
Q

Blood pressure pathologies

A
30
Q

Neurally mediated syncope

A

• Neurocardiogenic syncope
• Situational syncope
• Carotid sinus hypersensitivity

31
Q

Neurally mediated syncope pathophysiology

A
32
Q

Syncope pathophysiology

A
33
Q

Carotid sinus hypersensitivity sinus massage contraindications

A

• Carotid bruit
• Carotid stenosis
• MI in last 3 months
• Known sick sinus
• On antiarrhythmic drugs

34
Q

Other causes of syncope

A

STRUCTURAL HEART DISEASE
• Aortic stenosis
ARRHYTHMIA
• Bradyarrhythmia – sick sinus syndrome
- slow atrial fibrillation
- heart block 3rd degree
some 2nd degree (Wenckebach)
• Tachyarrhythmia – ventricular tachycardia

35
Q

Clinical assessment of syncope

A

History, full exam including CVS + BP +lying and standing
ECG + chest xray

Geriatrics (1 decks)

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