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HCoLL > Falls + Fractures > Flashcards

Falls + Fractures Flashcards

1
Q

What conditions with vision may affect the balance system? (4)

A
  • Cataracts
  • Age related macular degeneration
  • Diabetic retinopathy
  • Bifocal lenses
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2
Q

What conditions may affect proprioception (thus affecting the balance system) (3)

A
  • Sensory neuropathy
  • Joint replacements (lose proprioception)
  • Ageing
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3
Q

What conditions of the vestibular system may affect balance? (3)

A
  • Previous middle ear infections
  • Meniere’s disease
  • Ototoxic drugs (NSAIDs, aspirin, aminoglycosides)
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4
Q

What conditions of the brain/CV system may affect balance? (4)

A
  • Cerebrovascular disease
  • Dementia (affects judgement)
  • Low BP
  • Delirium (e.g. from infective cause)
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5
Q

What neuromuscular causes may affect balance? (3)

A
  • Proximal myopathy (eg steroid exposure, vit D defc)
  • Any neurological disease
  • Disuse atrophy
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6
Q

What are intrinsic RFs for falls related to? (4)

A
  • How well person can see
  • How well they can walk or maintain their balance
  • What kind of muscle strength they exhibit
  • How well they can endure physical activity
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7
Q

List the main intrinsic RFs for falls (11)

A

Balance/gait problems: Stroke/Neuropathy/Parkinsons/Arthritis/Vestibular

Visual impairment (bifocal / glaucoma / ARMD / retinopath)

Cognitive problems: delirium/dementia

Urinary incontinence: urgency/frequency

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8
Q

List the main extrinsic RFs for falls (5)

A 
Footwear
Polypharm
Sedatives/ CV med SEs
Lighting/stairs/rug
Lack of equipment
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9
Q

What are the short term complications of falls, due to trauma? (4)

A

o Soft tissue injury
o Fragility fractures (mortality and morbidity)
o Joint dislocations
o Subdural haemorrhage

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10
Q

What are the short term complications of falls, due to ‘long lie’? (4)

A

o Hypothermia
o Pressure sores
o Dehydration / AKI
o Infection (pneumonia)

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11
Q

What are the short term psychological (1) + social (2) complications of falls?

A

Psycho: loss of confidence / fear of falling

Social: Reduced mobility / Increased dependance

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12
Q

What are the long-term adverse complications of falls (7)

A

Fear of falling
Depression/Anxiety
Social Isolation

Injuries/Fractures
Death

Carer strain
Institutionalisation

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13
Q

What things should be included in the Hx in a falls pt (7)

A
  • Sx, circumstances, eye witness account
  • Any loss of consciousness
  • 1st fall / Recurrent falls
  • PMH → any falls RFs
  • DH → any falls RFs / recent changes
  • Alcohol

• Baseline cognition, function, mobility

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14
Q

What things should be included O/E in a falls pt? (5)

A
  • Cognitive assessment
  • Cardiovascular (pulse, L/S BP, murmurs, bruits)
  • Neurological
  • Feet, joints, eyes
  • Gait (get up and go)
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15
Q

What Ix should be done in a falls pt? (2)

A

ECG
Postural BP
Possibly TILT assessment

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16
Q

What interventions may be done to reduce intrinsic factors of falls (3)
+ to reduce extrinsic factors (1)

A

Intrinsic - Physio:
Cardio training (bike)
Strength training (weights)
Balance training

Extrinsic - OT:
OT home assessment/adjustments

17
Q

Outline the assessment (3) /management (2) for a falls patient

A

Dx reason for fall (eg visual disturbance)
Look for postural hypotension
Bone health assessment – past fractures, poss DEXA

Optomise management of contributing conditions
(eg cataracts, diabetes, overactive bladder)
Medication review
(minimise antihypertensives / start on Ca + VitD)

18
Q

List certain types of drugs that are known to increase falls risk (+how) (8)

A
  • Beta-blocker → hypotension
  • Nitrates → hypotension
  • Diuretics → hypotension
  • BZDs → sedation
  • Antihistamines → sedation
  • TCAs → sedation
  • Neuroleptics → sedation, muscle tremors/ spasms
  • Steroids → proximal muscle weakness, osteoporosis
19
Q

Define osteoporosis

A

A condition of skeletal fragility characterised by reduced bone mass and micro architectural deterioration predisposing to an increased risk of fractures

20
Q

Describe the aetiology behind osteoporosis

A

Normal processes of bone formation/resorption become uncoupled or unbalanced → bone loss

21
Q

List the clinical features of osteoporosis (3)

A

Asymp

Pain / loss of height with kyphosis development (due to spine fragility fractures)

Features of underlying disease (eg Cushing’s syndrome)

22
Q

List some secondary causes of osteoporosis (16)

A

Genetic: Marfans/Turners/Osteogenesis imperfecta

Inflammatory: RA/Ank Spon/IBD

Iatrogenic: Steroids/Sex-steroid antags/Lithium/Heparin

Endocrine: Cushings/Acromegaly/Hypopituitary/Prolactinoma

Nutritional: Ca+VitD defc / Malabsorption

23
Q

List the RFs for osteoporosis (12)

A 
o	Age
o	Women (men more likely 2o cause)
o	Previous fracture
o	FH
o	XS alcohol
o	Smoking
o	Drugs (steroids/ heparin/ phenytoin)
o	Amenorrhoea for 6m (excl pregnancy)
o	Late menarche/ early menopause
o	Immobility/ physical inactivity
o	Inflammatory arthritis
o	Gastrectomy
24
Q

What are the T score ranges (DEXA) for osteopenia/porosis?

Whats the diff b/wn T score + Z score

A 
Osteopenia = T -1SD to -2.5SD 
Osteoporosis = T < -2.5SD

T score = compared to young healthy adult
Z = compares to similar age (used in <50s)

25
Q

What Ix, other than DEXA, can be done in osteoporosis? (6)

A 
Renal func (where Vit D metab)
TFTs
Bone profile (Ca/Vit D; PTH; PO4-/alkaline PO4-)
Bone turnover markers

Multiple myeloma screen (ESR, Serum Ig + protein electrophoresis, urinary Bence Jones protein)

Consider cortisol, testosterone, oestradiol, PSA, tTG

26
Q

What are some long-term consequences of osteoporosis (3)

A

⇒ ↓QoL from pain/ kyphosis
⇒ ↓Independence
⇒ ↑Morbidity /↑Mortality (related to hip fractures)

27
Q

What lifestyle modifications can be done to help osteoporosis (6)

A
  • Improve Ca intake (1200-1500ml/day milk)
  • Weight-bearing exercises
  • Smoking cessation
  • Reduce alcohol
  • Exercises to promote bone density and reduce falls
  • Hip protectors (poor compliance)
28
Q

What medications can be used in osteoporosis (2+5)

A

Ca/VitD supplements**
Bisphosphonates**

HRT
Selective oestrogen receptor modulators eg Raloxefine
Testosterone treatment
PTH hormone
Strontium
29
Q 
How do bisphosphonates work?
Give egs (4)
A

Delay action of osteoclasts

Allendronic acid (PO but GI SEs)
Zolendronic acid (IV)
Risedronate sodium (PO)
Denosamab (SC)

HCoLL (8 decks)

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