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Geriatric Medicine > Functional decline and falls > Flashcards

Functional decline and falls Flashcards

Pressure sores Reduced mobility Falls

1
Q

Patient presents to A&E with a fall. Which bloods should you send for?

A

FBC, U+E, haematinics, bone, vit D

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2
Q

Patient presents to A&E with a fall. Which investigations/exams/reviews do you want to carry out?

A

ECG, L+S BP, AMT4, vision, med review, bone health

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3
Q

What are categories of causes of falls?

A
  1. mental health
  2. vision defects
  3. MSK
  4. Neuro
  5. CVS
  6. Environment
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4
Q

Which of the following is not typically a cause of a fall: incontinence, polypharmacy, or hyperglycaemia?

A

hyperglycaemia (hypo=risk for falls), incontinence-> rushing to bathroom

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5
Q

What are the autonomic symptoms of hypoglycaemia?

A

trembling, sweating, hunger, anxiety, palpitations, nausea, tingling

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6
Q

What are the neuroglycopaenia symptoms of hypoglycaemia?

A

confusion, weakness, drowsiness, headaches, dizziness, visual changes, speech changes

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7
Q

Which questions make up the AMT?

A
  1. what year is it
  2. How old are you
  3. what is your dob?
  4. where are you?
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8
Q

What are symptoms of mild hypoglycaemia?

A

non-specific symptoms, generally feeling unwell (nauseous)- check BM

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9
Q

What are symptoms of moderate hypoglycaemia?

A

confusion, disorientation, aggression

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10
Q

What are symptoms of severe hypoglycaemia?

A

seizure, unconscious, very aggressive

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11
Q

What is the treatment for mild hypo?

A

15-20g fast-acting CHO e.g. luocozade 170 ml, pure fruit juice 150-200 ml, glucotabs, followed by long-acting CHO e.g. two biscuits, slice of bread

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12
Q

What is the treatment for moderate hypo?

A

if cooperative, same treatment as mild, escalate to i mg IM of glucagon

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13
Q

What is the treatment for severe hypo?

A

IV glucose or IM glucagon

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14
Q

List examples of drugs that can cause falls

A

drugs that cause postural hypotension: nitrates, ACEi, diuretics, L-dopa, SSRIs

Benzos, opiates, oral hypoglycaemia agents

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15
Q

What is the definition of postural hypotension?

A

fall in systolic BP of at least 20mmHg (30 in HTN) and/or fall in diastolic BP at least 10mmHg within 3 min of standing.

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16
Q

What is the management of postural hypotension?

A

med r/v, slow from lying to standing, small frequent meals, raise head of bed, mineralcorticoid

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17
Q

Which blood test is important to do in patient who has been lying down for a long time?

A

creatinine! risk of rhabdo. Muscle can start to break down during this time frame, and this rhabdomyolysis leads to release of haem which is nephrotoxic and can cause an acute kidney injury. Rhabdomyolysis is assessed by measuring creatine kinase (CK) - a raised level suggests the patient requires IV fluids to increase urinary flow rates and reduce the risk that the kidneys become damaged by intratubular cast formation.

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18
Q

How are the descending motor tracts divided?

A

pyramidal and extrapyramidal http://freeosmosis.com/learn/Pyramidal_and_extrapyramidal_tracts?section=Physiology

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19
Q

What is the function of pyramidal tracts?

A

voluntary movement, carry motor fibres from the cerebral cortex to the spinal cord and brainstem. Pyramidal tract lesions can occur from any type of damage to the brain or spinal cord, for example a stroke.

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20
Q

What is the function of extrapyramidal tracts?

A

responsible for involuntary control of the muscles, including posture and balance adjustments. They descend from the brainstem to the spinal cord. Damage to the extrapyramidal tracts results in dyskinesias and disorders of involuntary movement. Parkinson’s disease is an example of this

21
Q

What are four classical features of idiopathic parkinson’s disease?

A 
TRAP
Tremor (asymmetric and resting)
Rigidity 
Akinesia
Postural instability
22
Q

Name examples of exclusion criteria for parkinsonian syndrome

A

MPTP exposure, fam hx, babinski sign, unilateral features, negative response to levodopa

23
Q

What is the diagnostic criteria for parkinson’s?

A

bradykinesia + 1

  • muscular rigidity
  • 4-6 Hz rest tremor
  • primary instability not caused by primary visual, vestibular, cerebellar, or proprioceptive dysfunction
24
Q

Name four non-motor symptoms of parkinson’s?

A

constipation, sleep disorders, depression, anxiety, erectile dysfunction, urinary frequency/incotinence/nocturia, altered sense of smell

25
Q

Name two facial features of parkinson’s disease

A

infrequency of blinking, hypomimia (reduction in facial expression), hypophonia (soft, monotonous voice), lips are parted

26
Q

How to describe parkinsonian tremor?

A

asymmetrical 4-6 Hz, enhanced by anxiety, pill rolling

27
Q

What are features of parkinsonian gait?

A

reduced arm swing, shuffling gait, freezing, stooped posture

28
Q

Name four differentials for parkinsonism

A
  1. idiopathic parkinson’s disease
  2. drug induced parkinson’s
  3. progressive supranuclear palsy
  4. parkinson’s plus syndromes
  5. lewy body dementia
29
Q

What is multiple system atrophy?

A

parkinsonism, cerebellar and autonomic dysfunction- orthostatic HTN (lying/standing BP)

30
Q

What is progressive supranuclear palsy?

A

axial imbalance, oculomotor disturbance, early bulbar involvement (speech and swallow)

31
Q

Which assessments would you conduct for supranuclear palsy?

A

eye movements and cranial nerve exam

32
Q

Which assessment would you carry out to support lewy body dementia?

A

cognitive assessments

33
Q

A patient has skin changes on back. What are five differentials for this?

A
  1. Pressure sores
  2. Staph infection
  3. BSC
  4. SCC
  5. contact dermatitis
34
Q

Name 4 factors that increase the risk of pressure sore development

A
  1. immobility
  2. cognitive impairment
  3. neuropathy
  4. age and frailty
  5. incontinence
35
Q

How would you describe a pressure sore in lower back region?

A

This patient’s sacral region bears a well-demarcated area of erythema around 14x 6cm with superficial skin loss. There is no clear evidence of slough, bruising, discharge or sinus formation. This is in keeping with a pressure ulcer.

36
Q

What are the four grades of classifying pressure sores?

A 
I-IV
I: non-blanching erythema 
II: partial thickness 
III: full-thickness skin loss
IV: full-thickness tissue loss
37
Q

What is the management of pressure ulcers?

A
  1. Positional changes
  2. Mattress support
  3. Dressings
  4. Barrier creams
  5. Abx
  6. Dietary support
  7. debridement
38
Q

What are some long term consequences of pressure sores?

A

bedbound potential, nursing home, infection- sepsis, pain

39
Q

What is an acronym to remember the causes of falls?

A 
DAME
drugs (plus alcohol)
age
medical- CVD, PD
environmental
40
Q

Which drugs are associated with falls?

A

sedatives, antihypertensives, antiarrhythmic, polypharmacy, extrapyramidal side effects

41
Q

Name examples of gait abnormalities

A

PD, hemiplegic gait, cerebellar disease, antalgic gait, foot drop (common peroneal nerve)

42
Q

What is acronym for taking history from patient who has fallen

A 
SPLATT
symptoms
previous falls
location
activity
time
trauma
43
Q

Which examinations/assessments should you carry out in patient who has fallen

A

cardio, CNS, vision, hearing, AMT, bloods, ecg

44
Q

Differentials for joint related causes of immobility?

A

osteoarthritis, RA, gout, psuedogout, infection

45
Q

Differentials for muscular related causes of immobility?

A

Myositis, myxoedema, PD, polymyalgia rheumatica

46
Q

Reduced effort tolerance differentials for immobility?

A

dyspnoea, anaemia, reduced CO

47
Q

What are complications of immobility?

A
  1. social
  2. psychological
  3. physical- muscle wasting, osteoporosis, pneumonia, constipation, incontinence
48
Q

What is a festinating gait?

A

parkinsonian shuffle

49
Q

After several months of treatment, L-DOPA does not seem to be effective in PD patient. How should you modify their treatment?

A

add a dopamine agonist (continue with L-DOPA)

Geriatric Medicine (7 decks)

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