Geriatrics

Question 1

Falls. Give 4 causes of falls in the elderly

Answer 1

DAME

1) Drugs (sedatives, alcohol)
2) Age-related changes (gait, balance, sarcopenia, sensory impairment)
3) Medical (stroke disease, heart disease, PD, dementia etc)
4) Environmental (obstacles, poor lighting, wet floor etc)

Question 2

Falls. What are the 3 main types of syncope?

Answer 2

1) Reflex
2) Cardiogenic
3) Orthostatic hypotension

Question 3

Syncope. Give 3 causes of reflex syncope

Answer 3

1) Vasovagal
2) Carotid Sinus Syndrome (CSS)
3) Situational (cough, micturition)

Question 4

Syncope. Give 3 causes of cardiogenic syncope

Answer 4

1) Structural
2) Arrhythmia
3) Drug-induced

Question 5

Syncope. Give 3 causes of orthostatic hypotension

Answer 5

1) Primary autonomic failure
2) Drug-induced
3) Hypovolaemia

Question 6

Falls. What are some important questions in the Hx of someone who has had a fall?

Answer 6

SPLATT
1) Symptoms (dizziness, chest pain, palpitations)
2) Previous falls?
3) Location (inside/outside?)
4) Activity
5) Time
6) Trauma sustained?
Also important to obtain a collateral Hx from witness if possible!

Question 7

Falls. What is the likely diagnosis if someone blacks out after eating?

Answer 7

Post-prandial syncope

Question 8

Falls. What is the likely diagnosis if someone falls after turning their head to one side?

Answer 8

Carotid sinus hypersensitivity

Question 9

Falls. What details would you want to get from a witness about a fall?

Answer 9

1) Loss of consciousness
2) Any tonic-clonic movements
3) Length of time on floor

Question 10

Falls. What symptoms would you ask the patient about?

Answer 10

1) Dizziness
2) Head spinning (?vertigo)
3) Palpitations (?arrhythmia)
4) Chest pain
5) Blackout (?TLOC)
6) Tongue-biting/loss of bladder control (?seizure, eg epilepsy)
7) Numbness/tingling (peripheral neuropathy, eg diabetes, B12 deficiency, alcoholism)
8) Visual changes (?glaucoma, cataracts, etc)
9) Difficult getting going, etc (?PD)

Question 11

Falls. How would you investigate the cause of a patient’s falls?

Answer 11

1) HISTORY!
2) Examination (including vital signs such as pulse rate and rhythm, BP lying and standing)
3) ECG
4) Blood tests (FBC, TFTs, B12)
5) Tilt-table test

Question 12

Falls. Give 4 complications of a long lie following a fall?

Answer 12

Rhabdomyolysis
Hypothermia
Dehydration
Pneumonia (hypostatic)
Pressure sores
Post-fall syndrome

Question 13

Falls. How would you prevent a fall from recurring?

Answer 13

1) Address causes/RFs
2) Stop unnecessary drugs
3) Physiotherapy (walking aids, how to get up from floor, improved gait, exercise plans)
4) Occupational therapy (remove hazards from home, equipment for mobility, correct footwear)