Immobility

Question 1

Postural Instability

Answer 1

Cerebral Perfusion

• Cardiac Output
• Vasomotor tone

Question 2

Gait and balance assessment

Answer 2

Sitting to standing ability 
Static standing balance 
Romberg test
Dynamic standing balance
Functional reach
Tandem (heel-toe) walking
Timed walk
Tinetti gait and balance scale
Berg Balance Scale

Question 3

Vertigo

Answer 3

Labrynthitis
Acute ear infection
Benign paroxysmal positional vertigo
Meniere’s
Cerebellar/ Brainstem  pathology

Question 4

A. Neurally-mediated (reflex) Syncope

Answer 4

Vasovagal syncope (common faint)
Carotid sinus hypersensitivity

“Situational” syncope
· acute haemorrhage
· cough, sneeze
· gastrointestinal stimulation (swallow, defaecation)
· micturition (post-micturition)
· post-exercise
· others (e.g. brass instrument playing, weightlifting)

Question 5

B. Orthostatic hypotension Syncope

Answer 5

Autonomic failure
· primary autonomic failure syndromes (e.g. pure autonomic failure, multiple system atrophy, Parkinson’s disease with autonomic failure)

· secondary autonomic failure syndromes (e.g., diabetic neuropathy, amyloid neuropathy)

· Drug (and alcohol)-induced orthostatic syncope
Volume depletion

· haemorrhage, diarrhoea, Addison’s disease (relative)

Question 6

C. Cardiac arrhythmias Syncope

Answer 6

Sinus node dysfunction (including bradycardia/ tachycardia syndrome)
Atrioventricular conduction system disease
Paroxysmal supraventricular and ventricular tachycardias

Inherited syndromes (e.g., long QT syndrome, Brugada syndrome)
Implanted device (pacemaker, ICD) malfunction
Drug-induced proarrhythmias

Question 7

D. Structural cardiac or cardiopulmonary disease Syncope

Answer 7

Cardiac valvular disease i.e. aortic stenosis
Acute myocardial infarction/ischaemia
Obstructive cardiomyopathy
Atrial myxoma
Acute aortic dissection
Pericardial disease/tamponade
Pulmonary embolus/pulmonary hypertension

Question 8

E. Cerebrovascular Syncope

Answer 8

Subclavian steal syndromes

Question 9

Syncope Red Flags

Answer 9

An ECG abnormality (those in bold)
Heart failure (history or physical signs)
Onset with exertion
Family history of sudden cardiac death (<40) years and/or an inherited cardiac condition
New or unexplained breathlessness
A heart murmur.

Question 10

seizure

IF

Answer 10

A bitten tongue
Head-turning to 1 side during episode
No memory of abnormal behaviour that was witnessed before, during or after episode by someone else
Unusual posturing
Prolonged, simultaneous limb-jerking
Confusion after the event
Prodromal déjà vu or jamais vu

Question 11

Outcomes after a fall

Answer 11

Injury (50%) - soft tissue, fracture, subdural etc.
Rhabdomyolysis (↑CK)
Loss of confidence / ‘Fear of falling’
Inability to cope 
Dependency / QOL
Carer stress
Institutionalisation 
Terminal decline