LO3 Falls

Question 1

What is the highest risk factor for a fall?

Answer 1

Having fallen in the past 12 months

Question 2

What 3 tests can be used to assess gait?

Answer 2

Timed Get Up and Go test
Berg balance scale
Elderly mobility scale

Question 3

How should orthostatic hypotension be measured? What is considered a significant drop?

Answer 3

Baseline BP lying down, then immediately on standing, and one and three minutes afterwards. SBP drop by >20mmHg, DBP drop by >10mmHg.

Question 4

What is the difference between an intracapsular and extracapsular fractures?

Answer 4

Intracapsular fractures are at the femoral neck.

Extracapsular fractures are more distal and can be trochanteric/sub-trochanteric.

Question 5

In a NOF, which way is the leg rotated?

Answer 5

Externally rotated and adducted

Question 6

What is the FRAX score? What information does it provide?

Answer 6

FRAX is an online tool which takes into account the following factors: age, gender, weight, height, previous fractures, FMH, smoking hx, glucocorticoids, RA, Osteoporosis RFs,malcohol intake, BMI. The FRAX score gives a 10 year probability of a fracture in the spine, hip, shoulder or wrist aged 40-90.

Question 7

What are the ACCESS risk factors for osteoporosis?

Answer 7

Alcohol use, corticosteroid use, calcium low, estrogen low, smoking, sedentary lifestyle

Question 8

What imaging technique is used to make a diagnosis of osetoporosis? What score indicates osteoporosis?

Answer 8

DEXA scan
>-1 is considered healthy
-1- -2.5 is osteopenia

Question 9

What is the first line medical management of osteoporosis?

Answer 9

Alendronate10mg once daily or 70mg once weekly,or risedronate5mg once daily or 35mg once weekly.

Question 10

What should be co-prescribed with first line medical management if calcium is sufficient and if calcium is inadequate?

Answer 10

If calcium is adequate prescribe 10 micrograms of vitamin D.

If calcium is inadequate, prescribe 10 micrograms of vitamin D (double if housebound) with 1000 mg of calcium

Question 11

How do steroid medications predispose to falls?

Answer 11

Proximal muscle weakness

Question 12

Which type of antidepressants predispose to falls?

Answer 12

TCAs, decrease BP and cause dizziness and confusion

Question 13

How do antihistamines predispose to falls?

Answer 13

Drowsiness

Question 14

How do B-blockers predispose to falls?

Answer 14

Decrease HR, lowers BP and therefore drops cerebral perfusion

Question 15

How do nitrates predispose to falls?

Answer 15

Drop blood pressure and therefore cerebral perfusion

Question 16

How do benzodiazepines predispose to falls?

Answer 16

Drop BP and therefore cerebral perfusion

Question 17

How do diuretics predispose to falls?

Answer 17

Can induce dehydration, therefore reducing preload and cardiac output

Question 18

How do neuroleptics predispose to falls?

Answer 18

Can induce drowsiness and Parkinsonism