Overview of falls and instability Flashcards
Indicators for potentially having a fall
unstable balance on standing
use of > 4 meds
hip weakness
are falls a normal aspect of aging?
No
what is a good previous indicator of a fall
a previous fall
is someone has dysequilibrium what should you think
neuromuscular dz
stroke
cerebellar dz
if it is vertigo what should you suspect
drugs depression vestibular neuronitis benign positional vertigo otitis media
what is fainting, lightheadedness, feeling that loss of consciousness is imminent
pre-syncope
difficulty initiating gait and festination
parkinson
foot drop indiactes what?
anterior tibialis weakness or reduced knee flexion
do you just tx a patient for osteoporosis?
Nope, make sure there isn’t a secondary cause
what is a potential screening for osteoporosis that is super cheap and has no radiation?
Quantitative ultrasonography of the calcaneus (if its positive must get a DEXA)
is osteoporosis reversible?
No, but you can stop the progression
ADRs of bisphosphonates
osteocencorsis on the jaw and atypical femur fractures
is hormone replacement therapy used for osteoporosis?
Nope
enlargement at DIP
Heberden’s nodes
enlargement at the PIP
Bouchard’s nodes
usually over age 50
Women 2x more than men
Morning stiffness > 1 hour
Shoulder and hip girdles
Polymyalgia rheumatica
tx for polymyalgia rheumatica
steroids
tx for temporal arteritis (giant cell arteritis)
temporal artery biopsy
do you wait for tx for giant cell arteritis?
never
Temporal HA, blindness
ESR, CRP highly elevated
giant cell arteritis
Tx for giant cell arteritis
Temporal artery biopsy
tx for giant cell arteritis?
steroids
what 2 conditions are highly associated
polymyalgia rheumatica
giant cell arteritis
are wound surface cultures helpful?
No
how many hip fractures remain in the nursing home 1 year after fracture?
30%
how many people will develop a pressure ulcer after a hip fracture?
30%
What are the 5 most common places for fractures following a fall?
hip femur humerus wrist ribs
What type of hematoma is a consequence of falls?
subdural hematoma
What are 3 reasons falls are underreported?
Injury minimal
“normal” with aging
fear of restriction in activities or institutionalization
What 3 drug levels should you get for a fall?
Digoxin, anticoags, ETOH
What vitamin deficiency could play a part in a fall?
Vitamin D level
If someone is dizzy, you should suspect what 5 things?
Vertigo (ear, drug toxicities, depression)
Dysequilibrium (neuromuscular disease, stroke, cerebellar dz)
Presyncope
Mixed dizziness
Nonspecific dizziness
5 causes of presyncope
Cerebral hypo-perfusion Orthostatic HPOTN Cardiac arrhythmias CHF Vasovagal episodes
Sudden, transient loss of consciousness characterized by unresponsiveness and loss of postural control, followed by spontaneous and typically complete recovery
Syncope
What test should you get if there is any LOC?
head CT
If there is gait initiation failure, what do you suspect?
high level sensorimotor disorder (frontal lobe or white matter)
Why would there be short step length?
fear of falling, neuro or MSS problem
Pelvic muscle weakness or unable to bend the knee or hemiplegia causes what?
circumdunction
A bone density between -1 to -2.5 means
osteopenia
A bone density above >1.0 means
Normal Bone Mineral Density
What bone density value means osteoporosis?
<-2.5
Can men get osteoporosis?
yes
What is type 1 and type 2 idiopathic osteoporosis?
type 1- postmenopausal
Type 2- age associated or senile
4 endocrine disorders that are causes of osteoporosis
cushing, DM, hyperparathryoidism, hyperthyroidism
When should men be screened for osteoporosis?
> 70 y/o
10% weight loss, physical inactivity, steroid use, androgen deprivation therapy, previous fragility fracture)
What is the gold standard for osteoporosis diagnosis?
Dual-Energy X-ray Aborptiometry (Lumbar spine, hip, and proximal femur)
Can any treatment reverse established osteoporosis?
No
What should you supplement with if on corticosteroids?
Ca and Vit D
First line Tx for osteoporosis
Bisphosphonates
What should you treat with if bisphosphonates have failed?
PTH hormone
ADRs of SERM
increased risk of DVT and hot flashes
What’s the most common presentation of pain?
OA
Stiffness after period of inactivity which is alleviated within 30 minutes of activity. Episodes of severe pain, tenderness of joints WITHOUT INFLAMMATION
OA
Heberden’s and Bouchard’s nodes associated with what?
OA
Morning stiffness > 1hour
polymyalgia rheumatica
