Falls

Question 1

Incidence of falling >=1x/year

Answer 1

> 65y - 30%

> 80y - 50%

Question 2

Timed up and go test

Answer 2

Time patient getting up from a chair without using their arms, walking 3m, turning around, returning to chair and sitting

Can use aid if normally uses

12-15s - increased risk of falls in older people

Question 3

Turn 180 test

Answer 3

Stand up and step around until facing opposite direction.

> 4 steps - further falls assessment

Question 4

Vasovagal syncope (uncomplicated faint)

Answer 4

Posture: prolonged standing, prevent by lying down

Provoking factors: fear, pain, phobia, dehydration

Progressive prodrome: pale, sweating, nausea

Brief myoclonus can occur

History of recurrent syncope usually before 40y

Question 5

Situational syncope

Answer 5

Triggers: micturition, swallowing, defacation, coughing, sneezing, post-exercise, laughing

Question 6

Carotid sinus syndrome

Answer 6

Syncope triggered by head rotation/presure on carotid sinus (tight collar) or unexplained syncope/falls > 40y

Venticular pause > 3s / fall in BP > 50mmg/Hg

Question 7

Orthostatic hypotension

Answer 7

Syncope when standing, standing after exertion, after eating, exercise, prolonged bed rest

Drugs: a-blockers, b-blockers, TCAs, antiHTN, diuretics, nitrates, L-dopa, dopaminergic agonists

Fall in systolic > 20mmgHg or diastolic > 10mmgHg or systolic < 90mmHg

Non-neurogenic: volume deletion, HF, arrhythmia, valve disease

Neurogenic: autonomic failure due to DM, Parknson’s , spinal cord injury

Question 8

Cardiac syncope

Answer 8

Syncope during exertion or when supine

Sudden onset palpitations immediately before

New SOB

Cormorbid HF

Blackout without prodrome > 65y

FH sudden death < 40y

Question 9

POTS

Answer 9

HR increases by > 30bpm or > 120bpm within 10 minutes of standing in absence of orthostatic hypotension

Question 10

Assessment of syncope

Answer 10

1) ECG for everyone

2) consider bloods

3) consider ABPM ton assess for post-prandial hypotension, exercise or drug induced hypotension

Question 11

Driving after simple faint

Answer 11

No restriction

Question 12

Driving after single syncope, explained and treated

Answer 12

No driving for 4 weeks

Question 13

Driving after single syncope, unexplained

Answer 13

No driving for 6 months

Question 14

Driving after 2 episodes of syncope

Answer 14

No driving for 12 months