Lectures Flashcards
1
Q
def: birth rate
A
no. of live births per 1,000 women in age group 15-44
2
Q
def: total fertility rate
A
expected no. of children born per woman in child-bearing years
3
Q
def: replacement level
A
no. of children required to join population to replace each couple
4
Q
def: perinatal mortality rate
A
no. stillbirths and deaths of infants under 1 wk per 1,000 live and stillbirths
5
Q
def: expectation of life at birth
A
average no. years which new born baby can be expected to survive if current mortality rates continue
6
Q
def: lying and standing BP postural hypotension
A
systolic drop >20mmHg
diastolic drop >10mmHg
7
Q
causes of falls
A
- ↓vision
- ↓righting reflexes
- ↓balance
- ↓ muscle strngth
- ↓joint mobility
- impaired sensory sustems
- cVS system problems
- neurological disease
- peripeheral neuropathy
- cognitive decline
- postural hypotension
- non-compliance with walking aid
8
Q
falls risk assessment
A
- assess gait, balance and mobility and muscle weakness
- assess osteoporosis risk
- assess perception of functional ability and fear of falling
- assess vision
- assess cognitive impaitment and neuro exam
- assess urinary incontinence
- assess home hazards
- CVS exam and meds review
9
Q
falls injuries
A
- fractures
- had injuries
- laceration
- bleeding
- bruising
- LOC
10
Q
risks with long lie
A
- hypothermia
- dehydration
- rhabdomyolysis
- pneumonia
- pressure ulcers
- delirium
11
Q
management of falls
A
- focus on injuries an healing initially
- rrehabilitation - improve confidence, mobility and safety
- MDT input
- bone health
- falls education
12
Q
what happens balance in ageing
A
loss of cilia insemicircular canals, utricle and saccule vestibular system
progressive decline in baroreceptor function
13
Q
conditions increasign risk of falls
A
- acute infection/sepsis (UTI, GIT, chest)
- parkinson’s disease
- stroke
- MS
- meniere’s disease
- diabetes
- peripheral vascular disaese
- chronic disease of MSK
14
Q
medication in falls
A
- psychotropic drugs
- analgesics
- CVS drugs
15
Q
medicaiton in falls: psychotropic drugs
A
- sedatives
- hypnotics
- anxiolytics
- antidepressants
- anticonvulsants
16
Q
medication in falls: analgesics
A
- codeine
- opioids
17
Q
medication in falls: CVS
A
- alpha blockers
- beta blockers
- diuretics
- antihypertensives
- ACE/ARB
- Ca channel blockers
- nitrates
18
Q
def: carotid sinus hypersensitivity
A
exaggerated response to carotid sinus baroreceptor stimulation - syncope may occur due to transient reduced cerebral perfusion
19
Q
what is CSH associated with
A
hypertension
Lewy body dimentia
IHD
medication
20
Q
what to ask in syncope history
A
driving hx and document in notes
21
Q
def: BPpV
A
benign paroxismal positional vertigo
22
Q
what test is used in BPPV
A
dix halpike and epley manouvre
23
Q
tx: BPPV
A
physio - balance excercises and muscle stregthening
stop night sedation
adequate fluid intake
24
Q
how to measure lying and standing blood pressure
A
- ensure pt lies in bed for 5 mins
- get them to stand and take blood pressure immediately
- repeat after 3 minutes
- should be first thing in morning
25
def: postural hypotension
systolic drop >20mmHg
diastolic drop >10mmHg
26
Q: pt presents with recurrent syncopal episodes occuring ontransition from sitting to standing or following porolonged periods of standing. Which of the following is the most appropriate immediate investigation?
## Footnote
A. 24hr ECG recording
B. carotid sinus massage
C. CT brain
D. erect and supine blood pressures
E. head-up table test
D. erect and supine BP
27
Q: 82 y/o pt presents with recurrent falls witnessed by daughter. Each occasion witnessed to stumble or trip before falling to ground. One occassion tripped over edge of rug, once fell while getting out of car and most recently fell out of bath. Not been noticed to lose consciousness. Which are indicated?
## Footnote
A. occupational therapy assessment
B. social work assessment
C. 24 hour ECG tape
D. erect and supine BP
E. urinalysis
F. medication review
A occ health
D erect and supine BP
F medication review
28
Q: what %age of falls result in hip fracture
## Footnote
A. 10%
B. 25%
C. 33%
D. 1%
E. 5%
D. 1%
29
Q: which of the following drugs may be associated with falls?
## Footnote
a. Gliclazide
b. Bendroflumethiazide
c. Fludrocortisone
d. Amitriptyline
e. All of the above
A gliclazide
B bendroflumethiazide
D amitriptyline
30
Q: which of the following category of persons have highest fall related mortality worldwide?
## Footnote
a. Females >70 years of age in Western countries
b. Females in the low- and middle- income countries of Europe
c. Males in the low- and middle- income countries of Europe
d. Males > 75 years old in Middle income Western countries
e. Females >65 in Africa
c
31
Q: 7. Which of the following interventions have been shown to prevent falls in community dwelling older adults?
## Footnote
a. Surgery for recurrent cataract
b. Insertion of a permanent pacemaker of 1st degree heart block
c. Exercise programmes targeting balance
d. Tai Chi
e. Insertion of a permanent pacemaker for cardioinhibitory carotid sinus hypersensitivity
D and E
32
Q: which of the following can increase falls risk?
## Footnote
a. Hypovitaminosis D
b. Steroid use
c. Simvastatin
d. Atypical antipsychotics
e. Contact lens use (no but bifocals can)
f. Urinary incontinence
A, B, D and F
33
Q; which of the following can results in gait impairment?
## Footnote
a. Dementia
b. Depression
c. Hallux valgus
d. Indwelling urethral catheter
e. Sensory polyneuropathy
f. Thyrotoxicosis
A, C, D, and E
34
Q: which of the following are intrinsic risk factors for falls?
## Footnote
a. Nitrazepam
b. Macular degeneration
c. Bifocal glasses
d. Cataracts
e. Parkinsons disease
B, D and E
35
Q: which of the following forms of excercises reduce falls risk
## Footnote
a. Chair exercises
b. Swimming
c. Tai Chi
d. Using an exercise bike
e. Walking groups
C
36
5 geriatric giants
1. immobility
2. intellectual impairment
3. incontinence
4. instability
5. (iatrogenesis)
37
Factors affecting brain in ageing
* cerebral atrophy
* ischaemia
* amyloid, tau
* temperature regulation
* pain perception
* thrist
* sleep-wake
* mood disorders and social isolation
38
Factors affecting senses in ageing
* presbyopia
* cataracts
* ARMD
* senile ptosis
* ectropion
* glaucoma
* presbyacusis
* impacted ear wax
* BPPV
* reduces taste and smell
39
Factors affecting lungs in ageing
* smoking
* kyphoscoliosis
* reduces gas exchange
* fibrosis
* emphysema
40
Factors affecting heart liver and kidneys in ageing
* atherosclerosis
* AF
HTN
aortic stenosis
diastolic dysfunction/CCF
decreased drug clearance
CKD
alcohol
41
Factors affecting bowel with ageing
* constipation
* diverticular disease
* presby-esophagus
* vaginal prolapse/stress
* BPH
* UTIs
* postmenopausal vaginal atrophy
* reduced bladder capacity
42
Factors affecting bones and joints in ageing
* osteoporosis and fractures
* calcification and calcinosis
* vitamin D deficiency
* sarcopenia
* osteoarthritis
43
def: frailty
clinically recognisavle state of increased vulnerabilty from ageing associated decline in reserve and function across multiple physiological systems such that the abiloty to cope with everyday or acute stressors is compromised
44
Things to assess in frailty
* reduced muscle strength and tolerance
* sarcopenia
* reduced gait speed
* low energy/physical activity
* unintentional weight loss
45
Tools to assess frailty
PRISMA 7 questionnaire
timed up and go test
polypharmacy
46
PRISMA 7 questionnaire
1. are you >85?
2. male?
3. any health problems that limit activities?
4. need someone to help on a regular basis?
5. any health problems requiring you to stay at home?
6. in case of need can you count on someone close to you?
7. do you regularly use a stick, walker or wheelchair?
47
Comprehensive Geriatric Assessment
* Medical diagnosis
* Medications
* Nutrition
* Swallow
* Vision
* Hearing
* Bladder
* Bowel
* Cognition
* Mood
* Skin
* Mobility
* ADLs
* Carer support/ family
* Home environment
48
Areas in CGA?
* physical health
* mental health
* functional status
* social functioning
* environment
49
Physio measuring sclaes
* sitting balance
* sit to stand
* 10 second TUSS ((time unsupported steady stand)
* timed up and go
* trunk impairment sclae
* functional reach
* turn 180 test
* berg balance
* selective finger movement
* modified rivermead mobility index
50
what is a swallow disorder medically called
oro-pharygneal dysphagia
51
signs of dysphagia
* coughing and choking
* eye watering
* wet voice/breathing
* wheeze or increased RR
* holding food in mouth too long
* drooling
* inability to swallow medication
52
subtle signs of dysphagia
loss of wright
dehydration
recurrent chest infections
53
SLT management of swallow
* food and fluid modification
* equipment - cups and straws
* swallow manouvres and positioning
* education
* tube feeding
54
def: aphasia
multimodal condition affecting one or all communication abilities - understanding, reading, writing, gesture, speech
language centres of brain cannot send or receive signals
55
def: dysarthria
motor speech disorder resulting from distrbance in muscular control of speech
56
def: dysphasia
disorder of language - thoughts and ideas cannot become spoken
57
def: dysfluency
stammering, - interruptuon of flow of articulation
58
def: dyspraxia
disorder of motor peech planning - messages from the brain to mouth are disrupted, articulation imapired even though muscles are not weak
59
def: dysphonia
both vocal cords not moving efficiently causing disturbances to quality of voice heard
60
Extrinsic fall factors mnemonic
STUMBLING
Stuff (clothes, shoes, furniture)
Trailing wires
Uneven, wet, polished floors
Mobility problems (rolator)
Bad lighting
Loose rugs
Ill fitting footwear
Nocturnal low temp
Glare and shadow
61
Intrinsic falls factors
* postural hypotension
* cardiac (MI/ arrhythmia)
* valvular heart disease
* vasovagal
* TIAs/strokes
* dizziness
* epilepsy
* cervical spndylosis
* visual impairment
* brain sidease/dimentia
62
non pharmacological falls management
adequate dies
weight bearing excercise
stop smoking
reduce alcohol
63
pharmacological falls management
* bisphosphonates
* denosumab (rank ligand inhibitor for bone health)
* teriparatide (osteoporosis)
* SERMs
* Strontium
* HRT
64
features of history and examination indicating vertebral fracture
