Overview of falls and instability

Question 1

Indicators for potentially having a fall

Answer 1

unstable balance on standing
use of > 4 meds
hip weakness

Question 2

are falls a normal aspect of aging?

Answer 2

No

Question 3

what is a good previous indicator of a fall

Answer 3

a previous fall

Question 4

is someone has dysequilibrium what should you think

Answer 4

neuromuscular dz
stroke
cerebellar dz

Question 5

if it is vertigo what should you suspect

Answer 5

drugs
depression
vestibular neuronitis
benign positional vertigo
otitis media

Question 6

what is fainting, lightheadedness, feeling that loss of consciousness is imminent

Answer 6

pre-syncope

Question 7

difficulty initiating gait and festination

Answer 7

parkinson

Question 8

foot drop indiactes what?

Answer 8

anterior tibialis weakness or reduced knee flexion

Question 9

do you just tx a patient for osteoporosis?

Answer 9

Nope, make sure there isn’t a secondary cause

Question 10

what is a potential screening for osteoporosis that is super cheap and has no radiation?

Answer 10

Quantitative ultrasonography of the calcaneus (if its positive must get a DEXA)

Question 11

is osteoporosis reversible?

Answer 11

No, but you can stop the progression

Question 12

ADRs of bisphosphonates

Answer 12

osteocencorsis on the jaw and atypical femur fractures

Question 13

is hormone replacement therapy used for osteoporosis?

Answer 13

Nope

Question 14

enlargement at DIP

Answer 14

Heberden’s nodes

Question 15

enlargement at the PIP

Answer 15

Bouchard’s nodes

Question 16

usually over age 50
Women 2x more than men
Morning stiffness > 1 hour
Shoulder and hip girdles

Answer 16

Polymyalgia rheumatica

Question 17

tx for polymyalgia rheumatica

Answer 17

steroids

Question 18

tx for temporal arteritis (giant cell arteritis)

Answer 18

temporal artery biopsy

Question 19

do you wait for tx for giant cell arteritis?

Answer 19

never

Question 20

Temporal HA, blindness

ESR, CRP highly elevated

Answer 20

giant cell arteritis

Question 21

Tx for giant cell arteritis

Answer 21

Temporal artery biopsy

Question 22

tx for giant cell arteritis?

Answer 22

steroids

Question 23

what 2 conditions are highly associated

Answer 23

polymyalgia rheumatica

giant cell arteritis

Question 24

are wound surface cultures helpful?

Answer 24

No

Question 25

how many hip fractures remain in the nursing home 1 year after fracture?

Answer 25

30%

Question 26

how many people will develop a pressure ulcer after a hip fracture?

Answer 26

30%

Question 27

What are the 5 most common places for fractures following a fall?

Answer 27

``` hip femur humerus wrist ribs ```

Question 28

What type of hematoma is a consequence of falls?

Answer 28

subdural hematoma

Question 29

What are 3 reasons falls are underreported?

Answer 29

Injury minimal "normal" with aging fear of restriction in activities or institutionalization

Question 30

What 3 drug levels should you get for a fall?

Answer 30

Digoxin, anticoags, ETOH

Question 31

What vitamin deficiency could play a part in a fall?

Answer 31

Vitamin D level

Question 32

If someone is dizzy, you should suspect what 5 things?

Answer 32

Vertigo (ear, drug toxicities, depression) Dysequilibrium (neuromuscular disease, stroke, cerebellar dz) Presyncope Mixed dizziness Nonspecific dizziness

Question 33

5 causes of presyncope

Answer 33

``` Cerebral hypo-perfusion Orthostatic HPOTN Cardiac arrhythmias CHF Vasovagal episodes ```

Question 34

Sudden, transient loss of consciousness characterized by unresponsiveness and loss of postural control, followed by spontaneous and typically complete recovery

Answer 34

Syncope

Question 35

What test should you get if there is any LOC?

Answer 35

head CT

Question 36

If there is gait initiation failure, what do you suspect?

Answer 36

high level sensorimotor disorder (frontal lobe or white matter)

Question 37

Why would there be short step length?

Answer 37

fear of falling, neuro or MSS problem

Question 38

Pelvic muscle weakness or unable to bend the knee or hemiplegia causes what?

Answer 38

circumdunction

Question 39

A bone density between -1 to -2.5 means

Answer 39

osteopenia

Question 40

A bone density above >1.0 means

Answer 40

Normal Bone Mineral Density

Question 41

What bone density value means osteoporosis?

Answer 41

<-2.5

Question 42

Can men get osteoporosis?

Answer 42

yes

Question 43

What is type 1 and type 2 idiopathic osteoporosis?

Answer 43

type 1- postmenopausal | Type 2- age associated or senile

Question 44

4 endocrine disorders that are causes of osteoporosis

Answer 44

cushing, DM, hyperparathryoidism, hyperthyroidism

Question 45

When should men be screened for osteoporosis?

Answer 45

>70 y/o | 10% weight loss, physical inactivity, steroid use, androgen deprivation therapy, previous fragility fracture)

Question 46

What is the gold standard for osteoporosis diagnosis?

Answer 46

Dual-Energy X-ray Aborptiometry (Lumbar spine, hip, and proximal femur)

Question 47

Can any treatment reverse established osteoporosis?

Answer 47

No

Question 48

What should you supplement with if on corticosteroids?

Answer 48

Ca and Vit D

Question 49

First line Tx for osteoporosis

Answer 49

Bisphosphonates

Question 50

What should you treat with if bisphosphonates have failed?

Answer 50

PTH hormone

Question 51

ADRs of SERM

Answer 51

increased risk of DVT and hot flashes

Question 52

What's the most common presentation of pain?

Answer 52

OA

Question 53

Stiffness after period of inactivity which is alleviated within 30 minutes of activity. Episodes of severe pain, tenderness of joints WITHOUT INFLAMMATION

Answer 53

OA

Question 54

Heberden's and Bouchard's nodes associated with what?

Answer 54

OA

Question 55

Morning stiffness > 1hour

Answer 55

polymyalgia rheumatica