Falls

Question 1

What is the most likely cause of a fall after looking upwards?

Answer 1

Vertebrobasilar insufficiency

Question 2

What is the most likely cause of a fall after getting up from bed?

Answer 2

Postural hypotension

Question 3

What should you ask about in the history of presenting complaint in a fall?

Answer 3

1. Who - witnesses?
2. What happened before, during, and after the fall
3. Why do they think they fell?
4. Where?
5. When?
6. How often do you fall?

Question 4

What could happen before a fall?

Answer 4

Warning, dizziness, chest pain, palpitations, syncope features.

Question 5

What could happen during a fall?

Answer 5

Incontinence, tongue biting, loss of consciousness, flushed/pale, injury.

Question 6

What could happen after the fall?

Answer 6

Get straight up, confusion, myalgia, numbness, weakness, speech/visual disturbance.

Question 7

What should be covered in a comprehensive examination after a fall?

Answer 7

1. Gait
2. CVS - pulse, BP, carotid bruits, murmurs
3. Resp - inspection, percussion, auscultation
4. GI - tenderness, organomegaly, check for constipation and anal tone
5. Neuro - full
6. MSK - full
7. ENT - ear wax, tympanic membranes intact

Question 8

What bedside tests should you consider for someone with a fall and why are you considering each of them?

Answer 8

1. Obs - sepsis, bradycardia
2. Lying/standing BP - orthostatic hypotension
3. Urine dip - infection, rhabdomyolysis
4. ECG - bradycardia, arrhythmias, ACS
5. Blood glucose - hypoglycaemia
6. VBG/ABG - infection, hypoxia, hypercapnia, electrolytes

Question 9

What bloods should you consider ordering for someone with a fall and why are you ordering each of them?

Answer 9

1. FBC - anaemia
2. U&Es - dehydration, electrolytes
3. LFTs - chronic alcohol use
4. Bone profile - calcium
5. TFTs, clotting, troponin, BNP, CK, folate, B12, cultures

Question 10

What imaging should you consider ordering for someone with a fall and why are you ordering each of them?

Answer 10

1. CXR - pneumonia
2. CT head - stroke, chronic/acute subdural
3. X-ray bones - if tender for pathology
4. Echo - valvular heart disease, CCF

Question 11

What are the differentials for a fall in an elderly individual?

Answer 11

1. Mechanical, polypharmacy
2. Arrhythmias, orthostatic hypotension, bradycardia, valvular heart disease, ACS
3. Stroke, peripheral neuropathy, seizures
4. Incontinence, UTI
5. Hypoglycaemia
6. Arthritis, disuse atrophy
7. BPPV, ear wax