What are 3 key considerations when a patient presents following a fall?
- Injuries sustained
- Circumstance of fall
- Falls risk factors
What is a basic management plan for an elderly patient that has sustained a fall?
- Pain relief
- Review anti-hypertensive medication
- Optometry review
- Physiotherapy for balance training
- Footwear review
- Consider treating ‘fear of falling’
- Consider environmental modification
What is a ‘hot fall’?
Patient is acutely unwell but presents with a fall as a non-specific marker of ill-health
What is a ‘cold fall’?
Generally occurs in older, frail people with multiple contributing factors
What are 3 common balance tests?
- Romberg’s test
- Timed up and go
- Sternal push or shoulder tug
What is the timed up and go test?
How long it takes a patient to stand up from a standard chair, walk 3 metres, turn around, walk back to chair & sit down
What is an average timed up and go speed for a 70 year old?
9 seconds
What are some differential diagnoses in a 23 year-old presenting with psychosis?
- Schizophrenia
- Drug-induced psychosis
- Schizoaffective disorder
- Delusional disorder
- Schizo-phreniform psychosis
- Brief psychotic disorders
What are some of the symptom clusters seen in schizophrenia?
- Positive symptoms
- Negative symptoms
- Cognitive symptoms
- Functional symptoms
- Impaired insight
What are the 2 main types of delirium?
- Hyperactive delirium
- Hypoactive delirium
What are features of hyperactive delirium?
- Repetitive behaviours
- Wandering
- Hallucinations
- Verbal or physical aggression
What are features of hypoactive delirium?
Patients appear quiet & withdrawn
What is the CAM diagnosis of delirium?
- Acute onset & fluctuating course
- Inattention
- Disorganised thinking
- Altered conscious state
Presence of 1 and 2 and either 3 or 4.
What are some clinical features of dementia?
- Agitation
- Psychosis
- Mood disorders
- Sexual disinhibition
- Eating problems
- Abnormal or inappropriate vocalisations
What is the differential diagnosis of dementia?
- Alzheimer’s disease
- Dementia with Lewy bodies
- Vascular dementia
- Frontal lobe dementia
What are the giants of geriatric medicine (4 starting with I)?
- Instability
- Immobility
- Incontinence
- Intellectual decline
What is Fried’s criteria of fraily?
- Unintentional weight loss
- Weakness
- Exhaustion
- Slow walking speed
- Low physical activity
Frail is 3 or more criteria
Which patients will benefit from a comprehensive geriatric assessment (CGA)?
- Recent onset of physical and/or cognitive impairment
- Changing physical and/or cognitive status
- Multiple interacting problems that are amenable to treatment
- Patients with fragmented specialty medical care
- Disorders that require rehabilitation therapy
- Consideration of change in living situation
- Evaluating patient competency/capacity
- Dealing with medico-legal issues
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Cardiovascular81
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Neurology50
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Endocrine20
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