Falls, frailty & pressure ulcers flashcards
10 high-yield MRCP Part 1 cards from the Intellect Medicos Geriatrics & Palliative Care course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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How is orthostatic hypotension defined?
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A fall in systolic BP of at least 20 mmHg and/or diastolic of at least 10 mmHg within 3 minutes of standing.
Why? Measure lying BP after 5 minutes supine, then at 1 and 3 minutes standing.
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Which drug is used for symptomatic orthostatic hypotension when non-drug measures fail?
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Midodrine (an α1-adrenoceptor agonist); fludrocortisone is an alternative.
Why? First review and stop culprit drugs, then use fluids, salt, compression stockings and slow standing.
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Name three drug classes that increase the risk of falls in older people.
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Any three of: benzodiazepines/Z-drugs, antipsychotics, antidepressants, antihypertensives/diuretics, opioids, anticholinergics.
Why? They cause sedation, postural hypotension or confusion. Medication review is part of every falls assessment.
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An older person presents after a fall and is at risk of further falls. What should NICE-recommended management be built on?
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A comprehensive falls assessment followed by comprehensive falls management that addresses each risk factor found.
Why? Falls are usually caused by several factors: gait/balance, drugs, vision, lying and standing BP, continence, cognition, home hazards. NICE NG249 (2025) uses "comprehensive" where the old CG161 said "multifactorial".
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Which single intervention has the best evidence for preventing falls in community-dwelling older people?
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A progressive, individually tailored falls prevention (strength and balance) exercise programme.
Why? Training balance, coordination, strength and power (e.g. Otago or FaME) reduces falls and fear of falling. NICE NG249 says to offer it to anyone who has fallen once and has a gait or balance problem.
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How many points does the Rockwood Clinical Frailty Scale have, and from what score is a person considered frail?
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9 points; a score of 5 or more indicates frailty (5 = mild).
Why? 1 = very fit, 9 = terminally ill. It is based on function and dependence over the previous 2 weeks.
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In which groups should the Clinical Frailty Scale NOT be used?
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Younger people (under 65) and people with stable long-term disabilities (e.g. learning disability, cerebral palsy).
Why? The scale was validated in older people; using it in these groups wrongly labels them frail.
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A category 1 pressure ulcer is ______; a category 4 ulcer is full-thickness tissue loss with exposed bone, tendon or muscle.
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non-blanchable erythema of intact skin
Why? Category 2 = partial-thickness skin loss (shallow ulcer or blister); category 3 = full-thickness skin loss with fat visible.
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A category 1 pressure ulcer is non-blanchable erythema of intact skin; a category 4 ulcer is ______.
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full-thickness tissue loss with exposed bone, tendon or muscle
Why? Category 2 = partial-thickness skin loss (shallow ulcer or blister); category 3 = full-thickness skin loss with fat visible.
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How often should an adult at HIGH risk of pressure ulcers be helped to change position?
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At least every 4 hours (at least every 6 hours if at risk but not high risk).
Why? Regular repositioning relieves pressure before ischaemic damage develops.