Case Mgmt Test 1

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bcb2127
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168963
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Case Mgmt Test 1
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2012-09-04 22:40:29
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Case Mgmt Test Vestibular
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Case Mgmt Test 1 (Vestibular)
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  1. (obj 1) It is estimated that about ___ of older adults fall each year, though only _-_% experience significant injury associated with the fall. falls are the most common cause of fatal accidents in the elderlay and are responsible for ___ of the 10,000 deaths due to accident. 
    • 1/3
    • 5-15%
    • 2/3
  2. (obj 1) T or F: a cycle of fall, fear of falling, decreased strength, balance and reflexes leading to further falls probably contribute to gradual physical decline in many older persons.
    T
  3. (obj 1.5) see guccione p.332-335 about the body systems that maintain static and dynamic postural control and enable coordinated response to perturbation. 
    or not
  4. (obj 1.6) "a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or ground other than as a consequence of sudden onset of paralysis, epileptic seizure, or overwhelming external force" --Definition:_____
    Fall
  5. (obj 2) Changes considered normal aging that contribute to falls:
    -visual impairments (name 2)
    -changes in ____ ____ receptors
    -decreased ______ due to loss of muscle fibers
    - increased ______ of connective tissue
    -_______ ______ velocity does not slow very much, yet even the 10% decrease between age 20 and 80 may make the difference, as the elderly person is unable to take the one quick step that would normally avert a fall. 
    • 1. visual- decreased accomodation and dark adaptation
    • 2. changes in inner ear receptors
    • 3. decreased strength due to loss of muscle fibers
    • 4. increased stiffness of connective tissue
    • 5. nerve conduction velocity does not slow much (10%)
  6. (obj 3) Diseases that frequently occur with age and how they are associated with increased fall risk: 
    -Nervous system disorders, such as ____ (central) or ____ ____ (peripheral), heighten fall risk significantly.
    - Not counting the many medications prescribed for hypertension or heart rate or rhythm disorders, untreated _____ ____ may be associated with reduced cardiac output and dizziness or blackouts.
    - ______ _____ or ______ are obvious contributors to falls. Various forms of _____ are associated with joint pain, muscle weakness, and decreased ability to maintian balance when challenged. 
    -Any disease that leads to _____ ____ contributes to fall risk.
    -Cognitive loss or ______
    • 1. stroke or diabetic neuropathy
    • 2. heart diseases
    • 3. visual impairments or blindness/forms of arthritis
    • 4. generalized weakness
    • 5. dementia
  7. (obj 4) Extrinsic or environmental factors associated with falls- give examples
    -uneven floor surfaces and thresholds, slick floors, throw rugs, pets, animals, small children, insufficient lighting, twigs, gravel, ice, snow, hypothermia
  8. (obj 5) Home Assessments- OT's do them so they must not be that hard. 
    -All stairs must have ____. 
    -____ ____ must be put away
    -all lights should be at least ____ watts
    - ___ ____ should be in every room c ______ accessible
    - there should be a ____ ____ between walls and floors, at thresholds, and on stairways, where top and bottom steps need to be marked. 
    -bathroom _____ are a given.
    • 1. stairs have rails
    • 2. throw rugs put away
    • 3. all lights should be 100 watts 
    • 4. night light in every room c flashlight accessible
    • 5. high contrast between walls and floors
    • 6. bathroom rails are a given
  9. (obj 7) meds commonly given that are associated c falls: 
    ________: especially diuretics and antiarrythmics
    ________: for angina
    ________: opioids
    ________: relaxants
    ________: for psychotic behaviors
    ________: for depression
    ________: for parkinsons
    • 1. antihypertensives
    • 2. sublingual nitrogen
    • 3. narcotics
    • 4. muscle relaxers
    • 5. tranquilizers/antipsychotics
    • 6. tricyclics
    • 7. antiparkinsons 
  10. (obj 8) 
    _______ can be associated with decreased judgment as well as hypokinesis that reduces an elderly person's level of fitness in a spiral fashion.
    ______ (chronic/unreversible) and _______ (acute and reversible) cause olderpersons to take unnecessary risks as they can't comprehend dangersous situations in the environment.
    • 1. depression
    • 2. dementia/delirium
  11. (Obj 9) risk factors for falls in older adults: name some
    muscle weakness, history of falls, gait deficit, use of AD, visual defecits, neurological deficits, arthritis, impaired ADL's, depression, cognitive impairment, age>80, meds, cardiovascular deficit
  12. (Obj 10) recommend an exercise and activity program to lessen risk of falling: 
    tailored to individual needs; directed towards joint and muscle flexibility, muscle strength/length, balance (static/dynamic/single leg), posture and general aerobic fitness
  13. (obj 11) Describe the relationship between a fall and fear of falling: 
    a fall frequently causes a fear of falling which inhibits the amount of and level of physical activity,which reduces level of fitness. 
  14. (Obj. 12) Instructions for getting down to the floor and getting back up:
    i'm sure you could b.s. something or look at bottomley p 174-176
  15. (obj 13)
    ______=room spinning
    *_____: otocoia from utircle escape into SCC: (canalithiasis or cupulolisthasis)
    *____: causes unilateral peripheral hypofunction
    other causes: unilateral central lesion CVA, CHI, MS, labyrinthitis
    *other causes: MS, Meniere's, migraine HA, fistula
    • -Vertigo
    • -BPPV
    • -UVL
  16. (obj13)
    _______: going to faint or pass out: has many causes, name some
    • lightheadedness
    • orthostatic hypotension, or hypo-perfusion to the brain caused by (cardiac arrythmia, vertebral artery syndrome, TIA, anemia, vasovagal syndrome) ALSO: hypoglycemia, anxiety, drug SE's
  17. (obj 13) ________: "off balance, poor balance" 
    may be caused by: 
    • -peripheral neuropathy
    • -BVL bilateral vestibular lesion
    • -Chronic UVL
    • -ototoxicity
    • -motor pathway lesion/vestibular cortex lesion
    • -muscle weakness
  18. (0bj 13) Duration of dizziness
    ________: BPPV, orthostatic hypotension
    ________: TIA, panic attack, migraine
    _____-____: Meniere's 
    • seconds
    • minutes
    • hours-days
  19. (obj 13) Differentiation of peripheral and central Vertigo
    Peripheral: Nausea (severe or moderate) Imbalance (mild or severe) Hearing Loss (common or rare) Neurologic Sysmptoms (rare or common) Compensation rate (rapid or slow) Gaze fixation causes (decreased nystagmus, or no change/increased nystagmus)
    • Nausea: severe
    • Imbalance: mild
    • Hearing loss: common
    • Neurologic symptoms: rare
    • Compensation Rate: rapid
    • Gaze fixation causes: decreased nystagmus
  20. (obj 13) differentiation of peripheral and central Vertigo
    Nausea (severe or moderate) Imbalance (mild or severe) Hearing Loss (common or rare) Neurologic symptoms (rare or common) Compensation rate (rapid or slow) Gaze fixation causes (decreased nystagmus or no change or increased nystagmus)
    • Nausea: moderate
    • Imbalance: severe
    • Hearing Loss: rare
    • Neurologic symptoms: common
    • Compensation rate: slow
    • Gaze fixation causes: no change or increased nystagmus
  21. (Obj 15)
    ______: named for the direction of the quick phase
    ____/_____ ______: named by the direction that the superior pole of the iris moves: to the left or the right
    • nystagmus
    • rotary/torsional nystagmus
  22. (obj 16) List the 5 criteria in the diagnosis of BPPV using the Hallpike-Dix test: 

    These criteria apply to the _____ and _____ canals but not the _____ canals
    • 1. torsional nystagmus reproduced c affected ear down
    • 2. brief latency (5-15secs) before the start of the nystagmus
    • 3. nystagmus of brief duration
    • 4. reversal of nystagmus direction on returning to upright
    • 5. fatigability: decreased response to repeated testing
    • -apply to the anterior and posterior but not the horizontal canals
  23. (obj 16)
    < __sec nystagmus: likely caused by canalithiasis
    >__ sec- likely cupuolithiasis
    if nystagmus is persistent, it may indicate a ______ lesion rather than BPPV
    • <60 sec=canalithiasis
    • >60sec = cupuolithiasis
    • persistent= central lesion rather than BPPV
  24. (obj 17) Effects of aging on the Vestibular system
    -loss of ___ ____
    -loss of ____
    - _____ in VOR gain
    -also oscillopsia, visual and somatosensory input changes 
    *all of these combined contribute to vestibular ________
    • -loss of hair cells
    • -loss of neurons
    • -decrease in VOR gain
    • *all contribute to vestibular hypofunction
  25. (obj 17)
    *if hypofunction is _______ there is dysequilibrium and gait ataxia= __ __ __
    *if hypofunction is ______ there is dysequilibrium and vertigo= _ _ _
    • *bilateral=Bilateral Vestibular Lesion (BVL)
    • *unilateral= Unilateral Vestibular Lesion (UVL)
  26. (obj 18) nOrmal and pathological changes to hearing
    . ______: age related hearing loss c three origins
    1. ______: outer and middle ear: excess wax, sclerotic tympanic membrane, or blocked eustachian tube; hearing aids most effective
    2. ______: the inner ear; auditory nerve degeneration, ototoxic drugs, meniere's disease, brain tumor
    3. _______: 
    -(higher or lower) frequency sounds are lost
    -(consonants or vowels) are more difficult to distinguish
    • Presbycussis
    • 1.Conductive
    • 2. Sensorineural
    • 3.Mixed
    • (higher frequencies)
    • (consonants)
  27. (obj 19) Med Part B regulation promoting Screening for Future fall risks
    • -eligible provider screen part B patients 65 years and older
    • -PT's required to report whether they asked if the individual had fallen within the past year and determine frequency, context, and characteristics
    • -provider must report screening for future future fall risk measure for at least 80% of the pt's to whit is applicable in order to receive the 1.5% bonus. 

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