Geriatric physiotherapy and falls

40 Gulf Prometric Physiotherapist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Geriatric physiotherapy and falls, part of Special Populations. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Hard

   Rehabilitation starts 6 weeks after a T10 compression fracture in a 75-year-old woman with increased thoracic kyphosis. Which programme is the best?

   1. AExtension-biased postural strengthening, balance work and graded walking
   2. BStrict bed rest for a further three months of recovery
   3. CPassive spinal manipulation to correct the kyphosis in clinic
   4. DDaily sit-ups and trunk rotations to mobilise the stiff thoracic spine and hips

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   Answer: A · Extension-biased postural strengthening, balance work and graded walking

   Extension-biased back and scapular strengthening reduces kyphotic loading, balance work reduces falls, and walking loads bone. Flexion and twisting increase the risk of further vertebral fractures. Manipulation and long rest are harmful.

   • B: Bed rest accelerates bone and muscle loss.
   • C: Manipulation risks refracture.
   • D: Sit-ups and rotation load the weak vertebra.

   Remember this

   After a vertebral fracture: extension-biased strengthening and balance work, no loaded flexion or twisting.

2. Question 2 · Easy

   Orthostatic hypotension is defined as a fall in blood pressure within three minutes of standing of at least:

   1. A5 mmHg systolic or 2 mmHg diastolic
   2. B10 mmHg systolic only
   3. C20 mmHg systolic or 10 mmHg diastolic
   4. D40 mmHg systolic and 20 mmHg diastolic

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   Answer: C · 20 mmHg systolic or 10 mmHg diastolic

   A drop of 20 mmHg systolic or 10 mmHg diastolic within three minutes of standing meets the definition. It causes dizziness and falls, especially with dehydration and some medicines. Blood pressure is measured lying, then at one and three minutes of standing.

   • A: 5/2 mmHg is within normal variation.
   • B: 10 mmHg systolic is within normal variation.
   • D: 40/20 mmHg is a larger drop than the threshold.

   Remember this

   Orthostatic hypotension: a fall of 20 systolic or 10 diastolic within 3 minutes of standing.

3. Question 3 · Easy

   In Fried's frailty phenotype, how many of the five criteria are needed to define a person as frail?

   1. ATwo criteria only
   2. BThree or more
   3. CAll five criteria
   4. DOne criterion only

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   Answer: B · Three or more

   The five criteria are unintentional weight loss, exhaustion, weakness (low grip strength), slow gait and low physical activity. Three or more define frailty, one or two define pre-frailty, and none means robust.

   • A: Two criteria also fall in the pre-frail group.
   • C: Frailty does not require all five criteria.
   • D: One criterion places a person in the pre-frail group.

   Remember this

   Fried frailty needs three or more of five criteria.

4. Question 4 · Medium

   An older woman cannot stand on one leg for 5 seconds with her eyes open. How should this be interpreted?

   1. AA sign of a cerebellar lesion needing urgent imaging
   2. BAnkle weakness alone, with no link to falls
   3. CA normal finding needing no action
   4. DAn increased risk of injurious falls

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   Answer: D · An increased risk of injurious falls

   Inability to hold single-leg stance for 5 seconds is linked to injurious falls in older adults. It shows reduced static balance and hip abductor control. A full falls assessment and balance training are indicated.

   • A: Poor single-leg stance alone is common and does not call for urgent imaging.
   • B: The finding is linked to falls, whatever its cause.
   • C: Healthy older adults can usually hold at least 5 seconds.

   Remember this

   Inability to hold single-leg stance for 5 seconds signals a higher risk of injurious falls.

5. Question 5 · Medium

   An 80-year-old complains of dizziness on standing. Blood pressure is 140/80 mmHg lying and 112/70 mmHg after one minute of standing. Which advice is most appropriate?

   1. ALie flat during the day to rest the circulation
   2. BRestrict fluids to reduce symptoms of dizziness during the day
   3. CStand up as quickly as possible so that the circulation can adjust to the change
   4. DRise slowly in stages, do ankle pumps before standing and review her medicines

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   Answer: D · Rise slowly in stages, do ankle pumps before standing and review her medicines

   The drop of 28 mmHg systolic meets the criteria for orthostatic hypotension. Staged rising, calf and ankle pumping, adequate hydration and medication review reduce symptoms. Fluid restriction and prolonged recumbency worsen the problem.

   • A: Staying flat causes deconditioning and worsens orthostatic intolerance.
   • B: Fluid restriction reduces blood volume.
   • C: Standing quickly increases the drop.

   Remember this

   For orthostatic dizziness: staged rising, ankle pumps, hydration and medication review.

6. Question 6 · Medium

   Which muscle fibre type declines most with ageing?

   1. AType II (fast-twitch) fibres
   2. BSmooth muscle fibres of the gut wall
   3. CCardiac muscle fibres of the myocardium
   4. DType I (slow-twitch) fibres of the postural muscles

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   After surgery for a hip fracture in an older adult, when should mobilisation start?

   1. AAfter the sutures have been removed at about two weeks
   2. BAfter six weeks of complete bed rest to protect the surgical repair
   3. COnly when the pain has fully resolved and the patient feels ready
   4. DThe day after surgery, within the surgeon's weight-bearing limits

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8. Question 8 · Medium

   The FRAX tool is used to estimate:

   1. AThe 10-year probability of a major osteoporotic fracture
   2. BWalking speed
   3. CLifetime risk of dementia
   4. DThe six-month risk of delirium after hip surgery in older adults

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9. Question 9 · Medium

   During Ramadan, a frail woman of 76 who is fasting feels dizzy during her afternoon exercise session in Doha. Which plan is best?

   1. AKeep the afternoon timing but lower the intensity slightly
   2. BMove the session to just before iftar, at the end of the fast
   3. CStop all activity for the whole month of Ramadan
   4. DMove light exercise to after iftar and ensure hydration

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10. Question 10 · Hard

    Which training emphasis best improves an older adult's ability to recover from a trip?

    1. ASlow isometric holds performed in sitting only
    2. BPower training with fast, controlled lower-limb movements
    3. CUpper-limb strengthening exercises only
    4. DLong-duration low-intensity walking at a steady pace only

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11. Question 11 · Medium

    A 70-year-old woman has a grip strength of 14 kg, where the cut-off for low strength in women is below 16 kg. Which conclusion is reasonable?

    1. ASevere sarcopenia needing no further tests or measurements
    2. BProbable sarcopenia needing confirmation of muscle mass
    3. CNormal muscle strength for a woman of her age and weight
    4. DConfirmed osteoporosis based on the grip strength alone

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12. Question 12 · Medium

    A 74-year-old walks 10 metres in 16.7 seconds. Which description fits his speed?

    1. AAbout 0.2 m/s, a household ambulator
    2. BAbout 0.6 m/s, a limited community ambulator
    3. CAbout 2.0 m/s, a competitive walker
    4. DAbout 1.7 m/s, an unrestricted community ambulator

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13. Question 13 · Medium

    A 78-year-old woman reports sudden mid-back pain after sneezing, with point tenderness at T10. Which response is most appropriate?

    1. ABegin vigorous abdominal curls to strengthen the trunk
    2. BApply deep friction massage and review in one month
    3. CAvoid spinal manipulation and flexion exercises; refer for imaging
    4. DPerform high-velocity thrust manipulation to the thoracic spine today

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14. Question 14 · Hard

    A man walks 4 metres in 8 seconds. Which statement is correct?

    1. AHis speed is 0.5 m/s, which is above the 0.8 m/s cut-off
    2. BHis speed is 2.0 m/s, which is normal for his age
    3. CHis speed is 0.8 m/s, exactly on the cut-off value
    4. DHis speed is 0.5 m/s, below the 0.8 m/s cut-off

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15. Question 15 · Easy

    On the Timed Up and Go test, which time suggests an increased risk of falls in a community-dwelling older adult?

    1. A12 seconds or more
    2. BUnder 5 seconds
    3. CAny time under 8 seconds
    4. DExactly 10 seconds

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16. Question 16 · Medium

    Which drug class is most strongly associated with falls in older adults?

    1. ABenzodiazepines and other sedative-hypnotics
    2. BStatins prescribed for lowering cholesterol levels
    3. CVitamin D supplements taken every day
    4. DMetformin prescribed for type 2 diabetes

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17. Question 17 · Medium

    An older adult stops walking when she starts talking. What does this suggest?

    1. AAn excellent balance reserve for her age
    2. BNo clinical meaning for falls risk at all
    3. CA higher risk of falls from dual-task interference
    4. DA normal level of attention for her age

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18. Question 18 · Medium

    A 70-year-old woman has a hip bone density T-score of -1.8. Which category applies?

    1. AOsteopenia (low bone mass)
    2. BSevere osteoporosis
    3. COsteoporosis with a fragility fracture
    4. DNormal bone density for age

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19. Question 19 · Hard

    Fluctuating confusion, with agitation at times and drowsiness at others, appears on day 2 after hemiarthroplasty in a woman of 84 who was oriented yesterday. What is the best response?

    1. ARestrain her to protect the surgical hip from sudden movements
    2. BRecognise probable delirium, tell the medical team and keep mobilising gently
    3. CIncrease the exercise intensity to tire her and settle her sleep
    4. DTreat it as progression of dementia and abandon her rehabilitation programme for now

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20. Question 20 · Medium

    The 30-second chair stand test is used mainly to assess:

    1. ALower-limb strength and endurance
    2. BWalking speed
    3. CGrip strength measured with a dynamometer
    4. DStatic balance

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21. Question 21 · Hard

    A woman's hip bone mineral density is 0.62 g/cm2. The young adult mean is 0.94 g/cm2 and the standard deviation is 0.12 g/cm2. What are her T-score and diagnosis?

    1. AAbout -2.7, osteoporosis
    2. BAbout -2.0, osteopenia
    3. CAbout -0.3, normal
    4. DAbout -3.3, severe osteoporosis

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22. Question 22 · Medium

    Which communication strategy is best when exercising an older adult with moderate dementia?

    1. AFrequent changes to the exercises to avoid boredom and keep interest
    2. BShort, one-step instructions with demonstration and routine
    3. CLong verbal explanations before every single exercise
    4. DWritten handouts as the only form of instruction given

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23. Question 23 · Medium

    Which exercise programme has strong evidence for reducing falls in community-dwelling older adults?

    1. ALow-intensity aerobic dance classes without balance work
    2. BSeated upper-limb exercise only, done twice a week
    3. CThe Otago Exercise Programme of strength and balance
    4. DPassive stretching alone, performed by the therapist

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24. Question 24 · Medium

    Which prescription is best for reversing sarcopenia in a frail older adult?

    1. ABed rest with protein supplements alone
    2. BLight stretching once a month on its own
    3. CProgressive resistance training, two to three days a week
    4. DResistance training with maximal loads every day of the week

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25. Question 25 · Hard

    An older man has developed a wide-based, shuffling 'magnetic' gait over a few months, with urinary urgency and slowed thinking. Which action is most appropriate?

    1. APrescribe a walking frame and review in six months
    2. BStart Parkinson's disease cueing and discharge
    3. CTreat it as normal ageing with general balance exercises
    4. DRefer for medical assessment of possible normal pressure hydrocephalus

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