Conditions 2

Question 1

Osteoporosis:

• Definition
• Definition of a fragility fracture + common bones
• Causes including secondary causes
• Investigations - when to assess risk
• What does FRAX look at
• Management

Question 2

Pressure sores:

• Definition
• Where are they common
• Causes
• Risk factors
• Classification - 1->4
• What screening tools are used
• Management: prevention, general

Answer 2

Pressure sores:

• Definition : break in skin due to repeated friction or sustained pressure
• Where are they common: back head, sacrum, heels, spine, elbow
• Causes:
• Risk factors : incontinence, immobility, loss sensation, cognitive impairment, broken skin, malnutrition
• Classification - 1->4
  1. non blanching erythema
  2. partial thickness loss (dermis + epidermis) - looks like blister
  3. full thickness (subcut)
  4. full thickness (into fascia, bone - needs mri pelvis for osteomyelitis)
• What screening tools are used: waterlow, braden risk assessment, northton
• Management: prevention, general
  Prevention: food nutrition, diabetes control, redistribution/reposition every 6 hours, heel pads, emollients, airflow mattress
  General: wound hydrocolloid/hydrogels dressing, debridement

Question 3

Urinary incontinence:

• Assessment
• Management

Answer 3

Urinary incontinence:

• Assessment: 3 day bowel and bladder diary, abdo/pr ex, urine dip midstream, bladder void scan, urodynamic studies (pressure flow cystometry, pad tests, cystoscopy)
• Management
  general: reduce water before bed, caffeine/alcohol, no constip
  sui: pelvic floor ex, duloxetine na reuptake inhib inc sphincter, tension free vag tape, sling procedure, cholpo suspension
  uui: bladder retraining, mirabegron, tamsulosin, finasteride

Question 4

Faecal incontinence:

• Factors causing it
• Causes
• Investigations
• Faecal loading: complication, management
• Chronic diarrhoea: investigations, management

Answer 4

• causes: chronic constip/faecal impaction, haemorrhoids, neurogenic dysfunction
• mx:
  1. bulk forming lax like ispaghula
  2. osmotic laxative macrogol

Question 5

Nutrition:

• Causes of malnutrition
• Consequences of malnutrition: effects on muscle, cardio-rest, gi, wound healing, psychosocial effects

Question 6

Polypharmacy:
- multimorb definition
- polypharm def
- risk factors
- complications
- mx

Answer 6

Polypharmacy:
- multimorb definition: Multimorb is when 2 or more long term health conditions
- polyph def: when 6 or more prescribed at any one time
- risk factors for multimorb: age, f, low socioeconomic status, poor nutrition, lack exercie
- complications: dec qol, inc SE, interactions, mental health
- mx: STOPP START, bisphosphonate holiday if >3 years, yearly med review if >65.
careful with: nsaids, gliclazide, citalopram (hyponat/ post hypot), zopiclone, opioids, antichol, apixaban, haloperidol, ramipril