CSI CASE 6 Flashcards by Ahmed Salih

What are some risk factors for falls?

neurological - depression, confusion, congenititve impariment, poor balance

unmodifiable - age, female, history of falls

chemcial- drugs side effects, polypharmacy (concurrent use of multiple medication)

cardiovascular - orhostatic hypotension (low bp after sitting long), arrthyrmia

neurmusclar - gait disorders e.g parkinsons, muscle weakness, pheripheral neruoahtpy

enviroment at home

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what are fragility fractures?

from mechanical forces wouldn’t normall result in fracture. - low level trayma

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What are common places for fragility fractures?

vertebrae, hip (promxial femur), wrist (distal radius)

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What is a cause factor for fragility fractures?

reduced bone mineral density - seen in osteoporis

also other causes: osteogensis imperfecta, acrogemally, inflam arthrieites, curshin’s syndrone

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What is osteoporsis?

reduction in bone mineral denisty, liable to fracture

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How is OP diagnosed?

dexa scan - determination of bone mass at skeletal locations

comapre to sex and age, T SCORE

smaller than -2.5

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What is pathiopgsyology of OP?

osteoclast activity > osteoblast activity

results sequneital trabecular loss

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what are causes of osteoporisis?

has to do with PTH, calincontin, Ca2+, ostrogen

age - less Ca2+ and Vit D

female - loss of oestrogen as ostrogen usually stimulates oestoblast activity and inbits osteoclasts

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what are clincal signs of OP?

trabecualae in cancellous bone reduced

cortial bone osteons thinning and havasian canal widening - reduction strength

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What are 2 components of the proxiaml femur?

and 2 main projections of superior shaft region

head and neck

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Where does the head of promxial femeur articulate with?

acetabulum of pelvic bone,

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what is the fovea?

non articular fit on medial surface for attachment of ligament of the head

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what is the intra-capsular and extra capsular

and what denotes them?

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what area does the retinacular vessel supply?

where does it supplied from?

fermonral head and beck,

from extra caplsular aterial ring supplied by lateral and medial circumflex vessels and

refinforced by superior and inferior gluteal arteries

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what is a non-major artery to fermoral head? (post skeletal maturity)

metaphyseal vessels

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What is inneravation of lateral circumflex fermonal artery?

lateral side of profunda fermoris

connects with branch of medial circumflex femonral artery form channel circulates neck of femur supplies femoral neck and head

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what do the 3 ateries look like on a diagram?

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What 2 classification of hip fractures?

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Which type of fracture is the worst?

intra capular asscoaited high risk of distuption and interrupt in blood supply to femonral suuply

as close promoxity of retinacular vessels

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What is garden calssifiction a predictable tool of?

avascular necoris i.e bone infaction

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What is garden 1?

undisplaced, incomplete

valgus impacted (outward inanglulation)

what is garden 2?

undisplaced, COMPLETE

no disturbance of medial trabeuclae

what is garden 3

partially displaced

complete fracture

medial trabeculae out of line with pelvic trabeculae

what is garden 4?

How can you assess how much displacement of hip joint?

shenton's line

What are osteogenic cells?

bone stem cells, precusor to other bone cells

What are osteocytes?

maintaining bone strucutre, former osteoblasts embedded in calcium hydroxyapatite secretions

What is mechanosta theory

Bone strucute is influenced by mechanical laoding, how bones chnage with havitual mechanical demands

What does incrase habitual mechanical laoding force do?

higher strain stimulus being exerted on bone. This puts the bone into a state of overload if it passes the formation threshold. **Formation modelling begins:** **-**osteocytes undergo perturbation (increased activity) -Bone tissue is secreted by osteoblasts as osteocytes are continuing to maintain it. This results in an increase in bone density and therefore whole bone strength.

how are intracapsular fractures fixed?

garden 1/2 - cannulated hip screws garden 3/4 - total hip replacement or hemi arhoplasty

when would you choose to give a hemi-arthoplsaty?

patients: able to walk out of door with no more than stick not coginively imparired are medically fit for anaethsia for proceudre

what are the types of extracapsular fractures?

interchanteric subchanteric

how can intertrochanteric fractures be manged?

dynamic hip screw or intra medullary nail

what is a good thing about dynamic hip screw?

more effective as it lets fracture ends slide, increase habital stress that promotes healing

How are subtrochandetric fractures manged?

intra medullary nail

how exactly does estradoil have affect on bone production?

stimaulates TGF actions on osteoclast/blasts and inhbits IL-6, IL-1, TNF

what is denosumab drug action?

blocks RANLK lingand a powerful stimulant of osteoclast acitivty treatment for osteoprosis intolerant of biphosophates used for 2nd prevention for postmenopausal women with increased risk of fractures difficulty using alendronic acid

What is a main type of drug treatment for hip fractures and how does it work?

bisphosponates binds to hydroxypatite crystals decrease rate of bone resportion and increase bone mineral density maintain strucutral and material properties of bone

what is alendronic acid? what is a main benefit of it?

syntheric analogue of pyrophosphate - used for **oestoperosis** inhibts enzyme for osteoclast turnover resportion reduced bone resportion and osteocalsts **normally prescribed (main drug) and can be taken orally**

What is tetriparadetide, when is it used?

PTH treatment, as increase osteoblast activity usually taken with vitamin D usually for postmenopausal women usally 3rd line treatment, only used in sever osteporis when biphosphonates not effective

What is zolendroic acid? What is special about it?

only IV admisniton slows down bone rsportions, allow more osteoblasts activity

How does raloxifene work? When would you use it?

prevents osteoprosis in post-menoapusal women mimics osteogresn works by being a slective oestrogen receptor modulator

what happens in delirum

happens when someone is very ill worsening of a person's mental state - they are more conufsed than usual

what is stonritum renelate not used much?

only used severe osteoprosis when other approved options not possible due to increase risk of heart attack

What is hyperactive delirum?

restless, agiated, agrresive, distressed, delusions,paranoid

hypoactive delirium?

withdraw, drowsy, unable sleep, can't stay focussed when awake,

what is the other type of delirium?

mixed delirium - mixture of symptoms

Causes of delirmum?

## Footnote Pain Infection Nutrition Constipation Hydration Medication Electrolytes

How is it different to dementia?

similar symptoms delilirum is very sudden 1-2 days and vary a lot

What treatment of delirium?

address underyling medical problem causing it e.g infection stop medication support + don't move unnecciarly provide supportive environemnt