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CSI > CSI CASE 6 > Flashcards

CSI CASE 6 Flashcards

1
Q

What are some risk factors for falls?

A

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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2
Q

what are fragility fractures?

A

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

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3
Q

What are common places for fragility fractures?

A

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

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4
Q

What is a cause factor for fragility fractures?

A

reduced bone mineral density - seen in osteoporis

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

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5
Q

What is osteoporsis?

A

reduction in bone mineral denisty, liable to fracture

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6
Q

How is OP diagnosed?

A

dexa scan - determination of bone mass at skeletal locations

comapre to sex and age, T SCORE

smaller than -2.5

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7
Q

What is pathiopgsyology of OP?

A

osteoclast activity > osteoblast activity

results sequneital trabecular loss

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8
Q

what are causes of osteoporisis?

A

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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9
Q

what are clincal signs of OP?

A

trabecualae in cancellous bone reduced

cortial bone osteons thinning and havasian canal widening - reduction strength

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10
Q

What are 2 components of the proxiaml femur?

and 2 main projections of superior shaft region

A

head and neck

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11
Q

Where does the head of promxial femeur articulate with?

A

acetabulum of pelvic bone,

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12
Q

what is the fovea?

A

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

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13
Q

what is the intra-capsular and extra capsular

and what denotes them?

A
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14
Q

what area does the retinacular vessel supply?

where does it supplied from?

A

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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15
Q

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

A

metaphyseal vessels

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16
Q

What is inneravation of lateral circumflex fermonal artery?

A

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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17
Q

what do the 3 ateries look like on a diagram?

A
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18
Q

What 2 classification of hip fractures?

A
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19
Q

Which type of fracture is the worst?

A

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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20
Q

What is garden calssifiction a predictable tool of?

A

avascular necoris i.e bone infaction

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21
Q

What is garden 1?

A

undisplaced, incomplete

valgus impacted (outward inanglulation)

22
Q

what is garden 2?

A

undisplaced, COMPLETE

no disturbance of medial trabeuclae

23
Q

what is garden 3

A

partially displaced

complete fracture

medial trabeculae out of line with pelvic trabeculae

24
Q

what is garden 4?

A
25
Q

How can you assess how much displacement of hip joint?

A

shenton’s line

26
Q

What are osteogenic cells?

A

bone stem cells, precusor to other bone cells

27
Q

What are osteocytes?

A

maintaining bone strucutre, former osteoblasts embedded in calcium hydroxyapatite secretions

28
Q

What is mechanosta theory

A

Bone strucute is influenced by mechanical laoding,

how bones chnage with havitual mechanical demands

29
Q

What does incrase habitual mechanical laoding force do?

A

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.​

30
Q

how are intracapsular fractures fixed?

A

garden 1/2 - cannulated hip screws

garden 3/4 - total hip replacement or hemi arhoplasty

31
Q

when would you choose to give a hemi-arthoplsaty?

A

patients:

able to walk out of door with no more than stick

not coginively imparired

are medically fit for anaethsia for proceudre

32
Q

what are the types of extracapsular fractures?

A

interchanteric

subchanteric

33
Q

how can intertrochanteric fractures be manged?

A

dynamic hip screw or intra medullary nail

34
Q

what is a good thing about dynamic hip screw?

A

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

35
Q

How are subtrochandetric fractures manged?

A

intra medullary nail

36
Q

how exactly does estradoil have affect on bone production?

A

stimaulates TGF actions on osteoclast/blasts

and inhbits IL-6, IL-1, TNF

37
Q

what is denosumab drug action?

A

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

38
Q

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

A

bisphosponates

binds to hydroxypatite crystals

decrease rate of bone resportion and increase bone mineral density

maintain strucutral and material properties of bone

39
Q

what is alendronic acid?

what is a main benefit of it?

A

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

40
Q

What is tetriparadetide, when is it used?

A

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

41
Q

What is zolendroic acid?

What is special about it?

A

only IV admisniton

slows down bone rsportions, allow more osteoblasts activity

42
Q

How does raloxifene work?

When would you use it?

A

prevents osteoprosis in post-menoapusal women

mimics osteogresn

works by being a slective oestrogen receptor modulator

43
Q

what happens in delirum

A

happens when someone is very ill

worsening of a person’s mental state - they are more conufsed than usual

44
Q

what is stonritum renelate not used much?

A

only used severe osteoprosis

when other approved options not possible due to increase risk of heart attack

45
Q

What is hyperactive delirum?

A

restless, agiated, agrresive, distressed, delusions,paranoid

46
Q

hypoactive delirium?

A

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

47
Q

what is the other type of delirium?

A

mixed delirium - mixture of symptoms

48
Q

Causes of delirmum?

A

Pain​

Infection​

Nutrition​

Constipation​

Hydration​

​

Medication​

Electrolytes​

49
Q

How is it different to dementia?

A

similar symptoms

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

50
Q

What treatment of delirium?

A

address underyling medical problem causing it e.g infection

stop medication

support + don’t move unnecciarly

provide supportive environemnt

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