Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine year 3- EOCP > Frailty- core conditions 2 > Flashcards

Frailty- core conditions 2 Flashcards

1
Q

Eczema

A

A chronic atopic condition caused by defects in the skin barrier leading to microbe entry this creates an immune response causing inflammation and associated symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Eczema- areas affected and triggers

A

Areas affected- Dry, red, itchy and sore patches of skin on flexor surfaces (the inside of elbows and knees) and on the face and neck
Triggers: change in temperature, certain dietary products, washing powders, cleaning products, emotional events or stresses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Eczema- treatment

A
  • Maintenance: emollients, avoid bathing in hot water, scratching or scrubbing the skin and using soaps or body washes
  • Flares- thicker emollients, topical steroids, ‘wet wraps’ and treating any bacterial or viral infections
  • Specialist treatment: zinc impregnated bandages, topical tacrolimus, phototherapy, systemic immunosuppressants such as oral corticosteroids, methotrexate and azathioprine
    Use emollients that are as thick as tolerated and required to maintain the eczema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Eczema- types of emollients

A
  • Thin creams: E45, Diprobase cream, Oliatum cream, Aveeno cream, Cetraben cream, Epaderm cream
  • Thick, greasy emollients- 50:50 ointment, Hydromol ointment, Diprobase ointment, Cetraben ointment, Epaderm ointment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Eczema- steroids

A
  • Use the weakest steroid for the shortest time period to get the skin under control
  • Side effects- thinning of the skin. Meaning its more prone to flares, bruising, tearing, stretch marks and enlarged blood vessels called telangiectasia
  • The thicker the skin, the stronger the steroid used
  • Only weak steroids are over the face, around the eyes and in the genital region
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Eczema- the steroid ladder: from weakest to most potent

A
  • Mild: Hydrocortisone 0.5%, 1% and 2.5%
  • Moderate: Evumovate (clobetasone butyrate 0.05%)
  • Potent: Betnovate (betamethasone 0.1%)
  • Very potent: Dermovate (clobetasol propionate 0.05%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Eczema: bacterial infections

A

The most common is staphylococcus aureus. Treatment is with oral antibiotics, particularly flucloxacillin. More severe cases require admission and intravenous antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Appearance of eczema and eczema herpeticum

A

Eczema herpeticum: viral infection caused by the herpes simplex virus (HSV) or varicella zoster virus (VZV)

All eczema has minute vesicles histologically (spongiosis). However eczema can vary in appearance from weepy to dry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Classifying eczema

A
  • Exogenous v Endogenous
  • Acute v chronic
  • Weepy v vesicular v dry and scaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Exogenous eczema

A
  • Contact dermatitis (irritant and allergic)
  • Photosensitive
  • Lichen simplex- eczema due to scratching
  • Asteatotic- crazy paving
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Eczema investigations

A
  • Patch testing- type IV delayed hypersensitivity
  • Prick testing- type I immediate hypersensitivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Endogenous eczema

A
  • Atopic eczema
  • Discoid
  • Eczema due to venous insufficiency (varicose/venous)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Inflammatory arthritis (rheumatoid arthritis)

A
  • 4 cardinal symptoms: Pain, stiffness, swelling, loss of function/difficulty in activities of daily living
  • Pain: often worse in the mornings and on activity
  • Stiffness: worse in the mornings (prolonged early morning stiffness >30 minutes) and on inactivity
  • Swelling in joints
  • Difficulty in ADL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Joints involved in rheumatoid arthritis

A

Wrists, metacarpal pharyngeal joints, PIP, ankles and metatarsal pharyngeal joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Non-inflammatory arthritis i.e. Osteoarthritis

A
  • 4 cardinal symptoms: pain, stiffness, swelling, loss of function/ difficulty in activities of daily living
  • Pain: worse during or after activity
  • Stiffness: can be in the mornings (tend to be less than 30 minutes) and on or after activity
  • Bony swelling
  • Difficulty in ADL
  • less stiffness and swelling then in inflammatory arthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Joint involvement in osteoarthritis

A

Spine (spondylosis), carpometocarpal joint, distal interphalangeal joint, knees, in the big toe the metatarsal pharyngeal joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Neck pain- specific neck conditions

A
  • Whiplash: history of trauma, flexion/extension of the neck, pain and stiffness
  • Torticollis: involuntary contraction of the neck and head turning, tense neck muscles but no focal neurology
  • Cervical radiculopathy: pain, torticollis and neurological findings (numbness, tingling, weakness in the hand/arm)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Non specific neck pain

A
  • Varying pain levels
  • Positional change
  • Asymmetrical range of movement
  • Pain radiates in a non segmental pattern
  • No muscle weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Serious differentials to exclude in neck pain

A
  • Cervical fracture: trauma, severe pain. If suspected mobilise and urgent imaging (x-ray/CT/MRI)
  • Meningitis- neck stiffness, photophobia, non-blanching rash if bacterial. Identify with lumbar puncture
  • Subarachnoid haemorrhage: sudden onset headache, vomiting, meningism. Identify with CT/MRI/LP
  • Tumour: weight loss, history of cancer, gradual onset, if affecting CSF flow you get papilloedema and signs of raised ICP. Identify with CT/MRI
  • Spinal abscess: bacterial or TB (weight loss, fever, recent infection, immunocompromised)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Red flag symptoms of neck pain: general signs and symptoms

A
  • Fever
  • Generalised neck stiffness
  • Lympahdenopathy
  • Nausea or vomiting
  • Pain that is increasing, is unremitting or disturbs sleep
  • Severe neck tenderness
  • Skin erythema, wounds or exudate
  • Unexplained weight loss
  • New symptoms before the age of 20 or over 55
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Neck pain- age related risk factors

A
  • For patients under 20: altered hair distribution, birthmarks, congenital abnormalities, family history, infections related to substance misuse
  • For patients over 50: history of cancer, vascular disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Neurological red flags

A
  • Altered cognitive status, new confusion
  • Altered muscle tone, clonus, spasticity.
  • Ataxia.
  • Babinski’s sign: up-going plantar reflex, hyper-reflexia
  • Loss of coordination: gait disturbance, clumsy or weak hands,
  • Loss of sexual, bladder, or bowel function.
  • Hoffman’s sign positive
  • Lhermitte’s sign (flexion of the neck causes an electric shock type sensation that radiates down the spine and into the limbs)
  • New or severe headache.
  • Photophobia (or phonophobia)
  • Visual loss.
  • Weakness involving more than one myotome
  • Loss of sensation involving more than one dermatome.
23
Q

Neck pain- Past medical history red flags

A
  • A history of inflammatory arthritis, cancer, tuberculosis, immunosuppression, drug abuse, AIDS, or other infections.
  • A history of violent trauma (for example, a road traffic accident) or a fall from a height or minor trauma in a person at risk of osteoporosis (especially in post–menopausal women).
  • Minor trauma may fracture the spine in people with osteoporosis.
  • Risk factors for osteoporosis.
  • A history of neck surgery
24
Q

Back pain- red flags

A
  • Age (>50 or very young)
  • Thoracic pain
  • Unexplained weight loss
  • Neurological symptoms
  • Atypical pattern of pain- i.e. night waking, sudden onset
  • Fever
  • IV drug use
    Steroid use
  • History of cancer
25
Q

Back pain: red flags- infection

A
  • For example: discitis, osteomyelitis, spinal abscess
  • Can be caused by common immunosuppressant medication: Methotrexate (and other DMARD’s), steroids, Azathioprine
  • Tuberculosis or recent UTI
  • Diabetes
  • History of intravenous drug use
  • HIV infection
  • Immunocompromised by medication ir otherwise
26
Q

Back pain red flags: cancer

A
  • Age >50
  • Pain which is: severe and unremitting, even when lying down. Aching pain preventing or disturbing sleep. Pain aggravated by straining (on coughing or sneezing), mid-thoracic pain
  • Localised spinal tenderness
  • Not improving with conservative therapy
  • Unexplained weight loss
  • Past history of cancer
  • The 5 cancers which metastasise to the bone: prostate, breast, kidney, thyroid, lung
27
Q

Back pain red flags: spinal fracture

A
  • Sudden onset, severe central spinal pain relieved by lying down
  • History of trauma: may be mild if osteroporotic or on corticosteroids
  • Structural deformity of the spine
  • Discrepancy between height values
  • Tenderness over a vertebral body on palpation
28
Q

Back pain red flags: cauda equina syndrome

A
  • Severe or progressive bilateral neurological deficits in the legs i.e. motor weakness with knee extension, ankle eversion or foot dorsiflexion
  • Incontinence or urinary retention
  • Saddle anaesthesia (sensory loss around the perineum and the genitals)
  • Loss of anal tone
29
Q

Back pain red flags: spinal cord compression

A
  • New progressive, severe back pain
  • New spinal nerve root pain which may radiate down the legs or around the chest/abdomen in a band
  • Reduced power, motor weakness
30
Q

Cauda equina vs spinal cord compression

A
  • The cauda equina contains the nerve roots of L1-5 and S1-5. Compression of the lumbosacral nerve roots leads to signs of lower motor neurone compression in the legs; flaccid paralysis and diminished reflexes.
  • Compression of the spinal cord itself can affect any part of the spinal cord (not only nerves affecting the legs) and the motor signs will be of upper motor neurone compression; increased tone and hyper-reflexia.
  • In suspected Cauda Equina or Spinal Cord Compression, an urgent MRI and treatment is needed as patients can rapidly become irreversibly paralysed
31
Q

What is a fracture

A

Break in the continuity of the bone, a soft tissue trauma where the bone happens to be broken

32
Q

Approach to fracture

A
  • Anatomy – Which bone? Which part of the bone?
  • Fracture type – transverse, oblique, spiral, communited
  • Number of fracture fragments – 2, 3, 4, multiple
  • Displacement of fragments – translation, angulation, rotation, shortening, distraction
  • Does the fracture extend to the joint - intra or extra articular?
  • Associated dislocation?
  • Think of neurovascular structures nearby that may or may not be compromised.
  • Fractures can be open or closed
33
Q

Assessing hip fractures

A
  • Shortened and externally rotated
  • Intracapsular vs extracapsular
  • Review shentons line- is it disrupted. Is it above or below the intertrochanteric line
34
Q

Intracapsular v extracapsular fractures

A
  • The capsule envelopes the femoral head and neck
  • Subcapital, transcerival and basicervial fractures are intracapsular hip injuries
  • Intertrochanteric and subtrochanteric fractures do not involve the head of the femur
35
Q

Intracapsular fractures- Subcapital

A
  • Shentons line is disrupted
  • Increased density of the femoral neck is due to overlapping, impacted bone
  • The lesser trochanter is more prominent than usual due to external rotation of the femur
36
Q

Itracapsular fracture- Garden stage

A
  • Garden stage I : undisplaced, incomplete, including valgus impacted fractures
  • Garden stage II : undisplaced, complete
  • Garden stage III : complete fracture, incompletely displaced
  • Garden stage IV : complete fracture, completely displaced
37
Q

Interpretation of garden stage

A
  • In general, stage I and II are stable fractures and can be treated with internal fixation (head-preservation) and stage III and VI are unstable fractures and hence treated with arthroplasty (either hemi- or total arthroplasty)
  • Garden showed that valgus reduction greater than 20° is associated with higher rates of AVN.
  • The higher stages are associated with greater chances of AVN
38
Q

Treatment of intracapsular fractures

A
  • Fluid resuscitation
  • Analgesia
  • Care of pressured area
  • Fixation of fractures <24hrs- blood supply to the femoral head is disrupted, may need Hemiarthroplasty/total hip replacement
  • Early mobilisation
39
Q

Treatment for extra-capsular fractures

A
  • Fluid resuscitation
  • Analgesia
  • Care of pressure area
  • Fixation of fracture <24hrs: blood supply to the femoral head is preserved, dynamic hip screw
  • Early mobilisation
40
Q

Wrist fracture: Fall on outstretched hand (FOOSH)

A
  • Elderly
  • Decreased bone mineral density- osteoporosis
  • Colles fracture
  • Smiths fracture
41
Q

Wrist fracture

A
  • Which bones are affected
  • Radius, ulna or both
  • Impaction?
  • Alignment- dorsiflexed/palmar flexed
  • Review carpal bones
42
Q

Colles and Smith fracture

A

Colles ‘dinner fork’ deformity- fracture of the distal radius with dorsal angulation and impaction of the fracture fragment

Smith fracture- distal radius fracture with volar angulation of the distal fracture fragment

43
Q

Treatment of wrist fracture

A
  • Analgesia
  • Reduction
  • Immobilisation- either stable/extra-articular (cast). Or unstable/intra-articular (open reduction internal fixation (OFIF))
  • Mobilisation
44
Q

Kellgren-Lawence grading scale for knee osteoarthritis

A
  • Normal: no features of OA
  • Doubtful: minute osteophytes, doubtful significance
  • Mild: definite osteophytes, normal joint space
  • Moderate: moderate joint space reduction
  • Severe: joint space is greatly reduced, subchondral sclerosis
45
Q

OA: hands

A
  • Herberden’s nodes- distal interphalangeal joint
  • Bouchard nodes- proximal interphalangeal joint
46
Q

RA: hands

A

Initial plain film may be normal and synovial

47
Q

Stages of rheumatoid arthritis

A
  1. Synovitis: synovial membrane is inflamed and thickened, bones and cartilage are gradually eroded
  2. Pannus: extensive cartilage loss, exposed and pitted bone
  3. Fibrous ankylosis: joint is invaded by fibrous connective tissue
  4. Bony ankylosis: bones fused
48
Q

Rheumatoid arthritis: hands initial phase

A
  • Soft tissue swelling
  • Juxta-articular osteopaenia
49
Q

Rheumatoid arthritis hands: later stages

A
  • Erosive arthropathy – periarticular damage – marginal erosions
  • Osteoporosis
  • Symmetrical and concentric joint space narrowing
  • Predilection for PIP & MCP (2nd and 3rd)
  • Subluxation/deformity – ulna deviation
  • Boutonniere and swan neck deformities
  • Carpal instability
50
Q

Frailty

A
  • A state of reduced resilience and increased vulnerability
  • A state in which minor events can trigger disproportionate adverse outcomes in health, wellbeing and functional ability
  • Related to but distinct from ageing, comorbidity and disability
51
Q

Frailty phenotype- physical characteristics

A
  • Unintentional weight loss
  • Exhaustion
  • Weakness (measured by grip strength)
  • Slow walking speed
  • Low physical activity
52
Q

Frailty deficits

A
  • Disease states: Hypertension, Arthritis, Chronic Kidney disease
  • Abnormal laboratory values: anaemia, haematinic deficiency
  • Symptoms/signs: polypharmacy, falls, urinary incontinence
  • Disabilities: visual impairment, hearing impairment and mobility and transfer problems
53
Q

5 frailty syndromes

A
  • Falls- i.e. collapse, legs gave way, ‘found lying on the fall’
  • Immobility- i.e. sudden change in mobility, ‘gone off legs’, ‘stuck in toilet’
  • Delirium- i.e. acute confusion, ‘muddledness’, sudden worsening of confusion in someone with previous dementia or known memory loss
  • Incontinence i.e. change in continence, new onset or worsening of urine or faecal incontinence
  • Susceptibility to side effects of medication i.e. confusion with codeine, hypotension with antidepressants
54
Q

What are older people with frailty more susceptible to

A

Are at increased risk of adverse outcomes including disability, hospitalisation, nursing home admission and mortality. Appropriate interventions can reduce this

Medicine year 3- EOCP (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions