Background Pathophysiology Reduced mass of structurally normal bone. Involves trabecular bone loss and cortical thinning. Primary (age-related) or secondary to disease or drugs. Actually  reduces  the risk of osteoarthritis. Osteopenia is a milder form. Epidemiology Lifetime risk of osteoporotic fracture: 1 in 3 women. 1 in 5 men. Signs and symptoms Fragility fractures: Fractures resulting from a low energy mechanism of injury that should not have cause a fracture in a healthy bone. In addition to osteoporosis, they may suggest underlying tumour (mets or a primary), or Paget's disease. Common sites: spine (vertebrae), hip (proximal femur), and wrist (distal radius). May also occur in arm (humerus), pelvis, or ribs. Vertebral fractures: Aka vertebral collapse, compression fracture. Often affects multiple vertebrae. Leads to back pain and height reduction. Causes thoracic kyphosis, leading to SOB, abdominal bulging due to loss of space under ribs, and neck pain. Neurological complica

Background Definition Non-progressive lesion of motor pathways in brain, presenting in infancy (<2 years). Causes a disorder of movement and posture – a motor developmental delay – and may affect other developmental domains – a global developmental delay. Causes and risk factors In-utero (80%): vascular occlusion, cortical malformation, maternal infection, prematurity, low birth weight. Birth (10%): hypoxic injury. Neonatal (10%): infection, kernicterus. Sub-types 3 sub-types, though can be mixed: Spastic CP (80%): may have initial hypotonia, then spastic hemiplegia, quadriplegia, or diplegia (usually in legs). Ataxic hypotonic CP: initial hypotonia, then incoordination, intention tremor, and ataxic gait. Dyskinetic CP: chorea, athetosis. Signs and symptoms General: Neonate with abnormal tone or posture. Persistent primitive reflexes. Missed motor milestones. Hyper-reflexia. Legs: Abnormal gait. Tiptoe walking. Leg scissoring. Hands: Asymmetric hand function under 12 months. Hand fi

Background Benign prostatic enlargement (BPE) Musculofibrous and glandular proliferation, leading to inner ('transitional') zone enlargement. Common cause of bladder outlet obstruction. Aka benign prostatic hypertrophy. Prostate cancer (PCa) Adenocarcinoma leading to peripheral enlargement. 1 in 8 lifetime risk. Can metastasize via lymphatics to seminal vesicles, bladder, and rectum, and via bloodstream to bone. Signs and symptoms Symptoms of prostate enlargement: Irritative (storage) bladder symptoms: frequency, urgency and incontinence, nocturia, dysuria. Obstructive (voiding) bladder symptoms: ↓stream (size and force), hesitancy and interruption, terminal dribbling, retention, overflow incontinence, bladder pain. Can lead to UTI, kidney impairment, or stones. These two symptom groups are collectively known as lower urinary tract symptoms (LUTS). Symptoms suggesting PCa as opposed to BPE: Haematuria, hematospermia. Perineal and suprapubic pain. Tenesmus Loin pain from ureteri

 Pathophysiology and epidemiology Dopamine theory: Overactive dopamine system, especially in the mesolimbic area, causes the positive symptoms of schizophrenia. Associated brain changes: Larger lateral ventricles. Reduced volume of the frontal lobe, parahippocampal gyrus, hippocampus, temporal lobe, and/or amygdala. None of these changes are especially sensitive or specific. Epidemiology: 0.5% lifetime risk. Presentation Signs and symptoms Positive symptoms: Hallucinations: commonly auditory. Usually in the 3rd person but can be 2nd person. May include thought echo, running commentary, or overheard conversations. Delusions: persecutory, reference, interference, passivity. Thought disorder: derailment, poverty, circumstantiality, perseveration, blocking. Negative symptoms: Apathy Self-neglect Paucity of speech. Social withdrawal. Emotional blunting. Anhedonia First-rank symptoms: A group of symptoms which are common and easy to identify. Individually not very sensitive, but all fairly s

Background   Definition and epidemiology Heart fails to provide adequate blood flow to meet body's needs. Chronic disease with intermittent decompensations (acute HF), and eventually terminal. The term 'congestive heart failure' is ill-defined, but typically refers to HF with fluid overload, especially pulmonary oedema. Prevalence: 1/70. Left ventricular failure (LVF) Heart failure with reduced ejection fraction (HFrEF) Overview: Left ventricular ejection fraction (EF) <40%. A normal EF is ≥50%, with 40-49% a 'mid-range' grey area. Also known as systolic heart failure or left ventricular systolic dysfunction (LVSD). Causes: IHD/MI: commonest cause. HTN Diabetes, usually via IHD. Dilated cardiomyopathy. Valve disease. Arrhythmias Drugs or alcohol. Heart failure with preserved ejection fraction (HFpEF) Overview: LV relaxation failure → inadequate filling → ↓stroke volume despite normal EF (≥50%). Also known as diastolic heart failure. Causes: HTN: commonest cause.