Selected Concepts from Lecture Notes on Cognitive Decline, Respiratory & Inflammatory Issues, and Fracture Types

Neurocognitive Disorders

• Short-term memory loss
  • First & most prominent cognitive deficit reported in progressive dementias.
  • Reflects hippocampal/entorhinal cortex pathology → impaired consolidation of new information.
• Alzheimer’s disease (AD)
  • Most common cause of dementia in older adults.
  • Hallmark clinical picture (all apply in the vignette):
    • Progressive anterograde amnesia (recent-event loss, repetitive questioning, misplacing objects).
    • Word-finding (anomic) difficulties ➔ early language disturbance.
    • Visuospatial & executive dysfunction appear later.
  • Neuropsychology: Mini-Mental State Examination (MMSE) typically <24/30; patient vignette shows 20/30.
  • Pathology: extracellular \beta-amyloid plaques, intracellular hyper-phosphorylated tau (neurofibrillary tangles).
  • Risk increases with age, family history (APOE-\varepsilon4), cardiovascular disease.

Respiratory—Pneumothorax Basics

• Pneumothorax = presence of air in pleural space → loss of negative intrapleural pressure.
• “Best explanation to a patient”:
  • “Air has leaked into the space between your lung and chest cavity (pleural space), causing the lung (or part of it) to collapse.”
• Relevant anatomy
  • Chest cavity bounded by ribs, diaphragm, mediastinum.
  • Visceral & parietal pleura form airtight potential space.
• Types
  • Spontaneous (primary vs second­ary), traumatic, iatrogenic, tension.
• Small airway rupture is key mechanism in primary spontaneous disease (bleb/bullae rupture).

Geriatric Immunology & Wound Healing

• Older adults exhibit impaired inflammation & delayed wound healing.
  • Problem: dysfunctional mast-cell degranulation & migration/chemotaxis of neutrophils/macrophages.
  • Consequences: ↓ cytokine release, ↓ vasodilation, ↓ leukocyte recruitment.
• Compounded by chronic illnesses (e.g., diabetes) & malnutrition.
• Clinical care: meticulous skin care, pressure-injury prevention, aggressive infection surveillance.

Bone Fracture Patterns

• Incomplete fracture
  • Bone is cracked but not all the way through.


• Greenstick fracture
  • Pediatric, one cortex broken while opposite side bends; bone damaged yet still in one piece.


• Spiral fracture
  • Fracture line encircles shaft (from torsional force); usually complete through both cortices.


• Comparison chart
  

• Any new cognitive decline warrants reversible-cause screen (TSH, B12, depression, medications) even if AD suspected.
• Sudden chest pain + dyspnea with hyperresonance = think pneumothorax; needle decompression if tension (mid-clavicular 2nd ICS).
• Elderly surgical patients ➔ delayed wound closure; optimize protein (1.2–1.5 g/kg/day) & control glucose (goal 140\text{–}180 mg/dL).
• Pediatric fracture descriptors: bowing, torus (buckle), greenstick—distinct from complete patterns seen in adults.