QuestionSBA
QuestionChoice
This is an incorrect option. This patient is agitated, has been aggressive towards staff and conservative managements to control his behaviour have failed.  'Sun-downing' refers to the phenomenon of patients with delirium experiencing worsening of their symptoms at night. Pharmacological management is indicated, no intervention could lead to further harm to members of staff, other patients or the patient himself.
50308
e
No intervention required as this is likely 'sun-downing'
QuestionChoice
Efforts to re-orientate this gentleman have already failed and he has been aggressive to staff. Pharmacological intervention is indicated.
50305
b
Continue to try and re-orientate him, no pharmacological management required
QuestionChoice
Conservative efforts to calm this patient down have failed, it is therefore indicated to prescribe a pharmacological agent that treats his agitation. In this case the gentleman has Parkinson's disease which means haloperidol should NOT be prescribed. In its place lorazepam 1mg PO OD should be prescribed as it does NOT actively block dopamine receptors like haloperidol does.
50304
a
Prescribe lorazepam 1mg PO OD
QuestionChoice
You should NEVER prescribe haloperidol to a patient with Parkinson's disease. Haloperidol blocks dopamine receptors in the corpus striatum and in turn can seriously worsen pre-existing Parkinson's disease.
50306
c
Prescribe haloperidol 10mg IM STAT
QuestionChoice
This would be correct if it was likely infection was driving this patient's delirious state however there is no evidence within the stem of this question indicating that this patient has an infection.
50307
d
Prescribe IV broad spectrum antibiotics and monitor observations, WCC and CRP
QuestionComment
is there a section for delirium in BNF 
17309
User
subscriber
SOB
QuestionComment
oh yeah, because i'm sure he's going to comply and actually swallow the meds. -_-
39760
User
subscriber
aaaaa
QuestionComment
is efforts to calming him down the same as re-orientating?
61066
QuestionComment
Yup
61649
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subscriber
Serotonin Occipital
User
subscriber
Ortho bro
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3644
IM lorazepam prescription in agitated/delirious patients with a history of Parkinson's disease
Topic
129
Elderly medicine
10115
Case Presentation: A 78 year old man is currently an inpatient on the elderly care ward. The nursing staff are worried due to him exhibiting aggressive behaviour, he has struck one of the HCAs trying to assist him. Efforts to calm him down verbally have failed.

**PH** Parkinson's disease, hypertension, hypercholesterolaemia

**DH** Co-beneldopa 200mg PO BD, ramipril 5mg PO OD, atorvastatin 40mg PO OD. NKDA

**On examination**
Temperature 37.2°C, HR 84, RR 16, BP 134/82, O2 97% RA.

**Investigations**

Bloods:

- FBC: Hb 138, WCC 7.8, Plts 283 x 10^9
- CRP 3
- U&Es: Na 143, K 4.7, Ur 6.0, Cr 103 (baseline 100), eGFR >90mL/min/1.73m<sup>2</sup>
- Ca2+ (adjusted): 2.3
- Mg2+: 0.9
- Phosphate: 0.83
- LFTs: ALP 36, ALT 28, bilirubin 18
- TFTs: TSH 1.2, T4 12, T3 7
- Vitamin B12: 488 pg/ml

MSU: no organisms detected.

Chest X-ray: no abnormalities detected.

Question: Select the most appropriate management at this stage.
a