Answers Anonymous7/12/15

Aaqid Akram MBChB (2013)Liberty-Breeze Heskeymee-Preston

Agenda

1. What is the difference between osteoporosis and osteomalacia?2. How do you clinically differentiate DVT from cellulitis?3. Conn’s syndrome – How does it cause polyuria and hypertension? 4. Management of acute respiratory conditions

Normal 1 SD

Osteopenia 2.5 SD

Osteoporosis >2.5 SD

Osteoporosis

• Progressive systemic skeletal disease• Reduced mass – low bone mineral density – normal mineral:matrix• Bone more fragile + susceptible to fractures• Increased risk• Age• Female• Steroids (3 months)• Low BMI• Alcohol / smoking

• Normal enough bone, just not enough of it!

Osteomalacia

• Inadequate mineralisation of bone matrix• Severe vitamin D deficiency• Found in diet (oily fish, liver, egg yolk, fortified breakfast cereals)• Precursor in skin following exposure to UV light (90%)• GI malabsorption / Liver disease / Kidney disease / anticonvulsants• Hydroxylation: liver + kidneys 1,25 dihydroxyvitamin D3• Required for calcium absorption• 20-30 mins of exposure to face and forearms 3 times a week (Caucasian)

• Pain + proximal muscle weakness• Soft bone – reduced mineral:matrix

DVT vs Cellulitis

• Very similar signs and symptoms• Severe DVT may mimic cellulitis / may occur simultaneously• Cellulitis

• Smaller area affected, but more pronounced features• Well defined margins• May see entry point• Fever

• DVT• Deep vein distribution • Well’s Score – Cancer / reduced mobility / calf size / previous DVT

• Differentiating tests: FBC / USS / (NOT D-DIMER)

The Adrenal Gland

Zona Glomerulo

sa

• Mineralocorticoids• Aldosterone

Zona Fasciculat

a

• Glucocorticoids• Cortisol

Zona Reticularis

• Androgens / Oestrogens• Testosterone / DHEA (Oestrogen precursor)

Medulla

• Catecholamines• Adrenaline / noradrenaline

Aldosterone

• Angiotensin II / Extracellular K+ / ACTH• Distal convoluted tubule / collecting duct

• Reabsorbs Na+ • Excretes K+ / H+

• Hyperaldosteronism• Hypertension• Hypokalaemia

• Downregulation of aquaporins in collecting duct• Unable to concentrate urine

• Loss of hydrogen ions• Metabolic alkalosis

• 1o = Adenoma (Conn’s) / hyperplasia• 2o = Renin angiotensin aldosterone (RAA) overactivity

Cortisol

• ACTH (Ant. Pituitary)• Increases metabolism• Releases amino acids + lipolysis

• Gluconeogenesis• Inhibits glucose uptake by cells

• Raises blood glucose levels• Increases cardiac muscle contractions• Water retention• Anti inflammatory / anti allergenic effects (Immunosuppression)

• Hyperadrenalism • Cushing’s syndrome (Cushing’s disease = pituitary adenoma)

Adrenal Insufficiency

• May affect cortisol and aldosterone release• 1o = adrenal gland dysfunction• 2o = pituitary dysfunction• Tumour• Congenital adrenal hyperplasia• Autoimmune• May lead to adrenal crisis • Inability to release cortisol in response to stress• Hypotension and shock

Management of acute respiratory conditions