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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