1. 7/12/15 Aaqid Akram MBChB (2013) Liberty-Breeze Heskeymee-Preston
Answers Anonymous
7/12/15
Aaqid Akram MBChB (2013)
Liberty-Breeze Heskeymee-Preston

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

3. 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!
Normal SD
Osteopenia 2.5 SD
Osteoporosis >2.5 SD
Require DEXA scan of hip and dependent on standard deviations below the young adult reference mean.
Imbalance between osteoclasts and osteoblasts working.

4. 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
Loss of skeletal mass caused by inadequate mineralisation of the normal osteoid tissue after the closure of the growth plates. Rickett’s is the same process before closure of growth plates.

5. 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)
Don’t forget about baker’s cyst: herniation of synovial membrane of knee joint

6. The Adrenal Gland Mineralocorticoids Aldosterone Glucocorticoids
Zona Glomerulosa
Mineralocorticoids
Aldosterone
Zona Fasciculata
Glucocorticoids
Cortisol
Zona Reticularis
Androgens / Oestrogens
Testosterone / DHEA (Oestrogen precursor)
Medulla
Catecholamines
Adrenaline / noradrenaline
DHEA = didehydroepandidrosterone

7. 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

9. Cortisol ACTH (Ant. Pituitary) Increases metabolism Hyperadrenalism
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)

10. 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

11. Management of acute respiratory conditions
Now to Liberty Breeze to tell you about respiratoy conditions. Please only provide feedback for Liberty Breeze on the feedback for sessions part.