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ACMSEducate UKMLA Lecture Series (ACMS Secretary)aConditions Endocrine Musculoskeletal 01 Diabetes Mellitus Type 1 02 Osteoporosis Diabetes Mellitus Type 2 Infectious Diseases 03 MeningitisStructure of Lecture A Pathophysiology Why does this disease occur B Signs/Symptoms How does this disease present C Investigations How do we diagnose it Management D How do we manage the disease 01a Diabetes Mellitus Type 1 (Endocrine)Diabetes Mellitus Type 1 - Pathophysiology Autoimmune destruction of pancreatic beta cells.Insulin deficiency leads to impaired glucose uptake by cells. Risk Factors Genetic predisposition. Vitamin D Exposure Viral infections - Enteroviruses Diabetes Mellitus Type 1 - Signs/Symptoms ● Polydipsia (Excessive Thirst) ● Weight ● Polyuria Loss (Excessive Urination)Diabetes Mellitus Type 1 - Investigations If SYMPTOMATIC, one of the following results is sufficient for diagnosis: Random blood glucose (Taken randomly) ≥ 11.1mmol/l or Fasting plasma glucose (After fasting 8-12 hours)≥ 7mmol/l 2-hour glucose tolerance (Taken 2 hours after ingesting glucose solution) ≥ 11.1mmol/l HbA1C (Amount of Glucose on Hb) ≥ 48mmol/mol (6.5%) If the patient is ASYMPTOMATIC, two results are required from different daysDiabetes Mellitus Type 1 - Management Pharmacological ● Insulin Therapy ● Blood Pressure Control ● Hypoglycemia Management Lifestyle ● Blood Glucose Monitoring ● Regular Follow-Up ● Psychosocial Support ● Exercise ● Healthy Diet ● Smoking Cessation 01b Diabetes Mellitus Type 2 (Endocrine)Diabetes Mellitus Type 2 - Pathophysiology A chronic metabolic condition characterized by inadequate insulin production from pancreatic beta cells, resulting in insulin resistance. This leads to an elevation in blood glucose levels, causing hyperglycemia.Diabetes Mellitus Type 2 - Signs/Symptoms Individuals with T2DM may initially be asymptomatic, but over time, they may develop: ● Polyuria ● Polydipsia ● Unexplained weight loss ● Blurry vision ● FatigueDiabetes Mellitus Type 2 - Investigations If symptomatic, one of the following results is sufficient for diagnosis: ● Random blood glucose ≥ 11.1mmol/l ● Fasting plasma glucose ≥ 7mmol/l ● 2-hour glucose tolerance ≥ 11.1mmol/l ● HbA1C ≥ 48mmol/mol (6.5%) If the patient is asymptomatic, two results are required from different days.Diabetes Mellitus Type 2 - Management Pharmacological Intervention Medication Types ● SGLT-2 Inhibitors (-flozins) => Lowers blood sugar by blocking reabsorption of glucose e.g Dapagliflozin ● DPP-4 Inhibitors (-gliptins) => Blocks DPP4 which destroys Incretin (Helps produce insulin) -> Increased incretin -> Increased Insulin e.g Sitagliptin ● Sulphonylureas (-zides) => Stimulate pancreatic beta cells to release insulin e.g Gliclazide ● Thiazolidinediones (-zones) => Decrease Insulin resistance e.g Pioglitazone ● Metformin => Inhibit hepatic gluconeogenesis & oppose action of glucagonDiabetes Mellitus Type 2 - Management Pharmacological Intervention First Line Therapy => MetforminDiabetes Mellitus Type 2 - Management Blood Pressure targets in Diabetes Blood pressure control needs to be strict in diabetes because these patients are at higher risk of macro- and microvascular complications. NICE Hypertension Guidance sets the same blood pressure targets as those who do not have diabetes below 140/90 mmHg , however in diabetics with Hypertension, ACE-inhibitors are first line as they are reno-protective OR ARB if patient has a black African or African-Caribbean family originDiabetes - Complications Macrovascular ● Cardiac Complications (Congestive HF,Diabetic Cardiomyopathy) ● PAD (Peripheral Artery Disease) ● Cerebrovascular Disease Microvascular ● Diabetic Retinopathy - Complications in the eyes due to diabetes ● Diabetic Neuropathy - Nerve damage that occurs due to diabetes ● Gastrointestinal Complications - GERD , Gastroparesis,NAFLD ,Enteropathy ● Foot Complications - Gout ● Sexual Dysfunction 02 Osteoporosis (Musculoskeletal)Osteoporosis - Pathophysiology Loss of bone density and microarchitectural deterioration => Leading to increase bone fragility and a consequent increase in fracture riskOsteoporosis - Signs/Symptoms ● Back pain, (Caused by a fractured or collapsed vertebra) ● Loss of height over time ● A stooped posture ● Bone Fractures (Occurs much more easily than expected)Osteoporosis - Investigations Gold Standard Investigation ● DEXA scan with a T-score of -2.5 or lower indicating osteoporosisOsteoporosis - Investigations Other Investigations ● X-rays - For suspected fractures ● MRI of the spine - Assessment of vertebral fractures ● Blood tests - To exclude metabolic bone diseases and assess - Vitamin D - Calcium - Hormone levelsOsteoporosis - Investigations FRAX Score The FRAX (Fracture Risk Assessment Tool) score is used to estimate the 10-year probability of a major osteoporotic fracture. Interpretation of FRAX scores: Normal: 10-year probability <10% Osteopenia (low bone density): 10-year probability 10-20% Osteoporosis: 10-year probability >20%Osteoporosis - Lifestyle Management Management of osteoporosis involves lifestyle modifications and pharmacological treatment. Lifestyle modifications: Reducing risk factors - Smoking Cessation - Diabetic Control Ensuring adequate intake of 1.Vitamin D 2.Calcium 3.Protein Regular weight-bearing exercise - Use of hip protectors in nursing home patientsOsteoporosis - Pharmacological Management Pharmacological treatment includes: Bisphosphonates First-line treatment for osteoporosis. For individuals with - Fragility fracture - T-score of -2.5 or lower or a T-score between -1 and -2.5 with a 10-year probability of a major osteoporotic fracture of 20% or higher or a hip fracture probability of 3% or higher based on the FRAX score.Osteoporosis - Bisphosphonates Side effects ● Gastrointestinal symptoms (e.g. dyspepsia, oesophagitis) ● Musculoskeletal pain ● Osteonecrosis (Loss of blood supply to bone) of the jaw and atypical femoral fractures (RARE) 03 Meningitis (Infectious Disease)Meningitis - Pathophysiology Meningitis is an inflammation of the meninges Layers of Meninges ● Dura Mater ● Arachnoid Mater ● Pia MaterMeningitis - Sign/Symptoms ● Headache ● Fever ● Neck stiffness ● Photophobia ● Nausea and vomiting ● Focal neurology ● Seizures ● Reduced conscious level ● Non-Blanching petechial rash Meningitis - Investigations Both are used to test for meningeal irritation Kernig’s Sign Brudzinski Sign Pain and/or Resistance to knee flexion Involuntary knee and hip flexion in => POSITIVE Kernig’s Sign response to neck flexion => POSITIVE Brudzinski SignMeningitis - Investigations Diagnostic investigations for suspected meningitis include: - Blood tests - FBC,U&Es, Clotting, Glucose - ABG - Blood cultures - Imaging: CT Head - Lumbar puncture for Cerebrospinal Fluid (CSF) analysisMeningitis - Management 2g of IV ceftriaxone twice daily - to ensure CNS penetration IV amoxicillin (Contains Penicillin) - added in patients at age extremes for listeria* coverage. *Listeria is a bacteria and is also a common cause of meningitis in Neonates and the elderly In cases of suspected viral encephalitis (Brain inflammation) - IV Aciclovir should also be administered. Patients allergic to penicillin => Chloramphenicol administered instead THANKS FOR LISTENING !! CREDITS: This presentation template was created by Slidesgo, including icons by Flaticon and infographics & images by Freepik