General Medicine

Infectious Diseases Long Essays

Question 1. What is the differential diagnosis of ulcers over the penis? How do you treat syphilis?

Answer:

Differential Diagnosis of Ulcers Over Penis:

• Chancre
• Chancroid
• lymphogranuloma venereum
• Genital herpes
• Neoplasm

Syphilis:

• It is a sexually transmitted disease

Syphilis Clinical Features:

1. Primary syphilis
   • Incubation period- about 21 days
   • Chancre develops
   • It is a solitary, painless, indurated, non-tendered, ulcerated, or eroded lesion
   • Initial,ly it was a dull red macule
   • Later it becomes ulcerated
   • Regional lymphadenopathy
2. Secondary syphilis
   • Appears about 6-8 weeks
   • Skin lesions appear as macules, papules, fol-locules, or, papulosquamous patches
   • Circinate lesions develop on the face
   • Headache
   • Fever, anorexia
   • Joint and muscle pain
   • Laryngitis, pharyngitis
   • Generalised lymphadenopathy
   • Lesions develop over the mucocutaneous junction
3. Tertiary syphilis
   • Develops about 5-10 years after primary infection
   • Affects the skin, central nervous system, CVS, mucous membrane
   • Lesions are called gumma
   • It is localized, chronic granulomatous lesion with a nodular or ulcerated surface
   • Causes generalized paresis, dementia, and strokes
   • Bone lesions cause osteomyelitis and destruction of joints

Syphilis Treatment:

Question 2. Describe clinical features, diagnosis, complications, and management of typhoid fever.
(or)
Discuss the etiology, clinical features, complications, and management of enteric fever.

Answer:

Typhoid Or Enteric Fever:

• It is an acute systemic illness

Etiology:

• Salmonella typhi
• Salmonella paratyphi

Enteric Fever Clinical Features:

• Incubation period- 10-14 days

1. First 5-7 days
   • High-grade, remittent fever with chills
   • Headache
   • Aches
   • Malaise
   • Constipation
   • Leucopenia
   • Dry cough
   • Epistaxis
   • Relative bradycardia
2. Between 1st and 2nd week
   • Rose spots develop over the trunk as small macules, red in color, and blanch on pressure
   • Splenomegaly
   • Bronchitis
   • Abdominal pain
   • Abdominal distension
   • Diarrhea
3. After 2nd week
   • Confusion
   • Delirium
   • Toxaemia
   • Coma

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Enteric Fever Diagnosis:

Enteric Fever Complications:

1. Intestinal complications
   • Hemorrhage
   • Paralytic ileus
   • Perforation
   • Peritonitis
2. Extraintestinal complication
   • Meningitis
   • Cholecystitis
   • Pneumonia
   • Myocarditis
   • Bone and joint infection
   • Encephalopathy
   • Granulomatous hepatitis
   • Nephritis

Enteric Fever Management

Question 3. Describe the etiology, pathology, clinical features, and management of cervical TB lymphadenitis.

Answer:

Tuberculous Lymphadenitis:

• It is defined as achronic specific granulomatous inflammation with caseation necrosis of the lymph node

Etiology:

• Mycobacterium tuberculosis complex which includes M. tuberculosis, M. bovis, M. africanum, M. canetti, and M.caprae

Pathology:

• Pathological stages of the disease are:

1. Stage 1- lymphoid hyperplasia
   • Formation of tubercles and granulomas occurs without cassation necrosis
2. Stages 2 and 3
   • Caseation necrosis in the affected lymph nodes occurs
   • It is followed by the destruction of capsules of lymph nodes
   • Periadenitis
3. Stage 4
   • There is a rupture of caseous material into the surrounding soft tissue
   • Formation of abscess cavity

Tuberculous Lymphadenitis Clinical Features:

• Persistent, painless swelling of the lymph nodes
• Release of discharge of fluid
• Fever
• Weight loss
• Fatigue
• Night sweats

tuberculous LymphadenitisManagement:

1. Anti-tubercular therapy
   • Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol are given for 2 months
   • Followed by Isoniazid and Rifampicin for the next 4 months
2. DOTS therapy
3. Surgery- indicated in
   • Persistent fluctuant lesions
   • Failure with chemotherapy
   • Symptomatic relief

Question 4. Describe the etiology, clinical features, and management of intestinal amoebiasis.

Answer:

Intestinal amoebiasis

Caused by entamoeba histolytic

• E. histolytica can cause two types of pathological lesions as follows

1. Primary (or) Intestinal Amoebiasis:

• This condition is called amoebic dysentery.
• These ulcers may be generalized (or) may be localized to the ileocaecal (or) sigmoidorectal region.
• Occasionally ulcers may involve deeper tissues and cause perforation (or) peritonitis.
• Erosion of blood vessels may lead to bleeding.
• The superficial lesions generally heal without scarring.
• Deep ulcers form scars leading to strictures, partial obstruction, and thickening of the gut wall.

2. Extra-intestinal amoebiasis (or) secondary (or) metastatic lesions.

• Amoebic liver abscess:

Question 5. Diphtheria-etiology, Clinical FeatuManagementtntA

Answer:

Etiology:

• It is caused by Corynebacterium diphtheria

Diphtheria-etiology Clinical Features:

• It is insidious at the onset
• Moderate grade fever
• Tachycardia
• Sore throat
• Formation of greyish-greenish pseudomembrane on the tonsils
• Swollen neck- Bull neck
• Tender lymphadenopathy
• Nasal infection
• Hoarseness of voice
• Cough
• Respiratory obstruction
• Acute circulatory failure
• Myocarditis
• Nerve palsies
• Dysphagia
• Dysphonia
• Paraesthesia in the limbs

Diphtheria-Etiology Management:

1. Antitoxin diphtheric serum (ADS)
   • The dose varies from 20,000 to 1,00,000 units depending on the duration and severity of the disease
   • In mild cases, a lesser dose may be used
2. Antibiotics
   • Penicillin G-6,00,000 units every 12 hourly intravenously or
   • Amoxycillin 500 mg 8 hourly for 7-10 days
   • Patient allergic to penicillin
     • Erythromycin- 500 mg 6 hoourly or
     • Azithromycin 500 mg daily or
     • Rifampicin 600 mg daily
3. Tracheostomy

Question 1. Oral manifestations of diphtheria

Answer:

Oral manifestations of diphtheria

• Diphtheria is an infectious disease caused by Corynebacterium Diphtheriae
• It is characterized by local exudative inflammation of the upper respiratory tract and usually with the formation of pseudomembrane at the level of the nasopharynx
• Oral manifestations
  • • Sore throat
      • Formation of thick, fibrinous, greyish-green pseudomembrane on tonsils, larynx, pharynx
        • Exudation in tonsillar area
        • Hoarseness of voice
        • Paralysis of the soft palate
        • Dysphagia
        • Dysphonia
        • Cervical Lymphadenopathy

Question 2. NSAIDs

Answer:

NSAIDs Classification

Question 3. Oral manifestations of AIDS

Answer:

Oral manifestations of AIDS

1. Bacterial infections
   • Tuberculosis
   • M. avium complex
   • Salmonellosis
2. Viral infection
   • Herpes simplex
   • Varicella zoster
   • Epstein Barr virus
3. Mycotic infections
   • Pneumocystis pneumonia
   • Candidiasis
   • Aspergillosis
   • Cryptococcosis
4. Parasitic infection
   • Toxoplasmosis
   • Cryptosporidiosis
5. Malignancies
   • Kaposi’s sarcoma
   • B cell lymphoma

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Question 4. Human immunodeficiency virus (HIV)- post-exposure prophylaxis

Answer:

Human immunodeficiency virus (HIV)- post-exposure prophylaxis

• Following exposure, postexposure prophylaxis may be required depending upon the category of exposure and HIV status of the exposure source
• Drugs used are:

1. Zidovudine 300 mg BD
2. Lamivudine 150 mg BD
3. Protease inhibitors
   • Lopinavir 400 mg BD or 800 md OD
   • Ritonovir 100 mg BD or 200 mg OD
     • Drugs are started within the first 72 hours
     • It should be continued for 4 weeks
     • The injured site on the wound should be thoroughly washed with soap and water
     • Antiseptics are also used

Question 5. Gonorrhoea

Answer:

Gonorrhoea Definition:

• It is a communicable sexually transmitted disease of humans

Etiology:

• It is caused by Neisseria gonorrhoea

Gonorrhoea Clinical Features:

1. In males
   • Dysuria
   • Increased frequency of micturition
   • Purulent discharge per urethra
   • Oedema of penis
   • Erythema of urethral meatus with purulent discharge
2. In females
   • Dysuria
   • Vaginal discharge
   • Abnormal menstrual bleeding
   • Rectal discomfort
3. In homosexuals
   • Asymptomatic
4. In children
   • Conjunctivae
   • Involvement of pharynx or respiratory tract

Gonorrhoea Complications:

• Acute epididymitis
• Prostatitis
• Periuretheral abscess or fistula
• Salpingitis
• Barthorlin’s abscess
• Premature birth
• Arthritis
• Bacteraemia
• Perihepatitis

Gonorrhoea Treatment:

1. For uncomplicated gonorrhea
   • 2.4 g of procaine penicillin IM + 1 g of oral probenecid or
   • Oral amoxicillin 2-3 g + Oral probenecid 1 g or
   • Cotrimoxazole (400+80 mg) 8 tablets orally
2. In penicillin-resistant gonorrhea
   • Ciprofloxacin-250-500 mg orally single dose or
   • Cefotaxime- 0.5-1 g IM as single dose or
   • Cefixime- 400 mg orally as a single dose or
   • Ceftriaxone-250 mg IM as single dose
3. In gonorrhea with complications
   • Aqueous crystalline penicillin G-10 million units 4 daily for 5 days
   • Ciprofloxacin 500 mg twice daily for 5 days
   • Ceftriaxone 1 g 4 daily for 5 days

Question 6. Chickenpox

Answer:

Chickenpox

• Chickenpox is caused by Varicella zoster virus
• It rarely occurs a second time
• The virus enters the mucosa of the upper respiratory tract and spreads by droplets from the throat

Chickenpox Clinical Features:

• It involves young children and adults
• The incubation period is 14-21 days
• Malaise
• Low-grade fever followed by a rash
• Rash is macula papular
• Heals by scabs formation

Chickenpox Sites Involved:

• Skin lesions- over trunk and face then spread to peripheral parts of the body
• Mucosal lesions- affects the mucosa of the pharynx and vagina

Chickenpox Complications:

• Superinfection of skin due to frequent scratching
• Encephalitis
• Cerebellar ataxia
• Myocarditis
• Osteomyelitis
• Septic arthritis
• Septicaemia
• Hepatitis
• Pneumonia

Question 7. Herpes simplex

Answer:

Herpes simplex

• It is a DNA virus o It belongs to the herpesviridae family.
• Man is the only natural host.
• Herpes simplex virus has two types as follows.

1. Herpes simplex type 1 – is usually associated with oral and ocular lesions.
2. Herpes simplex type 2 – is usually associated with genital infections.
   • Lesions caused by herpes simplex depend on the site of infection, age, and immune status of the individual as follows:
   • Cutaneous infections: These include:
     • Fever
     • Blisters on the cheeks, chins around the mouth, (or) on the forehand
     • Napkin rash on the buttocks of children, – Herpetic with low in medical professionals.
   • Eczema herpeticum:
     • The generalized herpetic eruption is seen in children suffering from eczema.
   • Mucosal lesions:
     • Acute gingivostomatitis
     • Recurrent herpes labialis.
   • Ophthalmic lesions:
     • Keratoconjunctivitis
     • Follicular conjunctivitis.
   • Visceral lesions:
   • Nervous system:
     • HSV meningitis,
     • Sacral autonomic dysfunction.
   • Genital lesions:
     • Infection of cervix, vagina, vulva (females)
3. Congenital lesions:
   • Subclinical or localized infection of skin mouth or eyes.
   • Besides primary infections, herpes viruses may present as latent infection, reactivation, and recrudescence.

Question 8. Herpes labialis

Answer:

Herpes labialis

• It occurs in patients with no prior infection with Herpes Simplex Virus-1

Herpes labialis Clinical Features:

• Age- children and young adults
• Incubation period-5-7 days

1. Prodromal generalized symptoms
   • Fever
   • Malaise
   • Headache
   • Nausea, vomiting
   • Painful mouth
   • Sore throat
   • Irritability
   • Excessive drooling of saliva
   • Lack of tactile sensation
   • Cervical lymphadenopathy
2. Later symptoms
   • Numerous vesicle formations over keratinized mucosa
   • Vesicles are thin-walled
   • They contain clear fluid
   • They rupture leaving multiple, small, punctuate shallow painful ulcers of 2-6 mm
   • Ulcers are surrounded by a red ring of inflammation
   • Ulcers may become secondarily infected
   • Healing starts in about 3 days and is completed within 7-14 days

Herpes labialis Treatment:

• To prevent secondary infection- antibiotics are used
• To control fever- Antipyretics are given

Question 9. Mumps

Answer:

Mumps

• Mumps is an acute viral infectious disease characterized by unilateral (or) bilateral nonsuppurative enlargement of the salivary glands usually the parotid gland.
• Submandibular and sublingual glands are occasionally involved.
• Usually, children are affected. May also occur in adults.
• Also known as epidemic parotitis

Mumps Causative organism:

• Organisms involved in paramyxovirus.

Mumps Route of infection:

• Infection is acquired by inhalation (or) direct contact or through the conjunctiva.
• The incubation period is 12 – 18 days.

Mumps Clinical Features:

• Unilateral (or) bilateral swelling of parotid glands.
• Fever, malaise
• Local pain and tender
• Involvement of extra parotid sites can cause more serious problems as follows.
  • CNS involvement may lead to
    • Meningitis,
    • Meningoencephalitis
    • Orchitis

Mumps Complications:

• Orchitis
• Oophoritis
• Arthritis
• Nephritis
• Pancreatitis
• Thyroiditis and myocarditis

Mumps Laboratory Diagnosis:

• Isolation of viruses from CSF, saline (or) urine.
• Serological tests with paired serum samples tested for the rise in the titer of antibodies by complement fixation test, ELISA, and haemagglutination tests.
• Serum amylase levare els elevated in both parotitis and acute pancreatitis.

Mumps Treatment:

• Treatment is conservative maintaining hydration. Prevention is using MMR vaccine

Question 10. Diphtheria

Answer:

Diphtheria Clinical Features:

• It is insidious at the onset
• Moderate grade fever
• Tachycardia
• Sore throat
• Formation of greyish-greenish pseudomembrane on the tonsils
• Swollen neck- Bull neck
• Tender lymphadenopathy
• Nasal infection
• Hoarseness of voice
• Cough
• Respiratory obstruction
• Acute circulatory failure
• Myocarditis
• Nerve palsies
• Dysphagia
• Dysphonia
• Paraesthesia in the limbs

Diphtheria Management:

1. Antitoxin diphtheric serum (ADS)

• The dose varies from 20,000 to 1,00,000 units depending on {ho duration and severity of the disease
• In mild cases, a lesser dose may be used

2. Antibiotics

• Penicillin G-o.00,000 units every 12 hourly intravenously or
• Amoxycillin 500 mg S hourly for 7-10 days
• Patient allergic to penicillin
  • Erythromycin- 500 mg 6 hourly or
  • Azithromycin 500 mg daily or
  • Riftamoicin 600 mg daily

3. Tradieostomy

Question 11. Three malarial parasites

Answer:

Three malarial parasites

• Malaria is a disease caused by four plasmodium speeds which are as follows:

1. P. vivax
2. P. Falciparum
3. P. Malaria
4. P. Ovale.

Question 12. Widal test

Answer:

Widal test

• It is an agglutination test for detection of agglutinin H and O in patients with enteric fever

Widal test Procedure:

• Mix equal volumes of serial dilutions of the serum and H and O antigens
• Incubate in a water bath at 37 degrees C for 4 hours
• Read after overnight refrigeration at 4 degrees C

Widal test Result:

• A Titre upto 160 indicates enteric fever

Question 13. Chancre

Answer:

Chancre

• Chancre is a typical lesion of primary syphilis that appears on genitals/at extragenital sites in 2-4 weeks after exposure to infection.
• Initially, the lesion is a painless papule that ulcerates in the center so that the fully developed chancre is an indurated lesion with central ulceration accompanied by regional lymphadenitis.
• Chancre heals without scarring, even in the absence of treatment.

Question 14. Two spirochaetal diseases

Answer:

Two spirochaetal diseases

Question 15. Oral manifestations of syphilis

Answer:

Oral manifestations of syphilis

• Syphilis is a sexually transmitted disease caused by spirochaetes, treponema pallidum.
• Syphilis is divided into 3 stages depending upon the period after which the lesions appear and the type of lesions.
• They are primary, secondary, and tertiary.
• Oral lesions occur in secondary syphilis known as mucous patches, on the tongue, gingiva, etc., or as a split papule on the lips, which are highly infectious.
• Tertiary/late syphilis/gumma is a granuloma with central necrosis, noninfectious, and is most common on the tongue and palate.
• Palatal perforation by ulcer after vigorous antibiotic use is known as the Herxheimer reaction.
• In congenital/prenatal syphilis, the most constant finding is relatively short roots of mandibular permanent 1st molars, short maxilla, Hutchinson triad (teeth, eye/ear involved), hypoplasia of incisors and molars i.e., notched incisors and mulberry molars.
• Treatment: Penicillin is the drug of choice.

Question 16. Congenital syphilis

Answer:

Congenital syphilis Major features are:

• Hutchinson’s triad includes.
• Hutchinson’s teeth-small, widely spaced, peg-shaped permanent teeth.
• Notched central incisors
• Intestinal keratitis with blindness and deafness from Stir cranial nerve injury.
• Saddle shaped nose
• Bony lesions like epiphysis and periostitis
• Mucocutaneous lesions of acquired secondary syphilis
• Diffuse fibrosis in the liver.

Question 17. VDRL test

Answer:

VDRL test

• It is an abbreviated form of the Venereal Disease Research Laboratory test
• It is the most widely used test for syphilis
• It is a simple arid rapid test
• It is a slide flocculation test

VDRL test Procedure:

• Cardiolipin antigen is freshly prepared
• A drop of this is added to a drop of inactivated patient’s serum on a slide
• Mix it by shaking

VDRL test Result:

• If floccules appear it indicates a positive test

Question 18. Prednisolone

Answer:

Prednisolone

• Prednisolone has potent glucocorticoid and mild mineralocorticoid activity
• It is the most commonly used glucocorticoid

Prednisolone Uses:

• Replacement therapy
• Rheumatoid arthritis
• Osteoarthritis
• Acute gout
• Allergic diseases
• Bronchial asthma
• Collagen diseases
• Eye diseases
• Renal diseases
• Skin diseases
• GIT diseases
• Liver diseases
• Malignancies
• Organ transplantation

Prednisolone Adverse Effects:

• HPA axis suppression
• Cushing’s syndrome
• Hyperglycemia
• Susceptibility to infection is increased
• Osteoporosis
• Avascular necrosis
• Peptic ulceration
• Mental disturbances
• Cataract and glaucoma
• Delayed wound healing

Question 19. Metronidazole

Answer:

Metronidazole

• Metronidazole is a nitroimidazole

Metronidazole Mechanism of Action:

• It is prodrug
• Susceptible micro-organisms reduce the nitro group of metronidazole by nitroreductase
• Convert it into a cytotoxic derivative
• It binds to DNA
• Inhibits protein synthesis

Metronidazole Uses:

• Anaerobic infection
• Amoebiasis
• Trichomonas vaginitis
• Giardiasis
• H.pylori infection
• Pseudomembranous colitis
• Draetmcwlosis
• Topical application

Metronidazole Adverse Reactions:

• Nausea, anorexia, abdominal pain, metallic taste in mouth
• Headache, dizziness
• Stomatitis, glossitis
• Furry tongue
• Insomnia, ataxia, vertigo
• Peripheral neuropathy
• Pruritis, urticaria, skin rashes

Question 20. Aminoglycosides

Answer:

Aminoglycosides

• Aminoglycosides are antibiotics with amino sugars in glycosidic linkages

Aminoglycosides Mechanism of Action:

• Penetrate bacterial cell membrane
• Bind to 30S ribosomes
• Inhibits bacterial protein synthesis

Aminoglycosides Uses:

• Tuberculosis
• Subacute bacterial endocarditis
• Plaque
• Tularemia
• Brucellosis

Aminoglycosides Adverse Effects:

• Ototoxicity
• Nephrotoxicity
• Neuromuscular blockade

Aminoglycosides Examples:

• Streptomycin
• Kanamycin
• Tobramycin
• Neomycin
• Gentamicin
• Netilmicin

Question 21. Chloramphenicol

Answer:

Chloramphenicol

• Chloramphenicol Is a broad spectrum and loll.

Chloramphenicol Mechanism of Action:

• It binds to 50S ribosome
• Inhibits transpeptidation reaction
• Inhibits protein synthesis

Chloramphenicol Uses:

• Typhoid lever
• Bacterial meningitis
• Anaerobic infections
• Rickettsial infection
• Kyo infections

Chloramphenicol Adverse Reactions:

• Gastrointestinal disturbances- nausea, vomiting, diarrhea
• Bone marrow depression
• Gray baby syndrome
• Hypersensitivity reactions
• Superinfection

Question 22. Malaria

Answer:

Malaria is a disease caused by four plasmodium species which are as follows:

1. P. vivax
2. P. Falciparum
3. Malaria
4. P. Ovale.

Malaria Life Cycle:

The malarial parasites pass their life cycle in two hosts.

1. Man intermediate host [a sexual development
2. Femalanopheles mosquito delinitive host [sexual development].

Malaria Clinical Features:

• Intermittent fever which is named malaria is caused by plasmodium
• It consists of
  • Febrile paroxysm
    • It comprises of three stages
  • Anaemia
    • Microcytic or normocytic hypochromic anemia develops
  • Splenomegaly.
    • The spleen becomes enlarged and palpable
    • Black water fever and pernicious malaria are the most commonly seen complications in falciparum malaria.

Question 23. Ludwig’s angina

Answer:

Ludwig’s angina

• Ludwig’s angina was described by Wilhelm Fredrich Von Ludwig in 1836
• It is rapidly spreading cellulitis involving simultaneously all three spaces i.e. Submandibular, sublingual, and submental spaces

Etiology:

• Odontogenic infection
• Traumatic injuries
• Infective condition
• Pathologic conditions

Ludwig’s angina Clinical Features:

1. Generalised symptoms
   • Dehydration
   • Fever
   • Dysphagia
   • Dyspnoea
   • Hoarseness of voice
   • Stridor
2. Extraoral features
   • Brawny hard swelling
   • Erythematous skin
   • Local rise in temperature
   • Drooling of saliva
   • Respiratory distress
3. Intraoral features
   • Trismus
   • Raised floor of mouth
   • Airway obstruction
   • Increased salivation

Ludwig’s angina Management:

• Airway maintenance
• Removal of the causative factor
• Administration of 4 fluids
• Antibiotics
  • Penicillin G-2-4 million units TV 4-6 hourly
  • Gentamycin-80 mg IM BD
  • Metronidazole-400 mg 8 hourly
  • Erythromycin-600 mg 6-8 hourly
  • Amoxicillin-500 mg 6-8 hourly orally
    • Surgical management

Infectious Diseases Short Question And Answers

Question 1. Four complications of viral hepatitis

Answer:

Four complications of viral hepatitis

• Hepatic necrosis
• Chronic hepatitis
• Cirrhosis of liver
• Hepatic failure
• Hepatocellular carcinoma

Question 2. Infectious Mononucleosis

Answer:

Infectious Mononucleosis

• It is an acute febrile illness associated with lymph node enlargement caused by Epstein Barr virus
• Features
  • Affects adolescents and adults
  • The incubation period is 7-10 days
• Clinical features
  • Fever, malaise
  • Conjunctival haemorrhage
  • Maculopapular rash
  • Sore throat
  • Lymphadenopathy
  • Splenomegaly

Infectious Mononucleosis Complications

• Chronic fatigue
• Hepatitis
• Hemolytic anemia
• Thrombocytopenia pleurisy
• Myocarditis
• Meningoencephalitis
• Rupture of an enlarged spleen

Question 3. Rubella

Answer:

Rubella

• Rubella is a mild childhood disease
• It may be acquired congenital or postnatally

Rubella Features:

• Infection is acquired by inhalation
• Incutwbon synod-2-3 weeks
• Fever, malaise
• Headache
• Mild conjunctivitis
• Lymphadenopathy
• Rasa develops on the forehead and face
• It spreads downward to the trunk and extremities
• It lasts for 1-5 days

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Rubella Prevention:

• It is prevented by MMR vaccine

Question 4. Mumps

Answer:

Mumps

• The incubation period is 12 – 18 days.

Mumps Clinical Features:

• Unilateral (or) bilateral swelling of parotid glands,
• Fever, malaise
• Local pain and tender
• The involvement of extra parotid sites can cause more serious problems as follows.
  • CNS involvement may lead to
    • Meningitis,
    • Meningoencephalitis
    • Orchitis

Question 5. Measles

Answer:

Measles Clinical Features:

• Insidious in onset
• Moderate fever
• Tachycardia
• Sore throat
• Formation of greyish-greenish pseudomembrane on tonsils
• Associated nausea and vomiting
• Bull neck- swollen neck
• Tender lymphadenopathy
• Xasal infection
• Hoarseness of voice
• Cough
• Respiratory obstruction
• Toxaemi
• Acute peripheral circulatory failure
• Nerve paralysis
• Dysphagia
• Dysphonia
• Paraesthesia

Question 6. Prevention of measles

Answer:

Prevention of measles

1. Active immunization
   • One injection of live attenuated measles vaccine along -with mumps and rubella vaccines, MMR vaccine to children over 1 year
2. Passive immunization
   • Human normal immunoglobulin is used

Dose:

Question 7. Diphtheria

Answer:

Diphtheria Clinical Features:

• It is insidious at the onset
• Moderate grade fever
• Tachycardia
• Sore throat
• Formation of greyish-greenish pseudomembrane on the tonsils
• Swollen neck- Bull neck
• Tender lymphadenopathy
• Nasal infection
• Hoarseness of voice
• Cough
• Respiratory obstruction
• Acute circulatory failure
• Myocarditis
• Nerve palsies
• Dysphagia
• Dysphonia
• Paraesthesia in the limbs

Question 8. Ascariasis

Answer:

Ascariasis

• Infection caused by Ascaris lumbricoides is known as ascariasis

Ascariasis Features:

• Migrating larvae in the lungs cause dyspnoea, wheezing, cough, and signs of pneumonia
• Loss of appetite
• Malnutrition
• Fever
• Eosinophilic leukocytosis
• Appendicitis
• Liver abscess

Ascariasis Diagnosis:

1. Stool examination- demonstrates adult worms or eggs
2. Barium meal- Demonstrate adult worms
3. Serodiagnosis- detects antibodies

Ascariasis Treatment:

• Pyrantel pamoate-11 mg/kg given orally
• Mebendazole-100 mg twice daily for three days

Question 9. Hookworm Disease
(or)
Ankylostomiasis

Answer:

Hookworm Disease

• Hookworm disease is a symptomatic infection caused by Ankylostoma duodenal and Necatar Ameri- can
• Occurs in all tropical and subtropical countries

Hookworm Disease Clinical Features:

• Dermatitis
• Lesions in the lungs- bronchitis and bronchopneumonia
• Microcytic, hypochromic anemia
• Epigastric pain
• Dyspepsia
• Vomiting
• Diarrhea

Hookworm Disease Diagnosis:

1. Blood examination
   • Eosinophilia
   • Microcytic, hypochromic anemia
2. Stool examination
   • Shows occult blood

Hookworm Disease Treatment:

• High protein diet
• Oral iron preparations
• Blood transfusion
• Drugs used are- mabendazole, albendazole, pyrantelpamoate

Question 10. Amoebic dysentery

Answer:

Amoebic dysentery

• Amoebic dysentery is also known as intestinal amoebiasis
• It is a condition in which the infection is confined to the intestine and is characterized by the passage of blood and mucus in the stool

Amoebic dyssentery Types:

1. Acute amoebic dyssentery
   • Multiple ulcers occur
   • These ulcers are deep and extensive
   • Its complications are
     • Pericaecal and pericolic abscess
     • Amoebic appendicitis
     • Perforation
     • Generalized peritonitis
     • Gangrene of guts
     • Fistula
2. Chronic amoebic dyssentery
   • A single latent ulcer is present in the caecum while multiple small superficial ulcers are scattered throughout the large intestine
   • Stricture formation occurs
   • Amoeboma in the caecum and large intestine develops

Question 11. Treatment of malaria

Answer:

Treatment of malaria

1. General management
   • Use of analgesics and antipyretics to treat fever
   • Administration of intravenous fluids
2. Treatment of acute attack
   • Chloroquine-600 mg followed by 300 mg in 6 hours and then 150 mg twice a day for 3 days
   • Chloroquine-resistant cases- Dihydrochloride 600 mg salt three times a day by mouth for 5 days
   • Followed by a single dose of sulphadoxine 1.5 g combined with pyrimethamine 75 mg

Question 12. Complication of malaria

Answer:

Complication of malaria

1. Pernicious malaria
2. Black water fever.

1. Pernicious malaria:

• It is a life-threatening condition

Pernicious malaria Cause:

• It is due to heavy parasitization.

Pernicious Malaria Clinical Features:

• It is grouped into the following:

2. Blackwater fever:

• This occurs in persons who are previously infected and had inadequate doses of quinine

Blackwater Fever Clinical Features:

• Intravascular hemolysis,
• Fever,
• Haemoglobinuria
• Vomiting and prostration with the passage of dark red (or) blackish urine hence called backwater fever.

Blackwater Fever Mechanism:

• An autoimmune mechanism may be involved in hemolysis
• Parasitized erythrocytes during previous infection act as antigen
• Antibodies are formed against it
• Due to this antigen-antibody reaction, massive destruction of erythrocytes occurs
• There is excessive deposition of haemosiderin pigment in the liver, spleen, and kidneys.
• Sequel of black water fever include
  • Circulatory failure
  • Renal failure,
  • Liver failure,
  • Anaemia.

Question 13. Complication of mumps

Answer:

Complication of mumps

• Orchitis
• Oophoritis
• Arthritis
• Nephritis
• Pancreatitis
• Thyroiditis and myocarditis.

Question 14. Diagnosis of typhoid fever

Answer:

Diagnosis of typhoid fever

Question 15. Complications of typhoid fever

Answer:

Complications of typhoid fever

1. Intestinal complications
   • Hemorrhage
   • Paralytic ileus
   • Perforation
   • Peritonitis
2. Extraintestinal complication
   • Meningitis
   • Cholecystitis
   • Pneumonia
   • Myocarditis
   • Bone and joint infection
   • Encephalopathy
   • Granulomatous hepatitis
   • Nephritis

Question 16. Clinical features of typhoid fever

Answer:

Clinical features of typhoid fever

• Incubation period- 10-14 days

1. First 5-7 days
   • High-grade, remittent fever with chills
   • Headache
   • Aches
   • Malaise
   • Constipation
   • Leucopenia
   • Dry cough
   • Epistaxis
   • Relative bradycardia
2. Between 1st and 2nd week
   • Rose spots develop over the trunk as small macules, red in color, and blanch on pressure
   • Splenomegaly
   • Bronchitis
   • Abdominal pain
   • Abdominal distension
   • Diarrhea
3. After 2nd week
   • Confusion
   • Delirium
   • Toxaemia
   • Coma

Question 17. Lepromatous leprosy

Answer:

Lepromatous leprosy

• Leprosy caused by mycobacterium leprae is of 2 types wepromatous leprosy represents low resistance and tuberculoid leprosy represents high resistance.
• Lepromatous leprosy is characterized by multiple symmetrical skin lesions that are hypopigmented and erythematous maculopapular/nodular.
• Nerve involvement is present with less severe sensory distribution.
• Histopathology involves the collection of foamy macrophages/lepra cells in the dermis separated from the epidermis by a clear zone.

Question 18. Lepra reaction

Answer:

Lepra reaction

• Lepra reaction/reactional leprosy:
• There may be two types:

1. Type 1 (Reversal reactions),
2. Type 2 (Erythema, nodosum leprosum)

1. Type 1: the polar forms of leprosy donor undergo any change in clinical ami histopathological picture.

• Borderline groups are unstable and may move across the spectrum in either direction with upgrading/downgrading of patients’ immune stale.

1. Upgrading read ion: Characterized by increased cell-mediated immunity and occurs in patients of borderline Icpromalous (BL) type on treatment who upgrade/shift towards tuberculoid type.
2. Downgrading reaction: Characterized by lowering of cellular immunity and is seen in borderline tuberculoid (BT) type who downgrade/shift towards Icpromalous type.

2. Type 2: Occurs in Icpromalous patients after treatment. It is characterized by tender cutaneous nodules, fever, iridocyclitis, synovitis, and lymph node involvement.

Question 19. Diagnosis of AIDS

Answer:

Tests for AIDS:

1. ELISA( Enzyme-Linked Immunosorbent Assay)
   • It is a color reaction test
   • Method:
     • A serum containing antibodies is developed from the patient’s blood sample
     • It is added to the ELISA plate
     • Wash off the inactive antibodies
     • A second layer of antibodies called conjugate is added
     • Excess antibodies are again washed off
     • A substrate is added to it
   • Result:
     • Color becomes darker- positive test
     • No color change- negative test
2. Western blot
   • Method
     • Viral proteins from the patient’s blood sample are passed through a gel
     • The separated proteins are then passed through an electric current
     • Human serum is added
     • A chromogen is added to it
3. Result:
   • A specific band of viral protein is detected

Question 20. Quinolones

Answer:

Quinolones

• Quinolones are a group of synthetic antimicrobial agents

Quinolones Uses:

• Uncomplicated UTI
• Diarrhea

Quinolones Adverse Effects:

• Hemolytic anemia
• Allergic reactions
• Headache
• Myalgia
• Drowsiness

Examples:

• Nalidixic acid
• Oxalinic acid
• Cinoxacin

Question 21. Cephalosporins

Answer:

Cephalosporins

• Cephalosporins are semi-synthetic antibiotics with a beta-lactam ring

Cephalosporins Uses:

• Gram-negative infections
• Surgical prophylaxis
• Gonorrhea
• Meningitis
• Mixed aerobic and anaerobic infection
• Typhoid
• Nosocomial infection
• Orodental infection

Cephalosporins Adverse Reactions:

• Hypersensitivity reactions
• Nephrotoxicity
• Diarrhea
• Bleeding
• Low WBC count
• Pain at the injection site
• Disulfiram like reaction

Question 22. Triple vaccine, Dan PT

Answer:

Triple vaccine, DPT

• DPT is used as an active immunization
• It is combination of Diphtheria toxoid, pertusis vaccine and tetanus toxoid

DPT Route of Administration:

• Intramuscular

DPT Dose:

• Initial dose- 6 weeks
• Three doses are completed at intervals of 4-6 weeks
• Booster doses-18 months and 5 years

DPT Adverse Reactions:

• Transient local inflammation
• Fever
• Occthe asional convulsions

DPT Advantages:

• Minimizes the number of injections
• Improves immune response

Question 23. Anti-amoebic drugs

Answer:

Anti-amoebic drugs

• Anti-amoebic drugs are drugs used in amoebiasis

Anti-amoebic drugs Classification:

1. Drugs effective in both intestinal and extra-intestinal amoebiasis
   • Metronidazole
   • Tinidazole
   • Secnidazole
   • Omid azole
   • Satranidazole
   • Emetine
2. Drugs effective in intestinal amoebiasis
   • Diloxanide furoate
   • Quiniodochlo
   • Iodoquinol
   • Tetracyclines
3. Drugs effective in extraintestinal amoebiasis
   • Chloroquine

Question 24. Quinsy

Answer:

Quinsy

• It is an infection in connective tissue between the tonsil and the superior constrictor
• It is also called peritonitis sellar abscess

Quinsy Fethe features:

• Acute pain in the throat
• Pain radiates to the ear
• Dysphagia
• Nausea
• Constipation
• Poor oral hygiene
• Body ache
• Headache
• Enlarged lymph nodes
• Dyspnoea
• Trismus
• Deviation of uvula
• Hoarseness of voice
• Foul breath

Quinsy Management:

• Antibiotics
• Incision over the most prominent part
• Analgesics
• Warm saline gargles 4 fluids
• Tonsillectomy

Question 25. Rabies prevention

Answer:

Rabies prevention

• Rabies vaccines are two types

1. Neural
2. Non-neural

1. Neural Vaccines:

1. Semple vaccine:
   • The most widely used vaccine
   • Developed by Semple at Central Research Institute, Kasauli.
   • It is a 5% suspension of infected sheep brain and inactivated by 5% phenol at 37°C leaving no residual live virus.
2. Beta Propiolactone (BPL) Vacine:
   • Modified sample vaccine
   • Instead of phenol, BPL is used as an activating agent.
3. Infant brain vaccine:
   • Used widely in America to Reduce neurological complications.
     • Vaccination Schedules:
       • Nowadays it’s not used.
       • In the past, they were given subcutaneously on the anterior abdominal wall.
       • 7 – 14 injections depend on the degree of risk.

2.  Non-Neural Vaccines:

1. Duck Egg Vaccine:
   • BPL is used as an inactivating agent
   • It has poor immunogenicity so not used now.
2. Tissue culture vaccines:
   • Following cell culture vaccines are available in India.
     • Human diploid cell strain vaccine [HDCS]
       • The HDCS vaccine is prepared by growing rabies virus on human diploid cells and is inactivated with BPL.
       • This vaccine is highly antigenic and free of side effects
   • Purified chick embryo cell vaccine [PCEC]
     • PCEC is now widely used.
     • It is cheaper
     • It contains BPL inactivated flurry LEP strain
   • Purified Vero cell vaccine [PVC]
     • This vaccine is under study

Question 26. Antiviral drugs

Answer:

Antiviral drugs

Question 27. BCG

Answer:

BCG

• The Bacille Calmette Guerin (BCG) vaccine was prepared by Calmette and Guerin in 1921
• Used for protection against tuberculosis infections

BCG Forms:

• Liquid form
• Freeze-dried form- commonly used

Dose and Administration:

• 0.1 ml is administered intradermally soon after birth

BCG Result:

• A small nodule develops at the injection site in about 2-3 weeks
• it gradually increases in size upto 441 mm in diameter
• It breaks into a shallow ulcer leaving 4-8 mm diameter round scar

BCG Contraindications:

• AIDS patients
• Eczema
• Pertussis
• Measles
• Patients on steroids

Question 28. Complications of Hepatitis B

Answer:

Complications of hepatitis B are:

1. Cirrhosis of liver
2. Liver failure
3. Hepatocellular carcinoma

Question 29. Chloroquine

Answer:

Chloroquine

• Chloroquine is antimalarial drug
• It is a synthetic 4-arninoquinolone

Chloroquine Uses:

• Malaria
• Extra-intestinal amoebiasis
• Photogenic reactions
• Lepra reactions

Chloroquine Adverse Reactions:

• Severe nausea and vomiting
• Pruritis
• Headache
• Visual disturbances
• Insomnia
• Skin rashes
• Cardiomyopathy
• Peripheral neuropathy
• Psychiatric problems
• Blurring of vision
• Confusion
• Bleaching of hair

Question 30. Human insulins

Answer:

Human insulins

• Human insulin is produced by recombinant DMA technology
• They are expensive
• Absorbed rapidly

Human insulins Forms:

• Regular B Lente
• Isophane insulin
• Lente
• Ultralente preparations

Human insulins Advantages:

• Less antigenic
• More stable
• Fewer chances of resistance
• Less chances of lipodystrophy

Human insulins indications:

• Allergy to conventional preparations
• Insulin resistance
• Lipodystrophy at the injection site
• Pregnancy

Question 31. Four causes of lymphadenopathy

Answer:

Lymphadenopathy Causes:

1. Inflammatory
   • Acute lymphadenitis
   • Chronic lymphadenitis
   • Granulomatous lymphaleukemiaeoplastic
2. • Benign
   • Malignant
3. Lymphatic leukaemia
   • Autoimmune disorders
   • Juvenile rheumatoid arthritis
   • Collagen diseases like systemic lupus erythematosus, polyarteritis nodosa
4. Generalised lymphadenopathy
   1. Tuberculosis
   2. Syphilis- secondary stage
   3. Infectious mononucleosis
   4. Sarcoidosis
   5. Toxoplasmosis
   6. Hodgkin’s disease
   7. Lymphosarcoma

Infectious Diseases Important Notes

1. Gas gangrene
   • Caused by clostridium perfrigens
   • It is characterised by skin color change from pallor to bronze/ purple
   • Skin is tense and tender
   • Gas in the tissues is elaborated by crepitus or visible on radiograph
   • Treatment
   • Surgical debridement
   • Antibiotic therapy with high dose of 4 penicillin, clindamycin, and metronidazole
   • Hyperbaric oxygen therapy
2. Hyperbaric therapy is used for treatment of
   • Gas gangrene
   • Osteoradionecrosis
   • Chronic osteomyelitis
3. Rubella ( German measles)
   • It is caused by a paramyxovirus
   • It is spread by droplet infection
   • It is characterised by Koplik’s spots on the buccal mucosa which is seen as small white spots surrounded by erythema
   • It is followed by the appearance of rash first on the back of ears and at hairline and maximum on face
   • Rubella in early pregnancy causes
     • Congenital abnormalities like deafness
     • Spontaneous abortion
     • Congenital heart diseases like persistent patent ductus arteriosus, atrial septal defect, etc
   • Complications
     • Pneumonia
     • Encephalitis
     • Otitis media
4. Hepatitis E
   • It is also called Non-A or Non-B hepatitis
   • Caused by HEV which is an RNA virus
   • Spreads by faeco oral route
   • Clinical illness resembles hepatitis A infection
   • Pregnant women are particularly liable to acute hepatic failure
   • Epidemics are almost exclusively caused by hepatitis E virus
5. Viruses and infections caused by them
6. Classification of virus
   
   • DNA Virus
     • Pox viridae
       • Small pox
       • Molluscus
       • Contagiosum
     • Herpesviridae
     • Adenoviridae
       • Major cause for nonbacterial pharyngitis and tonsillitis
     • Papovaviridae
     • Hepadnaviridae
   • RNA Virus
     
     • Picornaviridae
       • Polio
       • Coxsackie
       • Hepatitis A
       • Rhinovirus
     • Orthoviridae
       • influenza
   • Paramyxoviridae
   • Retrovirus
   • Togaviridae
   • Rhabdoviridae
   • Flaviviridae
   • Calciviridae
7. Types of fever In different infections
   • Saddleback fever – dengue
   • Step ladder fever – typhoid
   • Pell Ebstein fever – brucellosis and Hodgkin’s disease
   • Double rise of temperature in a day – kalaazar
8. Clinical features of syphilis
   • Congenital syphilis
     • Hutchison’s triad
     • Saddle nose
     • Sabre tibia
     • Rhagades
     • Bossing of frontal and parietal bones
     • Hypoplastic maxilla
     • Salt and pepper scars on retina
   • Primary syphilis
     • Painless chancre
     • Painless palpable rubbery inguinal lymph nodes
   • Secondary syphilis
     • Fever, malaise
     • Maculopapular rash on trunks and limbs
     • Condylomalata
     • Mucous patches in the genitalia, mouth, and pharynx
     • Snail track ulcers in mouth
   • Tertiary syphilis
     • Gumma
     • Cardiovascular syphilis
     • Aortitis
     • Aortic aneurysm
     • Aortic incompetence
     • Neurosyphilis
     • Tabesdorsalis
     • Meningovascular disease
     • General paralysis
9. Complications of different infection
10. Rashes in different diseases
11. Spots in different diseases

Read And Learn More: General Medicine Question and Answers

VIVA VOCE

1. Clostridium perfrigens causes gas gangrene
2. Clostridium tetani causes tetanus
3. Clostridium difficile causes pseudomembranous colitis
4. Koplik’s spots is a characteristic feature of measles
5. Rubella is transmitted by aerosol infection
6. Hepatitis A and E spread by fecal-oral route
7. Hepatitis B, C, and D spread by parenteral route
8. Hepatitis A affects children more than adults

Endocrine And Metabolic Diseases Important Notes

1. Acromegaly:
   • GH excess after epiphyseal closure results in acromegaly
   • Clinical features:
     • Skin thickening
     • Enlarged nose and tongue
     • Macroglossia
     • Carpal tunnel syndrome
     • Large hands and feet
     • Prognathic lower jaw
     • Diabetes mellitus
     • Hypertension
2. Thyroid storm/ thyrotoxic crisis, thyrotoxicosis
   • It is an acute life-threatening hypermetabolic state induced by the excessive release of thyroid hormones
   • Clinical features
     • Fever
     • Heat intolerance
     • Exophthalmos
     • Tachycardia
     • Increased appetite
     • Excessive Sweating
     • Weight loss
     • Systolic hypertension
     • Cardiac arrhythmias
3. Diabetes mellitus
   • Features
     • Polyuria, polyphagia, polydipsia
     • Glycosuria
     • Ketoacidosis
     • Kussmaul breathing
     • Circulatory shock, coma
     • Bone resorption, loosening of teeth
     • Acetone breath
   • Types
     • Type 1 (Insulin-dependent diabetes mellitus) 
       • Occurs in young age groups
       • Occurs due to deficiency of insulin
         • Destruction of beta cells during autoimmune diseases
         • Destruction of beta cells by viral infec­tion
         • Congenital disorder
       • Associated with acidosis ketosis or coma
     • Type 2 (non-insulin-dependent diabetes mellitus)
       • Occurs after the age of 40 years
       • Also called maturity-onset diabetes
       • The structure and functions of beta cells are normal
       • Occurs due to a reduced number of insulin receptors
       • Associated with obesity and hereditary
       • Rarely, associated with ketosis
   • Diagnosis
     • Fasting blood sugar > 126 mg/ dl or random blood sugar > 200 mg/dl is suggestive of diabetes
4. Blood glucose test
   
   
5. Cardinal features of diabetic ketoacidosis
   • Hyperglycaemia
   • Hyperketonaemia
   • Metabolic acidosis
6. Hyperthyroidism and hypothyroidism
   
7. Hypoglycemia-features
   • Sweating
   • Palpitation
   • Hunger
   • Confusion
   • Drowsiness
   • Incoordination
8. Tetany
   • Occurs when plasma calcium level falls below 6 mg%
   • Signs of Tetany
9. Risk factors of osteoporosis
   • Diet or calcium intake
   • Immobility
   • Thyrotoxicosis, hyperparathyroidism
   • Rheumatoid arthritis
   • Corticosteroids
   • Smoking and alcoholism
10. Cretinism and dwarfism

Endocrine And Metabolic Diseases Short Answers

Question 1. Tetany

Answer:

Tetany

• It is a clinical condition characterized by low levels of ionized calcium leading to increased neuromuscular excitability

Tetany Clinical Features:

1. In children
   • Characteristic triad- carpopedal spasm, stridor and convulsion
   • Carpopedal spasm- flexion at metacarpophalangeal joints and extension at interphalangeal joints with the opposition of the thumb
   • Stridor- closure of glottis
2. In adults
   1. Tingling sensation in peripheral parts of limbs or around the mouth
   2. Painful carpopedal spasm
   3. Rarely stridor and convulsions
3. Signs
   • Trousseau’s sign
     • Raising the blood pressure above systolic level by inflation of the sphygmomanometer cuff produces carpal spasm within 3-5 minutes
   • Chvostek’s sign
     • A tap at the facial nerve at an angle of the jaw produces twitching of facial muscles

Read And Learn More: General Medicine Question and Answers

Question 2. Causes of tetany

Answer

Causes of tetany

1. Hypocalcaemia
   • Malabsorption
   • Osteomalacia
   • Hypoparathyroidism
   • Chronic renal failure
   • Acute pancreatitis
2. Alkalosis andhypokalaemia
   • Repeated vomiting
   • Excessive intake of alkalies
   • Primary hyperaldosteronism
   • Hypomagnesaemia

Question 3. Treatment of tetany

Answer:

Treatment of tetany

1. Treatment of hypocalcemia
   • Injection of 20 ml of 10% calcium gluconate
2. Treatment of alkalosis
   • Intravenous administration of isotonic saline
   • Withdrawal of alkalies
   • Inhalation of 5% C02 in oxygen- to treat hyperventilation
   • Psychotherapy

Question 4. Diabetes mellitus- complications

Answer:

Acute metabolic complications:

1. Diabetic ketoacidosis
   • Develop in patients with severe insulin deficiency
   • Clinical Features:
     • Nausea, vomiting, anorexia
     • Deep and fast breathing
     • Mental confusion
     • Coma
2. Hyperosmolar hyperglycemia non-ketotic coma
   • It is a complication of type 2 diabetes mellitus
   • Caused by severe dehydration which leads to sustained hyperglycemia diuresis
3. Hypoglycaemia
   • Develop in type 1 diabetes mellitus

Late systemic complications:

1. Atherosclerosis
   • Common in both type 1 and type 2 diabetes mellitus
   • Atherosclerosis may lead to Myocardial in fraction cerebral stroke
   • Gangrene of toes and feet
2. Diabetic microangiopathy
   • It is the basement membrane thickening of small blood vessels and capillaries of different organs and tissues
   • Occurs due to increased glycosylation of hemoglobin and other proteins
3. Diabetic nephropathy
   • It is a severe complication of diabetes mellitus
   • Occurs in both types
4. Diabetic neuropathy
   • Effects all parts of the nervous system
5. Diabetic retinopathy
   • It is the cause of blindness
6. Infections
   • Diabetic patients are more susceptible to infections like tuberculosis, pyelonephritis, otitis, carbuncles, and diabetic ulcers

Question 5. Oral complications of diabetes mellitus

Answer:

Oral complications of diabetes mellitus

1. Periodontium
   • Alter response of the periodontal lesion to local irritants
   • Retards healing of tissues
   • GCF contains more glucose
   • Periodontal abscess formation
   • Tooth mobility
   • Severe and rapid bone resorption
2. Tongue
   • Altered taste sensation
   • Median rhomboid glossitis
   • Impaired local immune response
   • Decreased Langerhans cell
3. Oral candidiasis
   • Alveolar bone
   • Localized osteitis
4. Mouth
   • Burning mouth syndrome
   • Dvsgeusia
   • Dysesthesia
   • Xerostomia
   • Increased caries activity
5. Diabetic siaiadenosis- involving trigeminal nerve
6. Angular cheilosis
7. Oral lichen planus

Question 6. Diagnosis of diabetes mellitus

Answer:

Diagnosis of diabetes mellitus

1. Detection of glycosuria
   • It is detected by a dipstick test
   • The green color indicates urinary glucose concentration between 10-20 mg% or more
2. Urine for ketone bodies
   • Ketonuria indicates diabetes
3. Oral glucose tolerance test
   • Advise tire patient to take an unrestricted carbohydrate diet for 3 days before the test
   • Overnight fast
   • Collect a fasting sample of blood
   • Administer 75 g of glucose dissolved in 300 ml of water
   • Collect blood and urine samples at half-hour intervals for 2 hours

Question 7. Glucosuria

Answer:

Glucosuria

• It is the condition of glucose excretion in urine
• Glucose appears in urine when the plasma glucose concentration exceeds the renal threshold for glucose

Glucosuria Types:

1. Renal glycosuria
   • It is a benign condition
   • Occurs due to a reduced renal threshold for glucose
   • It is unrelated to diabetes
2. Alimentary glllucosuria
   • In certain individuals, blood glucose rapidly increases after meals which gets excreted in urine
   • This is known as alimentary glucosuria
   • It is observed in
     • Normal individuals
     • Individuals with
       • Hepatic diseases
       • Hyperthyroidism
       • Peptic ulcer

Question 8. Insulin

Answer:

Insulin

• Insulin is a hormone required for the regulation of blood glucose level

Insulin Secreted By:

• Beta cells of the islets of Langerhans of the pancreas
• Functions:
• Lowers blood glucose level
• Promotes glucose utilization and storage
• Inhibits glucose production
• Required for glucose uptake
• Increases glycolysis
• Decreases gluconeogenesis
• Promotes lipogenesis from glucose
• Reduces lipolysis and ketogenesis
• Enhances protein synthesis

Question 9. Oral hypoglycaemic drugs

Answer:

Oral Hypoglycemic Drugs Classification:

1. Sulphonylureas
   • First generation
     • Tolbutamide
     • Chlorpropamide acetohexamide
     • Tolazamide
   • Second generation
     • Clibendamide
     • Glipizide
     • Gliclazide
2. Biguanides- Metformin
3. Meglilinides- repaglinide, nateglinide
4. 4.Thiazolidinediones- Troglitazone, rosiglitazon
5. Alpha-glucosidase inhibitors- Acarbose, miglitol
6. Newer drugs
   • Amylin analog- pramlintide
   • GLP-1 analog- exenatide
   • DPP-4 inhibitor- Sitagliptin

Oral Hypoglycemic Drugs Features:

1. They are used in mild and early non-insulin-dependent diabetes mellitus
2. It lowers blood glucose levels
3. They are noninvasive drugs

Question 10. Sulphonylurea

Answer:

Sulphonylurea

• Sulphonylurea were the first oral hypoglycaemic drugs

Sulphonylurea Classification:

1. First generation
   • Tolbutamide
   • Chlorpropamide acetohexamide
   • Tolazamide
2. Second generation
   • Glibenclamide
   • Glipizide
   • Gliclazide

Sulphonylurea Mechanism of Action:

• It reduces the blood glucose levels by:
  • Stimulating the release of insulin from the pancreatic beta cells
    • Increasing the sensitivity of peripheral tissues to insulin
    • Increases the number of insulin receptors
    • Suppresses hepatic gluconeogenesis

Question 11. Metformin

Answer:

Metformin

• Metformin is biguanide

Metformin Mechanism of Action:

• Suppresses hepatic gluconeogenesis
• Inhibits glucose absorption from the intestines

Metformin Use:

• In obese patients with type-2 diabetes mellitus either alone or in combination with sulphonylureas

Metformin Adverse Effects:

• Nausea
• Diarrhea
• Metallic taste
• Mild lactic acidosis
• Anorexia
• Loss of appetite

Question 12. Glibenclamide

Answer:

Glibenclamide

• Glibenclamide is second generation sulphonylurea

Glibenclamide Mechanism of Action:

• It reduces the blood glucose levels by:

1. Stimulating the release of insulin from the pancreatic beta cells
2. Increasing the sensitivity of peripheral tissues to insulin
3. Increases the number of insulin receptors
4. Suppresses hepatic gluconeogenesis
   • DOSE- 5-15 mg
   • HALF-LIFE- 4-6 hours
   • DURATION OF ACTION-18-24 hours

Question 13. Treatment of diabetic ketoacidosis

Answer:

Treatment of diabetic ketoacidosis

1. Correction of hyperglycemia
   • Administration of regular insulin 0.1 U/kg bolus followed by 0.1 U/kg/hour by continuous 4 infusion till the patient recovers
2. Correction of dehydration
   • Normal salinelitersion of 1 litre m the first hour
   • Then 1 litre over the next 4 hours
   • Then quantity is titrated
3. Correction of acidosis
   • Use of sodium bicarbonate
4. Potassium
   • 10-20 mEq/ hour potassium chloride is added to the drip for rapid correction of hyperglycemia

Question 14. Prevention of tetanus

Answer:

Prevention of tetanus

1. Surgical
   • Removal of foreign bodies, blood clots
   • Cleansing
   • Radical excision
2. Antibiotics
   • Long-acting penicillin injection or erythromycin may be given
3. Immunization
   • Active immunization
     • DPT vaccine
     • It is combination of Diphtheria toxoid, pertusis vaccine and tetanus toxoid
     • Route of Adminis tration:
       • Intramuscular
     • Dose:
       • Initial dose- 6 weeks
       • Three doses are completed at intervals of 46 weeks
       • Booster doses-18 months and 5 years
   • Passive immunization
     • Antitetanus serum is used in a dose of 1500 IU by intramuscular route
   • Combined prophylaxis

Question 15. Cretinism

Answer:

Cretinism

• It is a characteristic feature of infantile hypothyroidism

Cretinism Clinical Features:

• Mental retardation
• Delayed milestones of development
• Protruding tongue
• Flat nose
• Dry skin
• Sparse hairs
• Enlarged skull
• Generalised edema
• Hypotension
• Atrophy of sweat glands
• Protruded abdomen

Cretinism Oral Manifestations:

• Delayed eruption and exfoliation of deciduous teeth
• Macroglossia
• Thick lips
• Constant drooling of saliva
• Malocclusion
• Underdevelopment of mandible
• Wide face

Question 16. Albuminuria

Answer:

Albuminuria

• The presence of albumin in the urine is known as albuminuria
• The Dipstick test is a standard test for it
• It identifies the presence of renal disease or urinary infection in diabetic individuals
• It detects urine albumin greater than 300 mg/1 and even smaller amounts of urinary albumin

Question 16. Phenylketonuria

Answer:

Phenylketonuria

• It is a common metabolic disorder

Phenylketonuria Causes:

• Deficiency of the hepatic enzyme phenylalanine hydroxylase

Phenylketonuria Mechanism:

2. Phenylalanine is diverted to alternate pathways

Phenylketonuria Clinical Features:

1. Effects on CNS
   • Mental retardation
   • Failure to walk or talk
   • Retarded growth
   • Seizures and tremors
   • Low IQ
2. Effect on pigmentation
   • Hypopigmentation
3. Urine
   • Contains phenylalanine and its metabolic products
   • Mousthe ey odor due to press ence of phenylacetate

Phenylketonuria Treatment:

• Intake of diet with low phenylalanine content
• Use of synthetic amino acid preparation
• Provide tyrosine in the diet
• Administration of 5-hydroxytryptophan and dopa in serious conditions

Question 17. Hyperpituitarism

Answer:

Hyperpituitarism

• Hyperpituitarism in infancy leads to gigantism and among adults it produces acromegaly

Hyperpituitarism  Causes:

• Hypersecretion of growth hormone
• Increased function of the anterior pituitary

Hyperpituitarism  Gigantism:

• Generalized symmetric overgrowth of the body
• Gentital underdevelopment
• Excessive sweating
• Headache
• Lassitude
• Joint and muscle pain
• Defective vision

Question 18. Goitre

Answer:

Goitre

• Goitre refers to enlargement of the thyroid gland irrespective of its cause

Goitre Classification:

1. Simple goitre
   • Diffuse hyperplastic goitre
   • Nodular goitre
   • Colloid goitre
2. Toxic goitre
   • Diffuse toxic goitre
   • Toxic nodular goitre
   • Toxic nodule
3. Neoplastic goitre
   • Benign tumours
   • Malignant tumours
4. Thyroiditis
5. Other rare conditions

Question 19. Exophthalmos

Answer:

Exophthalmos

• Exophthalmos is defined as abnormal protrusion of the eyeball anteriorly out of the orbit

Exophthalmos Causes:

1. Inflammatory/Infection:
   • Graves’ disease
   • Orbital cellulitis
   • Mucormycosis
   • Orbital pseudotumor
   • High-altitude cerebral edema
   • Wegener’s granulomatosis
2. Neoplastic:
   • Leukemias
   • Meningioma, (of the sphenoid wing)
   • Nasopharyngeal angiofibroma
   • Hemangioma, cavernous
3. Cystic:
   • Dermoid cyst
4. Vascular:
   • Carotid-cavernous fistula
   • Aortic insufficiency
5. Others:
   • Orbital fracture: apex, floor, medial wall, zygomatic
   • Retrobulbar hemorrhage
   • Cushing’s syndrome

Exophthalmos Complications:

• Corneal dryness and damage
• Keratoconjunctivitis
• Blindness due to compression of optic nerve and vessels

Question 20. Hyperparathyroidism

Answer:

Hyperparathyroidism

• It is an endocrine disorder occurring due to an excess of circulating parathyroid hormone

Hyperparathyroidism Types:

1. Primary hyperparathyroidism
   • Occurs due to tumor of glands
2. Secondary hyperparathyroidism
   • Occurs in response to hypocalcemia
3. Tertiary hyperparathyroidism
   • Occurs after long-standing secondary hyperparathyroidism

Hyperparathyroidism Clinical Features:

Age and sex- common in middle-aged women

1. Classic triad
   • Kidney stones
   • Bone resorption
   • Duodenal ulcers
2. Renal symptoms
   • Renal calculi
   • Hematuria
   • Back pain
3. Psychological symptoms
   • Emotionally unstable
4. GIT symptoms
   • Anorexia
   • Nausea, vomiting
5. Skeleta
   • Bone pain
   • Pathologic fractures
   • Bone deformities
   • Hypercalcemia
6. Generalised symptoms
   • Muscle weakness
   • Fatigue
   • Weight loss
   • Insomnia
   • Headache
   • Olydipsiaand polyuria
7. Oral manifestations
   • Intraoral and extraoral swelling
   • Gradual loosening of teeth
   • Drifting and loss of teeth
   • Malocclusion

Question 21. Risus sardonicus

Answer:

Risus sardonicus

• Risussardonicus or rictus grin is a highly characteristic, abnormal, sustained spasm of the facial muscles that appears to produce grinning.

Risus sardonicus Causes:

• Tetanus
• Poisoning with strychnine

Question 22. Gynaecomastia

Answer:

• Gynaecomastia is the presence of glandular breast tissues in males

Risus sardonicus Causes:

• Idiopathic
• Physiological
• Drug-induced
• Hypogonadism
• Androgen resistance syndromes
• Oestrogen excess

Risus sardonicus Investigations:

• Ultrasonography
• Mammography
• Random blood sample

Risus sardonicus Treatment:

• Self regressing
• Surgical excision for cosmetics reasons
• Androgen replacement

Question 23. Thyroxin

Answer:

Thyroxin

• Thyroxin is a hormone secreted by the thyroid gland
• The thyroid gland secretes mainly thyroxin, T4, and small amount of triiodothyronine, T3
• T3 is the active form of the hormone, Most of the T4 is converted into T3 in peripheral tissues
• Thyroid hormones are carried in plasma in the bound form with a plasma protein while a small amount circulates unbound
• Free form enters cells and exerts its metabolic effects
• its level is measured by thyroid function tests

Question 24. Anti-thyroid drugs

Answer:

Anti-thyroid drugs

• These are used to restore the patient to a euthyroid state and maintain it
• They are:

1. Propylthiouracil
   • Dose: 100-300 mg every 6-8 hours
2. Carbimazole
   • Dose: 10-20 mg every 6-8 hours

Anti-thyroid drugs Side Effects:

• Skin rashes
• Fever
• Peripheral neuritis
• Polyarteritis
• Agranulocytosis
• Aplastic anemia
• Prothrombin deficiency

VIVA VOCE

1. Acetone breath is seen in diabetes mellitus
2.  Congestive heart failure occurs in hypothyroidism
3. Carpal tunnel syndrome occurs in hypothyroidism
4. Metformin is a biguanide hypoglycaemic drug
5. Severe neurological and cardiac changes occur at calcium levels> 16 mg/ dl

Question 1. Hypercalcemia

Answer:

Hypercalcemia Causes:

• Conditions associated with hypercalcemia and increased PTH levels
  • Hyperparathyroidism
  • Chronic renal failure
• Conditions associated with hypercalcemia and low PTH levels
  • Multiple myeloma
  • Sarcoidosis
  • Hyperthyroidism
  • Thiazide diuretics
  • Milk alkali syndrome
  • Familial

Hypercalcemia Clinical features

• Nausea, vomiting
• Pain in abdomen
• Dehydration
• Hypotension

Hypercalcemia Treatment:

• Avoid calcium-containing antacids
• Replacement of fluid and electrolytes by 4-6 l of normal saline
  • To correct dehydration, hypotension, and calcium levels
• Forced diuresis by saline and diuretic frusemide given 4 to depress tubular reabsorption of calcium
• Drugs given include a generation bis- phosphonate ex: pamidronate given as a single 4 dose of 15-60 mg in normal saline
• Calcitonin is used in emergency state
• Cinacalcet is used orally in hypercalcemia crisis

Question 2. Thyrotoxicosis

Answer:

Thyrotoxicosis

• It is a clinically toxic manifestation due to excess thyroid hormones

Thyrotoxicosis Causes:

• Common causes
• Grave’s disease
• Toxic nodular goitre
  • Multinodular
  • Solitary nodule
• Less common causes
  • Thyroiditis Drug-induced
  • Factitious
  • Iodine induced
• Rarely
  • Pituitary or ectopic TSH
  • Thyroid carcinoma

Thyrotoxicosis Clinical features:

• Goitre
• Weight loss, vomiting, diarrhea
• Increased pulse rate, dyspnea, arrhythmia
• Nervousness, restlessness, tremors, muscular weakness
• Perspiration, clubbing, loss of hair, pre-tibial myxoedema
• Amenorrhea, abortions, infertility, loss of libido
• Lid lag, exophthalmos, diplopia, watering of eyes
• Fatigue, heat intolerance, polydipsia

Question 3. Calcium homeostasis

Answer:

Regulation of Calcium/ Hemostasis:

• Calcium level is regulated by

Calcitriol

• It is the active form of vitamin D

Calcium homeostasis Mechanism:

• It also promotes calcification and remodeling of bone.

2. Parathyroid hormones

• Secreted by Parathyroid glands

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Calcium Homeostasis Mechanism:

Question 4. Hypoglycemia-clinical features and management

Answer:

Hypoglycaemia

• It is defined as a fall in blood glucose concentration below 3.1 mmol/1

Hypoglycaemia Clinical Features:

1. CVS symptoms
   • Palpitation
   • Tachycardia
   • Anxiety
   • Cardiac arrhythmias
2. CNS symptoms
   • Tremors
   • Confusion
   • Headache
   • Tiredness
   • Difficulty in concentration
   • Slurred speech
   • Drowsiness
   • Convulsion
   • Coma
3. GIT symptoms
   • Nausea
   • Vomiting
4. Dermatological symptoms
   • Sweating
   • Hypothermia

Hypoglycaemia Management:

1. In unconscious patients
   • Stop anti-diabetic medication
   • Administer 50 ml of 50% intravenous glucose
   • Intramuscular injection of 1 ml of glucagon
2. Unconscious patients
   • Oral glucose intake
3. In severe cases
   • 1 mg glucagon subcutaneously or intramuscularly and repeated if necessary after 10 minutes

Question 5. Neurological complications of diabetes mellitus

Answer:

Neurological complications of diabetes mellitus

• Diabetes can involve any part of the nervous system except the brain
• Precipitating factors

1. Poor glycaemic control
2. Long control of diabetes

Pathological Changes:

• Axonal degeneration of myelinated and nonmyelinated fibers
• Patchy, segmental demyelination
• Vasculopathy

Question 6. Grave’s disease

Answer:

Grave’s disease

• Grave’s disease is a diffuse goiter affecting the whole functioning thyroid tissue causing hypertrophy and hyperplasia due to abnormal thyroid stimulants

Grave’s Disease Clinical Features

• It is a classical triad composed of

1. Goitre
   • Diffuse and symmetric enlargement of thyroid
   • The gland surface is smooth
   • Bruit is heard
2. Thyrotoxicosis
   • Excitability
   • Restlessness
   • Emotionally unstable
   • Insomnia
   • Muscle weakness
   • Fatigue
   • Myopathy
   • Heat intolerance
   • Increased sweating
   • Weight loss
   • Tachycardia
   • Palpitation
   • Increased cardiac output
   • Gynaecomastia
   • Increased libido
   • Pretibial myxoedema
3. Exophthalmos
   • Protrusion of eyeballs

Grave’s Disease Treatment:

1. Anti-thyroid drugs
   • To restore the patient to the euthyroid state
2. Radioactive iodine
   • It destroys thyroid cells and reduces the mass of thyroid-functioning tissue
3. Surgery
   • Reduce active thyroid mass

Question 7. Acromegaly- clinical features and complications

Answer:

Acromegaly:

• Acromegaly occurs due to excess secretion of GH later in life after epiphyseal closure

Acromegaly Clinical Features:

• Thick bones-larger hands and feet
• Enlarged skull
• Increased intracranial pressure
• Headache
• Photophobia
• Visual disturbances
• Hepatomegaly
• Cardiomegaly
• Osteoporosis
• Arthralgia
• Excessive sweating
• Myalgia
• Bowing of legs
• Barrel shaped chest

Acromegaly Oral Manifestations:

• Enlarged mandible
• Class 3 malocclusion
• Macroglossia D Thick lips
• Proclination of teeth
• Hypercementosis
• Large nose, ears, and prominent eyebrows
• Periodontitis
• Enlargement of maxillary air sinuses

Acromegaly Complications:

• High blood pressure (hypertension)
• Cardiovascular disease, particularly enlargement of the heart (Cardiomyopathy)
• Osteoarthritis
• Diabetes mellitus
• Precancerous growths (polyps) on the lining of your colon
• Sleep apnea is a condition in which breathing repeatedly stops and starts during sleep
• Carpal tunnel syndrome
• Reduced secretion of other pituitary hormones (hypopituitarism)
• Uterine fibroids, benign tumors in the uterus
• Spinal cord compression
• Vision loss

Question 8. Addison’s disease

Answer:

Addison’s disease

• It is due to progressive destruction of the three zones of the adrenal cortex and medulla with lymphatic infiltration

Addison’s Disease Clinical Features:

1. Glucocorticoid insufficiency
   • Weight loss
   • Nausea and vomiting
   • Malaise
   • Weakness
   • Anorexia
   • Diarrhea
   • Constipation
   • Postural hypotension
   • Hypoglycaemia
2. Mineralocorticoid deficiency
   • Hypotension
3. Loss of androgens
   • Reduction of pubic and axillary hair in females
4. Increased ACTH secretion
   • Pigmentation of exposed areas, pressure areas, mucous membranes, conjunctivae, and recently acquired scars

Question 9. Diabetes and surgery

Answer:

Diabetes and surgery

• Patients with diabetes need to maintain very good oral hygiene as they are prone to odontogenic, periodontal, and other infections
• In well-controlled diabetics, dental procedures generally do not require any special precautions
• Antibiotic coverage may be required
• In uncontrolled diabetics, infections and wound healing may be a problem even after minor procedures
• If major dental procedures or surgery is to be undertaken, prior control of diabetes by the physician is needed
• If the patient is on only oral antihyperglycemic drugs, he should start insulin
• Dental procedures may often reduce food intake and diabetics may go to hypoglycemia
• Dose adjustments may be required

Question 10. Gestational diabetes mellitus

Answer:

Gestational diabetes mellitus

• It is defined as glucose intolerance that develops during pregnancy and usually cures after delivery
• Persons affected are

1. Older women
2. Obese/overweight women
3. Women with a history of delivering large babies
4. Women with a history of gestational diabetes

Gestational Diabetes Mellitus Diagnosis:

• All women during pregnane}7 should be screened based on random blood sugar tests in each trimester
• 50 mg oral glucose is administered and serum glucose is measured at 60 min
• If the glucose level is less than 140 mg, it is normal if not then the following step is taken
• 100 mg of glucose is administered and glucose in the fasting state is measured at 1,2 and 3 hours
• Deviation from normal levels indicates gestational diabetes

Normal Values:

Question 11. Cushing’s syndrome

Answer:

Cushing’s syndrome

• Cushing’s syndrome is caused by increased plasma glucocorticoid levels due to enhanced production of cortisol

Cushing’s Syndrome Clinical Features:

• Age- common in 3rd and 4th decades of life
• Females are more affected
• Obesity
• Truncal fullness
• Moon facies
• Buffalo hump
• Purple striae are seen on the abdomen
• Oligomenorrhoea and amenorrhoea
• Impotence in males
• Elevated blood pressure
• Muscle weakness
• Bone pain
• Decreased glucose tolerance

Cushing’s Syndrome Investigations:

• Screening test
• Determine free cortisol in urine
• Plasma ACTH measurement
• Plasma ACTH levels of more than 200-500 Pg per ml indicate Cushing’s syndrome
• Dexamethasone suppression test
• Plasma values above 5 microgram/100 ml suggest Cushing’s syndrome

Cushing’s Syndrome Treatment:

• Medical treatment
• Metyrapone- dose- 2-6 g per day in divided dose
• Aminoglutethimide-1-2 g per day
• Surgical treatment
• Pituitary irradiation
• Adrenalectomy

Question 12. Eye signs on thyrotoxicosis

Answer:

Eye signs on thyrotoxicosis

1. Exophthalmos
   • It means protrusion of the eyeball
2. Spasm of the upper eyelid with lid retraction
3. Proptosis with widening of the palpebral fissure
4. Supraorbital and infraorbital swelling
5. Congestion, edema, and chemosis of the conjunctiva
6. Papilloedema
7. Corneal ulceration
8. External ophthalmoplegia
9. Weakness of the extrinsic ocular muscles
10. Other signs
    • Von Giraffe’s sign
      • When the patient is asked to look down, his upper eyelid fails to follow the rotation of the eyeball and thus lags behind
    • Joffroy’s sign
      • When the patient is asked to look upwards with the head fixed, there will be the absence of wrinkling on the forehead
    • Moebius sign
      • Failure of convergence of eyeballs
    • Dalrymple’s sign
      • Upper sclera is seen due to retraction of the upper eyelid
    • Stellwag’s sign
      • Absence of normal blinking

Question 1. Describe the etiology, clinical features, and management of tetanus.

Answer:

Tetanus:

• It is a disorder of neuromuscular excitability

Etiology:

• It is caused by exotoxin, tetanospasmin liberated by clostridium tetani

Etiology Clinical Features:

• Trismus
• Dysphagia
• Risussardonicus- in it eyebrows and corners of the mouth are drawn up due to spasms of the muscles of the face and jaw
• Opisthotonus- rigidity of the muscles of the neck and trunk
• Elevation of temperature
• Rapid pulse
• Cyanosis

Etiology Types:

1. Acute tetanus
   • The incubation period is less than 10 days
2. Chronic tetanus
   • The incubation period is about a month
3. Delayed tetanus or latent tetanus
   • In it organism remains latent for many years
4. Local tetanus
   • There is the presence of local contraction of muscles
5. Cephalic tetanus
   • There is irritation or paralysis of the cranial nerves
6. Bulbar tetanus
   • There is an extensive spasm of the muscles of deglutition and respiration
7. Late tetanus
   • The inoculation period is prolonged
8. Tetanus neonatorum
   • Recurrent tetanus

Etiology Management:

1. Passive immunization
   • 1 Lac units of Anti-tetanus serum is given half intravenously and half intramuscularly
2. Antibiotics
   • Penicillin injection of 10 lac units every 4 hours
   • Metronidazole
   • Tetracycline
3. Wound care
   • Thorough cleansing and debridement
   • Removal of all necrotic tissues and foreign bodies
   • All stitches are removed
   • Blood clots, foreign bodies, and pus are cleared
   • The wound should be left open
4. The patient is isolated to a quiet, dark, and well-ventilated room
5. Further treatment depends on the severity of the cases
   • In mild cases
     • Prozac in -200 mg IM
     • Barbiturate, amylobarbitone, or injection diazepam-5-40 mg 4 times in a day
   • In moderate cases
     • Passage of nasogastric tube for feeding
     • Passage of self-retaining catheter to drain the bladder
     • Administration of intravenous fluid
     • Maintenance of intake and output chart
     • Tracheostomy
   • In very severe cases
     • Use of muscle relaxant, 40 mg turbo- marine initially 4 and then IM injections
     • Tracheostomy
     • Sedation with pentothal sodium
     • Nasogastric feeding
     • Elimination of visceral stimuli
     • Intravenous administration of fluid and electrolytes
     • Constant nursing

Question 2. Describe the etiology and clinical features of acromegaly with special experience in dental problems.

Answer:

Acromegaly:

• Acromegaly occurs due to excess secretion of GH later in life after epiphyseal closure

Etiology:

• Pituitary adenoma
• Pancreatic islet cell tumors
• Hypothalamic tumors
• Bronchial carcinoid
• Small cell carcinoma of Hung

Acromegaly Clinical Features:

• Thick bones-larger hands and feet
• Enlarged skull
• Increased intracranial pressure
• Headache
• Photophobia
• Visual disturbances
• Hepatomegaly

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• Cardiomegaly
• Osteoporosis
• Arthralgia
• Excessive sweating
• Myalgia
• Bowing of legs
• Barrel shaped chest

Acromegaly Oral Manifestations:

• Enlarged mandible
• Class 3 malocclusion
• Macroglossia
• Thick lips
• Proclination of teeth
• Hypercementosis
• Large nose, ears, and prominent eyebrows
• Periodontitis
• Enlargement of maxillary air sinuses

Question 3. Enumerate the proliferating factors, pathogenesis, investigations, and management of diabetic ketoacidosis.

Answer:

Diabetic Ketoacidosis:

• It is a complication of diabetes mellitus

Diabetic Ketoacidosis Proliferating Factors:

• Undetected or undiagnosed type 1 diabetes
• Stress
• Infection

Diabetic Ketoacidosis Pathogenesis:

Diabetic Ketoacidosis Investigations:

• Diabetic ketoacidosis is confirmed by
  1. Hyperglycaemia
  2. Ketonaemia
  3. 1 leavy ketonuria
  4. Acidosis

Diabetic Ketoacidosis Management:

1. Correction of hyperglycemia
   • Administration of regular insulin 0.1 U/k bolus followed by 0.1 U/kg/ hour by ccontnousIV infusion till the patient recovers
2. Correction of dehydration
   • Normal saline infusion of 1 liter in the first hour
   • Then 1 litre over the next 4 hours
   • Then quantity is titrated
3. Correction of acidosis
   • Use of sodium bicarbonate
4. Potassium
   • 10-20 mEq/hour potassium chloride is added to the drip for rapid correction of hyperglycemia

Question 4. Classify diabetes mellitus. Discuss the complications and management of diabetes mellitus

Answer:

Diabetes mellitus

• Diabetes mellitus is defined as a heterogeneous metabolic disorder characterized by the common feature of chronic hyperglycemia with disturbance of carbohydrate, fat, and protein metabolism

Diabetes Mellitus Classification:

1. Primary diabetes
   • Type 1- IInsulin-dependentdiabete mellitus
     • IImmunemediated
     • Nonimmune mediated
   • Type 2- NNoninsulin-dependentdiabetes mellitus
     • Obese
     • Non-obese
2. Secondary diabetes
   • Pancreatic diabetes
   • Hormonal or endocrinal abnormalities
   • DDrug-inducedInsulin receptors antibodies
   • Genetic syndromes

Diabetes Mellitus Complications:

1. Acute metabolic complications
   • Diabetic ketoacidosis
     • Develop in patients with severe insulin deficiency
     • Clinical Features:
       • Nausea, vomiting, anorexia
       • Deep and fast breathing
       • Mental confusion
       • Coma
   • Hyperosmolar hyperglycaemia nonketotic coma
     • It is a complication of type 2 diabetes mellitus
     • Caused by severe dehydration which leads to sustained hyperglycemia diuresis
     • Clinical Features:
       • High blood sugar
       • High plasma osmolality
       • Thrombotic and bleeding complications
   • Hypoglycaemia
     • Develop in type 1 diabetes mellitus
     • Clinical Features:
       • Permanent brain damage
       • Worsening of diabetic control
       • Rebound hyperglycaemia
2. Late systemic complications
   • Atherosclerosis
     • Common in both type 1 and type 2 diabetes mellitus
     • Atherosclerosis may lead to
       • Myocardial infarction
       • Cerebral stroke
       • Gangrene of toes and feet
   • Diabetic microangiopathy
     • It is the abasementmembrane thickening of small blood vessels and capillaries of different organs and tissues
     • Occurs due to increased glycosylation of hemoglobin and other proteins
   • Diabetic nephropathy
     • It is a severe complication of diabetes mellitus
     • Occurs in both types
     • Features:
       • Asymptomatic proteinuria
       • Nephrotic syndrome
       • Progressive
       • Renal failure
       • Hypertension
   • Diabetic neuropathy
     • Effects all parts of the nervous system
   • Diabetic retinopathy
     • It is the cause of blindness
     • Other retinal complications include
       • Glaucoma
       • Cataract
       • Corneal disease
   • Infections
     • Diabetic patients are more susceptible to infections like tuberculosis, pyelonephritis, otitis, carbuncles and diabetic ulcers

Diabetes Mellitus Management:

1. Diet management
   • The daily energy requirement for an individual is calculated according to age, weight, height, and activity
   • Calorie requirement:
     • For men- 36 kcal/kg
     • For women-34 kcal/kg
2. Lifestyle modification
   • Physical exercise
   • Reduction of weight
   • Avoid alcohol and smoking
   • Behavioural exercises
3. Oral hypoglycaemic drugs
   • Sulphonylureas
   • Meglitinides
   • Biguanides
   • Thiazolidinedione derivatives
   • Alpha-glucosidase inhibitors
4. Insulin

Question 5. Discuss the complication of systemic ccorticosteroidtherapy with special reference to dental practice

Answer:

Complications of Systemic Corticosteroids:

1. Metabolic effects
   • Mood changes from euphoria to depression
   • Fluid retention and edema
   • Hypertension
   • Glucose intolerance
   • Osteoporosis
   • Increased susceptibility to infection
   • Reactivation of latent tuberculosis
   • Impaired wound healing
   • Gastric erosions
   • Masked perforation
   • HHemorrhagefrom stomach and duodenum
2. Suppression of hypothalamic-pituitary-adrenal axis
   • It occurs with high-dose therapy
   • This makes it difficult to withdraw steroids

Measures to Reduce Side Effects:

• Use of the lowest possible dose
• Administer on alternate days rather than daily
• Use of morning dose rather than any other time
• Use of steroids for established cases
• Monitor caloric intake to prevent weight gain and reduce sodium intake
• Use of H2 receptor blockers or proton pump inhibitors
• Provide high calcium intake and vitamin D

Question 6. Outline the conditions wthatproduce pigmentation of oral mucosa. Discuss the clinical features of Addison’s disease.

Answer:

Causes of Oral Pigmentation:

• Autoimmune adrenalitis
• Tubcrculousadrenalitis
• Bilateral adrenalectomy
• Drugs-ketoconazole
• Metastases in the adrenal
• Haemochromatosis
• Amyloidosis
• Histoplasmosis

Addison’s Disease:

• It is due to progressive destruction of the three zones of the adrenal cortex and medulla with lymphatic infiltration

Oral Pigmentation Clinical Features:

1. Glucocorticoid insufficiency
   • Weight loss
   • Nausea and vomiting
   • Malaise
   • Weakness
   • Anorexia
   • Diarrhea
   • Constipation
   • Postural hypotension
   • Hypoglycaemia
2. Mineralocorticoid deficiency
   • Hypotension
3. Loss of aandrogensReduction of pubic and axillary hair in females
4. Increased ACTH secretion
   • Pigmentation of exposed areas, pressure areas, mucous membranes, conjunctivae, and recently acquired scars

Question 7. Define hypo- and hyperthyroidism. Discuss clinical features, investigations, and treatment of hypothyroidism.

Answer:

Hyperthyroidism Definition:

1. Hypothyroidism
   • It is a clinical condition caused by low levels of circulating thyroid hormones
2. Hyperthyroidism
   • It is a clinical syndrome that results from exposure of the body tissues to excess circulating free thyroid hormones

Hypothyroidism Clinical Features:

1. In new bom
   • Cretinism
   • Mental retardation
   • Poor growth
   • Difficult to nurse a baby
   • Dwarfism
2. During childhood or adolescence
   • Juvenile hypothyroidism
   • Child appears young
   • Mental deficiency
   • Abdominal distension
   • Umbilical hernia
   • Prolapse of rectum
3. In adults
   • Fatigue
   • Weight gain
   • Skin becomes thickened and puffy
   • Muscle cramps
   • Paraesthesia
   • Impaired speech
   • Reduced cardiac output
   • Elevation of blood pressure
   • Shortness of breath
   • Abdominal distension
   • Aches and pains
   • Anaemia
   • Alopecia
   • Menorrhagia, infertility
   • Constipation

Hypothyroidism Investigations:

• Serum T3 and T4 levels- low
• Serum TSH- high
• Thyroid peroxidase antibodies- present
• Serum cholesterol triglyceride- high
• ECG- shows bradycardia, low amplitude of QRS, and ST-T changes
• Blood- macrocytic anemia
• X-ray chest- shows cardiomegaly
• Photomtogram- delayed ankle jerk

Hypothyroidism Treatment:

• Replacement of thyroid hormones by L-thyroxine
• Initial starting dose-50-100 micrograms daily as a single dose empty stomach in the morning for the first 3-4 weeks
• The dose is increased to 150 micrograms daily
• The maximum dose is 300 micrograms in a day
• In older persons or persons with ischaemic heart disease, a low dose of L-thyroxine 25 microgram/day is started and gradually increased

Question 8. Discuss the etiology, clinical features, and management of thyrotoxicosis. Mention a note on thyroid function tests

Answer:

Thyrotoxicosis is a syndrome resulting from an increased level of free thyroxin

Thyrotoxicosis Clinical Features

• Hyperactivity
• Irritability
• Heat intolerance
• Palpitations
• Fatigue
• Weakness
• Weight loss
• Increased appetite
• Tachycardia
• Systolic hypertension
• Presence of tremors
• Cardiac arrhythmias
• Excessive sweating
• Exophthalmos

Thyrotoxicosis Management:

1. General management
   • Rest
   • Nutritious diet
2. Drug therapy
   • Carbimazole
   • Initial dose of 30 nag/ day, maintenance dose of 10-20 mg/day is given
   • Potassium perchlorate – 800 nag/day in divided doses
   • Sodium or potassium iodide 6-10 nag/day
3. Surgical treatment
   • Subtotal thyroidectomy
4. Radioiodine treatment
   • Iodine is given in ddosesof 8-10 millicuries

Thyroid Function Tests:

1. Measurement of radioactive iodine uptake
   • The normal value is 30%
   • Higher values indicate thyrotoxicosis
   • It is no longer used because of
     • Lack of sensitivity
     • Lack of specificity
     • Time-consuming
     • Complicated procedures
2. Measurement of total T3 and T4 in blood by radioimmunoassay
   • Widely used
   • Normal Values:
     • Serum T3 total- 70-200 ng/1
     • Serum T4 total- 5.5-13.5 microgram/1
   • Drawbacks:
     • Measure the total amount of hormone
     • Gets changed with the fluctuations in their binding protein
3. Measurement of free T3 and T4 in blood
   • NORMAL VALUES
   • Serum free T3-1-2.6 nmol/1
   • Serum free T4-10-27 nmol/1
4. Estimation of TSH
   • Normal value- 0.15-3.5 mIU/1
   • High levels of ooccurin primary hypothyroidism
   • Low levels ooccurin hyperthyroidism and hypopituitarism
5. Ultrasound of thyroid
   • Measure the size and mass of the thyroid
   • Detects shape and nodularity of thyroid
6. Thyroid scan
   • It is used to detect functioning and nonfunctioning nodules in the thyroid
   • I¹³¹ or ^99mTc is used for
7. Antithyroid antibodies
   • Detects autoimmune thyroid disorders
   • Stimulating antibodies and TSH receptor-blocking antibodies are raised in Grave’s disease
8. Needle biopsy of thyroid
   • Detects malignancy

Question 9. Discuss ethe tiology, clinical features, and management of myxoedema

Answer:

Myxoedema:

• Myxoedema indicates severe hypothyroidism

Etiology:

1. Primary causes
   • Spontaneous atrophic hypothyroidism
   • Iodine deficiency
   • Following 1131 therapy
   • Post thyroidectomy
   • Hashimoto’s thyroiditis
   • Radiation
2. Secondary causes
   • Destruction of the pituitary gland
   • Post-surgery
   • Post radiation
   • Tumour
   • Disorders of hypothalamus

Myxoedema Clinical Features:

1. General symptoms
   • Age and sex- Middle-aged males are frequently affected
   • Weakness
   • Fatigue
   • Lethargy
   • Low blood pressure
   • Mental retardation
   • Dry coarse skin
   • Swelling of the face and extremities
   • Cold intolerance
   • Husky voice
   • Decreased sweating
   • Anorexia
   • Loss of memory
   • Hearing impairment
   • Arthralgia
   • Muscle cramps
   • Paraesthesia
2. Oral manifestations
   • Peri-orbital puffiness
   • Loss of facial hair
   • Swollen tongue, lips, and eyelids
   • Difficulty in speech
   • Underdevelopment of maxilla and mandible

Myxoedema Management:

• Replacement of thyroid hormones by L-thyroxine
• Initial starting dose-50-100 micrograms daily as a single dose empty stomach in the morning for the first 3-4 weeks
• The dose is increased to 150 micrograms daily the maximum dose is 300 micrograms every day
• In older persons or persons with ischaemic heart disease, a low dose of L-thyroxine 25 microgram/day is started and gradually increased

Question 10. Describe etiology, clinical features, diagnosis, and treatment of hyperthyroidism.

Answer:

Hyperthyroidism:

• It is a clinical syndrome that results from exposure of the body tissues to excess of circulating free thyroid hormones

Etiology:

1. Common
   • Grave’s disease
   • Toxic nodular goitre
     • Multinodular
     • Solitary nodule
2. Less common
   • Thyroiditis
   • Drug-induced
   • Self-induced
   • Iodine excess
3. Rare causes
   • Pituitary or ectopic TSH
   • Thyroid carcinoma

Hyperthyroidism Clinical Features:

1. Goitre
2. Gastrointestinal symptoms
   • Weight loss
   • Diarrhea
   • Vomiting
3. Cardiovascular symptoms
   • Sinus tachycardia
   • Exertional dyspnoea
   • Arrhythmias
   • Precipitation of angina
4. Neuromuscular symptoms
   • Nervousness, irritability
   • Restlessness
   • Tremors of hands
   • Muscular weakness
   • Exaggerated tendon reflexes
5. Dermatological symptoms
   • Increased sweating
   • Clubbing of fingers
   • Loss of hairs
   • Redness of palms
6. Reproductive symptoms
   • Menstrual irregularity
   • Abortions
   • Infertility
   • Loss of libido
7. Ophthalmological
   • Lid retraction
   • Wide palpebral fissures
   • Exophthalmos
   • Diplopia
   • Excessive watering of eyes
8. Miscellaneous
   • Heat intolerance
   • Excessive thirst
   • Fatigue
9. Oral manifestations
   • Early exfoliation of deciduous teeth
   • Premature eruption of permanent teeth
   • Alveolar bone atrophy
   • Increased susceptibility to oral infections

Hyperthyroidism Diagnosis:

• T3 and T4 levels- elevated
• TSH levels- low
• ¹³¹I uptake is increased
• Serum cholesterol level- low
• ECG changes- shows tachycardia, arrhythmias, ST- T changes
• USG- shows diffuse goitre
• Increased BMR
• Decreased urinary excretion of iodine

Hyperthyroidism Treatment:

1. Drug therapy
   • Anti-thyroid drugs
     • Carbimazole
     • Propylthiouracil -100-150 mg
   • Beta-blockers
     • Propanolol-80-160 mg daily
     • Metoprolol-50 mg/ day
2. Radioactive ablation of thyroid
3. Subtotal thyroidectomy
4. Treatment of relapse
   • Long-term drug therapy is used
   • Radioactive iodine therapy
5. Management of ophthalmopathy
   • Use of 60 mg of prednisolone daily
6. Management of dermopathy
   • Local betamethasone ointment or triamcinolone injection may be used

Question 11. What are the causes of hypocalcemia? Describe clinical features and outline the treatment of tetany

Answer:

Hypocalcaemia:

• It is a condition of low levels of calcium

Causes Of Hypocalcaemia:

• Sepsis
• Burns
• Acute pancreatitis
• Acute renal failure
• Alkalosis
• Drugs like diuretics, protamine, heparin, and glucagon
• Toxic shock syndrome
• Hypomagnesaemia
• Plasmapheresis
• Extensive transfusion
• Malignancy

Tetany:

• It is a clinical condition characterized by low levels of ionized calcium leading to increased neuromuscular excitability

Tetany Clinical Features:

1. In children
   • Characteristic triad- carpopedal spasm, stridor and convulsion
   • Carpopedal spasm- flexion at metacarpophalangeal joints and extension at interphase- large joints wwithotherposition of the thumb
   • Stridor- closure of the glottis
2. In adults
   • Tingling sensation in peripheral parts of limbs or around the mouth
   • Painful carpopedal spasm
   • Rarely stridor and convulsions
3. Signs
   • Trousseau’s sign
     • Raising the blood pressure above systolic level by inflation of the sphygmomanometer cuff produces carpal spasm within 3-5 minutes
   • Chvostek’s sign
     • A tap at the facial nerve at an angle of the aw produces twitching of facial muscles

Tetany Treatment:

1. Treatment of hypocalcemia
   • Injection of 20 ml of 10% calcium gluconate
2. Treatment of alkalosis
   • Intravenous administration of isotonic saline
   • Withdrawal of alkalies
   • Inhalation of 5% CO₂in oxygen- to treat hyperventilation
   • Psychotherapy

 

Diseases Of The Kidneys And Genitourinary System Important Notes

1. Rennin
   • It is an enzyme released from the chief cells of fundic glands of the stomach
   • It is milk milk-curdling enzyme
   • It is absent in man
2. Polyuria is seen in
   • Hypercalcemia
   • Glycosuria
   • Hypokalemia
3. Acute nephritic syndrome
   1. It is characterized by sudden onset of renal failure and oliguria
   2. Renal blood flow and glomerular filtration rate falls
4. Nephritic syndrome
   • It is characterized by protein loss in the urine of more than 3.5 g proteinuria/day, fluid retention or edema, hypercoagulability, hypercholesterolemia, and infections
   • Clinical features
     • Splenomegaly
     • Ascites
     • Varices and collateral vessel formation
5. Urine examination
   • Discoloration of urine

Diseases Of The Kidneys And Genitourinary System Long Essays

Question 1. Write about pathogenesis and treatment of acute glomerulonephritis.
(or)
Mention etiology, clinical features, complications, diagnosis, and management of acute glomerulonephritis.
(or)
A young person develops sudden facial puffiness. How do you investigate a case of acute glomerulonephritis, outline complications and treatment?
(or)
What are the causes and management of glomerulonephritis?
(or)
Describe the etiology, clinical features, complications, investigations, and management of acute nephritis.
(or)
Define acute nephritic syndrome. Discuss the clinical features and treatment of post-streptococcal acute glomerulonephritis.

Answer:

Glomerulonephritis/Acute Nephritis:

• It is an inflammation of the glomeruli and to a lesser extent the tubules of the kidney

Acute Nephritis Causes:

1. Infectious diseases
   • Post-streptococcal glomerulonephritis
   • Non-streptococcal glomerulonephritis
     • Bacterial
       • Infective endocarditis
       • Staphylococcal and pneumococcal infections
     • Viral
       • Hepatitis B
       • Infectious mononucleosis
     • Parasitic
       • Malaria
2. Systemic disorders
   • Systemic lupus erythematosus
   • Vasculitis
3. Primary glomerular diseases
   • Mesangiocapillary glomerulonephritis
4. Miscellaneous
   • Serum sickness
   • IgA nephropathy

Pathogenesis:

Acute Nephritis Clinical Features:

Acute Nephritis Complications:

• Hypertensive encephalopathy
• Pulmonary edema
• Uraemiaete

Read And Learn More: General Medicine Question and Answers

Acute Nephritis Diagnosis:

Acute Nephritis Management:

1. Bed rest
   • To improve acute symptoms
2. Diet
   • Restriction on dietary protein, sodium, and potassium intake
   • Restriction on fluid intake
3. Treatment of infection
   • Procaine penicillin IM for 6 days is used to treat streptococcal infections
4. Treatment of hypertension
   • Diuretics are used
   • Enalapril 2.5-10 mg daily is used
5. Dialysis
   • Required if there is presence of fluid overload

Acute Nephritic Syndrome or Acute Glomerulonephritis:

• It is an inflammation of the lomeruli and to la esser extent the tubules of the kidney

Post Streptococcal Acute Glomerulonephritis:

• It follows an acute streptococcal infection of the throat or skin

Question 2. Describe clinical features, diagnosis, and management of nephrotic syndrome.
(or)
Definenephroticc syndrome. Describe clinical features, investigations, and treatment of nephrotic syndrome.
(or)
Describe ethe tiology, clinical features, investigations, and management of the nephrotic syndrome.
(or)
Mention the causes of nephrotic syndrome. Describe clinical features, diagnosis, and treatment.

Answer:

Nephrotic Syndrome:

Nephrotic Syndrome Definition:

• It refers to massive proteinuria of ore than 3.5 g/day mainly of albumin, reduced albumin concentration, edema, hhyperlipidemia lipiduria, and hypercoagulability

Nephrotic Syndrome Causes:

1. Primary renal disorders
   • Minimal lesion
   • Membranous glomerulonephritis
   • Mesangioproliferative glomerulonephritis
   • Focal glomerulosclerosis
2. Secondary nephrotic syndrome
   • Infections- malaria
   • Following hepatitis B infection
   • Complication of infective endocarditis
   • Syphilis
   • Following collagen disease
   • Metabolic diseases- diabetes mellitus
   • Hereditary
   • Drugs- Gold, mercury, penicillamine, captopril, antitoxins

Nephrotic Syndrome Clinical Features:

• Edema-puffiness of eyelids or periorbital edema
• Generalised anasarca
• Ascites
• Bilateral pleural effusion
• Pulmonary edema
• Fever due to infection
• Arterial and venous thrombosis
• Pulmonary embolism
• Renal vein thrombosis
• Hypertension
• Hematuria

Nephrotic Syndrome Diagnosis:

Nephrotic Syndrome Management:

1. Relief of edema
   • Restriction of salt
   • Use of diuretics
   • Frusemide-80-120 mg/ daily
   • In severe cases ,salt-free albumin- 20 g in 100 ml in 1 hour or plasma albumin intravenous infusion is used
2. Control of proteinuria
   • ACE inhibitors, angiotensin receptor blockers, and NSAIDs are used
3. Treatment of hyperlipidemia
   • Lipid-lowering agent, atorvastatin 20 mg is used
4. Immunosuppressive therapy
   • Corticosteroids are given for 6-8 weeks at the dose of 1 mg/ kg daily
5. Control of infection
   • Antibiotics like cephalexin iareused
6. Anti-coagulants

Diseases Of The Kidneys And Genitourinary System Short Essays

Question 1. Uraemia

Answer:

Uraemia

• Uremia is a clinical state in which the blood urea nitrogen level, an indicator of nitrogen waste products, is elevated.

Uraemia Clinical Features:

• Confusion,
• Loss of consciousness,
• Low urine production,
• Dry mouth,
• Fatigue,
• Weakness,
• Pale skin or pallor,
• Bleeding problems,
• Rapid heart rate (tachycardia),
• Edema (swelling), and
• Excessive thirst.
• Uremia may also be painful.

Uraemia Treatment:

• Immediate treatment for uremia (within the first 24 hours after diagnosis) is needed to stabilize the patient and address the cause of uremia. Immediate treatment for uremia may include:
  • Blood products
  • Blood transfusions
  • Fluid therapy
  • Hemodialysis (Filtering blood outside the body)
  • Hospitalization
  • Intravenous fluid
  • Medication to increase blood pressure and cardiac output such as dopamine
• Ongoinguremia treatment
• Long-term treatment for uremia may include:
  • Dialysis
  • Dietary modification
  • Medication

Uraemia Complications:

• Complications of uremia include:
  • Anemia
  • Bleeding disorders (delayed blood clotting, platelet dysfunction)
  • Cardiac arrest
  • Fragile bones
  • Kidney failure
  • Malnutrition
  • Respiratory failure
  • Sexual dysfunction

Question 2. Proteinuria

Answer:

Proteinuria

• Urine containing more than 150 mg of proteins is called proteinuria

Proteinuria Tests:

• Heat coagulation method
• Electrophoresis of proteins
• Dipstick test
• Immunoelectrophoresis
• Radioimmunoassay

Etiopathogenesis:

1. Tubular proteinuria
   • Produces damage more to tubules than to glomeruli
   • Urine contains more than 1-3 g/day of proteins
2. Glomerular proteinuria
   • Glomerular injury occurs
   • Albuminuria occurs
3. Asymptomatic proteinuria
   • Common in younger individuals
   • It is postural or exercise-induced
   • There is presence of hypertension, haematuria, and impaired renal function
4. Orthostatic proteinuria
   • Persons passa an amount of proteins in the urine during the day assuming an  upright posture
5. Microalbuminuria
   • Contains 30-300 mg/ day albumin in urine
6. Bence-Jones proteinuria
   • Contains Bences Jonces proteins in urine
   • Identified by immunoelectrophoresis of urine

Question 3. Diuretics

Answer:

Diuretics

• Drugs that increase urine and solute excretion causing loss of sodium and water from the body are called diuretics.

Diuretics Classification:

1. High efficacy or loop diuretics Furosemide, Bumetanide, Torasemide
2. Medium efficacy diuretics
   • Benzothiadiazine or thiazides Hydrochlorothiazide, Benzthiazide
   • Thiazides like drugs Chlorthalidone, Metolazone
3. Low efficacy or weak diuretics
   • Carbonic anhydrase inhibitors Acetazolamide
   • Potassium-sparing diuretics Aldosterone antagonist- spironolactone Inhibitors of renal epithelial sodium channel- Triamterene, amiloride
   • Osmotic diuretics Mannitol, isosorbide, Glycerol

Question 4. Management of renal colic

Answer:

Management of renal colic

• Treatment for renal colic and kidney stones involves reducing pain and breaking up the stones.
• In some cases, kidney stones may pass on their own, allowing symptoms of renal colic to resolve.
• However, it is common for kidney stones to recur.
• Drinking plenty of fluids may help the stone to pass and may lessen the pain of renal colic.

Renal Colic Medications Used Are:

• Allopurinol (for uric acid kidney stones)
• Alpha-blocker medications to help stones pass
• Antibiotics to clear infections
• Cystine control medications to reduce cystine levels in urine
• Diuretics
• Pain medications
• Potassium citrate or sodium bicarbonate regulates urine pH and ppreventsstone formation
• Sodium cellulose phosphate to bind calcium in the intestine
• Other treatments for renal colic
• Heat therapy (For pain)
• Lithotripsy (Use of ultrasonic vibration to break down kidney stones)
• Surgery to remove large stones
• Ureteral stent placement, to keep the urine tubes from the kidneys to the bladder (Ureters) open
• Ureteroscopy (Minimally invasive surgery)

Diseases Of The Kidneys And Genitourinary System Short Answers

Question 1. Frusemlde

Answer:

Frusemlde

• It is high efficacy’- diuretics

Frusemlde Uses:

• Edema
• Hypertension
• Forced diuresis
• Hypercalcaemia
• Renal stones
• During blood transfusions

Frusemlde Adverse Effects:

• Acute salt depletion
• Hepatic coma
• Photosensitivity
• Headache
• Giddiness
• Nausea, vomiting
• Paresthesia, impotence

Question 2. Renal colic

Answer:

Renal colic Clinical Features

• Pain, especially in the back, side, or groin;
• Blood in the urine; abnormally colored urine;
• Fever;
• chills; and
• Nausea with or without vomiting.

Renal colic Causes:

• Bowel disease
• Surgery
• Genetics
• Certain dietary’ factors, or
• Diseases, such as ccystinuria

Question 3. Haematuria

Answer:

Haematuria Causes:

1. Renal disorders
   • Trauma
   • Glomerular disease
   • Carcinoma
2. Extrarenal disorders
   • Trauma
   • Injections
   • Urethritis
   • Prostatitis
3. Systemic disorders
   • Vasculitis
   • Bleeding diseases

Question 4. Trace elements

Answer:

Trace elements

Question 5. Nephrotic syndrome

Answer:

Nephrotic syndrome Definition:

• It refers to massive proteinuria mof ore than 3.5 g/ day mainly of albumin, reduced albumin concentration, oedema hyperlipidemia, lipiduria, and hypercoagulability

Nephrotic syndrome Clinical Features:

• Edema-puffiness of eyelids or periorbital edema
• Generalised anasarca
• Ascites
• Bilateral pleural effusion n Pulmonary edema
• Fever due to infection
• Arterial and venous thrombosis
• Pulmonary embolism
• Renal vein thrombosis
• Hypertension
• Hematuria

Question 6. Uraemia

Answer:

Uraemia

• Uremia is a clinical state in which the blood urea nitrogen level, an indicator of nitrogen waste products, is elevated.

Uraemia Clinical Features:

• Confusion
• Loss of consciousness
• Low urine production
• Dry mouth
• Fatigue
• Weakness
• Pale skin or pallor
• Bleeding problems
• Rapid heart rate (tachycardia)
• Edema (swelling), and
• Excessive thirst
• Uremia may also be painful.

Question 7. Complications of acute nephritis

Answer:

Complications of acute nephritis

• Hypertensive encephalopathy
• Pulmonary edema
• Uraemiaete

Question 8. Acute renal failure

Answer:

Acute Renal Failure Definition

• It is defined as sudden and usually reversible deterioration of renal function developing ooverdays or weeks with rapid rise in blood urea

Acute Renal Failure Causes:

1. Pre renal causes
   • Hemorrhage
   • Severe burns
   • Crushing injuries
   • Shock
   • Hypovolaemia
   • Septicaemia
   • Cardiac failure
2. Intra renal causes
   • Vasculitis
   • Renovascular obstruction
   • Acute tubular necrosis
3. Urinary tract obstruction

Acute Renal Failure Clinical Features:

• Oliguria
• Anuria
• Reduced GFR
• Septicaemia
• Acute ischemia

Question 9. Chronic renal failure- three laboratory abnormalities

Answer:

Question 10. Treatment of chronic renal failure

Answer:

Treatment of chronic renal failure

1. Treatment of hypertension
   • Salt restriction
   • Use of diuretics and ACE inhibitors or angiotensin receptor blockers
2. Diet
   • Protein restriction
   • Salt restriction
   • Fluid restriction
3. Treatment of anemia
   • Blood transfusion when hemoglobin level falls below 5 g/dl
4. Treatment of metabolic acidosis
   • Use of intravenous sodium bicarbonate 1 g/8 hourly
5. Treatment of infections
   • Use of antibiotics
6. Treatment of renal osteodystrophy
   • Administration of 1 alpha-hydroxycholecalciferol or 1,25 di- hydroxycholecalciferol- 0.25-1 microgram/day
7. Dialysis and renal transplantation
   • In severe cases

Question 11. Diabetic nephropathy

Answer:

Diabetic nephropathy

• It is a evere complication of diabetes mellitus
• Occurs in both types

Diabetic Nephropathy Features:

• Asymptomatic proteinuria
• Nephrotic syndrome
• Progressive Renal failure
• Hypertension

Question 12. Acute tubular necrosis

Answer:

Acute tubular necrosis

• There are clinically three distinct stages of acute tubular necrosis
• They are:

1. Oliguric phase
   • Patient passes less than 500 ml of urine per day
   • Urine contains proteins, casts, and cells
   • SThe specificgravity of urine is about 1.010 or more
   • Phase persists for 10-14 days
2. Diuretic phase
   • Patient passes large amount of solute-free urine 3-5 litres/day for 3-5days
3. Recovery phase
   • It occurs after 7-20 days
   • Urine volume becomes normal

Question 13. Define- nephrotic syndrome

Answer:

Nephrotic syndrome

• It refers to massive proteinuria mof ore than 3.5 g/day mainly of albumin, reduced albumin concentration, oedema hyperlipidemia, lipiduria, and hypercoagulability

Question 14. Importance of urine analysis

Answer:

Importance of urine analysis

• Urine analysis is saimple procedure used for diagnosing, screening, and treating infections
• For it, urine is collected in

Urine Analysis Uses:

• For urinary tract infections
• For kidney disorders
• in chrome disorders like diabetes mellitus
• In infections like polyuria
• In combination owithother tests

Urine Analysis Importance:

• Gross examination of urine- color ami consistency
• Microscopic examination- casts, cells present in urine
• prof urine
• The specific gravity of urine
• Presence of proteins
• Presence of glucose

Question 15. Drugs causing kidney damage

Answer:

Drugs causing kidney damage

• Drugs causing damage to kidneys are:
• Cyclosporine
• Aminoglycosides antibiotics
• Cisplatin
• Amphotericin B
• Beta lactam antibiotics
• Indomethacin

VIVA VOCE

1. The presence of albumin m urine is a sign of glomerular abnormally
2. Glomerular filtration «eases when systolic blood pressure falls below 70 mm of Hg

 

Diseases Of The Nervous System Long Essays

Question 1. Describe the etiology, clinical features, and localization of infra-nuclear facial nerve palsy.
(or)
Describe the etiology, clinical features, and management of facial palsy

Answer:

Facial palsy

• Idiopathic paralysis of the facial nerve of sudden onset

Etiology: 5 Hypothesis:

• Rheumatic
• Cold
• Ischaemia
• Immunological
• Viral

Facial Palsy Clinical Features:

• Pain in post auricular region
• Sudden onset
• Unilateral loss of function
• Loss of facial expression
• Absence of wrinkling
• Inability to close the eye “ Watering of an eye “
• Inability to blow the cheek
• Obliteration of nasolabial fold
• Loss of taste sensation
• Hyperacusis
• Slurring of speech

Facial Palsy Management:

• Physiotherapy
• Facial exercises
• Massaging
• Electrical stimulation a Protection for the eye
• Covering of eye with bandage
  • Medical management
    • Prednisolone 60-80 mg per day
    • 3 tablets for 1st 4 days
    • 2 tablets for 2nd 4 days
    • 1 tablet for 3rd 4 days
  • Surgical treatment
    • Nerve decompression
    • Nerve grafting

Question 2. Classify epilepsy. Describe clinical features, diagnosis, and management of grand mal epilepsy.

Answer:

Epilepsy:

• It is a group of disorders of cerebral functions characterized by chronic, recurrent, paroxysmal, nonsynchronous discharge of cerebral neurons

grand mal epilepsy Classification:

1. Partial or focal seizures
   • Simple partial seizures
     • Motor
     • Sensory
     • Visual
     • Versive
     • Psychomotor
   • Complex partial seizures
     • Temporal lobe
     • Frontal lobe
   • Secondary generalized partial seizures
2. Primary generalized seizures
   • Tonic-clonic
   • Tonic
   • Absence
   • Akinetic
   • Myoclonic
3. Unclassified seizures
   • Neonatal seizures
   • Infantile spasms

Grand Mal Epilepsy:

• It is a common type of epilepsy

grand mal epilepsy Clinical Features:

• Phases of grand mal epilepsy

1. Prodromal phase
   • Symptoms are uneasiness or irritability
   • It lasts for hours or days before an attack
2. Aura
   • Occurs when partial seizure becomes generalized
   • Symptoms are:
     • Visual disturbances
     • Hallucinations
     • Nausea
     • Epigastric discomfort
     • Alteration in psychic functions
3. The tonic and clonic phase
   • Symptoms are
     • Tonic contraction of muscles
     • Flexion of arms
     • Extension of legs
     • Cry due to spasm of respiratory muscles
     • It lasts for 10-30 seconds
     • Clonic phase causes:
     • Violent jerking of face and limbs
     • Biting of the tongue
     • Incontinence of urine and feces
     • It lasts for 1-5 minutes
4. Postictal phase
   • Symptoms are:
   • Deep unconsciousness with flaccid limbs
   • Loss of corneal reflex
   • Plantar extensor
   • It lasts for a few minutes to several hours

grand mal epilepsy Diagnosis:

• History of patient
• Clinical symptoms
• Blood test to assess metabolic disorders
• Brain imaging

grand mal epilepsy Management:

1. Elimination of causative agent
2. Protection of patient
   • Protected from a hot and sharp object
   • Use of padded mouth gag
   • Airway maintenance
   • 4 administration of Diazepam 5-10 mg
3. Long-term drug therapy
   • Phenytoin sodium-200-400 mg daily
   • Carbamazepine- 600-1800 mg daily in divided dose
   • Sodium valproate- 0-2000 mg daily
   • Phenobarbitone-60-180 mg daily
   • Primidone-750-1500 mg daily in a divided dose

Question 3. Describe the etiology and clinical features of meningitis. How would you proceed to establish the diagnosis?
(or)
What are the causes of meningitis? Describe clinical features, complications, and treatment of pyogenic meningitis.
(or)
Discuss the etiology, clinical features, and investigations of pyogenic meningitis.

Answer:

Meningitis:

• It is defined as inflammation of the pia-arachnoid and the fluid contained in the space

Pyogenic Meningitis:

• It is bacterial meningitis

Etiology:

• Gram negative bacilli
• Group B streptococci
• Listeria monocytogenes
• H. influenzae
• Neisseria meningitidis
• Mycobacterium tuberculosis

Read And Learn More: General Medicine Question and Answers

pyogenic meningitis Clinical Features:

• Classical triad- fever, headache, and neck rigidity
• Tachycardia, tachypnoea
• Convulsions in children
• Headache
• Blurring of vision
• Papilloedema
• Ecchymosis
• Associated lung, ear, and sinus infection

pyogenic meningitis Diagnosis

pyogenic meningitis Complications:

• Neurological deficiencies- hemiplegia, aphasia, blindness, deafness
• Mental deterioration
• Brain abscess
• Auditory impairment
• Subdural empyema
• Internal hydrocephalous

pyogenic meningitis Management:

• Ceftriaxone provides adequate coverage against infection

Question 4. Discuss clinical features, complications, and management of tubercular meningitis.

Answer:

Tubercular Meningitis:

• Meningeal involvement by the mycobacterium tuberculosis causes tubercular meningitis

Tubercular Meningitis Clinical Features:

• Insidious in onset
• Headache
• Vomiting
• Low-grade fever
• Confusion
• Lassitude
• Visual disturbances
• Papilloedema
• Neck rigidity
• Cranial nerve palsies
• Hydrocephalus

Tubercular Meningitis Complications:

• Hydrocephalous
• Focal deficits
• Cranial nerve palsies

Tubercular Meningitis Management:

1. General management
   • Maintenance of nutrition
   • Electrolyte balance
   • Care of bowel and bladder
2. Drug therapy
   • Anti-tubercular drugs
     • Injection of streptomycin 1 g IM daily
     • Tab icons 600-900 mg/ day
     • Tab ethambutol
   • Steroids
     • 20-30 mg prednisolone daily for a few weeks

Question 5. Discuss etiopathogenesis, and clinical features of Parkinsonian disease. Outline the drugs used in its treatment.

Answer:

Parkinsonian Disease:

• It is a syndrome consisting of akinesia and brake- nesia, rigidity, and tremors

Etiopathogenesis:

• There is a loss of pigmented cells in the substantianigra
• Dopamine levels in the striatum get depleted

Parkinsonian  Clinical Features:

• Both sexes are equally affected
• Age- The fifth decade and later age group are affected
• Muscle ache
• Depression
• Slow activity
• Tremors
• Rigidity
• Hypokinesia

Parkinsonian  Treatment:

1. Anticholinergics
   • Trihexyphenidyl
   • Benzhexol
   • Phenadrine
2. Amantadine
3. I-dopa- it is administered orally
4. Dopamine receptor agonists
   • Bromocriptine
   • Lisuride
   • Pergolide
5. Selegiline
   • Catechol-o-methyltransferase inhibitors

Question 6. Discuss various factors you consider in evaluating a patient for general anesthesia

Answer:

Preoperative Evaluation for General Anaesthesia:

• The patient’s history is asked
• Physical evaluation of the patient
• General examination of a patient
  • Weight and height
  • Pulse rate
  • Rhythm
  • Volume
  • Blood pressure is measured
  • Temperature is measured
  • Movements of eyeballs
  • Feel the carotid arteries
• Systems examined
  • Cardiovascular
  • Respiratory
  • Nervous system
  • GIT
  • Genitourinary tract

Question 7. Mention causes of cerebral embolism. What are its manifestations? Describe the principles of management.

Answer:

Cerebral Embolism:

• The emboli travel to the brain and cause cerebral embolism

general anesthesia Causes:

• Atherosclerosis
• High cholesterol level
• High blood pressure

General Anesthesia Clinical Features:

• Focal motor deficit
• Changes in sensorium
• Visual and sensory deficits
• Respiratory arrest
• Seizures
• Severe headache

general anesthesia Treatment:

• Use of anticoagulants like heparin and warfarin
• Use of thrombolytics like streptokinase to dissolve the clot

Question 8. Describe the pathogenesis, differential diagnosis, and management of coma

Answer:

COMA

Pathogenesis:

coma Differential Diagnosis:

• Cerebral anaemia
• Mechanical injury of the brain
• Convulsive attacks
• Cerebral vascular attacks
• Poisons
• Local infection of the brain and meninges

coma Management:

• Treatment of the underlying cause
• Provide proper nutrition
• Maintain patient’s physical health
• Prevention of infection
• Physiotherapy to prevent bone, joint, and muscle deformities

Question 9. Describe the clinical features of intracerebral hemorrhage

Answer:

Clinical Features of Intracerebral Haemorrhage:

• Hypertension
• Fever
• Cardiac arrhythmias
• Nuchal rigidity
• Subhyoid retinal haemorrhages
• Altered level of consciousness
• Focal neurological deficits
• Seizures
• Headache
• Nausea and vomiting

Question 9. Enumerate the causes of headaches. Discuss clinical features and management and prevention of migraine

Answer:

Causes of Headache:

1. Migraine headache
2. Tension-type of headache
3. Cluster headache
4. Miscellaneous headache
5. Traumatic headache
6. Headache due to vascular causes- hematoma
7. Headache due to nonvascular causes- due to increased pressure
8. Headache due to substance abuse- alcohol
9. Headache due to systemic infection
10. Headache due to metabolic disorders
11. Headache due to referred pain- from the ear, etc
12. Cranial neuralgia- trigeminal neuralgia
13. Unclassified headache

Migraine:

• It is characterized by an episodic, hemicranial, or unilateral throbbing headache and is often associated with nausea, vomiting, and visual disturbances

Headache Clinical Features:

• Starts after puberty
• Common in females
• Headache occurs at regular intervals
• Each attack lasts for hours to days
• Prodromal symptoms

1. 1. Photophobia
   2. Visual disturbances
   3. Dysphagia
   4. Tinnitus
   5. Hemiparesis
   6. Hemianaesthesia
   7. Severe and throbbing headache

Headache – Management:

• Removal of aggravating factors like alcohol, oral contraceptives, dietary factors
• Aspirin-600-900 mg/day.
• Paracetamol lg/day
• Anti-emetics like metoclopramide
• Ergotamine tartrate 0.5-1 mg sublingually orally or rectally
• Serotonin agonist sumatriptan 50-100 mg orally 2-3 times a day

Headache Prevention:

• Beta-blockers- propranolol- 80-120 mg/ day
• Pizotifen-1.5-3 mg at night
• Antidepressant- amitriptyline 50-100 mg at bedtime
• Flunarizine- 10 mg daily
• These all block 5-HT receptors

Diseases Of The Nervous System Short Essays

Question 1. Status epilepticus

Answer:

Status epilepticus

• It is a condition in which a series of seizures occur in the patient without regaining consciousness in between successive attacks

Status Epilepticus Precipitating Factors:

• Sudden withdrawal of drugs
• Irregular use of anti-convulsants
• following intracranial pathology

Status Epilepticus Management:

• Loosen clothes around neck
• Maintain airway
• Administration of high concentration of oxygen
• Diazepam 10-20 mg IV over 1-5 minutes
• Monitor BP, ECG, and blood gases
• Diazepam 10 mg IV repeat once after 15 minutes
• Start infusion drip of phenytoin, 18 mg/ kg at the rate of 50 mg/min
• If seizure are not controlled, start infusion drip of chloromethiazol 4 0.5-1.2 g/hour
• If seizures are not still controlled start 4 drip of thiopentone sodium 20 mg/kg 4 at 50-100 mg/min

Question 2. Anti-epileptic drugs

Answer:

Anti-Epileptic Drugs Classification:

Anti-Epileptic Drugs – Mechanism of Action:

• Blockade of sodium channels
• Prolongation of their inactive state
• Blockade of low threshold calcium current in the thalamic neurons
• Enhancing GABA-mediated inhibition

Question 3. Trigeminal neuralgia

Answer:

Etiology:

1. Pathological
   • Dental pathosis
   • Traction on divisions of trigeminal nerve
   • Ischaemia
   • Aneurysm of internal carotid artery
2. Environmental
   • Allergic
   • Irritation to the ganglion
   • Secondary lesions

Trigeminal Neuralgia Clinical Features:

• Age: Around 35 years
• Sex: Common in female
• Site: Right lower portion of the face, usually unilateral
• Duration: Few seconds to few minutes

Read And Learn More: General Medicine Question and Answers

• As time passes duration between the cycles decreases
• Nature: stabbing or lancinating
• Aggravating factors: Activation of TRIGGER ZONES
• These are Vermillion border of lip, around the eyes, ala of nose

Interference with other activities:

• Patient avoids shaving, washing face, chewing, brushing, as these may aggrevate pain
• These lead to poor lifestyle
• Extreme cases: leads to FROZEN OR MASK-LIKE FACE

Trigeminal Neuralgia Management:

1. Medical

• Carbamazepine: initial dose: 100mg twice daily until relief is achieved
• Dilantin: 300-400mg in single or divided doses
• Combination therapy: Dilantin + carbamazepine

2. Surgical

• Injection of alcohol in gasserian ganglion
• Nerve avulsion: Performed on lingual, buccal or mental nerve
• Part of nerve is sectioned
• Electrocoagulation of gasserian ganglion: diathermy is done
  • Rhizotomy: Trigeminal sensory root is sectioned
  • Newer technique: TENS
• Low-intensity current is used at high frequency is applied to the skin through electrodes attached by a conduction paste

Question 4. Etiology and clinical manifestations of depression

Answer:

Etiology

• Depression is a common psychiatric disorder

Clinical manifestations:

1. Emotional symptoms
   • Sadness
   • Misery
   • Hopelessness
   • Low self esteem
   • Loss of interest
   • Suicidal thoughts
2. Biological symptoms
   • Fatigue
   • Apathy
   • Loss of libido
   • Loss of appetite
   • Lack of concentration
   • Sleep disturbances
3. Symptoms of bipolar depression
   • Over enthusiasm
   • Overconfidence
   • Irritation
   • Aggression

Question 5. Petit mal epilepsy

Answer:

Petit mal epilepsy

• This form of epilepsy is seen in children

Petit mal epilepsy Features:

• Child stops working
• Looks confused
• Stares in space
• May blink or roll up eyeballs
• Fails to respond to verbal commands
• Attack is brief

Petit mal epilepsy Diagnosis:

• EEG changes shows spike and wave complexes at a frequency of 3 Hz per second

Question 6. Peripheral neuropathy

Answer:

Peripheral neuropathy

• Peripheral neuropathy is the disorder of peripheral nerves either sensory, motor, or mixed, symmetrical, and affecting distal parts of limbs

Question 7. Causes of epilepsy

Answer:

Causes of epilepsy

Question 8. Hypertensive encephalopathy

Answer:

Hypertensive encephalopathy

• Hypertensive encephalopathy is characterized by a very high blood pressure and neurological disturbances including transient abnormalities in speech, vision, paresthesia, disorientation, fits, loss of consciousness, and papilloedema

Hypertensive Encephalopathy Treatment:

• Intravenous sodium nitroprusside-0.3-1 micro- gratn/kg/ min
• Parenteral labetelol- 2 mg/min
• Hydralazine-5-10 mg every 30 min
• Bed rest
• Sedation
• Diuretics

Question 9. Discuss the differential diagnosis of headache

Answer:

The differential diagnosis of headache

1. Migraine headache
2. Tension type of headache
3. Cluster headache
4. Miscellaneous headache
5. Traumatic headache
6. Headache due to vascular causes- hematoma
7. Headache due to non vascular causes- due to increased pressure
8. Headache due to substance abuse- alcohol
9. Headache due to systemic infection
10. Headache due to metabolic disorders
11. Headache due to referred pain- from ear, etc
12. Cranial neuralgia- trigeminal neuralgia
13. Unclassified headache