Endocrine And Metabolic Diseases Short Question and Answers

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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
    Endocrine And Metabolic Diseases Blood Glucose Test
  5. Cardinal features of diabetic ketoacidosis
    • Hyperglycaemia
    • Hyperketonaemia
    • Metabolic acidosis
  6. Hyperthyroidism and hypothyroidism
    Endocrine And Metabolic Diseases 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 TetanyEndocrine And Metabolic Diseases Tetany
  9. Risk factors of osteoporosis
    • Diet or calcium intake
    • Immobility
    • Thyrotoxicosis, hyperparathyroidism
    • Rheumatoid arthritis
    • Corticosteroids
    • Smoking and alcoholism
  10. Cretinism and dwarfismEndocrine And Metabolic Diseases 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

Endocrine And Metabolic Diseases Diagnosis Of Diabetes Mellitus

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:

Endocrine And Metabolic Diseases Diabetic Ketoacidosis Pathogenesis

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

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