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Question Bank
- 1What is metabolism?
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The sum of the chemical reactions that take place within each cell of a living organism and that provide energy for vital processes and for synthesizing new organic material. - 2What is the role of hormones in metabolism?
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regulate metabolic activity • controlling the function of the body’s organs • energy storage and use • fluid, sugar, and salt levels - 3Untitled question
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untitled answer - 4What is the function of the thyroid gland?
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Cellular turnover growth in children energy/metabolism in adults - 5What is the role of thyroid releasing hormone (TRH)?
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Released from the hypothalamus, acts on the pituitary gland. - 6Function of TSH?
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Acts on thyroid gland to aid in the release of T3 and T4 - 7Function of Triiodothyronine (T3) and Thyroxine (T4)
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Regulates weight, metabolism, energy, skin, hair, and nail growth. - 8Function of Calcitonin?
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• Promotes Ca2+ retention in bones • Decreases Ca2+ levels in blood - 9What is a goiter?
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Irregular growth of the thyroid gland - 10What is the etiology of goiters?
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• Endemic: iodine deficiency • Physiologic: puberty, demand for T4, pregnancy • Drug/food consumption • Pathologic Disease - 11What are the causes of endemic goiters?
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Geographic areas where iodine deficiency exist - 12What is the classification of a goiter based on its texture/appearance?
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• Simple (Diffuse) – smooth texture • Nodular • Multinodular - 13What is the classification of a goiter based on its function?
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• Toxic (Functional) – excess thyroid hormone secretion • Non-Toxic (Non-functional) – normal of decreased thyroid hormone secretion - 14What is the cause of Graves disease?
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Diffuse hypertrophy and hyperplasia of follicular epithelial cells - 15Pathophysiology of Grave's Disease
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Thyroid-stimulating immunoglobulins bind to receptors on thyroid follicles - 16What are the clinical features of Graves' Disease?
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– 20–40-year-old – Female predilection – Exophthalmos, vision loss, pretibial myxedema – Coma and death – Rapid heart rate – Weight loss – Heat intolerance – Irritability – Changes of skin/hair/nails - 17What are the key facts about Graves' Disease?
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Elevated T4 and T3 levels; decreased TSH levels - 18What is the oral manifestation of hyperthyroidism in children?
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Rapid development of jaws and teeth • Premature loss of deciduous teeth • Early eruption of succedaneous teeth - 19What is the oral manifestation of hyperthyroidism in adults?
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• Posterolateral tongue enlargement • Lingual thyroid - Midline of posterior tongue • Xerostomia • Dental caries - 20What are the antithyroid medications used in the management of hyperthyroidism?
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Propylthiouracil and methimazole - 21What is the radioactive isotope used in the management of hyperthyroidism?
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I^131 - 22What is a thyroid storm?
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• Abrupt onset of severe hyperthyroidism • Acute elevation of catecholamine levels during stress - 23What is the emergency treatment for a Thyroid Storm?
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• Provide antithyroid medication • Propranolol • Keep patient cool with cold towels • Administer IV hydrocortisone or oral dexamethasone • Hypertonic glucose - 24What are the symptoms of a Thyroid Storm?
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High fever, agitation, delirium, congestive heart failure, and loss of consciousness. - 25What is Hashimoto's thyroiditis?
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An autoimmune disorder affecting the thyroid gland - 26What is the primary cause of hypothyroidism?
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1. Surgical removal or radiation 2. Hashimoto’s thyroiditis 3. Iodine insufficiency 4. Drug-induced thyroid inhibition 5. Congenital disease - Cretinism - 27Hypothyroidism - Secondary Causes
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Secondary: Pituitary disease - 28Hypothyroidism - Tertiary Causes
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Disease involving the hypothalamus - 29What is the cause of myxedema in hypothyroidism?
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Edema in the soft tissues due to a build-up of mucopolysaccharide - 30Myxedema charcteristics
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• Occurs in older children and adults • Changes in personality, mental sluggishness, cold intolerance, and obesity • Enlargement of the heart or heart failure - 31What is cretinism?
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hypothyroidism in infants or children - 32Characteristics of cretinism in infants or children?
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Impaired skeletal and CNS developmental abnormalities Facial features: short, coarse features - 33What is Hashimoto's Thyroiditis?
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An autoimmune disease where the body attacks the thyroid gland - 34What are the key characteristics of Hashimoto's Thyroiditis?
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• Antithyroid antibodies • Female predilection • 45-65 years of age • Diffuse, firm, symmetrically enlarged, painless thyroid goiter - 35Oral manifestations of hypothyroidism
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• Macroglossia • Thickening of the lips • Salivary gland enlargement • Xerostomia • Compromised periodontium • Delay in tooth eruption in children • Dysgeusia • Burning mouth syndrome - 36What is the characteristic of TSH in hyperthyroidism?
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T3/4: Elevated TSH: Normal or decreased - 37Labs for hypothyroidism
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T3/4: decreased TSH: slightly elevated or normal - 38What is the most important risk factor for thyroid carcinomas?
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Ionizing radiation - 39What percentage of solitary thyroid nodules are malignant?
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<1% - 40Which type of thyroid carcinoma is associated with Multiple Endocrine Neoplasia Syndrome II?
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• Benign (adenomas) • Malignant • Medullary thyroid carcinoma – Multiple Endocrine Neoplasia Syndrome II - 41What is the increased risk of thyroid storm precipitated by?
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Infections and surgery - 42What is a common adverse reaction in hyperthyroidism?
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Adverse reactions with epinephrine - 43Possible Dental Complications - Hypothyroidism
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• Exaggerated response to CNS depressants • Myxedematous coma • Poor wound healing - 44What layer of the adrenal cortex produces aldosterone?
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Zona glomerulosa - 45What layer of the adrenal cortex produces cortisol?
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Zona fasciculata - 46What layer of the adrenal cortex produces anabolic and sex hormones?
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zona reticularis - 47What is hyperaldosteronism?
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Sodium retention and potassium excretion → Hypertension and hypokalemia - 48What is the primary cause of primary aldosteronism?
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Autonomous overproduction of aldosterone → suppression of RAAS - 49What percentage of primary aldosteronism cases are due to hyperplasia vs neoplasm?
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Hyperplasia - 15% Neoplasm - 80% - 50What is secondary aldosteronism?
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Increase amount of aldosterone due to activation of the RAAS - 51Which conditions are associated with secondary aldosteronism?
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Chronic heart failure, decreased renal perfusion, hypoalbuminemia - 52What does cortisol do in the body?
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• Aids in state of stress, anxiety, infection, trauma, and illness • Metabolism – Lipolysis – Proteolysis – Gluconeogenesis – Increased BP • Catecholamine release • Digestion • Anti-inflammatory • Cardiovascular function - 53What is the clinical presentation of Cushing Disease/Syndrome?
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• Impaired/delayed wound healing, • psychosis, insomnia • peptic ulceration • growth suppression • suppressed immune, muscle weakness - 54Presentation of Cushing's Syndrome?
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1. Fullness of the face-Moon facies, Striae 2. Fat deposition between shoulder blades “buffalo hump” 3. Fat deposition in the abdominal area - 55What is the term for the fat deposition between the shoulder blades in Cushing's Syndrome?
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Buffalo hump - 56What is Adrenal Insufficiency
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Insufficient levels of adrenal hormone in circulation - 57Causes of Adrenal Insufficiency - Hypoadrenalism?
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• Primary: Addison’s Disease – Destruction of the adrenal cortex – Acute: Emergency – Chronic • Secondary: Disease of pituitary • Tertiary: Impaired function of hypothalamus – Use of steroids - 58What is Addison's Disease?
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Progressive destruction of adrenal cortex - 59What percentage of adrenal cortex must be destroyed before manifestations of Addison's Disease?
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90% - 60What causes Addison's disease?
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• Autoimmune adrenalitis (60-70%) • Infections • Metastatic neoplasms - 61What is autoimmune adrenalitis?
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Irregular shrunken glands - 62What are the GI symptoms of Addison's Disease?
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anorexia, nausea, vomiting, diarrhea - 63What is the cause of decreased heart size in Addison's Disease?
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chronic hypovolemia - 64What are the major clinical manifestations of Addison's Disease?
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• Progressive weakness and easy fatigability • Hyperpigmentation of skin and oral mucosa - 65What are the symptoms of Adrenal Crisis?
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Hypotension, Hypoglycemia, Joint Pain, Vomiting, Loss of Consciousness, Fever, Confusion & Psychosis, Hair Loss, Back Pain, Fatigue - 66What is adrenal crisis?
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A severe medical emergency caused by the sudden and severe decrease in adrenal gland function, leading to a life-threatening situation. - 67Dental complications related to adrenal gland?
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• Bone and tissue healing • Candidiasis • Exogenous steroid drug-drug interactions • Adrenal crisis - 68How to manage primary adrenal insufficiency?
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• No add. steroids • Base dosage = 25mg of hydrocortisone for minor procedures • will increase for more moderate and major procedures - 69What is the base line dosage for minor surgical procedures in primary adrenal insufficiency?
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25mg of hydrocortisone preoperatively - 70What is the daily therapeutic dose suggested for all surgical procedures in secondary adrenal insufficiency?
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Daily therapeutic dose - 71What is the first step in managing an adrenal crisis?
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Place patient in a supine position - 72What is the second step in managing an adrenal crisis?
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IV injection of glucocorticoids - 73What is the 3rd, 4th, 5th step in managing an adrenal crisis?
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3. Keep the patient cool with ice packs 4. Monitor blood pressure 5. Call EMS - 74What is the most important disease associated with the adrenal medulla?
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Neoplasms - 75Which rule is associated with pheochromocytoma?
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10% Rule 10% malignant 10% are bilateral 10% are extra-adrenal 10% occur in children 10% are familial - 76What syndrome is associated with pheochromocytoma?
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Multiple Endocrine Neoplasia Type II Syndrome - 77What is parathyroid activity controlled by?
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by level of free calcium - 78Function of parathyroid hormone (PTH) in the body?
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• Activates osteoclasts • ↑ reabsorption of calcium • ↑ conversion of Vitamin D to dihydroxy • ↑ urinary phosphate excretion • Augments GI Calcium absorption - 79Causes of primary hyperparathyroidism?
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Adenoma or hyperplasia Leads to Parathyroid carcinoma - 80What is the most common patient group for primary hyperparathyroidism?
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Middle-aged women - 81What are the clinical features of primary hyperparathyroidism?
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Stones, bones, abdominal groans, and psychic moans - 82Causes of secondary hyperparathyroidism?
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Renal failure most common Caused by any condition associated with chronic depression of serum calcium - 83Parathyroid hormone level changes with calcium?
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Parathyroid glands = hyperplastic Serum calcium levels normal = increase in parathyroid hormone - 84What are the bone changes associated with secondary hyperparathyroidism?
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Brown's tumors and metastatic calcification - 85What is the cause of hypoparathyroidism?
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Surgical removal or primary atrophy (decrease in size) - 86What are the symptoms of hypocalcemia in hypoparathyroidism?
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Chvostek's sign: twitching or contracture of facial muscle produced when tapping the facial nerve at a specific point on the face