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Question 1
What is metabolism?
The sum of the physical reactions that take place within each cell of a living organism and that provide energy for vital processes and for synthesizing new organic material.
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.
The sum of the biological reactions that take place within each cell of a living organism and that provide energy for vital processes and for synthesizing new organic material.
The sum of the enzymatic reactions that take place within each cell of a living organism and that provide energy for vital processes and for synthesizing new organic material.
Question 2
What is the role of hormones in metabolism?
Hormones regulate metabolic activity by controlling the body’s temperature and blood pressure.
Hormones regulate metabolic activity by controlling the body’s immune system and blood clotting.
regulate metabolic activity
• controlling the function of the body’s organs • energy storage and use • fluid, sugar, and salt levels
Hormones regulate metabolic activity by controlling the body’s digestion and absorption.
Question 3
Untitled question
untitled answer
Question 4
What is the function of the thyroid gland?
Aids in cellular turnover, growth in children, and energy/metabolism in adults.
Regulates blood pressure and heart rate.
Cellular turnover growth in children energy/metabolism in adults
Promotes Ca2+ retention in bones and decreases Ca2+ levels in blood.
Question 5
What is the role of thyroid releasing hormone (TRH)?
Released from the pituitary gland, acts on the hypothalamus.
Released from the hypothalamus, acts on the pituitary gland.
Regulates blood pressure and heart rate.
Promotes Ca2+ retention in bones and decreases Ca2+ levels in blood.
Question 6
Function of TSH?
They store iodine
They produce calcitonin
Acts on thyroid gland to aid in the release of T3 and T4
They secrete growth hormones
Question 7
Function of Triiodothyronine (T3) and Thyroxine (T4)
Colloid
Blood vessels
Regulates weight, metabolism, energy, skin, hair, and nail growth.
Parafollicular cells
Question 8
Function of Calcitonin?
• Promotes Ca2+ retention in bones • Decreases Ca2+ levels in blood
Question 9
What is a goiter?
A benign tumor of the thyroid gland
A condition where the thyroid gland produces too much thyroid hormone
An underactive thyroid gland
Irregular growth of the thyroid gland
Question 10
What is the etiology of goiters?
Genetic mutation
Infection of the thyroid gland
Hormonal imbalance
• Endemic: iodine deficiency • Physiologic: puberty, demand for T4, pregnancy • Drug/food consumption • Pathologic Disease
Question 11
What are the causes of endemic goiters?
Overproduction of thyroid hormones
Geographic areas where iodine deficiency exist
Excessive consumption of iodine
High altitude regions
Question 12
What is the classification of a goiter based on its texture/appearance?
Complex (Diffuse)
Multinodular (Smooth)
• Simple (Diffuse) – smooth texture • Nodular • Multinodular
Simple (Lumpy)
Question 13
What is the classification of a goiter based on its function?
Toxic (Non-functional)
Non-Toxic (Functional)
• Toxic (Functional) – excess thyroid hormone secretion • Non-Toxic (Non-functional) – normal of decreased thyroid hormone secretion
Non-Toxic (Non-functional)
Question 14
What is the cause of Graves disease?
Autoimmune thyroiditis
Diffuse hypertrophy and hyperplasia of follicular epithelial cells
Hyperthyroidism
Hypothyroidism
Question 15
Pathophysiology of Grave's Disease
Thyroid-stimulating immunoglobulins bind to receptors on thyroid follicles
Question 16
What are the clinical features of Graves' Disease?
– 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
Exophthalmos, vision loss, pretibial myxedema, coma and death, rapid heart rate, weight loss, heat intolerance, irritability, changes of skin/hair/nails
Exophthalmos, vision loss, pretibial myxedema, coma and death, rapid heart rate, weight loss, heat intolerance, irritability, changes of skin/hair/nails
Exophthalmos, vision loss, pretibial myxedema, coma and death, rapid heart rate, weight loss, heat intolerance, irritability, changes of skin/hair/nails
Question 17
What are the key facts about Graves' Disease?
Elevated T4 and T3 levels; decreased TSH levels
Elevated T4 and T3 levels; decreased TSH levels
Elevated T4 and T3 levels; increased TSH levels
Elevated T4 and T3 levels; decreased TSH levels
Question 18
What is the oral manifestation of hyperthyroidism in children?
Rapid development of jaws and teeth • Premature loss of deciduous teeth • Early eruption of succedaneous teeth
Premature loss of deciduous teeth
Delayed eruption of deciduous teeth
Early eruption of permanent teeth
Question 19
What is the oral manifestation of hyperthyroidism in adults?
• Posterolateral tongue enlargement • Lingual thyroid - Midline of posterior tongue • Xerostomia • Dental caries
Midline of anterior tongue
Xerostomia
Lingual thyroid
Question 20
What are the antithyroid medications used in the management of hyperthyroidism?
Calcium and vitamin D
Insulin and glucagon
Propylthiouracil and methimazole
L-thyroxine and levothyroxine
Question 21
What is the radioactive isotope used in the management of hyperthyroidism?
132I
I^131
125I
133I
Question 22
What is a thyroid storm?
• Abrupt onset of severe hyperthyroidism • Acute elevation of catecholamine levels during stress
Question 23
What is the emergency treatment for a Thyroid Storm?
• Provide antithyroid medication • Propranolol • Keep patient cool with cold towels • Administer IV hydrocortisone or oral dexamethasone • Hypertonic glucose
Administer IV hydrocortisone or oral dexamethasone
Hypertonic glucose
Administer insulin
Question 24
What are the symptoms of a Thyroid Storm?
Hypertension, hypoglycemia, and hypothyroidism
Hypothyroidism, hyperglycemia, and hypotension
Hypertension, hypoglycemia, and hypothyroidism
High fever, agitation, delirium, congestive heart failure, and loss of consciousness.
Question 25
What is Hashimoto's thyroiditis?
A genetic disorder
A type of thyroid cancer
A bacterial infection of the thyroid
An autoimmune disorder affecting the thyroid gland
Question 26
What is the primary cause of hypothyroidism?
Excessive iodine intake
1. Surgical removal or radiation 2.
Hashimoto’s thyroiditis
3. Iodine insufficiency 4. Drug-induced thyroid inhibition 5. Congenital disease -
Cretinism
Infection of the pituitary gland
Overproduction of thyroid hormones
Question 27
Hypothyroidism - Secondary Causes
Secondary: Pituitary disease
Question 28
Hypothyroidism - Tertiary Causes
Disease involving the hypothalamus
Question 29
What is the cause of myxedema in hypothyroidism?
Inflammation of the thyroid gland
Excessive production of thyroid hormones
Edema in the soft tissues due to a build-up of mucopolysaccharide
Hyperactivity of the adrenal glands
Question 30
Myxedema charcteristics
• Occurs in older children and adults • Changes in personality, mental sluggishness, cold intolerance, and obesity • Enlargement of the heart or heart failure
Question 31
What is cretinism?
hypothyroidism in infants or children
Question 32
Characteristics of cretinism in infants or children?
Hyperthyroidism
Hypothyroidism
Impaired skeletal and CNS developmental abnormalities Facial features: short, coarse features
Diabetes
Question 33
What is Hashimoto's Thyroiditis?
An autoimmune disease where the body attacks the thyroid gland
A genetic disorder affecting the thyroid
A type of cancer involving the thyroid
A chronic infection of the thyroid gland
Question 34
What are the key characteristics of Hashimoto's Thyroiditis?
Symptoms include weight loss and increased heart rate
• Antithyroid antibodies • Female predilection • 45-65 years of age • Diffuse, firm, symmetrically enlarged, painless thyroid goiter
Symptoms include fever and chills
It is more common in males
Question 35
Oral manifestations of hypothyroidism
• Macroglossia • Thickening of the lips • Salivary gland enlargement • Xerostomia • Compromised periodontium • Delay in tooth eruption in children • Dysgeusia • Burning mouth syndrome
Question 36
What is the characteristic of TSH in hyperthyroidism?
Elevated and abnormal
Decreased and normal
Decreased and abnormal
T3/4: Elevated TSH: Normal or decreased
Question 37
Labs for hypothyroidism
T3/4: decreased TSH: slightly elevated or normal
Decreased and normal
Decreased and abnormal
Elevated and abnormal
Question 38
What is the most important risk factor for thyroid carcinomas?
Infectious diseases
Ionizing radiation
Genetic mutations
Hormonal imbalances
Question 39
What percentage of solitary thyroid nodules are malignant?
50%
10%
<1%
90%
Question 40
Which type of thyroid carcinoma is associated with Multiple Endocrine Neoplasia Syndrome II?
Anaplastic thyroid carcinoma
Follicular thyroid carcinoma
• Benign (adenomas) • Malignant • Medullary thyroid carcinoma – Multiple Endocrine Neoplasia Syndrome II
Papillary thyroid carcinoma
Question 41
What is the increased risk of thyroid storm precipitated by?
Infections and surgery
Infections and medications
Infections and vaccinations
Infections and trauma
Question 42
What is a common adverse reaction in hyperthyroidism?
Adverse reactions with corticosteroids
Adverse reactions with insulin
Adverse reactions with antihypertensives
Adverse reactions with epinephrine
Question 43
Possible Dental Complications - Hypothyroidism
• Exaggerated response to CNS depressants • Myxedematous coma • Poor wound healing
Question 44
What layer of the adrenal cortex produces aldosterone?
Zona glomerulosa
Question 45
What layer of the adrenal cortex produces cortisol?
Zona fasciculata
Question 46
What layer of the adrenal cortex produces anabolic and sex hormones?
zona reticularis
Question 47
What is hyperaldosteronism?
Sodium retention and potassium excretion → Hypertension and hypokalemia
Question 48
What is the primary cause of primary aldosteronism?
Excessive mineralocorticoid receptor activity
Increased renin activity
Autonomous overproduction of aldosterone → suppression of RAAS
Decreased angiotensin II levels
Question 49
What percentage of primary aldosteronism cases are due to hyperplasia vs neoplasm?
50%
25%
75%
Hyperplasia - 15% Neoplasm - 80%
Question 50
What is secondary aldosteronism?
Increase amount of aldosterone due to activation of the RAAS
Question 51
Which conditions are associated with secondary aldosteronism?
Chronic heart failure, decreased renal perfusion, hypoalbuminemia
Hyperthyroidism
Diabetes mellitus
Hypothyroidism
Question 52
What does cortisol do in the body?
Promotes muscle growth
Reduces inflammation
Regulates blood sugar levels
• Aids in state of stress, anxiety, infection, trauma, and illness • Metabolism – Lipolysis – Proteolysis – Gluconeogenesis – Increased BP • Catecholamine release • Digestion • Anti-inflammatory • Cardiovascular function
Question 53
What is the clinical presentation of Cushing Disease/Syndrome?
• Impaired/delayed wound healing, • psychosis, insomnia • peptic ulceration • growth suppression • suppressed immune, muscle weakness
Weight loss, abdominal bruising, hypotension, diabetes, acne, arrhythmia, osteopenia
Question 54
Presentation of Cushing's Syndrome?
1. Fullness of the face-Moon facies, Striae 2. Fat deposition between shoulder blades “buffalo hump” 3. Fat deposition in the abdominal area
Full moon face
Moon face
Face fullness
Question 55
What is the term for the fat deposition between the shoulder blades in Cushing's Syndrome?
Buffalo hump
Hump shoulder blade
Hump back
Hump shoulder
Question 56
What is Adrenal Insufficiency
Insufficient levels of adrenal hormone in circulation
Question 57
Causes of Adrenal Insufficiency - Hypoadrenalism?
• Primary: Addison’s Disease – Destruction of the adrenal cortex – Acute: Emergency – Chronic • Secondary: Disease of pituitary • Tertiary: Impaired function of hypothalamus – Use of steroids
Question 58
What is Addison's Disease?
Progressive destruction of adrenal cortex
Progressive destruction of thyroid gland
Progressive destruction of pituitary gland
Progressive destruction of liver
Question 59
What percentage of adrenal cortex must be destroyed before manifestations of Addison's Disease?
90%
95%
80%
75%
Question 60
What causes Addison's disease?
• Autoimmune adrenalitis (60-70%) • Infections • Metastatic neoplasms
Question 61
What is autoimmune adrenalitis?
Irregular shrunken glands
Question 62
What are the GI symptoms of Addison's Disease?
anorexia, nausea, vomiting, diarrhea
headache, dizziness, vertigo
abdominal pain, constipation, fever
diabetes, hypoglycemia, hypothyroidism
Question 63
What is the cause of decreased heart size in Addison's Disease?
chronic hypovolemia
chronic hypertension
chronic hyperthyroidism
chronic hypothyroidism
Question 64
What are the major clinical manifestations of Addison's Disease?
Darkening of the skin, fatigue, and high blood pressure
• Progressive weakness and easy fatigability • Hyperpigmentation of skin and oral mucosa
Darkening of the skin, fatigue, and high blood pressure
Darkening of the skin, fatigue, and low blood pressure
Question 65
What are the symptoms of Adrenal Crisis?
Hypotension, Hypoglycemia, Joint Pain, Vomiting, Loss of Consciousness, Fever, Confusion & Psychosis, Hair Loss, Back Pain, Fatigue
Hypotension, Hypoglycemia, Joint Pain, Vomiting, Loss of Consciousness, Fever, Confusion & Psychosis, Hair Loss, Back Pain, Fatigue
Hypotension, Hypoglycemia, Joint Pain, Vomiting, Loss of Consciousness, Fever, Confusion & Psychosis, Hair Loss, Back Pain, Fatigue
Hypertension, Hypoglycemia, Joint Pain, Vomiting, Loss of Consciousness, Fever, Confusion & Psychosis, Hair Loss, Back Pain, Fatigue
Question 66
What is adrenal crisis?
A severe medical emergency caused by the sudden and severe decrease in adrenal gland function, leading to a life-threatening situation.
A rapid onset of diabetes
A sudden increase in blood pressure
A severe allergic reaction to dental procedures
Question 67
Dental complications related to adrenal gland?
• Bone and tissue healing • Candidiasis • Exogenous steroid drug-drug interactions • Adrenal crisis
Interactions between exogenous hormones and dental materials
Interactions between endogenous steroids and dental procedures
Interactions between endogenous hormones and dental materials
Question 68
How to manage primary adrenal insufficiency?
• No add. steroids • Base dosage = 25mg of hydrocortisone for minor procedures • will increase for more moderate and major procedures
Question 69
What is the base line dosage for minor surgical procedures in primary adrenal insufficiency?
10mg of hydrocortisone preoperatively
50mg of hydrocortisone preoperatively
25mg of hydrocortisone preoperatively
100mg of hydrocortisone preoperatively
Question 70
What is the daily therapeutic dose suggested for all surgical procedures in secondary adrenal insufficiency?
Twice daily dose
Three times daily dose
Daily therapeutic dose
Once daily dose
Question 71
What is the first step in managing an adrenal crisis?
Administer insulin
Administer oxygen immediately
Place patient in a supine position
Administer intravenous fluids
Question 72
What is the second step in managing an adrenal crisis?
Administer oxygen immediately
Administer insulin
IV injection of glucocorticoids
Administer intravenous fluids
Question 73
What is the 3rd, 4th, 5th step in managing an adrenal crisis?
3. Keep the patient cool with ice packs 4. Monitor blood pressure 5. Call EMS
Administer insulin
Administer oxygen immediately
Administer intravenous fluids
Question 74
What is the most important disease associated with the adrenal medulla?
Neoplasms
Cancer
Infections
Autoimmune disorders
Question 75
Which rule is associated with pheochromocytoma?
50% Rule
20% Rule
10% Rule
10% malignant 10% are bilateral 10% are extra-adrenal 10% occur in children 10% are familial
30% Rule
Question 76
What syndrome is associated with pheochromocytoma?
Multiple Endocrine Neoplasia Type IV Syndrome
Multiple Endocrine Neoplasia Type I Syndrome
Multiple Endocrine Neoplasia Type III Syndrome
Multiple Endocrine Neoplasia Type II Syndrome
Question 77
What is parathyroid activity controlled by?
by level of free calcium
Question 78
Function of parathyroid hormone (PTH) in the body?
PTH decreases calcium absorption in the intestines
PTH decreases bone resorption by activating osteoclasts
• Activates osteoclasts • ↑ reabsorption of calcium • ↑ conversion of Vitamin D to dihydroxy • ↑ urinary phosphate excretion • Augments GI Calcium absorption
PTH increases bone formation by activating osteoblasts
Question 79
Causes of primary hyperparathyroidism?
Adenoma or hyperplasia Leads to Parathyroid carcinoma
Question 80
What is the most common patient group for primary hyperparathyroidism?
Middle-aged women
Elderly men
Young adults
Children
Question 81
What are the clinical features of primary hyperparathyroidism?
Stones, bones, abdominal grunts, and psychic moans
Stones, bones, abdominal grunts, and psychic moans
Stones, bones, abdominal grunts, and psychic moans
Stones, bones, abdominal groans, and psychic moans
Question 82
Causes of secondary hyperparathyroidism?
Hypothyroidism
Diabetes mellitus
Renal failure most common
Caused by any condition associated with chronic depression of serum calcium
Chronic kidney disease
Question 83
Parathyroid hormone level changes with calcium?
Parathyroid glands = hyperplastic Serum calcium levels normal = increase in parathyroid hormone
Question 84
What are the bone changes associated with secondary hyperparathyroidism?
Osteosarcoma and osteoblastoma
Osteoporosis and osteomalacia
Brown's tumors and metastatic calcification
Osteoarthritis and osteoarthrosis
Question 85
What is the cause of hypoparathyroidism?
Infection of the parathyroid glands
Autoimmune destruction of the parathyroid glands
Surgical removal or primary atrophy (decrease in size)
Excessive intake of calcium supplements
Question 86
What are the symptoms of hypocalcemia in hypoparathyroidism?
Hypertension
Diabetes mellitus
Chvostek's sign:
twitching or contracture of facial muscle produced when tapping the facial nerve at a specific point on the face
Anemia