Endocrinology Archives - Rimikri Med https://med.rimikri.com/category/endocrinology/ Online preparation for medical examinations Fri, 02 Jun 2017 06:55:22 +0000 en-US hourly 1 https://wordpress.org/?v=6.2.6 https://i0.wp.com/med.rimikri.com/wcmdri/uploads/2017/05/cropped-logo-Circle-opt-1.png?fit=32%2C32&ssl=1 Endocrinology Archives - Rimikri Med https://med.rimikri.com/category/endocrinology/ 32 32 140363082 Diabetes insipidus https://med.rimikri.com/diabetes-insipidus-questions/ Sat, 20 May 2017 14:15:58 +0000 http://med.rimikri.com/?p=413 The post Diabetes insipidus appeared first on Rimikri Med.

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Endocrinology System

Diabetes insipidus

  • What are the causes of polyuria and polydipsia? H92
  • What is diabetes insipidus? H93
  • What are the types of diabetes insipidus? H94
  • How can you differentiate diabetes insipidus from diabetes mellitus? H95

 

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]]> 413 Obesity https://med.rimikri.com/obesity-questions/ Sat, 20 May 2017 14:14:34 +0000 http://med.rimikri.com/?p=410 The post Obesity appeared first on Rimikri Med.

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Endocrinology System

Definition and classification

  • Define obesity. 
  • What is body mass index (BMI)? 
  • What is the classification (or grading) of obesity? 
  • Please tell the BMI classifications. 
  • What is morbid obesity? 
  • What are the types of obesity depending on body fat distribution? 

Epidemiology

  • Q

Etiology and Pathophysiology

  • What are the causes of obesity? 
  • What are the endocrine causes of obesity? 
  • What are the drugs causing obesity? 
  • What are the syndrome in which obesity is a predominant feature? 
  • What is the link between obesity and diabetes mellitus? 
  • What are the mechanism of obesity? 

Clinical manifestations

  • Q

Examinations

  • Q

Investigations

  • How to investigate a case of obesity? 

Diagnosis

  • What are the differential diagnoses of simple obesity? 
  • Why not this is hypothyroidism? 
  • Why not this is Cushing’s syndrome? 

Treatment

  • What are the reversible conditions in obesity? 
  • How to treat a patient with simple obesity? 
  • What are the indication of surgery? 

Complications

  • What are the complications of obesity? 

Rimikri

SOLVES


Definition and classification

Define obesity.

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/ or increased health problems.

Or,

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health (WHO).

* Pre-exam preparation for medicine, HN Sarker
What is body mass index (BMI)?

Body mass index is a measure to determine the excessive adipose tissue. It is calculated as weight in kg divided by height in meter2. Normal BMI is 18.5 to 24.9 kg/m2.

* Long Cases in Clinical Medicine, ABM Abdullah Page: 621
What is the classification (or grading) of obesity?
BMI (kg/m2) Classification* Risk of obesity comorbidity
18.5–24.9 Reference range Negligible
25.0–29.9 Overweight Mildly increased
> 30.0

30.0–34.9

35.0–39.9

> 40.0

 Obese

Class I

Class II

Class III

 Moderate

Severe

Very severe
*Classification of the WHO and International Obesity Task Force. The Western Pacific Region Office of WHO recommends that, amongst Asians, BMI > 23.0 is overweight and > 25.0 is obese.
* Davidson’s Principles and Practice of Medicine, 22nd edition Page: 117
What is morbid obesity?

If the relative weight is > 200% (BMI > 40 kg/m2), it is called morbid obesity. It is associated with 10 fold increase in mortality.

* Long Cases in Clinical Medicine, ABM Abdullah Page: 621
What are the types of obesity depending on body fat distribution?
  1. Central obesity—(abdominal, visceral, android or apple-shaped) obesity.
  2. Generalized obesity—Subcutaneous fat accumulation causing generalized (gynoid or pear-shaped) obesity.
* Pre-exam preparation for medicine, HN Sarker

Etiology and Pathophysiology

What are the causes of obesity?

The ‘obesogenic’ environment

  1. Increasing energy intake
    • ↑ Portion sizes
    • ↑ Snacking and loss of regular meals
    • ↑ Energy-dense food (mainly fat)
    • ↑ Affluence
  2. Decreasing energy expenditure
    • ↑ Car ownership
    • ↓ Walking to school/work
    • ↑ Automation; ↓ manual labour
    • ↓ Sports in schools
    • ↑ Time spent on computer games and watching TV
    • ↑ Central heating

Potentially reversible causes of weight gain

  1. Endocrine factors
    • Hypothyroidism
    • Cushing’s syndrome
    • Insulinoma
    • Hypothalamic tumours or injury
  2. Drug treatments
    • Atypical antipsychotics (e.g. olanzapine)
    • Sulphonylureas, thiazolidinediones, insulin
    • Pizotifen
    • Corticosteroids
    • Sodium valproate
    • β-blockers

 Other causes:

  • Genetic factors
  • Psychological factors
* Davidson’s Principles and Practice of Medicine, 22nd edition Page: 117; Long Cases in Clinical Medicine, ABM Abdullah Page: 620
What are the endocrine causes of obesity?

Endocrine causes of obesity are:

– Hypothyroidism

– Cushing’s syndrome

– Insulinoma.

* Pre-exam preparation for medicine, HN Sarker
What are the drugs causing obesity?

Common drugs are—

  • Tricyclic antidepressants
  • Corticosteroids
  • Sulfonylureas
  • Sodium valproate
  • Estrogen-containing contraceptive pill.
* Pre-exam preparation for medicine, HN Sarker
What are the syndrome in which obesity is a predominant feature?
  • Cushing syndrome,
  • Laurence-Moon-Biedle syndrome,
  • Prader-Willi syndrome,
  • Pickwickian syndrome,
  • Alstrom’s syndrome,
  • PCOS (Polycystic ovary syndrome)
* Long Cases in Clinical Medicine, ABM Abdullah Page: 620
What is the link between obesity and diabetes mellitus?

Fat cells release free fatty acids and also TNF-α which are responsible for insulin resistance. A new protein called resistin secreted by the fat cells, also causes insulin resistance.

* Long Cases in Clinical Medicine, ABM Abdullah Page: 621
What are the mechanism of obesity?

As follows:

  • Insensitivity to leptin presumably in hypothalamus.
  • Neuropeptide Y induced hyperphagia.
  • Deficiency of production or action of anorexigenic hypothalamic neuropeptides.
  • Increased secretion of insulin and glucocorticoids.
  • Mutation in the gene of PPAR-γ  accelerates differentiation of adipocyte and may cause obesity.
* Long Cases in Clinical Medicine, ABM Abdullah Page: 621

Investigations

How to investigate a case of obesity?

In any case of obesity, detail history of the patient, specially dietary history, physical activity or sedentary work, any drug, alcohol should be taken. Whether the weight gain is recent or rapid (to exclude secondary disease like Cushing’s syndrome or hypothyroidism). Then following routine investigations should be done:

  • Fasting blood sugar
  • Lipid profile (ideally in a fasting morning sample)
  • Thyroid function test (FT3, FT4 , TSH)
  • Investigate for Cushing’s syndrome (overnight dexamethasone suppression test or 24-hour urine free cortisol)
  • Liver function test (elevated serum transaminases occur in patients with non-alcoholic fatty liver disease, USG of hepatobiliary system to see fatty liver)
  • X-ray chest, ECG, echocardiography – to see cardiac status
  • Lung function test for sleep apnea
  • X-ray of the individual joints in osteoarthrosis
  • In female, if PCOS is suspected, investigate accordingly (such as USG of ovary, serum FSH and LH).
* Long Cases in Clinical Medicine, ABM Abdullah Page: 621; Davidson’s Principles and Practice of Medicine, 22nd edition Page: 117

Diagnosis

What are the differential diagnoses of simple obesity?

As follows:

  • Hypothyroidism
  • Cushing’s syndrome
  • Metabolic syndrome.
 * Long Cases in Clinical Medicine, ABM Abdullah Page: 620
Why not this is hypothyroidism?

In the history, there is no cold intolerance, sleepiness, lethargy, etc. There is no nonpitting edema, no coarse puffy face, no slow relaxation of the ankle jerk.

* Long Cases in Clinical Medicine, ABM Abdullah
Why not this is Cushing’s syndrome?

In Cushing’s syndrome, there is usually central obesity with relatively thin limbs, plethoric moon face, multiple purple striae, proximal muscular weakness, etc. All are absent in this case.

* Long Cases in Clinical Medicine, ABM Abdullah

Treatment

How to treat a patient with simple obesity?

Management of obesity:

  1. Lifestyle modification
    • Maximize physics activity.
    • Changes in eating behaviour:
      • Food selection.
      • Portion size control.
      • Avoidance of snacking.
      • Regular meals to encourage satiety, and substitution of sugar with artificial sweeteners.
  2. Diatery modification : Low fat diet. Avoid fatty food and fast food.
  3. Drugs:
    • Orlistat: Inibits pancreatic and gastric lipases thereby decreases the hydrolysis of ingested triglycerides, reducing dietary fat absorption.
    • Sibutramine: Reduces food intake through β1-adrenoceptor and 5-HT2A/2C (5-hydroxytryptamine, serotonin) receptor agonist activity in the central nervous system
  4. Surgery:
    • Vertical banded gastroplasty.
    • Laparoscoic banding.
    • Roux-en-Y gastric bypass.
  5. Treatment of additional risk factors: Including smoking, excess alcohol consumption, diabetes mellitus, hyperlipidaemia and hypertension.
What are the indication of surgery?

In some cases of morbid obesity (BMI >40 kg/m2) or BMI > 35 kg/m2 and obesity related complications, after conventional treatment have failed.

* Long Cases in Clinical Medicine, ABM Abdullah Page: 622

Complications

What are the complications of obesity?

As follows:

  • Psychological – Low self esteem, depression.
  • Mechanical – Osteoarthritis of knee and hips, back strain, varicose veins, urinary incontinence, hiatus hernia, abdominal hernia, flat foot.
  • Hepatobiliary – Non-alcoholic steatohepatitis, cirrhosis, gallstones.
  • Respiratory – Exertional dyspnea, obstructive sleep apnea, Pickwickian syndrome.
  • Cardiovascular – Hypertension, atherosclerosis, ischemic heart disease, heart failure, thrombo embolism
  • Stroke
  • Metabolic – Diabetes mellitus (type 2), hyperlipidemia, atherosclerosis, hyperuricemia and gout.
  • Increased cancer risk – breast, uterus, colorectal, prostate, ovary.
  • Skin infection – groin and submammary candidiasis.
  • Menstrual abnormalities.
  • Increased morbidity and mortality.
  • Postoperative problems.
  • Accident proneness.
 * Long Cases in Clinical Medicine, ABM Abdullah Page: 621

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Endocrinology System

Definition and classification

  • Definition of diabetes mellitus. H
  • What are the types of diabetes mellitus? H
  • What is the etiological classification of DM? a
  • What is HbA1c? hl
  • What is hypoglycemia? Hl
    • What is severe hypoglycemia? Hl
  • What is Whipple triad? Hl
  • What is gestational diabetes mellitus? Hl, a
  • What is impaired glucose tolerance (IGT)? A
  • What is impaired fasting glucose (IFG)? A
  • What is latent diabetes? A
  • What is potential diabetes? A
  • What is brittle diabetes? A
  • What are dawn phenomenon and Somogyi phenomenon? A
  • What is insulin resistance syndrome or metabolic syndrome or syndrome X? a
  • Where is the site of lesion or cause of diabetic amyotrophy? A
  • What is hyperosmolar nonketotic diabetic coma (HNDC)? Why no ketoacidosis in such case? a

Epidemiology

  • Q

Etiology and Pathophysiology

  • What are the common causes of hypoglycemia? Hl
  • What are the causes of hyperglycemic coma? Hl
    • How can you differentiate at bed side? Hl
  • What are the causes of DKA? Hl
  • What are the causes of glycosuria? Hl
  • Name one condition where renal threshold is decreased. Hl
  • What are the causes of painless myocardial infarction? A
  • What are the causes of sudden death in diabetes mellitus? A
  • What are the causes of loss of vision in DM? a
  • What are the causes of unilateral wasting of leg? A
  • What are the causes of ulcer in DM? a
  • What is the pathology of ischemic ulcer? a

Clinical manifestations

  • What are the presentations of diabetes mellitus? H
  • What are the symptoms of hyperglycemia? Hl
  • What are the features of hypoglycemia? Hl
  • What are the clinical features of DKA? Hl
  • What is the average loss of fluid and electrolytes in adult diabetic ketoacidosis of moderate severity? Hl
  • What are the features of autonomic neuropathy in DM? a

Examinations

  • Q

Investigations

  • What investigations do you suggest in this case? A
  • What are the indications for oral glucose tolerance test? Hl
  • How to perform an oral glucose tolerance test (OGTT)? Hl
  • What is the values for fasting hyperglycemia and impaired glucose tolerance? Hl
  • What are the cardinal biochemical features of DKA? hl

Diagnosis

  • Which type of diabetes do you think? Hl
  • What is your differential diagnosis? hl
  • How can you differentiate between type I and type II diabetes mellitus? Hl
  • Can you tell WHO diagnostic criteria for diagnosis of diabetes mellitus? Hl, a
  • Can you tell ADA diagnostic criteria for diagnosis of diabetes mellitus? Hl
  • A 50-year-old diabetic man on insulin went to walk in the morning after taking insulin. He was found unconscious. What may be the possibilities? H33
    • How can you manage the patient? H34
  • What are the differences between diabetic ketoacidosis (DKA) and hyperosmolar nonketotic diabetic coma (HNDC)? a
  • How can you differentiate hypoglycemic coma and DKA at bed side? Hl
    • Suppose you cannot differentiate at bed side, which treatment would you start? Hl
  • How to diagnose clinically a case of hypoglycemic coma and hyperglycemic coma? a
  • What are the differences between hypoglycemic coma and diabetic coma (coma with ketoacidosis)? a
  • What are the differences between diabetic ketoacidosis and lactic acidosis? a
  • How can you diagnose gestational diabetes mellitus (GDM)? A
  • What are the differences between ischemic ulcer and neuropathic ulcer? a

Treatment

  • What are the modalities of treatment in diabetes mellitus? Hl
  • Please outline the management of diabetes mellitus. Hl
  • Please tell the guidelines for care of type II diabetes mellitus in Bangladesh. H
  • Please tell recommended composition of diet for people with diabetes. Hl
  • What are the roles of exercise in management of diabetes mellitus? Hl
    • Which type of exercise will do and how long? Hl
  • OHA
    • Classify oral hypoglycemic agents? hl
    • What is the indication of metformin? Hl
    • What are the contraindications of metformin? Hl
    • What is the complication? Hl
    • What is the indication of sulfonylurea? Hl
    • What is the mechanism of action of DPP-4 inhibitors? Hl
    • What is glucagon-like peptide (GLP-1)? hl
    • What are the actions of glucagon-like peptide (GLP-1)? Hl
  • Insulin
    • What are the indications (uses) of insulin therapy? Hl
    • What are the insulin preparations? Hl
    • What are the side effects of insulin? Hl
    • Can you demonstrate how to inject insulin subcutaneously? Hl
    • What are the commonly used sites for insulin injection? Hl
    • What are the routes of administration of insulin? Hl
  • What are the targets of treatment in diabetic patient? Hl
  • How can you manage hypoglycemia? hl
  • What are the principles of management of DKA? Hl
  • What are the principles of management of HONK? Hl
  • What are the differences in the treatment of HONK from treatment of DKA? hl
  • How to treat diabetic amyotrophy? A
    • What is the prognosis? A
  • How to treat a case of diabetic ulcer? A

Complications

  • What are the complications of diabetes mellitus? Hl, a
  • What are the complications of fetus in DM during pregnancy? A
    • What is the cause of macrosomia in DM? a
  • Retinopathy
    • What are the types of retinopathy? Hl
    • How can you differentiate between diabetic and hypertensive retinopathy? Hl
  • Neuropathy
    • Classify diabetic neuropathy. Hl, a
  • Nephropathy
    • What do you mean by microalbuminuria? What is it significance in diabetic patient? Hl
    • What is the natural history of diabetic nephropathy? hl

 

 

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Endocrinology System

Q. Name some endocrine diseases.

Ans. Some endocrine diseases are hypothyroidism, thyrotoxicosis, diabetes mellitus, hyperparathyroidism, hypogonadism, adrenal insufficiency, and Cushing’s syndrome.

 

Q. What are the major endocrine glands?

Ans. Pituitary gland, thyroid gland, parathyroid gland, endocrine pancreas, adrenal gland, and testes or ovary are the major endocrine glands.

 

Q. Name some hyperactive and hypoactive diseases in endocrine system.

Ans.

Gland Hyperactive Hypoactive
Pituitary Acromegaly Dwarfism
Thyroid Thyrotoxicosis Hypothyroidism
Parathyroid Hyperparathyroidism Hypoparathyroidism
Adrenal Cushing’s syndrome Addison’s disease

 

Q. Mention some medical emergency in relation to endocrine disorder?

Ans. Medical emergencies are:

  1. Hypoglycemia
  2. Diabetic ketoacidosis
  3. Pituitary apoplexy
  4. Thyrotoxic crisis
  5. Addisonian crisis
  6. Severe hypercalcemia.

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]]> 123 Hypothyroidism https://med.rimikri.com/hypothyroidism-questions/ Sat, 13 May 2017 06:56:23 +0000 http://med.rimikri.com/?p=101 The post Hypothyroidism appeared first on Rimikri Med.

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Endocrinology System

Hypothyroidism SOLVES

Definition

  • Q. Define hypothyroidism?
  • Q. What are primary and secondary hypothyroidism?
  • Q. What is myxedema?
    • Q. What is Hoffman’s syndrome?
  • Q. What is Pendred’s syndrome?
  • Q. What is subclinical hypothyroidism (borderline hypothyroidism or compensated euthyroidism)?
  • Q. What is Hashimoto’s thyroiditis?

Epidemiology

  • Q

Etiology and Pathophysiology

  • Q. What are the causes of hypothyroidism?
  • Q. What are the common causes of primary hypothyroidism?
  • Q. What is the most common cause of primary hypothyroidism?
  • Q. What are the common causes of transient hypothyroidism?
  • Q. What are the causes of goitrous hypothyroidism?
  • Q. If there is goiter with hypothyroidism, what is the likely cause?
  • Q. What are the causes of nongoitrous hypothyroidism?
  • Q. Why hypothyroidism in Graves’ disease?
  • Q. What is the difference between myxedema and hypothyroidism?
  • Q. Why nonpitting edema in myxedema?
  • Anemia in hypothyroidism
    • Q. What are the types of anemia in hypothyroidism?
    • Q. What are the causes of anemia in hypothyroidism?

Clinical manifestations

  • Q. What are the common presentations of hypothyroidism?
  • Q. What are the neurological features in hypothyroidism?
  • Q. What are the cardiovascular problems in myxedema?

Examinations

  • Q. What are the common findings on examination?
    • Q. What bedside physical sign will you see in myxedema?
    • Q. How slow relaxation is best elicited in the ankle? Why slow relaxation?

Investigations

  • Q. What investigations fo you suggest in hypothyroidism?
  • Q. Which biochemical investigations would you suggest to diagnose hypothyroidism? Why not serum T3?
    • Q. What are the expected findings in primary hypothyroidism?
    • Q. What are the expected findings in secondary hypothyroidism?
  • Q. If single investigation is asked for hypothyroidism, which one? / Tell one single investigation to diagnose hypothyroidism.
  • Q. How to interpret thyroid function test results? h22
  • Q. What are the biochemical abnormalities (other than thyroid hormones) in hypothyroidism?
  • Q. What are the ECG findings in hypothyroidism?
  • Q. How to investigaet a case of secondary hypothyroidism?
  • Q. How to investigate hypothyroidism in pregnancy?
  • Hashimoto’s thyroiditis
    • Q. What is the radio-iodine uptake in Hashimoto’s thyroiditis?
    • Q. What are the histological findings in Hashimoto’s thyroiditis?

Diagnosis

  • Q. What is the difference between primary and secondary hypothyroidism?
  • Q. What questions will you ask if you suspect hypothyroidism?
  • Q. One disease can be diagnosed by over telephone, which is the disease?
  • Q. Ask one question to a patient of hypothyroidism and what 2 clues can you get from the patient’s answer?
  • A middle-aged women presented with constipation, hoarseness of voice and cold intolerance. What is your probable diagnosis? h4
  • Q. What are your differential diagnoses?
    • Q. Why not this is nephrotic syndrome?
    • Q. Why not Cushing’s syndrome?

Treatment

  • Q. How will you treat the patient?
  • Q. What is the protocol of giving thyroxine?
    • Q. In which conditions initial small dose (25 μg) is used?
    • Q. Why thyroxine should be started in low dose?
    • Q. How long will you continue the treatment?
  • Q. What is the aim of treatment?
  • Q. In hypothyroidism, if there is no response after thyroxine therapy, what are the possibilities?
  • Q. Tell the follow up of hypothyroid patient during treatment.
  • Q. What are the clinical criteria of remission of hypothyroidism?
  • Special conditions
    • Q. If the patient has ischemic heart disease with hypothyroidism, how to treat?
    • Q. How to treat an elderly patient with hypothyroidism?
    • Q. Tell the treatment of hypothyroidism in pregnancy.

Complications

  • Q. What will happen if inadequate replacement is given during pregnancy?
  • Q. What is myxedema coma? What are the mechanisms? How to treat?
  • Q. What is myxdema madness?
  • Q. What is sick euthyroid syndrome?

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]]> 101 Thyrotoxicosis https://med.rimikri.com/thyrotoxicosis-questions/ Sat, 13 May 2017 06:38:03 +0000 http://med.rimikri.com/?p=97 The post Thyrotoxicosis appeared first on Rimikri Med.

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Endocrinology System

Definition

  • Q. What do you mean by thyrotoxicosis?
    • Q. What is factitious thyrotoxicosis?
    • Q. What is thyrotoxic periodic paralysis (TPP)?
  • Q. What do you mean by hyperthyroidism?
  • Q. What are primary and secondary hyperthyroidism?
  • Q. What is Graves’ disease?
    • Q. What is euthyroid Graves’ disease?
    • Q. What is hypothyroid Graves’ disease?

Epidemiology

  • Q

Etiology and Pathophysiology

  • Hyperthyroidism
    • Q. What are the common causes of hyperthyroidism?
    • Q. What is the most common cause of hyperthyroidism?
    • Q. What are the common causes of transient hyperthyroidism?
    • Q. What is the pathogenesis of weight loss in hyperthyroid?
    • Q. What are the causes of tachycardia in hyperthyroidism?
    • Q. What are the causes of primary hyperthyroidism?
  • Thyrotoxicosis 
    • Q. What are the causes of thyrotoxicosis?
    • Q. What are the causes of thyrotoxicosis without hyperthyroidism?
    • Q. What are the common causes of thyrotoxicosis with less of normal iodine uptake?
  • Geaves’ disease
    • Q. What is the cause of Graves’ disease?
    • Q. What is the natural history of Graves’ disease?
    • Q. What is the significance of thyroid bruit?

Clinical manifestations

  • Hyperthyroidism
    • Q. What are the common presentations of hyperthyroidism?
    • Q. Please tell the pathogenesis of weight loss in hyperthyroid.
    • Q. What are the causes of significant weight loss despite good appetite?
    • Q. What are the causes of tachycardia in hyperthyroidism?
  • Graves’ disease
    • Q. What are the clinical triad of Graves’ disease?
    • Q. What are the differences between Graves’ disease and toxic multinodular goiter?
  • Thyrotoxicosis 
    • Q. What are the signs you will find in thyrotoxicosis in head/neck/eye?

Examinations

  • Q. What are the common findings on examination?

Investigations

  • Q. What are the investigations done in hyperthyroidism?
  • Q. What investigations do you suggest in thyrotoxicosis?
  • Q. If single investigation is asked for hyperthyroidism, which one?
  • Q. What are the findings of radio iodine uptake test in thyrotoxicosis?
    • Q. What are the causes of thyrotoxicosis with low radioiodine uptake?

Diagnosis

  • Q. What questions will you ask if you suspect hyperthyroidism?
  • Q. What is your differential diagnosis?

Treatment

  • Q. What are the modalities of treatment of hyperthyroidism?
  • Q. How to treat thyrotoxicosis?
  • Q. Name antithyroid drugs.
  • Q. What are the contraindications of radioactive iodine therapy?
  • Q. What is the role of β-blocker in the treatment of thyrotoxicosis?
  • Q. How to treat thyrotoxicosis with atrial fibrillation?
  • Q. How can you follow up the patient?
  • Q. How will you treat thyrotoxicosis in pregnancy?
  • Q. Why carbimazole is not used in pregnancy?
  • Q. How to treat Graves’ disease?

Complications

  • Q. Tell the complications of thyrotoxicosis with their management?
    • Q. What is the mechanism of thyroid ophthalmopathy? What are the changes and how to treat?
    • Q. What is malignant exophthalmos?
    • Q. What is pretibial myxedema (dermopathy)?
    • Q. Is there any evidence of cancer in Graves’ disease?
  • Q. What is thyrotoxic crisis? How to treat?
  • Q. What are the side effects of antithyroid drugs?
    • Q. What is agranulocytosis?
    • Q. What advice would you give to the patient on antithyroid drugs?
  • Q. What are the complications of radioactive iodine?

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Endocrinology System

Definition

  • Q. What is Cushing’s syndrome?
  • Q. What is Cushing’s disease?
  • Q. What is pseudo-Cushing’s syndrome?

Epidemiology

  • Q

Etiology and Pathophysiology

  • Q. What are the causes of Cushing’s syndrome?
    • Q. What are the causes of moon face or puffy face?
    • Q. What are the causes of periorbital edema?
  • Q. What is the commonest cause of Cushing’s syndrome?
    • Q. What are the indications of long-term steroid therapy?
    • Q. Tell one absolute indication of steroid therapy.
  • Q. What is the difference between Cushing’s disease and Cushing’s syndrome?
  • Q. What are the causes of  pseudo-Cushing’s syndrome?

Clinical manifestations

  • Q. What are the common features of Cushing’s syndrome?
  • Q. What is the cause of back pain in Cushing’s syndrome?
  • Q. What is the cause of proximal myopathy?
  • Q. What are the striae in Cushing’s syndrome?
    • Q. What is striae? What are the causes?

Examinations

  • Q. How would you differentiate clinically different causes of Cushing’s syndrome?
  • Q. How would you differentiate clinically pseudo-Cushing’s syndrome from Cushing’s syndrome?
  • Q. How can you differentiate striae of Cushing’s syndrome from striae of other causes?

Investigations

  • Q. How to investigate this patient?
  • Q. What are the biochemical markers of different causes of Cushing’s syndrome?
  • Q. Why dexamethasone is used in the suppression test? Why not other steroids like prednisolone?
  • Q. Which test would differentiate pseudo-Cushing’s syndrome from Cushing’s syndrome?

Diagnosis

  • Q. What are the differential diagnosis?

Treatment

  • Q. How will you treat this case?

Complications

  • Q. What are the causes of death in Cushing’s syndrome?
  • Q. What is Nelson’s syndrome?

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]]> 85 Addison’s disease https://med.rimikri.com/addisons-disease-questions/ Sat, 13 May 2017 00:11:00 +0000 http://med.rimikri.com/?p=73 The post Addison’s disease appeared first on Rimikri Med.

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Endocrinology System

Definition

  • Q. What is Addison’s disease?
  • Q. What do you mean by adrenal insufficiency?
  • Q. What is secondary adrenocortical insufficiency?

Epidemiology

  • Q

Etiology and Pathophysiology

  • Q. What are the causes of Addison’s disease?
  • Q. What is the commonest cause of Addison’s disease?
  • Q. What is the next common cause of Addison’s disease?
  • Q. What diseases are associated with Addison’s disease?
  • Q. What is the most common cause of adrenal insufficiency? h81

Clinical manifestations

  • Q. What are the presentations of Addison’s disease?
  • Q. What are the common features of chronic presentation?
  • Q. What is the sites of pigmentation in Addison’s disease?
  • Q. What is the cause of pigmentation in Addison’s disease?
    • Q. What is the differential diagnosis of skin pigmentation?
    • Q. What is the differential diagnosis of buccal pigmentation?
  • Q. Why vitiligo occurs in Addison’s disease?
  • Q. Which clinical feature of Addison’s disease is unique to female and why?
    • Q. Why it is not affected in males?
  • Q. Which clinical feature of Addison’s disease is unique to male and why?
  • Q. Why dose hypotension occure in Addison’s disease?
  • Q. Why dose postural hypotension occure in Addison’s disease?

Examinations

  • Q. How can you differentiate primary and secondary adrenocortical insufficiency?

Investigations

  • Q. How will you investigate this patient?
  • Q. How to perform synacthen test?
  • Q. What is the finding of chest X-ray in Addison’s disease?
  • Q. What autoantibodies are present in autoimmune adrenalitis (Addison’s disease)?
  • Q. Which test would you do for adrenal insufficiency?
  • Q. Suppose the patient needs steroid for life saving before cortisol assay, which steroid would you prescribe?

Diagnosis

  • Q. What are the diagnostic criteria of Addison’s disease?
  • Q. What are the differential diagnosis?

Treatment

  • Q. How would you treat Addison’s disease?
  • Q. What advices would you give to patients on glucocorticoid replacement therapy?
  • Q. What drug is avoided in acute abdominal pain in Addison’s disease?

Complications

  • Addisonian crisis
    • Q. A patient with bronchial asthma was under good control with medication. He went to see his daughter far away from his house but forgot to bring his medicines. Without medication he was free from breathless but in the next morning he developed nausea, vomiting, and collapsed. What is your diagnosis? h78 (Adrenal crisis.)
    • Q. Suppose this patient suddenly develops vomiting and collapse, what may be the cause?
    • Q. What history would you take?
    • Q. What is Addisonian crisis?
    • Q. What are the causes of Addisonian crisis?
    • Q. What is the commonest cause of Addisonian crisis?
    • Q. How would you manage adrenal crisis?
    • Q. Why is mineralocorticoid (fludrocortisone) not given in Addisonian crisis?

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]]> 73 Gynaecomastia https://med.rimikri.com/gynaecomastia-questions/ Fri, 12 May 2017 14:32:13 +0000 http://med.rimikri.com/?p=38 The post Gynaecomastia appeared first on Rimikri Med.

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Endocrinology System

Definition

  • Q. What is gynaecomastia?

Epidemiology

  • Q

Etiology and Pathophysiology

  • Q. What are the causes? (+According to age of the patient)
  • Q. What are the cause of painful gynaecomastia?
  • Q. What are the mechanism of gynaecomastia?
  • Q. Why gynaecomastia in CLD?
  • Q. Why alcohol causes gynaecomastia?

Clinical manifestations

  • Q

Examinations

  • Q. What else or relevants do you want to examine to find out the cause?
  • Q. How to differentiate gynaecomastia from lipomastia?

Investigations

  • Q. How will you investigate a case of gynaecomastia?

Diagnosis

  • Q

Complications

  • Q

Treatment

  • Q. How will you treat gynaecomastia?

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