Disorders of metablosm

Question 1

1. Osteoporosis is now thought to be occurring due to
   (a) Lack of bone matrix
   (b) Deficiency of calcitonin
   (c) Deficiency of parathyroid hormone
   (d) Long-term negative calcium balance

Answer 1

(d) Once thought to be due to lack of adequate bone matrix,
osteoporosis is now believed to be due to long-term negative
calcium balance. The skeletal mass at old age is proportional
to that of maturity. Thus calcium intake at infancy and
childhood may play a significant role in occurrence and
severity of osteoporosis in old age

Question 1

2. The recommended daily allowance of calcium for children and
   adults is
   (a) 600 mg
   (b) 800 mg
   (c) 900 mg
   (d) 500 mg

Answer 1

(b) The RDA for infants is 360 mg, while it is 800 mg for children
as well as adults. However, adolescents, pregnant and
lactating women need to increase their daily intake to about
1200 mg

Question 2

3. Acrodermatitis enteropathica is a multiorgan disorder resulting
   from deficiency of
   (a) Iron
   (b) Zinc
   (c) Magnesium
   (d) Fluoride

Answer 2

(b) It is an autosomal recessive disorder resulting from faulty
zinc absorption and is manifested as diarrhea, vesicles,
eczematoid plaques, alopecia, stomatitis and glossitis

Question 3

4. Excessive accumulation of intracellular mucoploysaccharide
   including fibroblasts leading to formation of “gargoyle cells” is
   seen in
   (a) Hurler syndrome
   (b) Gaucher disease
   (c) Hereditary fructose intolerance
   (d) Niemann-Pick disease

Answer 3

(a) It is an autosomal recessive disorder and is characterized
by an increased mucopolysaccharide excretion in urine.
It is clinically manifested by prominent forehead, saddle
nose, hypertelorism, puffy eyelids, bushy eyebrows, thick
lips, large tongue, open mouth and noisy breathing due to
nasal congestion.

Question 4

5. Calcium does not play a significant role in which of the following
   bodily functions?
   (a) Regulation of body temperature
   (b) Formation of bones and teeth
   (c) Acts as secondary/tertiary messenger in hormone action
   (d) Nerve conduction

Answer 4

(a) Calcium plays an important role in teeth and bone
formation, in the maintenance of skeletal and teeth
framework, normal membrane permeability, normal heart
rhythm, neuromuscular excitability, in blood coagulation,
muscle contraction and as secondary/tertiary messenger
in hormone action

Question 5

6. The lowest turnover rates of phosphorus in the human body is
   in
   (a) Intestines
   (b) Bones and teeth
   (c) Kidney
   (d) Cell membranes

Answer 5

(b) There are multiple pools of phosphorus having different
turnover rates of which bones and teeth have lowest. A
major portion of phosphorus is incorporated into organic
phosphorus compounds like nucleic acids, phospholipids
of cell membranes, etc.

Question 6

7. Radiological evidence of “Erlenmeyer flask” deformity of distal
   femur is an early skeletal change seen in
   (a) Lipoid proteinosis
   (b) Gaucher’s disease
   (c) Kwashiorkor
   (d) Cushing’s disease

Answer 6

(b) Gaucher’s disease is a lysosomal storage disease characterized
by deposition of glucocerebroside in the cells of macrophagemonocyte system.

Question 7

8. Which hormone is responsible for regulation of phosphate levels
   in blood?
   (a) Calcitonin
   (b) Insulin
   (c) Parathormone
   (d) Alkaline phosphatase

Answer 7

(c) The blood levels of phosphorus are maintained by various
factors such as parathormone, phosphatase activity and
vitamin D.

Question 8

9. All except __________ are causes of hypophosphatemia.
   (a) Rickets and osteomalacia
   (b) Increased excretion due to diuretics, etc.
   (c) Ischemic heart disease
   (d) Decreased intake due to malabsorption, vomiting, etc.

Answer 8

(c) Normally, phosphate deficiency is nonexistent in man.
However, long-term antacid use will render phosphate
unabsorbable. Other causes of hypophosphatemia are
rickets, osteomalacia, decreased intake, increased cellular
uptake (carbohydrate rich diets), liver disease and increased
excretion due to diuretics or increased parathormone
levels

Question 9

10. Over half of all the body store of magnesium is found in
    (a) Bones
    (b) Teeth
    (c) Muscles
    (d) Liver

Answer 9

(a) More than half of magnesium is stored in bones and one
quarter in muscles. Remainder of magnesium is stored in
liver, pancreas, RBCs, serum and cerebrospinal fluid.

Question 10

11. Calcinosis cutis is the presence of calcification in
    (a) Liver
    (b) Brain
    (c) Heart
    (d) Skin

Answer 10

(d) In calcinosis cutis, there is formation of calcium carbonate
nodules in skin, surrounded by a foreign body giant cell
reaction. Similar nodules elsewhere in the soft tissues are
called calcinosis universalis

Question 11

12. Metastatic calcification is most commonly seen in
    (a) Hyperkalemia
    (b) Hyperparathyroidism
    (c) Osteoporosis
    (d) Pulp stones

Answer 11

(b) Metastatic calcification refers to deposition of calcium
in previously undamaged tissues and is most commonly
observed in hyperparathyroidism and hypervitaminosis
D.

Question 12

13. Hyperkalemia refers to increased _______ levels in blood.
    (a) Potassium
    (b) Sodium
    (c) Fluorine
    (d) Lead

Answer 12

(a) Hyperkalemia may result from excessive tissue breakdown,
adrenal insufficiency, advanced dehydration or over dosage
of potassium.

Question 13

14. Which one of the following special stains is utilized to demonstrate
    amyloid?
    (a) PAS
    (b) Perls’ Prussian blue
    (c) Alcian blue
    (d) Congo red

Answer 13

(d) Abnormal proteinaceous substance deposited in between
cells within the tissues and organs is called amyloidosis.
It is deposited in a variety of clinical disorders. It is seen
as intercellular pink, translucent material by H and E
staining, while a special stain called Congo red is also used
to demonstrate it.

Question 14

15. A reddish/brownish pigmentation of teeth along with
    photosensitivity and excretion of reddish-colored urine is
    characteristic of
    (a) Sideropenic dysphagia
    (b) Kwashiorkor
    (c) Congenital porphyria
    d) Amyloidosis

Answer 14

(c) It is a non sex-linked recessive disorder with both sexes
equally affected. Its first manifestation is excretion of red
urine containing uroporphyrin at birth or within first year.
Photosensitivity and vesiculobullous eruptions on exposed
parts of body occur later.

Question 15

16. Phosphate diabetes is a form of
    (a) Hypervitaminosis A
    (b) Hypervitaminosis E
    (c) Avitaminoses
    (d) Vitamin D resistant rickets

Answer 15

(d) Familial hypophosphatemia or vitamin D resistant rickets
is now recognized as an X-linked dominant defect in renal phosphate metabolism and is characterized by
hypophosphatemia, hypophosphaturia, rickets that does
not respond to administration of vitamin D, normal vitamin
D metabolism, diminished growth, etc.

Question 16

17. Which amongst the following is not a function associated with
    vitamin A?
    (a) Differentiation of epithelial cells
    (b) Vision
    (c) Lysosomal stability
    (d) Collagen synthesis

Answer 16

(d) A continuous supply of vitamin A is needed for rod (low
light) vision. It is also needed for lysosomal stability and is
essential for the process of differentiation of epithelial cells.

Question 16

18. Nyctalopia, keratomalacia and xerophthalmia are classical
    deficiency symptoms of which vitamin?
    (a) Vitamin C
    (b) Vitamin B12
    (c) Vitamin A
    (d) Vitamin E

Answer 16

(c) These features are seen in initial stages of deficiency.
In advanced cases, there is keratinizing metaplasia in
tracheobronchial tree, kidney, conjunctiva, cornea, salivary
glands and genitourinary tract.

Question 17

19. Hypophosphatasia is produced by a deficiency of
    (a) Phosphate
    (b) Alkaline phosphatase
    (c) Acid phosphatase
    (d) Vitamin D

Answer 17

(b) Hypophosphatasia is a hereditary disease transmitted as
autosomal recessive characteristic manifested in three
forms—Infantile, childhood and adult types.

Question 18

20. Tocopherol is the generic name for
    (a) Vitamin B12
    (b) Vitamin B6
    (c) Vitamin E
    (d) Vitamin K

Answer 18

(c) Tocopherol means “The alcohol which brings forth
offspring”. The main function of vitamin E is to prevent
peroxidation of polyunsaturated fatty acids.

Question 19

21. Which vitamin is responsible for iron uptake in the intestinal
    tract?
    (a) Vitamin C
    (b) Vitamin A
    (c) Vitamin B1
    (d) Folic acid

Answer 19

(a) The functions of vitamin C include normal development
of intercellular ground substance in connective tissues,
promotion of non heme iron absorption, maintenance of
intracellular oxidation reduction potential, etc. It also acts
as an antioxidant, aids iron uptake in GIT. Over and above all
this, it aids the hydroxylation of proline in collagen synthesis.

Question 20

22. Which amongst the following does not belong to the vitamin B
    complex group?
    (a) Inositol
    (b) Para-aminobenzoic acid
    (c) Tocopherol
    (d) Pantothenic acid

Answer 20

(c) Currently there are 11 well-known vitamins in the vitamin
B complex group namely, thiamine, riboflavin, niacin,
pyridoxine, pantothenic acid, biotin, folic acid, vitamin B12,
inositol, para-aminobenzoic acid and choline.

Question 21

23. Wernicke’s encephalopathy occurs in chronic ______ deficiency.
    (a) Thiamin
    (b) Riboflavin
    (c) Folic acid
    (d) Vitamin B12

Answer 21

(a) Alcoholic patients with chronic thiamine deficiency
suffer from CNS manifestations known as Wernicke’s
encephalopathy, which consists of horizontal nystagmus,
ophthalmoplegia, cerebral ataxia and mental derangement.

Question 22

24. Acromegaly occurs due to hypersecretion of
    (a) Hormones from posterior pituitary after ossification is
    complete
    (b) Hormones from anterior pituitary before ossification is
    complete
    (c) Hormones from posterior pituitary before ossification is
    complete
    (d) Hormones from anterior gland after ossification is complete

Answer 22

(d) Acromegaly occurs due to over secretion of anterior pituitary
hormones after ossification is complete and is manifested
by temporal headaches, photophobia and reduction in
vision. Terminal phalanges of hand and feet enlarge and
lips become negroid

Question 23

25. Cretinism and myxedema result from hyposecretion of
    (a) Thyroid hormones
    (b) Growth hormones
    (c) Adrenal medullary hormones
    (d) Parathormone

Answer 23

(a) If thyroid insufficiency occurs in infants, it is called cretinism,
if it occurs in childhood, juvenile myxedema and if it occurs
in adults, then it is referred to as adult myxedema.

Question 24

26. Repeated pathological fractures, generalized osteoporosis, giant
    cell tumors in jaws and urinary tract stones are characteristic
    signs of
    (a) Hypoparathyroidism
    (b) Hyperparathyroidism
    (c) Hyperthyroidism
    (d) Hypothyroidism

Answer 24

(b) Hyperparathyroidism may be primary (excessive secretion
of parathormone) or secondary (due to other disease
especially end stage renal diseases). Both types usually
manifest with urinary calculi, pathologic fractures, multiple
pseudocyst formation in bones and drifting and spacing of
teeth.

Question 25

27. Chronic insufficiency of adrenal cortical hormones lead to
    (a) Cushing’s disease
    (b) Goiter
    (c) Addison’s disease
    (d) Kimura’s disease

Answer 25

(c) It usually develops secondary to autoimmune destruction
of adrenal glands and frequently occur in conjunction
with other autoimmune disorders. It manifests as lethargy,
muscle fatigue, feeble heart action, vomiting, diarrhea and
severe anemia.

Question 26

28. Glycosuria, polydipsia, polyuria, weakness and weight loss are
    encountered in
    (a) Diabetes insipidus
    (b) Diabetes mellitus
    (c) Addison’s disease
    (d) Marasmus

Answer 26

(b) Diabetes mellitus (DM) is classified into type 1 or juvenile
and type 2 or maturity onset diabetes. It characterized by
glycosuria, polyuria, polydipsia, weakness and weight loss.
Accelerated and abnormal amino acids and fats result
in ketoacidosis. Its complications are atherosclerosis,
retinopathy, neuropathy, autonomic insufficiency and
susceptibility to infections.

Question 27

29. Which amongst the following is commonly associated with
    diabetes mellitus?
    (a) Candidiasis
    (b) Porphyria
    (c) Actinomycosis
    (d) Cardiac arrhythmia

Answer 27

(a) The oral manifestations in DM are mainly due to inflammation
and infection because of abnormal neutrophil function,
microangiopathy and altered oral flora. Most patients of DM
manifest with dry mouth, persistent gingivitis, periodontal
disease and candidiasis.

Question 28

30. Bronze diabetes occurs due to overload of which trace element
    in the body?
    (a) Copper
    (b) Lead
    (c) Iron
    (d) Zinc

Answer 28

(c) Bronze diabetes occurs due to iron overload and is
manifested by micronodular cirrhosis, marked brown
pigmentation, diabetes mellitus and skin pigmentation.