The document discusses several medical topics including: 1. The causes of hyperthyroidism including toxic diffuse goiter, multinodular goiter, and toxic adenoma. 2. The types of diabetes including type 1, type 2, and gestational diabetes. 3. The main functions of the liver including nutrient storage, toxin removal, and bile production. 4. The major and minor criteria for diagnosing acute rheumatic fever including migratory polyarthritis and recent streptococcal infection. 5. The classification of anemias into normocytic normochromic, microcytic hypochromic, and macrocytic megaloblastic types with examples of each.

1. 1. whats the causes of hyperthyrodisum?
o Toxic Diffuse Goiter(Grave’s) ~70%
o Multinodular Goiter ~20%
o Toxic Adenoma(nodule) ~ 5%
o Non Goitrous causes:
 Thyroiditis
 Thyroid hormone use
 Uncommon/Rare disorders
2. What type of DM ?
Type 1 Diabetes
 Characterized by beta cell destruction usaullyAbsolute insulin
deficiency
 5 - 10%
 Type 1 A ( Immune Mediated )
 Type 1 B ( Idiopathic )
Type 2 Diabetes
 Disease of insulin resistance
 Relative (rather than absolute) insulin deficiency
 90 – 95%
Gestational Diabetes Mellitus
 Glucose intolerance in pregnancy
 Diabetes mellitus with onset or first recognitionin pregnancy
3. Discuss the main functions of the liver and mention some liver
abnormalities related to dentalpractice.
 Temporarynutrient storage (glucose-glycogen)
 Remove toxins from blood
 Remove old/damaged RBC’s
 Regulate nutrient or metabolite levels in blood to keep constant
supply of sugars, fats, amino acids, nucleotides (including
cholesterol)
 Secrete bile via bile ducts and gall bladderinto small intestines.
 Makes clotting factors for the blood
Related to dental: liver cirrhosis and hepatitis

2. 4. What are the criteria used for Diagnosis of Acute Rheumatic
Fever?
Major criteria :
 Migratory polyarthritis
 Carditis,
 Subcutaneous nodules,
 Erythema marginatum, and
 Sydenham chorea.
Minor criteria:
 Fever, arthralgias, increased blood levels of acute phase reactants (
ESR/C-reactive), leukocytosis and prolonged PR interval on ECG.
Plus evidence of antecedent streptococcalinfection, e.g. positive throat
cultures for group A streptococci,elevated antistreptolysin O titre (> 250 U)
or a history of recent scarlet fever
5. Discuss the classification ofanemia and give an example for
each.
1- Normocytic Normochromic
MCV normal
MCH normal
anemia of Chronic Disease
hemolytic Anemia
marrow infiltration
2- Microcytic hypochromic
MCV < 80 fl
MCH < 27 pg/L
thalassemia
iron deficiency
Sideroblastic
3- Macrocytic Megaloblastic
MCV > 98 fl
vit.B12 deficiency
folate deficiency

3. 6. What are the criteria used for Diagnosis of Diabetes Mellitus?
A1C ≥6.5%
The test should be performedin a laboratory using an NGSP-certified
method standardized to the DCCT assay
Fasting plasma glucose (FPG)
≥126 mg/dl(7.0 mmol/l)
Fasting: no caloric intake for
at least 8 h
Two-hour plasma glucose ≥200 mg/dl(11.1 mmol/l) during an OGTT
The test should be performedas using a glucose load containing the
equivalent of 75 g anhydrous glucose dissolved inwater
A random plasma glucose ≥200 mg/dl (11.1 mmol/l)
In a patient with classic symptoms of hyperglycemia or hyperglycemic
crisis,

4. 7. Explain the importance ofrheumatologyin dentalpractice.
 need prophylactic antibiotic
 may the patient has valvular damage or take other medication , thus
we should contact with his rheumatoid doctor.
8. Mention few examplesof oral manifestationof systemic diseases
1. Hyperpigmentation……………………………Hyperbilirubinaemia
2. Oral ulcers…………………… Lupus erythematosusBehcet’s Disease
3. Oral bleeding…………………Chronic liver diseases
4. Gum hypertrophy…………Leukemia
5. Xerostomia……Sjögren syndrome………Lupus erythematosus.
6. Periodontitis………………diabetes
9. Mention the groupsof patients need STEROID supplementation
before dental procedures?
1- Patient taking large dose: for greater than 2 weeks
for extensive major or stressfuldental procedure
2- If the patient received at least 20mg of cortisolfor more than 2 weeks
within past year
10. Mention major and minor clinicalcriteria for diagnosis of
heartfailure
 Major:
 High diastolic BP & occasionaldecrease in systolic BP (decapitated
BP)
 JVD (jugular venous distension)
 Rales (Inspiratory)
 Displaced and sustained apical impulses

5.  Third heart sound – low pitched sound that is heard
 during rapid filling of ventricle
 Minor Criteria
 LL edema,
 Night cough
 Dyspnea on exertion
 Hepatomegaly
 Pleural effusion
 ↓ vital capacity by 1/3 of normal
 Tachycardia 120 bpm
 Weightloss 4.5 kg over 5 days management
11. Definition and classificationof Jaundice
 Jaundice or Icterus,is a yellow colour in the skin, nail beds,and
sclera of the eyes.
 Due to depositionof bilirubin, secondaryto hyperbilirubinemia (high
levels in the blood).
 Jaundice is a symptom of a pre-existing disorder,not a disease.
 Normal Serum Bilirubin (SB) is 0.3 to 1.0 mg%
 Jaundice : is increased levels of SB > 1.0 mg%
Jaundice – Classification
 Over productionof Bilirubin (Hemolytic)
From hemolysis of RBC
Lysis of RBC precursors – Ineffective erythropoesis
 Impaired hepatic function (Hepatitic)
Hepatocellular dysfunctionin handling bilirubin, Uptake, Metabolism
and Excretion of bilirubin
 Obstruction to bile flow (Obstructive)
Intrahepatic cholestasis
Extrahepatic Obstruction (Surgical Jaundice)

6. 12. Question – 4 )
A – Which hormone is responsible for the onset of puberty ?
…GnRH…………………………………………………………………….
B – What is the first signof puberty in Girls andBoys ?
Girls : BreastBudds (10-11 years )
Boys : Testes growth and scrotalthinning
C- What is precocious puberty ?
…Girls < 8 / Boys < 9………………………………………………………..
13. In medically compromised patient. What are the categoriesof
patientassessment?
Category I: Healthy patient
Category II: Medical conditions requiring schedule changes
Category III: Medical conditions requiring significant modifications in dental treatment
Category IV: Medical conditions requiring major modifications in dental treatment
Category V: Serious medical conditions