EMQs in Clinical Medicine.pdf - Peshawar Medical College

Metabolic and endocrine disturbances – revision boxes 211
REVISION BOXES
Metabolic and endocrine disturbances
Electrolyte imbalance can give rise to characteristic symptoms/signs. Calcium and
potassium imbalance are the most common examples that are used in EMQs (Box 1).
Box 1 Symptoms/signs of metabolic disturbance [5, 6, 80]
Symptom/sign
• Cardiac arrhythmias
ECG: tall ‘t’ waves
• Muscle weakness, tetany
ECG: small ‘t’ waves, prominent U wave
• Carpopedal spasm, perioral anaesthesia
Positive Trousseau’s, Chvostek’s sign
• Many vague symptoms:
Abdominal pain, constipation, vomiting
Depression
Anorexia (malignancy)
Confusion (especially elderly people)
Bone pain (malignancy)
↑ incidence renal stones
ECG: reduced Q–T interval
Metabolic disturbance
Hyperkalaemia
Hypokalaemia
Hypocalcaemia
Hypercalcaemia
Some vitamin deficiencies can give rise to well-defined symptoms/signs (Box 2).
Box 2 Signs of vitamin deficiency [79]
Signs
Deficiency
Prolonged bleeding
Vitamin K
Malnourished, bleeding gums (scurvy)
Vitamin C
Night-blindness
Vitamin A
Bowed legs (rickets)
Vitamin D
Nystagmus, ophthalmoplegia, ataxia Vitamin B 1
Diarrhoea, dementia, dermatitis
Nicotinic acid
Sore red tongue
Vitamin B 12 deficiency
Peripheral neuropathy
Endocrine disturbance often gives rise to a plethora of symptoms and signs, the
full details of which may be found in any good medical textbook.