Urticaria and Angioedema Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Urticaria and Angioedema. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Urticaria and Angioedema Indian Medical PG Question 1: Patient following peanut consumption presented with laryngeal edema, stridor, hoarseness of voice and swelling of tongue. Most likely diagnosis is:
- A. Foreign body bronchus
- B. Angioneurotic edema (Correct Answer)
- C. Foreign body larynx
- D. Pharyngeal abscess
Urticaria and Angioedema Explanation: ***Angioneurotic edema***
- The rapid onset of **laryngeal edema**, **stridor**, **hoarseness**, and **tongue swelling** following peanut consumption points to an allergic reaction, specifically **anaphylaxis** causing angioedema [1], [2].
- This is a life-threatening condition due to potential **airway obstruction**.
*Foreign body bronchus*
- While a foreign body could cause **stridor** if large enough to impact the trachea, symptoms like **laryngeal edema** and **tongue swelling** are not typical.
- It usually presents with sudden coughing, wheezing, and possibly dyspnea, often without rapid-onset, diffuse swelling.
*Foreign body larynx*
- A foreign body in the larynx might cause hoarseness and stridor, but **laryngeal edema** and **tongue swelling** are not primary features of a simple foreign body obstruction.
- The history of peanut ingestion and rapid systemic inflammatory response makes an allergic reaction more likely [2].
*Pharyngeal abscess*
- A pharyngeal abscess typically develops more slowly, with symptoms including **severe sore throat**, **fever**, and **difficulty swallowing**.
- It would not usually present with the rapid onset of severe **laryngeal edema** and **tongue swelling** immediately after peanut consumption.
Urticaria and Angioedema Indian Medical PG Question 2: What is the cause of cough and angioedema in a patient receiving ACE inhibitors?
- A. Bradykinin
- B. Increased renin levels
- C. Increased angiotensin-II levels
- D. Bradykinin accumulation (Correct Answer)
Urticaria and Angioedema Explanation: ***Bradykinin accumulation***
- **ACE inhibitors** block the enzyme **angiotensin-converting enzyme (ACE)**, which is responsible for degrading **bradykinin**.
- The resulting **accumulation of bradykinin** is a potent vasodilator and increases capillary permeability, leading to **cough** (5-20% of patients) and **angioedema** (0.1-0.7%).
- This is the most **precise answer** as it specifies the mechanism: impaired degradation leading to accumulation.
*Bradykinin (alone)*
- While **bradykinin** is the mediator involved, this option is **less precise** than "bradykinin accumulation."
- **Bradykinin** is naturally present in the body; the problem with ACE inhibitors is specifically the **accumulation** due to impaired degradation.
- The correct answer requires understanding that it's the **excess levels**, not just the presence, that causes symptoms.
*Increased renin levels*
- **ACE inhibitors** block the conversion of **angiotensin I to angiotensin II**, leading to reduced negative feedback.
- This causes **compensatory increase in renin secretion** from the juxtaglomerular apparatus.
- However, increased renin is **not responsible** for cough or angioedema—these are bradykinin-mediated effects.
*Increased angiotensin-II levels*
- **ACE inhibitors** actually **decrease angiotensin-II levels**, which is their primary **antihypertensive mechanism**.
- This option is **incorrect** as ACE inhibitors reduce (not increase) angiotensin-II.
- The reduction in angiotensin-II does not cause cough or angioedema.
Urticaria and Angioedema Indian Medical PG Question 3: Which is the best investigation to confirm diagnosis of anaphylaxis?
- A. IgA levels
- B. Serum tryptase (Correct Answer)
- C. IgD levels
- D. Serum precipitins
Urticaria and Angioedema Explanation: ***Serum tryptase***
- **Serum tryptase** is released from activated mast cells and is a reliable biomarker for confirming anaphylaxis, particularly when measured within 1-3 hours of symptom onset.
- Elevated levels help differentiate anaphylaxis from other conditions with similar symptoms, especially when the clinical picture is ambiguous.
*IgA levels*
- **IgA levels** are relevant in diagnosing conditions like selective IgA deficiency or celiac disease, but they do not play a direct role in confirming acute anaphylaxis.
- They reflect long-term immune status rather than immediate hypersensitivity reactions.
*IgD levels*
- **IgD levels** have no established role in the diagnosis or confirmation of anaphylaxis.
- Their physiological function is not fully understood, but they are not used as biomarkers for acute allergic reactions.
*Serum precipitins*
- **Serum precipitins** are antibodies detected in various hypersensitivity reactions, especially to inhaled antigens, and are not specific for anaphylaxis [1].
- They are primarily associated with conditions like hypersensitivity pneumonitis, reflecting different immunological mechanisms [1].
Urticaria and Angioedema Indian Medical PG Question 4: A patient on steroids presented with nocturnal cough and chronic urticaria. Bronchoalveolar lavage (BAL) staining was done, and the organism shown in the image was identified. What is the most likely organism?
- A. Enterobius vermicularis
- B. Strongyloides stercoralis (Correct Answer)
- C. Capillaria philippinensis
- D. Ancylostoma duodenale
Urticaria and Angioedema Explanation: ***Strongyloides stercoralis***
- The image shows a nematode larva in a **bronchoalveolar lavage (BAL) sample**, consistent with **Strongyloides stercoralis**, which is known for its ability to **autoinfect** and cause chronic infections.
- The patient's **steroid use** can lead to **Strongyloides hyperinfection syndrome**, explaining the pulmonary symptoms (**nocturnal cough**) due to larval migration into the lungs and the chronic **urticaria** often associated with strongyloidiasis.
*Enterobius vermicularis*
- This organism primarily causes **pinworm infection**, characterized by **perianal itching** and is typically identified by the **scotch tape test** for eggs, not usually found in BAL or associated with chronic urticaria.
- It does not commonly cause significant pulmonary symptoms or hyperinfection syndrome, especially not triggered by steroid use.
*Capillaria philippinensis*
- This nematode causes **intestinal capillariasis**, characterized by **chronic diarrhea**, **abdominal pain**, and **malabsorption**.
- It is not typically associated with pulmonary symptoms like nocturnal cough or chronic urticaria, and is transmitted through fish consumption.
*Ancylostoma duodenale*
- This is a **hookworm** that causes **iron deficiency anemia**. While it does have a lung migration phase that can cause transient cough, it is not typically associated with chronic urticaria or severe pulmonary disease due to steroid-induced hyperinfection.
- The image shows larvae, but the clinical context strongly points to *Strongyloides* due to the steroid use and specific symptoms.
Urticaria and Angioedema Indian Medical PG Question 5: What is a characteristic feature of Systemic Juvenile Idiopathic Arthritis?
- A. Uveitis is a feature
- B. It occurs after 16 years of age
- C. NSAIDs are contraindicated
- D. RA factor is negative (Correct Answer)
Urticaria and Angioedema Explanation: ### Explanation
**Systemic Juvenile Idiopathic Arthritis (sJIA)**, also known as Still’s disease, is a unique subtype of JIA characterized by prominent extra-articular features.
**Why the correct answer is right:**
In sJIA, the **Rheumatoid Factor (RF) is characteristically negative**. Unlike the polyarticular subtype (which can be RF positive), sJIA is considered an autoinflammatory disease rather than a classic autoimmune disease. Diagnosis is clinical, based on the presence of arthritis in one or more joints associated with (or preceded by) a fever of at least 2 weeks' duration that is daily ("quotidian") for at least 3 days, accompanied by features like an evanescent salmon-pink rash, lymphadenopathy, or serositis.
**Analysis of Incorrect Options:**
* **A. Uveitis is a feature:** This is incorrect for sJIA. Chronic anterior uveitis is a classic complication of **Oligoarticular JIA** (especially if ANA positive). Uveitis is very rare in the systemic subtype.
* **B. It occurs after 16 years of age:** By definition, JIA must have an onset **before the age of 16**. If similar symptoms occur after 16, it is termed Adult-Onset Still’s Disease (AOSD).
* **C. NSAIDs are contraindicated:** This is false. NSAIDs are often the **first-line** symptomatic treatment for pain and fever in JIA, though systemic steroids or biologics (IL-1 and IL-6 inhibitors) are usually required for definitive control.
**High-Yield Clinical Pearls for NEET-PG:**
* **Fever Pattern:** Classic "Quotidian" fever (spikes once daily, usually in the evening, returning to baseline).
* **Laboratory Markers:** Marked leukocytosis, thrombocytosis, and highly elevated ESR/CRP.
* **Ferritin:** Extremely high ferritin levels are common and can signal the onset of **Macrophage Activation Syndrome (MAS)**, a life-threatening complication of sJIA.
* **Biologics of Choice:** Tocilizumab (IL-6 inhibitor) and Anakinra/Canakinumab (IL-1 inhibitors).
Urticaria and Angioedema Indian Medical PG Question 6: A patient presents with thrombocytopenia, eczema, and recurrent infections. What is the most probable diagnosis?
- A. Wiskott Aldrich syndrome (Correct Answer)
- B. A beta gammaglobulinemia
- C. Chediak Higashi syndrome
- D. Lazy leukocyte syndrome
Urticaria and Angioedema Explanation: **Explanation:**
The classic triad of **thrombocytopenia, eczema, and recurrent infections** is the hallmark presentation of **Wiskott-Aldrich Syndrome (WAS)**.
1. **Why A is Correct:** WAS is an X-linked recessive disorder caused by a mutation in the *WASp* gene, which leads to defects in the actin cytoskeleton of hematopoietic cells. This results in:
* **Thrombocytopenia:** Characteristically presents with **micro-platelets** (small size), leading to bleeding tendencies (e.g., petechiae, melena).
* **Eczema:** Typically develops within the first year of life.
* **Immunodeficiency:** Defects in both T-cells and B-cells lead to recurrent infections with encapsulated bacteria and opportunistic pathogens.
2. **Why the others are Incorrect:**
* **B. Agammaglobulinemia (Bruton’s):** Presents with recurrent pyogenic infections due to B-cell deficiency, but lacks thrombocytopenia and eczema.
* **C. Chediak-Higashi Syndrome:** Characterized by **oculocutaneous albinism**, giant cytoplasmic granules in neutrophils, and peripheral neuropathy.
* **D. Lazy Leukocyte Syndrome:** A defect in neutrophil chemotaxis and mobility; patients have neutropenia but not the classic triad of WAS.
**High-Yield Clinical Pearls for NEET-PG:**
* **Inheritance:** X-linked Recessive (mostly males).
* **Lab Finding:** Low IgM, normal/high IgA and IgE, and **small-sized platelets** (pathognomonic).
* **Complications:** High risk of **autoimmune hemolytic anemia** and **B-cell lymphomas**.
* **Treatment:** Hematopoietic stem cell transplant (HSCT) is the definitive cure.
Urticaria and Angioedema Indian Medical PG Question 7: A child presents with delayed separation of the umbilical cord, leukocytosis, Down syndrome, and recurrent infections. What is the most likely diagnosis?
- A. Leukocyte Adhesion Deficiency (Correct Answer)
- B. Neonatal Sepsis
- C. Histiocytosis-X
- D. All of the above
Urticaria and Angioedema Explanation: ### Explanation
**Correct Option: A. Leukocyte Adhesion Deficiency (LAD)**
**Why it is correct:**
Leukocyte Adhesion Deficiency (Type 1) is a primary immunodeficiency caused by a defect in the **CD18 subunit of $\beta_2$-integrins**. This defect prevents neutrophils from adhering to the vascular endothelium and migrating into tissues (diapedesis).
* **Delayed separation of the umbilical cord:** This is the classic hallmark of LAD. Normally, neutrophils infiltrate the cord stump to facilitate its detachment; in LAD, the absence of neutrophils at the site leads to delayed separation (often >30 days).
* **Leukocytosis:** Because neutrophils cannot leave the bloodstream to enter tissues, they accumulate in the blood, leading to persistent, marked neutrophilic leukocytosis.
* **Recurrent Infections:** Patients suffer from skin and mucosal infections (e.g., omphalitis, periodontitis) characterized by a **lack of pus formation** despite high white cell counts.
* **Association:** While not a primary feature, LAD has been documented in case reports involving children with Down syndrome.
**Why other options are incorrect:**
* **B. Neonatal Sepsis:** While sepsis causes leukocytosis and infections, it does not explain the specific anatomical delay in umbilical cord separation.
* **C. Histiocytosis-X (Langerhans Cell Histiocytosis):** This typically presents with seborrheic-like skin rashes, lytic bone lesions, and hepatosplenomegaly, rather than a specific defect in cord separation or integrin function.
**High-Yield Clinical Pearls for NEET-PG:**
* **LAD Type 1:** Defect in **CD18** (Integrins).
* **LAD Type 2:** Defect in **Sialyl-Lewis X** (Selectins); presents with short stature and intellectual disability.
* **Key Triad:** Delayed cord separation + Recurrent "cold" infections (no pus) + Extreme neutrophilia.
* **Diagnosis:** Confirmed by **Flow Cytometry** showing decreased expression of CD11/CD18.
Urticaria and Angioedema Indian Medical PG Question 8: Which of the following is a feature of Henoch-Schönlein purpura?
- A. Palpable purpura and arthralgia (Correct Answer)
- B. Palpable purpura
- C. Occurs only in elderly persons
- D. Thrombocytopenia
Urticaria and Angioedema Explanation: **Explanation:**
**Henoch-Schönlein Purpura (HSP)**, now commonly referred to as **IgA Vasculitis**, is the most common systemic vasculitis in children. It is a small-vessel vasculitis characterized by the deposition of IgA-dominant immune complexes.
1. **Why Option A is correct:** The classic clinical tetrad of HSP includes **palpable purpura** (without thrombocytopenia), **arthralgia/arthritis**, abdominal pain, and renal disease (hematuria). Palpable purpura is the hallmark finding, typically distributed over the buttocks and lower extremities. Arthralgia occurs in about 75% of cases, most commonly affecting the knees and ankles. Therefore, Option A represents the most comprehensive clinical feature among the choices.
2. **Why other options are incorrect:**
* **Option B:** While palpable purpura is a feature, Option A is a more complete description of the systemic nature of the disease.
* **Option C:** HSP is primarily a **pediatric disease**, with a peak incidence between ages 3 and 10 years. It is rare in infants and less common in adults.
* **Option D:** A defining feature of HSP is that it is a **non-thrombocytopenic purpura**. The platelet count is characteristically normal or even elevated (thrombocytosis). This distinguishes it from Immune Thrombocytopenic Purpura (ITP).
**Clinical Pearls for NEET-PG:**
* **Preceding Event:** Often follows an Upper Respiratory Tract Infection (URTI), specifically Group A *Streptococcus*.
* **Renal Involvement:** The most serious long-term complication is **HSP nephritis**, which is histologically identical to IgA Nephropathy (Berger’s disease).
* **Gastrointestinal:** Intussusception (typically ileo-ileal) is a known surgical complication.
* **Diagnosis:** Primarily clinical; skin biopsy shows **leukocytoclastic vasculitis** with IgA deposition on immunofluorescence.
Urticaria and Angioedema Indian Medical PG Question 9: Excessive crying is a potential adverse reaction following which vaccination?
- A. Polio
- B. DPT (Correct Answer)
- C. BCG
- D. Measles
Urticaria and Angioedema Explanation: **Explanation:**
The correct answer is **DPT (Diphtheria, Pertussis, and Tetanus)**.
**Why DPT is the correct answer:**
Excessive, persistent, and inconsolable crying (defined as crying lasting for 3 hours or more) is a well-documented adverse event following immunization (AEFI) specifically associated with the **whole-cell Pertussis (wP)** component of the DPT vaccine. This reaction typically occurs within 2–24 hours of administration. It is believed to be caused by a combination of local pain at the injection site and a systemic inflammatory response to the pertussis antigens. While distressing to parents, it is usually self-limiting and does not result in long-term neurological sequelae.
**Why other options are incorrect:**
* **Polio (OPV/IPV):** Generally well-tolerated. OPV is rarely associated with Vaccine-Associated Paralytic Poliomyelitis (VAPP), but not persistent crying.
* **BCG:** Common reactions include a local papule, ulceration, and scarring at the site. Systemic reactions like excessive crying are not characteristic.
* **Measles:** Common side effects include fever and a mild rash occurring 5–12 days after vaccination, rather than immediate inconsolable crying.
**High-Yield Clinical Pearls for NEET-PG:**
* **Acellular Pertussis (aP):** Switching from DTwP to DTaP significantly reduces the incidence of excessive crying and febrile seizures.
* **Absolute Contraindication to Pertussis vaccine:** Encephalopathy within 7 days of a previous dose.
* **HHE (Hypotonic Hyporesponsive Episode):** Another specific AEFI of DPT characterized by sudden loss of muscle tone and pallor; it is also linked to the pertussis component.
* **Management:** Paracetamol can be used to manage pain and fever, but persistent crying is not a contraindication to subsequent doses.
Urticaria and Angioedema Indian Medical PG Question 10: Which of the following is NOT a criterion for Juvenile Rheumatoid Arthritis?
- A. Age greater than 16 years (Correct Answer)
- B. Arthritis duration greater than 3 weeks
- C. Arthritis duration greater than 6 months
- D. One or more joint involvement
Urticaria and Angioedema Explanation: **Explanation:**
Juvenile Idiopathic Arthritis (JIA), formerly known as Juvenile Rheumatoid Arthritis (JRA), is defined by a specific set of clinical criteria designed to distinguish it from adult inflammatory arthritides.
**Why Option A is the correct answer:**
The fundamental definition of JIA requires the **onset of symptoms before the age of 16 years**. Therefore, "Age greater than 16 years" is an exclusion criterion and does not fit the diagnostic framework. If the disease starts after age 16, it is classified under adult rheumatoid arthritis or other adult-onset connective tissue disorders.
**Analysis of other options:**
* **Option B & C (Duration):** To diagnose JIA, arthritis must persist for a minimum of **6 weeks**. While Option B (3 weeks) is technically incorrect in duration, and Option C (6 months) is longer than required, in the context of NEET-PG questions regarding "NOT a criterion," the age limit (Option A) is the absolute defining boundary. *Note: Standard criteria require ≥6 weeks; Option B is often used as a distractor in older question formats.*
* **Option D (Joint Involvement):** JIA is characterized by the presence of objective arthritis (swelling or limitation of motion with pain) in **one or more joints**. This is a core requirement for the diagnosis.
**High-Yield Clinical Pearls for NEET-PG:**
* **Subtypes:** The most common subtype is **Oligoarthritis** (involving ≤4 joints), which carries a high risk of **asymptomatic chronic anterior uveitis** (requires regular slit-lamp exams).
* **Systemic JIA (Still’s Disease):** Characterized by daily "quotidian" fevers, evanescent salmon-pink rashes, and hepatosplenomegaly.
* **Markers:** Rheumatoid Factor (RF) is usually negative in children (only positive in ~10-15% of cases, typically older girls). ANA positivity is a strong risk factor for uveitis.
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