Clinical Manifestations and Presentation of Diseases Practice Questions

Q: Which of the following is included in Ranson scoring system to predict the severity of acute pancreatitis at the time of admission? A. WBC count > 15 x 10^3/L B. Blood glucose > 200 mg/dL C. LDH > 350 units/L D. AST > 250 units/L

WBC count > 15,000/mm³. ***WBC count > 15,000/mm³*** - A **high white blood cell count** upon admission is one of the initial criteria in the Ranson scoring system indicating more severe inflammation [1]. - This parameter helps to assess the systemic inflammatory response in acute pancreatitis. *LDH > 350 units/L* - The Ranson criteria specify an **LDH level greater than 350 units/L** as a predictor of severity for acute pancreatitis, but it is assessed **at 48 hours after admission**, not at admission. - This value reflects ongoing tissue damage and enzyme release. *Blood glucose > 200 mg/dL* - A blood glucose level > 200 mg/dL is a criterion for the Ranson score, but it is assessed **at 48 hours after admission**, not at the time of admission. - This can indicate significant pancreatic damage impacting insulin production. *AST > 250 units/L* - While an elevated AST level can be present in acute pancreatitis, the specific Ranson criterion for AST is **> 250 units/L**, and it is assessed **at 48 hours after admission**, not upon admission. - This elevation can suggest hepatobiliary involvement or severe pancreatic necrosis.

Q: Which of the following are the extraintestinal manifestations of Crohn's disease related to disease activity?

Arthropathy. **Arthropathy** - **Peripheral arthropathy**, particularly **Type 1 (pauciarticular)**, is directly linked to **Crohn's disease activity**, meaning flares in bowel disease often coincide with flares in joint symptoms. - This form of arthritis typically affects large joints, is transient, and resolves with successful treatment of the underlying intestinal inflammation. *Primary sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a serious extraintestinal manifestation often associated with Crohn's disease but is **not directly correlated with its activity**. - Its progression is independent of whether the intestinal inflammation is well-controlled. *Pyoderma gangrenosum* - **Pyoderma gangrenosum** is a skin manifestation that can occur in patients with Crohn's disease, but its activity often **does not parallel the severity of the bowel disease**. - While it can be debilitating, effective treatment of Crohn's disease may not always lead to remission of pyoderma gangrenosum. *Amyloidosis* - **Amyloidosis**, specifically **AA amyloidosis**, is a rare but severe complication of chronic inflammatory diseases like Crohn's, resulting from long-term inflammation. - While prolonged, uncontrolled disease activity increases the risk, the **amyloidosis itself does not fluctuate with day-to-day or short-term changes in Crohn's disease activity**.

Q: Which of the following represents the underlying pathophysiology of the classic triad of brain tumor presentation? 1. Raised ICP 2. Seizures 3. Hemianopia 4. Focal deficit

1. Raised ICP. ***Raised ICP*** - **Increased Intracranial Pressure (ICP)** is the fundamental underlying cause of the classic triad of brain tumor symptoms [1]. - As a tumor grows, it occupies space within the rigid skull, leading to an increase in pressure that manifests as headache, nausea/vomiting, and papilledema [1]. *Anopia* - **Anopia** (complete blindness in one eye) is a specific visual field defect, not a general underlying pathophysiological mechanism for the classic triad. - While brain tumors can cause visual field defects, these are typically considered focal neurological deficits rather than the primary cause of the general triad [1]. *Focal deficit* - **Focal neurological deficits** (like hemianopia, weakness, or sensory loss) are *symptoms* caused by brain tumors, but they represent localized damage, not the overarching pathophysiology of the classic triad [1]. - The classic triad (headache, nausea/vomiting, papilledema) is a manifestation of diffuse increased pressure, not specific focal damage [1]. *Seizures* - **Seizures** are a common symptom of brain tumors, often due to irritation of cortical tissue [1]. - However, seizures are a *symptom* that can occur due to focal irritation or diffuse pressure and do not represent the primary underlying pathophysiology (raised ICP) that causes the classic triad itself [1].

Q: Which of the following are the causes of retroperitoneal fibrosis?

Drugs. ***Drugs*** - Various medications can induce retroperitoneal fibrosis, including **methysergide**, **beta-blockers**, and some **antibiotics**. - Drug-induced retroperitoneal fibrosis often resolves with **discontinuation of the offending agent**. *Lymphoma* - While lymphoma can cause retroperitoneal masses, it typically presents with distinct features such as **lymphadenopathy** and **B symptoms** (fever, night sweats, weight loss) rather than generalized fibrosis [1]. - Lymphoma involves neoplastic proliferation of lymphocytes, leading to **mass effect** and infiltration, which is distinct from the fibrotic process [1]. *Carcinoid tumours* - Carcinoid tumors can cause fibrosis, but typically in the **pericardium** or **pleura** (carcinoid heart disease) or **mesenterium**, not the retroperitoneum directly as a primary cause in this context. - The fibrosis associated with carcinoid syndrome is due to the release of **serotonin** and other vasoactive substances. *Continuous Ambulatory Peritoneal Dialysis (CAPD)* - CAPD can lead to **peritoneal fibrosis** (sclerosing encapsulating peritonitis), which affects the peritoneum lining the abdominal cavity, not the retroperitoneum. - This complication is distinct from retroperitoneal fibrosis and involves changes to the **peritoneal membrane**, often due to bio-incompatible dialysate.

Q: Which of the following statements are correct regarding Buerger's disease? 1. It involves small to medium arteries. 2. It is common in smokers. 3. It commonly involves lower limb vessels. 4. Cessation of smoking reverses the disease process.

1, 2 and 3. ***1, 2 and 3*** - Buerger's disease, or **thromboangiitis obliterans**, primarily affects **small to medium-sized arteries and veins** in the upper and lower extremities. - It is **strongly associated with tobacco use** and commonly affects the **distal arteries** of the limbs, leading to ischemia and potential gangrene. *1, 3 and 4* - While Buerger's disease involves small to medium arteries and commonly affects lower limb vessels, **cessation of smoking does not reverse the disease process** but rather stops its progression. - The damage caused to the vessels by inflammation and thrombosis is largely irreversible. *1, 2 and 4* - This option incorrectly states that cessation of smoking reverses the disease process, which is not true. - While smoking cessation is crucial for preventing progression, existing vascular damage is permanent. *2, 3 and 4* - This option misses that Buerger's disease involves **small to medium arteries**, which is a key characteristic of the condition. - Additionally, it incorrectly suggests that smoking cessation reverses the disease.

Q: The following are complications of gall stone except

Haemobilia. ***Haemobilia*** - **Haemobilia** refers to bleeding into the biliary tree, often caused by trauma, surgery, or vascular malformations, and is **not a direct complication of gallstones**. [1] - While gallstones can lead to inflammation and erosion, they typically do not cause bleeding into the bile ducts as a primary complication. *Acute pancreatitis* - **Gallstones** are a common cause of **acute pancreatitis** when a stone obstructs the ampulla of Vater, leading to reflux of bile into the pancreatic duct or obstruction of the pancreatic duct itself [1]. - This obstruction causes premature activation of pancreatic enzymes and autodigestion of the pancreas. *Cholangitis* - **Cholangitis** is an inflammation of the bile ducts, usually caused by bacterial infection, which is often precipitated by an obstruction of the biliary tree, most commonly by **gallstones** [1]. - The obstruction leads to stasis of bile, allowing bacteria to ascend from the duodenum and proliferate. *Biliary enteric fistula* - A **biliary enteric fistula** (e.g., cholecystoduodenal fistula) is a pathological connection between the gallbladder or bile duct and the gastrointestinal tract, which can occur due to chronic inflammation and erosion caused by **gallstones** [1]. - This can lead to gallstone ileus if the stone passes into the bowel and obstructs it [1].

Q: Which one of the following is not a correct statement regarding Raynaud's disease ?

The lower extremity involvement is symmetrical. ***The lower extremity involvement is symmetrical*** - **Raynaud's phenomenon** primarily affects the **fingers and toes**, but it is characterized by **asymmetrical involvement**, affecting different digits or limbs to varying degrees. Symmetrical involvement of the lower extremities is not a typical characteristic. - While it can affect the lower extremities, the hallmark of Raynaud's is its **episodic, asymmetrical, and often acral distribution** in response to triggers. *It commonly affects women* - **Raynaud's phenomenon** is indeed more prevalent in **women** than men, with an estimated prevalence of 5-10% in the general population. - This higher incidence in women is a well-documented epidemiological feature of the condition. *Exposure to cold precipitates vasoconstriction* - **Cold exposure** is the most common and classic trigger for **Raynaud's phenomenon**, leading to an exaggerated **vasoconstrictive response** in the small arteries and arterioles of the extremities. - This extreme vasoconstriction results in the characteristic color changes (pallor, cyanosis, and rubor) due to reduced blood flow. *It is idiopathic* - **Raynaud's disease**, also known as **primary Raynaud's phenomenon**, is indeed considered **idiopathic**, meaning its cause is unknown. - It occurs in the absence of any underlying medical condition, distinguishing it from secondary Raynaud's phenomenon, which is associated with autoimmune diseases or other factors.

Q: Dehydration is not a feature of one of the following diseases :

Cerebral malaria. ***Cerebral malaria*** - This condition is characterized by neurological symptoms, including **impaired consciousness** and **seizures**, resulting from parasitic infection of the brain. - While patients may have fever and fluid loss from sweating, severe **dehydration is not a primary or defining feature** compared to other diseases listed. *MDR-TB* - Patients with **multidrug-resistant tuberculosis (MDR-TB)** often experience constitutional symptoms such as fever, night sweats, and significant anorexia. - These symptoms can lead to **severe weight loss** and **malnutrition**, contributing to chronic dehydration in advanced stages. *Pertussis* - **Pertussis**, or **whooping cough**, is characterized by severe paroxysmal coughing fits accompanied by inspiratory "whoops" and post-tussive vomiting. - The recurrent vomiting, especially in infants and young children, can quickly lead to **significant fluid loss** and **dehydration**. *Cholera* - **Cholera** is an acute diarrheal illness caused by *Vibrio cholerae*, leading to profuse, watery diarrhea and vomiting [1]. - The rapid and severe fluid loss in cholera can cause **life-threatening dehydration** and electrolyte imbalances within hours if untreated [1].

Q: Which of the following conditions may produce "wrist drop" ?

Lead poisoning. ***Lead poisoning*** - **Lead neuropathy** predominantly affects motor nerves, often leading to **wrist drop** and **foot drop** due to involvement of the radial and peroneal nerves, respectively [1]. - The toxic effects of lead interfere with heme synthesis and neuronal function, leading to **demyelination** and axonal degeneration [1]. *Alcoholics* - **Alcoholic neuropathy** typically affects peripheral nerves, causing sensory and motor deficits, often as a **stocking-glove distribution** [3]. - While it can manifest as weakness, classic "wrist drop" is not a hallmark feature; rather, it often involves generalized weakness and sensory loss. *Beriberi* - **Beriberi** is caused by **thiamine (vitamin B1) deficiency** and presents in two main forms: wet (cardiovascular) and dry (neurological). - Dry beriberi causes **peripheral neuropathy** with symmetrical motor and sensory impairment, but **wrist drop** is not a characteristic isolated sign. *Diabetes mellitus* - **Diabetic neuropathy** commonly leads to a **stocking-glove sensory loss** and - Can cause motor weakness, but isolated **wrist drop** [2] is not a typical presentation; rather, it's often polyneuropathy or mononeuropathy multiplex [3].

Q: Which of the following is not associated with Acute Food Poisoning?

Tenesmus. ***Tenesmus*** - **Tenesmus** is a symptom of **inflammatory bowel disease** or other **colonic inflammation**, characterized by the sensation of incomplete defecation [1]. - While it can be associated with some forms of infectious colitis, it is **not a typical or direct symptom of acute food poisoning**, which primarily manifests with acute onset of nausea, vomiting, diarrhea, and abdominal cramps [2], [3]. *High skin surface temperature* - **High skin surface temperature** (fever) is a common symptom of acute food poisoning, as the body fights off pathogens or toxins. - It is an indication of the **systemic inflammatory response** to the ingested contaminants. *Onset with vomiting* - **Vomiting** is one of the most prominent and often initial symptoms of acute food poisoning, especially with preformed toxins [2], [3]. - It is the body's rapid mechanism to **expel harmful substances** from the gastrointestinal tract. *Leucocytosis* - **Leucocytosis** (an increase in white blood cells) is a common finding in many infections, including bacterial food poisoning. - It indicates an **active immune response** to combat the invading pathogens or toxins.

Question 1

Which of the following is included in Ranson scoring system to predict the severity of acute pancreatitis at the time of admission?

A. WBC count > 15 x 10^3/L
B. Blood glucose > 200 mg/dL
C. LDH > 350 units/L
D. AST > 250 units/L

Accepted Answer

WBC count > 15,000/mm³

Answer

LDH > 350 units/L

Answer

Blood glucose > 200 mg/dL

Answer

AST > 250 units/L

Question 2

Which of the following are the extraintestinal manifestations of Crohn's disease related to disease activity?

Accepted Answer

Arthropathy

Answer

Primary sclerosing cholangitis

Answer

Pyoderma gangrenosum

Answer

Amyloidosis

Question 3

Which of the following represents the underlying pathophysiology of the classic triad of brain tumor presentation?

1. Raised ICP
2. Seizures
3. Hemianopia
4. Focal deficit

Accepted Answer

1. Raised ICP

Answer

3. Anopia

Answer

4. Focal deficit

Answer

2. Seizures

Question 4

Which of the following are the causes of retroperitoneal fibrosis?

Accepted Answer

Drugs

Answer

Lymphoma

Answer

Carcinoid tumours

Answer

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Question 5

Which of the following statements are correct regarding Buerger's disease?

1. It involves small to medium arteries.
2. It is common in smokers.
3. It commonly involves lower limb vessels.
4. Cessation of smoking reverses the disease process.

Accepted Answer

1, 2 and 3

Answer

1, 3 and 4

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 6

The following are complications of gall stone except

Accepted Answer

Haemobilia

Answer

Acute pancreatitis

Answer

Cholangitis

Answer

Biliary enteric fistula

Question 7

Which one of the following is not a correct statement regarding Raynaud's disease ?

Accepted Answer

The lower extremity involvement is symmetrical

Answer

It commonly affects women

Answer

Exposure to cold precipitates vasoconstriction

Answer

It is idiopathic

Question 8

Dehydration is not a feature of one of the following diseases :

Accepted Answer

Cerebral malaria

Answer

MDR-TB

Answer

Pertussis

Answer

Cholera

Question 9

Which of the following conditions may produce "wrist drop" ?

Accepted Answer

Lead poisoning

Answer

Alcoholics

Answer

Beriberi

Answer

Diabetes mellitus

Question 10

Which of the following is not associated with Acute Food Poisoning?

Accepted Answer

Tenesmus

Answer

High skin surface temperature

Answer

Onset with vomiting

Answer

Leucocytosis

Clinical Manifestations and Presentation of Diseases — MCQs

Clinical Manifestations and Presentation of Diseases — MCQs

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