Clinical Manifestations and Presentation of Diseases — MCQs

Clinical Manifestations and Presentation of Diseases Indian Medical PG Practice Questions and MCQs

Question 111: In a head injury victim, which of the following is the most common initial manifestation of an increasing intra-cranial pressure?

A. Change in the consciousness level (Correct Answer)
B. Ipsilateral pupillary dilatation
C. Contralateral pupillary dilatation
D. Hemiparesis

Explanation: ***Change in the consciousness level*** - As **intracranial pressure (ICP)** rises due to brain swelling or hematoma, cerebral perfusion is compromised, leading to global brain dysfunction. [1] - This typically manifests first as **subtle changes in arousal**, attention, and orientation, rather than focal neurological deficits. [1] *Ipsilateral pupillary dilatation* - This is a later sign of increasing ICP, specifically indicating **uncal herniation** and compression of the **oculomotor nerve (CN III)**. [1], [2] - While concerning, it usually occurs after changes in consciousness have already been noted. *Contralateral pupillary dilatation* - This is an **atypical finding** in the context of increasing ICP and **unilateral mass effect**. - Pupillary changes due to uncal herniation are typically ipsilateral to the lesion. *Hemiparesis* - **Hemiparesis (weakness on one side of the body)** indicates focal brain compression or damage, often of the **corticospinal tract**. [2] - While it can occur with increasing ICP, it is usually preceded by or occurs concurrently with a decline in the level of consciousness, especially when ICP is rising broadly.

Question 112: The following constitute the Saint's triad except

A. Jaundice (Correct Answer)
B. Colonic diverticulosis
C. Gall stones
D. Hiatus hernia

Explanation: ***Jaundice*** - **Jaundice** is not part of Saint's Triad, which describes a common co-occurrence of three specific conditions. - While **gallstones** can cause jaundice, jaundice itself is a symptom, not one of the conditions in the triad. *Colonic diverticulosis* - **Colonic diverticulosis** is one of the three components of Saint's Triad. - It refers to the presence of **diverticula** (small pouches) in the colon. *Gall stones* - **Gallstones** (cholelithiasis) are another key component of Saint's Triad. - This condition involves the formation of **hardened deposits** in the gallbladder. *Hiatus hernia* - **Hiatus hernia** is the third component of Saint's Triad [1]. - It occurs when part of the **stomach protrudes** through the diaphragm into the chest cavity [1].

Question 113: A young patient presented in the emergency with haematemesis and was found to have massive splenomegaly. The following conditions are associated with the above clinical presentation except

A. Kala-azar
B. Portal hypertension
C. Idiopathic thrombocytopenic purpura (Correct Answer)
D. Malaria

Explanation: ***Idiopathic thrombocytopenic purpura*** - While ITP can cause **bleeding** (including hematemesis) due to **thrombocytopenia**, it is generally **not associated with massive splenomegaly**. Splenomegaly, if present, is usually mild. - The primary defect in ITP is **immune-mediated platelet destruction**, not a cause of massive splenic enlargement, which typically results from conditions involving portal congestion, infiltrative diseases, or hemolytic processes. *Kala-azar* - **Kala-azar (visceral leishmaniasis)** is notoriously associated with **massive splenomegaly** and can cause **hematemesis** due to complications like **esophageal varices** or coagulopathy. - The parasite (Leishmania donovani) infiltrates the reticuloendothelial system, leading to profound splenomegaly. *Portal hypertension* - **Portal hypertension** is a direct cause of **massive splenomegaly** due to congestion and can lead to **hematemesis** from **ruptured esophageal varices**. - The increased pressure in the portal venous system causes blood to back up into the splenic vein, enlarging the spleen. *Malaria* - **Chronic malaria**, particularly from *Plasmodium falciparum* or *Plasmodium vivax*, can lead to significant, often **massive splenomegaly** (hyperreactive malarial splenomegaly). - While hematemesis is not a primary symptom, severe malaria can cause **coagulopathy** or contribute to **gastrointestinal bleeding** in complicated cases, though massive splenomegaly itself is a prominent feature.

Question 114: Which one of the following is not a component of Charcot's triad?

A. Fever
B. Vomiting (Correct Answer)
C. Pain
D. Jaundice

Explanation: ***Vomiting*** - **Charcot's triad** consists of **right upper quadrant abdominal pain**, **fever**, and **jaundice**, which are classic signs of **acute cholangitis** [1]. - Vomiting is not considered one of the three classic components of Charcot's triad. *Fever* - **Fever** is a cardinal symptom of systemic inflammation and infection, a key component indicating the presence of an infectious process in the biliary tree. - It often accompanies the other two symptoms, pain and jaundice, to complete Charcot's triad in **acute cholangitis** [1]. *Pain* - **Right upper quadrant abdominal pain** is a critical component of Charcot's triad, arising from the inflammation and distension of the biliary tree due to obstruction and infection [1]. - This localized pain helps direct the diagnostic focus to the **liver and biliary system**. *Jaundice* - **Jaundice**, characterized by yellowing of the skin and eyes, results from the obstruction of bile flow leading to the accumulation of bilirubin in the bloodstream. - Its presence signifies **biliary obstruction**, often due to gallstones or strictures, which is a common precursor to cholangitis [1].

Question 115: Oliguria is defined as:

A. Less than 400 ml of urine excreted in a day (Correct Answer)
B. 600 ml to 700 ml of urine excreted in a day
C. More than 900 ml of urine excreted in a day
D. Absence of urine production

Explanation: ***Less than 400 ml of urine excreted in a day*** - **Oliguria** is medically defined as a daily urine output that is **less than 400 ml** in adults. [1] - This level of urine production is often insufficient to effectively excrete metabolic waste products. [1] *600 ml to 700 ml of urine excreted in a day* - This range of urine output is generally considered within the **normal limits**, not oliguric. - Normal daily urine production for an adult typically ranges from **800 to 2000 ml**. *More than 900 ml of urine excreted in a day* - An output of **more than 900 ml** per day for an adult indicates normal urine production, well above the threshold for oliguria. - This level suggests adequate kidney function in terms of fluid excretion. *Absence of urine production* - The complete absence of urine production is known as **anuria**, which is a more severe condition than oliguria. [1] - Anuria is typically defined as **less than 50 ml of urine** per day. [1]

Question 116: A 22 year old male addicted to alcohol and abused with pan-masala-arecanut comes to the clinic with limited mouth opening and restricted tongue movement. The clinical suspicion will be of:

A. Leukoplakia
B. Sub-mucous fibrosis (Correct Answer)
C. Sideropenic dysphagia
D. Chronic hyperplastic candidiasis

Explanation: ***Sub-mucous fibrosis*** - The combination of **pan-masala-arecanut** use and clinical symptoms like **limited mouth opening (trismus)** and **restricted tongue movement** are classic signs of **oral submucous fibrosis (OSMF)**, a precancerous condition. - OSMF is characterized by **progressive fibrosis** of the oral submucosa, leading to rigidity and loss of tissue elasticity, which impairs normal oral functions. *Leukoplakia* - **Leukoplakia** appears as a **white patch or plaque** that cannot be wiped away and is not attributable to any other known disease, often associated with tobacco use. - While it is also a **precancerous lesion**, it typically does not present with the severe **limited mouth opening** and **restricted tongue movement** seen in this patient. *Sideropenic dysphagia* - **Sideropenic dysphagia**, also known as **Plummer-Vinson syndrome**, is characterized by **iron deficiency anemia**, **dysphagia (difficulty swallowing)**, and esophageal webs. - It does not involve **limited mouth opening** or effects of betel nut chewing on oral mucosa. *Chronic hyperplastic candidiasis* - **Chronic hyperplastic candidiasis** (CHC) is a persistent white lesion caused by **Candida albicans**, often found in smokers and presenting as a non-scrapable white patch. - Although it can be chronic, CHC is a fungal infection that does not cause the **fibrotic changes** that lead to the severe **mouth opening restriction** observed here.

Question 117: Mondor’s disease is:

A. Named after the scientist who first coined the term “Actinomycosis of Breast”
B. Thrombophlebitis of superficial veins of the breast and anterior chest wall (Correct Answer)
C. Other name for tuberculosis of breast
D. Rare type of chronic intramammary abscess

Explanation: ***Thrombophlebitis of superficial veins of the breast and anterior chest wall*** - **Mondor's disease** is characterized by inflammation and thrombosis of the superficial veins, most commonly affecting the breast and anterior chest wall. - It typically manifests as a sensitive, cord-like structure under the skin, often associated with a recent trauma, surgery, or inflammation. *Named after the scientist who first coined the term “Actinomycosis of Breast”* - Mondor’s disease is named after **Henri Mondor**, who described this clinical condition in 1939. - He did not specifically coin the term "Actinomycosis of Breast," which is a separate bacterial infection. *Other name for tuberculosis of breast* - **Tuberculosis of the breast** is a rare infectious disease caused by *Mycobacterium tuberculosis*, leading to granulomatous inflammation. - Mondor's disease is a non-infectious thrombophlebitis, distinct from infectious conditions like tuberculosis. *Rare type of chronic intramammary abscess* - A **chronic intramammary abscess** is a localized collection of pus within the breast tissue, usually due to bacterial infection. - Mondor's disease involves inflammation of blood vessels and thrombosis, not pus formation or abscess development.

Question 118: Which one of the following is given a score of two in Alvarado score?

A. Leukocytosis (Correct Answer)
B. Anorexia
C. Pyrexia
D. Rebound tenderness

Explanation: ***Leukocytosis*** - A **leukocyte count greater than 10,000/mm³** (leukocytosis) is assigned a score of **two points** in the Alvarado score. [2] - This parameter reflects the systemic inflammatory response often associated with acute appendicitis. [1] *Anorexia* - **Anorexia**, or loss of appetite, is a common symptom in acute appendicitis but is only assigned **one point** in the Alvarado score. - It is a non-specific symptom that can be present in numerous conditions. *Pyrexia* - **Pyrexia** (fever) is another indicator of inflammation, but in the Alvarado score, a **fever of 37.3°C or higher** is given only **one point**. - This symptom, while important, does not carry the same weight as a significant elevation in white blood cell count. *Rebound tenderness* - **Rebound tenderness** is a sign of peritoneal irritation and is given **one point** in the Alvarado score. [1] - While strongly correlated with appendicitis, it is a clinical finding rather than a laboratory marker.

Question 119: Which one of the following statements is not correct regarding trichobezoar ( hair balls)?

A. It is associated usually with psychiatric illness.
B. It is usually associated with pyloric stenosis. (Correct Answer)
C. It is more common in females.
D. It is more common in young.

Explanation: ***It is usually associated with pyloric stenosis.*** - **Trichobezoars** are generally not associated with **pyloric stenosis**. The two conditions have distinct etiologies and pathophysiologies. - While both can present with gastric outlet obstruction symptoms, the presence of a hairball does not imply an underlying congenital or acquired narrowing of the pylorus. *It is associated usually with psychiatric illness.* - **Trichobezoars** are highly associated with **trichophagia** (compulsive hair eating), which is often a symptom of underlying psychiatric conditions like **trichotillomania** or **pica**. - These conditions involve an irresistible urge to pull out one's hair and/or consume non-nutritive substances, including hair. *It is more common in females.* - **Trichobezoars** are indeed more commonly found in **females**, especially young females [1]. - This increased prevalence is often linked to the higher incidence of **trichotillomania** and **trichophagia** in females. *It is more common in young.* - **Trichobezoars** are observed more frequently in **children and adolescents**, particularly among young girls [1]. - The behaviors of **trichotillomania** and **trichophagia** often develop during childhood or early adolescence [1].

Question 120: The following are features of hypovolemic shock except:

A. Acidosis
B. Oliguria
C. Low Blood Pressure
D. Bradycardia (Correct Answer)

Explanation: ***Bradycardia*** - Hypovolemic shock typically causes **tachycardia** (increased heart rate) as a compensatory mechanism to maintain cardiac output in the face of reduced blood volume [1]. - **Bradycardia** is generally not a feature of hypovolemic shock unless there are confounding factors or severe terminal stages. *Acidosis* - **Lactic acidosis** is a common feature of hypovolemic shock due to tissue hypoperfusion causing anaerobic metabolism [2]. - Reduced blood flow leads to inadequate oxygen delivery, forcing cells to produce lactic acid. *Oliguria* - **Oliguria** (decreased urine output) occurs in hypovolemic shock as the kidneys attempt to conserve fluid due to reduced renal perfusion. - The body prioritizes blood flow to vital organs, leading to decreased kidney function and urine production. *Low Blood Pressure* - **Hypotension** (low blood pressure) is a hallmark of shock, including hypovolemic shock, resulting from a significant reduction in circulating blood volume [1]. - The decrease in blood volume directly reduces venous return, stroke volume, and ultimately, systemic blood pressure.

Practice by Chapter

Approach to Common Symptoms (Fever, Pain, Fatigue)

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Constitutional Symptoms and Their Differential Diagnosis

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Syncope and Presyncope

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Dizziness and Vertigo

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Dyspnea and Respiratory Distress

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Chest Pain Evaluation

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Abdominal Pain Assessment

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Headache Classification and Management

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Weight Loss and Cachexia

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Edema and Fluid Retention

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