Clinical Manifestations and Presentation of Diseases Practice Questions

Q: Smoking is associated with all the following diseases except:

Sarcoidosis. ***Sarcoidosis*** - **Smoking** has been found to have a protective or null effect on the development of **sarcoidosis**, and it is generally *not* considered a risk factor. - The etiology of sarcoidosis is unknown, but it is thought to involve a combination of genetic predisposition and environmental triggers, none of which strongly implicate smoking. *Emphysema* - **Smoking** is the leading cause of **emphysema**, a type of **COPD**, by causing chronic inflammation and destruction of alveolar walls. - Toxins and irritants in smoke activate inflammatory cells and enzymes, leading to the breakdown of elastic fibers in the lungs. *Cardiovascular disease* - **Smoking** is a major risk factor for various **cardiovascular diseases**, including **atherosclerosis**, **coronary artery disease**, and stroke. - It damages blood vessel walls, increases **blood pressure**, and promotes clot formation, significantly increasing the risk of cardiovascular events. *Lung cancer* - **Smoking** is the primary cause of the vast majority of **lung cancer** cases, with dose-dependent effects on risk [1]. - Carcinogens in tobacco smoke directly damage DNA in lung cells, leading to uncontrolled cell growth and tumor formation [1].

Q: Which one of the following is the investigation of choice in a patient with haematemesis?

Flexible upper gastrointestinal endoscopy. ***Flexible upper gastrointestinal endoscopy*** - This is the **investigation of choice** for haematemesis as it allows for direct visualization of the upper gastrointestinal tract to identify the source of bleeding [1]. - It also enables **therapeutic intervention**, such as injection sclerotherapy, banding, or clip application, to stop the bleeding [1]. *Contrast enhanced CT scan* - A CT scan is generally **not the primary investigation** for acute haematemesis because it offers less diagnostic accuracy for mucosal lesions and cannot provide therapeutic intervention [1]. - While it can identify large bleeds or structural abnormalities, it is **less sensitive for smaller bleeds** or subtle mucosal abnormalities compared to endoscopy. *Barium meal for stomach and duodenum* - A barium meal is **contraindicated in acute gastrointestinal bleeding** as the barium can obscure endoscopic views and interfere with subsequent attempts at endoscopy or angiography [1]. - It provides **limited diagnostic information** about the active bleeding site and offers no therapeutic capabilities. *Selective left gastric angiography* - Angiography is typically reserved for cases of **severe, persistent bleeding** where endoscopy has failed to locate or control the bleed. - It is an **invasive procedure** with potential complications and is not indicated as the initial diagnostic investigation.

Q: The most common complication of pancreas divisum is:

Recurrent acute pancreatitis. ***Recurrent acute pancreatitis*** - **Pancreas divisum** is a congenital anomaly where the dorsal and ventral pancreatic ducts fail to fuse, leading to the **majority of pancreatic secretions draining through the smaller, narrower minor papilla**. - This anatomical variation can cause relative **obstruction to pancreatic exocrine flow**, particularly during periods of increased secretion, predisposing to **recurrent episodes of acute pancreatitis** [1]. *Obstructive jaundice* - **Obstructive jaundice** typically results from **biliary tract obstruction**, such as gallstones or tumors, affecting the common bile duct. - While pancreatic disease can cause jaundice, **pancreas divisum primarily affects the pancreatic duct system** and is not a common direct cause of biliary obstruction. *Peptic ulcer* - **Peptic ulcers** are lesions in the lining of the stomach or duodenum, usually caused by **_H. pylori_ infection** or **NSAID use**. - There is **no direct causal relationship** between pancreas divisum and the development of peptic ulcers. *Duodenal obstruction* - **Duodenal obstruction** can result from various causes such as **mass lesions (_e.g._, pancreatic head tumor), strictures, or malrotation**. - Pancreas divisum is an **anatomical variation of the pancreatic ducts**, and it does not directly cause mechanical obstruction of the duodenum itself.

Q: The most common route of spread in a case of pyogenic liver abscess is:

Haematogenous through portal vein. Haematogenous through portal vein - Pyogenic liver abscesses commonly result from bacterial translocation from the gut, reaching the liver via the portal venous system. - This route accounts for a significant proportion of cases, especially when associated with conditions like diverticulitis or appendicitis. *Hepatic artery* - While possible, spread via the hepatic artery is less common and usually seen in cases of septicemia or endocarditis. - It would imply a more generalized systemic infection rather than a localized abdominal source. *Ascending infection through biliary duct* - This mechanism is characteristic of cholangitis and often leads to multiple small abscesses or a subcapsular collection, not typically a solitary pyogenic liver abscess. - It occurs due to obstruction to biliary flow from stones or strictures. *Local spread* - Local spread can occur from adjacent infected organs like a subphrenic abscess or an infected gallbladder, but it is not the most common route for the initial development of a pyogenic liver abscess. - This typically results in direct extension into the liver parenchyma.

Q: A patient has recurrent abdominal pain and jaundice. The blood investigations reveal reticulocytosis and hyperbilirubinemia. What is the clinical diagnosis?

Hereditary spherocytosis. ***Hereditary spherocytosis*** - The combination of **recurrent abdominal pain**, **jaundice**, **reticulocytosis**, and **hyperbilirubinemia** is highly suggestive of hereditary spherocytosis, which causes chronic hemolytic anemia [1, 3]. - **Jaundice** and **abdominal pain** can result from pigment gallstones (due to chronic hemolysis) and splenic enlargement, both common in this condition [2, 3]. *Mirizzi's syndrome* - Characterized by **extrinsic compression of the common hepatic duct** by a stone impacted in the cystic duct or gallbladder neck. - While it causes jaundice and abdominal pain, it does not typically present with **reticulocytosis** or **hemolysis** [1]. *Sclerosing cholangitis* - A chronic cholestatic liver disease characterized by **inflammation and fibrosis** of the bile ducts. - While it causes jaundice and abdominal pain, it is not associated with **reticulocytosis** or signs of **hemolysis** [1]. *Choledochal cyst* - A **congenital dilation of the bile ducts**, leading to recurrent abdominal pain, jaundice, and a palpable mass. - It does not involve **hemolysis** or **reticulocytosis**, making it less likely in this context.

Q: The capillary refill time is prolonged in all types of shock EXCEPT:

Septic shock. ***Septic shock*** - In **warmed septic shock**, capillary refill time may be **normal or even brisk** due to peripheral vasodilation caused by inflammatory mediators. - While other forms of shock present with decreased peripheral perfusion and prolonged capillary refill, early septic shock can manifest with a **hyperdynamic circulation**. *Obstructive shock* - This type of shock, often due to conditions like **tension pneumothorax** or **cardiac tamponade**, leads to reduced cardiac output and poor peripheral perfusion. - Reduced peripheral blood flow results in a **prolonged capillary refill time**. *Hypovolemic shock* - Characterized by a significant **loss of circulating blood volume**, leading to reduced cardiac output and vasoconstriction. - This peripheral vasoconstriction directly causes a **prolonged capillary refill time** as blood flow to the capillaries is diminished. *Cardiogenic shock* - Results from **primary heart failure**, leading to decreased cardiac output and systemic hypoperfusion. - The reduced effective circulating volume and compensatory vasoconstriction cause impaired peripheral perfusion, manifesting as a **prolonged capillary refill time**.

Q: Which of the following statements regarding lymphoedema are correct? 1. Patients experience constant dull ache and even severe pain sometimes 2. Manual lymphatic drainage has a role 3. Primary lymphoedema is caused by congenital lymphatic dysplasia 4. Nonne Milroy's disease is a type of primary lymphoedema Select the correct answer using the code given below:

1, 2, 3 and 4. ***1, 2, 3 and 4*** - All four statements are correct regarding lymphoedema. Patients often experience **constant dull ache and severe pain** due to the swelling and tissue changes. - **Manual lymphatic drainage (MLD)** is a key component of complete decongestive therapy for lymphoedema, aiming to reduce swelling and improve lymphatic flow. **Primary lymphoedema** is indeed caused by **congenital lymphatic dysplasia**, which refers to abnormalities in lymphatic system development from birth. **Milroy's disease** (also known as Nonne-Milroy disease) is a specific type of primary lymphoedema characterized by early-onset lymphatic dysfunction. *1 and 2 only* - This option is incomplete as statements 3 and 4 are also correct. - It correctly identifies the role of manual lymphatic drainage and the presence of pain in lymphoedema but omits other accurate facts. *3 and 4 only* - This option is incomplete as statements 1 and 2 are also correct. - While correctly identifying the nature of primary lymphoedema and Milroy's disease, it misses other important aspects of lymphoedema. *1, 2, and 3 only* - This option is incomplete because statement 4, concerning Milroy's disease as a type of primary lymphoedema, is also correct. - It provides correct information about pain, MLD, and the cause of primary lymphoedema but omits a specific example of primary lymphoedema.

Q: A 45-year-old man presents with the following skin changes (as shown in the image). What relevant history should be taken to diagnose this condition?

History of dietary pattern, dementia, and diarrhea. ***History of dietary pattern, dementia, and diarrhea*** - The image displays skin changes consistent with a "Casal's necklace" pattern, characteristic of **pellagra**, a disease caused by **niacin (Vitamin B3) deficiency**. - Pellagra is classically associated with the "3 Ds": **dermatitis** (the observed skin changes), **diarrhea**, and **dementia**. A comprehensive history should therefore include questions about dietary patterns (especially corn-based diets lacking tryptophan and niacin), gastrointestinal symptoms like diarrhea, and neurological/psychiatric symptoms indicative of dementia. *Dementia* - While **dementia** is one of the classic "3 Ds" of pellagra (niacin deficiency), it is only one component of the presentation and insufficient on its own to guide a complete diagnostic history for this condition. - Focusing solely on dementia would miss crucial aspects like dietary intake and gastrointestinal symptoms that are integral to diagnosing pellagra. *Dietary history* - A **dietary history** is indeed very relevant for diagnosing pellagra, as it helps identify potential niacin deficiency, commonly associated with diets heavily reliant on corn without proper preparation. - However, pellagra is not only characterized by dermatological signs and dietary insufficiency but also by gastrointestinal and neurological symptoms. Limiting the history to diet alone would therefore be incomplete. *Depression* - **Depression** can be a symptom of various nutritional deficiencies and other medical conditions, but it is not one of the classic "3 Ds" of pellagra, which are dermatitis, diarrhea, and dementia. - While mood changes might be present in some patients with niacin deficiency, focusing solely on depression would not encompass the full clinical picture of pellagra and could lead to misdiagnosis.

Q: Frontal headache is due to inflammation of which sinus?

Frontal. ***Frontal*** - Inflammation of the **frontal sinuses** typically causes pain and pressure over the forehead, known as a **frontal headache**. - The pain is often worse in the morning, when bending over, or with changes in **barometric pressure**. *Sphenoid* - **Sphenoid sinusitis** usually causes a headache behind the eyes, at the **vertex of the head**, or in the occipital region. - It is less common than other forms of sinusitis and often presents with more diffuse, deep-seated pain. *Ethmoidal* - **Ethmoidal sinusitis** typically results in pain and pressure between the eyes or over the **bridge of the nose**. - It can also cause eye pain and is sometimes mistaken for a **tension headache**. *Maxillary* - **Maxillary sinusitis** commonly causes pain and pressure in the cheeks, under the eyes, and in the upper teeth, often exacerbated by **chewing or biting**. - This pain can radiate to the temples or ears, but it typically does not manifest as a **frontal headache**.

Question 1

Smoking is associated with all the following diseases except:

Accepted Answer

Sarcoidosis

Answer

Emphysema

Answer

Cardiovascular disease

Answer

Lung cancer

Question 2

Which one of the following is the investigation of choice in a patient with haematemesis?

Accepted Answer

Flexible upper gastrointestinal endoscopy

Answer

Contrast enhanced CT scan

Answer

Barium meal for stomach and duodenum

Answer

Selective left gastric angiography

Question 3

The most common complication of pancreas divisum is:

Accepted Answer

Recurrent acute pancreatitis

Answer

Obstructive jaundice

Answer

Peptic ulcer

Answer

Duodenal obstruction

Question 4

The most common route of spread in a case of pyogenic liver abscess is:

Accepted Answer

Haematogenous through portal vein

Answer

Hepatic artery

Answer

Ascending infection through biliary duct

Answer

Local spread

Question 5

A patient has recurrent abdominal pain and jaundice. The blood investigations reveal reticulocytosis and hyperbilirubinemia. What is the clinical diagnosis?

Accepted Answer

Hereditary spherocytosis

Answer

Mirizzi's syndrome

Answer

Sclerosing cholangitis

Answer

Choledochal cyst

Question 6

The capillary refill time is prolonged in all types of shock EXCEPT:

Accepted Answer

Septic shock

Answer

Obstructive shock

Answer

Hypovolaemic shock

Answer

Cardiogenic shock

Question 7

Which of the following statements regarding lymphoedema are correct?

1. Patients experience constant dull ache and even severe pain sometimes
2. Manual lymphatic drainage has a role
3. Primary lymphoedema is caused by congenital lymphatic dysplasia
4. Nonne Milroy's disease is a type of primary lymphoedema

Select the correct answer using the code given below:

Accepted Answer

1, 2, 3 and 4

Answer

1 and 2 only

Answer

3 and 4 only

Answer

1, 2 and 3 only

Question 8

A 45-year-old man presents with the following skin changes (as shown in the image). What relevant history should be taken to diagnose this condition?

Accepted Answer

History of dietary pattern, dementia, and diarrhea

Answer

Dementia

Answer

Dietary history

Answer

Depression

Question 9

Frontal headache is due to inflammation of which sinus?

Accepted Answer

Frontal

Answer

Sphenoid

Answer

Ethmoidal

Answer

Maxillary

Question 10

Gynecomastia is seen in all except;

Accepted Answer

Leprosy

Answer

Kidney failure

Answer

Liver failure

Answer

Stilbestrol therapy for prostate cancer

Answer

Teratoma of the testis

Answer

Hormonal

Answer

Idiopathic

Answer

Anorchism and After castration

Answer

Klinefelter's syndrome

Clinical Manifestations and Presentation of Diseases — MCQs

Clinical Manifestations and Presentation of Diseases — MCQs

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