Clinical Manifestations and Presentation of Diseases — MCQs

A 78 year old man who lives alone and prepares his own food is found to have ecchymotic patches over posterior aspect of his lower extremities. He has haemorrhagic areas around hair follicles, hair are fragmented and splinter haemorrhages are present in nail beds and several hematomas are present in the muscles of arms and legs. PT and CT are normal. This clinical syndrome is most likely due to

Q139

Which of the following regions is involved in Plummer-Vinson syndrome?

Q140

Perleche is caused by:

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

Question 131: Reversible dementia is seen in?

A. Pick's disease
B. Alzheimer's disease
C. Hypothyroidism (Correct Answer)
D. Subacute demyelination of spinal cord

Explanation: ***Hypothyroidism*** - **Hypothyroidism** can lead to cognitive impairment, including memory loss, slowed thinking, and executive dysfunction, which are reversible with appropriate **thyroid hormone replacement therapy**. - This condition is often characterized by other systemic symptoms like fatigue, weight gain, and cold intolerance, which also improve with treatment. *Pick's disease* - **Pick's disease** is a type of **frontotemporal dementia** caused by progressive degeneration of brain cells, primarily in the frontal and temporal lobes. - It is a **neurodegenerative** disorder, meaning it is progressive and irreversible. *Alzheimer's disease* - **Alzheimer's disease** is the most common cause of dementia, characterized by the accumulation of **amyloid plaques** and **neurofibrillary tangles** in the brain [1]. - It is a **progressive and irreversible neurodegenerative disease** with no cure [2]. *Subacute demyelination of spinal cord* - **Subacute demyelination of the spinal cord** typically refers to conditions like **subacute combined degeneration** due to **vitamin B12 deficiency** [1]. - While this can cause neurological symptoms, including cognitive changes, its primary impact is on the spinal cord and peripheral nerves, and "dementia" in the classic sense is not the primary or defining feature of spinal cord demyelination itself, although B12 deficiency can cause broader cognitive issues [1].

Question 132: Clinical features of rheumatic fever include all of the following EXCEPT:

A. Joint pains
B. Cardiomegaly
C. ST segment elevation (Correct Answer)
D. Increased PR interval

Explanation: ***ST segment elevation*** - While **pericarditis**, which can occur in rheumatic fever, may cause **ST segment elevation**, it is not considered a direct or primary clinical feature of the disease itself according to the **Jones criteria**. - **ST segment elevation** is more characteristic of conditions like **myocardial infarction** or benign early repolarization. *Joint pains* - **Polyarthritis** is a major criterion for diagnosing rheumatic fever, often presenting as **migratory polyarthritis** primarily affecting large joints. - The joint pain is typically very responsive to salicylates. *Cardiomegaly* - **Carditis**, a major manifestation of rheumatic fever, can lead to **myocarditis** and **valvular inflammation**, which may result in **cardiac enlargement** (cardiomegaly). - This reflects the significant inflammatory damage to the heart structures. *Increased PR interval* - Prolongation of the **PR interval** on an ECG is a common finding in rheumatic fever, indicating **first-degree AV block** due to inflammation of the conduction system. - This is considered a minor criterion according to the modified Jones criteria.

Question 133: An old man with hypertension and BP 210/110 mm Hg is classified as having severe hypertension. Which scale is used for this classification?

A. Nominal
B. Ordinal (Correct Answer)
C. Interval
D. Ratio

Explanation: ***Ordinal*** - The classification of **hypertension severity** (e.g., mild, moderate, severe) represents an **ordered ranking** where the difference between categories isn't necessarily equal or quantifiable [1], [2]. - This scale allows for **comparison of severity**, indicating that severe is worse than moderate, but without precise numerical differences between stages [2]. *Nominal* - This scale is used for **categorization without any order** or numerical value, such as gender or blood type. - It would classify hypertension as simply "hypertensive" or "non-hypertensive" without indicating severity. *Interval* - An interval scale has **ordered categories** with **equal differences** between points. - While it has order, it lacks a true zero point, common examples include Celsius or Fahrenheit temperature scales. *Ratio* - A ratio scale has **ordered categories**, **equal intervals**, and a **true zero point**, allowing for meaningful ratios. - Examples include height, weight, or blood pressure measurements themselves, but not their classification into severity stages [3].

Question 134: Aspirin triad is?

A. Samter's syndrome (Correct Answer)
B. Kartagener s syndrome
C. Young syndrome
D. Churg-Strauss syndrome

Explanation: ***Samter's syndrome*** - Also known as **aspirin-exacerbated respiratory disease (AERD)** or aspirin triad, this condition is characterized by **asthma**, **nasal polyps**, and a sensitivity to **aspirin** and other NSAIDs [1]. - The symptoms are typically triggered by NSAID ingestion, leading to a severe asthmatic response and rhinosinusitis [1]. *Kartagener's syndrome* - This is a subgroup of **primary ciliary dyskinesia** characterized by the triad of **situs inversus** (organ reversal), chronic sinusitis, and bronchiectasis. - It is a genetic disorder affecting ciliary function, which is unrelated to aspirin sensitivity. *Young syndrome* - This syndrome is characterized by the triad of **bronchiectasis**, rhinosinusitis, and **obstructive azoospermia** in men due to ciliary dysfunction. - It does not involve aspirin sensitivity or nasal polyps as primary features. *Churg-Strauss syndrome* - Now known as **Eosinophilic Granulomatosis with Polyangiitis (EGPA)**, it is a rare autoimmune disease characterized by **asthma**, **eosinophilia**, and **vasculitis**. - While asthma is a feature, the core triad of EGPA involves systemic vasculitis and high eosinophil counts, not nasal polyps or specific aspirin sensitivity.

Question 135: All of the following are the risk factors for testicular tumors except:

A. Testicular feminization syndrome
B. Klinefelter's syndrome
C. Acute Epididymo- Orchitis (EDO) (Correct Answer)
D. Administration of DES in utero

Explanation: ***Acute Epididymo- Orchitis (EDO)*** - **Acute epididymo-orchitis** is an inflammation or infection of the epididymis and testes, typically caused by bacteria or viruses, and is not a known risk factor for testicular tumors. - While it can cause testicular pain and swelling, it does not predispose individuals to the development of germ cell tumors or other testicular malignancies. *Testicular feminization syndrome* - This syndrome, also known as **Androgen Insensitivity Syndrome (AIS)**, is a significant risk factor for testicular germ cell tumors due to the presence of undescended testes (gonads) and abnormal hormonal environments. - Individuals with AIS have XY chromosomes but are phenotypically female, and if the gonads are not removed, they carry an increased risk of developing **dysgerminoma or seminoma**. *Klinefelter's syndrome* - **Klinefelter's syndrome** (47, XXY) is associated with an increased risk of extragonadal germ cell tumors, particularly **mediastinal germ cell tumors**, as well as a slightly elevated risk of testicular germ cell tumors. - This genetic condition is characterized by primary testicular failure, gynecomastia, and infertility, and the abnormal chromosomal complement contributes to the oncogenic risk. *Administration of DES in utero* - Maternal use of **diethylstilbestrol (DES)** during pregnancy has been linked to an increased risk of reproductive tract abnormalities and certain cancers in offspring, including testicular cancer. - Exposure to DES in utero has been associated with **epididymal cysts**, cryptorchidism, and an elevated risk of **clear cell adenocarcinoma** of the vagina/cervix in females, and testicular germ cell tumors in males.

Question 136: Gurd test detects:

A. Fat globules in bone marrow
B. Fat globules in urine (Correct Answer)
C. Fat globules in blood
D. Fat globules in sputum

Explanation: ***Fat globules in urine*** - The **Gurd test** is a clinical method used to detect the presence of **fat globules in urine**, which can be an indicator of fat embolism [1]. - Presence of **fat droplets in urine** occurs when fat emboli are filtered through the kidneys, suggesting systemic fat embolism [1]. *Fat globules in bone marrow* - The detection of **fat globules in bone marrow** is typically associated with bone marrow aspiration or biopsy findings, not a specific diagnostic test called Gurd test. - While **fat embolism syndrome** can originate from marrow trauma, the Gurd test specifically examines urine [1]. *Fat globules in blood* - **Fat globules in blood** (lipemia) can be detected through various laboratory tests assessing serum lipids or through direct microscopic examination of blood smears, but not with the Gurd test. - The Gurd test focuses on the excretion of fat through the kidneys, not its presence directly in the bloodstream [1]. *Fat globules in sputum* - **Fat globules in sputum** are not a typical diagnostic finding for conditions like fat embolism and would suggest a different pathology, such as aspiration pneumonia with lipid content or pulmonary injury where fat might be coughed up. - The Gurd test is not designed for the detection of fat in respiratory secretions.

Question 137: Least common association with Morbid Obesity is?

A. Rheumatoid Arthritis (Correct Answer)
B. Essential Hypertension
C. Large bowel cancers
D. Diabetes Mellitus type II

Explanation: Rheumatoid Arthritis - While obesity can exacerbate symptoms and complicate management of rheumatoid arthritis (RA), it is not a direct cause or a commonly associated comorbidity. [1] - The pathogenesis of RA is primarily autoimmune, distinct from metabolic factors linked to obesity. *Essential Hypertension* - Obesity is a major risk factor for developing essential hypertension, due to increased blood volume, sympathetic nervous system activity, and insulin resistance. - The prevalence of hypertension rises significantly with increasing body mass index (BMI). [2] *Large bowel cancers* - Obesity is a well-established risk factor for several types of cancer, including colorectal cancer (large bowel cancer), due to chronic inflammation, altered hormone levels, and insulin resistance. - Studies show a clear dose-response relationship between BMI and colorectal cancer risk. *Diabetes Mellitus type II* - Type 2 Diabetes Mellitus is strongly and causally linked to obesity, with insulin resistance being a direct consequence of excess adipose tissue. [3] - Most patients with Type 2 Diabetes are overweight or obese, highlighting this highly common association.

Question 138: A 78 year old man who lives alone and prepares his own food is found to have ecchymotic patches over posterior aspect of his lower extremities. He has haemorrhagic areas around hair follicles, hair are fragmented and splinter haemorrhages are present in nail beds and several hematomas are present in the muscles of arms and legs. PT and CT are normal. This clinical syndrome is most likely due to

A. Vitamin A deficiency
B. Vitamin C deficiency (Correct Answer)
C. Vitamin K deficiency
D. Pyridoxine deficiency

Explanation: ***Vitamin C deficiency*** - The constellation of **ecchymotic patches**, **perifollicular hemorrhages** with fragmented hairs, **splinter hemorrhages**, and **muscle hematomas** is classic for **scurvy**, caused by vitamin C deficiency [2]. - Vitamin C is essential for **collagen synthesis**, and its deficiency leads to weakened blood vessel walls and connective tissue, resulting in these bleeding manifestations [2]. *Vitamin A deficiency* - Primarily causes **ocular symptoms** such as **night blindness** and **xerophthalmia**, and can also lead to **hyperkeratosis follicularis** (bumpy skin) [1]. - It does not typically cause the diffuse ecchymoses, perifollicular hemorrhages, or muscle hematomas seen in this patient. *Vitamin K deficiency* - Leads to impaired synthesis of **coagulation factors II, VII, IX, and X**, resulting in prolonged **PT (prothrombin time)** and **aPTT (activated partial thromboplastin time)** [3]. - The patient's normal PT and CT strongly argue against vitamin K deficiency as the primary cause of bleeding [3]. *Pyridoxine deficiency* - Also known as **vitamin B6 deficiency**, it can cause **neurological symptoms** (neuropathy, seizures), **dermatitis**, and **sideroblastic anemia**. - It is not associated with the extensive bleeding and connective tissue manifestations described in this clinical scenario.

Question 139: Which of the following regions is involved in Plummer-Vinson syndrome?

A. Valleculae
B. Posterior pharyngeal wall
C. Postcricoid region (Correct Answer)
D. Pyriform sinus

Explanation: ***Postcricoid region*** - **Plummer-Vinson syndrome** is characterized by the formation of **esophageal webs** in the postcricoid region, leading to dysphagia. - This syndrome is often associated with long-standing **iron-deficiency anemia**. *Valleculae* - The valleculae are anatomical spaces located between the base of the tongue and the epiglottis, primarily involved in swallowing, but not typically affected by Plummer-Vinson syndrome. - While food can collect here, they are not the site of web formation characteristic of the syndrome. *Posterior pharyngeal wall* - The posterior pharyngeal wall is part of the pharynx and, while involved in the passage of food, is not the primary site for the formation of esophageal webs in Plummer-Vinson syndrome. - Web formation in this region would be highly unusual for the syndrome described. *Pyriform sinus* - The **pyriform sinus** is a potential space lateral to the laryngeal inlet, where food can temporarily pool, but it is not the location where esophageal webs form in Plummer-Vinson syndrome. - Obstruction or pathology in the pyriform sinus would present differently from the progressive dysphagia caused by a postcricoid web.

Question 140: Perleche is caused by:

A. Trauma to the corners of the mouth
B. Loss of vertical dimension (Correct Answer)
C. Lack of Vitamin C
D. Maintained vertical dimension

Explanation: ***Loss of vertical dimension*** - **Loss of vertical dimension** leads to over-closure of the mouth, causing the corners of the mouth to become folded and moist. - This moisture and skin folding create an ideal environment for **candidal** or **bacterial colonization**, leading to perleche. *Trauma to the corners of the mouth* - While trauma can cause lesions, it is not the primary or typical cause for the chronic, often bilateral, inflammation seen in perleche. - Trauma alone would not explain the characteristic **fissuring** and **erythema** associated with moisture accumulation. *Lack of Vitamin C* - A lack of Vitamin C (scurvy) primarily causes **gingival bleeding**, **poor wound healing**, and **petechiae**. - It does not directly cause the characteristic angular cheilitis seen in perleche. *Maintained vertical dimension* - A maintained or adequate vertical dimension would prevent the over-closure and skin folding that contributes to the moist environment at the oral commissures. - Therefore, it is a healthy state that typically works against the development of perleche.

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