Clinical Manifestations and Presentation of Diseases Practice Questions

Q: In which condition are McCallum patches typically observed?

Rheumatic fever. ***Rheumatic fever*** - **McCallum patches** are a classic pathological finding in rheumatic fever, representing **subendocardial lesions** in the left atrium. - They are considered a form of **localized endocarditis** and are part of the widespread inflammatory process characteristic of the disease. *Rheumatoid arthritis (RA)* - RA primarily affects the **synovial lining of joints**, leading to **pannus formation** and joint destruction. - While RA can affect the heart (e.g., pericarditis, myocarditis), it does not involve the formation of McCallum patches. *Systemic lupus erythematosus (SLE)* - SLE is a **systemic autoimmune disease** that can affect multiple organ systems, including the heart. - Cardiac manifestations of SLE often include **Libman-Sacks endocarditis**, pericarditis, and myocarditis, but not McCallum patches. *Polyarteritis nodosa (PAN)* - PAN is a **necrotizing vasculitis** of medium-sized arteries, which can affect various organs but typically spares the lungs. - It does not involve the formation of McCallum patches in the heart.

Q: Deficiency of which of the following causes a perioral rash, gonadal atrophy, neuritis, and pigmentation of skin creases?

Zinc. ***Zinc*** - **Zinc deficiency** can lead to acrodermatitis enteropathica, which manifests with a characteristic **perioral and acral rash** [1]. - Other common symptoms include **gonadal atrophy**, hair loss, **neuritis**, and impaired immune function [1]. *Copper* - **Copper deficiency** can cause neurological problems, anemia, and bone abnormalities. - It is not typically associated with **perioral rashes** or **gonadal atrophy**. *Selenium* - **Selenium deficiency** is linked to Keshan disease (cardiomyopathy) and skeletal muscle weakness. - It does not cause the specific constellation of symptoms described, such as **perioral rash** or **gonadal atrophy**. *Magnesium* - **Magnesium deficiency** primarily leads to neuromuscular hyperexcitability, such as tremors and tetany, or cardiac arrhythmias. - It is not known to cause a **perioral rash** or **gonadal atrophy**.

Q: What is the optimal timing for collecting a urine sample from a patient with tuberculosis or kidney disease?

In early morning. ***In early morning*** - The first morning urine sample is the most concentrated, increasing the likelihood of detecting **microorganisms** or abnormal cells in conditions like **tuberculosis** or kidney disease. - This increased concentration makes it easier to identify pathogens such as **Mycobacterium tuberculosis** or subtle indicators of **renal pathology**. *24 hrs urine* - A 24-hour urine collection is typically used for assessing **renal function** or quantifying substances excreted over a full day (e.g., protein, creatinine clearance), not for detecting pathogens [1]. - While it measures total excretion, the dilution over this period can make it less effective for identifying **low concentrations** of microorganisms or cells crucial for initial diagnosis. *12 hrs urine* - A 12-hour collection, similar to 24-hour, is more focused on **quantitative analysis** over an extended period rather than optimizing concentration for qualitative detection [1]. - It does not offer the same peak concentration benefits as the first morning void needed for **sensitive diagnostic screening**. *Any time* - Random urine samples are often diluted, which decreases the sensitivity for detecting **low colony counts** of bacteria or trace amounts of abnormal components. - Less concentrated samples can lead to **false negatives**, especially in diseases where pathogen shedding might be intermittent or minimal.

Q: Osborne waves in an ECG are seen in

Hypothermia. ***Hypothermia*** - **Osborne waves**, also known as **J waves**, are characteristic ECG findings in **hypothermia**, appearing as a hump or positive deflection at the junction between the QRS complex and the ST segment. - They become more prominent as the **body temperature drops**, reflecting delayed ventricular repolarization [2]. *Hypokalemia* - Hypokalemia is associated with **U waves** on the ECG, which are typically small deflections following the T wave, not Osborne waves [1]. - Other ECG changes include **flattened T waves** and **ST-segment depression**. *Hypothyroidism* - Hypothyroidism can lead to **sinus bradycardia** and **low voltage QRS complexes** on an ECG. - It does not specifically cause Osborne waves. *Hypocalcemia* - Hypocalcemia primarily manifests as a **prolonged QT interval** on the ECG due to delayed ventricular repolarization. - **Osborne waves** are not a typical finding in hypocalcemia.

Q: Which of the following is a cause of chronic cough with a noncontributory chest radiograph?

All of the options. ***All of the options*** - **Asthma**, **GERD (gastroesophageal reflux disease)**, and **post nasal drip** [1] are all common causes of chronic cough, where the chest radiograph is typically normal or noncontributory. - These conditions are often primary considerations in the evaluation of chronic cough, especially when other more serious causes (like lung cancer or interstitial lung disease) have been ruled out. *Asthma* - **Cough-variant asthma** is a common presentation where chronic cough is the predominant symptom, often exacerbated by exercise, cold air, or allergens. - A chest radiograph in asthma is typically **normal**, as the pathology involves airway hyperresponsiveness andbronchoconstriction rather than structural lung changes visible on plain film. *GERD* - **Gastroesophageal reflux disease (GERD)** can cause chronic cough due to irritation of the tracheobronchial tree by refluxed stomach acid, even in the absence of typical heartburn symptoms. - A chest radiograph in GERD is usually **unremarkable**, as the cough is a reflex response to esophageal irritation, not a direct lung parenchymal or airway disease process. *Post nasal drip* - **Post nasal drip (PND)**, often due to rhinitis or sinusitis [1], is a very frequent cause of chronic cough, as mucus dripping down the back of the throat irritates the cough receptors. - The chest radiograph is typically **normal** in cases of post nasal drip, as the issue originates in the upper respiratory tract.

Q: Which of the following are seen in chronic lymphedema?

All of the options. ***All of the options*** - **Chronic lymphedema** leads to significant tissue changes due to persistent fluid accumulation and inflammation, resulting in all the described clinical signs. - The combination of **Stemmer's sign**, **square toes**, and **hyperkeratosis** are classic indicators of advanced lymphedema, marking specific stages of its progression. *Square toes* - **Square toes** are a distinctive feature of chronic lymphedema, occurring due to protein-rich fluid deposition and fibrosis in the dorsum of the foot, specifically the toes. - The fibrosis leads to tissue thickening and hardening, making the toes appear "squared off" rather than rounded. *Stemmer's sign* - **Stemmer's sign** is a hallmark physical finding in lymphedema, defined as the inability to pinch and lift a fold of skin at the base of the second toe or middle finger. - This inability indicates **fibrotic thickening** of the skin and subcutaneous tissue due to persistent lymphatic fluid buildup. *Hyperkeratosis* - **Hyperkeratosis** refers to the thickening of the stratum corneum (outermost layer of the epidermis) and is a common dermatological manifestation of **chronic lymphedema**. - It results from chronic inflammation, impaired lymphatic drainage, and subsequent protein deposition, leading to rough, warty skin texture.

Q: Pinch purpura around the eyelids is one of the most common findings in

Primary systemic amyloidosis. ***Primary systemic amyloidosis*** - **Periorbital purpura**, or "pinch purpura" around the eyelids, is a classic and highly suggestive cutaneous manifestation of **primary systemic amyloidosis**, due to the fragility of small vessels infiltrated by amyloid deposits. - This symptom results from minor trauma or even rubbing, causing vessel rupture and extravasation of blood into the surrounding tissue. *Fabry's disease* - Fabry's disease is a **lysosomal storage disorder** characterized by the accumulation of globotriaosylceramide, leading to acroparesthesias, angiokeratomas, and renal/cardiac involvement. - It does not typically present with periorbital purpura but rather with **angiokeratomas** (small, dark red to purple papules), particularly over the lower trunk. *Porphyria cutanea tarda* - This condition is characterized by **photosensitivity**, skin fragility, blistering lesions, and hyperpigmentation, often triggered by sun exposure [1]. - While it affects the skin, it does not typically cause periorbital purpura but rather **vesiculobullous lesions** and increased skin fragility on sun-exposed areas [1]. *None of the options* - This option is incorrect because **primary systemic amyloidosis** is directly associated with pinch purpura around the eyelids.

Q: Which of the following is NOT a characteristic of pancreatic cholera?

Hypochlorhydria. ***Hypochlorhydria*** - Pancreatic cholera (also known as VIPoma ) is characterized by massive secretion of vasoactive intestinal peptide (VIP) , which stimulates intestinal fluid and electrolyte secretion [1]. - Unlike **gastrinomas** which cause hyperchlorhydria, VIPomas do not directly affect gastric acid secretion, so hypochlorhydria is not a typical feature. *Hypokalemia* - This is a hallmark of pancreatic cholera due to the large volume of diarrhea, leading to significant **potassium loss** in stool. - The elevated VIP levels stimulate intestinal secretion of electrolytes, including potassium. *Glucose intolerance* - VIP can stimulate **glycogenolysis** and inhibit insulin release, leading to elevated blood glucose levels. - This is a common metabolic disturbance seen in VIPoma patients. *Hypocalcemia* - Although less common than hypokalemia, VIP can significantly increase **intestinal calcium secretion**, leading to calcium loss and subsequent hypocalcemia. - This electrolyte imbalance contributes to the clinical symptoms of pancreatic cholera.

Question 1

In which condition are McCallum patches typically observed?

Accepted Answer

Rheumatic fever

Answer

Polyarteritis nodosa (PAN)

Answer

Rheumatoid arthritis (RA)

Answer

Systemic lupus erythematosus (SLE)

Question 2

Deficiency of which of the following causes a perioral rash, gonadal atrophy, neuritis, and pigmentation of skin creases?

Accepted Answer

Zinc

Answer

Selenium

Answer

Copper

Answer

Magnesium

Question 3

What is the optimal timing for collecting a urine sample from a patient with tuberculosis or kidney disease?

Accepted Answer

In early morning

Answer

24 hrs urine

Answer

12 hrs urine

Answer

Any time

Question 4

Osborne waves in an ECG are seen in

Accepted Answer

Hypothermia

Answer

Hypokalemia

Answer

Hypothyroidism

Answer

Hypocalcemia

Question 5

Which of the following is a cause of chronic cough with a noncontributory chest radiograph?

Accepted Answer

All of the options

Answer

Asthma

Answer

GERD

Answer

Post nasal drip

Question 6

Which of the following are seen in chronic lymphedema?

Accepted Answer

All of the options

Answer

Stemmer's sign

Answer

Square toes

Answer

Hyperkeratosis

Question 7

Pinch purpura around the eyelids is one of the most common findings in

Accepted Answer

Primary systemic amyloidosis

Answer

Fabry's disease

Answer

Porphyria cutanea tarda

Answer

None of the options

Question 8

Which of the following is NOT a characteristic of pancreatic cholera?

Accepted Answer

Hypochlorhydria

Answer

Hypocalcemia

Answer

Hypokalemia

Answer

Glucose intolerance

Clinical Manifestations and Presentation of Diseases — MCQs

Clinical Manifestations and Presentation of Diseases — MCQs

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