Clinical Manifestations and Presentation of Diseases — MCQs

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

Question 141: Dupuytren's contracture occurs in which of the following conditions? a) Diabetes Mellitus b) Alcohol c) Epilepsy d) Rheumatoid Arthritis e) Chronic Pulmonary disease

A. BCDE
B. ABCD
C. ABCE (Correct Answer)
D. ABDE
E. ACDE

Explanation: ***ABCE*** - **Dupuytren's contracture** is commonly associated with several medical conditions, including **diabetes mellitus**, **alcoholism**, **epilepsy** (especially with phenobarbital use), and **chronic pulmonary disease**. - These conditions are known risk factors that contribute to the development of fibrous tissue proliferation in the palmar fascia. *BCDE* - This option correctly identifies **alcohol**, **epilepsy**, and **chronic pulmonary disease** as risk factors, but incorrectly omits **diabetes mellitus**, which is a significant association. - **Rheumatoid arthritis** is generally not considered a primary risk factor for Dupuytren's contracture. *ABCD* - This option includes **diabetes mellitus**, **alcohol**, and **epilepsy**, all known associations. However, it incorrectly includes **rheumatoid arthritis** and omits **chronic pulmonary disease**. - **Rheumatoid arthritis** is a distinct condition with different pathological mechanisms, not typically linked to Dupuytren's. *ABDE* - This option includes **diabetes mellitus**, **alcohol**, and **chronic pulmonary disease** but incorrectly includes **rheumatoid arthritis** and omits **epilepsy**. - **Epilepsy**, particularly with certain medications, is a well-established risk factor for Dupuytren's contracture. *ACDE* - This option includes **diabetes mellitus**, **epilepsy**, and **chronic pulmonary disease** but incorrectly includes **rheumatoid arthritis** and omits **alcohol**. - **Alcoholism** is a strong and frequently cited risk factor for the development of his condition due to its effects on connective tissue.

Question 142: Which of the following is a minor criterion for the diagnosis of acute rheumatic fever?

A. Subcutaneous nodules
B. Carditis
C. Chorea
D. Fever (Correct Answer)

Explanation: ***Fever*** - **Fever** is a minor diagnostic criterion for **acute rheumatic fever** (ARF), indicating systemic inflammation [1]. - While non-specific, its presence alongside other criteria supports the diagnosis, particularly in the context of recent streptococcal infection. *Subcutaneous nodules* - **Subcutaneous nodules** are a **major criterion** for ARF, typically firm, painless lumps found over bony prominences. - Their presence indicates more severe, chronic inflammation in ARF. *Carditis* - **Carditis** is a **major criterion** for ARF, referring to inflammation of the heart, which can affect the pericardium, myocardium, or endocardium [1]. - It is the most serious manifestation of ARF, as it can lead to permanent **rheumatic heart disease** [2]. *Chorea* - **Chorea** (specifically **Sydenham chorea**) is a **major criterion** for ARF, characterized by involuntary, jerky movements, often presenting late in the disease course [1]. - It results from inflammation affecting the basal ganglia.

Question 143: Stauffer syndrome is related to

A. Carcinoma colon
B. Carcinoma breast
C. Renal cell carcinoma (Correct Answer)
D. Hepatocellular carcinoma

Explanation: ***Renal cell carcinoma*** - **Stauffer syndrome** is a paraneoplastic syndrome predominantly associated with **renal cell carcinoma** (RCC) [1]. - It is characterized by **non-metastatic hepatic dysfunction** (elevated transaminases, alkaline phosphatase, bilirubin) that resolves upon tumor resection. *Carcinoma colon* - Colorectal carcinoma can be associated with various paraneoplastic syndromes, such as **acanthosis nigricans**, but typically **not Stauffer syndrome**. - Liver dysfunction in colorectal carcinoma is usually due to **metastatic disease**, not a paraneoplastic effect. *Carcinoma breast* - Breast cancer is linked to paraneoplastic syndromes like **Lambert-Eaton myasthenic syndrome** [2] or **hypercalcemia of malignancy**, but not Stauffer syndrome. - Liver involvement in breast cancer is commonly due to **metastasis**. *Hepatocellular carcinoma* - Hepatocellular carcinoma itself is a primary liver malignancy and can cause various forms of **liver dysfunction**. - However, Stauffer syndrome refers to **non-metastatic liver dysfunction** as a paraneoplastic effect of an **extrahepatic tumor**, most notably RCC [1].

Question 144: Burning sensation of the tongue is called:

A. Glossitis
B. Glossopyrosis (Correct Answer)
C. Glossalgia
D. Glossodynia

Explanation: ***Glossopyrosis*** - This term directly translates to an intense **burning sensation of the tongue**, combining 'glosso-' (tongue) and 'pyrosis' (burning). - It is often used to describe the primary symptom of **burning mouth syndrome** when the burning is a prominent feature. *Glossitis* - Refers to **inflammation of the tongue**, which may cause swelling, color changes, and loss of papillae, but does not specifically denote a burning sensation. - While inflammation can cause discomfort, the term describes the underlying pathological process rather than the subjective symptom of burning. *Glossalgia* - This term refers to **pain in the tongue**, combining 'glosso-' (tongue) and 'algia' (pain). - While a burning sensation is a type of pain, glossalgia is a more general term and does not specifically convey the quality of "burning." *Glossodynia* - This term also refers to **pain in the tongue**, similar to glossalgia, derived from 'glosso-' (tongue) and '-dynia' (pain). - Like glossalgia, it is a broader term for tongue pain and does not specifically denote a burning sensation, which is a more specific descriptor.

Question 145: Visual analogue scale is most widely used to measure

A. Sleep
B. Sedation
C. Depth of anaesthesia
D. Pain intensity (Correct Answer)

Explanation: ***Pain intensity*** - The **Visual Analogue Scale (VAS)** is a psychometric response scale primarily used to measure the subjective intensity of **pain**. - It allows patients to indicate their pain level on a continuous scale, typically a 10 cm line, providing a more nuanced measure than categorical scales. *Sleep* - While sleep quality and subjective experience can be assessed, the **VAS** is not the primary or most widely used tool for measuring sleep itself. - **Polysomnography** and various sleep questionnaires are more commonly employed for sleep assessment. *Sedation* - Though subjective sedation levels can be rated, more specific scales like the **Ramsay Sedation Scale** or **Richmond Agitation-Sedation Scale (RASS)** are more commonly used for objective and consistent evaluation of sedation. *Depth of anaesthesia* - **Depth of anaesthesia** is primarily measured using objective physiological parameters and processed **electroencephalogram (EEG)** analysis (e.g., Bispectral Index or BIS), not subjective scales like the VAS. - These objective measures provide real-time data to guide anesthetic administration.

Question 146: Grey Turner's sign is seen in:

A. Acute pancreatitis (Correct Answer)
B. Acute cholecystitis
C. Acute hepatitis
D. Acute appendicitis

Explanation: ***Acute pancreatitis*** - **Grey Turner's sign** is characterized by **flank ecchymosis** (bruising) resulting from retroperitoneal hemorrhage in cases of severe acute pancreatitis [1]. - This sign indicates pancreatic necrosis and hemorrhage, often associated with a **worse prognosis** [1]. *Acute cholecystitis* - Acute cholecystitis primarily presents with **right upper quadrant pain**, fever, and leukocytosis due to gallbladder inflammation, not flank ecchymosis [2]. - **Murphy's sign** (inspiratory arrest on palpation of the right upper quadrant) is characteristic. *Acute hepatitis* - Acute hepatitis involves **liver inflammation** causing jaundice, fatigue, and elevated liver enzymes, but does not cause flank bruising. - It does not present with signs of retroperitoneal hemorrhage. *Acute appendicitis* - Acute appendicitis typically causes **periumbilical pain** that migrates to the right lower quadrant, associated with nausea, vomiting, and fever [2]. - Classic signs include **McBurney's point tenderness** and rebound tenderness, not flank ecchymosis.

Question 147: Which of the following is seen in Rheumatoid Arthritis?

A. Presence of Rheumatoid Factor (RF)
B. Presence of Anti-CCP antibodies
C. Higher risk of extra-articular manifestations
D. All of the above (Correct Answer)

Explanation: ***All of the above*** - **Rheumatoid arthritis** is an autoimmune disease characterized by chronic inflammation that can affect various body systems, and the presence of **Rheumatoid Factor (RF)**, **Anti-Cyclic Citrullinated Peptide (Anti-CCP) antibodies**, and a **higher risk of extra-articular manifestations** are all characteristic features [1]. - While RF and anti-CCP are diagnostic markers, extra-articular manifestations highlight the systemic nature of the disease, affecting organs beyond the joints. *Presence of Rheumatoid Factor (RF)* - While many patients with **rheumatoid arthritis** test positive for **RF**, it is not specific to RA and can be seen in other conditions, such as systemic lupus erythematosus, Sjögren's syndrome, and chronic infections [1]. - Approximately 20% of RA patients are seronegative for RF. *Presence of Anti-CCP antibodies* - **Anti-CCP antibodies** are highly specific for **rheumatoid arthritis** and often appear early in the disease course, making them a valuable diagnostic and prognostic marker [1]. - Their presence is strongly associated with an erosive disease course. *Higher risk of extra-articular manifestations* - **Extra-articular manifestations** of **rheumatoid arthritis** indicate systemic involvement and can include rheumatoid nodules, vasculitis, pleuritis, pericarditis, scleritis, and Felty's syndrome [1]. - The presence of these manifestations often correlates with more severe disease and a poorer prognosis [1].

Question 148: Persistent diarrhoea is defined as diarrhoea lasting more than?

A. 28 days
B. 21 days
C. 14 days (Correct Answer)
D. 7 days

Explanation: ***14 days*** - **Persistent diarrhea** is clinically defined as an episode of diarrhea that lasts for **14 days or longer**. - This definition helps differentiate it from **acute diarrhea** (less than 14 days) and aids in guiding appropriate diagnostic and management strategies. *28 days* - Diarrhea lasting **longer than 28 days** is typically classified as **chronic diarrhea**, which is a distinct category from persistent diarrhea. - Chronic diarrhea often requires a more extensive workup to identify underlying causes, which can include malabsorption syndromes, inflammatory bowel disease, or irritable bowel syndrome. *21 days* - While 21 days is a prolonged period, it falls within the spectrum of **persistent diarrhea**, but the standard definition starts at **14 days**. - There is no specific clinical classification for diarrhea lasting exactly 21 days as distinct from persistent or chronic. *7 days* - Diarrhea lasting less than 14 days, including **7 days**, is generally considered **acute diarrhea**. - Acute diarrhea is very common and often self-limiting, frequently caused by infections and typically resolves without specific intervention.

Question 149: All the following are causes of hyperthermia except

A. Hypothyroidism (Correct Answer)
B. Cerebral hemorrhage
C. Succinyl Choline
D. Pheochromocytoma

Explanation: ***Hypothyroidism*** - Hypothyroidism is characterized by a **reduced metabolic rate** and **decreased heat production**, leading to **cold intolerance** and sometimes **hypothermia**, not hyperthermia [1]. - The body's inability to generate sufficient heat due to low thyroid hormone levels makes hyperthermia an unlikely presentation. *Cerebral hemorrhage* - **Cerebral hemorrhage**, especially in the **hypothalamus** or brainstem, can disrupt the body's **thermoregulation center**, leading to **uncontrolled hyperthermia** [1]. - This is a neurogenic cause of hyperthermia, often refractory to antipyretics. *Succinyl Choline* - **Succinylcholine** can trigger **malignant hyperthermia** in susceptible individuals, particularly when combined with volatile anesthetics [2]. - Malignant hyperthermia is a severe, rapid increase in body temperature due to uncontrolled muscle contractions. *Pheochromocytoma* - **Pheochromocytoma** causes the excessive release of **catecholamines** (epinephrine and norepinephrine), which increase the **metabolic rate** and lead to peripheral vasoconstriction. - This heightened metabolic activity and reduced heat dissipation can result in **hyperthermia** [2].

Question 150: Blue sclera is seen in-

A. Ehlers-Danlos syndrome
B. Marfan syndrome
C. Osteogenesis imperfecta (Correct Answer)
D. Rheumatoid arthritis

Explanation: Blue sclera is seen in- ***Osteogenesis imperfecta*** - **Blue sclera** is a classic sign due to the underlying **collagen disorder** where the sclera is thinner, allowing the underlying choroidal vessels to show through. - This genetic disorder is characterized by **brittle bones** and **connective tissue fragility**. *Ehlers-Danlos syndrome* - While it is a **collagen disorder** and can cause **connective tissue laxity**, **blue sclera** is not a primary or common feature. [1] - It often presents with **hyperextensible joints**, **fragile skin**, and easy bruising. [1] *Marfan syndrome* - This is a genetic disorder affecting connective tissue, primarily due to a defect in **fibrillin-1**, but it is not typically associated with **blue sclera**. - Key features include **tall stature**, **long slender limbs (arachnodactyly)**, and **cardiovascular abnormalities** like aortic dissection. *Rheumatoid arthritis* - This is an **autoimmune inflammatory disease** primarily affecting synovial joints and is not associated with **blue sclera**. - Ocular manifestations in rheumatoid arthritis typically involve **scleritis** or **episcleritis**, which are inflammatory conditions of the sclera, not a blue discoloration.

Practice by Chapter

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Syncope and Presyncope

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Dyspnea and Respiratory Distress

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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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