Clinical Manifestations and Presentation of Diseases Practice Questions

Q: Which of the following conditions can lead to non-traumatic amputation?

Diabetes mellitus. ***Diabetes mellitus*** - **Peripheral neuropathy** and **vascular disease** in diabetes lead to impaired sensation, poor wound healing, and increased risk of infection, often necessitating amputation. - **Diabetic foot ulcers** are a common precursor to amputation, especially when complicated by osteomyelitis or gangrene. *All of the listed conditions* - While other conditions listed can lead to non-traumatic amputation, this option is incorrect as it includes conditions that are less likely or have different mechanisms compared to the more direct and common pathway seen in diabetes. - The question asks for a specific condition that *can* lead to non-traumatic amputation, and while some others might, diabetes is a primary and very common cause. *Leprosy* - **Peripheral nerve damage** in leprosy causes loss of sensation, leading to unnoticed injuries, repeated trauma, and secondary infections, which can ultimately result in auto-amputation or surgical amputation. - While it can lead to amputation, it is primarily due to undetected injuries and subsequent infection rather than direct vascular compromise. *Sickle cell anemia* - **Vaso-occlusive crises** in sickle cell anemia can lead to severe *ischemia* and tissue necrosis, which may necessitate amputation if not managed effectively. - This is a less common cause of non-traumatic amputation compared to diabetes, and usually occurs in severe, recurrent episodes affecting the extremities.

Q: A patient who is a known case of cystic fibrosis comes to the emergency department with a complaint of abdominal pain. He gives a history of similar episodes in the past. Abdominal X-ray and USG were done in the patient after stabilization. The patient is not at risk of which of the following conditions?

Niacin deficiency. ***Niacin deficiency*** - Cystic fibrosis primarily affects **fat-soluble vitamin absorption (A, D, E, K)** due to pancreatic insufficiency. - **Niacin** (Vitamin B3) is a water-soluble vitamin, and its deficiency is not a typical complication of cystic fibrosis unless there are severe, prolonged dietary restrictions. *Vitamin B12 deficiency* - While Vitamin B12 is water-soluble, proper absorption requires **intrinsic factor** and functional ileum, and its malabsorption can occur in CF patients due to **impaired pancreatic enzyme activity** and bacterial overgrowth leading to **bacterial degradation of B12**. - Additionally, chronic pancreatic insufficiency can impact the release of **R-binders** and subsequent B12 absorption [1]. *Neuropathy* - **Neuropathy** can develop in cystic fibrosis patients, particularly due to **Vitamin E deficiency** which is common given the malabsorption of fat-soluble vitamins. - Vitamin E is a crucial antioxidant, and its prolonged deficiency can lead to **neurological damage**, including peripheral neuropathy and ataxia. *Pancreatic carcinoma* - Patients with cystic fibrosis have a significantly **increased risk of developing pancreatic adenocarcinoma** compared to the general population. - This elevated risk is attributed to chronic inflammation and fibrosis within the pancreas.

Q: Which of the following is the least common site of pain in a case of rheumatoid arthritis?

Low back. Low back - **Low back pain** is rarely a primary manifestation of **rheumatoid arthritis (RA)** because the **sacroiliac joints** and lumbar spine are typically spared. - If low back pain occurs in RA, it is more likely due to a co-existing condition or **secondary to cervical spine involvement**, leading to referred pain. Cervical - **Cervical spine involvement** is common in RA, particularly affecting the **atlantoaxial joint**, and can lead to neck pain, stiffness, and neurological deficits [1]. - **Subluxation** of the atlantoaxial joint can occur due to ligamentous laxity and bone erosion caused by the inflammatory process [1]. Ankle - The **ankles** are frequently affected in RA, presenting with pain, swelling, and morning stiffness. - **Synovitis** of the ankle joint and surrounding tendons is a characteristic feature. Knee - **Knee involvement** is common in RA, often presenting as **bilateral synovitis**, pain, swelling, and reduced range of motion. - **Baker's cysts**, which are popliteal cysts due to fluid accumulation, can also be associated with knee inflammation in RA.

Q: Winberger sign is present in -

Rickets. ***Rickets*** - Winberger sign, specifically refers to a **radiolucent band** at the metaphysis often seen in the distal femur, which is a key radiographic feature of **rickets**. - This sign indicates a **defect in mineralization** of the growing bone due to vitamin D deficiency [1]. *Secondary syphilis* - Secondary syphilis presents with a **maculopapular rash**, **lymphadenopathy**, and constitutional symptoms, not bone abnormalities like Winberger sign. - While syphilis can affect bones later in its course (tertiary syphilis), it typically presents as **periostitis** or **gummas**, which are different from Winberger sign. *Tuberculosis* - Tuberculosis primarily affects the lungs but can cause **skeletal tuberculosis** (Pott's disease), characterized by vertebral collapse and cold abscesses. - It does not present with Winberger sign; its bone manifestations are typically destructive lesions or **osteomyelitis**. *Scurvy* - Scurvy, caused by **vitamin C deficiency**, affects collagen formation, leading to **subperiosteal hemorrhages** and impaired bone growth in children. - Radiographic findings include a **scorbutic rosary** and general rarefaction, not specifically Winberger sign.

Q: Odynophagia is

Pain during swallowing. ***Pain during swallowing*** - **Odynophagia** specifically refers to **pain experienced during the act of swallowing**, which can range from mild discomfort to severe pain. - This symptom often indicates inflammation, infection, or structural damage to the esophagus or throat structures involved in swallowing [1]. *Bad odour from mouth* - This symptom is known as **halitosis**, which is unrelated to the sensation of pain during swallowing [2]. - Halitosis is primarily caused by microbial activity in the mouth, certain foods, or underlying medical conditions such as poor oral hygiene or gum disease. *Psychiatric disease* - While psychological factors can sometimes influence somatic symptoms, **odynophagia is a physical symptom** with a direct physiological basis, not a psychiatric disease itself. - Psychiatric conditions might cause globus sensation (a feeling of a lump in the throat) but generally not true pain during swallowing. *Difficulty in swallowing* - Difficulty in swallowing is medically termed **dysphagia**, which is a distinct symptom from odynophagia [2]. - Dysphagia refers to the sensation of food or liquid getting stuck or not passing smoothly, which may or may not be painful [1].

Q: A man takes peanut and develops tongue swelling, neck swelling, stridor, hoarseness of voice. What is the probable diagnosis?

Angioneurotic edema. Andioneurotic edema - The combination of **tongue swelling**, **neck swelling**, **stridor**, and **hoarseness of voice** following peanut ingestion is highly suggestive of **angioneurotic edema**, a severe allergic reaction that can lead to airway obstruction [1]. - This is a life-threatening condition requiring immediate medical intervention, often associated with generalized **anaphylaxis** when triggered by allergens [2]. *FB in larynx* - While a **foreign body (FB) in the larynx** can cause stridor and hoarseness, the widespread swelling of the tongue and neck points away from a localized laryngeal obstruction [3]. - A laryngeal FB would typically be associated with a more sudden onset of choking and coughing, not diffuse edema [3]. *Parapharyngeal abscess* - A **parapharyngeal abscess** would typically present with **fever**, **severe throat pain**, and **trismus** (difficulty opening the mouth), which are not mentioned in this scenario. - The acute, rapid onset of symptoms after peanut consumption is inconsistent with the slower progression of an abscess. *FB bronchus* - A **foreign body in the bronchus** would primarily cause **coughing**, **wheezing**, and possibly **respiratory distress**, often unilateral, rather than severe global swelling of the tongue and neck. - Inspiratory stridor and hoarseness are more indicative of upper airway involvement than bronchial obstruction.

Q: Which of the following is NOT true about Henoch-Schönlein purpura?

Non-palpable purpura. ***Non-palpable purpura*** - **Henoch-Schönlein purpura (HSP)** is characterized by **palpable purpura**, typically on the lower extremities and buttocks, which is a hallmark clinical feature [1]. - Non-palpable purpura would suggest a **platelet disorder** or other coagulopathy rather than a vasculitic process like HSP. *Glomerulonephritis* - **Renal involvement**, presenting as glomerulonephritis, is a common and serious complication of HSP that can lead to chronic kidney disease [1]. - This typically presents with **hematuria** and **proteinuria**, and in some cases, **renal failure** [2]. *IgA deposition* - **IgA immune complex deposition** in small blood vessels is the defining **pathological feature** of HSP, leading to inflammation and vessel damage [1]. - This can be seen in affected organs, including the skin (vasculitis), kidneys (glomerulonephritis), and gastrointestinal tract [3]. *Abdominal pain* - **Gastrointestinal involvement** is common in HSP, manifesting as colicky abdominal pain, nausea, vomiting, and sometimes **gastrointestinal bleeding** or **intussusception** [1]. - This pain is often severe and can mimic acute abdominal conditions requiring surgical evaluation.

Q: 65-year-old man presents with anemia, posterior column dysfunction, and plantar extensor. Which of the following is the likely cause

Vitamin B 12 deficiency. ***Vitamin B12 deficiency*** - **Vitamin B12 deficiency** commonly presents with a triad of symptoms, including **anemia** (megaloblastic), **neurological dysfunction** (posterior column dysfunction leading to impaired proprioception and vibratory sense), and in severe cases, abnormal reflexes like a **plantar extensor response** (Babinski sign) due to demyelination of the corticospinal tracts [1]. - The combination of **anemia** and specific neurological deficits, especially involving the **posterior columns** and motor pathways, is highly characteristic of this deficiency [1]. *Friedreich's ataxia* - This is a **hereditary neurodegenerative disorder** primarily affecting the **spinal cord** (dorsal columns, spinocerebellar tracts, corticospinal tracts) and cerebellum [2]. - While it causes **ataxia** and neurological symptoms, it typically does not present with **anemia** as a primary feature. *Tabes dorsalis* - **Tabes dorsalis** is a late neurological manifestation of **syphilis**, characterized by degeneration of the **posterior columns** of the spinal cord. - While it causes **posterior column dysfunction**, it is not typically associated with **anemia**; its characteristic symptoms include lancinating pains, Argyll Robertson pupils, and sensory ataxia. *Vitamin B1 deficiency* - **Vitamin B1 (thiamine) deficiency** can lead to conditions like **beriberi**, affecting cardiovascular, neurological, and gastrointestinal systems. - Neurological manifestations primarily involve peripheral neuropathy and Wernicke-Korsakoff syndrome, but **anemia** and specific **posterior column dysfunction** in the manner described are not typical features.

Q: What is the name of this test to be done before drawing an arterial blood gas sample:

Allen test. ***Allen test*** - The **Allen test** is performed to assess the patency of the **ulnar artery** and ensure adequate collateral blood flow to the hand before an **arterial blood gas (ABG) sample** is drawn from the **radial artery**. - This prevents **ischemic complications** in case the radial artery is damaged during the procedure. *Both radial & ulnar artery are occluded* - While both arteries are initially occluded during the Allen test, this statement describes only a **partial step** of the complete procedure, not the name of the test itself. - The crucial part of the test involves releasing one artery to observe **reperfusion**. *Trendelenburg test* - The **Trendelenburg test** is used to evaluate **venous insufficiency**, typically in the **lower limbs**, and is unrelated to arterial blood sampling. - It involves assessing the filling pattern of **varicose veins** after leg elevation. *Ulnar artery kept occluded, Radial artery released; These are steps of Allen's test* - This statement describes a specific step within the Allen test; however, for the test to be valid, the radial artery is typically the one from which the sample is drawn, thus the **ulnar artery's patency is being assessed**. - The correct sequence for assessing radial artery patency after initial occlusion is to release the ulnar artery, not the radial artery, to observe hand reperfusion; an alternative sequence is used if the sample is taken from the ulnar artery.

Q: Which of the following symptoms suggests CHF in infants

Diaphoresis with feedings. ***Diaphoresis with feedings*** - **Diaphoresis (sweating)** during feeding is a classic symptom in infants with **congestive heart failure (CHF)** due to the increased metabolic demand and sympathetic activation required for feeding [1]. - Infants with CHF also often exhibit **poor feeding** and **failure to thrive** due to the high energy expenditure associated with their cardiac condition [1]. *Fever* - **Fever** is a general sign of inflammation or infection and is not a specific indicator of **CHF** in infants. - While an infection could exacerbate CHF, fever itself is not a direct symptom of heart failure. *Persistent irritability* - **Persistent irritability** can be a non-specific sign of discomfort or illness in infants, including those with CHF, but it is not a primary or characteristic symptom. - Irritability can arise from many conditions, making it a less precise indicator for CHF. *Cyanosis* - **Cyanosis** (bluish discoloration of the skin) is a sign of **hypoxemia** and is typically seen in infants with **cyanotic congenital heart defects**, not necessarily in all forms of **CHF** [1]. - While some severe forms of CHF can lead to respiratory distress and secondary cyanosis, it's not a universal or early symptom of CHF itself.

Question 1

Which of the following conditions can lead to non-traumatic amputation?

Accepted Answer

Diabetes mellitus

Answer

All of the listed conditions

Answer

Leprosy

Answer

Sickle cell anemia

Question 2

A patient who is a known case of cystic fibrosis comes to the emergency department with a complaint of abdominal pain. He gives a history of similar episodes in the past. Abdominal X-ray and USG were done in the patient after stabilization. The patient is not at risk of which of the following conditions?

Accepted Answer

Niacin deficiency

Answer

Vitamin B12 deficiency

Answer

Neuropathy

Answer

Pancreatic carcinoma

Question 3

Which of the following is the least common site of pain in a case of rheumatoid arthritis?

Accepted Answer

Low back

Answer

Cervical

Answer

Ankle

Answer

Knee

Question 4

Winberger sign is present in -

Accepted Answer

Rickets

Answer

Secondary syphilis

Answer

Scurvy

Answer

Tuberculosis

Question 5

Odynophagia is

Accepted Answer

Pain during swallowing

Answer

Bad odour from mouth

Answer

Psychiatric disease

Answer

Difficulty in swallowing

Question 6

A man takes peanut and develops tongue swelling, neck swelling, stridor, hoarseness of voice. What is the probable diagnosis?

Accepted Answer

Angioneurotic edema

Answer

FB in larynx

Answer

Parapharyngeal abscess

Answer

FB bronchus

Question 7

Which of the following is NOT true about Henoch-Schönlein purpura?

Accepted Answer

Non-palpable purpura

Answer

Glomerulonephritis

Answer

IgA deposition

Answer

Abdominal pain

Question 8

65-year-old man presents with anemia, posterior column dysfunction, and plantar extensor. Which of the following is the likely cause

Accepted Answer

Vitamin B 12 deficiency

Answer

Friedreich's ataxia

Answer

Tabes dorsalis

Answer

Vitamin B1 deficiency

Question 9

What is the name of this test to be done before drawing an arterial blood gas sample:

Accepted Answer

Allen test

Answer

Both radial & ulnar artery are occluded

Answer

Trendelenburg test

Answer

Ulnar artery kept occluded, Radial artery released; These are steps of Allen's test

Question 10

Which of the following symptoms suggests CHF in infants

Accepted Answer

Diaphoresis with feedings

Answer

Fever

Answer

Persistent irritability

Answer

Cyanosis

Clinical Manifestations and Presentation of Diseases — MCQs

Clinical Manifestations and Presentation of Diseases — MCQs

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