Clinical Manifestations and Presentation of Diseases — MCQs

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

Question 161: All are caused by parvo virus infection except

A. Gloves and socks syndrome
B. Erythema infectiosum
C. Encephalopathy (Correct Answer)
D. Aplastic crisis

Explanation: ***Encephalopathy*** - While parvovirus B19 can have neurological manifestations in rare cases, **encephalopathy** is not a typical or commonly recognized direct manifestation of parvovirus infection. - Neurological complications, when they occur, are usually secondary or related to severe anemia/aplastic crisis, rather than a direct encephalitic process. *Gloves and socks syndrome* - This syndrome, characterized by **pruritic maculopapular rash** on the hands and feet, is a known but less common manifestation of **parvovirus B19 infection**. - It often presents with fever, malaise, and can be seen in both children and adults. *Erythema infectiosum* - Also known as **fifth disease**, it is the most common manifestation of **parvovirus B19 infection** [1] in children, characterized by a **"slapped cheek" rash** followed by a lacy rash on the trunk and extremities [1]. - It is usually a benign, self-limiting childhood illness [1]. *Aplastic crisis* - **Parvovirus B19** has a tropism for **erythroid progenitor cells** [1], leading to their lysis and a temporary cessation of red blood cell production. - In individuals with underlying chronic hemolytic anemias (e.g., **sickle cell disease**, **hereditary spherocytosis**), this can precipitate a severe and life-threatening **aplastic crisis** [1].

Question 162: Neurofibromatosis presents as all of the following except -

A. Lymphadenovarix (Correct Answer)
B. Von Recklinghausen's disease
C. Elephantiasis neuromatodes
D. Plexiform neuroma

Explanation: ***Lymphadenovarix*** - **Lymphadenovarix** is a rare condition characterized by the abnormal dilation of lymphatic vessels, forming a varicose appearance, and is not a feature of neurofibromatosis. - It is often associated with lymphatic obstruction or congenital lymphatic malformations, unrelated to neural crest cell anomalies. *Von Recklinghausen's disease* - This is an older name for **Neurofibromatosis type 1 (NF1)**, which is the most common form of neurofibromatosis. - NF1 is a **genetic disorder** that causes tumors to grow on nerve tissue, as well as various skin and bone abnormalities. *Elephantiasis neuromatodes* - This term refers to a severe form of **plexiform neurofibroma** that causes extensive overgrowth of skin and subcutaneous tissues, leading to a thickened, elephant-like appearance. - It is a significant and disfiguring manifestation of **Neurofibromatosis Type 1**. *Plexiform neuroma* - A **plexiform neuroma** is a pathognomonic feature of **Neurofibromatosis Type 1 (NF1)**, consisting of a diffuse neurofibroma that involves multiple nerve fascicles. - These tumors can be extensive, involve deep tissues, and are associated with a risk of **malignant transformation** to malignant peripheral nerve sheath tumors (MPNST). [1]

Question 163: Ulnar nerve injury results in:

A. Pointing index
B. Ape thumb deformity
C. Clawing of fingers (Correct Answer)
D. Wrist drop

Explanation: ***Clawing of fingers*** - An ulnar nerve injury, particularly at the elbow, often leads to **paralysis of the interossei muscles** and the **medial two lumbricals**. [1] - This results in **hyperextension at the metacarpophalangeal joints** and **flexion at the interphalangeal joints** of the 4th and 5th fingers (and sometimes 3rd), creating the characteristic claw hand deformity. [1] *Pointing index* - **Pointing index**, also known as the **sign of benediction** or **preacher's hand**, occurs with **high median nerve lesions** affecting the lateral lumbricals and flexor digitorum superficialis. - The patient is unable to flex the index and middle fingers, especially when attempting to make a fist. *Ape thumb deformity* - **Ape thumb deformity** is caused by a **median nerve injury**, specifically affecting the **thenar muscles** (abductor pollicis brevis, opponens pollicis, and superficial head of flexor pollicis brevis). - This paralysis leads to the thumb being pulled laterally and into the same plane as the other fingers, losing its ability to oppose. *Wrist drop* - **Wrist drop** is a classic sign of **radial nerve injury**, which paralyzes the **extensor muscles of the wrist and fingers**. - This prevents the patient from extending their wrist and metacarpophalangeal joints.

Question 164: Myoglobinuria is associated with which of the following:

A. Tumours
B. Electrical injury
C. Crush injury
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - **Myoglobinuria** can result from various forms of severe muscle damage leading to the release of myoglobin, the common underlying mechanism for all listed conditions. - Conditions like **electrical injury** and **crush injury** directly cause widespread muscle tissue destruction, releasing myoglobin into the bloodstream, while some tumors can indirectly cause muscle breakdown or be associated with paraneoplastic syndromes affecting muscles. [1] *Tumours* - While generally not a primary cause, certain **malignancies** can indirectly lead to **rhabdomyolysis** and subsequent myoglobinuria through various mechanisms. [1] - Examples include paraneoplastic syndromes, tumor lysis syndrome, or direct muscle involvement by metastatic disease. *Electrical injury* - **Electrical current** passing through the body causes direct **thermal and contractile damage** to muscle cells, leading to their rapid breakdown and release of myoglobin. [1] - The severity of myoglobinuria is often proportional to the voltage and duration of electrical exposure. *Crush injury* - **Crush injuries** directly disrupt muscle cell membranes due to **mechanical compression**, leading to the release of intracellular contents, including myoglobin, into the circulation. - This is a well-recognized cause of **rhabdomyolysis** and can result in acute kidney injury.

Question 165: Which is not a major criteria for the diagnosis of rheumatic fever?

A. Arthritis
B. Carditis
C. Subcutaneous nodules
D. Increased ASLO (Correct Answer)

Explanation: ***Increased ASLO*** - An **elevated anti-streptolysin O (ASLO) titer** indicates a recent streptococcal infection [1] and is a **minor criterion** for the diagnosis of rheumatic fever, not a major one. - While essential for diagnosis as evidence of prior infection, it does not represent direct organ involvement or a principal manifestation of the disease. *Arthritis* - **Arthritis** (specifically **migratory polyarthritis**) is a **major criterion** for the diagnosis of rheumatic fever. - It primarily affects large joints and shifts from one joint to another without leaving permanent damage. *Carditis* - **Carditis** (inflammation of the heart, involving the pericardium, myocardium, or endocardium) is a **major criterion** for rheumatic fever [1]. - It is the most serious manifestation, potentially leading to permanent **rheumatic heart disease** [2]. *Subcutaneous nodules* - **Subcutaneous nodules** are firm, painless nodules typically found over bony prominences (e.g., elbows, knees, ankles) and are a **major criterion** for rheumatic fever. - These nodules are a less common but distinct manifestation of the disease.

Question 166: Following are the indications of cryotherapy

A. Hemoangiomas
B. Epistaxis
C. Vasomotor rhinitis
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - **Cryotherapy** is a versatile treatment that can be effectively used for all the conditions listed: **hemoangiomas**, **epistaxis**, and **vasomotor rhinitis**. - Its mechanism involves controlled tissue destruction through freezing, making it suitable for various dermatological and ENT applications. *Hemoangiomas* - **Cryotherapy** can be used for treating certain types of smaller, superficial **hemoangiomas**, especially in locations where other treatments might be more invasive. - The freezing process causes **vascular damage** and thrombosis, leading to the regression of the *vascular lesion*. *Epistaxis* - **Cryotherapy** can be employed to control **epistaxis** (nosebleeds), particularly in cases where **cautery** or packing is less effective or unsuitable. - It works by freezing and destroying the **bleeding vessels** in the nasal mucosa, forming a scab that prevents further bleeding. *Vasomotor rhinitis* - **Cryotherapy** to the **inferior turbinates** can be a treatment option for **vasomotor rhinitis** resistant to medical therapy. - The freezing process causes **mucosal injury** and fibrosis, which can reduce the hyperactivity of the nasal turbinates and alleviate symptoms like chronic *rhinorrhea* and **congestion**.

Question 167: The skin changes seen in protein energy malnutrition can be due to deficiency of all of the following nutrients except:

A. Essential fatty acids
B. Zinc
C. Tryptophan
D. Pyridoxine (Correct Answer)

Explanation: ***Pyridoxine*** - **Pyridoxine (vitamin B6)** deficiency can lead to **seborrheic dermatitis-like lesions**, glossitis, and cheilosis, but these are not the characteristic skin changes directly attributed to **protein-energy malnutrition (PEM)** itself. - While essential for many metabolic processes, its deficiency symptoms are distinct from the typical **dermatological manifestations of PEM**, such as those seen in kwashiorkor or marasmus [3]. *Essential fatty acids* - Deficiency of **essential fatty acids (EFAs)**, particularly **linoleic and alpha-linolenic acids**, can cause **scaly dermatitis**, **xerosis (dry skin)**, and **impaired skin barrier function**. - These conditions often contribute to the skin changes seen in **malnutrition**, making the skin more susceptible to infection and damage. *Zinc* - **Zinc deficiency** is a common complication of **protein-energy malnutrition** and can cause distinctive skin lesions, including **acrodermatitis enteropathica-like rash**, characterized by **vesiculobullous or pustular lesions** around body orifices and on the extremities. - It plays a crucial role in **skin integrity, wound healing**, and immune function, and its absence severely impacts cellular processes in the skin. *Tryptophan* - **Tryptophan** is an essential amino acid and a precursor to **niacin (vitamin B3)** [1]. - Deficiency can lead to **pellagra-like dermatosis**, characterized by the "necklace" sign, symmetrical, pigmented, and erythematous lesions on sun-exposed areas [2]. This is often seen in **severe protein-energy malnutrition** cases where overall intake of essential amino acids and vitamins is compromised.

Question 168: Behcet's syndrome is characterized by all, Except:

A. Myocarditis (Correct Answer)
B. Erythema Nodosum
C. Thrombophlebitis
D. Oral and Genital ulcers

Explanation: ***Myocarditis*** - While Behcet's syndrome can affect various organ systems, **cardiac involvement** in the form of myocarditis is **rare** and not a characteristic feature. - Cardiac manifestations are more commonly pericarditis or intracardiac thrombi, not primarily inflammation of the heart muscle itself. *Erythema Nodosum* - **Erythema nodosum** is a common mucocutaneous manifestation of Behcet's syndrome, characterized by **tender, erythematous nodules** typically on the shins. - It is part of the diagnostic criteria and reflects the systemic inflammatory nature of the disease. *Thrombophlebitis* - **Thrombophlebitis**, particularly **venous thrombosis**, is a hallmark feature of Behcet's syndrome due to its characteristic **hypercoagulable state**. - This can affect both superficial and deep veins, sometimes leading to life-threatening complications. *Oral and Genital ulcers* - **Recurrent oral aphthous ulcers** are the **most common and often the first symptom** of Behcet's syndrome, a mandatory criterion for diagnosis. - **Genital ulcers**, specifically aphthous lesions on the scrotum or labia, are also very common and contribute significantly to the diagnostic criteria.

Question 169: Blue sclera is seen in:

A. Rheumatoid arthritis
B. Diabetes mellitus
C. Osteogenesis imperfecta (Correct Answer)
D. Hypertension

Explanation: ***Osteogenesis imperfecta*** - Blue sclera in **osteogenesis imperfecta** is due to the underlying defect in **collagen type I synthesis**, which causes the sclera to be thin and translucent [1]. - This thinness allows the underlying **choroidal pigmentation** to show through, giving it a characteristic blue hue. *Rheumatoid arthritis* - While rheumatoid arthritis can affect the eyes (e.g., scleritis, episcleritis), it does not typically cause **blue sclera**. - Ocular manifestations are usually related to inflammation and can lead to **scleral thinning** or perforation but are distinct from the blue appearance seen in osteogenesis imperfecta. *Diabetes mellitus* - Diabetes mellitus can lead to various ocular complications, such as **diabetic retinopathy**, **cataracts**, and **glaucoma**. - It does not cause a change in the color of the sclera to blue. *Hypertension* - Hypertension can affect the eyes, particularly the **retinal vasculature** (hypertensive retinopathy), and increase the risk of conditions like **glaucoma**. - It has no direct association with the phenomenon of **blue sclera**.

Question 170: Allergic salute is seen in -

A. Nasal Myiasis
B. Allergic rhinitis (Correct Answer)
C. Chronic sinusitis
D. Chronic conjunctivitis

Explanation: ***Allergic rhinitis*** - The **allergic salute** is a characteristic physical finding in allergic rhinitis [1], where individuals repeatedly push their nose upward with their hand to relieve nasal itching and clear obstruction. - This repetitive gesture can lead to a visible transverse crease on the dorsum of the nose, known as the **nasal crease**. *Nasal Myiasis* - **Nasal myiasis** is an infestation of the nasal cavity by fly larvae, causing symptoms like nasal discharge, epistaxis, and local pain. - It does not involve nasal itching that would provoke the "allergic salute" action. *Chronic sinusitis* - **Chronic sinusitis** is a prolonged inflammation of the sinuses, causing facial pain/pressure, nasal obstruction, and discharge. - While it can cause nasal obstruction, it typically doesn't present with the intense nasal itching that would lead to the "allergic salute." *Chronic conjunctivitis* - **Chronic conjunctivitis** is an inflammation of the conjunctiva, primarily affecting the eyes with symptoms like redness, itching, and discharge. - It does not directly affect the nasal passages or provoke nasal symptoms like itching that would result in an allergic salute.

Practice by Chapter

Approach to Common Symptoms (Fever, Pain, Fatigue)

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Constitutional Symptoms and Their Differential Diagnosis

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Syncope and Presyncope

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Dizziness and Vertigo

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Dyspnea and Respiratory Distress

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Chest Pain Evaluation

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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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