Clinical Manifestations and Presentation of Diseases — MCQs

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

Question 171: Which of the following are true/false about clinical features of Fat embolism syndrome? 1. Tachypnea 2. Systemic hypoxia may occur 3. Fat globules in urine are diagnostic 4. Manifests after several days of trauma 5. Petechiae in anterior chest wall

A. 1, 3, 4, 5 true & 2 false
B. 1, 2, 3, 5 true & 4 false
C. All are true (Correct Answer)
D. 2, 4 false & 1, 3, 5 true

Explanation: ***All are true*** - **Tachypnea** (1), **systemic hypoxia** (2) [2], **fat globules in urine** (3) [2], **petechiae in the anterior chest wall** (5) [1], and manifestation **after several days of trauma** (4) [1] are all recognized clinical features or associated findings of **Fat Embolism Syndrome (FES)**. - The classic triad of FES includes **respiratory insufficiency**, **neurological symptoms**, and **petechial rash**, which frequently emerge 24-72 hours post-injury [1]. *1, 3, 4, 5 true & 2 false* - This option incorrectly states that systemic hypoxia is false. **Systemic hypoxia** is a common and serious manifestation of **Fat Embolism Syndrome**, often resulting from pulmonary microvascular obstruction [2]. - While other points are correct, the misidentification of hypoxia as false makes this option incorrect. *1, 2, 3, 5 true & 4 false* - This option incorrectly states that FES does not manifest after several days of trauma. **Fat Embolism Syndrome** typically has a delayed onset, occurring **12-72 hours (several days)** after the initial injury [1], [2]. - The delayed presentation is a key diagnostic characteristic distinguishing it from immediate post-traumatic complications. *2, 4 false & 1, 3, 5 true* - This option is extensively incorrect as it falsely identifies both **systemic hypoxia** and the **delayed manifestation** as false. - **Systemic hypoxia** is a hallmark of pulmonary involvement in FES [2], and **delayed onset** is a crucial diagnostic criterion.

Question 172: Diabetes is associated with all of the following in the elderly EXCEPT:

A. Cognitive decline
B. Myocardial infarction (Correct Answer)
C. Cerebrovascular accident
D. Osteoarthritis

Explanation: ***Myocardial infarction*** - Diabetes is a major risk factor for **myocardial infarction** (heart attack), significantly increasing its incidence in the elderly [1]. - It accelerates **atherosclerosis**, leading to coronary artery disease, which is the primary cause of myocardial infarction [2]. *Cognitive decline* - Diabetes is strongly associated with an increased risk of **cognitive decline** and **dementia** in older adults. - Mechanisms include microvascular damage, chronic inflammation, and insulin resistance affecting brain function. *Cerebrovascular accident* - Diabetes is a significant risk factor for **cerebrovascular accidents** (strokes), both ischemic and hemorrhagic, in the elderly [2]. - It promotes **atherosclerosis** in cerebral vessels and contributes to hypertension and dyslipidemia, increasing stroke risk [2]. *Osteoarthritis* - While not a direct causal link like cardiovascular complications, diabetes can indirectly contribute to **osteoarthritis** progression, particularly in obese individuals with diabetes. - High glucose levels can lead to changes in cartilage composition and increased inflammation, potentially exacerbating joint damage.

Question 173: Acrodermatitis enteropathica is associated with deficiency of?

A. Vitamin B12
B. Molybdenum
C. Free fatty acids
D. Zinc (Correct Answer)

Explanation: ***Zinc*** - **Acrodermatitis enteropathica** is a rare, autosomal recessive genetic disorder characterized by impaired **zinc absorption**, leading to **zinc deficiency** [1]. - Clinical manifestations include **dermatitis**, **diarrhea**, and **alopecia**, which respond dramatically to **zinc supplementation** [1]. *Vitamin B12* - Deficiency of **Vitamin B12** (cobalamin) is associated with **megaloblastic anemia** and **neurological symptoms**, not typically acrodermatitis. - Causes include **pernicious anemia**, malabsorption disorders, and strict vegan diets. *Molybdenum* - **Molybdenum** is a trace element that acts as a cofactor for several enzymes, but its deficiency is **extremely rare** and not associated with acrodermatitis enteropathica. - Symptoms of molybdenum deficiency, if they occur, are non-specific and may include neurological disturbances. *Free fatty acids* - Deficiency in **essential free fatty acids**, particularly **linoleic acid** and **alpha-linolenic acid**, can lead to skin problems like scaling and dryness. - However, it does not typically present with the classic triad of symptoms seen in acrodermatitis enteropathica, which is primarily due to zinc malabsorption.

Question 174: All the following can cause mouth ulcers except ?

A. Sickle cell anemia
B. Psoriasis (Correct Answer)
C. Mouth washes
D. Lichen planus

Explanation: ***Psoriasis*** - While psoriasis is an inflammatory condition affecting the skin, nails, and joints, it typically does **not cause mouth ulcers** [3], [4]. Oral lesions in psoriasis are rare and atypical, presenting as geographic tongue-like lesions or plaques rather than ulcerations. - The primary lesions of psoriasis are **erythematous plaques with silvery scales**, not aphthous-like ulcers found in the oral cavity [3]. *Sickle cell anemia* - Individuals with sickle cell anemia can experience **oral manifestations** due to chronic hypoxia and impaired microcirculation, including delayed healing and increased susceptibility to infections. - **Recurrent aphthous ulcers** are reported to be more common in patients with sickle cell disease, possibly due to their compromised immune status and tissue perfusion [1]. *Mouth washes* - Certain ingredients in **mouthwashes**, especially those containing strong detergents like **sodium lauryl sulfate (SLS)** or high concentrations of alcohol, can cause irritation and breakdown of the oral mucosa. - This irritation can lead to the development of **chemical burns** or **ulcerations**, particularly with prolonged or frequent use in sensitive individuals. *Lichen planus* - **Oral lichen planus** commonly presents with various lesions in the mouth, including reticular (Wickham's striae), atrophic, erythematous, bullous, and ulcerative forms [2]. - **Erosive and ulcerative forms** of lichen planus are especially painful and can mimic recurrent aphthous ulcers, making it a direct cause of mouth ulcers [1], [2].

Question 175: Raynaud's phenomenon is commonly seen in

A. Upper limb of female (Correct Answer)
B. Lower limb of female
C. Lower limb of male
D. Upper limb of male

Explanation: Upper limb of female - **Raynaud's phenomenon** is characterized by episodic digital ischemia, primarily affecting the **fingers and toes**. - It is significantly more prevalent in **females** and typically manifests in the **upper limbs** (fingers) due to exposure to cold or stress. *Lower limb of female* - While Raynaud's can affect the lower limbs (**toes**), it is less common as the primary site of presentation. - The classic description and initial manifestations are predominantly in the **fingers**. *Lower limb of male* - Raynaud's phenomenon is **less common in males** compared to females. - When it does occur in males, it is often associated with a **secondary cause**, such as connective tissue diseases. *Upper limb of male* - Raynaud's phenomenon in the upper limbs of males is **less frequent** than in females. - If a male presents with Raynaud's, particularly in the upper limbs, investigation for **underlying diseases** (e.g., scleroderma) is often warranted.

Question 176: Which of the following is not true about polymyositis

A. Limb girdle weakness
B. Para-neoplastic syndrome
C. Ophthalmoplegia (Correct Answer)
D. Spontaneous discharge in EMG

Explanation: ***Ophthalmoplegia*** - **Polymyositis** primarily affects **proximal limb and trunk muscles**, sparing the extraocular muscles [1]. - **Ophthalmoplegia**, or paralysis of the extraocular muscles, is not a typical feature of polymyositis and would suggest a different neuromuscular disorder. *Limb girdle weakness* - **Polymyositis** characteristically causes **symmetric proximal muscle weakness**, affecting the muscles of the shoulder (pectoral) and hip (pelvic) girdles [1]. - Patients typically present with difficulty rising from a chair, climbing stairs, or lifting objects overhead [1]. *Para-neoplastic syndrome* - Polymyositis, like other inflammatory myopathies, can be a **paraneoplastic syndrome**, particularly in older adults [2]. - It is important to screen for underlying malignancies in patients diagnosed with polymyositis, especially if they have atypical features or are above a certain age [2]. *Spontaneous discharge in EMG* - **Electromyography (EMG)** in polymyositis typically shows findings of muscle irritation and degeneration, including **spontaneous activity** (e.g., fibrillations, positive sharp waves) at rest. - These findings reflect active muscle inflammation and necrosis, which are hallmarks of the disease.

Question 177: Haemorrhagic shock due to acute blood loss includes: 1. Increasing pallor 2. Restlessness 3. Air hunger 4. Water-hammer pulse

A. 1 & 2
B. 1, 2 & 3 (Correct Answer)
C. 2, 3 & 4
D. 1 & 4

Explanation: ***1, 2 & 3*** - **Increasing pallor** occurs due to reduced blood flow to the skin as the body shunts blood to vital organs in response to hypovolemia. - **Restlessness** and **air hunger** are signs of cerebral hypoxia and metabolic acidosis, respectively, as the circulatory system fails to deliver sufficient oxygen to tissues and clear CO2. *1 & 2* - This option is partially correct as **increasing pallor** and **restlessness** are indeed seen in hemorrhagic shock. - However, it incorrectly excludes **air hunger**, which is a significant clinical sign of severe hemorrhage and ensuing metabolic acidosis. *2, 3 & 4* - This option correctly identifies **restlessness** and **air hunger** as features of hemorrhagic shock. - However, **water-hammer pulse** is characteristic of conditions leading to a wide pulse pressure, such as aortic regurgitation, not the narrow pulse pressure seen in hypovolemic shock [1]. *1 & 4* - This option correctly identifies **increasing pallor** as a feature of hemorrhagic shock. - It incorrectly includes **water-hammer pulse**, which is not a sign of hypovolemic shock; rather, a weak, thready pulse is expected due to reduced stroke volume [1].

Question 178: Which of the following is not a major criterion for rheumatic fever?

A. Subcutaneous nodule
B. Arthralgia (Correct Answer)
C. Carditis
D. Erythema marginatum

Explanation: **Arthralgia** - **Arthralgia** is a **minor criterion** for the diagnosis of **rheumatic fever**, indicating joint pain without objective signs of inflammation. - Major criteria require more definitive signs of inflammation, such as actual **arthritis** (pain with swelling, warmth, redness, or tenderness). *Subcutaneous nodule* - **Subcutaneous nodules** are **major criteria** for **rheumatic fever**, typically appearing over bony prominences. - These nodules are painless and firm, usually associated with severe carditis. *Carditis* - **Carditis** is a **major criterion** for **rheumatic fever**, representing inflammation of the heart [1]. - It can manifest as valvulitis, myocarditis, or pericarditis, and is the most serious manifestation of the disease [1]. *Erythema marginatum* - **Erythema marginatum** is a **major criterion** for **rheumatic fever**, characterized by a fleeting, non-pruritic rash with red margins and a clear center. - It is typically seen on the trunk and proximal extremities, sparing the face.

Question 179: Pleural effusion in rheumatoid arthritis is typically associated with the following features except

A. Glucose > 60 mg/dl (Correct Answer)
B. Protein > 3 gm/dl
C. Pleural fluid LDH to serum LDH ratio of >0.6
D. Pleural fluid protein to serum protein ratio of >0.5

Explanation: ***Glucose > 60 mg/dl*** - Pleural effusions in rheumatoid arthritis are typically characterized by **low glucose levels** (< 30 mg/dL), often due to increased cellular metabolism within the pleural space. - Therefore, a glucose level greater than 60 mg/dL would be an **atypical finding** for a rheumatoid pleural effusion. *Protein > 3 gm/dl* - Rheumatoid pleural effusions are generally **exudative**, meaning they have high protein content, typically greater than 3.0 g/dL. - This high protein level reflects increased capillary permeability and inflammation characteristic of rheumatoid disease. *Pleural fluid LDH to serum LDH ratio of >0.6* - An LDH ratio of pleural fluid to serum greater than 0.6 is a key criterion for an **exudative effusion** based on Light's criteria. - Rheumatoid effusions are almost always exudative, consistent with this elevated LDH ratio. *Pleural fluid protein to serum protein ratio of >0.5* - A pleural fluid protein to serum protein ratio greater than 0.5 also indicates an **exudative effusion**, as per Light's criteria. - This finding is common in rheumatoid pleural effusions due to increased protein leakage into the pleural space from inflammation [1].

Question 180: In shigella dysentery associated hemolytic uremic syndrome, the false statement is ?

A. Hepatic failure (Correct Answer)
B. Leucocytosis
C. Thrombotic angiopathy
D. Neurological abnormalities

Explanation: Detailed assessment of the complications of Hemolytic Uremic Syndrome (HUS) following Shigella infection shows that hepatic failure is not a characteristic component. ***Hepatic failure*** - **Hepatic failure** is not a typical hallmark or direct complication of **Shiga toxin-producing E. coli (STEC) HUS**, which primarily targets the kidneys. - The primary organs affected in **HUS** are the **kidneys (acute kidney injury)**, brain (neurological symptoms), and hematopoietic system (thrombocytopenia, microangiopathic hemolytic anemia) [2]. *Leucocytosis* - **Leucocytosis** (elevated white blood cell count) is a common finding in **Shigella dysentery**, reflecting the systemic inflammatory response to the infection. - It can be a predictive marker for the severity of **HUS** development in patients with **STEC** infection. *Thrombotic angiopathy* - **Thrombotic angiopathy** is the underlying pathological process in **HUS**, characterized by **microvascular thrombosis** and **endothelial damage** [1]. - These microthrombi lead to **thrombocytopenia**, **microangiopathic hemolytic anemia**, and **ischemic organ damage**, particularly in the kidneys [1], [2]. *Neurological abnormalities* - **Neurological abnormalities** such as seizures, altered mental status, and strokes can occur in a significant proportion of **HUS** patients. - These complications are due to **cerebral microthrombosis** and **endothelial damage** in the brain, affecting blood flow and neuronal function.

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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