Clinical Manifestations and Presentation of Diseases Practice Questions

Q: Which of the following is a minor criteria for diagnosis of Rheumatic Fever (RF) according to modified Jones criteria?

Fever. ***Fever*** - **Fever** is considered a **minor criterion** in the modified Jones criteria for diagnosing Rheumatic Fever. - A temperature of **≥38°C** [1] is typically required to meet this criterion. *Subcutaneous nodules* - **Subcutaneous nodules** are a **major criterion** of the modified Jones criteria for Rheumatic Fever. - These firm, painless nodules are usually found over bony prominences. *Arthritis* - **Arthritis** (polyarthritis) is a **major criterion** for the diagnosis of Rheumatic Fever. - It characteristically presents as a **migratory polyarthritis**, affecting large joints. *Past History of Rheumatic Fever* - A **past history of Rheumatic Fever** is not a *diagnostic criterion* itself, but rather an important part of the patient's medical history that influences clinical suspicion [2]. - It would increase the likelihood of a recurrence, but does not serve as a minor or major diagnostic criterion in the modified Jones criteria [2].

Q: A35 yr old lady with Normal PT and increased aPTT. 2 year back, she was operated for cholecystectomy & did not have any bleeding episode. What is next investigation for clinical diagnosis -

Factor VIII assay. ***Factor VIII assay*** - An isolated **increased aPTT** with a **normal PT** points to an abnormality in the **intrinsic pathway** of coagulation, which includes Factor VIII [1]. - The absence of bleeding episodes for a cholecystectomy suggests a **mild deficiency** or a defect that doesn't cause severe hemorrhage, making Factor VIII deficiency (Hemophilia A) a strong consideration [2]. *Platelet aggregation test* - This test evaluates **platelet function**, abnormalities of which typically present with mucocutaneous bleeding and a normal PT and aPTT. - The patient's presentation of an isolated prolonged aPTT does not primarily suggest a platelet function disorder. *Anti viper venom assay* - This test is primarily used to detect the presence of **lupus anticoagulant**, which can cause a prolonged aPTT but is often associated with thrombotic events, not bleeding. - While lupus anticoagulant can prolong aPTT without bleeding, a Factor VIII deficiency is a more common cause of an isolated prolonged aPTT that is compatible with no significant bleeding history. *Ristocetin cofactor assay* - This assay is used to evaluate **von Willebrand factor (vWF)** activity, which is involved in platelet adhesion and also stabilizes Factor VIII [3]. - While vWF deficiency can cause a prolonged aPTT, it typically presents with mucocutaneous bleeding, and the patient's history doesn't strongly suggest this [3].

Q: Lambert-Eaton Myasthenic Syndrome is associated with?

Small cell lung carcinoma. ***Small cell lung carcinoma*** - **Lambert-Eaton Myasthenic Syndrome (LEMS)** is a paraneoplastic syndrome, most commonly associated with **small cell lung carcinoma (SCLC)** [1], [2]. - SCLC cells express **voltage-gated calcium channels** that are targeted by autoantibodies in LEMS, leading to impaired acetylcholine release [1]. *Vitiligo* - **Vitiligo** is an autoimmune skin condition causing depigmentation and is generally associated with other autoimmune diseases, not LEMS. - While both LEMS and vitiligo can involve immune dysregulation, there is no direct and common association between the two. *Hyperthyroidism* - **Hyperthyroidism**, particularly due to Graves' disease, is an autoimmune condition primarily affecting the thyroid gland. - It is not a known direct or common association with LEMS. Myasthenia gravis, however, can be associated with hyperthyroidism. *All of the options* - While LEMS is an autoimmune disorder, its primary and most significant association is with **small cell lung carcinoma** [1], [3]. - The other conditions listed (vitiligo, hyperthyroidism) are not directly or commonly linked to LEMS.

Q: Skin stigmata of Liver disease include all of the following, Except

Subcutaneous nodules. ***Subcutaneous nodules*** - **Subcutaneous nodules** are characteristic of conditions like **rheumatoid arthritis**, **rheumatic fever**, or **sarcoidosis**, but are not typically associated with liver disease. - While some systemic diseases with liver involvement can present with nodules (e.g., metastatic cancer), they are not a direct skin stigmata *of* liver disease itself. *Paper money skin* - **Paper money skin**, or **spider angiomata**, are common in chronic liver disease due to increased circulating **estrogens** which cause arteriole dilation. - They appear as small, red, spider-like lesions, particularly on the upper trunk and face. *Drumstick fingers* - **Drumstick fingers**, also known as **clubbing**, can be a manifestation of **chronic liver disease**, especially in conditions like **primary biliary cholangitis** [1]. - It involves bulbous enlargement of the distal phalanges with increased convexity of the nail fold [1]. *Palmar Erythema* - **Palmar erythema** is a reddening of the palms, particularly the thenar and hypothenar eminences, due to increased **estrogen levels** in liver disease. - It is a common sign of **chronic liver disease**, reflecting altered hormone metabolism.

Q: In heat stroke, skin will be:

Warm. ***Warm*** - In **heat stroke**, the body's thermoregulatory mechanisms fail, leading to an inability to dissipate heat effectively, resulting in a **hot, dry, or sometimes moist skin** with a core body temperature often exceeding 40°C (104°F) [1], [2]. - This elevated skin temperature is a direct consequence of the body's inability to cool itself, indicating a life-threatening emergency [1]. *Cyanosis* - **Cyanosis** indicates poor tissue oxygenation, often presenting as a bluish discoloration of the skin and mucous membranes. - While severe heat stroke can lead to organ dysfunction and potentially metabolic acidosis, cyanosis is not a primary or defining characteristic of the initial presentation of heat stroke. *Cold* - **Cold skin** is typically associated with conditions where the body is losing heat or experiencing systemic shock, such as hypothermia or circulatory collapse. - In contrast, heat stroke is characterized by an excessive accumulation of body heat, making cold skin an unlikely presentation. *Normal* - **Normal skin temperature** suggests effective thermoregulation and is inconsistent with heat stroke, a condition where the body's core temperature is significantly elevated [2]. - Absence of visible signs of distress or abnormal skin temperature would rule out heat stroke, which is a medical emergency.

Q: Manifestations of epidemic Dropsy are all except -

Cutaneous hemangiomas. The manifestations of epidemic dropsy are caused by the contamination of edible oils with sanguinarine, leading to systemic toxicity. While cutaneous hemangiomas are benign vascular tumors not associated with this condition, other systemic effects are prominent. Gastrointestinal bleeding can occur due to congestion and capillary damage in the GI tract, as hemorrhagic manifestations are common due to capillary fragility and increased vascular permeability [1]. Breathlessness is a frequent symptom [1] due to cardiac involvement (e.g., congestive heart failure) and pulmonary edema [1] resulting from widespread capillary leakage. Congestive heart failure (CHF) is a severe cardiac manifestation, primarily due to myocardial damage and increased vascular permeability leading to fluid overload. The direct cardiotoxic effects of sanguinarine on the myocardium contribute to pump failure [1].

Q: A 24 year old male presents with altered sensorium and rapid shallow breathing. ABG shows:pH 7.2, sodium 140, bicarbonate 10 and chloride 98. Probable diagnosis is -

DKA. ***DKA*** - The patient presents with **altered sensorium** and **rapid shallow breathing** (Kussmaul breathing), consistent with severe metabolic acidosis [1]. - The ABG results show **pH 7.2** (acidosis), **bicarbonate 10** (metabolic component), and an **elevated anion gap** (Na - (Cl + HCO3) = 140 - (98 + 10) = 32), which are characteristic findings in **diabetic ketoacidosis (DKA)** [1], [2]. *Amphetamine toxicity* - Amphetamine toxicity typically causes **sympathomimetic effects** such as tachycardia, hypertension, hyperthermia, and agitation, rather than directly leading to a high anion gap metabolic acidosis of this severity. - While it can cause some metabolic derangements, the primary acid-base disturbance is usually different or less pronounced in this manner compared to DKA. *Renal tubular acidosis* - Renal tubular acidosis (RTA) typically presents with a **normal anion gap metabolic acidosis** (hyperchloremic metabolic acidosis), where the anion gap would not be significantly elevated. - The calculated anion gap of 32 in this patient rules out RTA as the primary cause of this severe acidosis. *Ethylene glycol poisoning* - Ethylene glycol poisoning also causes a **high anion gap metabolic acidosis** and altered mental status. - However, it is typically associated with additional specific symptoms like **flank pain**, **oliguria**, and detection of **calcium oxalate crystals** in the urine, which are not mentioned in this case.

Q: Most characteristic feature of drug induced lupus

Anti histone antibody. Most characteristic feature of drug induced lupus ***Anti histone antibody*** - **Anti-histone antibodies** are present in 95% of patients with **drug-induced lupus (DIL)**, making them the most characteristic serological marker. - While other autoantibodies may be found, anti-histone antibodies are almost pathognomonic when DIL is suspected. *Rare anti-ds DNA* - **Anti-dsDNA antibodies** are characteristic of **systemic lupus erythematosus (SLE)** but are rarely found in DIL [1]. - Their absence helps differentiate DIL from SLE. *Renal involvement* - **Renal involvement** is common in **SLE** but is rare in DIL, with **nephritis** occurring in less than 5% of cases. - This clinical difference is important in distinguishing the two conditions. *All of the options* - This option is incorrect because **rare anti-dsDNA** and **rare renal involvement** are features that help *differentiate* DIL from SLE, rather than being characteristic features of DIL itself.

Q: Which test is suitable to elicit mouth breathers?

On intra-oral clinical examination. ***On intra-oral clinical examination*** - An intra-oral examination allows for direct observation of conditions that can indicate **mouth breathing**, such as a **dry mouth (xerostomia)**, generalized gingivitis, or an **anterior open bite**. - In mouth breathers, the oral mucosa often appears dry and irritated due to constant exposure to air, making this a reliable clinical sign. *Nasal airflow test* - While this test assesses nasal patency, it doesn't directly confirm **mouth breathing** itself, as individuals with restricted nasal airflow might still attempt to breathe through their nose. - It primarily helps identify **nasal obstruction** as a potential cause for mouth breathing but isn't a definitive diagnostic tool for the behavior itself. *On inspection* - **Inspection** can reveal some external signs like a constantly open mouth or an elongated face, but these are not always definitive and can be subjective. - It may suggest mouth breathing but is not as precise as an intra-oral examination or a dental mirror test to *directly elicit* the act of breathing through the mouth. *All of the options* - While all these methods can provide *some* information related to mouth breathing, an **intra-oral clinical examination** directly uncovers the *signs and effects* of mouth breathing within the oral cavity. - No single method is comprehensive alone, but intra-oral exam provides the most direct clinical evidence among the given choices.

Q: A 20-year-old alcoholic malnourished patient presented to the hospital with respiratory distress. His pulse was 112/minute. The patient had edema, hypertension, a systolic murmur along the left sternal edge, and bilateral crepitations in the lungs. A diagnosis of congestive high-output cardiac failure was made. Which vitamin is deficient?

Vitamin B1. ***Vitamin B1*** - The constellation of **high-output cardiac failure** (tachycardia, edema, hypertension, systolic murmur, pulmonary crepitations) in an alcoholic and malnourished patient strongly indicates **wet beriberi**, which is caused by **thiamine (Vitamin B1) deficiency** [1]. - **Alcoholism** is a major risk factor for thiamine deficiency due to poor nutritional intake and impaired absorption/meta [2]. *Vitamin B 6* - Deficiency of **pyridoxine (Vitamin B6)** can cause **sideroblastic anemia**, neurological symptoms like neuropathy and seizures, and **dermatitis**, but typically not high-output cardiac failure. - While alcoholics can be deficient in B6, it doesn't directly cause a primary cardiac syndrome like beriberi. *Vitamin B2* - **Riboflavin (Vitamin B2)** deficiency leads to symptoms such as **cheilosis**, **angular stomatitis**, **glossitis**, and **seborrheic dermatitis**, and sometimes corneal vascularization. - It is not directly associated with the described **congestive high-output cardiac failure** symptoms in this patient. *Vitamin C* - **Scurvy**, caused by **Vitamin C deficiency**, presents with **gingival bleeding**, **perifollicular hemorrhages**, **poor wound healing**, and **joint pain** [3]. - It does not cause high-output cardiac failure, although severe scurvy can lead to anemia and non-specific weakness.

Question 1

Which of the following is a minor criteria for diagnosis of Rheumatic Fever (RF) according to modified Jones criteria?

Accepted Answer

Fever

Answer

Subcutaneous nodules

Answer

Arthritis

Answer

Past History of Rheumatic Fever

Question 2

A35 yr old lady with Normal PT and increased aPTT. 2 year back, she was operated for cholecystectomy & did not have any bleeding episode. What is next investigation for clinical diagnosis -

Accepted Answer

Factor VIII assay

Answer

Platelet aggregation test

Answer

Anti viper venom assay

Answer

Ristocetin cofactor assay

Question 3

Lambert-Eaton Myasthenic Syndrome is associated with?

Accepted Answer

Small cell lung carcinoma

Answer

Vitiligo

Answer

Hyperthyroidism

Answer

All of the options

Question 4

Skin stigmata of Liver disease include all of the following, Except

Accepted Answer

Subcutaneous nodules

Answer

Paper money skin

Answer

Drumstick fingers

Answer

Palmar Erythema

Question 5

In heat stroke, skin will be:

Accepted Answer

Warm

Answer

Cyanosis

Answer

Cold

Answer

Normal

Question 6

Manifestations of epidemic Dropsy are all except -

Accepted Answer

Cutaneous hemangiomas

Answer

Gastrointestinal bleed

Answer

Breathlessness

Answer

CHF

Question 7

A 24 year old male presents with altered sensorium and rapid shallow breathing. ABG shows:pH 7.2, sodium 140, bicarbonate 10 and chloride 98. Probable diagnosis is -

Accepted Answer

DKA

Answer

Amphetamine toxicity

Answer

Renal tubular acidosis

Answer

Ethylene glycol poisoning

Question 8

Most characteristic feature of drug induced lupus

Accepted Answer

Anti histone antibody

Answer

Rare anti-ds DNA

Answer

Renal involvement

Answer

All of the options

Question 9

Which test is suitable to elicit mouth breathers?

Accepted Answer

On intra-oral clinical examination

Answer

Nasal airflow test

Answer

On inspection

Answer

All of the options

Question 10

A 20-year-old alcoholic malnourished patient presented to the hospital with respiratory distress. His pulse was 112/minute. The patient had edema, hypertension, a systolic murmur along the left sternal edge, and bilateral crepitations in the lungs. A diagnosis of congestive high-output cardiac failure was made. Which vitamin is deficient?

Accepted Answer

Vitamin B1

Answer

Vitamin B 6

Answer

Vitamin B2

Answer

Vitamin C

Clinical Manifestations and Presentation of Diseases — MCQs

Clinical Manifestations and Presentation of Diseases — MCQs

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