Clinical Manifestations and Presentation of Diseases — MCQs

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

Question 221: Which of the following statements is true about Quincke's disease?

A. Bacterial infection
B. Peritonsillar abscess
C. Vocal cord edema
D. Edema of uvula (Correct Answer)

Explanation: Edema of uvula - **Quincke's disease** is an historical term used to describe isolated, acute, and often **recurrent edema of the uvula**, which presents as a sudden swelling. - It is often considered a form of **angioedema** specifically affecting the uvula, with varying etiologies including allergic, idiopathic, or hereditary causes [1]. *Bacterial infection* - While uvular edema can sometimes accompany bacterial infections in the throat, Quincke's disease specifically refers to the **isolated edema** rather than the underlying infection itself. - Other signs of bacterial infection, such as **fever**, **purulence**, or severe systemic symptoms, are not defining characteristics of Quincke's disease. *Peritonsillar abscess* - A **peritonsillar abscess (quinsy)** is a collection of pus behind the tonsil and is a distinct condition with different symptoms including severe **unilateral throat pain**, trismus, and muffled voice. - While both can cause throat discomfort, a peritonsillar abscess is an **infectious process** requiring drainage, unlike Quincke's disease which is primarily angioedema [1]. *Vocal cord edema* - **Vocal cord edema** primarily affects the larynx, leading to **hoarseness** or stridor, and can potentially cause airway compromise. - Quincke's disease is specifically localized to the **uvula**, affecting swallowing and causing a "foreign body" sensation, but typically does not involve the vocal cords.

Question 222: In alcohol intoxication with liver damage, which laboratory finding is key?

A. Elevated AST/ALT (Correct Answer)
B. Metabolic acidosis
C. Hypoglycemia
D. High BAC

Explanation: Elevated AST/ALT - In alcohol intoxication, particularly with liver damage, **AST and ALT levels** are typically elevated due to hepatocellular injury [1]. - The ratio of AST to ALT is often greater than **2:1**, which is characteristic of alcoholic liver disease. *Metabolic acidosis* - While metabolic acidosis can occur in severe intoxication, it is not specific to **liver damage** from alcohol consumption [3]. - Acidosis often results from other complications, such as lactic acidosis or kidney issues rather than direct liver injury [3]. *High BAC* - Blood Alcohol Concentration (BAC) does not provide insight into the **degree of liver damage**; it merely indicates intoxication levels [2]. - High BAC can occur without significant liver injury and does not differentiate between alcohol-related liver conditions [2]. *Hypoglycemia* - Hypoglycemia can occur in alcohol intoxication due to impaired gluconeogenesis, but it's not a definitive marker of **liver damage** [3]. - Other conditions can also cause hypoglycemia, making it a less specific laboratory finding in this context [3].

Question 223: A patient undergoing caesarean section following prolonged labour under subarachnoid block developed carpopedal spasm. Lignocaine was used as anesthetic agent. The most likely diagnosis is:

A. Amniotic fluid embolism
B. Hypokalemia
C. Hypocalcemia (Correct Answer)
D. Lignocaine toxicity

Explanation: No relevant citations could be added to the original text as the provided references do not address the specific medical scenario described. ***Hypocalcemia*** - **Carpopedal spasm** is a classic sign of hypocalcemia, often observed in situations that cause increased respiratory alkalosis, such as hyperventilation in labor. - The use of **subarachnoid block** and the stress of prolonged labor can contribute to hyperventilation, leading to a decrease in ionized calcium and subsequent neuromuscular hyperexcitability. *Amniotic fluid embolism* - This serious obstetric emergency typically presents with **sudden cardiovascular collapse**, respiratory distress, and coagulopathy. - Carpopedal spasm is not a primary or characteristic feature of amniotic fluid embolism. *Hypokalemia* - Hypokalemia can cause muscle weakness, fatigue, and cardiac arrhythmias, but **carpopedal spasm** is not a typical symptom. - While electrolyte imbalances can occur in labor, carpopedal spasm is more specifically associated with calcium deficiency. *Lignocaine toxicity* - Lignocaine toxicity usually manifests with central nervous system symptoms such as **perioral numbness**, metallic taste, tinnitus, and in severe cases, seizures and cardiac arrest. - Carpopedal spasm is not a commonly reported symptom of lignocaine toxicity.

Question 224: A 52-year-old male alcoholic presents with ataxia, confusion, and nystagmus. Physical examination reveals impaired memory. Laboratory results show an increased MCV and normal B12 levels. Analyze and determine the most likely deficiency.

A. Folate
B. Thiamine (Correct Answer)
C. B12
D. Niacin

Explanation: ***Thiamine*** - The constellation of **ataxia, confusion, and nystagmus** in an alcoholic points to **Wernicke's encephalopathy**, caused by thiamine deficiency [1]. - The **impaired memory** and increased **MCV** (macrocytic anemia) are also consistent with chronic alcohol abuse and potential thiamine deficiency [1],[2]. *Folate* - Folate deficiency can cause **macrocytic anemia** (elevated MCV) and some neurological symptoms but typically does not cause the classic triad of **ataxia, confusion, and nystagmus** seen in Wernicke's encephalopathy. - While alcoholics are often folate deficient, the neurological presentation is more characteristic of thiamine deficiency. *B12* - **B12 deficiency** can cause neurological symptoms, including neuropathy and cognitive impairment, and **macrocytic anemia**. - However, the question states that **B12 levels are normal**, ruling out B12 deficiency in this case. *Niacin* - Niacin deficiency (pellagra) presents with **dermatitis, diarrhea, and dementia**. - While dementia is a neurological symptom, the specific triad of **ataxia, confusion, and nystagmus** is not characteristic of pellagra.

Question 225: In a diabetic patient with peripheral neuropathy, which of the following changes is most commonly observed?

A. Increased nerve conduction velocity
B. Decreased sensory perception (Correct Answer)
C. Enhanced autonomic response
D. Improved pain perception

Explanation: ***Decreased sensory perception*** - **Diabetic peripheral neuropathy** primarily affects the longest nerves first, leading to a "stocking-glove" distribution of sensory loss [1]. - This sensory loss often includes the inability to perceive pain, temperature, and touch, increasing the risk of injuries and foot ulcers [1]. *Increased nerve conduction velocity* - **Diabetic neuropathy** characteristically leads to **demyelination** and axonal damage, which slows nerve conduction velocity, rather than increasing it [1]. - An increase in nerve conduction velocity would indicate healthier nerve function, which is contrary to the pathology of neuropathy. *Enhanced autonomic response* - **Diabetic autonomic neuropathy** can lead to a *dysregulation* or *impairment* of autonomic responses, such as orthostatic hypotension or gastroparesis, not an enhancement [2]. - Enhanced autonomic response would imply a heightened and potentially problematic sympathetic or parasympathetic activity that is unrelated to peripheral sensory changes. *Improved pain perception* - **Diabetic neuropathy** typically results in *reduced or altered pain perception*, often leading to painless injuries or a sensation of numbness, rather than improved perception [1]. - Some patients may experience neuropathic pain, which is an abnormal and often severe pain sensation, but this is distinct from improved normal pain perception.

Question 226: A 70-year-old woman presents with a sudden onset of weakness in her legs and difficulty swallowing. Examination reveals a heliotrope rash and Gottron's papules. Which enzyme is most likely to be elevated?

A. Creatine kinase (Correct Answer)
B. Lactate dehydrogenase
C. Aldolase
D. Aspartate transaminase

Explanation: ***Creatine kinase*** - Elevated **creatine kinase (CK)** levels are a hallmark of **muscle damage** and inflammation, as seen in this patient's presentation of weakness, heliotrope rash, and Gottron's papules, consistent with **dermatomyositis** [1]. - CK levels directly correlate with the degree of muscle destruction, making it a crucial marker for monitoring disease activity and treatment response in inflammatory myopathies. *Lactate dehydrogenase* - While **lactate dehydrogenase (LDH)** can be elevated in muscle damage, it is a less specific indicator as it is present in various tissues throughout the body, including the liver, heart, and red blood cells [2]. - Therefore, isolated LDH elevation would not specifically point to **muscle-related inflammation** or damage with the same precision as CK in the context of these symptoms. *Aldolase* - **Aldolase** is another enzyme found in muscle tissue and can be elevated in myopathies, indicating muscle damage. - However, CK is typically considered a more sensitive and specific marker for **inflammatory myopathies** such as dermatomyositis, and its elevation is more consistently pronounced in these conditions. *Aspartate transaminase* - **Aspartate transaminase (AST)** is found in muscle tissue, but it is also abundantly present in the liver, heart, and kidneys [2]. - Significant elevation in AST without concurrent elevation of liver-specific enzymes (like ALT) would suggest muscle damage, but it is less specific than CK for primary **muscle inflammation**.

Question 227: In a patient with severe alcoholic hepatitis, which finding is the most indicative of a poor prognosis?

A. Hypokalemia
B. Mild elevation of AST and ALT
C. Leukocytosis
D. Elevated serum bilirubin (Correct Answer)

Explanation: ***Elevated serum bilirubin*** - Extremely **high levels of serum bilirubin** in severe alcoholic hepatitis indicate significant liver dysfunction and cholestasis, suggesting a poor prognosis [1]. - It is a key factor in calculating the **MELD score**, which helps predict survival and severity of liver disease [1]. *Mild elevation of AST and ALT* - While elevated liver enzymes indicate liver injury, **mild elevations** do not typically correlate with poor prognosis in alcoholic hepatitis [1]. - This finding is often seen in less severe cases and may not reflect the **extent of liver failure**. *Leukocytosis* - **Leukocytosis** can occur in various conditions, but is not specifically indicative of **severity in alcoholic hepatitis**. - It may indicate infection or inflammatory response, rather than liver function deterioration. *Hypokalemia* - **Hypokalemia** can result from various causes including diuretics or gastrointestinal losses, and is not a specific indicator for liver dysfunction. - It does not directly relate to the **severity of alcoholic hepatitis** or predict prognosis effectively.

Question 228: A 70-year-old woman with a history of rheumatoid arthritis presents with a painful, erythematous nodule on her leg. A biopsy shows granulomatous inflammation. What is the most likely diagnosis?

A. Rheumatoid nodule (Correct Answer)
B. Gouty tophus
C. Squamous cell carcinoma
D. Erythema nodosum

Explanation: Rheumatoid nodule - Commonly associated with **rheumatoid arthritis**, these nodules are typically **painless** but can be painful when inflamed, matching the scenario depicted. - The biopsy demonstrating **granulomatous inflammation** [1] is consistent with the histological findings of rheumatoid nodules. *Erythema nodosum* - Typically presents as **painful, erythematous nodules** on the **lower extremities**, but is associated with **inflammatory conditions** or infections rather than granulomatous inflammation. - Biopsy findings for erythema nodosum usually show **septal panniculitis**, distinct from the granulomatous inflammation seen here. *Squamous cell carcinoma* - Often presents as a **keratotic or ulcerated lesion**, rather than a nodular, erythematous form, and is not associated with **granulomatous inflammation**. - Biopsy would typically reveal **malignant keratinocytes**, which would differ from the findings associated with rheumatoid nodules. *Gouty tophus* - Characterized by **monosodium urate crystals** deposition, typically presenting as **subcutaneous nodules**, but not granulomatous in nature. - Painful tophi usually arise in chronic gout and would not show granulomatous inflammation in biopsy results, making this diagnosis unlikely.

Question 229: In assessing a patient with suspected metabolic acidosis, which blood gas parameter is most critical for confirming the diagnosis?

A. Blood pH (Correct Answer)
B. Oxygen saturation
C. Carbon dioxide partial pressure
D. Blood urea nitrogen

Explanation: ***Blood pH*** - A **low blood pH** (below 7.35) is the defining characteristic of **acidemia**, which is central to the diagnosis of any acidosis, including metabolic acidosis [1], [2]. - While other parameters help classify the type of acidosis, the pH directly reflects the overall acid-base balance and confirms the presence of an acidic state [2]. *Oxygen saturation* - **Oxygen saturation** indicates the percentage of hemoglobin binding sites occupied by oxygen and is crucial for assessing **oxygenation status**. - It does not directly provide information about the **acid-base balance** of the blood. *Carbon dioxide partial pressure* - **Carbon dioxide partial pressure (PaCO2)** is a primary indicator of the **respiratory component** of acid-base balance [1]. - While important for differentiating respiratory from metabolic acidosis (e.g., in compensatory mechanisms), it does not directly confirm an acidic state in the same way pH does [2]. *Blood urea nitrogen* - **Blood urea nitrogen (BUN)** is a marker of **kidney function** and can be elevated in various conditions, including dehydration or kidney disease. - It is not a direct measure of **acid-base status** but may be indirectly related if kidney dysfunction is causing metabolic acidosis.

Question 230: A 45-year-old man presents with hoarseness of voice and difficulty in breathing. Examination reveals a lesion affecting the left recurrent laryngeal nerve. What is the most likely diagnosis?

A. Vocal cord polyp
B. Reinke's edema
C. Thyroid nodule (Correct Answer)
D. Laryngeal carcinoma

Explanation: ***Thyroid nodule*** - A lesion affecting the **left recurrent laryngeal nerve** can cause **hoarseness of voice** and **difficulty in breathing** due to vocal cord paralysis. - An enlarged **thyroid nodule** or **thyroid cancer** can compress this nerve which anatomically loops around the subclavian artery on the right side and the aortic arch on the left side, then ascends to the larynx. *Vocal cord polyp* - While a vocal cord polyp can cause **hoarseness**, it typically does not cause **difficulty in breathing** to the extent that it implies recurrent laryngeal nerve involvement. - Polyps are usually benign growths on the vocal folds themselves, often caused by **voice misuse**. *Reinke's edema* - Reinke's edema is characterized by swollen, gelatinous vocal folds due to **fluid accumulation** from chronic irritation, most commonly **smoking**. - It primarily causes a **low-pitched hoarseness** but typically does not involve recurrent laryngeal nerve paralysis or significant airway obstruction. *Laryngeal carcinoma* - A laryngeal carcinoma can certainly cause hoarseness and even dyspnea, but the phrasing "lesion affecting the left recurrent laryngeal nerve" points more specifically to an extrinsic mass compressing or invading the nerve. - While it's a possibility, a **thyroid mass** is a classic cause of isolated recurrent laryngeal nerve palsy in this context given the nerve's anatomical course.

Practice by Chapter

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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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