Clinical Manifestations and Presentation of Diseases — MCQs

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

Question 241: Vitamin deficiency associated with cystic fibrosis is

A. B12
B. B6
C. C
D. K (Correct Answer)

Explanation: ***K*** - Cystic fibrosis is characterized by **exocrine pancreatic insufficiency**, leading to malabsorption of fats and fat-soluble vitamins (A, D, E, K) [1]. - **Vitamin K** is crucial for coagulation; its deficiency can lead to **bleeding disorders**, which is a concern in CF patients [1]. *B6* - **Vitamin B6 (pyridoxine)** deficiency is not a primary or common deficiency directly linked to the malabsorptive issues in cystic fibrosis [2]. - While general malnutrition can occur, there isn't a specific mechanism in CF that predominantly targets B6 absorption [2]. *C* - **Vitamin C (ascorbic acid)** is a water-soluble vitamin, and its absorption is generally not significantly impaired in cystic fibrosis. - Malabsorption in CF primarily affects fat and fat-soluble substances due to pancreatic enzyme deficiency [1]. *B12* - While **Vitamin B12** malabsorption can occur in some gastrointestinal disorders, it is not a primary or specific vitamin deficiency associated with the typical pancreatic insufficiency in cystic fibrosis. - B12 absorption requires intrinsic factor and an intact ileum, which are not directly affected by the exocrine pancreatic dysfunction in CF.

Question 242: Which of the following is the most specific risk factor for esophageal cancer in Plummer-Vinson syndrome?

A. Risk factor for adenocarcinoma
B. Associated with esophageal webs (Correct Answer)
C. Associated with iron-deficiency anemia
D. Causes glossitis

Explanation: ***Risk factor for adenocarcinoma*** - Patterson-Kelly-Brown syndrome is **not** known to be a direct risk factor for adenocarcinoma, which makes this statement false. - The syndrome primarily involves esophageal symptoms without a proven link to increased cancer risk. *Anemia* - Anemia is a common feature in Patterson-Kelly-Brown syndrome due to **iron deficiency** from poor dietary intake or malabsorption. - It may also result from chronic blood loss associated with esophageal webs. *Esophageal webs* - Esophageal webs are a hallmark of Patterson-Kelly-Brown syndrome, causing **dysphagia** and other swallowing difficulties. - They are formed due to mucosal alterations and are a classic manifestation of the condition. *Glossitis* - Glossitis, or inflammation of the tongue, is often observed in patients with Patterson-Kelly-Brown syndrome due to **iron deficiency** and **nutritional deficiencies**. - It is associated with the underlying nutritional issues that often accompany the syndrome.

Question 243: Patchy hair loss with velvety skin points to the diagnosis of which of the following conditions?

A. Cushing's syndrome (Correct Answer)
B. Trichotillomania
C. Adenoma sebaceum
D. Alopecia areata

Explanation: Cushing's syndrome - Patchy hair loss (alopecia) and velvety skin (acanthosis nigricans) are characteristic cutaneous manifestations seen in Cushing's syndrome due to excess glucocorticoids [2]. - Hyperandrogenism, often associated with Cushing's, can contribute to hair thinning in affected areas [2]. Alopecia areata - Characterized by well-demarcated, smooth patches of hair loss on the scalp or body [1], but typically does not present with velvety skin. - It is an autoimmune condition where the immune system attacks hair follicles. Trichotillomania - Involves compulsive hair pulling, leading to irregular patches of hair loss with hairs of varying lengths [1]. - The skin beneath the affected areas is typically normal and does not exhibit a velvety texture. Adenoma sebaceum - These are angiofibromas (small, red bumps) primarily found on the face, particularly around the nose and cheeks, and are associated with tuberous sclerosis. - They do not typically cause widespread patchy hair loss or generalized velvety skin.

Question 244: Which of the following is the least likely direct cause of foot ulcers in diabetes?

A. Microangiopathy
B. Macroangiopathy
C. Neuropathy
D. Decreased immunity (Correct Answer)

Explanation: ***Decreased immunity*** - While **compromised immunity** in diabetes increases the risk of infection in an existing ulcer, it is **not a direct cause** of the initial ulcer formation itself [3]. - The primary mechanisms for foot ulcer development involve structural and functional changes in the feet due to persistent hyperglycemia [2]. *Neuropathy* - **Diabetic neuropathy** leads to loss of protective sensation, making patients unable to feel pain from pressure, friction, or injury to the foot [1]. - Motor neuropathy causes muscle weakness and foot deformities (e.g., **Charcot foot**), altering gait and creating high-pressure areas [1]. *Microangiopathy* - **Diabetic microangiopathy** affects small blood vessels, leading to impaired blood flow and reduced oxygen and nutrient delivery to tissues. - This compromises tissue healing and makes the skin more fragile, increasing susceptibility to breakdown and ulceration. *Macroangiopathy* - **Diabetic macroangiopathy** results in **atherosclerosis** of larger arteries, particularly in the lower extremities (peripheral artery disease) [1]. - Reduced blood supply due to **ischemia** impairs wound healing and can lead to tissue necrosis, significantly contributing to chronic and non-healing ulcers [1].

Question 245: Most common manifestation of mumps in adult males -

A. Aseptic meningitis
B. Encephalitis
C. Orchitis (Correct Answer)
D. Sinusitis

Explanation: ***Orchitis*** - **Orchitis**, or inflammation of the testicles, is the most common extracranial complication of **mumps** in post-pubertal males. - It occurs in 20-30% of adult males and can lead to **testicular atrophy** and, rarely, infertility. *Aseptic meningitis* - While **aseptic meningitis** is a common complication of **mumps**, occurring in up to 50% of cases, it is often subclinical and less frequently symptomatic than orchitis in adult males. - Symptoms include headache, fever, and neck stiffness, but it's not the most common manifest **symptom** in this demographic. *Encephalitis* - **Encephalitis** is a rarer but more severe complication of **mumps**, characterized by inflammation of the brain tissue. - It presents with altered mental status, seizures, and focal neurological deficits, significantly less common than orchitis. *Sinusitis* - **Sinusitis** is an inflammation of the sinuses, typically caused by bacterial or viral infections, and is **not a recognized complication of mumps**. - It is an unrelated condition and does not manifest as a direct result of mumps virus infection.

Question 246: In which of the following conditions can strawberry tongue be observed?

A. Streptococcal scarlet fever
B. Kawasaki disease
C. Both conditions mentioned above (Correct Answer)
D. None of the options

Explanation: ***Both conditions mentioned above*** - **Strawberry tongue** is a characteristic finding in both **streptococcal scarlet fever** and **Kawasaki disease** [2]. - In both conditions, the tongue initially appears white with prominent red papillae, resembling a white strawberry, and later becomes bright red, described as a red strawberry [2]. *Streptococcal scarlet fever* - **Strawberry tongue** is a classic symptom of **scarlet fever**, which is caused by Group A Streptococcus infection [2]. - Other symptoms often include a **diffuse red rash**, sore throat, and fever [2]. *Kawasaki disease* - **Strawberry tongue** is one of the mucocutaneous manifestations of **Kawasaki disease**, a multisystem vasculitis primarily affecting young children [1]. - Other key features include **fever lasting ≥5 days**, conjunctival injection, rash, cervical lymphadenopathy, and extremity changes [1]. *None of the options* - This option is incorrect because **strawberry tongue** is indeed observed in both scarlet fever and Kawasaki disease [1], [2]. - The presence of this specific tongue appearance is a well-documented clinical sign in these two distinct conditions.

Question 247: Which is the most common organ involved in sarcoidosis

A. Lung (Correct Answer)
B. Liver
C. CNS
D. Eye

Explanation: ***Lung*** - The **lungs** are affected in over 90% of sarcoidosis cases, making them the most common organ involved [1]. - Manifestations often include **bilateral hilar lymphadenopathy**, interstitial lung disease, and pulmonary fibrosis [1]. *Liver* - While the liver can be involved in sarcoidosis (around 50-80% of cases), its involvement is often asymptomatic and less frequently the primary presenting organ compared to the lungs [1]. - Granulomas in the liver typically do not severely impair liver function. *CNS* - **Neurosarcoidosis** affects a small percentage of patients (5-10%), making it a much less common site of involvement compared to the lungs [1]. - Symptoms can be highly varied, including cranial neuropathies, seizures, and meningitis. *Eye* - Ocular involvement occurs in 25-50% of sarcoidosis patients, presenting as **uveitis**, conjunctivitis, or retinal vasculitis [1]. - Despite being relatively common, it is still less frequent than pulmonary involvement.

Question 248: A lumpy feeling in the throat that is relieved upon eating is typically attributed to which condition?

A. Globus pharyngeus (Correct Answer)
B. Pharyngeal pouch
C. Diverticular disease
D. Esophageal atresia

Explanation: ***Globus pharyngeus*** - This condition is characterized by a sensation of a **lump or foreign body in the throat** without any physical obstruction. - The symptom is often **relieved by eating or swallowing**, as the act of swallowing can temporarily alleviate the feeling. *Pharyngeal pouch* - A pharyngeal pouch, specifically **Zenker's diverticulum**, typically causes **dysphagia**, **regurgitation of undigested food**, and sometimes **halitosis** [1]. - The sensation of a lump generally **worsens with eating** or drinking due to food accumulating in the pouch, contrary to the scenario described [1]. *Diverticular disease* - Diverticular disease primarily affects the **colon**, leading to symptoms like **abdominal pain**, **bloating**, and changes in bowel habits. - It does not typically present with a lumpy feeling in the throat that is relieved by eating. *Esophageal atresia* - Esophageal atresia is a **congenital condition** where the esophagus is not fully formed, usually diagnosed in **neonates**. - It causes immediate symptoms like **choking**, **coughing**, and **regurgitation during feeding**, and is not consistent with the adult presentation described.

Question 249: Which parameter is the most definitive in ruling out malnutrition?

A. Edema
B. Skinfold thickness
C. Normal ECF volume
D. Normal lean body mass (Correct Answer)

Explanation: ***Normal lean body mass*** - Maintaining **normal lean body mass** is the most definitive indicator that the body has sufficient protein stores and energy reserves, effectively ruling out significant malnutrition [3]. - Malnutrition, particularly **protein-energy malnutrition**, directly leads to the depletion of muscle and fat stores, which is reflected in reduced lean body mass [3]. *Edema* - **Edema** can be a sign of malnutrition (e.g., kwashiorkor due to severe protein deficiency), but its absence does not definitively rule out malnutrition as other forms exist without it [1], [3]. - Edema can also be caused by various other conditions such as **heart failure**, **kidney disease**, or **liver disease**, making it a non-specific indicator for ruling out malnutrition. *Skinfold thickness* - **Skinfold thickness** measures subcutaneous fat, which can be low in malnutrition, but it does not fully assess protein stores or visceral fat, making it less definitive. - While a low skinfold thickness suggests **fat depletion**, a normal reading could still coexist with protein malnutrition if fat stores have been relatively preserved [2]. *Normal ECF volume* - **Normal extracellular fluid (ECF) volume** is not a primary or definitive parameter for ruling out malnutrition. - Malnutrition can affect fluid balance, but ECF volume is influenced by many factors unrelated to nutritional status, such as **renal function** and **hydration status**.

Question 250: Which vitamin deficiency is commonly associated with night blindness and other vision problems?

A. Vitamin A (Correct Answer)
B. Vitamin C
C. Vitamin E
D. Vitamin B12

Explanation: ### Vitamin A - **Vitamin A** (retinol) is a crucial component of **rhodopsin**, a pigment found in the **rod cells** of the retina, which is essential for vision in **low light conditions** [1], [2]. - A deficiency in Vitamin A leads to **impaired rhodopsin regeneration**, causing **night blindness** (nyctalopia) and, in severe cases, can progress to **xerophthalmia** and permanent blindness due to damage to the cornea and conjunctiva [1], [4]. ### Vitamin C - **Vitamin C** (ascorbic acid) is important for **collagen synthesis**, acting as an antioxidant, and supporting immune function. - Deficiency leads to **scurvy**, characterized by gum inflammation, bleeding, and poor wound healing, but it is not directly associated with night blindness. ### Vitamin E - **Vitamin E** is a powerful **antioxidant** that protects cell membranes from oxidative damage. - While it plays a role in nerve and muscle health, its deficiency is mainly associated with neurological problems like **ataxia** and peripheral neuropathy, not night blindness [3]. ### Vitamin B12 - **Vitamin B12** (cobalamin) is vital for **red blood cell formation**, neurological function, and DNA synthesis. - Deficiency can cause **megaloblastic anemia** and neurological damage, including **peripheral neuropathy** and visual disturbances such as optic neuropathy, but night blindness is not a primary symptom.

Practice by Chapter

Approach to Common Symptoms (Fever, Pain, Fatigue)

Practice Questions

Constitutional Symptoms and Their Differential Diagnosis

Practice Questions

Syncope and Presyncope

Practice Questions

Dizziness and Vertigo

Practice Questions

Dyspnea and Respiratory Distress

Practice Questions

Chest Pain Evaluation

Practice Questions

Abdominal Pain Assessment

Practice Questions

Headache Classification and Management

Practice Questions

Weight Loss and Cachexia

Practice Questions

Edema and Fluid Retention

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free