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 types of gangrene is least likely to be associated with diabetes?

A. Dry gangrene
B. Wet gangrene
C. Fournier's gangrene (Correct Answer)
D. Gas gangrene

Explanation: Fournier's gangrene - This is a rare, life-threatening necrotizing fasciitis of the perineum and genital area, which can occur in people with diabetes but is not primarily or exclusively associated with the systemic vascular or neuropathic complications that lead to the other common types of gangrene in diabetic patients. - While diabetes is a risk factor for Fournier's gangrene due to immunosuppression, it's not a direct consequence of the typical diabetic microvascular or macrovascular disease processes that predominantly cause dry or wet gangrene [1]. Wet gangrene - This type of gangrene is highly associated with diabetes, often resulting from a combination of poor circulation, neuropathy, and infection in a moist environment [1]. - In diabetic patients, impaired immune function and high glucose levels create a favorable environment for bacterial growth, leading to rapid tissue destruction and liquefaction [1]. Dry gangrene - This is very common in diabetes due to the underlying atherosclerosis and peripheral artery disease, which lead to chronic ischemia without significant bacterial infection [1]. - Reduced blood flow, particularly to the extremities, causes tissue death and often results in a shriveled, dark, and mummified appearance [1]. Gas gangrene - Diabetics are at increased risk for gas gangrene due to their compromised immune systems and the development of wounds amenable to infection by Clostridium species [1]. - This rapid and aggressive infection is characterized by the production of gas in tissues and can arise from even minor trauma or surgical wounds in diabetic patients.

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: 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 246: 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 247: 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 248: 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 249: Casal's necklace is associated with the deficiency of:

A. Deficiency of Vitamin A
B. Deficiency of Iron
C. Deficiency of Vitamin B12
D. Deficiency of Niacin (Vitamin B3) (Correct Answer)

Explanation: ***Deficiency of Niacin (Vitamin B3)*** - **Casal's necklace** is a characteristic dermatological manifestation of **pellagra**, which is caused by **niacin (Vitamin B3) deficiency**. - It presents as a **symmetrical, photosensitive dermatitis** on the neck and other sun-exposed areas, resembling a necklace. *Deficiency of Vitamin A* - Vitamin A deficiency primarily affects **vision**, leading to **night blindness** and **xerophthalmia**. - It can also cause follicular **hyperkeratosis** (dry, rough skin), but not the distinct 'necklace' pattern seen in pellagra. *Deficiency of Iron* - Iron deficiency typically causes **anemia**, leading to symptoms like **fatigue**, **pallor**, and **koilonychia** (spoon-shaped nails). - It does not directly cause skin lesions like Casal's necklace. *Deficiency of Vitamin B12* - Vitamin B12 deficiency is associated with **megaloblastic anemia** and **neurological symptoms** (e.g., peripheral neuropathy, cognitive impairment). - While it can cause **hyperpigmentation** in some cases, it does not specifically manifest as Casal's necklace.

Question 250: A patient presents to you with fever, night sweats, ptosis, and bilateral facial nerve palsy. Investigations showed leukocytosis and bilateral hilar lymphadenopathy. Which of the following is the most likely diagnosis?

A. Sarcoidosis (Correct Answer)
B. Tuberculosis
C. Lymphoma
D. Hypersensitive pneumonitis

Explanation: ***Sarcoidosis*** - The combination of **fever**, **night sweats**, **bilateral facial nerve palsy**, **ptosis**, and **bilateral hilar lymphadenopathy** is highly suggestive of **neurosarcoidosis** manifesting as Heerfordt's syndrome (uveoparotid fever) [1]. - **Leukocytosis** is a non-specific finding but can be present due to inflammatory processes in sarcoidosis. *Tuberculosis* - While tuberculosis can cause **fever**, **night sweats**, and **hilar lymphadenopathy** [2] [3], it is less likely to present with **bilateral facial nerve palsy** and **ptosis** simultaneously. - Pulmonary tuberculosis often shows specific patterns like **apical infiltrates** or cavitations, rather than solely bilateral hilar lymphadenopathy, especially without other classic symptoms like productive cough. *Lymphoma* - Lymphoma can cause **fever**, **night sweats**, and **lymphadenopathy** (including hilar) [4]. - However, **bilateral facial nerve palsy** and **ptosis** are not typical primary manifestations of lymphoma and would require other evidence of direct mass effect or widespread infiltration. *Hypersensitive pneumonitis* - This condition is characterized by **inflammation of the lung alveoli** and small airways due to repeated exposure to inhaled antigens, leading to symptoms like cough, dyspnea, and fever. - It typically does **not cause neurological symptoms** such as facial nerve palsy or ptosis, nor is it prominently associated with hilar lymphadenopathy.

Practice by Chapter

Approach to Common Symptoms (Fever, Pain, Fatigue)

Practice Questions

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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