Clinical Manifestations and Presentation of Diseases — MCQs

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

Question 261: Obesity is commonly associated with all of the following conditions except?

A. Cushing syndrome
B. Pickwickian syndrome
C. Prader-Willi syndrome
D. Anorexia nervosa (Correct Answer)

Explanation: ***Anorexia nervosa*** - This is an **eating disorder** characterized by an abnormally low body weight, intense fear of gaining weight, and a distorted perception of weight [1]. - Individuals with anorexia nervosa are typically **underweight**, the opposite of obesity, and often engage in extreme dietary restriction. *Cushing syndrome* - This syndrome is caused by **prolonged exposure to high levels of cortisol**, often leading to characteristic symptoms like central obesity, moon face, and buffalo hump [3]. - The **central adiposity** seen in Cushing syndrome is a form of obesity, making it commonly associated with overweight or obese states . *Pickwickian syndrome* - Also known as **obesity hypoventilation syndrome (OHS)**, this condition is strongly linked to severe obesity. - It is characterized by **sleep-disordered breathing** and chronic daytime hypoventilation in obese individuals, leading to hypercapnia and hypoxemia. *Prader-Willi syndrome* - This is a **genetic disorder** associated with several physical, mental, and behavioral problems, including chronic feelings of hunger [2]. - This **insatiable appetite** often leads to compulsive eating and severe, early-onset obesity [2].

Question 262: Which zone of the prostate is primarily involved in Benign Prostatic Hyperplasia (BPH)?

A. Central zone
B. Peripheral zone
C. Transitional zone (Correct Answer)
D. Prostate capsule

Explanation: ***Transitional zone*** - The **transitional zone** surrounds the urethra and is the primary site of origin and enlargement in **Benign Prostatic Hyperplasia (BPH)**. - Its hypertrophy leads to compression of the urethra, causing **lower urinary tract symptoms (LUTS)**. *Central zone* - The **central zone** surrounds the ejaculatory ducts and is less commonly involved in BPH. - It is more frequently associated with the development of **prostate carcinoma**. *Peripheral zone* - The **peripheral zone** is the largest zone of the prostate and is where the majority of prostate cancers originate. - While it can be affected by BPH, it is not the primary zone for hypertrophy. *Prostate capsule* - The **prostate capsule** is the outer fibrous layer that encloses the prostate gland. - It does not undergo hyperplasia in BPH; rather, it encases the enlarging gland.

Question 263: Bilateral parotid enlargement occurs in all, Except:

A. HIV
B. SLE
C. Chronic pancreatitis (Correct Answer)
D. Mumps

Explanation: ***SLE*** - **Systemic Lupus Erythematosus (SLE)** typically does not present with **bilateral parotid enlargement**, which is more characteristic of other conditions. - Salivary gland involvement in SLE is less prevalent and usually not the primary clinical feature associated with the disease. *HIV* - **HIV** infection can lead to **bilateral parotid enlargement** due to associated conditions such as lymphadenopathy and infections like **salivary gland infections**. [1] - **Lymphoid tissue** hyperplasia in response to HIV is another factor contributing to this enlargement. *Sjogren's syndrome* - **Sjogren's syndrome** is a common cause of **bilateral parotid enlargement** due to inflammatory infiltrates affecting the salivary glands. - Patients typically experience **xerostomia** (dry mouth) and **xerophthalmia** (dry eyes) alongside gland enlargement [2]. *Chronic pancreatitis* - Patients with **chronic pancreatitis** may develop **bilateral parotid enlargement** due to associated changes such as **sialadenosis** from malnutrition and electrolyte imbalances. - The enlargement occurs as a **compensatory mechanism** related to the pancreatic pathology affecting nearby structures.

Question 264: Which of the following is a feature of crush syndrome -

A. Myoglobinuria (Correct Answer)
B. Hypocalcemia (low calcium levels)
C. Hyperphosphatemia (high phosphate levels)
D. Hyperkalemia (high potassium levels)

Explanation: ***Myoglobinuria*** - **Crush syndrome** is characterized by extensive **muscle damage** and the release of intracellular components. - **Myoglobinuria** occurs when damaged muscle cells release large amounts of **myoglobin** into the bloodstream, which is then filtered by the kidneys, potentially leading to **acute kidney injury**. *Hyperkalemia (high potassium levels)* - While **crush syndrome** does cause **hyperkalemia** due to the release of intracellular potassium from damaged muscle cells, the question asks for *a* feature, and myoglobinuria is a direct and defining consequence of muscle breakdown seen in this condition. - Elevated potassium levels can lead to dangerous cardiac arrhythmias and are a critical and life-threatening complication of **crush injury**. *Hypocalcemia (low calcium levels)* - Crush syndrome typically leads to **hypercalcemia** rather than profound hypocalcemia, due to bone damage or excessive breakdown, though calcium can bind to damaged muscle tissue and precipitate, causing some transient reduction. - **Hypocalcemia** is not a primary or direct feature of **crush syndrome**'s pathophysiology in the way myoglobinuria is. *Hyperphosphatemia (high phosphate levels)* - **Hyperphosphatemia** is indeed a feature of **crush syndrome** because **phosphate** is released from damaged muscle cells and is an intracellular anion. - However, **myoglobinuria** is specifically indicative of muscle damage and plays a direct role in the kidney complications, making it a more defining feature in the context of the damage process itself.

Question 265: Which of the following conditions is least likely to cause multiple painful ulcers on the tongue?

A. TB
B. Herpes
C. Behcet disease
D. Sarcoidosis (Correct Answer)

Explanation: ***Sarcoidosis*** - While sarcoidosis can affect any organ, **oral involvement is rare** and typically presents as **nodules, plaques, or generalized swelling**, not usually multiple painful ulcers on the tongue. - The lesions, when they occur, are often **painless** and appear as submucosal nodules, red patches, or diffuse swelling. *TB* - Oral tuberculosis can present as **multiple painful ulcers** on the tongue, often with a **granulomatous appearance** mimicking squamous cell carcinoma. - These ulcers are typically **irregular, undermined, and persistent**, often associated with pulmonary TB. *Herpes* - **Herpes simplex virus (HSV)** infection, particularly primary herpetic gingivostomatitis, commonly causes **multiple painful ulcers** on the tongue, gums, and other oral mucosa. - These ulcers begin as vesicles that **rupture to form painful erosions** and are a classic presentation of oral herpes. *Behcet disease* - **Oral aphthous ulcers** are a hallmark feature of Behcet disease, commonly presenting as **multiple, recurrent, painful ulcers** on the tongue and other oral mucosal surfaces. - These ulcers are clinically indistinguishable from common aphthous stomatitis but are more frequent and often associated with genital ulcers, skin lesions, and ocular inflammation.

Question 266: Which of the following is NOT a common complication of acute pancreatitis?

A. Subcutaneous fat necrosis
B. Hyperlipidemia
C. Hypercalcemia (Correct Answer)
D. Increased amylase level

Explanation: ***Hypercalcemia*** - Acute pancreatitis is primarily associated with **increased amylase levels** and **hyperlipidemia**, while hypercalcemia is generally a separate condition. - It is not a classical complication or result of acute pancreatitis, but rather might be a cause in cases like **hyperparathyroidism** [1]. *Subcutaneous fat necrosis* - This occurs as a result of **lipolysis** during acute pancreatitis due to the release of **lipases** into circulation [1]. - It is characterized by the presence of **fat necrosis** on the abdomen or buttocks. *Increased amylase level* - A hallmark of acute pancreatitis is **elevated levels of amylase** and sometimes lipase, indicating pancreatic inflammation [1]. - The rise typically occurs within the first 24 hours of the onset of pancreatitis. *Hyperlipidemia* - This is often found in acute pancreatitis due to excess **lipolysis**, leading to elevated triglycerides in the blood [1]. - It can be both a cause and a consequence of pancreatic inflammation, contributing to the disease process [1].

Question 267: According to standard clinical practice guidelines, significant weight loss requiring medical evaluation is defined as:

A. 5% weight loss in 1-2 months
B. 10% weight loss in 2-3 months (Correct Answer)
C. 5% weight loss in 2-3 months
D. 10% weight loss in 1-2 months

Explanation: ***10% weight loss in 2-3 months*** - **Unexplained weight loss** of **10%** or more of usual body weight over a period of **2-3 months** is generally considered a significant amount requiring medical evaluation. - This degree of weight loss can be indicative of underlying serious medical conditions like cancer, gastrointestinal disorders, endocrine disorders, or chronic infections [1]. *5% weight loss in 1-2 months* - While any unexplained weight loss should be noted, a **5% loss** in this timeframe is usually not considered immediately "significant" enough to warrant an aggressive workup unless other concerning symptoms are present. - It might be due to minor lifestyle changes, temporary illness, or benign factors. *5% weight loss in 2-3 months* - A **5% weight loss** over **2-3 months** is a less critical threshold than 10% for initiating an extensive medical evaluation for serious underlying disease. - This level of weight change could be due to a variety of less severe causes or even normal fluctuations. *10% weight loss in 1-2 months* - While a **10% weight loss** is significant, the **1-2 month** timeframe is generally considered slightly too short to immediately classify it as "requiring medical evaluation" in the strictest sense compared to the 2-3 month period which allows for better observation. - Rapid weight loss over a very short period might sometimes be related to acute illness or dehydration rather than chronic underlying conditions, though still warrants attention.

Question 268: Which of the following statements about alcoholic hepatitis is false?

A. Gamma glutamyl transferase is raised
B. Alkaline phosphatase is raised
C. SGOT is raised > SGPT
D. SGPT is raised > SGOT (Correct Answer)

Explanation: ***SGPT is raised > SGOT*** - In **alcoholic hepatitis**, the ratio of **AST (SGOT)** to **ALT (SGPT)** is typically **2:1 or higher**, meaning SGOT is usually significantly higher than SGPT. - This is because alcohol depletes **pyridoxal phosphate**, a cofactor for ALT, leading to relatively lower ALT levels. *Gamma glutamyl transferase is raised* - **Gamma-glutamyl transferase (GGT)** is frequently elevated in **alcoholic liver disease**, including alcoholic hepatitis [1]. - It serves as a sensitive marker for **biliary tract injury** and **alcohol consumption** [1]. *SGOT is raised > SGPT* - This statement is **true** for alcoholic hepatitis, as the **AST (SGOT)** to **ALT (SGPT)** ratio is typically **2:1 or greater**. - The disproportionately high AST is a characteristic feature reflecting the **mitochondrial damage** caused by alcohol within hepatocytes [2]. *Alkaline phosphatase is raised* - **Alkaline phosphatase (ALP)** can be elevated in alcoholic hepatitis, although usually to a lesser extent than in obstructive jaundice [1]. - Its elevation often reflects superimposed **cholestasis** or **biliary inflammation** [1].

Question 269: Which of the following is seen in sarcoidosis

A. Decreased calcium levels in the blood (Hypocalcemia)
B. Increased phosphate levels in the blood (Hyperphosphatemia)
C. Increased calcium levels in the blood (Hypercalcemia) (Correct Answer)
D. Decreased phosphate levels in the blood (Hypophosphatemia)

Explanation: ***Increased calcium levels in the blood (Hypercalcemia)*** - In sarcoidosis, activated macrophages in granulomas produce **1-alpha hydroxylase**, which converts **25-hydroxyvitamin D to 1,25-dihydroxyvitamin D (calcitriol)** [1]. - This increased calcitriol leads to enhanced intestinal **calcium absorption** and occasional bone resorption, resulting in **hypercalcemia** [1]. *Decreased calcium levels in the blood (Hypocalcemia)* - **Hypocalcemia** is not characteristic of sarcoidosis; the disease typically involves dysregulated vitamin D metabolism causing elevated, not decreased, calcium [1]. - Conditions like **hypoparathyroidism** or **vitamin D deficiency** (unrelated to the sarcoidosis pathogenesis) would cause hypocalcemia. *Increased phosphate levels in the blood (Hyperphosphatemia)* - **Hyperphosphatemia** is not a feature of sarcoidosis. Calcium and phosphate levels often have an inverse relationship, so with hypercalcemia, phosphate levels tend to be normal or slightly decreased due to suppression of parathyroid hormone. - Hyperphosphatemia is more commonly associated with **renal failure** or certain **endocrine disorders**. *Decreased phosphate levels in the blood (Hypophosphatemia)* - While **hypophosphatemia** can occur in conditions with high vitamin D activity (as increased active vitamin D can promote renal phosphate excretion), it is not the primary or most notable electrolyte disturbance specifically linked to sarcoidosis. - **Hypercalcemia** is the more consistently observed electrolyte abnormality in sarcoidosis related to ectopic vitamin D production [1].

Question 270: Aspirin sensitive asthma is associated with:

A. Extrinsic asthma
B. Associated with nasal polyp (Correct Answer)
C. Obesity
D. Usually associated with urticaria

Explanation: **Associated with nasal polyp** - **Aspirin-exacerbated respiratory disease (AERD)**, also known as aspirin-sensitive asthma, is characterized by a triad of **asthma**, **rhinosinusitis with nasal polyposis**, and respiratory reactions to **aspirin** and other NSAIDs [1]. - The presence of **nasal polyps** is a key clinical feature differentiating AERD from other forms of asthma [1]. *Obesity* - While **obesity** can exacerbate asthma severity, it is not specifically associated with the pathogenesis or diagnosis of **aspirin-sensitive asthma**. - It is a general risk factor for various health issues, including more severe asthma, but lacks specificity for AERD. *Extrinsic asthma* - **Extrinsic asthma** (allergic asthma) is typically triggered by environmental allergens and involves an **IgE-mediated response** [2]. - AERD is considered a **non-allergic** or **intrinsic asthma** phenotype, as it is not triggered by traditional allergens but by pharmacologic agents [1]. *Usually associated with urticaria* - **Urticaria** (hives) can be a feature of aspirin and NSAID sensitivity, particularly in some forms of **NSAID-induced urticaria/angioedema**. - However, the classic respiratory reactions of **aspirin-sensitive asthma** (bronchospasm, rhinitis) are distinct from urticarial reactions and typically do not present with primary urticaria.

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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