Clinical Manifestations and Presentation of Diseases Practice Questions

Q: What is the primary clinical feature of Henoch-Schonlein purpura?

Skin rash characterized by palpable purpura. ***Skin rash characterized by palpable purpura*** - **Palpable purpura** is the hallmark cutaneous manifestation of **Henoch-Schonlein purpura (HSP)**, a small-vessel vasculitis [1]. - This rash typically appears on the **lower extremities and buttocks**, reflecting the deposition of IgA in vessel walls [1]. *Abdominal pain due to vasculitis* - While **abdominal pain** is a common feature of HSP due to gastrointestinal vasculitis, it is not considered the primary clinical feature [1]. - Gastrointestinal involvement can manifest with pain, bleeding, and intussusception, but the **skin rash** is more consistently present and diagnostic. *Joint pain associated with the condition* - **Arthralgia** or **arthritis** (joint pain) is seen in a significant number of HSP patients, particularly in the knees and ankles. - However, it is a secondary manifestation, and not the **defining primary sign** of the disease. *Kidney involvement in the disease* - **Renal involvement**, presenting as hematuria and proteinuria, occurs in about one-third of HSP cases and can lead to serious long-term complications. - Despite its significance for prognosis, **kidney disease** is a later and not universally present feature, making the rash the most critical initial diagnostic clue.

Q: All are seen in Samters triad except?

Bacterial infection. ***Bacterial infection*** - **Samter's triad**, also known as aspirin-exacerbated respiratory disease (AERD), consists of **asthma**, **nasal polyps**, and **aspirin sensitivity** (or NSAID sensitivity) [1]. - **Bacterial infection** is not a component of Samter's triad, although patients with nasal polyps may be more prone to secondary bacterial sinusitis. *Asthma* - **Asthma** is one of the three main components of Samter's triad, typically becoming more symptomatic after aspirin ingestion [1]. - Patients experience **bronchoconstriction** and worsening respiratory symptoms. *Nasal polyp* - **Nasal polyps** are a characteristic feature of Samter's triad, often extensive and recurrent [1]. - They contribute to nasal obstruction and chronic rhinosinusitis. *Aspirin sensitivity* - **Aspirin sensitivity** (or NSAID sensitivity) is the third key component, where ingestion of aspirin or other NSAIDs triggers severe respiratory reactions [1]. - This sensitivity is due to an abnormal arachidonic acid metabolism pathway involving **leukotrienes**.

Q: In inflammatory myopathy, which group of muscles is not affected

Ocular. ***Ocular*** - The **extraocular muscles** responsible for eye movement are generally spared in typical inflammatory myopathies, distinguishing them from other neuromuscular disorders. - Inflammatory myopathies primarily affect **skeletal muscles**, but **ocular muscles** have unique immunological and physiological properties that often protect them. *Facial* - While less commonly affected early in the disease, some inflammatory myopathies, particularly **dermatomyositis**, can eventually involve **facial muscles**, leading to weakness. - Involvement of **facial muscles** can manifest as difficulty with smiling, whistling, or closing the eyelids. *Proximal muscles of limb* - Inflammatory myopathies characteristically cause **proximal muscle weakness**, affecting muscles of the **shoulders, hips, and thighs** [1]. - This weakness often presents as difficulty climbing stairs, getting up from a chair, or lifting objects overhead [1]. *Distal muscles of limb* - While less common than proximal involvement, **distal muscle weakness** (affecting hands and feet) can occur in some subsets of inflammatory myopathies, such as **inclusion body myositis**. - This can lead to difficulties with fine motor tasks or foot drop.

Q: Which of the following is NOT a feature of POEMS Syndrome?

Multiple sclerosis. ***Multiple sclerosis*** - **Multiple sclerosis** is a chronic, demyelinating disease of the central nervous system and is not part of the diagnostic criteria or typical manifestations of POEMS syndrome [1]. - POEMS syndrome is a **paraneoplastic syndrome** associated with plasma cell dyscrasia, not an autoimmune CNS disorder [2]. *Polyneuropathy* - **Polyneuropathy** is a core and defining feature of POEMS syndrome, typically a demyelinating sensorimotor type [2]. - The "P" in POEMS stands for **Polyneuropathy**. *Organomegaly* - **Organomegaly**, particularly hepatomegaly, splenomegaly, or lymphadenopathy, is a common feature of POEMS syndrome. - The "O" in POEMS stands for **Organomegaly**. *Endocrinopathy* - **Endocrinopathy**, such as hypogonadism, diabetes mellitus, or hypothyroidism, is frequently observed in POEMS syndrome [2]. - The "E" in POEMS stands for **Endocrinopathy**.

Q: Acute orchitis is characterized by all of the following except:

Decreased blood flow. ***Decreased blood flow*** - **Acute orchitis** is an inflammatory process that typically leads to increased blood flow (hyperemia) to the affected testis due to the inflammatory response. - Decreased blood flow would be more characteristic of conditions like **testicular torsion**, which is an emergent condition causing ischemia. *Increased local temperature* - **Inflammation** is characterized by the classic signs of rubor (redness) and calor (heat), leading to an **increased local temperature** in the affected area. - This is a common finding in acute orchitis due to the inflammatory response. *Erythematous scrotum* - The inflammatory process in orchitis causes **vasodilation** and increased vascular permeability, leading to redness and swelling of the overlying scrotal skin. - An **erythematous scrotum** is a typical clinical sign of acute orchitis. *Raised TLC* - **TLC (Total Leukocyte Count)** is often elevated in cases of acute infection or inflammation, such as orchitis. - A **raised TLC** indicates a systemic inflammatory response to the infection.

Q: Metabolic change in severe vomiting is

Metabolic alkalosis due to loss of gastric acid. **Metabolic alkalosis due to loss of gastric acid** - Severe vomiting leads to the loss of **hydrochloric acid (HCl)** from the stomach, causing an increase in plasma bicarbonate and subsequently **metabolic alkalosis** [1], [3]. - This condition is often accompanied by **hypokalemia** due to renal compensation and increased aldosterone activity [1]. *Respiratory alkalosis due to hyperventilation* - **Hyperventilation** causes a decrease in arterial partial pressure of carbon dioxide (PaCO2), leading to **respiratory alkalosis** [2]. - While vomiting can sometimes cause mild hyperventilation due to discomfort, the primary metabolic derangement from severe vomiting is related to acid loss, not CO2 expulsion [4]. *Hyperkalemia due to renal dysfunction* - **Hyperkalemia** is an elevated potassium level, typically associated with **renal failure** or certain medications. - In severe vomiting, the loss of gastric fluid and subsequent fluid shifts tend to cause **hypokalemia** as the kidneys try to conserve hydrogen and excrete potassium [1]. *Metabolic acidosis due to renal failure* - **Metabolic acidosis** is characterized by a decrease in blood pH and bicarbonate, often caused by the accumulation of acids or loss of bicarbonate [3]. - **Renal failure** is a common cause of metabolic acidosis due to impaired acid excretion, which is not the primary issue in severe vomiting.

Q: Which of the following is NOT a symptom of mild dehydration?

Normal BP. ***Normal BP*** - In **mild dehydration**, the body's compensatory mechanisms, such as increased heart rate and vasoconstriction, typically manage to maintain a **normal blood pressure**. [1] - A significant drop in **blood pressure** (hypotension) is usually indicative of **moderate to severe dehydration**, where these compensatory mechanisms begin to fail. [2] *Thirst* - **Thirst** is one of the **earliest and most reliable** indicators of dehydration, as the body signals a need for fluid intake. [3] - It arises in response to increased plasma osmolality and decreased blood volume, both occurring even in **mild dehydration**. [3] *Restlessness* - **Restlessness** can be an early sign of discomfort and altered mental status associated with **mild dehydration**, particularly in infants and young children. - As the body struggles to maintain fluid balance, individuals may experience irritability and general unease. *Dry tongue* - A **dry tongue** and **dry sticky mucous membranes** are common signs of mild to moderate dehydration. - This symptom results from reduced salivary production due to decreased fluid volume in the body.

Q: If a claw hand develops in a patient with Leprosy, what is the classification of the deformity?

Grade II. A **claw hand** deformity, characterized by hyperextension of the metacarpophalangeal joints and flexion of the interphalangeal joints, indicates a significant and **visible disability** but the affected part is still functional to a limited degree. In the context of leprosy, this observable and permanent deformity falls under **Grade II** on the WHO disability grading scale, signifying a clear and established disability. This grade indicates **no disability** or deformity related to leprosy. A patient with a claw hand has an obvious physical deformity and functional impairment, thus not fitting this classification. This grade refers to a **detectable impairment** but **no visible deformity**. A claw hand is a clearly visible deformity, making Grade I an inappropriate classification. While Grades are typically 0, I, and II in the WHO disability grading for leprosy, some classifications might refer to severe, non-functional deformities as higher grades. However, Grade II adequately captures **visible and significant deformities** like a claw hand, and a Grade III is not a standard or commonly used classification for a claw hand in leprosy in the WHO system.

Q: Who coined the term 'cafe coronary'?

Roger Haugen. ***Roger Haugen*** - Dr. Roger Haugen is widely credited with coining the term "**cafe coronary**" in 1966. - He described cases of sudden death during meals that mimicked myocardial infarction but were caused by **choking on food** [1]. *J. Morton* - While J. Morton was a physician and made contributions to medical literature, he is **not associated** with coining the term "cafe coronary." - His work focused on other areas of medicine, not specifically on choking incidents. *Neil Markson* - Neil Markson is **not recognized** in medical history for coining the term "cafe coronary." - This name does not commonly appear in the context of the history of this medical term. *M. Hoppefield* - M. Hoppefield is **not attributed** to coining the term "cafe coronary." - There is no historical information linking this individual to the origin of this specific medical phrase.

Q: What is the medical term for the condition characterized by excessive sweating?

Hyperhidrosis. ***Hyperhidrosis*** - This term directly translates to **"excessive sweating"**, with "hyper-" meaning excessive and "hidrosis" referring to sweating. - It describes a condition where the body produces more sweat than is necessary to regulate body temperature. *Anhidrosis* - **Anhidrosis** refers to the **absence of sweating**, which is the opposite of excessive sweating [2]. - Individuals with anhidrosis may be unable to cool themselves effectively, leading to overheating [2]. *Hypohidrosis* - **Hypohidrosis** describes **decreased sweating**, a reduction in the normal amount of sweat produced. - It is less severe than anhidrosis but can still impair the body's ability to regulate temperature. *Normal sweating* - This option refers to the physiological process of sweating in appropriate amounts to **regulate body temperature** in response to heat or exercise [1], [3]. - It implies that there is no abnormal excess or deficiency in sweat production.

Question 1

What is the primary clinical feature of Henoch-Schonlein purpura?

Accepted Answer

Skin rash characterized by palpable purpura

Answer

Abdominal pain due to vasculitis

Answer

Joint pain associated with the condition

Answer

Kidney involvement in the disease

Question 2

All are seen in Samters triad except?

Accepted Answer

Bacterial infection

Answer

Nasal polyp

Answer

Aspirin sensitivity

Answer

Asthma

Question 3

In inflammatory myopathy, which group of muscles is not affected

Accepted Answer

Ocular

Answer

Facial

Answer

Proximal muscles of limb

Answer

Distal muscles of limb

Question 4

Which of the following is NOT a feature of POEMS Syndrome?

Accepted Answer

Multiple sclerosis

Answer

Organomegaly

Answer

Endocrinopathy

Answer

Polyneuropathy

Question 5

Acute orchitis is characterized by all of the following except:

Accepted Answer

Decreased blood flow

Answer

Increased local temperature

Answer

Erythematous scrotum

Answer

Raised TLC

Question 6

Metabolic change in severe vomiting is

Accepted Answer

Metabolic alkalosis due to loss of gastric acid

Answer

Respiratory alkalosis due to hyperventilation

Answer

Hyperkalemia due to renal dysfunction

Answer

Metabolic acidosis due to renal failure

Question 7

Which of the following is NOT a symptom of mild dehydration?

Accepted Answer

Normal BP

Answer

Thirst

Answer

Restlessness

Answer

Dry tongue

Question 8

If a claw hand develops in a patient with Leprosy, what is the classification of the deformity?

Accepted Answer

Grade II

Answer

Grade 0

Answer

Grade I

Answer

Grade III

Question 9

Who coined the term 'cafe coronary'?

Accepted Answer

Roger Haugen

Answer

J. Morton

Answer

Neil Markson

Answer

M. Hoppefield

Question 10

What is the medical term for the condition characterized by excessive sweating?

Accepted Answer

Hyperhidrosis

Answer

Hypohidrosis

Answer

Anhidrosis

Answer

Normal sweating

Clinical Manifestations and Presentation of Diseases — MCQs

Clinical Manifestations and Presentation of Diseases — MCQs

On this page

Practice by Chapter

Want unlimited practice?