Clinical Manifestations and Presentation of Diseases — MCQs

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

Question 321: Which of the following is not seen in chronic regional pain syndrome?

A. Anhidrosis (Correct Answer)
B. Severe Pain
C. Swelling
D. Osteoporosis

Explanation: ***Anhidrosis*** - **Anhidrosis**, or the **absence of sweating**, is generally *not* a characteristic feature of chronic regional pain syndrome (CRPS); rather, **hyperhidrosis** (excessive sweating) is often observed in the affected limb. - CRPS typically involves sympathetic nervous system dysfunction, which can lead to changes in sudomotor activity, usually resulting in increased rather than decreased sweating. *Severe Pain* - **Severe, unremitting pain** is the cardinal symptom of CRPS and is disproportionate to the initial injury, if any. - The pain is often described as burning, throbbing, or aching and can spread beyond the site of injury. *Swelling* - **Edema** or **swelling** of the affected limb is a common finding in CRPS, especially in the early stages. - This swelling can be accompanied by changes in skin temperature and color due to vasomotor dysfunction. *Osteoporosis* - **Osteoporosis** or **bone demineralization** is a common complication in CRPS, particularly in later stages. - It results from increased osteoclastic activity and reduced bone formation, which can be seen on imaging as patchy or diffuse bone loss.

Question 322: For the following causes of sexual dysfunction, select the most likely clinical feature that can be caused by vascular disease.

A. failure of erection with absent nocturnal penile tumescence (NPT) (Correct Answer)
B. absence of orgasm with normal libido and erectile function
C. ejaculatory dysfunction
D. decreased libido

Explanation: **_failure of erection with absent nocturnal penile tumescence (NPT)_** - **Vascular disease** often impairs blood flow to the penis, which is essential for achieving and maintaining an erection [1]. - **Absent nocturnal penile tumescence (NPT)** indicates an organic cause of erectile dysfunction, frequently due to vascular insufficiency rather than psychological factors [1], [2]. *ejaculatory dysfunction* - While ejaculatory dysfunction can occur with sexual health issues, it is less directly linked to the **vascular supply** than erectile function [2]. - Conditions like **neurological damage** or medication side effects are more common causes of ejaculatory dysfunction [2]. *absence of orgasm with normal libido and erectile function* - An inability to achieve orgasm with intact libido and erectile function typically suggests a **neurological** or **psychological** etiology. - **Vascular disease** primarily affects the physical ability to achieve an erection, not the sensory or psychological components of orgasm [1]. *decreased libido* - **Decreased libido (sex drive)** is more commonly associated with hormonal imbalances (e.g., low testosterone), psychological stress, depression, or certain medications [1]. - While vascular disease can contribute to overall poor health, it is not a direct or primary cause of **reduced sexual desire** [1].

Question 323: Which condition is primarily associated with Letessier-Meige disease?

A. Lymphedema (Correct Answer)
B. A-V malformations
C. Chronic venous insufficiency
D. Abdominal aortic aneurysm

Explanation: ***Lymphedema*** - **Letessier-Meige disease**, also known as **primary lymphedema type I** or **Meige disease**, is a congenital form of lymphedema. - It is caused by **hypoplasia** or malformation of the lymphatic vessels, leading to chronic swelling, typically in the lower limbs. *A-V malformations* - **Arteriovenous malformations** are abnormal connections between arteries and veins, bypassing the capillary system. - They are distinct from lymphatic system disorders and can cause symptoms related to shunting blood, such as bleeding or heart failure. *Abdominal aortic aneurysm* - An **abdominal aortic aneurysm** is a localized dilation of the abdominal aorta due to weakening of the vessel wall. - This condition is a vascular disease involving arteries, with no direct association with lymphatic system dysfunction. *Chronic venous insufficiency* - **Chronic venous insufficiency** results from incompetent venous valves, leading to blood pooling in the veins, particularly in the lower extremities. - While it can cause leg swelling, it is a disorder of the venous system rather than the lymphatic system, which is affected in Letessier-Meige disease.

Question 324: Blumberg's sign is

A. Rebound tenderness during abdominal palpation (Correct Answer)
B. Board-like rigidity of abdomen
C. Pressure over left iliac fossa causing pain in right iliac fossa
D. Pressure over right iliac fossa causing pain in left iliac fossa

Explanation: ***Rebound tenderness during abdominal palpation*** - Blumberg's sign refers specifically to **rebound tenderness**, which is pain experienced upon the rapid release of pressure applied to the abdomen. - It is a classic sign indicating **peritoneal irritation** or inflammation, often seen in conditions like appendicitis. *Board-like rigidity of abdomen* - **Board-like rigidity** describes a state of involuntary abdominal muscle contraction, making the abdomen feel hard and inflexible. - This is a sign of **generalized peritonitis**, a more severe and widespread inflammation of the peritoneum than what typically elicits Blumberg's sign alone. *Pressure over left iliac fossa causing pain in right iliac fossa* - This describes **Rovsing's sign**, where palpation of the left lower quadrant causes pain in the right lower quadrant. - Rovsing's sign is another indicator of **peritoneal irritation** in the right lower quadrant and is commonly associated with appendicitis. *Pressure over right iliac fossa causing pain in left iliac fossa* - Applying pressure to the right iliac fossa usually causes pain in that same area if **appendicitis** is present (e.g., McBurney's point tenderness). - This specific pain pattern (pain in the left iliac fossa from right iliac fossa pressure) is not a recognized named sign for **abdominal pathology**.

Question 325: What is the ratio of pleural fluid protein to serum protein in transudative pleural effusion?

A. < 0.4
B. < 0.5 (Correct Answer)
C. < 0.6
D. < 0.3

Explanation: ***< 0.5*** - A pleural fluid protein to serum protein ratio of **less than 0.5** is a key criterion for defining a **transudative pleural effusion** according to Light's criteria [1]. - This low ratio indicates that the fluid accumulation is due to systemic factors affecting hydrostatic or oncotic pressures, rather than inflammation of the pleura causing increased capillary permeability [1], [2]. *< 0.3* - While a very low ratio might suggest a transudate, Light's criteria specifically set the threshold at **less than 0.5**, making < 0.3 an unnecessarily restrictive and less accurate cut-off [1]. - Using < 0.3 could lead to misclassification of some transudates as exudates, as the more inclusive < 0.5 criterion is widely accepted. *< 0.4* - This ratio is within the range that would be considered a transudate, but it is not the universally accepted and most specific cut-off point used in **Light's criteria** [1]. - Using < 0.4 instead of < 0.5 might still allow for misclassification in some cases, as the standard diagnostic threshold is less than 0.5. *< 0.6* - A ratio greater than or equal to **0.5** (including 0.6) typically indicates an **exudative pleural effusion**, where the fluid is high in protein due to local inflammation or malignancy [1]. - Therefore, a ratio of < 0.6 would encompass both transudates and some exudates, making it an incorrect and non-specific criterion for defining a transudate.

Question 326: Sarcoidosis is least likely to be associated with:

A. Pericardial effusion (Correct Answer)
B. Uveitis
C. Erythema nodosum
D. Lymphadenopathy

Explanation: ### Pericardial effusion - While cardiac involvement in **sarcoidosis** can occur, leading to **cardiomyopathy** or **arrhythmias**, **pericardial effusions** are relatively rare [1]. - Less than 5% of patients with sarcoidosis develop pericardial effusions, making it the **least likely** among the given options [1]. ### Uveitis - **Uveitis** (inflammation of the uvea of the eye) is a common ocular manifestation of **sarcoidosis**, affecting 25-50% of patients [1]. - It can manifest as acute or chronic anterior uveitis, or posterior uveitis, and can lead to **vision impairment**. ### Erythema nodosum - **Erythema nodosum** is a common dermatological manifestation of **sarcoidosis**, particularly in acute forms like **Lofgren's syndrome** [1]. - It presents as **painful, tender red nodules** typically on the shins [1]. ### Lymphadenopathy - **Lymphadenopathy**, particularly **bilatéral mediastinal and hilar lymphadenopathy**, is a hallmark of **sarcoidosis** and is present in over 90% of cases [1]. - It is often one of the first findings on **chest X-ray** in pulmonary sarcoidosis [1].

Question 327: Which of the following conditions is least likely to cause hypercalcemia?

A. SLE (Correct Answer)
B. Berylliosis
C. TB
D. Sarcoidosis

Explanation: ***SLE*** - **Systemic lupus erythematosus (SLE)** is an autoimmune disease rarely associated with hypercalcemia. While various electrolyte imbalances can occur in SLE, hypercalcemia is not a typical manifestation, and other calcium-related issues like hypocalcemia (due to renal involvement or vitamin D deficiency) might be more common [3], [4]. - The inflammatory and immune mechanisms in SLE do not generally promote the increased production of activated **vitamin D** or significant bone resorption seen in other causes of hypercalcemia. *TB* - **Tuberculosis (TB)**, particularly disseminated forms, can cause hypercalcemia due to **granuloma formation** [1]. - These **granulomas** contain **macrophages** that have aberrant 1-alpha-hydroxylase activity, leading to increased production of **1,25-dihydroxyvitamin D**, which enhances calcium absorption from the gut and bone resorption [1]. *Berylliosis* - **Berylliosis** is a chronic inflammatory disease caused by exposure to beryllium, characterized by **granuloma formation** in various organs, most commonly the lungs. - Similar to sarcoidosis and TB, the **granulomas** in berylliosis can produce **1,25-dihydroxyvitamin D**, leading to increased calcium absorption and subsequent **hypercalcemia** [1]. *Sarcoidosis* - **Sarcoidosis** is known to cause **hypercalcemia** in a significant percentage of patients (around 10-20%) [1], [2]. - The mechanism involves **macrophages** within the **granulomas** producing **1,25-dihydroxyvitamin D**, which leads to increased intestinal calcium absorption and bone resorption [1].

Question 328: Which condition is characterized by the presence of Kayser-Fleischer rings?

A. Wilson's disease (Correct Answer)
B. Von Gierke's disease
C. Phenylketonuria (PKU)
D. Diabetes mellitus

Explanation: ***Wilson's disease*** - **Kayser-Fleischer rings** are a hallmark sign of Wilson's disease, caused by the deposition of **copper in the Descemet's membrane** of the cornea [1]. - This is a genetic disorder of **copper metabolism**, leading to excessive copper accumulation in various organs, including the liver, brain, and eyes [1]. *Von Gierke's disease* - This is a **glycogen storage disease (Type I)** characterized by a deficiency in **glucose-6-phosphatase**, leading to an inability to convert glycogen to free glucose. - Clinical features include **hypoglycemia**, hepatomegaly, and lactic acidosis, not copper accumulation or Kayser-Fleischer rings. *Phenylketonuria (PKU)* - PKU is an inherited metabolic disorder where the body cannot process **phenylalanine**, an amino acid, due to a deficiency of the enzyme **phenylalanine hydroxylase**. - Untreated PKU can lead to severe intellectual disability, but it does not involve copper metabolism or the formation of corneal rings. *Diabetes mellitus* - Diabetes mellitus is a metabolic disorder characterized by **high blood sugar levels** (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both [2]. - Its complications affect various organs but do not include the deposition of copper in the cornea to form Kayser-Fleischer rings.

Question 329: Muehrcke lines in nails are seen in:

A. Nephrotic syndrome (Correct Answer)
B. Guillain-Barré syndrome
C. Nail-patella syndrome
D. Acute tubular necrosis (ATN)

Explanation: ***Nephrotic syndrome*** - **Muehrcke lines** are characterized by paired, white transverse lines separated by normal pink nail beds, which do not move with nail growth. - They are associated with **hypoalbuminemia**, a hallmark of nephrotic syndrome [1], due to decreased protein synthesis in the nail matrix. *Guillain-Barré syndrome* - This is an **acute demyelinating polyneuropathy** primarily affecting the peripheral nervous system. - It does not typically manifest with nail changes like Muehrcke lines, which are related to systemic metabolic derangements. *Nail-patella syndrome* - This rare genetic disorder is characterized by a **tetrad of abnormalities**: nail dysplasia, patellar hypoplasia/aplasia, elbow abnormalities, and iliac horns. - The nail changes are primarily **dysplastic or absent** rather than the transverse white lines seen in Muehrcke lines. *Acute tubular necrosis (ATN)* - ATN is an intrinsic kidney injury characterized by **damage to the renal tubules**, often leading to acute kidney failure. - While it affects kidney function, it does not typically cause the systemic hypoalbuminemia or nail changes seen in nephrotic syndrome.

Question 330: Which condition is characterized by atrophic dry nasal mucosa, extensive encrustations, and a woody hard external nose?

A. Diabetes mellitus (Correct Answer)
B. Congenital syphilis
C. Stargardt disease
D. Rhinoscleroma

Explanation: ***Diabetes mellitus*** - While not directly causing nasal changes, uncontrolled **diabetes** can significantly impair general tissue health and immune response, contributing to chronic infections and slow healing in the nasal passages. - This can predispose individuals to severe **atrophic rhinitis** and secondary infections, leading to extensive encrustations and a "woody" induration of the external nose due to persistent inflammation and fibrosis. *Stargardt disease* - This is a form of inherited **macular degeneration** primarily affecting vision. - It has no known association with nasal mucosal changes, crusting, or external nasal induration. *Congenital syphilis* - Can cause "snuffles" in infants, which is a severe rhinitis with discharge and obstruction, and may lead to a **saddle nose deformity** due to cartilage destruction. - However, it does not typically present with the specific combination of **atrophic dry mucosa**, extensive encrustations, and a **woody hard external nose** as described in the adult presentation. *Rhinoscleroma* - Is a chronic granulomatous disease of the nose caused by the bacterium **Klebsiella rhinoscleromatis**, characterized by firm, rubbery, or woody nodules and progressive sclerosis. - Although it causes nasal deformity and obstruction, it initially presents with nasal discharge, crusting, and granuloma formation, not primarily **atrophic dry mucosa** and extensive encrustations across the entire nasal lining, especially in its later, fibrotic stages.

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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