Clinical Manifestations and Presentation of Diseases — MCQs

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

Question 341: A girl who developed abdominal pain and presented to the emergency department with a seizure after taking sulphonamides is likely to have a diagnosis of:

A. Acute intermittent porphyria due to other triggers (Correct Answer)
B. Congenital erythropoietic porphyria with skin manifestations
C. Infectious mononucleosis with fever and lymphadenopathy
D. Kawasaki disease with prolonged fever and rash

Explanation: ***Acute intermittent porphyria due to other triggers*** - The combination of **abdominal pain**, **seizure**, and the **ingestion of sulfonamides** (a known trigger) is highly suggestive of an acute porphyric attack [1]. - **Sulfonamides** induce δ-aminolevulinate synthase, leading to an overproduction of neurotoxic porphyrin precursors [1]. *Congenital erythropoietic porphyria with skin manifestations* - This condition primarily presents with **severe photosensitivity**, **blistering skin lesions**, and **hemolytic anemia**, rather than acute neurological symptoms [1]. - While it is a type of porphyria, its clinical presentation and triggers are distinct from the neurovisceral symptoms described. *Infectious mononucleosis with fever and lymphadenopathy* - Characterized by **fever**, **fatigue**, **sore throat**, and **lymphadenopathy**, symptoms not aligned with the severe abdominal pain and seizure observed. - This condition is caused by the Epstein-Barr virus and is not triggered by sulfonamide use. *Kawasaki disease with prolonged fever and rash* - This is an **acute vasculitis** in children, involving **prolonged fever**, **rash**, **conjunctivitis**, and lymphadenopathy, but not seizures or abdominal pain caused by sulfonamides. - It primarily affects the cardiovascular system and is not related to porphyria or drug-induced attacks.

Question 342: True regarding the presentation of primary tuberculosis is

A. B/L pleural effusion with negative Tuberculin test
B. U/L hilar lymphadenopathy (Correct Answer)
C. Sustained chronic pyrexia
D. B/L pleural effusion with positive tuberculin test

Explanation: ***U/L hilar lymphadenopathy*** - A **unilateral hilar lymphadenopathy** is a classic radiographic finding in **primary pulmonary tuberculosis** in children and often in adults, representing the enlargement of lymph nodes draining the primary lung lesion. - The disease typically begins with a primary lesion (Ghon focus) in the lung parenchyma and regional **lymph node involvement** constitutes the primary complex [1]. *B/L pleural effusion with negative Tuberculin test* - **Bilateral pleural effusion** is an uncommon presentation for primary tuberculosis; typically, effusions are unilateral. - A **negative Tuberculin test** (PPD) would make a diagnosis of tuberculosis less likely, although it can be negative in immunocompromised individuals or in the very early stages of infection. *Sustained chronic pyrexia* - While fever (pyrexia) is a common symptom of tuberculosis, **sustained chronic pyrexia** is more characteristic of secondary (post-primary) or disseminated tuberculosis, not necessarily primary infection which is often asymptomatic or mildly symptomatic [2]. - Fevers in primary TB, if present, can be low-grade and intermittent rather than sustained and chronic. *B/L pleural effusion with positive tuberculin test* - Although a **positive Tuberculin test** indicates prior exposure to M. tuberculosis, **bilateral pleural effusion** is an unusual initial presentation of primary tuberculosis. - Pleural effusions in TB are typically unilateral and usually result from a hypersensitivity reaction or direct spread from a primary lesion, but bilateral involvement is less common.

Question 343: What does sialosis refer to?

A. Inflammatory parotid enlargement due to infection
B. Autoimmune parotid gland dysfunction
C. Ductal obstruction leading to salivary retention
D. Non-inflammatory parotid enlargement due to metabolic conditions (Correct Answer)

Explanation: ***Non-inflammatory parotid enlargement due to metabolic conditions*** - **Sialosis** specifically denotes **non-inflammatory, non-neoplastic** enlargement of the parotid glands, often linked to systemic conditions. - It is frequently associated with **metabolic disorders** like diabetes mellitus, alcoholism, malnutrition, and certain drug therapies. *Inflammatory parotid enlargement due to infection* - This description refers to **sialadenitis**, which is an **inflammation** of the salivary glands, usually bacterial or viral (e.g., mumps). - It presents with acute pain, swelling, and sometimes pus discharge, differentiating it from the chronic, non-tender enlargement of sialosis. *Autoimmune parotid gland dysfunction* - This typically describes conditions like **Sjögren's syndrome**, an **autoimmune exocrinopathy** causing sicca symptoms (dry eyes and mouth) due to lymphocytic infiltration of the salivary glands. - While it involves parotid enlargement, the underlying mechanism is autoimmune inflammation, not metabolic. *Ductal obstruction leading to salivary retention* - This scenario points to **sialolithiasis** (salivary stones) or ductal strictures, causing symptoms of painful swelling, especially during eating, due to **salivary back-up**. - This is a mechanical obstruction leading to retention, distinct from the parenchymal hypertrophy seen in sialosis.

Question 344: Volcano ulcers in the esophagus are seen in

A. Herpetic esophagitis (Correct Answer)
B. Candida esophagitis
C. HIV esophagitis
D. Aphthous ulcer in Crohn's

Explanation: ***Herpetic esophagitis*** - **Herpes simplex virus (HSV)** esophagitis is characterized by multiple, small **volcano-like ulcers** with a raised border and central erosion. - These ulcers are typically formed by the rupture of HSV-induced vesicles, commonly found in **immunocompromised patients**. *Candida esophagitis* - This condition is characterized by **white, adherent plaques or pseudomembranes** on the esophageal mucosa, not discrete volcano ulcers. - It is caused by **Candida albicans** and often presents with dysphagia and odynophagia, particularly in immunocompromised individuals. *Aphthous ulcer in Crohn's* - **Aphthous ulcers** in Crohn's disease are typically found in the mouth, but can occur in the esophagus, though they are usually **solitary, deep craters** with undermined edges rather than volcano-like lesions. - These ulcers are associated with **granulomatous inflammation** and tend to be more painful and chronic. *HIV esophagitis* - **HIV-associated esophageal ulcers** are often large, shallow, and discrete, but they do not typically present with the classic "volcano" morphology. - These ulcers are primarily thought to be related to **idiopathic processes** or other opportunistic infections, not specifically "volcano" ulcers.

Question 345: All of the following are features of scurvy except which of the following?

A. Ecchymosis of lower limbs
B. Bleeding gums
C. Hyperkeratosis
D. Hypoglycemia (Correct Answer)

Explanation: ***Hypoglycemia*** - **Hypoglycemia** is not a feature of scurvy. Scurvy results from a deficiency of **vitamin C**, which is essential for collagen synthesis [1]. - Vitamin C is not directly involved in glucose regulation or insulin sensitivity, meaning its deficiency does not typically lead to low blood sugar levels. *Hyperkeratosis* - **Hyperkeratosis** (thickening of the outer layer of the skin, often around hair follicles) is a recognized dermatological manifestation of **scurvy**. - This is due to impaired collagen synthesis affecting skin integrity and maintenance. *Ecchymosis of lower limbs* - **Ecchymosis** (bruising) is a classic symptom of scurvy, often prominent on the lower limbs, due to impaired vessel integrity [1]. - **Vitamin C** is crucial for **collagen formation**, which is a vital component of blood vessel walls; its deficiency leads to fragile capillaries that easily rupture [1]. *Bleeding gums* - **Bleeding gums** (gingival hemorrhage) is one of the most well-known and characteristic signs of advanced **scurvy** [1]. - This is due to the weakening of connective tissue in the gums, compromising their structure and leading to spontaneous bleeding [1].

Question 346: The presence of estrogen receptors is associated with certain types of breast cancer. Which of the following factors is known to increase the risk of developing breast cancer?

A. Smoking
B. Nulliparity (Correct Answer)
C. Oral contraceptives
D. Multiparity

Explanation: Nulliparity - **Nulliparity** (never having given birth) increases the risk of breast cancer because a woman has more **menstrual cycles** throughout her reproductive life, leading to greater lifetime exposure to **estrogen** [1]. - Childbirth and breastfeeding are thought to provide a degree of protection against breast cancer, possibly due to hormonal changes, cellular differentiation, and a reduction in the total number of menstrual cycles. *Smoking* - While smoking is a known risk factor for many cancers, its association with breast cancer is **controversial** and less direct compared to other factors. - The evidence linking smoking directly to increased breast cancer risk is **inconsistent** across studies, with some finding a modest link, especially in women who start smoking at an early age. *Oral contraceptives* - The use of **oral contraceptives** has been shown to have a **minimal** and transient effect on breast cancer risk. - This risk is often considered small and resolves over time after discontinuation, and the overall benefit-risk profile is still favorable for many women. *Multiparity* - **Multiparity** (having multiple live births) is generally associated with a **decreased risk** of breast cancer, particularly if the first full-term pregnancy occurs at a younger age. - The hormonal changes during pregnancy and the differentiation of breast tissue are believed to provide protective effects against malignant transformation.

Question 347: Which of the following is NOT a feature of Hartnup's disease?

A. Cerebellar ataxia
B. Mental retardation (Correct Answer)
C. Psychological disturbances
D. Pellagroid skin lesion

Explanation: ***Mental retardation*** - While Hartnup's disease can lead to neurological symptoms and developmental delays, **frank mental retardation** is not a typical or primary feature. - The neurological deficits are usually reversible with treatment, and intellectual function is generally preserved. *Pellagroid skin lesion* - Hartnup's disease is an autosomal recessive metabolic disorder affecting the absorption and transport of **neutral amino acids**, including **tryptophan**. - Tryptophan is a precursor to **niacin**, so its malabsorption can lead to a deficiency, manifesting as **pellagroid skin lesions** [1] (photosensitive rash) similar to pellagra [1]. *Cerebellar ataxia* - Malabsorption of tryptophan also impacts **neurotransmitter synthesis** (serotonin and niacin-derived coenzymes), leading to psychiatric and neurological symptoms. - **Cerebellar ataxia** is a common neurological feature, resulting in uncoordinated movements, typically episodic and precipitated by stress or illness. *Psychological disturbances* - The neurological manifestations of Hartnup's disease commonly include various **psychological disturbances**. - These can range from **anxiety**, **depression**, and **mood swings** to psychosis in severe cases.

Question 348: What is the optimal timing for collecting a urine sample from a patient with tuberculosis or kidney disease?

A. 24 hrs urine
B. 12 hrs urine
C. Any time
D. In early morning (Correct Answer)

Explanation: ***In early morning*** - The first morning urine sample is the most concentrated, increasing the likelihood of detecting **microorganisms** or abnormal cells in conditions like **tuberculosis** or kidney disease. - This increased concentration makes it easier to identify pathogens such as **Mycobacterium tuberculosis** or subtle indicators of **renal pathology**. *24 hrs urine* - A 24-hour urine collection is typically used for assessing **renal function** or quantifying substances excreted over a full day (e.g., protein, creatinine clearance), not for detecting pathogens [1]. - While it measures total excretion, the dilution over this period can make it less effective for identifying **low concentrations** of microorganisms or cells crucial for initial diagnosis. *12 hrs urine* - A 12-hour collection, similar to 24-hour, is more focused on **quantitative analysis** over an extended period rather than optimizing concentration for qualitative detection [1]. - It does not offer the same peak concentration benefits as the first morning void needed for **sensitive diagnostic screening**. *Any time* - Random urine samples are often diluted, which decreases the sensitivity for detecting **low colony counts** of bacteria or trace amounts of abnormal components. - Less concentrated samples can lead to **false negatives**, especially in diseases where pathogen shedding might be intermittent or minimal.

Question 349: Administration of glucose solution is prescribed for all of the following situations except?

A. History of unconsciousness (Correct Answer)
B. Neonates
C. Child of a diabetic mother
D. History of hypoglycemia

Explanation: History of unconsciousness - While unconsciousness can be caused by hypoglycemia, administering glucose without confirming the cause could be dangerous if the underlying issue is hyperglycemia or another condition [1]. - A definitive diagnosis of hypoglycemia (e.g., via a blood glucose test) is crucial before administering glucose, especially in an unconscious patient [3][4]. Neonates - Neonates, particularly those who are preterm or small for gestational age, are prone to hypoglycemia because their glycogen stores are limited and their metabolic rate is high. - Glucose solution is often administered prophylactically or therapeutically to maintain adequate blood glucose levels in these vulnerable infants. Child of a diabetic mother - Infants born to diabetic mothers are at very high risk for neonatal hypoglycemia due to chronic exposure to high glucose levels in utero, leading to pancreatic beta-cell hyperplasia and hyperinsulinism [2]. - Glucose solution is commonly given to these infants to prevent or treat plummeting blood glucose levels after birth. History of hypoglycemia - A patient with a history of hypoglycemia (low blood sugar) will likely benefit from glucose administration during an acute episode to rapidly raise blood glucose levels [3]. - This is a direct and appropriate treatment for confirmed or suspected episodes of low blood sugar [4].

Question 350: Obesity is associated with all of the following conditions except:

A. Hypoventilation
B. Diabetes Mellitus
C. Hypertension
D. Hyperventilation (Correct Answer)

Explanation: ***Hyperventilation*** - Obesity is generally associated with **hypoventilation**, as seen in **Obesity Hypoventilation Syndrome (OHS)**, due to excess weight restricting chest and diaphragm movement [1], [3]. - **Hyperventilation**, which involves increased depth and rate of breathing, is not a typical direct complication of obesity. *Hypoventilation* - **Obesity Hypoventilation Syndrome (OHS)** is a recognized complication where increased adipose tissue impairs respiratory mechanics, leading to **chronic hypoventilation** [3]. - This results in elevated arterial carbon dioxide (hypercapnia) and reduced oxygen (hypoxemia), especially during sleep, commonly known as **sleep apnea** [3]. *Hypertension* - Obesity often leads to **insulin resistance** and activation of the **renin-angiotensin-aldosterone system**, both contributing to higher blood pressure. - The increased body mass also requires a greater cardiac output, placing more strain on the cardiovascular system. *Diabetes Mellitus* - Obesity is a primary risk factor for **Type 2 Diabetes Mellitus**, as excess adipose tissue promotes **insulin resistance** in peripheral tissues [2]. - This resistance forces the pancreas to produce more insulin, eventually leading to pancreatic beta-cell exhaustion.

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

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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

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